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Breakthroughs in Multiple Sclerosis

Medically reviewed by Joseph V. Campellone, M.D.
Written by Emily Wagner, M.S.
Posted on May 19, 2021

Doctors and scientists continue to work on finding new treatments, diagnostic techniques, and risk factors for multiple sclerosis (MS). MS is an autoimmune disease that causes the body’s immune system to attack the fatty tissue that protects and surrounds nerve cells. This fatty tissue is known as myelin. The damage from the immune attacks creates areas of scar tissue, or sclerosis (also known as plaques or lesions), on the nerve fibers. Neurologists and neuroscientists conduct MS research by studying the central nervous system in hopes of discovering more about the disease.

New medications and therapies are being developed and researched every year to treat the many forms of MS. These include disease-modifying therapies (DMTs), which work to slow disease progression, and other medications that help improve symptoms. Researchers are also studying new ways to diagnose MS, as well as what genes or risk factors may increase one’s chances of developing the disease.

Genes in the Development and Progression of MS

Genes play an important role in the development of many diseases, particularly in the case of MS. They can even influence disease activity, severity, relapse rate, and more.

A 2019 study by Ivan Kiselev and colleagues looked at the genetic differences between two different types of MS, primary progressive MS (PPMS) and relapsing-remitting MS (RRMS). Currently, not much is known about how genes can affect what type of MS a person develops. However, the group found that there were notable differences in genes related to the immune system when comparing people with PPMS and those with RRMS. These findings imply that genetic differences exist in people living with different types of MS.

Another group investigated how differences in immune-related genes increase the risk of MS in African Americans who have some European genetic ancestry. Nathan Nakatsuka and colleagues discovered that there are two inherited variations in genes that can increase the risk of developing MS. In general, race plays an important role in the development and progression of MS. The condition is most frequently diagnosed in white people of northern European descent. African Americans are more likely to have greater disability than other racial groups, likely due to several factors.

New Methods for Diagnosing MS

Diagnosis is the first step to understanding and treating a disease. MS is often diagnosed by MRI scans, blood tests, and spinal taps (fluid removed from the space that surrounds the spinal cord). MRI scans help doctors visualize the brain and spinal cord so they can locate lesions in these areas.

One clinical trial is studying the use of positron emission tomography (PET) scans to diagnose and monitor MS. PET scans are used to diagnose several diseases, including heart disease, cancer, and brain disorders. Now, researchers are hoping that this technique can be used to look at the levels of myelin in people living with MS. The pilot study of 20 people will compare healthy participants to those with MS.

New Treatments and Clinical Trials for MS

The U.S. Food and Drug Administration is often approving new MS treatments. Some recent approvals include:

Almost 2,300 clinical trials involving MS can be found on ClinicalTrials.gov from all over the world. Research continues to grow, and new medications and treatments are being studied in humans in hopes of successfully treating the disease.

Evobrutinib

Evobrutinib is an experimental oral medication that targets an enzyme called Bruton’s tyrosine kinase (BTK), which is responsible for activating B cells. B cells are specialized types of cells in your immune system. B cells make antibodies, which help you fight disease and play an important role in MS. Evobrutinib is also able to act on brain and spinal cord lesions. Because of the unique way that evobrutinib works, it can reduce inflammation, which is important in MS disease progression.

There are currently two late-stage clinical trials (“evolutionRMS 1” and “evolutionRMS 2”) that are recruiting participants, ages 18 to 55, with RRMS and active secondary progressive MS (with relapses). Participants will be randomly assigned to take evobrutinib twice daily or Aubagio (teriflunomide) as a placebo. The study will last for 96 weeks and will measure how many relapses participants experience on a yearly basis.

Tolebrutinib

Tolebrutinib is another experimental medication that targets the BTK enzyme. There are currently two late-stage clinical trials that are recruiting participants. Participants are eligible for the “Hercules” trial if they are between the ages of 18 and 60 with nonrelapsing secondary progressive MS. Participants are eligible for the “Perseus” trial if they are between the ages of 18 and 55 with primary progressive MS. These studies will measure tolebrutinib’s impact on disability from MS.

