Ever since disease-modifying therapies emerged onto the scene in the mid-1990s, suppression of damaging inflammation and prevention of the entry of harmful immune cells into the central nervous system (CNS) has formed the backbone of MS treatment. In more recent years, the dialogue has shifted to the topic of remyelination – in other words, coercing the body’s innate repair system to rebuild the myelin damaged during MS. This topic continues to be an unmet need in MS and is receiving a lot of attention at this year’s ECTRIMS conference, where the leaders in remyelination research have converged to share their perspectives and latest findings on myelin repair.
This morning at ECTRIMS we heard from several researchers and clinicians about the use of imaging as a tool to predict disease outcomes in MS. Over the last few days we saw results from studies repeatedly demonstrating that imaging is a strong predictor of:
- The development of MS in those who exhibit early signs
- The development of disability (or worsening of disease)
Imaging has been heralded as the strongest predictor of disease outcomes in MS, and longer studies are not able to pinpoint the long term predictive nature of imaging measures.
Dr. Olga Ciccarelli from University College London presented an overview of the different imaging tools and patterns that can predict risk of developing confirmed MS among those with clinically isolated syndrome (CIS). She referenced studies showing that, after a 20 year follow up, those individuals with CIS who had an abnormal MRI (many lesions displayed on scan) had an 82% risk of developing MS, whereas those with a normal MRI had a 21% risk of MS.
She also noted that T2 lesions, which are seen via a specific MRI method that shows tissue damage and inflammation, are a strong prognostic factor, meaning they can predict disease, which was demonstrated in a paper published in 2015 in Brain by Dr. Mar Tintoré from Vall d’Hebron University Hospital in Barcelona, Spain.
Additional studies were presented showing that people with early signs of MS who also exhibited spinal cord lesions were more likely to develop MS. Dr. Ciccarelli published similar work showing that spinal cord lesions and spinal cord atrophy (tissue damage) can predict levels of disability after 5 years in patients with CIS. She is currently working on the longest follow-up study of patients with CIS (30 years), which will reveal the strength of imaging as a predictive tool for MS disease and add to our current knowledge around risk models for MS.
We also heard from Dr. Tintoré who has done significant work on monitoring CIS patients over the long term. She has been leading a large, real-world, prospectively acquired (acquiring data over time) CIS cohort that has enabled her to identify predictors of EDSS changes, treatment responses, and other disease outcomes. She presented data from her cohort study showing that, after 15 years of follow up, those with CIS who had more than 10 lesions observed on their first (baseline) MRI had an 85% risk of MS, compared to 19% for those who had no lesions on their first MRI. She found that a lower proportion of patients developed accumulation of disability after 10 and 15 years, and early treatment appeared to have prevented the buildup if disability.
Dr. Wallace Brownlee, also from University College London, presented his study on the prognostic strength of imaging in terms of predicting a secondary progressive disease course in those with CIS. He initially enrolled 178 patients with CIS, of which 164 were followed up for a total of 15 years. After the 15 year follow up period ended, 57% of patients had relapsing-remitting MS (RRMS), and 15% had secondary progressive MS (SPMS). He noted that those with CIS who had spinal cord and T1 brain lesions had a higher probability of developing SPMS, meaning those imaging markers are strong predictors of transition to SPMS.
As imaging techniques become more refined, and studies better designed and include larger numbers of people to infer more definitive conclusions, clinicians are becoming better equipped to foretell the outcome of one’s MS over the short and long term. This is especially important for those with the earliest signs of MS as deciding the most appropriate treatment course for those individuals can influence how their disease unfolds in the future
Stay turned for most updates from ECTRIMS, and follow me on Twitter where I will posting live from the sessions throughout the day!
