Past, Present and Possible Future Directions of MS Research Topic of Educational Talk

Past, Present and Possible Future Directions of MS Research Topic of Educational Talk

The science underlying our understanding of multiple sclerosis — through to new technologies that might expand that understanding in ways “never imagined” — was the focus of a recent educational webinar titled “The Evolving Science of Multiple Sclerosis (MS).

Kottil Rammohan, MD, a professor of clinical neurology and director of the MS Center of Excellence at the University of Miami Miller School of Medicine, gave the talk.

The April 19 webinar was sponsored by EMD Serono and hosted by John Walsh, MD, the company’s vice president of U.S. Medical Affairs, Neurology and Immunology.

Rammohan began by mentioning the first characterization of MS by Jean-Martin Charcot in the 1800s, and surveyed the variety of failed treatments used on MS patients at different times, including exposure to cold and infection with malaria.

It was not until 1959 that the presence of oligoclonal bands — which indicate local central nervous system production of antibodies — in patients’ cerebrospinal fluid, which bathes the brain and spinal cord, was set as a diagnostic criterion for MS.

Soon afterward, a type of white blood cell known as B-cells or B-lymphocytes (blood cells that produce antibodies) was identified as playing a role in disease progression.

Today, Rammohan said, the picture is much more complex due to the amount of research conducted since 1959, and the known complexity of the disease itself.

He thinks of MS, he said, as having four phases. The first is the immune system reaction against myelin — the protective layer wrapped around neurons that plays a role in transmitting nerve impulses in the brain. Normally, the immune system has a mechanism called tolerance that prevents it from attacking the body’s own cells and tissues. Tolerance to self is lost in this first MS phase, Rammohan said.

Second is the breakdown of the blood-brain barrier — a network of blood vessels and tissue closely spaced that helps keep harmful substances from reaching the brain — allowing immune cells to enter the brain. Some of these cells will specifically target myelin.

The third phase is a second wave of immune cell migration into the brain, while the final phase is marked by brain injury caused by an orchestrated immune response against myelin — orchestrated in the sense that many factors are working together, including crosstalk between B-cells and two other white blood cell types, T-cells and macrophages.

Rammohan pointed out that while the brain injury seen in MS patients is well-characterized, leading to the development of several therapies, and contributing genetic and epigenetic factors known, the actual cause of MS remains a mystery.

He believes that infection by a virus may be the disease’s initial trigger,  but how MS continues to progress is not known.

New technology — from genomics, or the analysis of the whole set of roughly 20,000 genes in a person’s DNA, to bioinformatics, the analysis of large amounts of complex biological data — as well as new fields like epigenetics, the study of the suppression and de-repression of genes — all offer the potential to advance disease understanding in ways not previously possible.

Bioinformatics, in particular, will allow researchers to analyze a thousand genes at once, he said, whereas previously they had to be studied individually.

These technological advances, he said, “will allow us to understand the whole system” underlying MS development — an advance he believes will give rise to insights “never imagined.”

Janet Stewart is a life sciences writer and editor, holds an MSc. in Virology and Immunology and has worked on research on multiple sclerosis during the course of her graduate studies.
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Janet Stewart is a life sciences writer and editor, holds an MSc. in Virology and Immunology and has worked on research on multiple sclerosis during the course of her graduate studies.
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8 comments

    • I made HSCT 18 months ago, I have SPMS, the procedure stopped new attacks but my walking ability still deteriorating. The studies shows that HSCT is very efficient for RRMS with 5 or less EDSS.
      it passed FDA phase III and it is approved procedure in many countries.

  1. Lawrence Helson MD says:

    Tolerence in MS> an area for interrogation. Consider PD-1 and PD-L1 therapeutics in early phase disease.

  2. Jason says:

    Here are some of insurers that are providing coverage:

    Select Health Care plus approved 2014
    Blue Cross & Blue Shield of Michigan approved 2015
    Community Care Oklahoma – PPO Select approved 2015
    CareFirst Blue ShieldBlue Cross Blue Shield ”Blue Preferred” approved 2015
    Aetna Select, Illinois approved 2015
    Aetna POS approved 2015
    UMR / United Healthcare Choice Plus approved 2015
    Community Care PPO Select approved 2015
    UHC- CarePlus approved 2015
    Anthem BC-BS of OH approved 2015
    BCBS of MO approved 2015
    BCBS of Illinois approved 2015 (self-insured plan & employer overrode prior denials)
    UHC plan approved 2015
    United Healthcare Choice Plus approved 2015
    United Healthcare Choice Plus approved 2015
    Cigna approved 2015
    Anthem Blue Cross OH approved 2015
    United Healthcare Choice Plus approved 2015
    Aetna approved 2015
    Coventry (an Aetna company) approved 2015
    Anthem BCBS PPO approved 2015
    Cigna PPA (self-insured) approved 2015
    United Healthcare Choice Plus approved 2015
    United Healthcare approved 2016
    United Healthcare Complete Medicare Supplement insurance approved 2016
    Cigna Vantage Flex Silver Fox 1900 Plan (an off-market plan from Florida) approved 2016
    BCBS Texas approved 2015
    United Healthcare approved 2016
    BCBS Illinois approved 2016
    BCBS (Premium Policy) and Medicare Secondary approved 2016
    BCBS NC (called Blue Local Plan) approved 2016
    Cigna approved 2016
    Aetna Open Access approved 2016
    BCBS NC (PPO) approved 2016
    Medicare with BCBS secondary approved 2016
    Medicare with BCBS secondary approved 2016
    BCBS LA approved 2016
    BCBS IN approved 2016
    BCBS Illinois approved 2016
    UHC Choice Plus Silver Plan approved 2016
    BCBS MA approved 2016

  3. Jason says:

    Here’s a few more:

    Blue Cross & Blue Shield of Michigan (PPO) thru the ‘Obamacare’ exchange – Silver Multi-state plans approved 2014
    NGS Cofinity (contract with Optum) approved 2014
    United Healthcare – PPO approved 2014
    Aetna approved 2014
    Cigna approved 2014
    Blue Cross & Blue Shield of Michigan approved 2014
    Cigna approved 2014
    HealthLink (state of Illinois employees) approved 2014
    Harvard Pilgrim PPO approved 2014
    Cigna approved 2014
    SelectHealth approved 2014
    Aetna approved 2014
    BlueShield of CA – High Option PPO approved 2014
    United Healthcare approved 2014
    Blue Cross & Blue Shield of Michigan approved 2014
    United Healthcare Choice approved 2014
    Select Health Care plus approved 2014
    Blue Cross & Blue Shield of Michigan approved 2015
    Community Care Oklahoma – PPO Select approved 2015
    CareFirst Blue ShieldBlue Cross Blue Shield ”Blue Preferred” approved 2015

  4. Jason says:

    “#AAN2018 – Blood Stem Cell Transplant Superior to DMDs in Highly Active RRMS, MIST Trial Shows”

    Why are we using drugs?

    • JOYCE says:

      Just saw Meridith Viara’s husband on ‘The View’ this a.m. who has MS and went to Italy for Stem Cell treatment and said he saw people actually get out of their wheel chairs. he has written a book on this called “Chasing Hope’

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