MS Research

Jul 1, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I knew my kids would eventually beat me at things, but I never guessed it would be this soon. Emily could draw better than me at age 4. Eric is almost nine. He plays minecraft constantly and I don't know the first thing about the video game. At 12, Emily may be a better cyclist than me. I like to think of myself as a decent cyclist. No, Im not my sister who does triathlons. No, I certainly dont look good in skin tight racing outfits. But I ride my bike to work most days. And, this year will be my 13th MS Bike tour from Dauphin to Clear Lake. Ill even have company. The Kinsmen Club is entering a team. Most of us are not what you would traditionally call athletes, so we were happy when Emily said she wanted to ride too. We had been training on Wednesday and Sunday evenings, mostly in the rain and always on flat roads. A few weeks ago, we decided to do some hills. We started at Countryfest Road and headed into the Park. Emily took off up the first hill. I'm not sure I could have caught her if I tried. It seems Emily may have a better weight to power ratio than the rest of us. This made me doubt whether cycling was the best way for me to raise money for MS.

In June I was lucky enough to see where some of the money raised during the MS Bike Ride goes. I went to a conference and meetings in Montreal put on by the MS Society to discuss what kind of research the Society should fund. Traditionally Universities have done basic research to figure out the causes of MS and possible treatments. The MS Society spends most of its research money funding this basic research. Then drug companies would take these possible treatments and do more research and figure out which would work in the real world. In the last few years a gap has developed. The drug companies have found it too risky to take every idea out of a University and fund research to see which makes a good treatment. There is a need for someone to fund research that has left the University but isnt ready for a drug company yet. The MS Society is looking to see if it should fund some of this translational research.

How is MS been research going? There is lots going on, but the very short answer is good and bad. The good news is we now have about 10 treatments for relapsing, remitting MS. The bad news is we don't have any treatments for progressive MS. When I mention MS research, people ask me about CCSVI or chronic cerebrospinal venous insufficiency. You've probably heard of this MS therapy, otherwise known as Liberation Treatment in the news. The idea is that if you open up the narrowed neck veins of people with MS more blood will drain out of their brains. This means less blood will back up and leak into the brain. This backed up blood leaking into the brain was believed to trigger the immune response which caused MS symptoms. Unfortunately, CCSVI doesn't seem to have been the miracle cure it was once thought to be. The MS Society and others continue to fund research to see if CCSVI works, but the trials to date dont seem promising.

My favorite part of the meetings in Montreal was meeting the researchers who are actually trying to cure MS. In fact they were introducing themselves to me. Hello! Im Sam David. Of course he was. Id never met this cheerful little man before but immediately felt comfortable talking to him. He noticed I was from Manitoba and told me he had trained in Winnipeg. Dr. Sam David is a professor of Neurology and Neurosurgery at McGill. His lab researches spinal cord injury, Multiple Sclerosis and other neurodegenerative disorders. Dr. David was very pleasant and very knowledgeable, but that isn't what impressed me the most. After our meetings we had dinner in a room that required you to climb two sets of three stairs. Several people in our group had MS. One gentleman from BC, who used a cane, was having a little trouble getting down the stairs. Dr. David immediately and cheerfully went to help. He offered the gentleman his arm and chatted with him down the stairs and all the way to the elevator. When I came upon them and offered to help, they declined. Dr. David said, Don't worry. I originally trained as a physio, so I know what I am doing. I shook my head in mild disbelief that a world renowned MS researcher also had no problem just helping someone down the stairs.

I ate supper at a table with Dr. Jorge Alvarez from the University of Montreal. He was originally from Columbia, got his PhD. in Texas and now works on how the body controls what crosses the blood vessels to get inside the brain. This is important in MS because if we believe the immune system attacks the myelin sheaths around nerve cells, the immune cells have to cross the blood brain barrier to do their damage. If we know more about how the brain allows things to cross this barrier, maybe we can stop the immune cells from getting to the myelin in the brain. He was obviously bright and passionate about his work. He was trying to explain his research to me, but frankly I got lost. We were talking during the very beginning of the World Cup soccer tournament. The next day Dr. Alvarez was planning to dress in his Columbian soccer jersey and go to a Greek restaurant and watch the Columbia vs Greece game. Columbia won 3-1 so I hope the patrons of the Greek restaurant weren't too hard on him.

There always has to be a contrarian in every crowd. Dr. Peter Stys, a Neuroscientist at the Hotchkiss Brain Institute at the University of Calgary, played that role during the talk he gave us about his research. Many researchers believe in the outside-in theory of MS. That means they believe something happens which gets the immune system excited. The immune system then attacks and damages the myelin sheaths around nerve fibres. Dr. Stys isn't so sure. Dr. Stys said imagine you were from another planet and you landed on earth at the site of a train wreck. You have no idea what a train is but this thing you see is obviously damaged. You also see lots of rescue workers in red overalls all around the train wreck. The red rescue workers are breaking windows and cutting through the walls of the train to get at the passengers. As an alien you might look at the scene, see the damage the rescue workers are doing and assume they caused the train wreck in the first place. Dr. Stys thinks we might be making a similar wrong assumption about immune cells and myelin damage. Dr. Stys is an inside-out theory of MS guy. He thinks the damage to the myelin happens first and that leads to inflammation and immune cells coming to the scene. He has some compelling pictures to support his theory. Dr. Stys lab uses some really complicated machines to take some extraordinary pictures of nerve cells and their myelin sheaths. One set of pictures shows very early MS before the patient would even have symptoms. These early signs of myelin damage are not associated with inflammation and immune system attack. If inflammation and immune system attack happened first, you would expect to see inflammation before myelin damage, but in very early disease, Dr. Stys sees the opposite. When Dr. Stys uses his fancy cameras to take pictures of the cross section of myelin wrapped around a nerve cell, he sees more interesting things. In early MS he sees damage to the myelin sheath on the inside of the myelin first. If inflammation was the cause of the damage, you would expect to see damage to the outside of the sheath first.

Meeting these three and many other very young bright MS researchers in Montreal gave me a lot of hope that one day we really will end MS. Just like maybe one day young cyclists will take over the MS fund raising. We eventually caught up to Emily when she stopped and waited for us on another hill. We thanked her for waiting and told her we wanted to go a little farther up the hill. Frustrated, she decided to walk her bike so she wouldnt lose track of us this time. It seems she can even pass us when walking her bike. She may be young and bright, but next year I think Im going to get her to pull me up the hill.

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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Dr. Jorge Alvarez -

Dr. Sam David -

Dr. Peter Stys -


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