MS Research Spotlight: Biomarkers Identified, Smoldering Inflammation, and More

MS Research Spotlight covers key research news from the past two weeks.


MS in 2018: new therapies and biomarkers

JANUARY 1, 2019 || The Lancet (via Science Direct)

This review of MS research in 2018 covers progress especially in experimental medicine and translation research.

(Translational research describes a two-way research process which integrates research derived from clinical practice, bench research, population studies, and policymaking in order to accelerate scientific discovery to the benefit of patients and the community at large.)

Success in MS research in 2018 came by way of reports on MS biomarkers, the successful completion of several clinical trials, and a better understanding of the disease course of MS.

Featured in this review:

  • The asthma drug, ibudiblast, was shown to reduce brain atrophy in people with progressive forms of MS and may open the doorway to drug repurposing that can speed up novel new treatments and lower drug costs.
  • Siponimod research suggests that those with SPMS, who had more aggressive disease activity, who were younger and had fewer problems with disability might benefit from this immunomodulating drug.
  • Pediatric multiple sclerosis research gained new ground after the first-ever phase III clinical trial for children with MS was published. This research showed fingolimod to be a much more effective therapy for young people with MS than interferons.
  • Biomarkers that more accurately identify gray matter atrophy were identified which could help individual patients to have more personalized monitoring and therapeutic choices moving forward.
  • Discoveries about the neurofilament light chain (which is a foundational aspect of the overall neural network) find it can be a useful biomarker for identifying MS, both relapsing remitting and progressive, as well as gauging its severity.

Read more about this progress here.

Alemtuzumab linked to clinical and MRI disease remission in MS

JANUARY 1, 2019 || Neurology Advisor

People with RRMS who use alemtuzumab may experience more periods of remission and declines in disabling symptoms according to a new study in Italy published in the Journal of Neurology.

The retrospective, multicenter, real-world study collected MRI data from 40 patients with relapsing-remitting MS. After 3 years, 45 percent of subjects showed no evidence of disease activity (NEDA) and 11 percent had “sustained disability improvement.”

Read the original study here.

Gray matter atrophy in MS despite clinical and lesion stability during natalizumab treatment

DECEMBER 21, 2018 || PLoS One

Researchers investigated different variations of gray matter loss in patients using natalizumab for between 2 and 5 years. They discovered that even with findings of disease stability in patients using this medication, a brain volume loss of 2 percent still occurred.

This decline in brain matter was only confirmed in gray matter; white matter tissues were not lost during this period.

To scientists, this confirms that atrophy of these different kinds of brain tissues occurs independently. The researchers suspect that natalizumab may be useful in protecting white matter against damage, but not gray matter.

Ultimately, the researchers noted that “how a particular drug affects a tissue compartment can vary depending on what substrate is most affected by that DMT.”

They suggest that future similar research should include separate observations of changes in both gray and white matter to achieve a much more accurate picture of how MS medications can (or cannot) prevent loss of brain tissue.

Slowly expanding/evolving lesions as an MRI marker of chronic active MS lesions

DECEMBER 19, 2018 || Multiple Sclerosis Journal

It appears that “smoldering inflammation” in MS may be useful as a biomarker of ongoing acute inflammation in people with MS. “Smoldering inflammation” refers to chronic inflammation which never resolves.

For some with MS, slowly expanding or evolving lesions (SELs) reflect loss of brain tissue in people who do not have active disease. These SELs may correlate to “smoldering inflammation” in a way that can be useful as a traced marker in MRI testing.

The study distinguishes between acute and chronic lesions (plaques) by stating that “while acute MS plaques predominate in early relapsing MS (RMS) patients and are the likely substrate of clinical attacks, pathologically defined smoldering plaques are more prominent in progressive MS patients… and may expand as a result of sustained inflammatory processes driven by a rim of iron-laden microglia/macrophages.”

This is an important distinction: chronic inflammation “sheltered” behind a blood-brain barrier that isn’t under active attack by the immune system has been shown to be a signature of the more progressive forms of MS.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Olga Ciccarelli, Multiple sclerosis in 2018: new therapies and biomarkers, The Lancet Neurology, Volume 18, Issue 1, 2019, Pages 10-12, https://doi.org/10.1016/S1474-4422(18)30455-1. (http://www.sciencedirect.com/science/article/pii/S1474442218304551)
  2. Jacobs S. Alemtuzumab Linked to Clinical and MRI Disease Remission in Multiple Sclerosis. Neurology Advisor. https://www.neurologyadvisor.com/multiple-sclerosis/no-evidence-of-disease-activity-neda-3-and-disability-improvement-with-alemtuzumab-ms/article/823868/. Published January 1, 2019. Accessed January 10, 2019.
  3. Gray matter atrophy in multiple sclerosis despite clinical and lesion stability during natalizumab treatment Koskimäki F, Bernard J, Yong J, Arndt N, Carroll T, et al. (2018) Gray matter atrophy in multiple sclerosis despite clinical and lesion stability during natalizumab treatment. PLOS ONE 13(12): e0209326. https://doi.org/10.1371/journal.pone.0209326
  4. Elliott C, Wolinsky JS, Hauser SL, et al. Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Multiple Sclerosis Journal. 2018:135245851881411. doi:10.1177/1352458518814117.

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