5 important updates from ECTRIMS and what they mean for you

For MS doctors and and researchers in MS there is one key event in the calendar every year. It is an event organized by the European Committee for Treatment and Research in Multiple Sclerosis and generally known as ECTRIMS.

Our Medical Lead, Dr. Adrian-Minh Schumacher, attended this year's congress in October. Here is 5 things that he took home from the event.

#1 Disability Progression

“I want to talk about progressive MS!”

As the recipient of the 2021 Charcot award, Prof. Alan Thompson from University College London gave the central lecture of the conference.

He dedicated his talk to the big task we have to tackle: challenging progression in MS.

This is extremely important as there are 1-1.5 million people worldwide living with progressive MS and they can often feel overlooked in comparison to other types of MS.

The science:

Nowadays, we have a much better idea of the different mechanisms that play a role in MS progression. We now know that immune cells called microglia get activated. These cells cause nerve cells (neurons) and their conducting fibres to degenerate due to energy failure and oxidative stress. Despite the better general understanding, we still have to find out the exact roles of these mechanisms. This could be an important future research topic.

Prof. Thompson also brings up another important topic, called ‘silent progression’. Silent progression is when someone with Relapsing Remitting MS’s (RRMS) disability gets gradually worse.

It is called ‘silent progression’ because it is happening in the background, unrelated to relapses, which are normally the focus of monitoring and treatment plans. To tackle this challenge, we would need to classify the disease state of patients better. We can do this e.g. by using advanced MRI methods to then identify patients that would profit from early treatment limiting progression.

What it means for you:

People with progressive MS often feel forgotten so to have it at the core of ECTRIMS is an important step.

Keep your eyes open for any types of studies on progressive MS. As researchers focus on this aspect of MS, it is important to gather as much data as possible to advance quickly. At this moment though, you have to still manage your expectations on a new release of a progressive MS drug.

#2 COVID-19 and MS

Good news for the MS community! In the past months, many researchers collected data on MS patients with regard to COVID-19 infections and also vaccinations. This gives doctors a clearer picture when recommending treatment and vaccinations for people with MS.

The science:

Maria Pia Sormani, an epidemiologist from Italy, compared MS patient cohorts to a general population of comparable age and sex. She reported that the frequency of severe COVID cases is higher in the MS patient population.

Patients on B-cell depleting therapies (like Rituximab or Ocrelizumab) have a higher risk of severe COVID-19. Even more so if they have been on treatment for several years already. On the other hand, there are emerging hints that interferon therapies could be protective against serious COVID-19 infections.

Prof. Anat Achiron presented very valuable findings from Israel. Her home country has been ahead of many other countries in gathering data about vaccinations in MS patients. She concluded that vaccination side effects in MS patients were similar to the general population.

She also did not find evidence of increased relapse risk in MS patients in the first few weeks after vaccination. Yet, patients on treatment with Rituximab, Ocrelizumab or Fingolimod did not mount a good immune response after vaccination. The group of Fingolimod patients showed poor responses in both pillars of the immune system: antibodies and immune cells.

ECTRIMS and the European Academy of Neurology will put together revised recommendations about vaccinations in MS patients with the insights from new data incorporated.

What it means for you:

If you are on a B-cell therapy (Ocrelizumab, Rituximab, Ofatumumab) I recommend checking in with your treating physician. The same applies if you are on a therapy with Fingolimod, Siponimod or Ponesimod. You would need to re-evaluate whether your vaccination response is strong enough. It might be that other measures are needed. Generally, take good care to stay safe and limit the risk of getting infected with COVID-19.

#3 Multiple Sclerosis and Comorbidities

Many MS patients also suffer other conditions - like other autoimmune diseases, for example diabetes or Crohn's. The big question is how the two or more conditions might influence one another. And how we manage this situation.

The science:

Stefanie Binzer and her team from Sweden focused on the impact of inflammatory bowel disease on disability progression in MS. To do this they analyzed the data of Swedish MS patients. They could identify a higher risk for disability in patients suffering both MS and inflammatory bowel disease.