How quickly time flies. A little over a year ago, the MS Society announced the recipients of the International Progressive MS Alliance planning awards, the first step in an unprecedented global effort designed to forge collaborations between people of all research backgrounds and scientific expertise around the world, who together have the capacity to speed up the development of treatments for progressive MS. Each of the 11 grant recipients developed proposals for larger-scale projects aimed at addressing the most complex scientific and healthcare challenges in progressive MS. The proposals were submitted for another round of reviews, after which three projects would be selected for €4.2 million (or $6 million) in funding.
Today at an ECTRIMS press conference, The Alliance announced the successful awardees of the €4.2 million Collaborative Network Award grants. The three selected multi-national research networks will tackle critical gaps facing progressive MS research, including the development of effective drugs for countering disease progression, the discovery of new biomarkers that can help researchers measure progression and the response to treatments, and the design of faster and smaller clinical trials that will cut down on the time needed to bring new therapies from the drawing board to people living with MS.
I’m happy to note that one the grant recipients is from Canada: Dr. Douglas Arnold from the Montreal Neurological Institute at McGill University. Additionally, several other Canadian researchers were among the collaborators listed for all three grants, including Dr. Jack Antel from McGill University and Dr. Alexandre Prat from the University of Montreal.
Read on for descriptions of the selected studies.
The MS Society of Canada’s research team has arrived in the vibrant city of London, England to attend the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). The ECTRIMS Congress is the largest international meeting devoted to scientific research and health management of multiple sclerosis, and each year the list of topics and number of participants grows.
In May of this year ECTRIMS announced that a record breaking 1,985 abstracts were submitted for the Congress, representing a broad a range of topics such as neuroprotection, advance imaging techniques, multidisciplinary rehabilitation, cognitive treatments, comorbidities, and new directions in progressive MS research. Selected abstracts will be presented throughout the week at poster sessions (researchers showcase their data on posters and engage in discussions) and scientific sessions (presentations that are delivered to a larger audience). The conference also includes smaller workshops and presentation sessions for nurses, junior neurologists in training, and media.
ECTRIMS is a great platform for announcing breaking news in MS research and treatment, and provides an opportunity for researchers, clinicians and trainees to share the freshest data from their laboratories, in addition to networking, taking part in educational workshops, hearing about updates in other research areas, and collaborating with MS professionals across geographical regions, industries and expertise.
This year the research team will be delivering live updates throughout the week via Twitter (@Dr_KarenLee), Facebook (Multiple Sclerosis Society of Canada), and my blog. We are excited to hear about the latest advances, particularly in progressive MS where researchers are on the cusp of a new era of disease-modifying therapies and symptom-improving interventions.
Stay tuned for more updates and feel free to leave and questions or comments below!
At its heart, multiple sclerosis is believed to occur when rogue immune cells attack myelin – a fatty coating that surrounds nerve cells in the brain and spinal cord. But what if these deviant immune cells could be taught to leave myelin alone? Or the immune system reprogrammed to fight these cells off? This is what researchers are hoping to do as they bring an age-old technology, vaccines, to bear in the treatment of MS.
When you think of vaccination, your mind probably goes to the shots you received as a child that were meant to protect you against certain bacterial or viral infections. Today, scientists are trying to adapt this same technology (with a few tweaks of course) to help stop autoimmune attacks. In the last few years a number of MS-focused vaccines have shown promising results in early phase clinical trials, and with each success the technology is closer than ever to offering a viable treatment option.Continue reading
Multiple sclerosis is a deeply personal disease. No two people experience MS in exactly the same way, and while the underlying autoimmune event that attacks myelin is consistently at the core of the MS disease process, the signs, symptoms, and progression of the disease can vary enormously from person to person.
In the same vein, every person living with MS responds to treatments in her or his own way. A little over twenty years ago, there were no therapies available that could alter the course of the disease and reduce the number of relapses and brain lesions; today, 11 disease-modifying therapies are approved for relapsing-remitting MS in Canada with several others in the pipeline. A wide selection of disease-modifying therapies is ideal in that it means more options that can manage the individual needs of people living with MS. Despite the crucial advancements in treatment options for MS, some people do not respond to the treatments that are available, which again speaks to the varying nature of the disease.
