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Deepening Our Understanding of the Science Behind Multiple Sclerosis

By John Walsh, MD
 

Since the first medication to treat multiple sclerosis (MS), interferon beta-1b, was approved in 1993, the scientific community has worked tirelessly to provide more treatment options and resources for people living with this complex and highly individualized disease. Currently, there are 16 disease-modifying treatments approved by the FDA for MS.1 While significant progress has been made to advance the understanding of MS, there remain unmet needs for people living with MS.

Thus, despite the progress made so far, more work needs to be done. We know now, from preliminary results of an MS prevalence study conducted by the National Multiple Sclerosis Society (NMSS), approximately 1 million people are living with MS in the United States alone.2 This number is more than double the previous estimate reported in 2016,3 making the need for dedicated and thorough attention to the disease even more urgent. Every new scientific advancement in MS could result in a better understanding of this complicated, multifaceted disease, and potentially translate into a meaningful change in treatment.

One of the most promising developments in MS research is in the identification of disease biomarkers of MS, which could lead to an exciting advancement in the field. MS presents with a wide variety of symptoms, and diagnosing a patient with MS today does not rely on one specific test; rather, it is a multi-step process that requires first ruling out other diseases.4 In some cases, the relevant tests can be invasive, may result in delays in MS diagnosis, and subsequently could negatively impact long-term outcomes. Identifying biomarkers specific to MS offers an opportunity to improve diagnoses, make more informed treatment decisions and hopefully improve outcomes for MS patients.5

Understanding the complex relationship of the interaction between B and T cells, which are known to play central roles in the development and perpetuation of MS, has become an area of active investigation as well. Lymphocyte-mediated neuro-inflammation and myelin injury in the CNS compartment underlie clinical relapses and MS progression. B and T cells do not act independently of each other; they stimulate each other, activating and perpetuating the inflammatory cascade. However, the complex details of the intimate relationship between B and T cells in MS have not yet been elucidated.

Recent evidence points to specific subsets of B and T cells—memory B and T cells—playing a key role in MS. Cells from the B-cell lineage, including primarily memory B cells, are found to persist in the inflamed MS CNS, and depletion of memory B cells reduces MRI lesions and relapses.6,7 In studies of T cells from MS patients, 84% of T cells reactive to a myelin protein were found to be of the memory T cell subset, and the numbers of circulating memory T cells correlated positively with Expanded Disability Status Scale (EDSS) scores.8,9 Examining interactions between B and T memory cells more closely may help us uncover even more about the pathophysiology of MS including how to rebalance the immune system when inflammation gets out of control and ultimately, provide potential new opportunities for treatment.

For more than 20 years, EMD Serono has been committed to the advancement of the understanding of MS and its treatment. The remaining mysteries of the brain, mirrored in the evolving and individualized nature of MS, make continued understanding of the condition essential, and we are continually striving to examine MS inside out. Our momentum propels us towards developing a deeper knowledge of the disease: how to tackle it using cutting-edge science and how to ensure that each person affected by the disease has the treatment options necessary to achieve better outcomes.

Beyond treatment, we aim to ensure patients feel supported in every phase of their journey. Our patient support service, MS LifeLines®, provides valuable information about MS and treatment, and a broad range of financial assistance programs for eligible patients.

There is a lot more work to be done to uncover the science of MS. At EMD Serono, we are just beginning to scratch the surface. All of the work being done in MS research today gives hope to the scientific community and patients that we will comprehensively understand and be able to more effectively treat this unpredictable disease in the future.

1. National MS Society. Medications. Available at: https://www.nationalmssociety.org/Treating-MS/Medications. Accessed: May 21, 2018.

2. National MS Society. Preliminary Results of MS Prevalence Study Estimate Nearly 1 Million Living with MS in the U.S. Available at: https://www.nationalmssociety.org/About-the-Society/News/Preliminary-Results-of-MS-Prevalence-Study. Accessed: May 21, 2018.

3. Multiple Sclerosis Foundation. Common Questions. Available at: https://msfocus.org/Get-Educated/Common-Questions. Accessed: December 13, 2017.

4. Mayo Clinic. Multiple sclerosis:diagnosis & treatment. Available at: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274. Accessed: May 21, 2018.

5. Housley WJ, Pitt D, Hafler DA. Biomarkers in multiple sclerosis. Clinical Immunology. 2015: 161(1):51-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26143623. Accessed: May 21, 2018.

6. Baker D, Marta M, Pryce G, Giovannoni G, Schmierer K. Memory B cells are major targets for effective immunotherapy in relapsing multiple sclerosis. EBioMedicine. 2017;16:41-50.

7. Hauser SL, Waubant E, Arnold D, et al. B-cell depletion with rituximab in relapsing–remitting multiple sclerosis. N Engl J Med. 2008;358:676-688.

8. Burns J, Bartholomew B, Lobo S. Isolation of myelin basic protein–specific T cells predominantly from the memory T‐cell compartment in multiple sclerosis. Ann Neurol. 1999;45(1):33-39.

9. Fan X, Jin T, Zhao S, et al Circulating CCR7+ ICOS+memory T follicular helper cells in patients with multiple sclerosis. PLoS One. 2015;10(7):e0134523.

John Walsh, MD

Vice President of Neurology & Immunology (N&I)
US Medical Affairs
EMD Serono
Rockland, MA

Dr. Walsh has extensive background in the field of MS and is a Board Certified physician with more than 20 years of experience providing medical care to patients. He also serves as a National Disaster Medical Assistance Team Physician Medical Officer for the US Department of Health & Human Services.

 

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About Practical Neurology

Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.

 
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