Expert Voices: Current state of MS treatments and cure research

In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Tim Coetzee, PhD, some of your questions related to the current state of multiple sclerosis (MS) treatment and cure research.

Coetzee serves as the National MS Society’s chief advocacy, services, and science officer. In this capacity, he leads the society’s work in state and federal advocacy, delivery of services and connection programs, healthcare professional engagement and training, and the society’s global research programs.

Most recently, he served as the president of Fast Forward, a venture philanthropy of the National MS Society where he was responsible for strategic funding of biotechnology and pharmaceutical companies as well as partnerships with the financial and business communities. Prior to Fast Forward, he led the society’s global research initiatives on nervous system repair and protection in multiple sclerosis as well as the society’s fellowship and faculty award programs. 

Prior to joining the society, Coetzee held faculty appointments at the University of Connecticut Health Sciences Center where he conducted research into the structure and function of myelin. He received his PhD in molecular biology from Albany Medical College in 1993 and has since been involved in the field of MS research. Coetzee has been with the National MS Society since fall 2000. 

What in the MS therapy development pipeline most excites you?

Tim Coetzee’s role at the National MS Society includes organizing funding for innovative MS research conducted across the globe. (Photo courtesy of Tim Coetzee)

I am very excited by progress being made in the MS therapy development pipeline overall. Because of the advances in the science of MS, we now have a large number of treatments in various stages of testing for relapsing and progressive MS. One of the most exciting developments is with a group of treatments known as Bruton’s tyrosine kinase inhibitors, or BTKi. These treatments have shown great promise in Phase 2 clinical trials and now there are multiple Phase 3 clinical trials for various types of BTKi molecules. There’s reason to think that this type of approach may hold promise for stopping MS progression, but we won’t know until the larger trials are completed.

What has been most disheartening in the field of MS treatment research?

While I’m excited by the momentum in MS treatment development overall, I am also frustrated by the continued challenges in finding effective treatments for progressive MS. The recent approval of some modestly effective treatments for progressive MS is encouraging, but we have to do more. That’s why the National MS Society joined with other MS societies from around the world to launch the International Progressive MS Alliance. Recently, we published a scientific strategy paper where we discussed the challenges and opportunities in progressive MS. I am optimistic that by coming together, we can accelerate progress and find solutions for people with progressive MS.

It is also becoming clear that people from diverse backgrounds may not respond to MS therapies the same way. That’s why there’s a big push to make sure that clinical trials include participants of diverse races and ethnicities, and for more information from these trials about the backgrounds of participants and any differences seen in trial outcomes based on these characteristics.

Are there any specific aspects of MS that make finding a cure particularly difficult?

Finding cures for everyone with MS is our top priority, but as you note, this is also a big challenge. A big part of finding a cure is understanding what causes MS. To do that, we need to identify all relevant risk factors for MS, what windows of risk are, and determine whether any risk factor is necessary and sufficient to cause disease. We also need to understand contributions of genetic factors and environmental interactions to MS risk, along with understanding how the roles of sex, ethnicity, and race contribute to MS risk. Other key aspects focus on stopping disease activity in people living with the disease; in other words, putting it into permanent remission, and also restoring functions that have been lost through regenerative medicine and rehabilitation, wellness, and exercise strategies. Tackling these and other issues is a central part of the society’s Pathways to Cures Research Roadmap.

Which treatment research frontiers would you like to see get more funding?

There are a few areas that require additional focus by the global funding community. Progressive MS is a top priority given the major gaps in treatments. There is also a great need to address the lack of progress in developing effective treatments for managing symptoms and improving quality of life. The good news is that there are more researchers focused on symptom management and quality of life. This research has shown that by focusing on things like sleep, nutrition, and psychosocial behaviors, among others, people with MS may have less disease progression and better quality of life. Nevertheless, more needs to be done to accelerate the turning of these research advances into treatments.

What challenges typically impede trials in progressing from animal to human testing?

Often the biggest challenge in progressing a treatment from animal to human testing is our poor understanding of the biological target of the treatment. The animal models (most often, rodents) used for developing treatments don’t represent the full complexity of MS, and thus, something that works in animals may fail when it’s evaluated in people with MS. The research community has recognized this challenge and is working diligently to find new model systems that more accurately reflect MS disease mechanisms.

Many people with MS ask if there’s realistic hope to be found in stem cell therapies. Do you have thoughts on that?

Stem cell therapies hold promise, and there’s been significant progress made, but continued research is needed to determine the effectiveness and safety of different stem cells in treating MS and restoring function. The National MS Society reviewed evidence on the use of a particular type of stem cell therapy — autologous hematopoietic stem cell transplant (aHSCT) — for the treatment of MS and concluded that aHSCT is a good treatment option for some people, specifically for people who have very aggressive relapsing-remitting MS who have not benefited from disease-modifying therapies.

Stem cell therapy is an active area of research, and I encourage individuals to stay informed by visiting the society’s online resources on stem cells. There’s often a lot of hype around stem cell therapies, and it’s important to be informed to be able to separate facts from hype.

Are there any avenues of treatment or cure research that you feel people should have their eye on?

I am very excited by the research community’s continued focus on myelin repair to protect nerve connections and restore function. There are several clinical trials of myelin repair treatments underway and I am confident more are coming. While there have been some disappointments in this line of research, we are making breakthroughs, and I expect that myelin repair treatments will soon be part of what doctors use to treat MS.

Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. 

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.