© MICHELE LEVANI
There must be biomarkers
Surely an MS disease course leaves tracks somewhere in a person’s body. Investigators are attempting to identify “biomarkers”—indicators in a
bodily fluid (like the cholesterol levels that can
predict heart disease risk) that would point to
the presence or progression of MS. Finding and
understanding such markers would allow physicians to make far more precise prognoses and
select the best treatment for each individual. Dr.
Weiner’s research team has identified some blood
biomarkers that seem to distinguish RRMS from
PPMS. These intriguing findings need to be validated by additional study.
“It’s going to take considerable work and more
research funding to get us to the same point
with progressive MS as we are with relapsing-remitting,” said Timothy Coetzee, PhD, chief
research officer for the National MS Society.
Finding treatments for progressive MS
In MS, the immune system attacks myelin, the
protective sheath surrounding nerve fibers. Many
researchers are rethinking the role that inflammation plays in PPMS and SPMS. According to Dr.
Weiner, “In progressive MS, the immune system
itself may change and become more chronic
instead of producing the acute inflammation characteristic of relapsing-remitting.”
This would help explain why the disease-modifying drugs that have proven successful for so
many people with RRMS have shown so little benefit in the progressive MS crowd. “The drugs we
have target inflammation, and relapsing-remitting
patients are the ones who have the most inflammation,” Dr. Tremlett said. Still, not everyone is ready
to shut the door on the use of standard disease-modifying drugs for progressive MS.
“One of the more exciting observations emerging
from new research on progression is the finding that
some patients with progressive MS do have inflammation as part of their disease, and this inflammation could be treatable with existing MS therapies,”
Dr. Coetzee said. “This observation points out our
need to clearly define what constitutes progressive
MS in greater detail than we currently do.”
The bottom line is that—as of now—there are
no approved treatments that stop progression.
Some drugs have shown promise in changing the
disease course for the better in certain subgroups.
These treatments include the chemotherapy agents
mitoxantrone (Novantrone) and cyclophospha-mide (Cytoxan) that suppress the immune system,
and immune modulators rituximab (Rituxan) and
fingolimod (Gilenya) that target immune cells
thought to play a role in demyelination. Current
and future clinical trials should provide some
answers about effectiveness and safety.
Prevent damage or repair it
Beyond addressing the immune aspects of MS is
a whole new world of efforts to prevent or repair
MS damage. Protection entails shielding those all-important nerve cell fibers that connect the system
from degeneration; repair means building new tissue, which would involve recruiting stem cells that
either live within the brain or could be derived
from other sources.