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ACTRIMS Meeting Focuses on Understanding MS to Stop It

February 16, 2018

Nearly 1,000 doctors and researchers attended the ACTRIMS (Americas Committee for the Treatment and Research in MS) meeting in San Diego in early February to share their results.
Many invited speakers provided overviews on research related to this year’s theme of understanding more of the basic biology of MS to find better therapies. In addition, advances were reported from many different avenues of research, driving breakthroughs that will stop MS, restore function and end MS forever.
  Following is a small sample of the presentations:
Many presentations showed results from emerging therapies or continued benefits of available therapies, and longer-term safety information and data showing that early and ongoing treatment with a disease-modifying therapy has long-term benefits for controlling disease activity, delaying buildup of disabilities, and protecting quality of life.
Vitamin D and progression: Primary results from the phase 2 trial of ibudilast in primary progressive and secondary progressive MS were announced last fall, but data are still being analyzed. Dr. Justin Abbatemarco (Cleveland Clinic) presented the team’s findings related to participants’ blood levels of vitamin D and brain imaging and levels of progression. They found that higher levels of vitamin D were linked to higher measures of the amount of nerve-insulating myelin in the brain (whole brain MTR – “magnetic transfer ratio”). They did not find links with most other imaging or disability measures. (Read more)
Rituximab for progression? Within the tissues covering the brain and spinal cord (meninges), abnormal clusters of immune B cells have been found in progressive and relapsing MS. These clusters have been linked to increased damage to the adjoining surface of the brain, and may play a role in progression. A team led by Dr. Peter Calabresi (Johns Hopkins University) reported results from a study, funded by the International Progressive MS Alliance, that asked whether getting the powerful B cell therapy (rituximab) into the spinal fluid was safe and whether it could reduce inflammation and B cell clusters in a small number of people with secondary- or primary-progressive MS. They reported no serious adverse events, but the treatment did not reduce the meningeal B cell clusters seen on MRI. (Read more)
Better care at an MS center? The National MS Society funded Dr. Michael Halpern (Temple University College of Public Health) to understand differences in the medical care received by people with MS who visit MS centers compared to those who receive care in a private practice or neurology clinics. Among his findings, Dr. Halpern reported that, compared with those treated at MS centers, individuals receiving MS care at primary care practices had greater duration of illness and were more likely to have MS symptoms or poor health. In addition, only 51% received disease-modifying therapies, compared to 84% of those treated at MS centers. This suggests opportunities for providing treatment updates to primary care providers to improve the care of people with MS. (Read more)
Low rates of testing for cognitive changes and depression: Medical records and surveys of two MS clinics and ten university-based MS centers suggest that MS doctors infrequently use standard methods to detect cognitive issues or depression in their patients with MS, and even when these are detected, the doctors don’t always refer the individuals to neuropsychologists to address the problem. This gap in care was reported by Dr. Guy Buckle (Andrew C. Carlos MS Institute at Shepherd Center) and colleagues. (Read more about this study. Read more about addressing cognitive symptoms and depression)
MS symptoms impact many types of daily activities: Dr. Deborah Miller (Cleveland Clinic) and collaborators supported by the National MS Society have been gathering opinions from people with MS about how their symptoms impact their lives. The researchers named common MS symptoms, and participants described their own activities affected by those symptoms. Most symptoms were found to affect more than one activity – for example, pain and spasticity impacted many different daily activities. At the same time, many activities were affected by more than one symptom -- for example, walking and sleeping were impacted by multiple symptoms. (Read more) Documenting these impacts contributes to the work that the Society’s MSOAC initiative is doing toward getting a new measure of disability approved for use in future trials of MS therapies.
Several studies from the laboratory or early-stage trials suggest that many researchers are moving ahead with new strategies to repair the myelin coating on nerve fibers that is damaged in MS.
Barancik Prize winner focuses on myelin regeneration: For the first time, the winner of the National MS Society’s Barancik Prize for Innovation in MS gave a talk and was presented his prize at ACTRIMS. Dr. Robin Franklin’s research focuses on finding ways to improve the regeneration of nerve-insulating myelin in MS. He reviewed recent findings, including new evidence related to why myelin repair can be impaired, and new clues for overcoming obstacles to myelin repair. (Read about why he won, read a blog about his work, or watch a video about him.)
Impediment to myelin repair? “OPCs” are stem cells that live in the brain, and after myelin is damaged by immune system attacks in MS, they can move into lesions and begin myelin repair. In contrast, Leslie Kirby and colleagues (Johns Hopkins) reported that in the presence of inflammatory signals, OPCs can be hijacked to act as immune helpers that can ramp up immune damage to myelin and suppress myelin repair. Understanding this new finding might lead to new ways to protect the nervous system and resume normal repair mechanisms. (Read more)
Can nerves be repaired? When the protective myelin coating is damaged, the underlying nerve fiber (axon) becomes more vulnerable to injury or loss. Dr. Andrew Sas and colleagues (University of Michigan) reported their work identifying specific immune cells called neutrophils that secrete a factor that might regenerate damaged axons in a lab mouse model. The team is hoping this early work may lead to the development of a new approach to nervous system repair in MS. (Read more)

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.