More than 8500 researchers, healthcare providers and others convened in Boston on September 10-13, 2014 to present findings and share ideas at the ACTRIMS-ECTRIMS (Americas and European Committees for Treatment and Research in MS) joint meeting, the world’s largest gathering dedicated to multiple sclerosis research.
Over 1,000 presentations covered virtually every aspect of MS research. Among these were the latest results from trials of emerging therapies, nervous system repair and rehabilitative strategies, studies furthering our understanding of progressive MS, and much more.
Access research news, blogs, a Webcast, and other updates from the meeting here -- including a special announcement of the first research projects launched by the international Progressive MS Alliance.
Below are a few highlights from the many presentations focusing on stopping MS, restoring function, and ending MS forever. In most cases, studies presented are considered preliminary. Many results will be analyzed more thoroughly, and usually published in peer-reviewed medical journals.
STOPPING MS – Emerging Therapies
Many studies were presented related to investigational therapies moving through the development pipeline, and others explored benefits and safety of currently available therapies.
Results from phase 3 trial of DAC HYP – A concentrated (high-yield) formulation of Daclizumab (Biogen Idec and AbbVie) targets the immune attack in MS. More than 1,800 participants with relapsing-remitting MS received either DAC HYP injected under the skin once every four weeks, or Avonex® (interferon beta, Biogen Idec) injected once weekly, for 96 to 144 weeks. The annual relapse rate (the primary endpoint of the study) was reduced by 45% in the DAC HYP group over Avonex, and disease activity on MRI was reduced by 54%. There was no apparent reduction in progression of disability. Serious infections, skin-related adverse events, and liver enzyme abnormalities were increased in the DAC HYP group. Biogen Idec and AbbVie plan to file for marketing approval in 2015. (Read the abstract.)
Generic glatiramer acetate – To test equivalence of a generic form of glatiramer acetate, a clinical trial involving 735 people with relapsing-remitting MS was conducted. GTR (generic glatiramer acetate, Synthon BV) reduced disease activity on MRI scans similarly to Copaxone® (glatiramer acetate, Teva Pharmaceutical Industries Ltd). Participants were randomly assigned to receive GTR (20 mg/day injected under the skin), Copaxone (20 mg/day injected under the skin), or inactive placebo (injected daily under the skin) for nine months. Disease activity on MRI brain scans, the primary endpoint of the study, was equally reduced in both the Synthon GTR and the Copaxone groups. Clinical outcomes and safety/tolerability were similar as well. (Read the abstract.)
Trial of a fingolimod-like modulator -- RPC1063 (Receptos, Inc.) is an investigational therapy similar to fingolimod, but which appears selective in its activity while it inhibits immune cells from entering the brain and spinal cord. In a phase 2 trial, 258 participants with relapsing MS took oral RPC1063 (.5 mg), RPC1063 (1 mg), or placebo. Results showed cumulative new, active MRI lesions were reduced by 86% in both RPC1063 arms over placebo between weeks 12 and 24 (the primary endpoint). The study was not designed to detect reductions in annual relapse rates. RPC1063 was deemed tolerable, with most common adverse events being respiratory infections, headache, and urinary tract infection. No notable heart, lung, eye problems or cancers were noted. A phase 3 study is ongoing versus interferon beta-1a. (Read the abstract.)
STOPPING MS – Understanding Progression
Is body temp a clue to MS progression? Dr. Victoria Leavitt (Manhattan Memory Center, New York) and colleagues compared the average core body temperatures (measured with an ear thermometer) of 111 people with relapsing-remitting MS to that of 85 people who did not have MS. The RR MS group had a higher average body temperature, and the researchers also reported that people with RR MS had higher body temperatures than people with secondary-progressive MS. The researchers speculate that higher temps reflect the inflammatory process in the brain, which is active in RR MS. Further research is necessary to determine whether body temperature is a useful tool for tracking the shift from RR MS to secondary-progressive MS. (Read abstracts P910 and P930.)
MS and something else -- “Comorbidities” are medical conditions that can occur alongside MS, such as hypertension, diabetes, or heart disease. Dr. Ruth Ann Marrie (University of Manitoba) noted that these can play a role in disease progression, citing a 2010 study in which she and colleagues examined nearly 9,000 people enrolled in the NARCOMS patient registry, and found that these and similar conditions were associated with a substantially increased risk of disability progression. “Among people with MS, we have an opportunity to aggressively treat comorbidity and improve the course of disease,” she said. (Read the abstract.)
Read more about managing MS and another condition.
Is cholesterol a marker for MS progression? -- Cholesterol is an important component of myelin, the nerve insulation damaged by MS. Dr. Charlotte Teunissen (VU University Medical Center Amsterdam) reviewed the evidence that cholesterol may be a useful biomarker for MS progression, noting that high serum cholesterol is related to clinical signs of progression, such as reduced thickness of the retinal nerve fiber layer (in the back of the eye). Related to cholesterol is its metabolite (breakdown product) 24S-hydroxycholesterol, and its levels have been linked to brain tissue volume and also disease progression. Serum levels of this molecule change before the appearance of clinical signs in mouse models of MS. Dr. Teunissen is now funded by the international Progressive MS Alliance to search for such biomarkers. (Read the abstract.)
RESTORING FUNCTION – Myelin Repair
Clinical trial results -- First results from a small, phase 1 clinical trial involving people with relapsing MS were presented by Dr. Jeffrey Cohen of the Cleveland Clinic. This was a safety trial of a strategy aimed at using people’s own stem cells taken from their bone marrow, called mesenchymal stem cells, to inhibit immune mechanisms and augment natural tissue repair processes. After the cells were grown and re-injected, the researchers reported finding no serious safety concerns or any uptick in disease activity. A larger, controlled study of this approach to test for benefits is in the planning process. (Read the abstract.)
