Because people with MS experience the disease in so many different ways, some MS investigators wonder whether MS has a single cause, and whether a single therapy will be found to work for all those who have it. The possibility of multiple causes of MS is the focus of the path-breaking international collaboration known as The MS Lesion Project, funded through the Society’s Promise: 2010 Initiative.
Disease activity and symptoms vary greatly among people with MS. In 1998 the National MS Society convened a task force to discuss whether looking at lesions—that is, areas of brain tissue where myelin has been stripped from nerve fibers—would reveal why people experience the disease so differently. The task force noted that this issue was of prime importance, and ripe for development, and recommended a targeted research initiative to investigate it. Understanding lesion patterns can provide more information about differences in disease between individuals, which will enable doctors to make more accurate diagnoses, prognoses, and treatment decisions.
Claudia F. Lucchinetti, MD (Mayo Clinic and Foundation) and collaborators from the U.S., Germany and Austria were chosen to conduct this study for their groundbreaking contributions in this area. They have amassed a large collection of tissue samples from people with MS—a painstaking effort, because these are obtained through brain biopsies (a rare procedure) or autopsy.
Using samples of brain tissue from MS patients, the team found four distinct types of lesions (patches of disease activity and damage), which differed in the pattern of damage to myelin (the substance that insulates nerve fibers) and in the activity of immune cells and immune proteins. The team has been working to find a way to detect the patterns non-invasively, such as with MRI (magnetic resonance imaging) scans or blood work, and determining whether the patterns predict different disease course or response to specific therapies.
Making Excellent Progress
- One of their first findings showed that individuals with a specific lesion pattern responded to plasma exchange therapy, a treatment used occasionally to treat individuals experiencing severe MS attacks that do not respond to standard steroid therapy.
- In October 2007, the team reported on an analysis of MRI scans on 168 individuals from whom biopsy materials had been collected. Some key findings:
- Larger biopsied lesion size was associated with a slightly higher disability score (using the EDSS scale of disability) at last clinical follow-up.
- They confirmed an earlier finding that people with either of two lesion patterns often showed ring-shaped patterns on MRI.
- Recently the team found evidence that natural myelin repair occurs in patients across most types and stages of MS. Further research should determine why some individuals show efficient myelin repair while others do not, and offer clues to ways to stimulate natural repair. Read details of this study <link tonews bulletin on Dec 1, 2006>.
Brain tissue samples are essential to efforts such as this. Read more about how to participate in such research.