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Understanding the Canadian Proactive Cohort Study for People Living with MS: a conversation with Dr. Jiwon Oh

As one of the leading MS researchers in the country, researcher and clinician Dr. Jiwon Oh is ambitious to say the least. In addition to being a staff neurologist at St. Michael’s Hospital, where she specializes in caring for people living with MS, Dr. Oh also leads the magnetic resonance imaging (MRI) research program at the largest MS clinic in Canada. Adding to this list of achievements, she has also recently been selected to lead a team of nearly 50 researchers as part of the Canadian Proactive Cohort for People Living with MS (CanProCo). We sat down with her to find out more about this exciting new initiative. Here are some highlights:

What led you to this project?

Portrait shot of Dr. Jiwon Oh.
Dr. Jiwon Oh

Dr. Oh: Over the past 10 years, we’ve seen a huge amount of advancements. For example, the number of treatments for relapsing-remitting MS (RRMS) has tripled. There’s a lot of hope and clearly a lot of effort internationally to better understand the disease, develop better treatments, and improve the lives of our patients. But as a clinician, I think the one area where there’s a real need for improvement is in understanding why progression in MS occurs and exploring treatment options for progressive MS. That’s what drew me to this project. It’s a huge national effort focused entirely on trying to understand progression in MS.

Can you explain what the CanProCo is?

Dr. Oh: This project has been many years in the making and the MS Society of Canada has taken the lead in raising funds to enable the establishment of project that will recruit a cohort of people living with MS at key centres across Canada. We plan on following the cohort for a minimum of five years to look at a wide array of factors that may be relevant to progression in MS. This will help us understand the mechanisms underlying progression as well as the risk factors. Ultimately, the goal is to try and develop better management strategies, whether it’s developing better treatments that target progression,  methods to prevent progression, or developing systematic ways to holistically manage patients with progressive MS.

To be clear, this is not a cohort that will only include people living with progressive MS, but also individuals diagnosed with other forms of MS. We want to study why progression in MS occurs across the spectrum of disease, which is why the cohort will include people with many different subtypes of MS.

What about the CanProCo is uniquely exciting in the field of MS research?

Dr. Oh: As I mentioned, it’s the first cohort effort that is specifically trying to understand progression in MS. The other thing is the fact that it’s a national effort. With our high rates of incidence and prevalence, Canada has a long history of significant contributions to the field of MS research. Canadians have a unique way of coming together to find solutions. In CAnProCo, many leading experts from across the country will come together to collaboratively study progression in MS. Each of these experts have strengths in different fields of science that are crucial to understanding MS – neuro-immunologists, epidemiologists, neuroimaging experts, clinical experts and so on.

What’s the significance of a project of this kind in advancing our knowledge of MS?

Dr. Oh: One of the truly greatest unmet needs in MS is trying to understand and treat progression across the spectrum of MS. The CanProCo is aims to address this need. There are other cohorts that exist globally but none that focus on this specific need. When you have a targeted goal like this, it increases your likelihood of exploring the appropriate avenues which will hopefully give you more insight and lead you closer to answers that will benefit people living with MS.

How do you think this information will lead to opportunities to collaborate internationally in the future?

Dr. Oh: One of the mandates of this cohort is to try and improve efficiency by linking our cohort to other existing cohorts, which will allow us to take advantage of collaborative efforts from around the world. For example, the International Progressive MS Alliance funded an imaging project by Dr. Doug Arnold, a Canadian neurologist and scientist. We’ll likely collaborate with Dr. Arnold as the CanProCo can be used to validate some of his findings. We will also contribute our data to MSBase, a large worldwide registry of MS patients. So, while one of the goals of the cohort is to use the data we collect, another important goal is to engage in other collaborative efforts to mutually benefit and improve efficiency of scientific discovery.

We know MS affects everyone differently. How do you think this project will help bring about solutions that can be applied across the board to people living with MS?

Dr. Oh: One of the challenges of MS is that it requires personalized disease management. The benefit of this cohort is that we’re not just collecting biological data, but we’re looking at a wide array of factors that may be relevant to progression in MS that ranges from biological data to clinical and environmental data to health outcomes and more. Using this wide lens which spans across many different scientific fields will allow us to personalize and tailor management and treatment of people living with MS in many different realms.

Can you highlight what this study means for people living with MS when it comes to better understanding of biological mechanisms of progression, identification of risk factors (environmental, clinical, health systems) for progression, and developing markers that can assist in patient care, including markers that can better predict how people will do over time?

Dr. Oh: We’re not just trying to understand mechanisms relevant to progression. We’re trying to see what kind of modifiable environmental factors there are that may help prevent progression. For instance, we’re assessing factors like smoking, cannabis, and diet, all which may influence progression in MS. We’ll be able to assess comorbidities that may contribute to progression in some people, and how all of these factors are linked to one another.  MS is a very heterogeneous disease and it’s never clear in one person what needs to be changed to help with the disease and because we’re looking at so many  factors that span many different scientific fields of study, we’re hoping to understand what will be relevant for an individual person. I think that will be the difference we can make on an individual level.

How have the stories of your patients inspired you to continue your efforts towards ending MS?

Dr. Oh: MS is one of the few chronic neurological diseases that affects young people. Every day I see young people starting out their lives and careers and families while dealing with the prospect of having accelerated neurological disability and I can’t imagine how challenging that is. That’s what motivates me to do something that can really help. It’s also inspiring to see the strength and hope people have, despite the uncertainty. I learn from my patients as much as they learn from me.

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