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Are We Close to a Cure for MS?
00:00:09:49 - 00:00:33:91
Eric Peacock
One last separate topic now, outside of spasticity. And this is one we see frequently from, well, we see it from newly diagnosed patients in particular, but we also see it from veterans who've had it for years. And the question is, are we getting any closer to a cure for MS? I know you're involved with lots of different types of clinical trials and studies. Where do you think we are on that front?
00:00:33:91 - 00:01:37:46
Dr. Boster
I think that it's unlikely that we're gonna have a cure in my lifetime. And I'm not saying that to be a Debbie Downer. We have a better understanding of the immune system and MS pathogenesis than ever before, and yet, it's still largely uncharted territory. And we're still uncovering and learning about the nervous system and about the immune system and the way they interact. Now, before someone risks getting discouraged, I do think it is extremely realistic that we can make MS completely boring during our lifetime. I'll give you an example. Diabetes used to be a death sentence. If you got diabetes, before the era of insulin, people would lose their kidneys and they would pass. Nowadays, it's not remotely easy to have diabetes, but if someone works hard at it, and things go well, it can be very boring. And you might not even know your friend has diabetes unless you happen to see them inject their insulin.
00:01:37:46 - 00:01:40:44
Dr. Boster
Today, in some cases, we are becoming successful making MS boring. And I think that a realistic goal is that it should be boring for everyone who has the condition. Right now, we've gotten really good. We have many, many disease-modifying therapies. They're all anti-inflammatory, they're all different flavors of medicines that quell inflammation, which is a really good thing to do. We really need three kinds of medicines to beat the disease. A second category of medicine is a remyelinating agent, a drug that would take an axon that's been stripped of the myelin, and recoat the myelin on it. And I think that we are probably less than nine years out from having remyelinating agents available. That's a short period of time. I think in under a decade, we're gonna have remyelinating agents that are available. There's a lot of MS clinical trials ongoing. I've participated in some, and they're really exciting. There's a third agent after an anti-inflammatory and a remyelinating agent, and this is a neuroprotective agent, because we know that people impacted by MS have accelerated shrinkage of the brain. They lose their functional reserve, and we need something that would protect against that, and that unfortunately doesn't exist yet. But there are, again, many early studies looking into therapeutics that might do that. So what we want to do in the interim is what we can do. In the now, I want my patients to be four for four in their fight against MS. I want them to take the most effective DMT they're comfortable with, and I want them to make sure it's working the way that we talked about. I want number two, for people to exercise as part of their lifestyle. Number three, I want them to supplement low levels of vitamin D, and I want them to eat clean. And number four, I want them to avoid tobacco. And so if we can do that, we can preserve the reserve, and we can help people's brain age as naturally as possible so that when the remyelinating agent hits, they're healthy enough that they can benefit from it.
00:03:48:53 - 00:03:50:68
Eric Peacock
Terrific advice.
Will we ever see a cure for multiple sclerosis? That’s one of the most frequently asked questions — and topics of conversation — among people living with this disease. “I’m so tired of feeling this way every day,” said one member of MyMSTeam. “I wish MS had a cure.” Another commented, “Praying that a cure for this disability is found in my lifetime!”
Although neuroscience researchers have more insights into possible causes of MS, we’re still a long way off from a cure, according to Dr. Aaron Boster. A board-certified neurologist and president of The Boster Center for Multiple Sclerosis in Columbus, Ohio, Dr. Boster also has a YouTube channel with a full video library that covers many aspects of treating and living with MS.
“I don’t really think that in my lifetime that we will cure the disease. I hope I’m wrong,” Dr. Boster said in an exclusive interview with MyMSTeam. ”And it’s not out of a lack of desire or effort.”
The good news: Scientists are honing in on ways to improve quality of life with MS, which affects nearly 1 million people in the U.S. More MS therapies are being developed than ever before, according to the National Multiple Sclerosis Society. The disease is also being diagnosed earlier, so disease-modifying treatments (DMTs) can begin sooner. And scientists are discovering possible risk factors that could eventually help prevent the disease.
Thanks to these advances, MS is becoming a manageable chronic disease, Dr. Boster said. Like diabetes, MS may not be curable, but it can be managed with diet, lifestyle modifications, and medications.
“If we get ahold of it early, and we’re aggressive and it’s treated, then we can make the disease boring, so that you live your best life despite MS,” Dr. Boster explained. “That is realistic today in 2024.”
MS is thought to occur when the body’s immune system attacks the central nervous system (CNS), causing inflammation that damages the myelin sheath, a protective coating around nerves of the brain and spinal cord. This neurological (nerve) damage disrupts the signals those nerves send to other parts of the body, causing common MS symptoms such as:
“We’re only now starting to be able to impact areas of the immune system that we’ve never been able to reach before,” Dr. Boster told MyMSTeam.
Health experts believe that stopping inflammation is the key to stopping MS in its tracks. Dr. Boster identified three treatment types under development that are important steps toward improved quality of life — and possibly a cure:
DMTs work by modifying immune system activity to slow the course of active MS. Although these drugs can’t cure MS, they’ve been highly effective at reducing the inflammation that causes nerve damage and slowing disease progression.
