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Potential New Drug Treatment For Multiple Sclerosis
CAMH-led pre-clinical studies using a small molecule drug have shown promise as a potential new treatment for multiple sclerosis (MS). The results have been published today in the journal Science Advances.
Expanding on Dr. Fang Liu's earlier work that identified a novel drug target for the treatment of MS, she and her team have now created a small molecule compound that is effective in two different animal models of MS. This represents a key advancement that brings this MS research closer to the clinic to impact patient care.
MS is a progressive neurological disease that currently has no cure. It is associated with a wide-range of debilitating symptoms, including problems with coordination, cognition, muscle weakness and depression. For unknown reasons, it is more common in northern latitudes and more than twice as common in women.
It is known that MS damages myelin, a protective sheath that forms around nerves in the brain and spinal cord. As the myelin damage is triggered by inflammation in the immune system, up until now all current drug treatments for MS target the immune system.
In this study, CAMH Senior Scientist Dr. Fang Liu and her team treated MS in a completely different way -- targeting the glutamate system. Study results showed that the newly synthesized lead compound not only reduced MS-like symptoms, it also may repair the damaged myelin in two different pre-clinical models of MS.
"Our compound had a stunning effect on rescuing myelin and motor function in the lab models, and I hope these effects will translate to the clinic to add to current treatments and bring new hope to patients with MS," said Dr. Liu. "As with cancer chemotherapy drug cocktails, simultaneous targeting of the MS disease pathway at multiple points can have synergistic effects and result in better outcomes."
Dr. Iain Greig, Reader in Medicinal Chemistry at the University of Aberdeen, alongside his team, are working to turn the molecules identified by Dr. Liu into advanced "drug-like" molecules suitable for continued development towards clinical use in patients. He added: "In all my years as a medicinal chemist, I have never seen a more promising starting point for a drug development project. It has been a huge pleasure to be involved in this program and I am looking forward to continuing to drive it towards to the clinic."
Much of the funding for this novel treatment for MS, which Dr. Fang and her team have been investigating for over a decade, has come from the Multiple Sclerosis Society of Canada and the National Multiple Sclerosis Society USA's Fast Forward commercial research program.
"We are pleased to have helped enable the early development of a novel neuroprotective strategy for MS, and look forward to seeing it progress through the critical next stages needed to determine its potential benefits for people living with MS," said Walt Kostich, PhD, head of the National MS Society (USA)'s Fast Forward commercial research program.
Dr. Liu believes that the evidence of efficacy and tolerability generated in this study for the small molecule drug makes it a good candidate to be developed for human trials. The next steps in drug development will involve some further pre-clinical research, including investigating safety and stability of the compound. CAMH and the University of Aberdeen have already filed patent applications to protect this research and are actively seeking industry partners to further advance this work towards clinical trials over the next few years.
What To Know About MS Treatment
Multiple sclerosis (MS) is a chronic disease that affects the central nervous system (CNS). In MS, the immune system attacks and damages the protective coating that surrounds the nerves. This results in a wide variety of symptoms.
The exact cause of multiple sclerosis (MS) is unknown, but researchers believe it involves certain genetic and environmental factors.
There is no cure for MS. However, doctors can recommend several treatments to slow its progression, ease symptoms, and improve the quality of life for people with the condition. Treatment is not always necessary and people may prefer to forego it given the potential side effects of some medications.
Keep reading to learn more about the treatments and therapies available for MS.
As there is no cure for MS, treatment will aim to:
Most people with MS have a team of healthcare professionals working on their care. A neurologist is a specialist in MS and serves as the leader of the team. The neurologist makes the MS diagnosis and suggests treatment options for the patient.
The course and symptoms of MS vary from person to person, and therefore the treatment will be unique for each patient.
Other members of an MS treatment team may include:
Health care professionals use medications to treat and manage MS symptoms. There are many FDA-approved MS treatment medications. These medications, also called disease-modifying therapies (DMTs), come in oral, injectable, and infusion forms. The National Multiple Sclerosis Society lists the following medications:
Oral medicationsA person can take oral medications in tablet form. These include:
A person can inject the following medications for MS:
Doctors will administer this type of therapy via an injection into a person's vein. It includes:
Learn more about what these MS medications do and how they work here.
Some healthcare providers may use medications approved for other diseases to treat MS. This is referred to as off-label use.
A physical therapist (PT) teaches individuals special exercises along with training them in the use of mobility aids such as canes, crutches, scooters, and wheelchairs.
Physical therapy helps a person be safe and independent in their mobility and walking.
A physical therapist may suggest:
Occupational therapy involves helping people with MS be safe and productive in their personal care, leisure activities, and workplace. Occupational therapists may recommend canes, shower support bars, and other assistive devices.
Occupational therapists also help a person modify their activities and movements to adapt to their changing body. Activity modifications may include:
Learn more about occupational therapy for MS here.
A speech-language pathologist (SLP) evaluates and treats problems with speech and swallowing. Treatment consists of individualized strategies to help a person with their communication, eating, and swallowing as necessary. Some strategies may include:
People with MS can develop problems with failing to store urine or failing to empty their bladder. These symptoms can lead to urinary incontinence, skin breakdown, and infections.
Behavioral strategies can help train the bladder and limit complications, such as:
Health care professionals also treat MS bladder symptoms with medications such as Botox or Bactrim.
Adopting a healthy lifestyle can help a person manage their MS symptoms. Examples of healthy routine changes include:
The following medications and therapies may help a person experiencing these other symptoms of MS:
Learn about the different types of mental health resources and how to access them here.
In addition to medication, many people with MS try some form of alternative treatment to manage their MS symptoms, particularly chronic pain.
