Multiple sclerosis is a traitorous disease. Developing in one out of 1,000 people, usually before age 45, MS causes patients’ immune systems to suddenly turn on their own nerve cells and attack them as foreign invaders. Victims suffer tremors, muscle weakness, paralyzing fatigue, blurred vision, incontinence and unsteady balance, among other devastating symptoms. Perhaps more disheartening, treatments for the most advanced stages of the disease have been limited or nonexistent.
But medical research such as that underway at Barrow—-which has one of the largest clinical research protocols in the country—is gaining on MS, thanks in part to a new modus operandi.
“The traditional approach to treating inflammatory diseases is to suppress the immune system,” says Timothy L. Vollmer, MD, program
director for the Neuroimmunology Program at Barrow, which receives funding from Barrow Neurological Foundation. “We’re trying not to suppress the immune system but to reprogram it, so it not only stops the attack that’s causing the disease, but maintains the body’s ability to respond normally.”
MS is an affliction of the central nervous system, which comprises the brain, optic nerves and spinal cord. It is the progressive eating-away of the myelin, a fatty white coating that sheaths many crucial nerves and that allows impulses to be transmitted at top speed.
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Susan Rhodes, laboratory coordinator, Neuroimmunology Research, and Timothy L. Vollmer, MD, director of the Neuroimmunology Program at Barrow. Dr. Vollmer’s research receives support from Barrow Neurological Foundation. |
Among the most promising research underway is a possible MS vaccine.
The vaccine contains the DNAblueprint for a protein that tells the immune system not to attack its own cells. The idea is that, once the vaccine is injected into the patient, the protein is internalized by the body’s cells, where it reeducates them.
“The goal is to have the immune system become tolerant and send a message to the brain to shut off an autoimmune attack there,” Dr. Vollmer says.
The vaccine would ward off the disease in at-risk patients, such as those who have family members with MS (whose risk of getting the disease is 30 to 50 times greater than the average) and those who have begun to exhibit the early symptoms.
The DNA vaccine originated at Stanford University and is in clinical trials at Barro w. “That’s a strength of Barrow in general: We specialize in taking a lab concept and turning it into practical treatment,” Dr. Vollmer says. With 21 active clinical protocols, Barrow is one of the largest clinical MS research centers in the country, if not the largest.
Developing MS treatments that don’t require injections
Preventing patients from ever getting MS is one front on the battle to vanquish the disease. For patients who are already suffering from it, other research is underway. In the early stage of the disease, the patient often suffers symptoms, then recovers, then relapses. Ty pically, patients stave off a relapse by injecting themselves regularly with an MS drug. Atreatment in pill form is currently being studied in clinical trials.
“I think that what our MS patients are longing for is a way to protect themselves that doesn’t involve injections,” says Denise Campagnolo, MD, director of MS Clinical Research at Barrow.
The drug fingolimod reduces the overall numbers of immune cells that have turned on their fellow central-nervous-system cells. The compound is currently in Phase III trial tests.
“As long as it’s safe and it works, it will be a benefit to persons living with MS who are unwilling or unable to do self injections,” Dr. Campagnolo says.
A promising one-two punch
Another trial in Barrow’s lab involves using two already- approved drugs, but in a more effective combination. The first drug—a chemotherapy agent called mitoxantrone—kills the immune system cells that are attacking their own. The second—glatiramer acetate, prescribed to reduce MS patients’ relapse rate—keeps the replacement cells manufactured by the bone marrow from also turning against their fellow cells. The one-two punch is so far proving promising.
“ Clinically, patients who receive this combination therapy enjoy a much longer disease-free period,” says Fu-Dong Shi, PhD, director, Neuroimmunology Lab. “This combination is really utilizing a new concept, basically trying to reprogram the immune system. It is of tremendous interest for immunologists.”
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Fu-Dong Shi, PhD, director of Barrow’s Neuroimmunology Lab. |
Many MS patients suffer the pro g ressive forms of the disease, in which symptoms steadily increase in intensity. They currently have few effective therapies.
“At any given moment, roughly 60 percent of patients have progressive MS,” Dr. Vollmer says. “Right now that 60 percent doesn’t have much in the way of treatment options.”
Dr. Campagnolo seconds that. “All currently approved self-injecting medications are modest at best,” she says.
But two drugs may change that. They are currently finishing Phase III clinical tests (the last phase before a drug can be approved for use): MBP (myelin basic protein) and rituximab, which is currently approved for treating rheumatoid arthritis and some cancers. If successful, rituximab could be available within the next year for MS patients. MBP is not far behind.
“ MBP is a very selective therapy that only affects the immune system as it is involved with the brain. Rituximab is an antibody that destroys B lymphocytes, one part of the immune system,” Dr. Vollmer says. “Reported results have exceeded expectations, so this is an exciting time.”
Barrow’s research into the DNAvaccine and potential new drugs offers concrete hope to MS patients in all phases of the disease.
“ Treatment of MS will become more complicated because we will have more tools,” Dr. Vollmer says. “But we will have the means to tailor the tools to the particular patient.”
-MS research at Barrow receives funding from Barrow Neurological Foundation, including money from the Health & Wealth Raffle.
