Dr Susan Kohlhaas
Director of Research and External Affairs, the MS Society
Despite dramatic progress in treatment, MS remains a devastating diagnosis. But, Dr Susan Kohlhaas explains, stopping MS is finally a very real prospect.
Twenty-five years ago, a multiple sclerosis (MS) diagnosis was even more terrifying than it is today. With no treatment available on the NHS, it meant going through life not knowing if you’d wake up with numb legs or a loss of vision, or what else might be around the corner. For many people, these episodes led to a decline in their body’s ability to perform basic functions like walking, speaking, and eating.
Today, however, if you live with relapsing MS – where symptoms come and go – there are over a dozen licensed treatments. Relapses happen when the immune system mistakenly attacks myelin – the protective coating around our nerves. But in just two decades, we’ve learnt how to stop this from happening as often.
And yet, people with MS still face a scary and uncertain future.
Until recently, we had no idea how to stop MS decline. Although preventing immune attacks helps keep myelin intact, it doesn’t repair the damage from attacks that do happen, and it doesn’t stop nerve cells from dying off in the progressive phase of the condition. And when a nerve is destroyed, there’s no way to bring it back.
We desperately need to find a way to protect nerves and repair damaged myelin.
Unlocking existing drugs’ potential
Recent scientific breakthroughs give us reason to hope, and we now know myelin repair happens naturally in the brain. In MS there’s a problem with that natural process, so scientists have been trying to get it working properly again.
Using brain tissue from our MS Society Tissue Bank at Imperial College London – which allows people to donate their brain and spinal cord tissue for MS research after their death – they found a drug originally used to treat skin cancer could stimulate a molecule partially responsible for promoting myelin repair.
At the MS Society Cambridge Centre for Myelin Repair, researchers have also discovered that a certain diabetes drug can trick older myelin-making cells in rats into behaving like younger, more efficient cells.
And it’s not just in the lab; over 750 people are already taking part in one of the largest ever trials for MS progression. MS STAT2, funded by a partnership between the MS Society, the National Institute for Health Research, the National MS Society (in the USA) and sponsored by University College London, is testing whether a common cholesterol-lowering drug slows progression, by protecting nerves.
A new type of trial
While progress has been accelerating, for people with MS it still feels agonisingly slow. It takes years to go from a discovery in the lab to demonstrating that a treatment is safe and effective: our challenge is to speed this up.
We’ve been working on new ways to test potential treatments much more quickly. The MS-SMART trial showed it was possible to test three drugs in a single trial – the first time this has been attempted for a progressive neurological condition. While none of these drugs slowed progression, MS-SMART gave us both the tools and momentum to transform how we run clinical trials. Our ambition is to launch a trial with multiple drugs and also multiple stages. Instead of stopping and starting separate trials, we’ll have a programme that adapts with each new discovery.
What the next decade holds
We can see a future where nobody needs to worry about MS getting worse. By 2025, we plan to be in the final stages of testing a range of treatments for everyone with MS. Some of the best minds in the country are working together to make it happen, drawn to an area of research with so much excitement. There’s still a long way to go but, for the first time, there’s genuine hope that we can stop MS.