What are the basic approaches to therapy?
There are three basic approaches to therapy in multiple sclerosis (MS)
- Shorten exacerbations and expedite the return to a remission
- Prevent future worsening
- Provide symptomatic relief for the disabilities caused by MS
The most common approach to treating a patient who has worsened sufficiently to impair function is to use some form of corticosteroids. Many of our patients have benefited greatly from periodic treatment consisting of intravenous methylprednisoline and rehabilitation technique therapies.
Treatments aimed at the underlying disease process to prevent future worsening are available for some types of MS and are being researched in clinical trials for other types of MS.
Treatments to relieve symptoms are very valuable to the MS patient, even if they do not directly affect the disease process. We believe that our multidisciplinary team can improve the life style of our patients so that they can maximize the use of body functions that are healthy. Symptomatic treatments, for example, can help pain, stiffness, tremor, fatigue, bowel and bladder function and activities of daily living in general.
Working toward a cure for MS
Multiple sclerosis involves impaired regulation of the immune system. White blood cells, including B and T lymphocytes, monocytes, dendritic cells and plasma cells, enter the central nervous system resulting in destruction of myelin and other nervous system components. Myelin is a lipid-predominant covering of the axons, which are the projections of nerve cells. When myelin is damaged, conduction of nerve impulses is impaired, leading to problems with motor skills, sensory perceptions, coordination and other functions. Unfortunately, in many cases, not only is the myelin destroyed or injured but also the axons and neurons.
Several disease modifying treatments for relapsing forms of MS now exist, but most of these are either sub-optimally effective or carry major risks. New treatments for MS are being developed now at the John L. Trotter MS Center. Some research is at the cell culture stage, some research involves animals with models of MS, and much of our research involves clinical trials in people. Clinical trials ongoing at the John L. Trotter MS Center include several that are testing new drugs, including drugs for the progressive forms of MS where good treatments are lacking, as well as studies of dietary changes to improve MS. We currently have two longitudinal studies of new cutting-edge imaging techniques in MS patients. These techniques were invented at Washington University and are funded by the National MS Society, the National Institutes of Health and the Missouri Spinal Cord Injuries Research Program, following extensive peer reviews.
Some of the agents that have been tested in recent clinical trials at the Trotter MS Center include B cell depleting agents (we were the first to initiate a controlled trial of B cell depletion with rituximab in MS), ibudilast for progressive MS and anti-LINGO-1 for re-myelination. Research studies at the Trotter MS Center are continually changing as we complete some studies and initiate others.
Ongoing laboratory studies are directed toward discovering mechanisms that underlie the development of MS. Some of our projects involve studies of antibodies to myelin in the blood and spinal fluid, endogenous immune suppressors and enhancers, adipokines and diet in MS (adipokines are factors made by adipose tissue), mechanisms by which oligodendroglial cells die (these are the cells that make myelin), blood-brain barrier function in MS (believed to be critically important to new lesion development), dendritic cells in MS and several other promising leads. Our intention is to use information from our research studies to initiate clinical trials in patients, and we have already successfully done this with our studies on B cells in MS.
In 2014, our large five year program project grant was awarded a five-year renewal by the National Institutes of Health. The research is led by Anne Cross, MD, and involves many investigators from Washington University (Drs. Robert Naismith, Laura Piccio, Sheng-Kwei “Victor” Song, Robyn Klein, Yong Wang, John Russell and Peng Sun) and will continue to investigate ways to determine pathology underlying MS lesion development using diffusion imaging (a type of MRI) in patients.
Regulation of the inflammatory response is being examined by Drs. Gregory Wu, Laura Piccio, Erin Longbrake and Robyn Klein. Researchers at The John L. Trotter MS Center are investigating ways to modulate the immune system to lessen the damaging effects of the immune system in MS.
The John L. Trotter MS Center continues to work to better understand MS, work begun by our founder, Dr. John L. Trotter (1943-2001).