Dr Lisa Melton, Head of Research at MS Research Australia, is in Berlin to attend the 34th Congress of the European Committee for Treatment and Research in MS (ECTRIMS). This is the largest global conference on MS. As well as attending the conference sessions and reporting back for us, Dr Melton is attending meetings with our partners in the International Progressive MS Alliance, MS International Federation and other collaborators. Here’s what she had to say about day 2.
Another productive day networking with international colleagues and researchers with so many new contacts being made. Squeezed into the middle of the day was a productive meeting of the MS International Federation International Scientific and Medical Advisory Board. International access to MS medications was a key topic of discussion to ensure that people with MS can receive the best care no matter where in the world they live. But there was more than just productive discussions, with many interesting research presentations from around the world.
Novel anti-virus trial results
The results of a very interesting trial funded by the MS Society UK, known as CHANGE-MS, were presented by Professor Frederik Barkhoff. The trial targeted the remnants of viruses that have been left in our DNA throughout our evolution – these are known as Human Endogenous Retroviruses (HERVS). While mostly dormant, these virus remnants can produce some proteins that can interact with and potentially damage cells in the brain. This trial aimed to block one of these proteins with an antibody-based drug. The team used MRI techniques to examine the effects of the drug in people with relapsing MS. It had no effect in suppressing inflammation nor the appearance of new lesions, but it did seem to reduce the progression of those lesions into permanent ‘black holes’ and slowed down the rate of brain tissue loss. While it was a small trial these results suggest that the treatment may be reducing neurodegeneration and should perhaps be taken forward to larger trials in progressive forms of MS.
Several talks focussed on how other health conditions, known as co-morbidities, may influence the onset and progression of MS. We heard about how people with MS experience significantly more co-morbidities in the year leading up to a diagnosis of MS, including mood and psychiatric conditions and cardiovascular conditions. Following diagnosis, people with MS also experience more comorbidities than the general population. On the same topic, Associate Professor Ingrid van der Mei from the Menzies Institute for Medical Research in Tasmania, (pictured above with her student Yan Zhang presenting their work on symptom severity using the AMSLS at ECTRIMS) presented work in the poster session this evening from the Australian MS Longitudinal Study showing the same results. Her PhD student Jing Chen presented a poster describing how comorbidities can add to the impact of MS on daily life and employment. Portuguese researchers also showed that cardiovascular comorbidities present at or after diagnosis, such as hypertension and smoking are associated with a significantly higher level of disability in the longer-term.
Environmental risk factors in MS
In this session we heard an overview of the environmental risk factors that have been strongly linked to MS, including vitamin D, smoking and obesity. High body mass was linked to worse outcomes in MS, whereas vitamin D, although known to influence onset of MS, did not seem to influence disability outcomes. And yet more evidence was presented strongly linking smoking to worse outcomes in MS. However, a particularly interesting presentation centred on the conflicting evidence surrounding the role that a high salt diet may play in MS. Several studies have strongly linked high salt to MS risk, but others have shown no effect. Dr Linker described how challenging it can be to accurately measure salt intake via food questionnaires and analysis of urine. But newer techniques such as light scans (spectroscopy) that can measure salt build up in the skin may provide more accurate tools. These studies have provided some new evidence that high salt may indeed influence MS, and he also presented interesting results linking high salt to disturbances of gut bacteria that can in turn promote a more inflammatory state in the immune system – still more work to be done in this area, but interesting connections are emerging between risk factors that may help us to home in on the mechanisms of MS.
Debating treatment approaches
An excellent ‘Hot Topic’ session covered the thorny issue of whether hitting MS hard and early with high efficacy medications is a better approach than taking a step-wise approach with escalation of treatment where needed. Professor Paolo Muraro, who has been looking deeply into the immune outcomes following AHSCT and other immune reconstitution therapies such as Lemtrada, provided the reasoning for a hard-hitting approach from an immune system perspective, showing that these treatments have a long-lasting effect in resetting the immune system to a more tolerant, less inflammatory state. Professor Gavin Giovanonni provided the clinical case for treating early with high-efficacy strategies with the strong driver being to preserve as much brain tissue as possible early in the disease course. Professor Daniel Ontaneda suggested that this approach carries much higher-risks and that with more data and research we can refine this approach with personalised medicine to target the optimal treatment approach to individuals based on how risky a person’s diseases is and with strong predictions of how they will respond to a medication.
There were also interesting presentations about when to stop and when to start treatment in people with MS. While there is now little argument that early treatment is associated with better long-term outcomes, Dr Iaffaldano refined this thinking for us with data from the Big MS Data Network, a collaboration between several very large national and international clinical databases. Their analysis showed that for every 6 months delay in treatment there is a greater risk of disability progression later in the disease – the optimal window was narrowed down to the first 6 months following onset. At the other end of the spectrum Professor Corboy, examined whether and when it might be safe to stop treating MS. He provided some evidence absence of disease activity on treatment and advancing age may suggest treatment could be safely stopped, but cautioned that it is a grey area with many factors to take into account.
You can also follow Dr Melton’s updates from ECTRIMS via Twitter @lisameltonMSRA