As per yearly tradition, the 7th joint ECTRIMS/ACTRIMS meeting ended with late-breaking research news. This year, we heard about discoveries related to human brain anatomy, a new biomarker for phase 2 clinical trials and a potential drug for progressive MS.
Dr. Danny Reich: Lymphatic vessels are discovered using imaging techniques
The lymphatic system’s function is to remove dead cells and waste from the body’s organs. Lymphatic vessels run alongside blood vessels and transport a colourless fluid that contains infection-fighting immune cells and waste called lymph. Dr. Danny Reich, a senior investigator at the National Institute of Neurological Disorders and Stroke, reported the existence of previously unknown lymphatic vessels in the brain of human and nonhuman primates. High-resolution Magnetic Resonance Imaging (MRI) scans were obtained from five healthy human volunteers and three primates. Imaging revealed the presence of lymphatic vessels in the outermost layer of the brain and spinal cord, called the dura mater. This discovery may shed light on how the brain expels waste, holding promise for a better understanding of the normal physiology of lymphatic drainage from the brain and spinal cord and potential abnormalities in neurological diseases.
Dr. Maria Pia Sormani: Neurofilament light chain (NfL) is a promising biomarker in phase II clinical trials
NfL is one of the proteins of the neural cytoskeleton (which supports the shape of the cell), and helps in the growth of axons or nerve fibers commonly damaged in MS. Following damage to the axons, NfL levels in the cerebrospinal fluid change and are thus considered a promising biomarker of injury in neurological disorders. Dr. Maria Pia Sormani, a researcher at the University of Genoa, and her team explored whether NfL could be used as an outcome measure in Phase 2 clinical trials for relapsing-remitting MS. They analyzed the levels of NfL in participants of the FREEDOMS study (a clinical trial testing the efficacy of Gilenya). Their data showed a decrease in NfL in individuals taking fingolimod compared to those on placebo. NfL may qualify as an informative and convenient endpoint for future Phase 2 clinical studies as it can capture both inflammatory and degenerative aspects of MS.
Dr. Robert Fox: Ibudilast shows potential for progressive MS, is well-tolerated, and slows brain atrophy compared to placebo
Treatment options for progressive MS are still limited but there has been a recent increase in treatments for progressive MS in the research pipeline. Ibudilast, which reduces inflammation in nerve cells by targeting pro-inflammatory signaling pathways, was tested for potential use in progressive MS. Dr. Robert Fox, a neurologist at the Mellen Center for Multiple Sclerosis at Cleveland Clinic, and a team of researchers analyzed the safety, tolerability and efficacy of ibudilast. In phase 2 of the SPRINT (Secondary and Primary Progressive Ibudilast NeuroNEXT Trial) -MS trial, 255 participants with either primary or secondary progressive MS were randomized to receive either ibudilast (up to 100mg) or placebo. The study met its primary outcome by reducing brain atrophy by 48% compared to placebo. Ibudilast was reported as being safe and well-tolerated, with gastrointestinal symptoms (nausea, diarrhea, abdominal pain or vomiting) seen as the most common adverse events.
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