Multiple Sclerosis (MS) is a chronic autoimmune disease characterized by the immune system’s attack on myelin, which is the protective coating that surrounds your nerve cells.
This attack results in nerve damage, leading to communication disruptions between your brain and the rest of your body. MS primarily affects the brain, spinal cord and optic nerves, causing a range of symptoms such as vision problems, muscle weakness, fatigue and coordination difficulties.
Canada has one of the highest rates of MS globally, with approximately 90,000 Canadians living with the disease. On average, 12 Canadians receive an MS diagnosis each day. Most individuals are diagnosed in the prime of their lives, between the ages of 20 and 49.
Causes of MS
The causes of MS are still a mystery, although the best evidence available suggests it results from a complex interplay between genetics, biological factors, lifestyle and the environment, such as exposure to viruses. Recently, compelling evidence has shown that a common virus called Epstein-Barr can trigger MS. While there is strong evidence of this, Epstein Barr is common and many who contract it will not go on to develop MS.
Symptoms of MS
The symptoms of MS vary widely among individuals. While some may experience mild symptoms that do not require treatment, others may struggle with
- Difficulty walking
- Extreme fatigue
- Muscle weakness or spasms
- Blurred or double vision
- Numbness and tingling
- Sexual problems
- Poor bladder or bowel control
- Pain
- Depression
- Cognitive difficulties
Early signs of MS
An initial MS attack usually involves visual symptoms. This leads to
- Complete or partial loss of vision (usually in one eye)
- Pain when you move your eyes
- Blurry or double vision
Most individuals experience periodic exacerbations known as relapses, followed by periods of remission where symptoms are stable, known as relapsing-remitting MS (RRMS). However, for some individuals, the disease progresses steadily over time, leading to worsening symptoms and disability, known as primary-progressive MS (PPMS) or secondary-progressive MS (SPMS).
An initial MS attack usually involves visual symptoms. This leads to
- Complete or partial loss of vision (usually in one eye)
- Pain when you move your eyes
- Blurry or double vision
Most individuals experience periodic exacerbations known as relapses, followed by periods of remission where symptoms are stable, known as relapsing-remitting MS (RRMS). However, for some individuals, the disease progresses steadily over time, leading to worsening symptoms and disability, known as primary-progressive MS (PPMS) or secondary-progressive MS (SPMS).
Treatments for MS
The available treatments can be categorized into symptom management therapies, relapse management therapies and disease modifying therapies (DMTs).
Symptom Management Therapies
These are medications that help manage a variety of commonly experienced symptoms including muscle spasticity(muscle relaxants), double vision (prisms), bladder dysfunction (antispasmodics, botox), bowel dysfunction (stool softeners, diet), fatigue (central nervous system stimulants), depression (anti-depressants), and pain (neuropathic pain agents).
Relapse Management Therapies
In cases with severe relapses, steroids may be used to reduce inflammation in the central nervous system. Steroids are typically safe to use over a short period of time (3 to 5 days) and are not recommended for use long-term. These treatments can reduce the intensity and duration of a relapses.
Disease Modifying Therapies (DMTs)
These therapies are administered through injections, intravenous infusions or oral medications and are designed to reduce or prevent the frequency and intensity of relapses, prevent new brain lesions seen on MRI, and slow down the progression of disease-related disability. While there are over a dozen DMTs available, the most commonly used ones are monoclonal antibodies (MABs) given as infusions or injections. While DMTs help prevent new damage, they do not typically reverse disability. Very few of the currently available DMTs will slow or stop progressive MS, an important unmet need.
New treatments could revolutionize care
There are many more DMTs under Phase 2 and Phase 3 trial that may be available in a few years subject to Health Canada approval. If successful, these therapies may have improved safety, and ideally, impact on stopping progression and enhancing repair.
There is a need for innovative research programs that can lead to discovery of new diagnostic biomarkers and development of novel targets for safe and effective therapies. Among the few novel treatments developed in the last decade, treatments using stem cells has emerged for those with poor prognosis.
Stem cell therapy using hematopoietic stem cells that are found in bone marrow involves depletion of one’s immune cells using chemotherapy and reintroducing their previously collected stem cells to repopulate the immune system with healthy cells that won’t continue to attack the central nervous system. Trials around the world, including Canada have been informative and have identified patient populations and conditions under which this treatment might be beneficial. Autologous hematopoietic stem cell transplant is still considered high risk and is only available at three sites in Canada for a subset of individuals that meet very rigid eligibility criteria.
Preclinical studies have shown neuro-protective effects of other stem cell therapies as well. Early phase and first in human studies are currently underway to test the safety and efficacy of mesenchymal stem cells and neural stem cells for different forms of MS.
Cell therapies not only have the potential to restore immune tolerance, but have potential to be personalized with fewer side effects that are the most common drawback to existing treatment options. It is important to leverage immune cell products that are being tested in other autoimmune diseases into developing novel therapies for MS.
For this reason, UBC is uniting world leading scientists on a mission to find next-generation cell-based therapies that will transform patient health. The MS Research Network will benefit from the thriving biomanufacturing and life sciences ecosystem at UBC that includes the Academy of Translational Medicine, a translational medicine pathway to accelerate discoveries into the clinic and Canada’s Immuno-Engineering and Biomanufacturing Hub, a UBC-led coalition of multi-sectoral partners for developing and manufacturing next-generation immune-based therapies. In addition, the MS Research Network has strong collaborative partnerships with the Djavad Mowafaghian Centre for Brain Health (DMCBH) that has experts working on all facets of brain health and houses the UBC Hospital MS Clinic and the School of Biomedical Engineering (SBME) where innovative bioengineering techniques can be used to leverage discoveries in other fields into will paving the way for new and safer ways to manage MS. The goal is to restore quality of life for those living with MS.
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