One important way researchers share their latest findings at big meetings like the American Academy of Neurology is during the twice daily “poster sessions.” During these sessions, researchers display the results of their studies on wall sized posters and these posters are pinned to rows upon rows of portable display boards in one of the largest halls of the convention center. During these “sessions” the authors of the posters stand by their boards and are available to present and discuss their work with other scientists. Think scientific speed dating! The MS poster sessions have been jam packed, so it really feels like you are in the trenches of MS research.
We are learning more and more about what drives MS progression, or worsening – which many people with MS will eventually experience. Understanding the factors that drive MS progression will provide new approaches to stopping, reversing and restoring what’s been lost. One of these factors appears to be smoking. Previous studies have shown that smoking can increase the risk of developing secondary progressive MS (the progressive form of MS that follows an initial diagnosis of relapsing MS) by as much as 3-fold! The good news reported this week during a poster session on MS health outcomes research is that this risk is reduced by quitting. The authors found that for every year that passes after a person stops smoking, the risk for progression is reduced by 5%. The reasons why smoking promotes progression remain to be determined, but I think we know enough now to strongly state that people with MS who smoke should really stop.
Did you know that according to clinicaltrials.gov, there are 57 clinical trials testing a variety of therapies for progressive forms of MS? While we still wait for definitive results for these ongoing trials, some hints regarding the effectiveness of these and other therapies were presented this week.
Analysis of brain atrophy (shrinkage) from clinical trials of Gilenya found a consistent reduction in the rate of brain atrophy. Since many believe atrophy is a consequence of neurodegeneration, and in turn that neurodegeneration is probably responsible for progression, this is a strong hint that Gilenya might be able to slow down progression.
There were several reports on the activity of an investigational agent called laquinimod suggesting that it may also be a good candidate for the treatment of progressive disease. One report found that laquinomod could suppress the activation microglial cells. Microglial cells are the only immune cells that live exclusively inside the central nervous system (brain and spinal cord). While these cells are important for protecting the nervous system from infections, overactive microglia may have a detrimental role in promoting and prolonging inflammation in the brain, which may be a factor that fuels progression. A group of Canadian researchers reported that laquinimod could inhibit microglial cell activation and in turn could also reduce injury to neurons. Another study looked more closely at previous results from clinical studies of laquinimod in relapsing disease and found evidence that treatment with this agent significantly slowed progression and reduced brain atrophy even in a subset of the study participants who didn’t have relapses, suggesting that laquinimod also holds promise for progressive forms of MS.
Non-pharmacological approaches for slowing progression are also being tested and reported this week. I learned that an herb called Curcuma longa contains a compound called Ar-tumerone and that this compound can reduce the activity of microglial cells and also promote the proliferation of neural stem cells. Neural stem cells are a natural, internal source of nervous system cells that have potential to regenerate nerves and oligodendrocytes (myelin producing cells that are damaged in MS). Although this is at a very early stage, Curcuma longa strikes me as a very interesting candidate to consider for the treatment of progressive MS.
The 1-year results of a low fat, plant-based diet in MS were reported by a group from Oregon Health and Science University in poster session devoted to diet and hormonal influences in MS. The study included 61 participants, about half of whom were on the test diet. While the team failed to show any measurable clinical or imaging (MRI) benefits, the subjects on the test diet did lose an average of 16 pounds and had significant improvements in their cholesterol levels. The small size of this study probably limited the ability to detect changes but I am encouraged that they achieved excellent compliance to the diet and have developed a model for other trials of MS diets to follow.
Well that’s it for now, back to the trenches!