When are we able to solve MS?

Short answer

It is impossible to predict when we may be able to cure MS. This is mostly due to the fact that we do not yet fully understand how MS develops. Moreover, MS is a complex disease that varies greatly from person to person. At present, we can significantly slow the progression of the disease and also treat accompanying symptoms. Promising developments in fundamental research on MS do offer hope for the future!

Longer answer

What is Multiple Sclerosis

Unfortunately, MS is a familiar abbreviation for many people. Possibly due to personal experiences within family or among friends, or perhaps from the news. MS is short for Multiple Sclerosis. The name multiple sclerosis is a combination of the Latin word multiple and the Greek word sklērós, meaning “multiple hardenings.” The name refers to the multiple hard scars in the central nervous system (brain and spinal cord) that are found in MS. The name dates back to the 19th century, when the disease was first systematically described.

MS is a disease in which local inflammation occurs in the central nervous system. The inflammation affects the protective layer surrounding the nerve pathways (myelin) (see also the answer to “How is a neuron made?). Due to the damage, signals from the nerve cells are transmitted less efficiently or may not be transmitted at all. It can even lead to the death of the unprotected nerve cell altogether. The site of damage is referred to as a “lesion.” These lesions can develop in various locations within the central nervous system. Depending on where they are, a person may experience problems with vision, memory, thinking, emotions, balance, or walking.

Attacks, recovery, and gradual decline

We know that the nature of the symptoms vary from person to person (which depends on the location of the lesions). In addition, in MS we distinguish between different disease courses: how the disease develops over time. Most patients initially experience a course called relapsing-remitting MS. Which involves alternating periods of attacks (relapses) and recovery (remission). During relapses, new symptoms often appear or existing symptoms worsen. During remissions, these symptoms partially or sometimes completely disappear. Patients can also have a progressive course. In this case, patients experience a steady increase in disease severity and a decline in function either from the beginning (primary progressive MS) or after an initial relapsing-remitting phase (secondary progressive MS), without clear relapses and remissions.

Microscopic images of brain tissue from a person with MS. Brown indicates healthy tissue (myelin) around nerve pathways (using a stain applied by the researchers to the tissue, under normal conditions myelin is white in color). Black shows active immune cells that are breaking down this layer. Where the tissue is damaged, spots called lesions form. During the course of the disease, a lesion can be actively inflamed (with immune cells attacking the tissue), become chronically active, settle down (inactive, with immune cells leaving the tissue alone), or partially repair itself (a process called remyelination). This image has been adapted with permission from Luchetti et al., 2018.

An increased risk of MS?

There is evidence that both genetic factors and lifestyle can influence the risk of developing MS. For example, women are more likely to develop MS. Smoking and being overweight also increase the risk of getting MS. In addition, the Epstein-Barr virus may also play a role in MS. This is a common virus from the herpes family, best known as the cause of mononucleosis (glandular fever). But correlation does not imply causation! Scientists use this phrase when they find a link between certain factors and a disease (such as MS) but cannot prove that these factors actually cause the disease. For now, this is the situation regarding the link between the Epstein-Barr virus and MS.

Current Treatment of MS

Although MS cannot currently be cured, treatments can slow down the disease process. The most common approach is the use of disease-modifying therapies. This group of medications suppresses the patient’s immune system and is particularly effective for patients with relapsing-remitting MS. There are many such medications available, often with names that are almost unpronounceable, such as interferon-beta, glatiramer acetate, fingolimod, and natalizumab. The main goal of these medications is to reduce and prevent overactive inflammatory responses in the body, thereby decreasing the severity of relapses (and associated symptoms).

In addition to disease-modifying medications, symptom management and lifestyle adjustments can also support people with MS. Medications are available for symptoms such as fatigue, muscle stiffness, and pain, which are common in MS. Furthermore, physical therapy and psychological support can help improve quality of life. Getting support for healthy nutrition, getting regular exercise, and to quit smoking can also benefit patients.

No cure yet, but progress

There’s more however! Currently, a lot of effort is going into developing new treatment methods. Stem cell therapy works for some patients, but there are still some challenges associated with it (see the answer to “Why don’t we use stem cell therapy for MS?”).

Additionally, several clinical trials offer hope. For example, it appears that a new generation of medications, called Bruton’s tyrosine kinase (BTK) inhibitors, may be effective even for people with progressive MS. This is important because progressive MS is much harder to treat than relapsing-remitting MS. The BTK molecule naturally plays a key role in activating specific immune cells. BTK inhibitors are small drugs that, due to their size, can cross into the brain. Once in the brain, they specifically inhibit these immune cells, reducing inflammation and, consequently, the breakdown of myelin in MS. Because BTK inhibitors specifically target the relevant immune cells, the entire immune system does not need to be suppressed (as is the case with the disease-modifying therapies mentioned above). This could be a significant improvement!

New treatments are also being investigated that may potentially repair damaged myelin. This is done by stimulating the development and growth of cells that produce myelin (oligodendrocytes). Research into these types of drugs is still ongoing, and they are not yet available to patients. Unfortunately, MS is still not curable, but the prospects in MS research are promising!