ANK-700

This clinical trial is testing the safety of the medication ANK-700 in people aged 18 to 65 with RRMS. This experimental drug, developed by Anokion, works by suppressing the immune cells that play a role in inflammation in MS. The trial is divided into two parts: In the first part, participants will receive one dose of ANK-700 to make sure it is safe for humans. In the second part, participants will receive either three doses of ANK-700 or a placebo to determine if the drug is effective in treating RRMS.

Stem Cell Therapy

Stem cell therapies are becoming a popular treatment option for a variety of neurological disorders and diseases. Adult stem cells, also known as mesenchymal stem cells, are found in the skin, fat tissue, and bone marrow. A research group in Israel conducted a clinical trial looking at the effects of mesenchymal stem cell transplant in participants with progressive MS with moderate to severe disability.

Participants either received mesenchymal stem cells — through injection into either a vein or the spinal cord — or a placebo. After six months, the placebo-treated group received the mesenchymal stem cell injection, and the experimental group received a second injection of stem cells or a placebo. The overall results were positive. The study showed that fewer participants in the treatment group experienced worse symptoms, compared to the sham group. Further clinical trials will need to be conducted with more participants to verify these findings.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 167,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Genetic Differences Between Primary Progressive and Relapsing-Remitting Multiple Sclerosis: The Impact of Immune-Related Genes Variability — Multiple Sclerosis and Related Disorders
  2. Two Genetic Variants Explain the Association of European Ancestry With Multiple Sclerosis Risk in African-Americans — Scientific Reports
  3. Does Multiple Sclerosis-Related Disability Differ Between Races? — Neurology
  4. Multiple Sclerosis — Mayo Clinic
  5. Entire-Body PET Scans for Multiple Sclerosis (EPSMS) — ClinicalTrials.gov
  6. Positron Emission Tomography Scan — Mayo Clinic
  7. Emerging Treatments for Multiple Sclerosis — Mayo Clinic
  8. Studies Found for: Multiple Sclerosis — ClinicalTrials.gov
  9. Evobrutinib — Multiple Sclerosis News Today
  10. B-Cell — Arizona State University
  11. Merck’s MS Therapy Evobrutinib Significantly Reduces Brain Lesions, Phase 2 Trial Shows — Multiple Sclerosis News Today
  12. Evobrutinib Is the First and Only BTK Inhibitor To Demonstrate Reduction of a Key Biomarker of Neuronal Damage and Inflammation in Patients With MS — Biospace
  13. Study of Evobrutinib in Participants With RMS (evolutionRMS 1) — ClinicalTrials.gov
  14. Study of Evobrutinib in Participants With RMS (evolutionRMS 2) — ClinicalTrials.gov
  15. Tolebrutinib — Multiple Sclerosis Trust
  16. Nonrelapsing Secondary Progressive Multiple Sclerosis (NRSPMS) Study of Bruton’s Tyrosine Kine (BTK) Inhibitor Tolebrutinib (SAR442168) (HERCULES) — ClinicalTrials.gov
  17. Primary Progressive Multiple Sclerosis (PPMS) Study of Bruton’s Tyrosine Kinase (BTK) Inhibitor Tolebrutinib (SAR442168) (PERSEUS) — ClinicalTrials.gov
  18. Assessment of ANK-700 in Patients with Relapsing Remitting Multiple Sclerosis (MovieS-it) — ClinicalTrials.gov
  19. Anokion Planning Launch of Phase 1 Trial of Investigational MS Therapy ANK-700 — Multiple Sclerosis News Today
  20. The Potential To Transform Treatment — Anokion
  21. Stem Cells: What They Are and What They Do — Mayo Clinic
  22. Beneficial Effects of Autologous Mesenchymal Stem Cell Transplantation in Active Progressive Multiple Sclerosis — Brain
Posted on May 19, 2021
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Joseph V. Campellone, M.D. is board-certified in neurology, neuromuscular disease, and electrodiagnostic medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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