Ongoing research is helping to expand the arsenal of treatment options for MS, while placing greater emphasis on a more personalized approach to treating the disease. The publication of the results from the Canadian Bone Marrow Transplantation (BMT) Trial in The Lancet represents the culmination of an extensive and collaborative effort funded by the MS Society of Canada’s affiliated Multiple Sclerosis Scientific Research Foundation (MSSRF) to identify a potential treatment for MS involving stem cells. The trial involved a procedure in which selected volunteers living with MS were given high-dose chemotherapy to dismantle the disease-causing immune system, followed by transfusion of their own stem cells to rebuild a healthy immune system that no longer attacks myelin. Given the risks associated with the procedure, individuals who were selected for the trial were those experiencing highly aggressive, inflammatory relapsing-remitting MS that did not respond to available treatments.
Our understanding of the genetic basis of multiple sclerosis has taken off over the past few years. Admittedly, the first link between MS and our genes was made in the early 1970s when scientists identified a set of immune-related genes that they found to be associated with an increased risk of MS. However, it wasn’t until the last ten years that a combination of advances in genetic sequencing technology, the bringing together of large population datasets, and bolstered by insights from the genetic blueprint constructed by the Human Genome Project, really put MS genetics on the map. Today, researchers to date have discovered over 100 genetic variants that have been linked to an increased risk of MS, and the overwhelming majority of these variants contain instructions for making proteins that influence the immune system. Individually, these variants only influence risk by a very small degree, and researchers are continuing to piece together the ways in which these genes interact and how they’re influenced by the environment to build up to a tipping point for triggering MS.
At the same time that scientists have been searching for genetic risk factors for MS, another story has been gradually unfolding since the 1980s looking at how MS is inherited within families. A pioneer in this field is Dr. Dessa Sadovnick from the University of British Columbia, who’s devoted her career to answering the question of why and how MS appears to cluster among relatives in certain families. Her early studies gathered enough evidence to build a strong case for receiving a $2.2 million grant by the MS Society and its affiliated MS Scientific Research Foundation to fund The Canadian Collaborative Project on Genetic Susceptibility to Multiple Sclerosis (CCPGSMS). A crucial outcome of this project was the development of one of the largest and richest MS genetic databases in the world encompassing over 30,000 people with MS and their relatives from 15 MS Clinics across Canada.
Since 2009, people around the world have marked the last Wednesday of every May in their calendar as World Multiple Sclerosis Day. Launched by the Multiple Sclerosis International Federation, World MS Day is an annual campaign that supports and connects the 2.3 million people living with MS across the globe with the goal of raising awareness and taking action to end MS.
This year’s World MS Day revolves around the theme of independence. For some people living with MS, independence means not having to rely on others for anything. For others, it means having the freedom of choice, even if one of those choices is accepting the support of others. Every person has their own definition of what independence means to them, and this year we’re celebrating all forms of independence for all people affected by MS.
The precise causes of multiple sclerosis continue to baffle the scientific community, although in general most researchers agree that a combination of genes and environmental factors appear to play a role in influencing the risk of developing MS. In those people living with MS, there is a great deal of research ongoing that’s looking at different types of exposures that can impact the course of the disease, such as the rate of relapses, severity, and progression. At AAN, a handful of researchers took to the podium to present their latest findings about the genetic and environmental factors that affect the risk of MS and play a role in modifying disease course.
Between 2 – 5% of multiple sclerosis cases emerge before the age of 18. Research into MS in children and adolescents – referred to as pediatric-onset MS – is not only important for managing the disease in youth, but can also provide insights into some of the earliest triggers and drivers of MS, with implications for understanding and treating MS across all groups. Since MS is believed to spring from a combination of specific genetic and environmental factors, invited speakers at the pediatric-onset MS seminar session presented new data exploring these factors in children and adolescents.