The MS Society of Canada is proud to share new developments in multiple sclerosis (MS) research from the 6th annual Americas Committee for Treatment and Research in MS (ACTRIMS) Forum. This year, the meeting was held virtually on February 25-27. The complete program guide is available here. Below are some highlights of the cutting-edge research presented by clinicians and scientists at the virtual forum.
The Role of Aging in Progressive MS
Dr. Benjamin Segal of Ohio State University kicked off this year’s forum by delivering the Kenneth P. Johnson Memorial Lecture. In his opening address, Dr. Segal discussed potential mechanisms by which aging may alter the immune function of individuals with MS and contribute to disease progression. He indicated that several age-related processes, such as increased release of inflammatory molecules or having a leaky gut barrier, can activate immune cells in the brain called microglia. These activated microglia are pro-inflammatory and may contribute to the neurodegenerative features of progressive MS.
Dr. Wee Yong from the University of Calgary further discussed how microglia cells ‘go rogue’ in progressive MS. As aging occurs, these cells undergo significant changes in the types of genes they express which consequently affect their function. For instance, changes in the expression of the osteopontin gene can impair the microglia’s ability to remove toxic molecules (i.e., oxidized phosphatidylcholines) from the central nervous system, causing neurotoxicity and greater lesion volume in the spinal cord of aged mice. According to Dr. Yong, medications that decrease microglia activity may be beneficial in progressive MS. The anti-malarial drug, hydroxychloroquine, is capable of suppressing microglia activity and is now being investigated in a clinical trial involving primary progressive MS patients.
Spectrum of MS in the Hispanic and Latino Populations
Members of the Latin American Committee for Treatment and Research in Multiple Sclerosis (LACTRIMS) shared new insights on the spectrum of MS in Latin American countries. According to Dr. Fernando Garcia of ULACIT University in Panama, the demographic spectrum of MS in Latin American populations is similar to North American and European populations, in terms of gender, age of onset, disease phases and clinical characteristics. Dr. Victor Rivera from Baylor College of Medicine also noted that despite the low prevalence of MS in most Latin American countries, the disease poses a substantial socioeconomic burden to local communities due to lack of access to correct and timely diagnosis as well as safe and effective medications. Currently, the goal is to bring the neurological community and MS organizations together to improve MS education, management and access to care among Latin American populations.
Dr. Carlos Pérez of the University of Texas Health Science Center also discussed the importance of enrolling diverse participants in MS clinical trials, to enhance the generalizability and efficacy profiles of current MS therapies. Results from his research showed that while Latino and African American populations are at lower risk of developing MS compared to Caucasians, they are at greater risk of developing severe disability. Furthermore, in looking at patterns of disease-modifying therapy (DMT) use over time, he indicated that different racial backgrounds tend to switch or discontinue a DMT due to variabilities in treatment response and side effects. For instance, African Americans were more likely to require escalation therapy as they respond less to injectable medications and experience the highest rates of adverse events particularly to interferons. These findings suggest that diverse representation in future MS clinical trials should be enhanced to improve the accuracy of clinical data and inform MS treatment guidelines.
Updates on Pediatric MS
New research by Prince Sebastian of Australian National University using data from US clinics showed that low sun exposure is a risk factor for pediatric-onset MS. His research indicated that spending more time outdoors during the summer months, even 30 minutes to an hour daily, was strongly protective against MS in children.
A poster presentation by Lindsay Logan from the Hospital for Sick Children (SickKids) reported mental health outcomes in pediatric patients with neuroinflammatory disorders (i.e., MS) during COVID-19 lockdown. She noted that children below 13 years of age experienced higher rates of depression and anxiety during the lockdown, and that a decrease in their physical activity further exacerbated these symptoms.
Updates on COVID-19 and MS
Dr. Amber Salter of Washington University in St. Louis presented updates from COViMS, the North American initiative that captures clinical information and outcomes of people with MS who have developed COVID-19. Data from COViMS and other MS registries worldwide showed that older age and higher disability were associated with severe COVID-19 outcomes particularly death. Furthermore, the association between severe COVID-19 infection and use of anti-CD20 disease-modifying therapies (ocrelizumab and rituximab) is still unclear, but there is growing evidence suggesting that these medications may be associated with poorer COVID-19 outcomes.
Dr. Amit Bar-Or of the University of Pennsylvania also reviewed various considerations around COVID-19 vaccine safety, effectiveness and use of MS disease-modifying therapies (DMTs). He indicated that currently approved COVID-19 vaccines are generally safe for use in people with MS and those who are on MS medications. Some DMTs may impact the effectiveness of the COVID-19 vaccine, so patients along with their neurologists may need to consider scheduling the time of vaccination with the DMT dose. For more information, the Canadian Network of MS Clinics and the MS Society of Canada’s Medical Advisory Committee have developed a COVID-19 vaccine guidance for Canadians living with MS.
These are just some of the interesting new developments in MS research. To browse the full online program and presentation abstracts, please click here.