An Inside Conversation with MS Researchers
At the Society’s annual National Conference in November 2012, a panel of prominent MS researchers was convened to share insights in key areas of study. Dr. Elliot Frohman, Director of MS Programs and the MS Clinical Center at the University of Texas Southwestern. Dr. Wendy Gilmore, Associate Professor of Neurology and Cell and Neurobiology; Division Chief, MS Comprehensive Care Center & Research Group, Keck School of Medicine of USC. Dr. James Salzer, Professor and
Co-Director of the Center of Excellence for Multiple Sclerosis Departments of Cell Biology and Neurology at NYU. And, Dr. Tim Coetzee, Executive Vice President, Chief Research Officer, National MS Society. The panel was moderated by Melanie Lawson, an Emmy Award-winning television journalist on KTRK TV13 in Houston, Texas, who has lived with MS for many years.
Among the topics discussed, myelin regeneration was most exciting, and for good reason. When Melanie Lawson asked Dr. Salzer to address the question of how nerves and cells that make myelin speak to each, he explained: “when we talk about nerves and the cells that make the myelin sheath, they really function as a unit. They work together. The nerves instruct the cells to make the myelin sheath. Once it’s formed, the myelin sheath enables nerves to conduct electricity that are critical to the body to function. Also the sheath is critical to the survival of the nerve fiber. When you lose the sheath, the nerve fiber is vulnerable over the course of the disease. An important and unsolved problem in MS therapy is neuro-protection. If we regenerate the myelin sheath, we would protect nerves from damage. In an acute attack when you lose the myelin sheath it manifests as the inability to conduct impulses properly. Inflammation contributes to interruption of the signal. For patients who have the disease over decades, even when inflammation subsides, nerves are vulnerable. We’ve learned that there is progressive degeneration. Understanding the communication between the two sets of cells is critical to developing new therapies. This is an encouraging time to be in the MS field because of the advances in neuro-protection.”
Tim Coetzee commented further on the Society’s research program as it relates to restoring function. Tim used the word “breathtaking” when talking about recent developments in MS research. The area of most excitement is the experimental work being done to restore myelin. “To think that we are actually in a place in 2012, where there are therapies in clinical trials to potentially restore myelin,” said Tim. “It’s breathtaking to think we’ve come this far.” He informed the audience that the pharmaceutical company, Biogen Idec, which already makes Avonex and Tysabri, was currently testing a compound, called Lingo-1, in a phase one safety trial, that has demonstrated in the laboratory the ability to clear away damage in the nervous system.
Dr. Frohman also weighed in on the subject of restoring nerves, noting that there is the possibility over the next several years that we could develop the capability to promote repair of nerves. He stated that most patients experiencing the first MS event (such as optic neuritis, or a spinal cord lesion) that prompted them to seek attention already have established disease. The disease modifying therapies that are currently available are good at reducing risk for future events. The possibility that we could add a therapy to promote myelin repair on already affected nerves would dramatically change the treatment landscape.
If you’d like to reads more about this exciting area of MS research, the following are summaries of three research projects that address nervous system repair and protection.
First trial of experimental anti-LINGO to stimulate myelin repair – BIIB033 (Biogen Idec). The authors concluded that the results support advancing this myelin repair strategy into a phase II clinical trial. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=6377
Trial of patients’ own adult stem cells appear safe and hints of benefit – Researchers reported that injecting a person’s own bone marrow stem cells appeared safe and possibly beneficial in helping to protect the nervous system from injury. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=5951
Collaboration to find new therapies to repair the nervous system in people with MS – Building on findings from the Society’s Promise 2010 campaign, Fast Forward is funding research to stimulate myelin repair in MS. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=6767
Partnering on Progressive MS
By Marcella Durand
Treatments for relapsing-remitting multiple sclerosis have moved forward, but treatments for progressive MS have remained maddeningly elusive. A newly formed International Progressive MS Collaborative intends to find out why.
A far-ranging collaboration between the National MS Societies of the U.S., Canada, Italy, the Netherlands and the United Kingdom, and the Multiple Sclerosis International Federation, its mission is to speed the development of effective therapies for progressive forms of MS. “Overcoming the challenges of progressive MS is a key objective of the Society’s Strategic Response to MS,” says Timothy Coetzee, PhD, chief research officer of the Society. “This is just one of the ways we’re collaborating worldwide to speed clinical trials in progressive MS.”
The collaborative’s first step was to publish an opinion paper in Multiple Sclerosis Journal that outlined the challenges in developing therapies for progressive MS. It identified five key research priorities, as follows:
01 Experimental models of MS. Animal models that more closely reflect the symptoms and underlying tissue damage of progressive MS are urgently needed.
