Researchers are continuously uncovering new ways to help cure multiple sclerosis (MS). One area in particular that shows promising results is neuroprotection. Neuroprotection aims to prevent nerve cells from becoming damaged, thus slowing down the progression of the disease. Initially, MS symptoms develop when the nerve cells become damaged. Although the cause has not yet been determined, it is thought that MS is triggered when nerve cells are exposed to chemicals. These chemicals are revealed when tissue inflammation is present. The theory behind neuroprotection is that if the nerve cells can somehow be protected from these chemicals, MS can be lessened or prevented.
How can neuroprotection help?
There are several ways in which neuroprotection treatments can work or rather can be applied. One example in particular is to toughen the nerve cells so that they are less likely to be attacked. Another example is to prevent harmful molecules from causing nerve damage to begin with. Strategies to prevent nerve cell damage are linked to those aiming to encourage myelin repair. While both areas work towards preventing nerve damage, neuroprotection treatments solely focus on protecting nerve cells. On the contrary, myelin repair treatments strive to set myelin back on nerve cells so that the myelin sheath can work to protect the nerve cells from initial damage.
What causes nerve cell damage?
According to the Multiple Sclerosis Society UK, research on MS has identified some of the mechanisms that lead to nerve cell damage. Currently, clinical trials on underway to test treatment options aimed at preventing these mechanisms, such as sodium channel blockers. It is believed that if viable medications can be developed, the progression of all types of MS can be significantly slowed down. Currently, this is not the case for available treatment options.
An excessive amount of sodium in the brain is thought to be associated with nerve damage in individuals with MS. For this reason, clinical trials are testing their neuroprotective potential. However, in order to understand how well these drugs work to protect damage to the nerve cells, they have been initially put to the test on a condition commonly known as optic neuritis. Optic neuritis is an inflammation that damages the optic nerve, a group of nerve fibers responsible for conveying signals between the eyes and the brain. It is sometimes experienced by individuals with MS, causing sudden blurred vision and possibly partial or total blindness. Neuroprotective treatments are tested in optic neuritis because the nerves that are present in the back of the eyes can be more easily identified. They give researchers a well-rounded image of the neuroprotection potential of treatments such as phenytoin.
Phenytoin is an example of a sodium channel blocker that is used to treat conditions such as epilepsy. It was tested in a phase 2 clinical trial to reveal its effectiveness in the prevention of nerve cell damage. The results revealed that there was 30% less damage to the nerves of the visual system in participants who had been taking phenytoin as opposed to those who had been taking placebo. In turn, this trial supports the neuroprotective role of phenytoin, encouraging further development in the treatment of diseases such as MS. Amiloride is another example of a sodium channel blocker and it is currently used to treat conditions such as heart disease. Similar to phenytoin, it too was tested in a study and the results of the trial revealed that participants who had been taking amiloride experienced the same amount of nerve damage at the back of their eyes as those who had been taking placebo. Even so, more research needs to be conducted in order to portray finalized outcome results.
Glutamate receptor blockers are chemicals involved in the transmission process of signals between nerve cells. Since extreme levels of glutamate can lead to loss of nerve fibers, hindering these channels can help to protect the nerves. Riluzole is an example of a glutamate channel blocker that is currently being tested for individuals with MS. A study was conducted with 16 individuals with primary progressive MS and the results suggested that riluzole may help to slow down spinal cord atrophy.
An example of a new project underway for neuroprotection is MS SMART Trial. MS SMART is a 3-year phase 2 trial that began in 2015. It is co-funded by the MS Society and unlike most trials, it aims to identify the usefulness of three drugs that are thought to have neuroprotective potential. Participants with secondary progressive MS will be divided into 4 groups and each group will be given one of the following three drugs – amiloride, riluzole, or fluoxetine. Furthermore, each participant’s brain volume will be assessed through MRI scans. Researchers will observe the neuroprotective effects of each drug to see whether they help reduce or prevent nerve damage.
MS Society funding
The MS Society is currently funding and working to develop an MRI-based study. This study will use modern imaging techniques to pinpoint changes in the brains of individuals with secondary progressive MS given simvastatin in comparison to those given a placebo. Simvastatin is part of a group of medicines known as statins and it is used to treat high cholesterol. Most recently, evidence has led researchers to believe that this medication has neuroprotective effects. Additionally, a project has been funded by the MS Society to test whether BHDPC can, in fact, protect myelin and nerve cells from damage in an animal model of MS. Researchers will be able to understand and determine whether BHDPC or other molecules for that matter, would prove to be effective treatments for individuals with MS.
Since multiple sclerosis is an autoimmune disorder that affects the brain and/or spinal cord, researchers are continuously striving to understand its exact cause. By performing various studies, they hope to understand why the immune system mistakenly attacks parts of the body that are essential for daily function. Still, the question remains as to why MS causes unpredictable symptoms such as fatigue, tingling and numbness, vision problems, and bladder issues. What is known is that once the nerve cells become damaged, they trigger inflammation. This can prove difficult for the brain to send signals to the rest of the body. Moreover, each individual is subject to experience different symptoms of MS, depending on the nature and intensity of their condition. For this reason, treatment depends on each individual case. Some treatment options are recommended to treat relapses (attacks), while others are designed to help ease symptoms and improve an individual’s overall quality of life. Hopefully, neuroprotection will be added to the list, although research is still at a fairly early developmental stage.
Studies are exploring the potential of neuroprotection as a long-term approach rather than making the particular medication available to individuals with MS for a short-term period. That being said, although there are presently no neuroprotective treatments available to individuals with MS, researchers are continuing to push ahead towards understanding neuroprotection better. They are beginning to implement new technologies for developing medications that can slow down the progression of multiple sclerosis. In the off chance that these therapies reveal natural repair mechanisms as opposed to disease specific mechanisms, they can still prove useful in the diagnosis and treatment of brain diseases such as stroke or epilepsy.
More specific therapies are now being implemented into clinical phases and if proven successful, they can help to improve your overall quality of life, especially if you are suffering from progressive forms of MS. The results are promising and there are exciting treatments being tested and developed for future MS management and treatment regimes.