http://www.medscape.com/medscape/Neurology/AskExperts/MS/2001/12/NEUR-ae109.html

Question

What is the most important research project on multiple sclerosis going on right now?
Orlando Santana, MD

Response
from Mark S. Freedman, MD, 12/27/01

Multiple sclerosis (MS) research has been steadily escalating over the last decade with many exciting new approaches to understanding the disease process and establishing new therapies. One important area is the understanding of normal myelination in an effort to find ways to encourage remyelination. The molecules and cells involved in myelination are being elucidated, as are ways to foster their growth in damaged areas of the brain, be it from MS or from other damaging brain diseases. A project has even begun to put myelinating cells from the peripheral nervous system (Schwann cells) into MS brains to see if these cells could generate remyelination.

On the immunology front, work has determined that not all inflammation may be bad and, in some cases, may actually be neuroprotective and foster either preservation of tissue or its regrowth. Immunology is still one of the most active areas of research, and as we learn about the normal functioning of the immune system, we can understand further what occurs in an autoimmune process. This has led to the development of novel therapies that target the mechanisms believed to operate in MS, and many trials with new agents are in process.

Imaging techniques are constantly expanding and allowing us to see more and more into the molecular aspects of disease. This has revealed changes early on that might indicate the first signs of the neurodegenerative process thought to occur secondary to the inflammation brought on by the aberrant immune reaction. This may allow us to detect whether new agents may be effective much earlier during trials of these compounds. There have been several large trials of agents in MS, comprising some 1000-plus patients, and all of these data will be analyzed in a newly formed center in Munich so that more can be learned about response to therapy.

Finally, in an effort to really understand immunologically what has occurred in MS and to look at a possible long-lasting treatment, we and other groups are examining the process of high-intensity immunosuppression with an autologous stem cell transplant rescue. This latter study seeks to prove whether replacement of the supposedly "aberrant" immune system with a fresh, naive one will lead to a lasting remission (ie, cure). If not, patients are closely monitored by MRI and repeated immunologic testing in order to ascertain what the earliest change might be towards redeveloping the disease. I believe that all of these are important areas for studies that will yield vast amounts of new information regarding MS and its potential therapy.
 

Suggested Reading

• Allamargot C, Pouplard-Barthelaix A, et al. A single intracerebral microinjection of platelet-derived growth factor (PDGF) accelerates the rate of remyelination in vivo. Brain Res. 2001;918:28-39.