Tuesday, December 11, 2007

In an astonishing scientific tour de force, Canada has established itself as a world leader in Multiple Sclerosis research. A little over a decade ago there were no effective therapies to help slow the inevitable progress of what is essentially still an incurable disease.

Today, there are five with at least 15 more in various stages of clinical tests. Globally, there are likely 150 such trials underway, says Dr. Wee Yong, chair of the medical advisory board of the Multiple Sclerosis Society of Canada and a neuroscientist at the University of Calgary.

"There have never been so many bright rays of hope for those with MS," he says. "This is truly an exciting time."

Canada is one of the world leaders in research, adds Aprile Royal, assistant vice-president medical information and education at the society.

"The amount of work being done here is truly impressive," she says. "For a country with such a small population we are having a major impact globally."

Nor is the research focused solely on remitting/relapsing MS, the type which affects almost 85% of those with the disease, points out Dr. Yong. Research is being done simultaneously into both early stage and latter stage progressive MS.

Work by Canadian and internationals scientists now seems to cover the entire spectrum, from identifying genetic markers that may trigger the disease, through providing protection against its progress and even into ways to restore the damage done to the central nervous system, medications that can actually repair the myelin sheathing damaged by the body's own immune system.

"We are also looking at treating MS as we would other immune system diseases, with a combination of drugs," says Dr. Yong. "That approach has worked with cancer and with HIV/AIDs and may indeed achieve the same results with MS."

One of the promising current research projects is the use of a 50-year-old acne treatment, says Ms.Royal. "If it proves successful, then we are looking at a cost of $800 a year instead of about $20,000," she says.

"But perhaps best from the patients' point of view, it comes in pill form and there are none of the side effects of current injectable therapies."

That drug is minocyline, an anti-bacterial and immuno-modifier. It is about to start Stage 3 clinical testing, the final phase before achieving Health Canada approval, at the University of Calgary.

"It seems to have an appreciable effect when used in very early stage MS," says Dr. Yong. "It seems to have the ability to reduce the number and size of lesions."

Part of minocycline's promise lies in its easy to take pill form. "If you take it right after the first episode, it may delay needing injections of other medications. That is an important benefit if you are about to start on drugs you have to take for the rest of your life," he says.

"We also have another five oral medications in phase two testing."

Researchers are also following up on the promise shown by one of the newest therapies for the treatment of MS. The novel mode of action is most encouraging, one which prevents some of the immune system's cells from entering the brain where the damage is done. While not without its challenges, the hope is to have medications that work more effectively without making you feel worse due to side effects of the drug itself. They may also offer patients the blessing of fewer treatment injections, a difference that could amount to hundreds of injections each year. These are significant advances in the quality-of-life parameters that so many MS patients have been struggling with for some time now.

"There are three other similar drugs in the testing phase now as well," Dr. Yong says.

Nor has prevention been overlooked. Researchers now believe smoking and even second-hand smoke may be a factor in developing MS, based on statistical evidence. Vitamin D deficiency is another possible factor.

Researchers at the University of Toronto and McGill University are looking at the long-term safety data and potential efficacy of Vitamin D3 therapy.

MSpatients in this trial are given high doses of Vitamin D3 (a minimum of 10,000 IU daily) over a prolonged period of time and its effects are tracked with regular MRI scans.

Some of the most fascinating research involves what triggers MS at the genetic level.

"It is not a simple process," says Dr. Yong. "There is no single factor and different genes affect different people. What we need to do is identify which genes are associated with which risk factors. People carrying those genes will then know what to avoid."

Finally, there are grounds for optimism that researchers can find ways to repair damage to the central nervous system already done by MS. "We are working on ways to repair that damage not just through things like stem cells but also through medications, which can effectively repair dam-aged myelin coating.

"I have already seen three articles in experimental literature about work being done in that field."

As Ms. Royal says: "I don't think the future has ever looked brighter for MS patients."