Research into the inflammatory nature of MS has led to profound progress in the treatment of the relapsing-remitting form of the disease. But this leaves us with many unanswered questions, and no treatment options, for progressive MS. Progressive MS bears severe consequences, including pronounced disability, cognitive decline, and extreme fatigue. As the need for treatments grows, so too do research efforts to help understand the onset and nature of progressive MS.
Encouraging results from one clinical trial conducted by Paris-based biotechnology company MedDay could pave the way for a novel, promising treatment option for people with progressive MS. The phase III, placebo-controlled clinical trial – dubbed MS-SPI – included 154 participants who were randomly selected to receive either MD1003 (treatment being evaluated) or a mock treatment (control) over a period of one year.
At almost every MS research conference I’ve attended, one of the most actively discussed topics is immunology. It is clear that that the immune system is acting in an uncharacteristic way in MS, as evidenced by many elegant experiments showing a build-up of immune cells in the brain and spinal cord causing severe tissue damage. These studies encourage the belief that MS begins with the immune system.
But there are a group of scientists that are now wondering whether, in MS, the immune system misbehaves causing tissue damage, or if the break down of nerve tissue is actually taking place before the immune cells arrive and cause more harm.
This important example of ‘which came first, the chicken or the egg?’ has prompted new research that is moving away from the immune system and focusing efforts on trying to understand the mechanism of tissue breakdown in the nervous system, also known as ‘neurodegeneration’.
In 2011, the MS Society funded an extensive, multi centre research grant spearheaded by Dr. Peter Stys from the University of Calgary. Dr. Stys is interested in learning more about neurodegeneration and whether this is the first step in propagating MS. He presented data here at the endMS conference which challenges the conventional wisdom that MS is an autoimmune disease driven by white blood cells that enter the nervous system and break down tissue. Instead he proposes that perhaps the tissue is undergoing some process of degeneration first, followed by inflammation through mechanisms that may involve copper or other key molecules.
Research in this area is critical as it would not only provide clues about the cause of MS, but also insights on progressive MS which is characterized more so by tissue damage rather than inflammation.
This alternative view of the cause of MS was supported by data presented by MS Society funded researcher Dr. George Harauz from the University of Guelph. In his presentation Dr. Harauz provided very detailed descriptions of the structure and function of myelin – one of the most important substances in the brain and also a major target of harmful immune cells in MS. Dr. Harauz stated that it is possible that early alterations to myelin may, down the road, lead to development of MS. I had a chance to chat with Dr. Harauz, who has been studying myelin and MS at the University of Guelph for over 25 years.
Our immune systems are designed to fight off disease, and one way they do this is through a complex, highly controlled process known as inflammation. We know that in MS, the immune system misbehaves, and inflammation occurs not only to ward off harmful agents, but also to inflict damage on nerve tissues which comprise the brain and spinal cord.
Researchers around the world are trying to determine how inflammation drives MS disease. I met with esteemed neuroimmunologist Dr. Amit Bar-Or, who shared some valuable insight on inflammation and MS. As I mentioned in my last post, Dr. Bar-Or is both a research scientist and neurologist, which allows him to combine both clinical and laboratory expertise when trying to investigate the full impact of inflammation in MS. I wanted to know how far we’ve come in the last decade in terms of our understanding of inflammation, and what the future holds for this promising avenue of MS research. This was his response.
Since we are on the topic of progressive MS, I thought it would be a great time share this insightful interview with Dr. Erin MacMillan who is a MS Society-funded postdoctoral fellow at the University of British Columbia. It was interesting to hear that Dr. MacMillan has a backgound in physics and we wanted to learn more about how she applies her extensive physics knowledge to detect early changes in the brain of people with MS, as well as what her research could mean for progressive MS.
I mentioned earlier that progressive forms of MS are still without an effective treatment, which has been recognized by the MS scientific community as a major gap that needs to be addressed.
According to Dr. Robert Fox from the Cleveland Clinic, who opened today’s session on progressive MS, there are a number of clinical trials underway showing the therapeutic potential of several treatment. Dr. Fox will be leading one of the trials, which involves evaluating the safety and tolerability of the anti-inflammatory drug ibudilast in people with progressive MS (read about the trial Stem cells are also being looked at for their ability to treat progressive as well as relapsing-remitting MS. Amiloride – an oral drug used to treat high blood pressure – has been shown to have nerve-protecting qualities and is now in early trials for progressive MS. Dr. Fox noted that, in the future, there should be increased focus on regenerative treatments for MS that can rebuild the tissues in the central nervous damaged from inflammation.
In an effort to address the growing need for research in progressive MS, Dr. Fox announced at ECTRIMS that several MS Societies from around the world are joining forces in a collaboration that will leverage the necessary resources to speed up the creation of progressive MS therapies. The MS Society of Canada has been a key player in this initiative since the very beginning when there were only a few of us who came together to brainstorm how we would tackle this critical priority in MS research. Today, thehas expanded immensely, engaging the best and brightest researchers around the globe.
I, along with many of my peers here, am hopeful that the work funded by the Alliance will solve the complex puzzle of progressive MS. That is not to say that there isn’t already some excellent research happening in the field right now. Dr. Ciccarelli and her lab from the UK presented interesting data from their study on progressive MS today.