In another interesting study, Jeff Rodgers from Swansea University looked at lifestyle data from patients in the UK. In his study, he put the MS patients in three boxes: never smokers, former smokers and current smokers. Over time, the likelihood of disability progression was clearly higher for current smokers. Recent smokers and never smokers turned out to be comparable. This shows that smoking causes real disability progression. Stopping this habit can reverse this risk to a similar level - like people who have never been smoking at all.

What it means for you:

If you are still smoking as an MS patient: stop! This data shows that it is still worth stopping even if you have been smoking for many years. If you suffer other autoimmune disease, make sure with your care team that they are well controlled, like your MS.

#4 Microglia and MS

A lot of the mechanisms in MS are still unclear. To come up with novel ways to treat people we have to understand them better - on a cellular level. In the past years, researchers have identified a certain cell type, microglia, as crucial players in MS disease course. They are complex cells as they can be both drivers of disease progression but also regulators of inflammation in the brain.

The science:

Prof. Martin Kerschensteiner from Munich, Germany, showed the central role of microglia in his overview of the conference’s scientific highlights. Microglia are stellar cells that only appear in the central nervous system. They are closely related to a group of cells we call phagocytes, which can clean debris and play a big role in inflammation in general.

Microglia have shown to interact closely with astrocytes. These are another brain specific cell type who e.g. form the scars when a piece of the brain is being injured. Some researchers have focused on the behavior of microglia in the border of MS lesions.

The borders are interesting, because especially in long-standing MS it seems that they are slowly extending the lesion. One can think of it like a slowly smoldering fire. Being able to understand these kinds of slowly expanding lesions would provide a key in treating progression. Microglia are also the cells that eat up synapses from nerve cells. This can be detrimental to cognitive function and might also be a reason for fatigue. However, there is also much evidence for repair mechanisms initiated by microglia. For instance, they build close contacts to nerve fibres which are getting back their protective myelin sheath. All in all: if we want to understand MS better, we have to understand microglia better.

What it means for you

If you want to have a deeper understanding of cells in the brain, you can go ahead and watch this video: https://www.youtube.com/watch?v=fZSUv-9NB2g

#5 New therapeutic approach: specialist stem cells

To come up with a therapy for progressive MS patients is challenging. We so far do not have therapies that can stop progression or even reverse it. This means setting aside medication therapies and going for a whole different approach.

At the conference Prof. Cohen and a team from the Cleveland Clinic, presented results from an exciting stem cell trial using with mesenchymal stromal cells that secrete neurotrophic factors (MSC-NTF).

The science:

Prof. Cohen’s talk shows first results from a phase 2 open label clinical trial. His team looked at a special stem cell therapy (NurOwn®, Brainstorm Cell Therapeutics) which was given to 18 people with progressive MS.

The cells were derived from individuals’ own bone marrow. Next, these cells underwent a specific engineering in a petri dish making them secrete neurotrophic factors. Neurotrophic factors are natural proteins that regulate growth, survival and changes in neurons. The idea is that those factors could lead to better protection or even recovery of neurons damaged by MS.

Study participants received cell treatments by injection into the spinal canal three times in total, every second month. The researchers were able to show general safety of the treatment. The improvements in cognition, mobility and other functions seemed to show a positive trend. The study also measured levels of anti-inflammatory and neuroprotective substances in the spinal fluid.

The results generally suggested nerve protection and reduced inflammation. These results still have to be considered very preliminary. Brainstorm Cell Therapeutics already moving forward in getting more evidence on this approach to fight progressive MS. Ideal evidence would come from a placebo-controlled, randomized study with way more patients.

What it means for you:  

This is a very interesting approach! The safety and tolerability of the invasive treatment is a good sign. You have to stay patient though: more patients have to be treated, data gathered and long term results have to be awaited. Keep your fingers crossed.