This year’s meeting of the Americas Committee for the Treatment and Research of MS (ACTRIMS Forum) was held in February in West Palm Beach, Florida. Some 900 researchers attended in person, and another 600 attended remotely to hear about and share the latest progress in MS research. The theme this year was Biomarkers – the search for tests that can be used to detect and possibly prevent MS before symptoms appear, and to track the course of disease progression and monitor response to therapy in order to personalize treatment.
Below are only a few highlights of many important presentations, grouped according to three pathways to cures: stopping MS disease activity, restoring function by reversing damage and symptoms, and ending MS by preventing new cases. Follow the links provided below to read the scientific summaries (abstracts) of the highlighted studies. Anyone can access the scientific abstracts (more than 400), presented at ACTRIMS Forum 2022 here
Usually, study results presented during conferences like this are considered preliminary until they are published in peer-reviewed journals.
Stopping MS in its tracks involves reducing or eliminating the impact of MS before symptoms appear through early detection, and preventing worsening of quality of life and disease progression for each person with MS through precision medicine.
Barancik Prize for Innovation in MS:
As this year’s recipient of the Barancik Prize, Dr. Amit Bar-Or (University of Pennsylvania) gave the prize lecture about the work he and his collaborators are doing to understand how immune cells interact to inflame or calm immune attacks in MS, with the goal of precision, customized medicine that will stop an individual’s MS and ultimately bring on permanent remission without further treatment. (Read more
; view a video interview
Co-existing health conditions impact MS:
Dr. Ruth Ann Marrie (University of Manitoba) gave the Kenneth P. Johnson Memorial Lecture, reviewing the growing evidence that comorbidities, or co-existing health conditions in a person who has MS, can profoundly impact symptoms and disease course. They can make it harder to diagnose MS, can complicate the use of disease-modifying therapies, and can increase the frequency of relapses and progression. It is still not proven, but there is hope that addressing co-morbidities such as diabetes, depression, and being overweight, may reduce MS activity and symptoms as well. (Abstract KPJ1.1
Radiologically isolated syndrome (RIS) is a rare phenomenon in which people with no apparent symptoms of MS show MS-like damage in an MRI scan. Dr. Jiwon Oh (University of Toronto) cautions that testing suggests that many people with RIS do have symptoms like cognitive dysfunction, fatigue, or depression, and that quick screening might pick up these symptoms. Her team is following a group of 50 people with RIS using advanced MRI technology and cognitive testing. They found that more than a third had signs of cognitive dysfunction. This and other studies are building evidence that may inform treatment decisions and how MS is diagnosed. (Abstract S2.3
) Clinical trials are underway, including a study in which 100 people with RIS will be treated with ocrelizumab. (Abstract P094
Blood test for MS?
Dr. Tanuja Chitnis (Harvard) and colleagues presented findings validating the MS Disease Activity test developed by Octave Bioscience. Using a blood sample, the test measures 18 proteins involved in MS, and calculates a score for disease activity. Linking test scores of blood samples from 617 people with MS with the presence of MS-like damage on MRI scans, the team showed that a person with a medium/high score was five times more likely to have one area of damage and a person with a high score was 15 times more likely to have 2 areas of damage. The team is continuing to analyze outcomes relating to MS progression. If validated, this test could be used to help diagnose MS or monitor response to therapy so that a more personalized approach to treatment could be made. (Abstract P018
Treatment response and technology:
Dr. J.R. Falet (McGill University) and colleagues fed information about three large clinical trials in people with progressive MS into an artificial intelligence computer program. In these trials, treatments had reduced the risk of MS progression by more than 20%. The “machine learning” program determined the top 25% of responders. Among this smaller group, the risk of MS progression was reduced by almost 60%. The team determined that using this method could reduce the number of people needed for a trial from 3,000 to about 500. Further exploration of how the data is analyzed and interpreted is necessary before this program can be put into action to expedite the development of more effective treatments for people with progressive MS. (Abstract S1.1
) This study was funded through the International Progressive MS Alliance.
