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Emerging Therapies, Myelin Repair, Strategies to Address Symptoms Among Research News from AAN Meeting

May 9, 2016

More than 11,000 neurologists and other researchers
from around the world gathered for the AmericanIMG_3603.JPG
Academy of Neurology’s (AAN) annual meeting held in Vancouver, British Columbia in April. Several large sessions focused on emerging therapies, myelin repair strategies, pediatric MS, and new approaches to addressing symptoms that impact the quality of life for people with MS. Below are some highlights of MS-related presentations focusing on stopping MS, restoring function, and ending MS forever. In most cases, studies presented are considered preliminary. Many will be analyzed more thoroughly, and likely published in peer-reviewed medical journals. Confidence in a study’s findings is reinforced when it is repeated by others who attain similar results.
 
Stopping MS
Many studies presented showed continued benefits of available therapies and longer-term safety information, as well as more evidence that early and ongoing treatment with a disease-modifying therapy has long-term benefits for controlling disease activity, delaying accumulation of disability and protecting quality of life.
 
High-Dose Biotin – Dr. Ayman Tourbah (University Hospital of Reims) presented preliminary results from a randomized, double-blind, phase III study to test whether experimental MD1003 (concentrated oral biotin, a B vitamin, by MedDay Pharma) could slow or reverse vision loss compared to placebo. The trial involved 93 people with relapsing or secondary progressive MS who had chronic or progressive visual loss from bouts with optic neuritis. Vision tests and other measures taken at 6 months found no statistical differences between those in the biotin group compared to those in the placebo group. No serious safety issues were reported. (Abstract S49.005) These results are in contrast to previously announced results of another trial demonstrating a modest positive effect on disability.  
 
Lipoic Acid for Secondary Progressive MS – Dr. Rebecca Spain and colleagues (Oregon Health & Science University) reported promising results from a clinical trial of oral lipoic acid, an antioxidant supplement, in 51 people with secondary progressive MS. Antioxidants block the action of “free radicals,” which are normal by-products of bodily processes that may cause tissue injury in MS. The two-year, double-blind, randomized controlled trial compared 1200 mg daily lipoic acid to inactive placebo. The results suggested that the lipoic acid group had less brain atrophy (shrinkage) than the placebo group. Overall, the treatment was safe and tolerated, with stomach upset being the most pronounced side effect. Larger studies will be needed to fully understand the potential of lipoic acid to slow MS-related damage to the brain. (Abstract P1.373)
 
People Are Being Misdiagnosed with MS – In an invited plenary talk, Drs. Andrew Solomon (University of Vermont) and John Corboy (University of Colorado) noted that other conditions are frequently misdiagnosed as MS. They noted that this occurs when the published diagnostic criteria are not applied appropriately, and when there is an over-reliance on MRI scans, which are often read by radiologists who are not trained in MS. Migraine and fibromyalgia are among conditions frequently misdiagnosed as MS. Misdiagnosis sets the stage for inappropriate use of therapies and potential for side effects. (No Abstract)
 
Kids of Parents with MS Did Better in School – Dr. Julie Moberg (University of Copenhagen) and colleagues from Denmark studied over 4,000 individual children from families with a parent with MS, compared to children who did not have a parent with MS. They found that the kids from MS families got higher than average grades in their final exams and often chose to pursue health-related education. (Abstract P1.382)

No Link Found Between High Salt in Diet and MS Disease Activity – Dr. Kathryn Fitzgerald (Johns Hopkins University) and an international team of colleagues investigated a previously proposed link between high-salt diet and MS disease activity by leveraging urine samples gathered over five years during and after a large clinical trial. By comparing well-documented relapses, MRI and measures of disability with salt levels in the urine over five years, the team was not able to confirm a connection between a high-salt diet and MS course or activity. (Abstract S37.002) Another study testing a possible link between salt and MS susceptibility is summarized below.
 
Dystel Prize Winner – Professor Claudia Lucchinetti (Mayo Clinic) was chosen by a committee of her peers to receive the National MS Society/American Academy of Neurology’s 2016 John Dystel Prize for Multiple Sclerosis Research. She was honored with the Prize for driving advances in the neuropathology of MS – how the disease damages brain and spinal cord tissues – and translating this understanding into better care for people with MS. Read more about her major contributions to MS research
 
Restoring Function – Myelin Repair
Myelin wraps around nerve fibers, like insulation on an electric cord. In MS the myelin is damaged, disrupting signals and making nerves more susceptible to damage that leads to progression. Myelin repair is seen as a promising approach for restoring lost function and slowing down – or even stopping – progression, and there are clinical trials of myelin repair agents going on right now in MS.
 
Stimulating the Brain’s Self-Repair Mechanisms – Dr. Ari Green (University of California, San Francisco) led a small, phase II clinical trial to test whether an oral allergy medication, called clemastine, could promote the brain’s own myelin-repair abilities. They administered clemastine or inactive placebo twice daily to 50 people with MS and optic nerve damage for 150 days. The team measured the speed of nerve transmission in the optic (eye) nerve as an indicator that myelin repair occurred. Results suggested that nerve signaling speed increased when the participants were taking clemastine. It’s important to note that the dose exceeded the maximum recommended dose, and was accompanied by side effects including fatigue. Additional research will be needed to understand the potential benefits of this approach for treating MS. Read details about this study and how the idea for this trial came from innovative research by an investigator whose career was launched with funding from the National MS Society. 
 