The U.S. Food and Drug Administration (FDA) has approved more than 25 DMTs, which can be administered orally or by injection or infusion. In clinical trials, DMTs have been shown to help reduce the frequency and severity of flare-ups. They can also reduce the development of new lesions and slow disability. New DMTs continue to be developed for more effective treatment of MS.
DMTs are prescribed primarily for people with relapsing forms of MS, which include relapsing-remitting MS (RRMS), clinically isolated syndrome (CIS), and active secondary-progressive MS (SPMS). They include drugs in several different classes that work in different ways.
Here are some classes of DMTs along with examples:
Read more about specific medications in this list of treatments for MS.
In addition to treating relapsing MS, ocrelizumab is the first and only DMT approved by the FDA to treat primary progressive MS (PPMS).
Although DMTs are the best defense against MS to date, each person responds differently to the medications, and the drugs can have a risk of significant side effects. Your neurologist can recommend the best treatment options and discuss potential side effects for your type and stage of MS. In partnership with your neurologist, you’ll make decisions about when to start, stop, or switch MS medications.
Although DMTs can reduce inflammation that damages nerves, they can’t stop or repair damage that has already occurred. Remyelination treatment would change that.
“We’re probably a few years out from having remyelinating agents available. That’s a short period of time,” said Dr. Boster, who shared that he has taken part in several “really exciting” trials.
According to one group of researchers, treatments aimed at remyelination are likely to become available within the next decade. Scientists are currently studying ways to stimulate the brain’s natural ability to repair damaged nerves in a person with MS.
A few of the compounds currently being studied for remyelination include:
Results from these and other clinical studies will hopefully make it clear which remyelination strategies are most likely to be safe and effective for people with MS.
Researchers are also investigating therapies that could slow brain atrophy, one of the most destructive actions of progressive MS and a reliable predictor of future physical and cognitive disability.
“We know that people impacted by MS have accelerated shrinkage of the brain and lose their functional reserve,” said Dr. Boster. “We need something to protect against that.”
Unfortunately, he added, a neuroprotective agent doesn’t yet exist.
But neurology research is advancing nonetheless: “We have had multiple failures in the last couple of years — remodeling agents that haven’t worked, neuroprotective agents that haven’t worked. And that breaks my heart. But each time we do that we become slightly smarter.”
A few examples of medications being studied for their potential neuroprotective abilities include:
If studies can show that one or more drugs can safely prevent the worsening of brain atrophy in MS, new treatments focused on neuroprotection may be forthcoming.
Ongoing research in the treatment of MS continues to expand, and more experimental therapeutics are emerging with the potential of new treatments becoming available in the next 10 years. Along with studies of neuroprotective therapies, researchers are investigating immunomodulatory treatments, bone marrow transplantation, and personalized medicine as promising areas of research.
Breakthroughs in gene research are identifying genetic variants and genetic biomarkers associated with disease activity in people with MS. Genetic biomarkers, also known as genetic markers, can help identify who is susceptible to disease. Genetic research is one avenue that may lead to new types of treatment for MS.
“Each time there’s a little bit of research, we add a pebble onto a pile of tasks. And each little tiny piece of information gives us more and more knowledge and more and more tools. And the totality of that will eventually reach the peak,” Dr. Boster said.
Until a cure is discovered, Dr. Boster says the best defense against MS is fourfold. He recommends the following strategies for improving your quality of life with MS. Talk to your health care team if you need help managing your condition.
Deciding on an MS treatment requires a careful discussion with your neurologist to determine which medication is right for you. “I want [my patients] to take the most effective DMT they’re comfortable with,” Dr. Boster explained. “I also want to make sure it’s working for them.”
Aside from promoting good health in general, physical activity can help manage many symptoms of MS. “Exercise should be part of your lifestyle,” Dr. Boster said.
Vitamin D and diet are essential to good MS defense, according to Dr. Boster. Low levels of vitamin D are common in people with MS. You can ask your doctor to check your vitamin D levels with a blood test. If you have low levels of the vitamin, Dr. Boster recommends discussing supplementation with your physician.
Diet is another important MS defense. A nutritious, well-balanced diet has the potential to reduce symptoms and improve quality of life. The National Multiple Sclerosis Society recommends the following:
Try these ideas for healthy snacks and quick bites.
Smoking has been shown to increase the risk of developing MS, promote disease activity, and worsen symptoms and disability progression. It may also inhibit the benefits of DMTs. It’s very important to avoid tobacco, Dr. Boster warned.
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 213,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Do you follow news about MS research and the search for a cure? What works for you to manage your MS until a cure becomes available? Share with others in the comments below or by starting a new conversation on MyMSTeam.
Kiran Chaudhari, M.B.B.S., M.D., Ph.D.
is a specialist in pharmacology and neuroscience and is passionate about drug and device safety and pharmacovigilance.
Learn more about him here.
Kelly Crumrin
is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses.
Learn more about her here.
Laurie Berger
has been a health care writer, reporter, and editor for the past 14 years.
Learn more about her here.
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Just to add to my reply, because I forgot to put it in 😬 I often say "it's Northern-Railing" it 🤣
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