Costs of MS:
Dr. Bruce Bebo (National MS Society, USA) presented findings from a National MS Society-supported study focused on estimating the total economic burden of MS in the United States. In 2019, the overall economic burden of MS was $85.3 billion. Of that number, $63.3 was in direct medical cost; prescription medication, outpatient medication and administration, and outpatient care were the three largest cost categories. Nearly $22.1 billion was in indirect cost, non-medical costs, and healthcare costs for treatments not covered by insurance. The study also showed that employers experience significant productivity loss from those individuals with MS due to missed workdays or reduced productivity. These findings will help to elevate the urgency to find solutions for MS among policy makers and funders. (Abstract CE3.1
Restoring function in people with MS involves improving nervous system repair to reverse or slow MS progression and improve symptoms, and implementing rehabilitation and symptom management strategies to restore function, reverse MS symptoms and enhance quality of life.
Experimental repair therapy:
As the damage to the brain caused by MS accumulates, it becomes increasingly harder for the remaining cells to keep up with the energy demands required for normal nervous system function. Dr. R. Glanzman (Clene Nanomedicine, Holladay, Utah) and colleagues reported on the company’s experimental therapy Biocatalytic Nanocrystalline Gold (CNM-Au8). Previous study results had shown that the compound can provide supportive energy to brain cells. Now, early results from a phase 2 study of 150 people with MS and damage to the optic nerve show improvements in vision, hand function, and cognition. Analysis is ongoing. Through Fast Forward, the National MS Society is providing funding to measure and track blood markers in trial participants to help determine if the compound is helping. (Abstract P113
Tremor (involuntary movement) is a less common symptom of MS and difficult to treat. Dr. A. Bayoumi (McGovern Medical School, Houston) and colleagues used a specialized MRI imaging technique called diffusion tensor imaging (DTI, which measures the diffusion of water within structures of the brain) to study 28 people with MS and tremor, and 36 people with MS and without tremor. Increased water flow – indicating tissue damage – was noted in specific areas of the brain in people with tremor. The team is continuing to analyze these findings to determine if they will yield clues to resolving tremor and restoring function. Abstract P235
Transcranial stimulation at home:
Dr. Leigh Charvet (New York University) reported results of a secondary outcome from a National MS Society-funded trial that combined online brain training with at-home transcranial direct current stimulation (tDCS) in 106 people enrolled to treat MS fatigue. This cap-like device delivers a mild, painless current to specific parts of the brain, under the video supervision of a professional. After receiving 30 (20-minute) sessions, the team found that those receiving the live currents had less cognitive decline compared to those receiving sham currents, especially in those with greater degrees of physical disability. (Abstract CE3.2
) In a second study of 60 people with MS, an at-home tDCS program combined with hand dexterity training resulted in improvements in hand function (Abstract P410
Ending MS forever requires preventing MS before it occurs by limiting exposure to MS risk factors in the general population, and reducing or eliminating the impact of MS before onset of signs/symptoms by identifying pre-clinical MS in the high-risk population.
The MS Twin Study:
Dr. F. Beltrán (University of Munich) reported on The MS Twin Study, a multicenter effort studying identical twins in which only one twin had MS – a unique opportunity to study early biological events in MS. In a small cohort of participants in which the twin without MS had some evidence of nerve damage in the spinal cord, there also was evidence of an immune system responses similar to that seen in the twin with MS. Twins have identical genes, so such studies will allow researchers to distinguish other non-genetic differences that may underlie MS. (Abstract S2.4
) Read more results from this twins study
Gut microbiome and MS risk:
Drs. X. Zhou and S. Baranzini (UCSF) used cutting-edge technology to examine the gut bacteria from 576 people with MS and 576 people without MS living in the same house. Several species were significantly increased in untreated people with MS compared with their household controls, while other species were decreased. The composition and function of the microbiome (all of the gut bacteria) differed for types of MS and types of disease-modifying therapies in use. These results strongly support a link between gut bacteria and MS risk, course, and treatment. The international MS Microbiome Study continues this line of research for clues to what causes MS and how to prevent or treat it. (Abstract P265