World MS Day 2020

As World MS Day 2020 focuses on the importance of staying connected, researchers at the Brain and Mind Centre look at the significance of the connection between patients and scientists. Through participation in research trials and collaborative research partnerships, research connections have contributed to more advances in MS treatment in the past 10 years than for any other neurodegenerative disorder.

Professor Michael Barnett directs the Brain and Mind Centre MS Clinic, a collaboration between the University of Sydney and Royal Prince Alfred Hospital, and says this past decade has seen great leaps in treatment and early intervention. Two highlights of more than 15 years with the clinic have been the significant advances in MRI technologyand the great leaps in drug treatments facilitated by clinical trials, which have dramatically improved monitoring and prognosis of MS.

“The understanding of all neurodegenerative diseases has come a long way, but it’s only in MS that we’ve been able to control the pace and progress of the disease to such a great extent. It is in large part down to our connection with patients, scientists and research partnerships, that we’ve been able to translate discoveries into trials, and then treatments.”

Professor Barnett said when he embarked on his neurology training 25 years ago, at the University of Sydney MS Clinical Trials Unit, Professors Jim McLeod and John Pollard, both ‘giants’ of Australian neurology, were launching the world’s first patient trial for a drug for MS. Today, there are 17 medications now available in Australia and Professor Barnett said being able to connect his patients with his research teams through clinical and research trials, has helped him achieve vastly improved outcomes for his patients.

“Even 10 years ago, I was seeing people who hadn’t been able to control that early, acute inflammatory stage of the disease, which had caused significant disability. Today, most people who are newly diagnosed with MS are able to manage its progression and symptoms.”

Environment lawyer and PhD candidate Lauren Butterly agrees. Diagnosed with MS 10 years ago, she says the first year of her diagnosis was incredibly challenging, as doctors worked to find the right medication and establish a management plan. However once in place, Lauren says her MS management has been absorbed into her life.

“At first it’s so unknown, everything about it is new and scary. Then you get a treatment plan that starts to work, things plateau and you can build your confidence with it,” Lauren said.

“One day, you wake up and realise it wasn’t the first thing you thought about that day. Maybe it is cold and you don't want to get out of bed… but you realise it wasn’t about MS”

“Keeping connected was so important: From a personal perspective I had MS role models I could see who were working and achieving all their career goals, and from a health perspective, I hit it head on. I researched my options, talked them through with Michael and got started on a medication. Through his association with the university research, he found a medication that started working, which I’ve been on for nine years with no new lesions.”

Looking ahead to the next major challenge in MS, Professor Barnett and his team are working towards the development of neuroprotective therapies, with a focus on imaging biomarkers of nerve fibre (axonal) and myelin (the fatty sheath around nerves) damage. As all current therapies are anti-inflammatory treatments, there is still no treatment for remyelination – the repair of damaged neurones.

New medications, such as gold nanoparticle-based therapy currently in clinical trial phase at the Brain and Mind Centre are showing promise.

“These will yield the next generation of neuroprotective therapies.”

Some of the biggest developments in MS research are carried out at the molecular level, yet their impact on the treatment of MS are immense. Biomarkers are the tiny tell-tale events, such as lesions in MS, which signal the presence of a disease or its progression. Dr Chenyu (Tim) Wang is a postdoctoral researcher at Brain and Mind Centre and the Director of Operations at Sydney Neuroimaging Analysis Centre, and part of the team that has identified new imaging biomarkers that accelerate thed diagnosis, and facilitate the monitoring, of MS.

The biomarkers were discovered through collaboration with University of Sydney, Brain and Mind Centre, the Sydney Neuroimaging Analysis Centre, hospital partners and the countless patients we work with to improve outcomes for people living with MS. In a disease where outcomes depend on early intervention, this research could have great implications.

“Only one in 10 new lesions in the brain cause noticeable symptoms. Yet there can be millions of nerve fibres being permanently destroyed by a single new lesion, which may not be immediately apparent to either the patient or their treating neurologist,” Dr Wang said.

“These are hidden signs that tell us the disease is progressing.”