By Bruce Bebo, PhD, as told to Hallie Levine
I’ve been part of the leadership team for the National Multiple Sclerosis Society for a decade. I was inspired to pursue this advocacy work because my mother was diagnosed with the disease when I was a child. Back then, there were virtually no treatments for her, and she suffered unnecessarily. As a kid, I vowed I’d do everything in my power to change that.
Today, the outlook for people diagnosed with MS is much different. We have over 25 disease-modifying treatments for people with this condition. These medications have allowed us to significantly delay the onset of clinical symptoms in many people and minimize them once they do occur. As a result, most people with MS are now able to live fulfilling, happy, productive lives.
I recently attended the European Committee for Treatment and Research in Multiple Sclerosis conference. It’s the world’s largest MS research conference with over 8,700 participants from more than 100 countries. Here’s a roundup of what I learned, which makes me even more optimistic for the future of treatment for relapsing remitting multiple sclerosis.
We may be able to stop MS before it starts. Sometimes MS is picked up before symptoms begin, usually because a neurologist spots something suspicious on a scan for some other reason. Now, there may be drugs available to stop the progression of the disease. Researchers took 87 people who had something called radiologically isolated syndrome (RIS). That’s when you show MS-like brain lesions on MRI but have no MS symptoms. They gave half of the people in the study dimethyl fumarate (Tecfidera), a prescription medication used to treat relapsing forms of multiple sclerosis. The other half got a placebo. Those who got the drug had an 80% lower risk of MS compared to those on placebo.
We’re on the hunt for biomarkers. Other autoimmune diseases such as rheumatoid arthritis and type 1 diabetes have biomarkers, which means doctors can run blood tests to determine if someone is at high risk to develop them. Right now, there’s no such test for multiple sclerosis. It’s only diagnosed after someone begins to show symptoms, which may be fairly along in the disease process. Researchers are working hard to develop different kinds of biomarkers — in blood, in spinal fluid, and possibly in imaging tests such as MRIs and PETs — to help us diagnose people with multiple sclerosis even earlier.
A biomarker we’re particularly excited about are neurofilament light chains (NFL). These are structural proteins inside nerve cells. When they get damaged, they are released into the surrounding fluid. From there, they find their way into the bloodstream, where they can be measured. It appears that elevated levels of NFL are associated with an increased risk to develop MS. Another biomarker we talked about a lot at the conference is serum glial fibrillary acidic protein (s-GFAP). These proteins are involved in controlling astroglial cells, which nourish cells in the brain and spinal cord. The hope is that we could use it, either by itself, or in combination with NFL, to help earlier diagnose MS. They may also help us set up more personalized treatments. It would be great if we could use these biomarkers as part of a panel of tests to help determine the best disease-modifying therapy to put a patient with MS on.
Promising new drugs are in the pipeline. More and more, researchers and pharmaceutical companies are paying attention to a specific type of immune cell in the brain called microglia. Some of these cells can cause MS to progress, and some may actually help reverse it. We’re looking for drugs that can get rid of the harmful cells and/or enhance the good ones. One way we want to do this is through a type of drug known as a Bruton tyrosine kinase (BTK) inhibitor. These drugs inhibit the enzyme BTK, which in turn inhibit microglia. They will also hopefully reduce the activation of immune B cells, which are also involved in the progression of MS. There are at least four clinical trials going on right now, testing the use of these inhibitors for both relapsing remitting and progressive MS.
We’ve learned about what doesn’t work. For years, researchers thought that low levels of vitamin D might help to both treat and prevent MS. But two large trials reported at the conference revealed that that wasn’t true. One study of 140 people with relapsing remitting MS found that taking a high dose daily (5,000 IU) for 96 weeks didn’t reduce MS activity. Another found that people with clinically isolated syndrome (meaning they’d developed a neurologic symptom that hadn’t yet developed into definite MS) who took high levels of vitamin D for 48 weeks were no less likely to go on to develop MS than those who took a placebo. We don’t know for sure whether vitamin D can prevent MS from developing before you actually show symptoms, but we know pretty definitively now one thing: Vitamin D doesn’t seem to do much for people who already have MS. We can move on.
How you eat may be important to ease symptoms of MS. Intermittent fasting has been touted to help treat many diseases, including MS. A study funded by the National Multiple Sclerosis Society found that this type of eating pattern lowered inflammation and provided potentially beneficial brain changes. It was a small study but similar to results that we’ve seen before. We should take it with a note of caution but view it as growing evidence that diet can affect a person’s experience with MS. There appear to be real biological changes that happen because of intermittent fasting that provide benefits to people with multiple sclerosis. Once we learn what these pathways are, we may get a better sense of what non-drug therapies can help people with relapsing remitting MS.
The takeaway? Our knowledge of multiple sclerosis has greatly increased over the years and has been translated into a plethora of new treatments. As a result, the future is brighter than ever for people with relapsing remitting MS. It’s important that people with MS and their loved ones stay informed about all the research advances, including potential new therapies that may be available.
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Bruce Bebo, PhD, executive vice president, research, National Multiple Sclerosis Society.
ECTRIMS 2022 annual conference: “High Dose Vitamin D3 Supplementation Does Not Reduce Disease Activity in Relapsing Remitting Multiple Sclerosis in a Large Randomized Controlled Trial,” “Results from PREVANZ, a Phase 2B Placebo Controlled Double Blind Dose Ranging Study of Vitamin D to Prevent Progression to Definite Multiple Sclerosis After a High Risk Clinically Isolated Syndrome,” “Randomized Clinical Trial of Intermittent Energy Restriction in People with Multiple Sclerosis,” “Multi-Center, Randomized, Double-Blinded Assessment of Dimethyl Fumarate in Extending the Time to a First Clinical Demyelinating Event in Radiologically Isolated Syndrome (ARISE).”