Stem Cell Therapy – Another approach to myelin repair is the transplantation of myelin repair-promoting stem cells. Advances in this approach were reported by a team led by Dr. Saud Sadiq (Tisch MS Research Center of New York), who transplanted bone marrow-derived stem cells into the spinal cord in people with progressive forms of MS in a phase 1 clinical trial. Based on preliminary findings, headache and fever were the most frequent side effects, and there were no serious adverse events reported so far (the trial has not yet been completed). There were hints that some may be responding, but the trial was not designed to detect a clinical benefit, so caution should be used when interpreting these results. The team has announced plans to advance this treatment to a phase II trial. (Abstract I10.008)  Read more about stem cell research in MS
 
Restoring Function – Addressing Symptoms
Research is helping to advance the recognition of, and strategies for addressing, MS symptoms such as cognitive problems, depression, pain and fatigue.
 
Does Hormone Replacement Impact Quality of Life? – Since sex hormones appear to influence the onset and course of MS, National MS Society-supported Dr. Riley Bove (University of California, San Francisco) and collaborators used the Nurses’ Health Study (involving hundreds of thousands of female nurses followed over time) to look at the potential impacts of hormone replacement therapy after menopause. Among 95 participants who met their criteria, 61 had used hormone replacement and 34 had not. They found that hormone users with MS had self-reported higher physical quality of life scores than women with MS who did not use hormones after menopause. This was not found in women who did not have MS. Further research is needed to confirm this observation. (Abstract I5.007)
 
Brain Games to Improve Cognition – Dr. Leigh Charvet and colleagues (New York University and the State University of New York at Stony Brook) tested a computer-based cognitive training program in 135 people with MS. Of this group, 71 people used the training program – a series of brain-training games that are continuously adapted to keep the individual challenged – and 64 played regular video games for one hour per day, five days per week, over 12 weeks. Although the “placebo” video game group logged more playing time, those in the training group showed significantly greater improvement in cognitive function, as shown by a number of neuropsychological tests. Further testing of this and similar home-based programs should increase the availability of brain games for improving cognition in MS. (Abstract P2.170)

Cognition and Attention in Kids with MS – Computer-based rehab is especially attractive for improving cognition in children. Dr. Pietro Iaffaldano (University of Bari Aldo Moro, Italy) and colleagues administered attention-specific computerized training or unspecified computerized training to 16 children with MS and 20 children with ADHD. The attention-specific training improved attention in both groups, and improved processing speed and memory in the kids with MS as well. (Abstract S9.003)

Treadmill for Mental and Physical Fitness – Dr. Rebecca Spain and the Oregon team tested whether walking on a treadmill for 30 minutes, four times per week for eight weeks, would improve fitness, cognition, and fatigue in 11 people with MS. They found significant improvements in cardiovascular fitness and cognition. One participant fainted and did not complete the program, so it’s a good idea to consult a healthcare provider to find a suitable exercise program. Although small, the study adds to growing evidence that exercise can improve mental and physical fitness in people with MS. (Abstract P2.174)

Meditation By Phone – A type of meditation, called mindfulness-based intervention, is mental training aimed at reducing reactions that may worsen any pain or emotional distress. However, traveling to weekly sessions can be difficult for people with mobility issues, so Ariana Frontario and colleagues (New York University and the State University of New York at Stony Brook) tested the feasibility of delivering mindfulness training via group phone conference. They found that 25 people who underwent a six-week program improved in cognition and sleep quality, and had reduced fatigue and depression, compared with 10 people who did not complete the program. This type of “telehealth” approach may increase access to life-changing programs for people affected by MS. (Abstract P3.092)
 
Ending MS
The cause of MS is still not known, but both genetic and environmental risk factors have been implicated for increasing the risk of developing MS. It is important to note that many people have MS risk factors and will never develop MS, and also that many people develop MS without having been exposed to identified risk factors.
 
Study Complicates Idea That Dietary Salt May Trigger MS – Some recent lab studies have pointed to dietary salt as a possible trigger of MS immune attacks. Dr. Marianna Cortese (University of Bergen, Norway) and researchers at Harvard assessed the intake of salt and other minerals in the Nurses’ Health Study group (involving more than 150,000 female nurses in the U.S. followed over time). None of the minerals, including salt, seem to alter the risk of developing MS. Additional research is underway to explore the possible link between salt and MS. (Abstract S37.001)

Risk Genes in Kids with MS – Dr. Lisa Barcellos (University of California, Berkley) and members of the National MS Society-supported Network of Pediatric MS Centers conducted the first genome-wide association study designed to identify genes that contribute to susceptibility of children to developing MS. The investigators reported that variants within genes identified in adult MS are also risk factors in children, suggesting that similar biological processes are involved in both groups. (Abstract S29.001) One of the previously identified risk factors for MS is childhood or adolescent obesity. Investigating this lead, the team found links between MS risk genes and obesity in childhood, and also overlap of some genes that confer risk of increased body mass and MS risk genes. These findings may provide clues to how inflammation is triggered and how it might be prevented. (Abstract P1.375)

Read more about research into MS

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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