Although the conference was well underway yesterday, today began with the official Opening and Welcome led by the Presidents of ECTRIMS and ACTRIMS, Professors David Miller and Jack Antel and a warm welcome from Professor Catherine Lubetski, head of the Parisienne Conference Committee. She noted the long history of MS in Paris with the disease first described in the late 1800s by French neurologists Cruveillhier and Charcot.
Plenary lecture on the neuropathology of MS
After a rousing cultural welcome from a troupe of fantastic Can Can dancers, we returned to the serious business of the conference with Professor Lassmann delivering the ECTRIMS-ACTRIMS Plenary lecture on the neuropathology of MS. He focussed on the once overlooked but now very well described phenomenon of lesions in the outer most layers of the brain, the cortex. These do not show up on standard MRI scans, but are now known to contribute significantly to the disability in MS. The study of cortical lesions in post mortem tissue has revealed a great deal about the biology of MS, but given their contribution to the progression of MS, he noted that it is crucial that we develop methods to detect cortical lesions during life, to improve MS monitoring and treatment.
The experimental study of myelin and nerve injury
I then attended a session on the experimental study of myelin and nerve injury, with a series of young investigators detailing their elegant studies using microscopy to tease out the sequence of events in myelin and nerve damage. Their studies reveal some of the molecules involved that could become targets for treatments to protect nerves and myelin, and several provided promising experimental evidence of methods to protect neurons by preventing the damaging effects of excess calcium in the nerves and using alpha-lipoic acid – the latter of which has recently been shown in a pilot clinical trial to have some effects in reducing brain volume loss in people with MS.
Immune cells in both attacking and repairing
Another fascinating session covered the two-faces of immune cells in both injury and repair in neurological disease with several speakers presenting their data on the crucial role that different types of immune cells play in actually promoting repair, rather than damaging CNS tissues. In particular, Dr Michal Schwartz from Israel provided great insights from her studies of Alzheimer’s disease provided on the crucial role of certain types of T-cells in stimulating growth of new neurons and myelin producing cells to promote repair and brain plasticity
Burning Debate –B cells or T cells
A highlight of the day was the “Burning debate”, billed as ‘the rumble in the jungle’ between the two heavy-weights of MS research, Professors Hauser and Hafler. The two spoke to an overflowing room on whether B cells or T cells are most important in driving the inflammation in MS – but despite presenting compelling evidence on both sides of the story, there was no bitter fight to the death, the two reached a very amicable conclusion…the activities of B-cells and T-cells go hand in hand and are inseparable! Although, Professor Hauser, did leave us with the tantalising notion that perhaps B-cells may be the ring-leaders.
Microbiome in MS
I finished the day in another packed Hot Topic session on the role of the microbiome in MS. Drs Werkele, Kasper, and Tremlett presented intriguing evidence that the enormous collection of bacteria that live in our guts have a key role in influencing both the immune system and the brain directly. Dr Werkele discussed the data from both animal studies and human twin studies that the microbiome of people with MS possesses some properties that may heighten the chance of triggering MS. Dr Kasper revealed the different types of bacteria that may be involved, and how the molecules they produce can drive changes in immune cells that can promote or reduce autoimmunity. Dr Helen Tremlett provided fascinating pilot data from some small studies in children with MS suggesting that the diversity of groups of bacterial types in the children with MS is different to those without MS, and that the diversity may also influence risk of future relapses. All acknowledged the many unanswered questions that remain in this relatively new focus of MS research. In particular, really understanding whether the difference are part of the cause of MS or a result of MS, which microbes are most important, where and how they are acting in the gut to influence MS and whether we will be able to target the microbiome as a potential way to treat and prevent MS.
It was a day, for me of feeling rather thinly stretched, across so many important and interesting sessions running in parallel – as noted by Professor Lubestski at the start of the day – over 16 parallel sessions, 10 hot topic sessions, not to mention the more than 2000 posters of which I have barely scratched the surface.
I was fortunate however to run into Professor Michael Pender from Queensland who was presenting his poster on the important phase I clinical trial of the EBV-targeting T-cell therapy. His early results of the trial support by MS Research Australia are really encouraging, showing good safety in the 10 patients treated so far and intriguing hints of some clinical benefits for the patients involved. This is exciting news and we are preparing a news article solely on this news.
My Australian colleagues and colleagues from the other international MS organisations with which we work, particularly commented on the important sessions they attended including the session covering the new diagnostic criteria for MS that will help to speed up diagnosis and improve early and effective management of MS. As well as the important insights emerging from studies into treatments for progressive MS – the field is surely and steadily moving forward!
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