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This year’s meeting of the Americas Committee for the Treatment and Research of MS (ACTRIMS Forum) was held in late February in San Diego, CA. Over 1270 researchers attended in person, and another 530 attended remotely to hear about and share the latest progress in MS research. 
 
Below are just a few highlights of many important presentations, organized along the three Cures pathways: stopping MS, restoring function, and ending MS forever. Follow the links provided to read the scientific summaries (abstracts) of the highlighted studies. Anyone can access the scientific abstracts (more than 450) here.
 
Study results presented during conferences like this are typically considered preliminary until they are published in peer-reviewed journals.
 
STOPPING MS
Stopping MS in its tracks involves reducing or eliminating the impact of MS before symptoms appear through early detection and preventing worsening of quality of life and disease progression for each person with MS through precision medicine.
 
Barancik Prize for Innovation in MS: Ruth Ann Marrie, MD, PhD, a neurologist and researcher at the University of Manitoba, was awarded this year’s Barancik Prize for her landmark discoveries that deepen understanding of how and when MS evolves. Her prize lecture focused on how having other conditions along with MS (“comorbidities”) can in some cases, hasten disease progression, and she also shared evidence that addressing other conditions may help delay progression. (Read more about Dr. Marrie’s research; Listen to a RealTalk MS podcast featuring Dr. Marrie)
 
Racial/ethnic diagnostic differences: Dr. James Sumowski (Icahn School of Medicine at Mount Sinai, New York) looked at age of diagnosis among different racial and/ethnic groups to determine whether differences might yield clues to disability progression. Data were analyzed for 830 patients identifying as white (487), Black (165), or Hispanic/Latinx (178). Age of diagnosis was significantly younger among Hispanic/Latinx people than in other groups. Receiving an MS diagnosis earlier than age 20 also was more likely for Hispanic/Latinx people. Black people and Hispanic/Latinx reported worse disability than white people. Results suggest that Hispanic/Latinx people with MS accumulate disability at an earlier age. (Abstract P184) Learn more about MS in the Hispanic/Latinx and Black Communities
 
Intermittent fasting: With funding from the National MS Society, Dr. Laura Piccio (Washington University in St. Louis and University of Sydney) and colleagues tested the benefits of intermittent fasting (restricting people to 400-500 calories for 2 days per week). This was compared to an unrestricted diet over 12 weeks in 34 people with MS who completed the study. Participants in the fasting group lost weight, had reduced signs of inflammation in their bloodwork, and results from a test measuring cognition (information processing speed) improved. There were no serious side effects. (Abstract CE2.2) Get the latest on intermittent fasting and other diets for MS.
 
Stopping progression: Young investigator Emily Kamma (University of British Columbia, Vancouver) presented novel research that is helping to reveal what underlies MS progression. A genetic mutation was identified in several families in which people were diagnosed with a highly severe form of progressive MS. Kamma’s team used this mutation to genetically engineer a mouse model, which showed hallmarks of progressive MS. The team is now using this model to study mechanisms underlying MS progression. (Abstract CE2.3)
 
RESTORING FUNCTION
Restoring function in people with MS involves improving nervous system repair to reverse or slow MS progression and improve symptoms and implementing rehabilitation and symptom management strategies to restore function, reverse MS symptoms and enhance quality of life.
 
Myelin repair: Research is ongoing to test approaches to stimulating the repair of myelin, the protective coating on nerve fibers that is damaged in MS. For example, Dr. Karimi-Abdolrezaee (University of Manitoba, Winnipeg) reported on explorations of Neuregulin-1, a factor that may have promise for promoting myelin repair. In lab dishes and in mice with myelin damage, they showed that Neuregulin-1 could enhance normal repair processes at least in part by increasing the ability of cells called microglia to clear away myelin debris that can inhibit repair. (Abstract P349) Clinical trials of myelin repair strategies are underway in people with MS – view a list on clinicaltrials.gov 
 
Fighting fatigue: Dr. Tiffany Braley (University of Michigan) reported on a 12-week trial comparing the effects of cognitive behavioral therapy delivered by phone, the stimulant modafinil, and a combination of both to treat fatigue in 336 people with MS. All treatments reduced fatigue. People who reported sleep problems were more likely to respond to cognitive behavioral therapy. When assessing how participants perceived their own overall improvement, the combination therapy achieved the highest scores. This study was funded by the National MS Society and the Patient-Centered Outcomes Research Institute (PCORI). (Abstract CE1.2) It yields important clues to how to treat the persistent fatigue experienced by people with MS.
 
