Cure for multiple sclerosis: progress, research and treatment

Multiple sclerosis (MS) is a chronic inflammatory disease of the brain and spinal cord that affects nearly one million people in the United States. There is no cure for MS. However, drugs called disease-modifying therapies (DMTs) can help prevent MS relapses and slow down the disease.

In MS, the immune system attacks the myelin sheath which insulates nerve fibers in the brain and spinal cord. As a result, nerve signaling is disrupted, which can lead to symptoms such as numbness, vision changes, weakness, and walking problems, among others.

This article will discuss MS discoveries and treatments that can help people with this potentially debilitating disease.

How close is science to finding a cure for MS?

There is immense hope of one day finding a cure for MS. However, the timeline for ending MS forever remains unknown.

As scientists around the world search for a cure for MS, the National MS Society has set itself three goals, namely:

• No MS disease activity: This goal is to stop the disease (no more lesions or disease progression) in people already diagnosed with MS. A lesion is an area of ​​MS-related inflammation or damage in the brain or spinal cord.
• Symptoms and Disabilities of Reverse MS: This goal involves finding treatments to repair myelin as well as lifestyle/rehabilitation strategies to restore normal functioning.
• No new MS diagnoses: This goal is to eliminate or reduce risk factors in people at risk of developing MS. Risk factors are triggers or exposures that can increase your chances of developing a disease.

Research progress

In their search for a cure, researchers are digging deep to learn all they can about MS. The good news is that a lot of progress has been made. Here are some examples of this progress:

Triggers

A variety of factors have been identified that can make you more vulnerable to developing MS, including smoking, low vitamin D levels, and obesity in adolescence.

Research has also uncovered a possible link between your gut microbiome (the organisms in your digestive tract) and the development of MS.

Finally, about 200 genes have been identified that may contribute (usually at a low level) to MS risk.

Diagnostic

Advances have been made in magnetic resonance imaging (MRI) techniques to diagnose and monitor MS. MRI involves the use of magnetic fields and radio waves to create three-dimensional images of the soft tissues of the body.

Treatment/Rehabilitation

The emergence of targeted and highly effective DMTs has reduced the number and severity of relapses people experience.

Additionally, the discovery of several compounds that may promote remyelination in animal models offers hope that function may one day be restored for people with MS. Remyelination is the formation of new myelin sheaths around nerve fibers.

MS treatment options

DMTs are “big picture” drugs. They work to reduce the number and severity of MS flare-ups and to slow down the disease.

There are nine classes of DMT available. The vast majority are approved by the Food and Drug Administration (FDA) to treat relapsing forms of MS.

Recurrent MS includes:

• Relapsing-remitting MS (RR-MS): This is the most common type of MS. In RRMS, people experience worsening neurological symptoms, or relapses, which eventually resolve or improve.
• Active secondary progressive MS: People with RRMS may progress to this type. They experience symptoms that gradually worsen with occasional relapses.
• Clinically isolated syndrome: This is a first episode of symptoms that does not yet meet the criteria for an official diagnosis of MS.

Some of the approved DMTs include:

• Mavenclad (cladribine) is administered orally in two annual treatment cycles. It works by temporarily lowering the number of immune system cells.
• Vumerity (diroximel fumarate) is a pill taken twice a day by mouth that is said to have anti-inflammatory and antioxidant properties.
• Bafiertam (monomethyl fumarate) is similar to Vumerity and is taken by mouth twice a day.
• Ponvory (ponesimod), Mayzent (siponimod)and Zeposia (ozanimod) work by trapping white blood cells in the lymph nodes so that they cannot enter the brain and spinal cord and attack the myelin.
• Kesimpta (ofatumumab) is an injectable DMT given once a month. It is a monoclonal antibody that targets B cells (anti-infective cells) that have a specific CD20 marker on their surface.
• Ocrevus (ocrelizumab) is an infused DMT administered once every six months. It works similar to Kesimpta but is approved to treat both relapsing MS and primary progressive MS.

Emerging treatments for MS

Stem cell therapies and a medicine called ibudilast are two emerging strategies for the treatment of MS. Both of these therapies are experimental, which means they are not yet approved by the Food and Drug Administration (FDA) for the treatment of MS.

Stem cell therapies

Stem cells are self-replicating cells, or cells that have the unique ability to transform into multiple cell types (eg, blood cells, nerve cells, fat cells, and bone cells). They are found in embryos and adults and are sometimes created in the laboratory. A autologous stem cell transplantation uses the person’s own stem cells.

Different stem cell therapies are being used or explored in MS care, including:

• an autologous hematopoietic stem cell transplant attempts to jump-start a person’s immune system using their own hematopoietic stem cells. Research suggests that this treatment is a potentially effective option for people with highly active relapsing-remitting MS that is unresponsive to DMTs.
• an autologous mesenchymal stem cell transplant involves taking a person’s own mesenchymal stem cells, modifying them in the lab, and injecting them back into their bloodstream or spinal canal. Mesenchymal stem cells are tissue-protective/anti-inflammatory cells found throughout your body, including bone marrow, fat, and dental tissues.
• an autologous induced pluripotent stem cell-derived transplant involves taking a person’s own cells (usually skin or blood), turning them into specialized cells (including cells that make myelin) in a lab, and introducing them back into the body.

Ibudilast

Ibudilast is an investigational oral drug that slows the progression of brain shrinkage (compared to placebo) in people with primary or secondary progressive MS.

In the Phase 2 clinical trial that revealed the above results, no major safety issues were reported. However, participants taking ibudilast experienced more depression and gastrointestinal side effects (eg, nausea, diarrhea, stomach pain, vomiting) than those taking a placebo.

Ibudilast works by blocking an enzyme called phosphodiesterase and has been found to protect nerve cells from damage and encourage myelin repair. It is currently used in Asia as a treatment for asthma and post-stroke dizziness.

Summary

Currently, there is no cure for MS. However, experts have made significant progress in understanding the disease and in developing more effective, targeted disease-modifying therapies.

Current research focuses on reducing potential risk factors, stopping disease activity, and promoting myelin repair. Two experimental MS treatments on the horizon are stem cell therapies and the oral drug ibudilast.

A word from Verywell

The recent knowledge acquired on MS and the progress made in treatment are encouraging. They offer hope and are a potential step forward in finding a cure for MS.

As you continue to focus on caring for your MS, take comfort in knowing that researchers continue to work tirelessly to find a cure. This includes staying in contact with your healthcare team, taking your medications as prescribed, and practicing healthy lifestyle habits, such as getting enough sleep and maintaining a healthy weight.