“Stem cells could rebuild damaged tissue by either
replacing myelin-producing cells or replacing the
nerve cells,” Dr. Chitnis said.
Where does nerve damage start?
The damage in progressive MS may be attributed to the degeneration of axons—the fibers
that transmit messages between nerve cells. Some
evidence indicates that nerve fiber degeneration
occurs independent of inflammation, while other
data suggests that degeneration stops when the
inflammation does.
It is known that loss of myelin leaves axons
exposed and exposed axons are associated with
progression and long-term disability. “We don’t
yet know whether the myelin sheath is the primary target,” said Dr. Tremlett, “or is something
attacking the axons first, and the inflammation
and demyelination are secondary?” Dr. Chitnis
acknowledged that it’s difficult to treat progression, “because a lot of the inflammation is sequestered in brain tissue itself, and you can’t access it.
The current treatments all target immune system
cells, and for progressive MS we likely need treatments that protect the nerves.”
Changing the game
Historically, scientists would form single independent groups with a principal investigator leading
the charge. Now, researchers build consortiums
across multiple disciplines, involving academia,
funding sources, drug companies and the FDA.
The MS research community is part of this change
in the way disease is explored. “Getting together in
big teams is really beneficial because people start to
see things from another’s perspective,” Dr. Tremlett noted. “You need people with different experiences and expertise working together.”
As part of this movement, the Society recently
convened the four international teams from the
Promise: 2010 Nervous System Repair and Protection Initiative. They are continuing to explore:
n finding better ways to detect and quantify tissue
damage in MS;
n restoring myelin by recognizing and amplifying
natural repair factors in the brain;
n screening molecules for protective properties;
n developing better imaging technologies to visualize myelin and nerve fiber damage.
Dr. Weiner envisions a three-pronged approach in
researching progressive MS. “First, we need to find
out if treating RRMS early will prevent people from
becoming progressive,” he said. “Second, we need
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to understand the factors that trigger axon degeneration and block them. And third is to get better
understanding of the different kinds of inflammation that occur and how to shut them down.”
While scientists work. . .
“It’s good to see that researchers are looking at
this disease from a different angle. I hope that