Aspirin/acetaminophen for overheating after exercise: Evidence is increasing of the healthy benefits of exercise, but people with MS may avoid it because of fatigue or because overheating can temporarily worsen symptoms. Dr. Victoria Leavitt (Columbia University, New York) and colleagues administered 650 milligrams of aspirin, acetaminophen, or inactive placebo to 60 people with MS before exercising to determine whether this would reduce overheating. They report that overheating was reduced 79% more after aspirin and 57% more after acetaminophen, compared with placebo. Other tests suggested that aspirin and acetaminophen improved exercise benefits. There were no serious adverse events in this National Institutes of Health-funded study. (Abstract P067) Note: Overuse of aspirin or acetaminophen can lead to side effects, so it’s important to speak with your healthcare provider before trying this. Read a blog from a participant in this study
 
Increasing exercise: Dr. E. Anne Yeh (University of Toronto) emphasized that moderate to vigorous physical activity is key to moving the needle in MS – “the stuff that makes you sweat.” Evidence in mouse models suggest that exercise can improve repair of nerve-insulating myelin and decrease inflammation. Unfortunately, studies of why exercise works in people are more limited. Her team is developing an app to increase exercise in teens, with funding from the National MS Society. She notes that coaching calls – human interactions – are proving to be crucial to the success of this app. (no Abstract) Get guidelines on fitness in MS
 
Tracking MS with Tech: Dr. Jennifer Graves (University of California, San Francisco) and colleagues presented their work on using wearable sensors to detect changes in function in people with MS. Strapped to the wrist or leg, these bracelets use multiple sensors that can detect function in 5 minutes by assessing finger taps or foot taps, compared with a lengthy neurologic exam. They have found meaningful changes in people that were not picked up by study measures such as the EDSS disability scale. Dr. Graves’ team is working with colleagues to use sensors in a clinical trial in people with progressive MS. (no Abstract ) Learn more about sensor technology for MS
 
ENDING MS
Ending MS forever requires preventing MS before it occurs by limiting exposure to MS risk factors in the general population and reducing or eliminating the impact of MS before onset of signs/symptoms by identifying pre-clinical MS in the high-risk population. Several lectures focused on the role of the Epstein-Barr virus (EBV) and other viruses as potential triggers of MS.
 
Vaccine for EBV? Dr. Jeffrey Cohen (National Institutes of Health, Bethesda, MD) and Dr. Peter Calabresi (Johns Hopkins University, Baltimore) participated in an invited debate focused on the question of whether we know enough yet to target EBV as a way to either prevent or treat MS. Dr. Cohen described EBV vaccine trials his team is conducting to prevent mononucleosis (an illness caused by EBV infection in teens). One strategy involves using “nanoparticles” that help stimulate the immune system to recognize components of EBV. Studies in mice have indicated that this technology can increase the ability of the vaccine to neutralize EBV. He also noted that there are several other EBV vaccine strategies being tested.
 
Dr. Peter Calabresi advised caution about proceeding with an EBV vaccine aimed at preventing MS until more is known. He noted that while there is accumulating evidence that EBV is a contributing factor to the development of MS, there are likely other risk factors that act in concert with EBV. He also noted that a vaccine designed to prevent MS would have to be given during childhood – so it would need to be exceptionally safe, require large numbers of healthy participants and decades to determine its effectiveness as a prevention strategy for MS. Both Drs. Cohen and Calabresi agreed that more research to understand the connection between EBV infection and MS was needed and that insights from these studies could reveal targets for additional safe and effective MS treatments. (Abstract S2.4) Read more about the complex link between EBV and MS.
 
Are emotional changes a sign of pre-MS? Dr. Anibal Chertcoff (University of British Columbia), Dr. Marrie, and others looked at health claims of 6,863 people with MS and 31,865 people without MS in British Columbia, Canada. They compared the number of physician visits, hospital admissions, and prescriptions for psychiatric conditions like depression and anxiety in each of the 5 years before MS was diagnosed. All were significantly increased in people with MS, indicating that an uptick in mental health changes may be part of the pre-MS “prodrome.” Identifying specific signs of the MS prodrome may enable earlier treatment to stop or even prevent MS. (Abstract S1.3) Learn more about the prodrome in a RealTalk MS podcast
 
These and many other studies are bringing us closer than ever to cures for MS. Read more about Pathways to Cures