On December 8-11, 2019 in Calgary, Alberta, the MS Society of Canada held the 2019 endMS Conference to bring together multiple sclerosis (MS) researchers from across Canada and the world to ‘Discover, Innovate, and Act’.
The endMS Conference is the largest scientific meeting focused on MS research in Canada. Showcasing research that highlighted the work being done within the four areas of the MS Society of Canada’s strategy: Discover, Innovate, and Act, we heard about advancements in treatment and care, enhancing well-being, understanding and halting disease progression, and preventing MS. The conference also explored how research can be translated into programs and policy – adding to the a growing collection of data and tools within the MS community to mobilize collective action in creating greater awareness of the realities of living with MS — and creating positive change to enhance the lives of those living with the disease.Scientific Co-chairs, Dr. V. Wee Yong (University of Calgary), Dr. Catherine Larochelle (CHUM/Université de Montréal), and Dr. Charity Evans (University of Saskatchewan) were instrumental in helping to develop the scientific agenda.
This year’s conference was the largest of five conferences that have been held to date, with over 300 delegates in attendance. Almost half were trainees, who represent the next generation of MS researchers and the leaders of tomorrow. For insight into a trainee’s experience at the conference, please read the blog by Hélène Jamann.
We were delighted to welcome Aaron Solowoniuk, the original drummer of Billy Talent, who shared his personal journey with MS and the work he is doing to inspire and help others with MS.
We also welcomed neurologist and researcher, Dr. Alan Thompson (University College London), as the scientific keynote speaker. Dr. Thompson provided an overview of the current challenges in research and management of MS. In his keynote, he noted that incidence of MS has increased over time, while not clear why, it may be due to increased smoking, obesity and reduced childbirth. In Denmark over the last six decades, the number of women diagnosed with MS has almost doubled, and men showed a 24% increase, in addition to an increased incidence in those over 50 years of age. We are starting to know more about some of the causes with studies that have identified a number of genes that may be involved in making a person more susceptible to MS and many of these genes are associated with the immune system.
Dr. Thompson emphasized that progressive MS is one of the biggest challenges and we need to understand the mechanisms that underpin it and its progression. There is a need for precision (or personalized) medicine that uses clinical and patient information, genes and other markers of the disease to better predict disease course and treatment. Additionally, we need research on what markers to use and how they can predict the disease trajectory for improved approaches to treatment and care. Artificial intelligence approaches are being used to create predictive models of the disease. There is also ongoing research on new disease modifying therapies to prevent tissue damage within the central nervous system and therapies to promote recovery (for example, treatments that could repair damaged myelin).
Dr. Thompson serves as the Scientific Steering Committee Chair of the International Progressive MS Alliance, a global collaboration of MS organizations, researchers, clinicians and people living with MS that is working together to expedite the development of effective disease modifying and symptom management therapies for progressive forms of MS. This collaboration is supporting new research in progressive MS and developing new tools for clinical trials to test drug candidates.
The endMS Conference offered two and half days full of scientific talks and panel discussions across the four goals coming out of Discover. Innovate. Act.. The content coming out of the two and a half days was rich, and you can view videos of the broad range of presenters in a previous post. Some highlights from conference speakers:
Advance Treatment and Care
- Dr. Patricia Coyle (Stony Brook University Medical Center) discussed how the cause of MS involves a complex interaction between a person’s genetics, environmental factors and host immune system. She offered that a person with MS can make positive lifestyle choices based on current research and evidence. She recommends that people with MS should quit smoking, correct for vitamin D deficiency, build a ‘cognitive reserve’ (i.e., intellectual stimulation, education) and target optimal body weight for improved health outcomes. These types of lifestyle changes can benefit those living with MS and be considered a complementary disease modifying therapy.
- Dr. Michelle Ploughman (Memorial University) shared lessons learned from stroke rehabilitation that can be used to create interventions to promote neuroplasticity and restore function in people with MS. Exercise in animal models of MS has been shown to reduce severity of motor deficits and increase remyelination of damaged nerve cells. Dr. Ploughman is developing methods to increase exercise intensity in people with MS in order to promote neuroplasticity and restore function. She finds that fitness levels of people with MS is low. As part of her research, she is examining ways to enhance aerobic exercise in people with MS, looking at the effect of cooling the room to limit fatigue, encouraging high intensity training and practice tailored to individual, and using specialized equipment to prevent falls during exercise.
- Dr. Helen Tremlett (University of British Columbia) is investigating the MS ‘prodrome’, an early set of signs or symptoms before a person is diagnosed with MS. To determine whether the prodromal period exists in MS, her team is looking at the earliest symptoms five to ten years prior to diagnosis by looking at healthcare utilization and clinical data. In people with MS, healthcare use is higher in the five years before the first demyelinating event or MS symptom. In the five to ten years before diagnosis, people with MS reported sleep disturbances, increased pain, irritable bowel syndrome, headaches and migraines, and had greater visits to psychiatrists, urologists, and dermatologists. Understandably, many of these symptoms are common and do not necessarily predict the onset of MS. If we can further understand the prodromal period and these early symptoms, it may be a window of opportunity to identify and manage MS.
- Dr. Ruth Ann Marrie (University of Manitoba) is examining how comorbidities (the presence of two or more conditions like hypertension, diabetes, depression, etc.) affects MS throughout the disease course. Comorbidities can cause diagnostic delays, greater disability at diagnosis, increased relapse rate, accelerated disability progression, and lower quality of life. By better managing comorbidities, it may mitigate the negative effects on MS disease course.
- Dr. Marcia Finlayson (Queen’s University) explored the existing research on the challenges, impacts, and rewards of caregiving in MS. There is a need for more research to understand MS caregivers and their experiences, both positive and negative, over time and across geographies. Research is needed to identify what outcomes matter most to caregivers and their families and the development of interventions, including information and awareness, that can help them achieve these outcomes.
Understand & Halt Disease Progression
- Dr. Jiwon Oh (St. Michael’s Hospital, University of Toronto) is leading a major initiative, the Canadian Prospective Cohort (CanProCo), to understand the spectrum of factors associated with clinical disease progression in MS over five years. It is the first study of its kind to look at the underpinnings of MS progression. The study aims to recruit 1000 participants from across Canada (more information here). To-date, the study has recruited 40% (399) of participants.
- Dr. Peter Stys (University of Calgary) is examining the molecular mechanisms of MS pathology, aiming to uncover the primary driver of disease. Dr. Stys shared his latest findings, indicating subtle but widespread lipid pathology that occurs early on in the disease in an animal model. This observed pathology may underpin diffuse manifestations of MS, such as fatigue, cognitive decline, depression, MS prodrome, and ‘silent progression’, although more research is needed.
This is just a snapshot of some of the research highlighted at the conference. For more information, follow the MS Society of Canada’s Facebook channel to watch recorded endMS Conference speakers.