What kind of progress in multiple sclerosis (MS) research can be expected in the next 10 years?
That’s a question often on the minds of people with MS, researchers and donors to the Multiple Sclerosis Society of Canada.
“If the past decade is any measure, I think we can look forward to significant progress in understanding this complex disease and to better treatments for people who have MS,” said Dr. William J. McIlroy, MS Society national medical advisor.
It was just seven years ago when the first treatment that actually had an effect on the course of MS came on the Canadian market. Now there are a total of four treatment choices – three beta interferon products (Avonex, Betaseron and Rebif) and a synthetic compound of amino acids (glatiramer acetate/ Copaxone). They all reduce the frequency and severity of MS attacks and may delay progression of disability over time.
In addition, a growing number of physicians are utilizing a chemotherapy drug called mitoxantrone (Novantrone) to slow down particularly aggressive MS.
“However, the search is still on for even better therapies. That’s why the real hope is in laboratories in Canada and around the world, and why the MS Society directs a significant portion of donors’ dollars to MS research,” Dr. McIlroy said.
MS Society supported research involves four basic strategies.
The first approach is to find the cause of the disease using major developments in immunology, pathology, infectious disease and genetics.
“MS is a disease of the immune system. For reasons not yet understood, immune system cells start attacking myelin, the protective covering that surrounds nerve fibres, and damages nerve fibres as well,” Dr. McIlroy explained.
About one-third of MS Society funded research projects are related to immune system research. One approach is that of Dr. Katerina Dorovini-Zis at the University of British Columbia who has developed an artificial model of the cellular barrier (blood-brain barrier) that normally keeps immune system cells out of the central nervous system.
She is focussing on the possibility that some cells in this important barrier actually activate T cells and stimulate them to enter the central nervous system and start attacking myelin.
Genetics is another key component in the search for the MS cause.
The MS Scientific Research Foundation, which is closely related to the MS Society, is funding a major examination of all facets of MS genetics. The study began in 1993 and now involves 18 MS clinics across Canada and 19,000 people with MS and their families.
“The project, led by Dr. Dessa Sadovnick at the University of British Columbia and Dr. George Ebers at the University of Oxford and the University of Western Ontario, has demonstrated that the cause of MS is complex and is influenced by a number of genes,” said Dr. McIlroy.
The study has also uncovered 45 families in Canada, which have four or more MS affected individuals. In these families, a single gene seems to play a big role.
But genetics is not the entire answer. Environmental factors are also important and act at a population level to influence whether someone who is genetically susceptible will develop MS.
The second approach is to monitor disease development in MS by brain imaging. In this area Canadians are recognized leaders.
Dr. Don Paty at the University of British Columbia was one of the first MS investigators to realize in the 1980s that MRI, then a brand new diagnostic tool, probably had even greater potential to provide a window into the brain to see how MS develops.
“MS is not a static disease. Contrary to the belief just 25 years ago, there can be spontaneous myelin repair. MRI coupled with pathological techniques allowing researchers to better understand this process, to monitor the effects of therapy and to grasp the fundamentals of MS,” Dr. McIlroy said.
The quest to find better therapies is ever present in all MS research. About half of all MS Society supported research projects are directed at trying to protect myelin or to stimulate its regrowth and repair.
Three researchers at the Hospital for Sick Children in Toronto are approaching this problem in separate ways.
Dr. Joan Boggs is examining how major myelin proteins and a group of lipids (fats) work together to carry signals that keep myelin healthy. She has created model membranes that should help her determine which proteins and lipids interact and how they transmit the needed signals for myelination.
Drs. Mario Moscarello and Fabrizio Mastronardi are testing in animal models whether Vitamin B12 can boost myelin repair, especially in combination with other therapies.
Myelin repair using adult stem cells is the focus of a large collaborative study involvig researchers at the University of Toronto McGill University, the University of Rochester, University of Calgary and the Mayo Clinic. Now at the animal model stage, the investigators hope to find ways to turn the body’s own stem cells into a cellular repair team that could lead to extensive re-myelination.
The fourth approach is to take advantage of clinical trial advances. “Canada is well placed to provide leadership in this area. There are more than 20 MS clinics across the country providing specialized MS care and contributing to research. All the recent major MS therapeutic studies had significant input from Canadian clinics,” said Dr. McIlroy.
“Here in Toronto, the MS population is well served by MS Clinics at St. Michael’s Hospital, Sunnybrook Hospital and the world’s first pediatric MS Clinic at the Hospital for Sick Children.
“My view for the future of MS research is optimistic. While no one can predict when scientific advances will occur, I am confident that MS research will lead to more effective treatments, ways to prevent MS and ultimately, a cure,” Dr. McIlroy concluded.
For more information about MS research, contact the Multiple Sclerosis Society of Canada at 416 922-6065 or visit the web site at www.mssociety.ca