Explorations of Progressive MS Reported at AAN 2019

At last week’s Annual Meeting of the American Academy of Neurology (AAN), there was a dedicated session focused on progressive MS. To me, that’s an indicator of the ever-increasing awareness of the need for more research in progressive MS. I think this awareness can be directly linked to efforts of the International Progressive MS Alliance, in which I am involved (by the way, there’s still time to check out this recent Alliance webinar on solving progressive MS). 
The AAN meeting involves large general sessions each morning followed by hundreds of parallel sessions and courses related to all types of neurological disorders. Dr. Claudia Lucchinetti of the Mayo Clinic gave a talk about the processes and biological events that scientists believe are involved in progression. One of those events appears to be obstructions in energy production in nerve cells by the mitochondria, the tiny powerhouses that drive cellular activity. This potential mechanism of interest is one reason why researchers are conducting clinical trials to test whether biotin (a B-vitamin) can “feed” the mitochondria and preserve their optimal function. We should know more about biotin when one phase 3 trial is completed around 2020.
Below are a couple of other AAN presentations that I thought were noteworthy. There were many more, so feel free to browse the scientific summaries (abstracts) for yourselves, and also check out my colleague’s blog from the AAN, “Myelin Repair, Gut Bacteria, and When Does MS Begin?” 
Can a dietary supplement correct bile acid processing in progressive MS?
People with MS may have abnormalities in the way they process energy and other maintenance activities, known as metabolism. One team at Johns Hopkins University focused on bile acid metabolism. Bile acids are produced by the liver and can influence the composition of gut bacteria. They also influence immune and brain cells. Dr. Pavan Bhargava described lab work suggesting that dietary supplements of bile acid might lead to beneficial effects on the immune system, gut bacterial composition or other aspects of disease activity. With funding from the National MS Society, the team is conducting a clinical trial in people with progressive MS who have signs of abnormal bile acid metabolism. I look forward to the results testing this novel approach to treating progressive MS (abstract S55.002).
Impacts of high blood pressure, high cholesterol and other vascular risk factors on MS: “Comorbidity” is defined as having two or more chronic conditions, and people living with MS often have additional health issues. There’s growing evidence that having other health conditions may contribute to MS progression. Dr. Vijayshree Yadav of Oregon Health & Sciences University described a study of people with MS who also have “vascular risk factors” like high blood pressure, diabetes, heart disease, obesity and high cholesterol. The team compared people with and without vascular risk factors. Over three years, they found that those with these conditions had more fatigue, higher disability scores, lower brain volume and reduced brain ATP—which provides energy inside cells. It’s hoped that treating vascular conditions may improve MS symptoms and progression (abstract S55.001).

Rewiring the Brain: Researchers from the University of Genoa tested whether exercises for the hands and arms could improve function in 35 people with primary or secondary progressive MS. Sure enough, motor performance improved, and fatigue was reduced in the active treatment group. In an exciting turn, there were improvements in “functional connectivity,” or communication lines between specific brain regions. This work adds to evidence that the brain has the power to reorganize itself to compensate for MS damage (abstract S33.002).
Antioxidant Help Fatigue? One of the biological processes that drives progression is called oxidative stress, which makes it harder for nerve cells to do their job. Dr. Krysten Krysko of the University of California, San Francisco (who is training to do MS clinical research with a Society-funded Sylvia Lawry Physician Fellowship) presented the findings of a novel, small clinical trial in 15 people with progressive MS who had fatigue. Her team showed that the antioxidant N-acetyl cysteine was well tolerated, reduced fatigue, and affected biological indicators of oxidative damage. There is also evidence that this antioxidant may improve nerve cell communication, and thus may be neuroprotective, so if these findings are confirmed in larger trials it would be exciting (abstract P5.2-093).

Being able to map out the complex story of biological events responsible for progressive MS will help uncover more and more possible ways to intervene and stop MS in its tracks and reverse the damage MS causes to the nervous system.

Read more details about AAN 2019 on our website.
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Douglas Landsman, PhD

Dr. Douglas Landsman is Vice President, Researchh at the National MS Society. He leads the biomedical research and fellowship/faculty award programs, and plays a key role in the International Progressive MS Alliance. He has a long-standing interest in nerve-muscle interaction and developing strategies for promoting nervous system repair after disease or injury.