Turning skin cells into stem cells -- Cell-based therapies represent a promising area of research for both slowing MS activity and for repairing the brain’s myelin that has been damaged by MS, although they are still experimental in MS. Finding good sources of stem cells and faster ways to produce them would help drive progress. One approach is to use a person’s skin or other adult cells and reprogram them to become stem cells (called “induced pluripotent stem cells”). Dr. Stefano Pluchino’s team (University of Cambridge, UK) and collaborators in Italy described a new process they successfully used to transform mouse skin cells directly into brain stem cells in only one step, rather than many steps previously required. (Read the abstract.)
Moving repair cells to lesions – Dr. Catherine Lubetzki (Salpetriere Hospital, Paris) described the chemical factors that can activate and recruit immature myelin repair cells residing in the brain (oligodendrocyte precursor cells or OPCs) to sites of MS injury. Some immune factors activate OPCs, and other proteins, such as semaphorins, guide them to where they are needed and increase myelin repair. She noted that new insights into these processes have led to lab testing of potential new myelin repair strategies which are being readied for testing in people. (Read the abstract.)
Read more about research to repair the nervous system.
RESTORING FUNCTION -- Rehabilitation
Overcoming cognitive problems – Dr. Laura De Giglio (Sapienza University of Rome, Italy) and team previously reported that Nintendo’s videogame “Dr. Kawashima Brain Training™” improved attention, processing speed and working memory in people with MS. Now they report that it also increased “connectivity” between areas of the brain, shown by functional MRI (which captures active images of the brain while a person is performing tasks). Further research in larger groups of people should help refine this approach for improving cognitive function in people with MS. (Read the abstract.)
Aerobic fitness and the brain -- Dr. Rob Motl (University of Illinois at Urbana-Champaign) and team explored the relationship between aerobic fitness and hippocampal volume in MS. The hippocampus – a region of the brain important for cognition and memory – has a role in transforming new information into long-term memory. Novel evidence showed an association between aerobic fitness and greater hippocampal volume. This work provides a stronger basis for examining aerobic exercise training as an approach for delaying or reversing shrinkage of the hippocampus in MS, which is exciting news for people with MS who struggle with memory loss. (Read the abstract.)
Read more about rehabilitation research to restore function.
ENDING MS – Finding and Understanding MS Risk Genes
The big picture -- Dr. David Hafler (Yale University) delivered the keynote lecture on how to use risk genes as guideposts for understanding what goes wrong in MS, how to fix it, and even prevent it. He and others founded the International MS Genetics Consortium, a team that has revolutionized the study and understanding of MS genetics. He noted that there will likely be hundreds of MS risk genes uncovered. “Each by itself has a small effect on disease risk; but each interacts with the environment,” he noted. “These are not bad genes, and it’s not a bad environment – it’s a bad interaction.” (Read the abstract.)
Latest Genetics Results -- Dr. Philip De Jager (Harvard’s Brigham and Women’s Hospital, Boston) presented the latest findings by the International MS Genetics Consortium from a National MS Society-funded study. The goal was to replicate and expand its pivotal genetics study published in 2013. From cumulative studies involving over 80,000 people, Dr. De Jager announced that they have identified more than 159 genetic variations related to MS, and more importantly, have begun to identify the specific immune cells and proteins involved, and how much weight each one carries in terms of risks of developing MS. “We have created a reference map of MS susceptibility,” said Dr. De Jager. “Now we turn to the task of understanding the biology of MS susceptibility.” (Read the abstract.)
African American genetics study -- Dr. Noriko Isobe (University of California, San Francisco) and the International MS Genetic Consortium reported on how genes differ between African Americans and Caucasians with MS, following up on a 2013 study. Seven novel genes were identified among African Americans with MS that were not uncovered in the larger gene scans. These results may help sort out why MS is often more severe for African Americans, and also may help identify the MS risk genes that may be most important. (Read the abstract.)
ENDING MS – Lifestyle Factors
Vitamin D and genes -- Dr. Jennifer Graves and the Network of Pediatric MS Centers reported on findings from an ongoing study of what triggers MS in kids. They showed that low vitamin D status, which has been linked to MS risk, was associated with MS relapses only if kids have a specific immune gene (HLA-DRB1*15:01/03). Further research, which is underway, may shed new light on who may be helped most by vitamin D supplementation. (Read the abstract.)
Vitamin D Timing and MS risk – Because low levels of vitamin D have been linked to increased risk of developing MS, Dr. Marianna Cortese (University of Bergen, Norway) and team wanted to know at what ages vitamin D supplements might decrease the risk of MS. They surveyed 953 people with MS and 1717 people without MS about their use of cod liver oil (a source of vitamin D) during childhood, adolescence and adulthood. They found that those who reported taking cod liver oil at ages 13-18 had nearly half the risk of developing MS compared to those who never took cod liver oil or who took it at other ages. According to this study, teen years may be the best time for vitamin D supplements to reduce the risk of developing MS. (Read the abstract.)
Read more about vitamin D and MS.
Diet and MS – Looking for links between dietary patterns and the risk of developing MS, Dr. Dalia Rotstein (Harvard’s Brigham and Women's Hospital, Boston) and colleagues evaluated dietary habits reported by women involved in the Nurses’ Health Study (I and II), focusing in on any apparent differences between the 480 women who developed MS and those who did not. The researchers looked at five popular diets, such as the Mediterranean diet, and found that none were associated with higher or lower risk of developing MS. The need for more research on diet is one of the drivers of the National MS Society’s planned summit meeting on wellness research and programs. (Read the abstract.)
Read more about diet and MS.