Progressive MS: A Key Topic at MSParis2017

Greetings from MSParis2017, the name for this year’s joint ACTRIMS/ECTRIMS (American/European Committee for Treatment and Research in MS) meeting held in Paris, France this week. The content of the meeting is online, and we’ve also created a web hub for MSPARIS2017 to help others keep up with the news.
Today, there was an exciting announcement of top-line results from a clinical trial of ibudilast in people with either primary progressive or secondary progressive MS. Ibudilast is an oral therapy, and I’m proud the Society helped fund this trial. Investigators reported that ibudilast reduced brain shrinkage (atrophy), which has been linked to disability. I’m looking forward to hearing additional details about this study during a presentation on Saturday, and especially what plans might be underway for further testing.

It’s been amazing for me to see the research community focus on progressive MS–ways to stop it and reverse the damage. I may be biased, but I think this is due in part to the activities of the International Progressive MS Alliance, the first global MS research initiative focused on progressive MS, which I am involved with as a staff lead for the National MS Society.

For the second year in a row, Alliance activities were the focus of a scientific session. This time, the leaders of the three Collaborative Research Networks, funded by the Alliance, shared information with all attendees at ECTRIMS. They were also involved in a terrific webinar.
Based on what I’ve heard so far this week at MSParis2017 (and we’re just at the beginning of the meeting), efforts to repair myelin, the nerve insulation that’s damaged by MS, are gaining more momentum. You may have heard that there are clinical trials right now that are testing ways to repair myelin. But research is also blossoming around how the brain repairs itself, and there might be things we can do to encourage that natural regrowth. A whole “Hot Topics” session at the conference focused on how brain activity might influence brain repair and rewiring.
Researchers from Paris explained that after the nerve wire (axon) is stripped of myelin, there’s a chance that immature myelin-making cells (oligodendrocytes, everybody’s favorite word) in the brain will repair it. But investigators are now finding that these cells are more likely to rebuild myelin on axons that show electrical activity. To make a long story short, they used a lab model to stimulate bare axons and found that this led to better myelin repair (Abstract 157).
Along the same lines, researchers from Milan, Italy discussed how brain-stimulating approaches, like repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have been used to treat some symptoms like depression and pain. But based on a growing body of brain science, it’s possible that combining these kinds of external stimulators with things like brain exercises (think memory or other challenging games) and rehabilitation may help rewire the brain and improve function. There’s a lot to figure out yet, but I think these approaches open new possibilities for restoring function (Abstract 159).
There’s emerging evidence that people can take steps to reduce–at least somewhat–their risks of disease worsening. A past NIH-funded clinical trial called CombiRx is still yielding some important information since it tracked people for up to 7 years. More than 800 participants filled out smoking surveys at the start of the study, and researchers looked for any links between smoking status and MS disease activity. They found that current smokers were more likely to experience relapses and disease progression than those who never smoked or who quit (Abstract P410).

Here's another: I attended a compelling presentation today based on a large-scale patient registry called MSBase, adding to evidence that being on a disease-modifying therapy early and consistently delayed the transition to secondary progressive MS (Abstract #128).

There will be more blogging on what people can do right now to maximize their health–especially the next blog coming from MSPARIS2017. Stay tuned!
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Douglas Landsman, PhD

Dr. Douglas Landsman is Vice President, Researchh at the National MS Society. He leads the biomedical research and fellowship/faculty award programs, and plays a key role in the International Progressive MS Alliance. He has a long-standing interest in nerve-muscle interaction and developing strategies for promoting nervous system repair after disease or injury.