Every year, the MS Connect Conference allows people affected by multiple sclerosis (MS) to engage with leading Canadian investigators and learn about recent updates in MS research. This year, the MS Society of Canada hosted a 6-day virtual conference on November 23-28 which featured presentations on topics such as neurorehabilitation, cognition, nutrition, and fatigue. Below are highlights of select talks from the 2020 MS Connect Conference. If you missed out on the live presentations, recordings for each session are available online – please click here to watch.
Current MS Research Landscape
Clinical neurologist and invited keynote speaker, Dr. Jack Antel, kicked off the conference by sharing important research discoveries that led to our understanding of MS. This includes genetic and environmental factors that influence MS susceptibility, biological mechanisms of MS development and disease course, strategies for monitoring MS, and current therapies for relapsing forms of the disease.
Today, we face challenges in understanding progressive MS. According to Dr. Antel, the next frontier in MS research is to identify biomarkers for progressive MS and understand the factors that drive disease progression. The goal of newer MS therapies in development is to maintain (neuroprotection) and restore (tissue repair/remyelination) function. These key areas of research in progressive MS are actively being pursued and Canadian researchers are making critical contributions.
Remyelination or the process of restoring myelin (the protective coating surrounding nerve cells) is believed to be important in restoring function and slowing progression of disability in MS. Dr. Wee Yong of the University of Calgary indicated that lifestyle factors, particularly exercise, can potentially enhance remyelination and promote brain repair. Dr. Yong’s laboratory showed that exercise can in fact restore myelin in MS animal models, and as a next step they plan to combine exercise with other repair therapies to further optimize the benefits. According to Dr. Yong, people with MS are recommended to get at least 150 minutes of physical exercise per week, however it is currently unclear on how much exercise is needed to enhance brain repair.
Dr. Michelle Ploughman of Memorial University of Newfoundland is investigating whether high dose exercise (continuous exercise of vigorous intensity, for at least 30 minutes, 3-5x a week) could serve as a disease-modifying intervention to delay MS severity by promoting brain neuroplasticity and repair. The goal of Dr. Ploughman’s research is to allow patients to return to a previous level of functioning. She indicated that while intensive exercise can significantly improve walking and fatigue in people with MS, the benefits to the brain are short-term. This means that if a patient stops training, they tend to lose the neurological benefits of exercise; therefore, intensive exercise must be maintained. To date, Dr. Ploughman is pursuing new and exciting MS rehabilitation research with other Canadian investigators, including testing a new device called PoNS to improve walking and balance in individuals living with MS (with Dr. Sarah Donkers) as well as mapping how fitness can change the biology of the immune system and protect against MS progression (with Dr. Craig Moore).
Cognitive dysfunction (i.e. deficits in processing speed, memory, and executive function) is common among people with MS and can significantly impact basic day-to-day activities. Impairment rates can range from 40% in people with relapsing MS and 80-90% in people with progressive forms of the disease. According to Dr. Anthony Feinstein of the University of Toronto and Sunnybrook Health Sciences Centre, cannabis use, particularly tetrahydrocannabinol (THC), negatively impacts cognitive function in people with MS by reducing the activity of different brain regions. These negative effects may be reversible with abstinence. Interestingly, the cannabidiol (CBD) variant of cannabis is safer and will not result in the same cognitive deficits.
Dr. Feinstein also points out that cognitive rehabilitation is more effective in improving cognitive dysfunction compared to pharmacological medications. There is also preliminary evidence indicating that exercise can help improve cognition in MS patients although these findings need to be replicated. Together with a team of international researchers, Dr. Feinstein is conducting a clinical trial (CogEx study) investigating whether cognitive rehabilitation, aerobic exercise, or a combination of both, can lead to improvements in cognitive function among individuals with progressive MS.
Dr. Catherine Larochelle of the Centre hospitalier de l’Université de Montréal (CHUM) provided an overview of how diet and the types of food you consume can influence MS risk by affecting immune cell activity and gut microbiome composition. Other risk factors for MS, such as obesity and cardiovascular comorbidities, can also be tied to diet. Furthermore, Dr. Larochelle discussed a phenomenon in MS called ‘inflammaging’ or ‘age-related inflammation’, where immune cells experience more rapid aging compared to people without MS. Her research has shown that restricting dietary intake of methionine, an amino acid found in meat, fish, dairy products and other foods, can actually mimic the benefits of calorie restriction in mice by increasing life expectancy (delaying the aging process) and reducing inflammation. They also found that activated pro-inflammatory T cells consume high levels of methionine and is associated with neuroinflammation in a mouse model of MS. These findings indicate that we can potentially change the activity of immune cells and reduce inflammation by modifying the type of dietary nutrients we consume, such as methionine. While limiting dietary nutrients may be difficult for individuals and could lead to malnutrition and other deficits in needed calories, Dr. Larochelle indicates that this could be a potential therapeutic for people living with MS. This is a developing area of research and we need to continue to understand the connection between diet and MS.
Dr. Marcia Finlayson of Queen’s University discussed several strategies for effectively managing MS fatigue. She indicated that since fatigue is a multidimensional and complicated symptom, it requires a stepwise, multi-pronged treatment approach. The three common approaches to managing MS fatigue include: i) self-management intervention which is a combination of patient education, counselling, and skill development, ii) medications, and iii) exercise. There is also a number of ongoing clinical trials that are looking to address MS fatigue through diet, hypnosis, and direct brain stimulation. Dr. Finlayson points out that we need to determine the type and/or sequence of interventions that will be most effective for different groups of people with MS, the frequency and maintenance of each intervention, and the most effective method of delivery (in person or remotely through technology).
These are just some of the interesting research updates from the 2020 virtual MS Connect Conference. To browse additional sessions, including virtual research poster presentations from MS trainees across the country, please click here.