Alternative treatments will not cure or reverse the course of MS. However, they may offer some relief from symptoms like pain.
Patients with MS rate pain as one of their most aggravating symptoms, and it is associated with decreased quality of life, and increased disability.
Some of these alternative treatments may include:
The specific area of the CNS that is inflamed or scarred causes a person's symptoms. Because each individual's MS activity in the brain is unique to them, symptoms can range from mild to severe and can come and go or change over time.
MS may include any combination of these symptoms:
MS is the result of an abnormal immune system response within the central nervous system. The actual cause of MS is unknown. Possible contributing factors in developing the disease include:
Below are answers to some frequently asked questions about MS.
Can you live a normal life with MS?People with MS may need to adjust their lifestyle in some ways. However, many people can lead active, healthy, and long lives.
Staying fit, eating well, and looking after physical and mental health are important for everyone, especially those with long-term conditions such as MS.
How do people with MS cope?People with MS cope with their condition in different ways. Many people like to find out as much as possible about their condition to feel empowered to make appropriate lifestyle choices and treatment decisions.
Many people benefit from online or in-person support groups. The National MS Society offers practical help, information, and support for people with MS and their carers.
What is the first-line treatment for multiple sclerosis?Disease-modifying therapies (DMTs) are the first-line treatment for MS. They are drugs a person can take orally, by injection, or by infusion. DMTs reduce the risk of relapses and slow the progression of MS.
Other treatments include physical and occupational therapy, speech therapy, bladder therapy, and lifestyle modifications.
Multiple sclerosis is an inflammatory and neurodegenerative disease of the CNS. There is no cure for MS.
According to the National Multiple Sclerosis Society, combining disease-modifying therapies (DMTs), symptom management, and a healthy lifestyle is the best treatment plan for managing MS.
Some people may not choose treatment. It is important that a person weigh possible side effects against their quality of life. A doctor can help a person decide which treatment is right for them.
Read this article in Spanish.
5 Steps To Take If You're Unhappy With Your Current MS Treatment
There are many reasons to consider changing your MS treatments. These five steps will help you assess your needs and make the transition an easier one.
While multiple sclerosis has no cure, many treatments are available that can slow the disease's progression, control flare-ups, and manage symptoms. Some treatments may work well for you, but others may not. If you're not satisfied with your current treatment, you might want to try something else.
Your current medication might have side effects that bother you, or it may no longer seem to be as effective as it was. You might be having challenges taking your medication, such as missing doses or having trouble with the injection process.
Medications for MS include disease-modifying therapies that prevent relapse and progression, as well as symptomatic treatments that ease the effects of MS, such as muscle spasms, bladder problems, or pain.
A variety of treatment options are available for MS. If you're unhappy with your current treatment plan, here are five steps you can take to change it.
You might want to switch treatments because you're not sure if the medication you're taking is effective. Talk with your doctor about the goals of each medication and what you should look for to determine whether it's working.
Don't stop taking your medication or change your dose without talking with your doctor first.
Disease-modifying MS medication can be working properly even if your symptoms seem to be the same. This is because the medication is preventing new symptoms from developing as it controls inflammation.
It may be that your current symptoms simply aren't reversible, and your treatment is aimed instead at preventing your condition from progressing.
If you are taking a medication to control specific symptoms of MS, sometimes it's not the medication that needs changing but the dose. Ask your doctor whether your current dose should be adjusted. Also, make sure that you've been taking your medication as prescribed.
If you still think that your current treatment isn't working, make sure that you've given it enough time. Disease-modifying medications for MS can take between 6–12 months to take effect.
If you've been on your current treatment for less time, your doctor may recommend that you wait before considering a change.
Whatever your reason, you should be clear with your doctor why you are asking for a change. Maybe the medication you're on makes you moody or requires regular liver function tests.
Perhaps even though you've received training to self-inject your medication, you might still dread the task and want to switch to an oral alternative. Specific feedback about your current treatment can help your doctor recommend another option that's better for you.
Changes to your daily life can sometimes affect how different medications are absorbed or metabolized, which affects their benefits and side effects. Tell your doctor about anything that's different, such as your diet, activity level, or sleeping patterns.
Dietary factors like salt, animal fat, sugar, low fiber, red meat, and fried food are linked to increased inflammation that can make MS symptoms worse. If you think you're having a relapse, it might be because of health issues and not necessarily a sign that your disease-modifying MS medication has stopped working.
Update your doctor about any lifestyle changes that could be affecting your treatment so that together, you can make an informed decision.
Increased lesions on an MRI scan and changes in your neurologic exam are two signs that a treatment change might be in order. Ask your doctor if you can have current testing done to see if you should switch medications.
Your doctor can compare your current tests with previous tests to see if there are changes in certain results that could be affecting your health. For example, if you have developed mild anemia (low red blood cells), that could be affecting your energy level separately from your MS.
But if you have developed problems with coordination, then it could be your MS. And some changes, such as worsening vision, could be due to MS or other problems like cataracts or glaucoma, and more detailed testing can get to the bottom of it.
The acronym S.E.A.R.C.H. Acts as a guide for choosing the best MS treatment based on the following factors:
The Multiple Sclerosis Association of America provides S.E.A.R.C.H. Materials to help you determine the best MS treatment for you. Consider each of these factors and discuss them with your doctor.
There are multiple treatment options available for MS. If you want to change your current treatment, be clear about why so that your doctor can help you choose another that's a better fit for you.
Sometimes, treatments are working as intended, even if you don't notice any changes. Check with your doctor to see whether this is true in your case before switching medication.
As you consider your options, continue taking your current medication, and don't change your dose until you speak with your doctor.
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