Sep 18, 2008 - The Atlas of MS, providing data on MS around the world, was introduced on the second day of the first World Congress on Treatment and Research in MS, along with novel strategies to repair MS damage, new data on children with MS, and updates on alternative interventions. The congress, being held this week in Montreal, Quebec, is the largest international conference on MS research and treatment in 2008.
During the Plenary session, the Don Paty Memorial Lecture by Dr. T. Jock Murray (Dalhousie University, Halifax, Nova Scotia) provided an outstanding overview of progress made over the decades in our understanding of MS. Summing up this progress, he said, “We are moving from a negative era of despair to an era of hope and inspiration for people with MS.”
Atlas of MS
The Atlas highlights the need for changes to improve MS care, including efforts to better inform the public and health professionals about the disease, and the need to make health services specific to MS more available and accessible. Survey results are presented in charts, maps and text on the Web site www.atlasofms.org. (Abstract #P423)
Repairing and Protecting Against MS Damage
Evidence that an approved therapy, Copaxone ® (glatiramer acetate, Teva Pharmaceutical Industries), may contribute to neural health was reported today based on a subgroup of the PreCISe study (in which the drug reduced the risk of developing MS and delayed the development of MS among individuals with CIS – clinically isolated syndrome – a first event suggestive of MS). Douglas L. Arnold, MD (NeuroRx, Montreal) and colleagues used magnetic resonance spectroscopy to examine levels of NAA – a marker of nerve fiber integrity – in a subgroup of 34 people. These levels were significantly higher in people taking Copaxone compared to those on placebo at one year. (Abstract #17)
One experimental strategy under study for repairing tissue damage in MS is cell transplants, such as “mesenchymal stem cells” which are derived from bone marrow. Antonio Uccelli, MD (University of Genoa) studied whether mesenchymal cell transplants would affect the immune attack as well as tissue damage in mice with the MS-like disease EAE. Despite finding little evidence that these cells developed into actual replacement nerve cells, they found evidence that brain tissue was protected from disease, as well as an increase in T cells that regulate the immune attack and a decrease of pro-inflammatory cells. (Abstract #27) Results of an early clinical trial of mesenchymal stem cells are slated to be presented during the conference on September 19.
People with MS have varying symptoms, which means that the underlying damage probably differs as well, and understanding these differences is a vital first step to devising repair strategies. A. Giorgio, MD (University of Siena, Italy) and colleagues examined changes in brain volume over an average time period of 18 months using MRI in 963 people with different types of early and later MS who were involved in placebo arms of clinical trials or who were not taking any disease-modifying therapy. Using a new technique to analyze brain atrophy, the investigators reported that reductions in brain volume were similar in people in the earliest stages of MS as to those in late stages. They concluded that this damage occurs steadily during the disease’s evolution. Further work is needed to verify these findings over longer periods of time. (Abstract #16)
Dr. Hanneke Hulst (VU University Medical Center, Amsterdam) and colleagues reported on a posthoc analysis of data compiled during year one of a clinical trial of the experimental oral therapy ibudilast (MN-166, MediciNova, Inc) involving 297 people with relapsing MS. They found that the relative proportion of acute inflammatory lesions – detected on MRI scans – that evolved into destructive lesions (defined as persistent black holes on MRI scans) was significantly reduced in the treated group compared with the placebo group. This suggests a possible neuroprotective effect of this drug. (Abstract #P271)
Off the Beaten Path
Growing evidence is linking increased levels of vitamin D to decreased MS risk, but one question is, "Will vitamin D supplements protect people from developing MS?" First, we’d need to know the safety of increasing supplementation in people with MS. Jodie Burton, MD (St. Michael’s Hospital, Toronto) and colleagues compared administering escalating doses of vitamin D3 (the equivalent of 4,000 to 40,000 international units per day) to 25 people with MS over 52 weeks, with 24 untreated controls. Calcium levels remained within normal limits. Immune system analysis showed that reactivity of T cells – major players in the MS attack – was reduced. Trends toward clinical improvement were noted, but they were not significant. The group is now planning a phase II study of vitamin D supplementation that will focus on MRI and clinical endpoints. (Abstract #P20)
Ikuo Tsunoda, MD, PhD (University of Utah, Salt Lake City) and colleagues administered resveratrol, a component of red wine, to mice with an MS-like disease induced by a virus. Resveratrol enhances the activity of SIRT1, a molecule that might help to preserve nerve fibers. In this National MS Society-funded effort, treated mice gained more weight than untreated mice, a sign of clinical improvement that the researchers say might be attributed to nerve protection. In mice infected with a low dose of virus, fewer died with resveratrol treatment. The team is proceeding with the pathologic studies necessary to confirm this hypothesis. (Abstract #P212)
Although exercise is helpful in managing many MS symptoms, research on the type and intensity of this exercise continues. Heather Hayes, DPT (University of Utah, Salt Lake City) and colleagues were funded by the National MS Society to compare a standard exercise program with a high-intensity resistance training program in 19 people with moderately severe MS. There were no significant differences in the improvement of strength or mobility between the two programs –fatigue improved significantly in both groups. The results showed no significant additional benefit of this high-intensity program for people with moderately severe MS – such studies help to direct exercise protocols for people with this disease. (Abstract #P385)
Different Mechanisms at Play in African Americans with MS?
Researchers at the National MS Society-funded Pediatric Center of Excellence in Stony Brook, New York, reported on a study of fatigue in 51 children with pediatric MS. William Macallister, PhD, reported that fatigue was a major MS symptom for 43% of these children, who can experience this symptom even early in the disease and in the absence of other significant neurologic impairments. Fatigue can impact school performance and other quality of life issues. (Abstract P397)
Mark Gorman, MD (Massachusetts General Hospital, Boston) presented a study comparing disease characteristics of adults with MS and children seen at their National MS Society-supported Pediatric MS Center of Excellence. They found that relapses were more frequent in the pediatric group, despite data that disease progression appears to be slower in pediatric-onset MS. (Abstract P128)
Women and MS
• Dr. M. Mendibe (Hospital de Cruces, Baracaldo, Spain) and colleagues analyzed the evolution of disability in 451 women with MS and showed that having children did not affect the development of disability. (Abstract #P99)
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