Last year, we discussed Myelin Remodeling through Experience Dependent Oligodendrogenesis and the TREAT-MS trial which helps inform patients and the broader health care community on whether patients would most benefit from less aggressive therapy or an early, possibly more risky aggressive therapy to treat MS. Every year more new cutting edge therapies and trials are taking place in order to find the best way to treat MS patients. In this update, we will be discussing a few new cutting edge therapies and some new ways Johns Hopkins Project Restore is helping diagnose MS and the best ways to treat patients well into the future including: measuring inflammation and progression, discovering biological pathways associated with MS activity and clinical trials including treatment strategies, novel therapies and lifestyle modifications as well as some updates on other important matters related to MS.
First, we would like to discuss the OCT Program or Optical coherence tomography which is one of the defining aspects of the MS Precision Medicine Center of Excellence for Multiple Sclerosis. OCT is a noninvasive imaging test that uses light waves to examine tissue and nerve endings in the retina which helps make it possible for doctors to detect abnormalities that indicate disease progression, according to Johns Hopkins Medicine. Another way to help diagnose and follow disease progression is by getting an MRI, which can create detailed images of nearly every structure and organ inside the body by using magnets and radio waves. Also, the use of wearable technologies to track changes neurological function can help determine disease progress.
Speaking of OCT, this diagnostic tool can really help those MS patients who have symptoms of optic neuritis. Since MS can effect your vision, it is important that research takes place to determine the extent of eye damage. That is exactly the kind of research that is taking place at Johns Hopkins Medicine. Research says that patients who have anti-myelin-oligodendrocyte-glycoprotein lgG (MOG) rather than anti-aquaporin-4 lgG (AQP) optic neuritis have a better chance of visual recovery. Dr. Elias Sotirchos, clinical and research fellow at Johns Hopkins University in Baltimore conducted research comparing MOG optic neuritis patients to AQP optic neuritis patients.
“Our study suggests that when evaluating a patient with optic neuritis, taking into account the combination of visual function and optical coherence tomography findings may provide diagnostic clues,” Dr. Sotirchos told Neurology Today.
The researchers looked at 27 eyes of MOG patients and 74 eyes of AQP patients, determining that MOG optic neuritis patients had better visual acuity than AQP optic neuritis patients. However, when compared to the 62 eyes of the healthy controls researchers reported that visual acuity of those with optic neuritis was decreased. Dr. Sotirchos also reported that compared with normal eyes the retinal nerve fiber layer thickness were markedly decreased in MOG optic neuritis. Also noted, was that the difference between MOG and APQ retinal fiber layer thickness was not statistically significantly different.
“Future studies are necessary,” said Dr. Sotirchos, “to confirm and expand on these findings and may shed light on the cause of the diverging correlations between retinal neuro-axonal loss and visual function in MOG versus AQP autoimmunity.
Another study conducted by Dr. Fillppatou’s team and reported about in the Johns Hopkins MS Journal is about the role of retinal imaging with OCT in assessing individuals with radiologically isolated syndrome (RIS). It still remains largely unexplored, that is until now. The reason for doing a study like this and using this type of test is to asses retinal layer thickness in RIS and examine their associations with clinical features suggestive of increased risk for conversion to multiple sclerosis.
In this study, a total of 30 RIS subjects and 60 age and sex matched healthy controls (HC) underwent OCT, followed by automated segmentation of retinal layers. According to the MS Journal, the results showed retinal layer thickness did not differ between RIS and HC. However, RIS subjects with spinal cord (SC) lesions had lower ganglion cell plus inner plexiform layer (GCIP) thickness compared to HC and RIS without SC lesions. Similarly, RIS subjects with infratentorial (IT) brain lesions had lower GCIP thickness compare to HC. The conclusion being the presence of SC or IT lesions in RIS may be associated with retinal neuro-axonal loss, supporting the presence of more disseminated disease.
Discovering biological pathways associated with MS activity is also an important aspect of finding new ways to diagnose and treat MS patients. Studying certain aspects including: genetics, immune dysregulation, metabolism, microbiome from blood, neuroendocrine changes, stem cells/neurons and altering the timing or amount of calories in MS (ATAC-MS). Using research studies while utilizing cutting edge technology puts Johns Hopkins Project Restore MS Research Center in a unique position to try new clinical trials that help doctors come up with exciting treatment strategies, novel therapies and lifestyle modifications.
Some of these clinical trials we have talked about in detail before such as: myelin repair and neuroprotection (anti-LINGO) and traditional verse early aggressive therapy for MS (TREAT-MS). Other clinical trials and treatments being used to combat MS are: bile acid supplementation in MS, vitamin D to ameliorate MS (VIDAMS), intranasal insulin for cognitive dysfunction in MS, a phase 1b open-label study of liothyronine in MS and functional electrical stimulation for persons with secondary progressive MS. The bottom line is the use of technology to improve MS clinical trials and patient care is the reason Johns Hopkins is a leader in this field.
Lastly, we would just like to thank all of our followers who come out to our MS4MS sporting event fundraisers and all of the individuals who follow us on our social media accounts. With the help from you, we are really able to make an impact not only on those who have their own personal journey with MS by sharing their stories to spread awareness but make a huge impact by supporting and donating to Johns Hopkins Project Restore MS Research Center. Thank you for supporting MS4MS and Johns Hopkins Medicine. Visit here for more information on the cutting edge research taking place at Johns Hopkins.
Check back here on MS4MS.org for our end of the year update from The Project Restore and please contact us directly if you have any additional questions.