Unraveling Clues to Multiple Sclerosis: The Body's Nervous System Gone Haywire

By Nauen, Elinor | The Saturday Evening Post, July-August 2009 | Go to article overview

Unraveling Clues to Multiple Sclerosis: The Body's Nervous System Gone Haywire


Nauen, Elinor, The Saturday Evening Post


If you were asleep for the past decade and a half, you would surely be surprised to wake up in the world of iPods, smart cellular phones, and Global Positioning Systems. What we know about multiple sclerosis (MS) has changed about as much as consumer electronics in that same time frame.

"It's a fascinating time in MS research," says Patricia O'Looney, Ph.D., vice president of biomedical research at the National Multiple Sclerosis Society. "The knowledge is so great now."

[ILLUSTRATION OMITTED]

Multiple sclerosis is an unpredictable and often disabling disease of the central nervous system. It is believed to he an autoimmune disease, which means that the immune sys tern reacts against itself. One of its quirks is that its progress, severity, and symptoms are different in everybody.

An estimated 400,000 people in the United States are affected by MS. Someone is diagnosed with MS every hour, every day of the year.

Symptoms that might send someone to a neurologist for tests include: loss of mobility; numbness, tingling, or pain; and sudden, often temporary, blindness. People may have mysterious, erratic symptoms for years before diagnosis. Most people--two to four times as many women as men--are diagnosed between ages 20 and 50.

Not surprisingly, genetics plays a major role in current research. "So far, researchers have found as many as 12 genes (out of about 20,000 in the human genome) that are linked to MS. Most of these are connected to the regulation of the immune system, which is inherited from our parents. In the end, we may find as many as 80 MS genes," says Dr. O'Looney. "Identifying these genetic markers will help us understand why there's such variability and unpredictability in the disease. There might even be some genes linked to particular types of MS. When you identify genes, it may lead to targets for new therapies."

Being able to predict the course of disease might mean being able to tailor treatment to each patient. But finding these genes (80 out of 20,000) is like looking for a needle in a haystack. The best way to find the needle is to look at a large number of samples from people. To that end, researchers here and in the U.K. are collecting and studying blood samples from MS patients and their family members.

Even with genetic susceptibility, something has to trigger the disease, and researchers are looking for these catalysts. One hypothesis is that a lack of sunlight and vitamin D-which, in part, regulates the immune system--might play that role. One bit of evidence is a higher prevalence of MS the farther you live from the equator in your early years. What complicates this research is that there may be different triggers in different people. If a virus is the culprit, as many suspect, it likely has vanished from the body years before the onset of symptoms.

With more than 130 clinical trials under way around the world, including more than a dozen phase 3 (late-stage) trials in process, nearing completion, or finished, MS research is making huge strides toward solving these unknowns. Many of these trials focus on treatment. The vast majority of people with MS have a type called relapsing-remitting and take one of the FDA-approved disease-modifying therapies. Fifteen years of data demonstrate their effectiveness. "What research has told us is that the disease is much more active than originally thought," Dr. O'Looney explains. "Even if a person is aware of one or two flareups a year, the disease could still be active, although asymptomatic, particularly in the brain. There are times when a person feels OK, but damage is taking place. That's why the National MS Society advocates so strongly that people diagnosed with MS should be on drug therapy." Not everyone responds the same to these medications, so having several to choose among is important. One option we can expect to see within a year or so is an oral medication, which may be offered alongside or as a replacement for the injectable medications. …

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