Multiple Sclerosis Research Update

May 23, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Put down your phone and pay attention!" "You're embarrassing me in front of all these people!" "If you just put down your phone you might learn something!" That was my daughter Emily attempting to parent me at an MS talk held at the Countryfest Community Cinema. The talk reminded me of ones I attended in lecture theaters in University. Way back then, if I wanted to remember the lecture, I'd have to madly scribble down notes. Now I just take pictures of the slides. That is how I have something to write about this week. So to you Emily I say, "Ha ha!"

My teenaged daughter finds me frustrating. Multiple Sclerosis research is both exciting and frustrating at the same time. May 12 Dr. James Marriott came to Dauphin and gave a very interesting talk about some of the MS research that is being conducted. He talked about a drug that looks promising for treating primary progressive MS. That is way more exciting that it originally sounds, because right now we don't have any treatments for progressive MS. Dr. Marriott also talked about stem cell treatments that might help all types of MS. These both sound really promising, but the frustrating part is that no one can go get these treatments tomorrow. They are both still in clinical trials, so it will be years before someone with MS today will see any benefit.

There are different types of MS. The most common type is called relapsing remitting MS. That means the symptoms, for example lack of balance, show up for a while and then go away. And then they can come back again. Another type of MS is called primary progressive MS. In primary progressive MS, the symptoms start and just get worse over time. There is no "getting better" phase. Right now there are several drugs to treat relapsing remitting MS, but none for primary progressive. The medication Dr. Marriott was talking about is called ocrelizumab. A study called Oratorio had 732 participants with primary progressive MS. One third of the participants got a placebo and two thirds got ocrelizumab. Its full results haven't been published yet, but compared to placebo the ocrelizumab reduced the risk participants would get worse at a timed 25 foot walk, reduced having their MRI measured lesion volume get worse and reduced the chance of having their brain volume go down as measured on MRI.

How does ocrelizumab work? Ocrelizumab is an antibody to the protein CD20. CD20 is a protein on the immune cell called B cells. B cells are believed to be involved in the abnormal immune response in MS. Ocrelizumab binds to CD20, found on the surface of B cells, and causes cell death. The more ocrelizumab injected the more the B cells are depleted and less damage to the myelin sheath around nerve cells.

The second exciting thing Dr. Marriott talked about were stem cells. Nerve cells, or neurons, can't divide or make copies of themselves at all. That is why if someone's spinal cord is cut, they are paralyzed below the cut and the spinal cord can't heal. Liver cells can divide, but they can only become liver cells. So the liver can heal itself from some damage, but liver cells can't create bone cells. Stem cells can divide and become any kind of cell in the body. They can become nerve cells, liver cells, bone cells or even other stem cells.

Like every thing else about biology, stems cells are more complicated than they first appear. Usually, only stem cells from embryos can become any cell in the body. We adults have stem cells, but each type of stem cell can only become a few different types of cells. Mesenchymal Stem Cells (MSC's) can become skin cells, neurons, connective tissue, cartilage, fat cells, bone cells, muscles, gut lining and lung cells.

Right now there is a large trial with about 160 subjects being conducted around the world to see if these Mesenchymal Stem Cells can help MS. The Canadian arm of the study is called MESCAMS and it will recruit 20 subjects in Winnipeg and 20 subjects in Ottawa. Just another example of amazing international research being done right here in Manitoba.

These subjects will have MSC drawn out of their hip bone and grown in a lab. Then half the subjects will have their own stem cells re-injected and the other half will have a sham infusion. Both groups will be followed for 6 months. Then they will switch and the sham group will receive stem cells and the stem cell group will get the sham. So unlike many trials, every subject will eventually get the real treatment, not just the placebo. We are hoping these stem cells will reduce the autoimmune attack on the nerve cells, and maybe, just maybe cause some healing or repair. Again very exciting, but years away from being available to someone with MS down the street in Dauphin.

If you are the teenager of a frustrating parent who won't listen, like Emily, I suggest taking your parent for a walk. Walking should reduce the screen time of your over-exposed parent and get them some much needed exercise. It is even better if you take your parent on a walk with a purpose. The MS Walk at Clear Lake on Sunday, May 29 is a great choice. You can teach your parent some social responsibility by raising money for a disease that affects many Manitobans. You can teach your parent that some amazing research is being done right here in Manitoba to help end MS. It is good to teach your parent now that if they put in some effort now that they might be interesting people again when you are in your twenties and no longer know everything.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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