The Potential for Neuronal Repair in Multiple Sclerosis

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The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.

The panelists are:

• Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
• Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
• Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School

According to Lublin, remyelination “is one of the most exciting aspects of MS research right now, and that is repairing the damaged nervous system.” The investigational monoclonal antibody called anti-LINGO has been studied in acute optic neuritis, showing “a positive effect on affecting a visual outcome, a laboratory outcome of vision.” There is another study with the same molecule in relapsing remitting MS.

The potential for neuronal repair “is pertinent not just to MS, but any nervous system disease where you need to repair, not just remyelinate but have axons resprout, etc,” said Coyle. She indicated that other drugs being studied for this purpose include phenytoin, which showed better preservation of the retinal nerve fiber layer in an acute optic neuritis modeal, and a humanized anti-IgM monoclonal antibody that is being studied in stem cells.

It does not seem like it will be a one-time fix, though. “In MS, there are ongoing insults, and even the clinical attacks are just the tip of the iceberg. We’re not seeing everything down below,” said Coyle. Repair strategies may be needed on a regular basis in combination with disease-modifying therapies. Safety would be the main concern with potential combination strategies, said Dhib-Jalbut, “But I think there is room to combine anti-inflammatory drugs and neuroprotective drugs and that would be safe.”