02 Identification and validation of targets and repurposing opportunities. Advances in MS genetics and the systematic re-evaluation of drugs approved for other indications may help identify new therapeutic targets in progressive MS.
03 Proof-of-concept clinical trial strategies. Lesion activity on MRI is an accepted biomarker in clinical trials for relapsing-remitting MS, but no comparable measure has been identified for progressive MS — yet.
04 Clinical outcome measures. Establishing clearer outcome measures for progressive MS will help evaluate possible therapies.
05 Symptom management therapies and rehabilitation strategies. Developing symptom management therapies and rehabilitation strategies in progressive MS may be advanced by targeted research and assessing potential treatments in rigorous, well-designed trials.
The collaborative has convened five working groups to discuss these challenges and opportunities and to make research recommendations in each of the key areas. “Tackling these issues will require an integrated, multidisciplinary approach to enable effective translation of research into therapies,” wrote the authors of the paper. [To read the paper in full, go to tinyurl.com/bdjv5ak.]
The collaborative will host an international conference in 2013 to plan how to continue moving research forward. Visit www.nationalMSsociety.org/progressiveMS for more information on progressive MS, or sign up for MS eNEWS at www.nationalMSsociety.org/signup for the latest on the collaborative’s progress.
Study Suggests Eyes Offer Unique Window to MS Damage and Repair
A team of researchers scanned the eyes of a group of people with MS over nearly two years, and also did MRI scans and regular clinical exams. The researchers, from Johns Hopkins University and other institutions across the country, found that thinning of the back layer of the eye may represent a window to global damage occurring in the nervous system, and suggest that this tool may be useful for tracking nerve protection in clinical trials involving people with MS. The study, by John Ratchford, MD, Peter Calabresi, MD, and colleagues, was funded in part by the National MS Society’s Promise: 2010 Nervous System Repair and Protection initiative.
Resources to find Clinical Trials
Being Overweight May Be Associated With an Increased Risk of Developing MS
Researchers report that being overweight or obese was associated with an increased risk of developing MS or clinically isolated syndrome (CIS, a first clinical episode suggestive of MS, indicating increased MS risk) in girls. In a study that compared 75 children or teens with MS or CIS with the health records of more than 900,000 healthy children or teens. This finding, if confirmed, opens up the possibility that reducing obesity could reduce some risk of MS in girls. Annette Langer-Gould, MD, PhD, and colleagues (Kaiser Permanente of Southern California, Pasadena) and others report their findings in the January 30, 2013, online issue of Neurology.
People Living With MS May Hold the Key to Curing MS
Individuals with MS, and often their family members, can make a difference in studies of the genes that put people at risk for MS by donating their DNA from blood samples. Understanding the role of genes in MS could revolutionize the way this disease is diagnosed and treated, and ultimately lead to ending MS forever through its prevention.
The National MS Society has been supporting a DNA Bank at the University of California at San Francisco (UCSF) for many years. This bank is a shared resource that is feeding many of the genetic breakthroughs happening today. The UCSF Multiple Sclerosis Genetics Group is a founding member of the International MS Genetics Consortium seeking to understand the genetic basis of MS. A large number of participants are needed to accelerate discovery. Please note: this is a nationwide study; and people everywhere can participate without living near or traveling to San Francisco, CA.
Family MS Study
The UCSF MS Genetics Group is looking for participation of two types of families: single-case and multi-case families.
- Single-case families are those where only one member is diagnosed with MS. Participation will require a one-time donation of blood from the individual with MS and, if available, a control. The control cannot be a family member but can be a spouse or friend. Preferably the control will be of the same ethnicity and approximately the same age as the individual with MS.
- Multi-case families are those where multiple living, family members have been diagnosed with MS. For these families, the group collects blood samples from all affected family members, unaffected siblings, and both parents of individuals diagnosed with MS. If not all of the individuals requested are able to participate, enrollment is still possible and will be discussed by phone.
African-American MS Study
Different populations are being studied to learn why some ethnic groups develop MS at higher rates than others. The MS Genetics Group is asking for the donation of a blood sample from African-American individuals with MS and controls without MS. It is not required, but the participation of certain family members is preferred as well.
What is Involved?
Participants for either study will be asked to:
- Read and sign a consent and authorization form
- Sign a form to release medical records (only individuals with MS)
- Complete a family information form
- Donate a blood sample (approximately five tablespoons)
- At all times, records and other information that is shared with the investigators are handled in a confidential manner. There will be no charges for participation in this study.
To participate or request additional information, complete this brief intake survey (https://redcap.ucsfopenresearch.org/surveys/?s=RPKGc4) OR contact the DNA bank directly: