The National MS Society is focused on achieving breakthroughs to cures for multiple sclerosis. Our progress will be hastened with a roadmap that describes the knowledge gaps, milestones and research priorities that will lead to cures for everyone living with MS. The roadmap was developed in consultation with scientific experts, health care providers and people affected by MS. We believe the Pathways to MS Cures Roadmap will inspire the alignment of global resources on the most pressing questions in MS research and accelerate scientific breakthroughs that lead to cures for everyone living with MS.
The Roadmap includes three Pathways: STOPPING MS disease activity, RESTORING function by reversing damage and symptoms, and ENDING MS by preventing new cases. Research proposals should address critical knowledge gaps in our understanding of the roadmap. Many gaps apply to more than one pathway.
NOTE: If you would like advice about whether and how your research may fit with these priorities, please reach out to a research staff person.
Read the entire Pathways to MS Cures Roadmap in Multiple Sclerosis Journal (open access). Briefly:
Goal 1: STOP pathway -- No more disease activity
Stopping MS is defined as achieving a state of no new disease activity, no worsening ofdaily living or quality of life, and no change in disease manifestations or clinical activity inpeople living with either relapsing or progressive forms of MS. Understanding disease heterogeneity across diverse populations of people with all forms of MS over time is important to stopping disease activity and protecting the central nervous system from further assault, and to create a permissive environment for myelin repair and other restoration efforts. Target areas include
Early Detection: Reduce or eliminate the impact of MS before neurological deficits accumulate
in an individual with MS, and
Precision Medicine: Achieve no worsening of daily living or quality of life, and no change in disease manifestations,
for each individual with MS.
Knowledge gaps in the STOP pathway include but are not limited to:
Early Detection and Precision Medicine
- Biomarkers/Screening tools that identify MS in its earliest stages with enough confidence to initiate interventions
- Biological processes driving early MS compared to later stages of disease
- Understanding the heterogeneity of pre-symptom phases of MS in diverse populations
- Biomarkers of prognosis and therapeutic response in individuals
- Pathways driving non-lesional pathology/neurodegeneration involved in progressive stages of disease
- New molecular targets and therapeutic approaches for neuroprotection
- Interventions that target the earliest disease-causing pathways
- Understanding the roles of aging, sex, ethnicity, race, and genetics in MS pathology and response to therapies
Goal 2: RESTORE Pathway -- reverse symptoms, and recover function to enable full participation in society
MS can result in many different symptoms, including vision loss, pain, fatigue, sensory loss, impaired coordination, mobility, and cognitive and mood changes. Symptom severity and duration varies from person to person. Historically, rehabilitation aims to improve symptoms, with medical management of the disease kept separate. There is data supporting the idea that restoration of function, not only symptom management, is possible in MS. Target areas include
Regeneration: Improve or enhance tissue repair/regeneration to reverse or slow MS progression and improve symptoms, and
Restoration of Activity: Advance implementation of rehabilitation and symptom management strategies to restore function, reverse symptoms and enhance quality of life.
Knowledge gaps in the RESTORE pathway include but are not limited to:
Regeneration
- Physiological mechanisms, molecular targets and therapeutic approaches to promote myelin and neural repair
- Clear understanding of the functional heterogeneity of cells involved in repair
- Better physiologic, fluid biomarkers, imaging, and functional measures for earlier readouts of remyelination, reversal of tissue damage, and functional recovery
- Understanding of the roles of aging, sex, ethnicity, race, and genetics in tissue restoration
- Better animal models to study repair
Restoration of Activity
- Understanding how rehabilitation and exercise impact the central nervous system and the extent that they can facilitate CNS repair processes
- Sensitive, valid, and clinically meaningful measures of disability and tools that establish measurable relationships between physiologic findings and meaningful recovery of function
- Sufficiently powered intervention studies that incorporate endpoints focused on type and dose parameters, targeting (including, but not limited to) cognitive or motor rehabilitation, resilience, diet, exercise, electrical stimulation, pain, fatigue, depression, anxiety, and bladder impairment
- Outcome measures, biologic, behavioral or technology driven that can be used to individually tailor interventions
- Innovative approaches that translate research findings to clinical practice and daily disease management
Goal 3: END Pathway -- No new cases of MS (prevention)
Ending MS is defined as no new cases of MS. Preventing new cases of MS will require population-based public health initiatives and individual-based interventions. While efforts will be made to advance both targets, a focus on Secondary Prevention could potentially lead to the development of approaches with benefits for people living with MS in the near term. Target areas include
Primary prevention: To prevent MS before it occurs by limiting exposure to MS risk factors
in the general population, and
Secondary prevention: To reduce or eliminate the impact of MS before onset of signs/symptoms by identifying pre-clinical MS
in the high-risk population.
Knowledge gaps in the END pathway include but are not limited to:
Primary and Secondary Prevention
- Identify all relevant risk factors for MS, windows of risk, and determine whether any risk factor is necessary and sufficient to cause disease
- Understanding the contributions of genetic/epigenetic factors and environmental interactions to MS risk
- Understanding the roles of sex, ethnicity, and race with MS risk
- Understanding the early pathological pathways/events that lead to the initiation of MS
- Screening tools that identify MS in its earliest stages with enough confidence to trigger intervention
- Discovery of biomarkers that detect early MS before symptoms appear
- Interventions that target the earliest disease-causing pathways and the ability to determine which treatment will work for which person