This year’s annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) took place from October 12 to 14 in Milan. This most important scientific MS congress discusses the most important questions about therapy and diagnosis of multiple sclerosis and outlines the future challenges for the therapists. An opening lecture traditionally provides an overview – the ECTRIMS Lecture.
This lecture was given by Stephen Hauser from the University of California San Francisco (UCSF). Prof. Stephen Hauser is more than any other clinical scientist for the establishment of B-cell-depleting therapies in the treatment of multiple sclerosis. These drugs are currently considered one of the most effective treatment concepts for relapsing MS, but have also had initial success in treating the chronically progressive phase of the disease.
Complete control of MS?
Stephen Hauser sees MS as an example of a significant success story of molecular medicine and titled his lecture “We are halfway home, but we are not all the way there” – a quite encouraging statement.
His lecture was divided into the discussion of three essential principles in the treatment of MS patients, which in my opinion are quite groundbreaking and remarkable. The first principle is “earlier is better”. Stephen Hauser sees an absolute necessity for early and as efficient as possible therapy. Based on various clinical studies, he shows that the probability of the best possible, possibly even complete control, is greater the earlier intervention takes place in the course of the disease. A view that I also represent again and again in my contributions.
EBV antibodies as biomarkers for MS?
However, this presupposes that the risk of developing an autoimmune reaction against the CNS and thus becoming ill with MS is recognized as early as possible. In this context, it is of interest (in analogy to other autoimmune diseases) to identify serum antibodies that indicate a possible later autoimmune disease. Initial analyses therefore suggest that certain antibodies against surface proteins of the Epstein Barr Virus (EBV) could serve as such biomarkers. Their identification, for example within risk groups, could then allow even earlier and therefore more efficient therapy.
On this basis, Stephen Hauser then posits that he considers MS to be “curable” – although he qualifies this by saying that “cure” needs to be defined. One can certainly have ambivalent feelings about this statement, but there is no doubt that it defines a goal against which new therapy options must be measured.
However, since the cellular drivers of MS are very heterogeneous, his third thesis is, the path to complete disease control or cure of MS will only be possible through a differentiated influence on the individually different cellular drivers – and this inevitably requires new therapy concepts that go beyond mere (peripheral) inflammation inhibition.
Dynamic therapy development, also for progressive MS
Against this background, it was then exciting to hear in the various scientific sessions what new developments are hoped for. Understandably, a large space is occupied by the so-called BTKi (Bruton Tyrosine Kinase Inhibitors), which are currently being tested by various companies in clinical study programs, also for progressive MS. Also exciting are study programs for Simvastatin, alpha-lipoic acid, Vidofludimus, N-acetyl cysteine and so-called RIPK1 inhibitors, which aim to slow down or even prevent progressive neurodegeneration, which is probably the biggest challenge for MS therapy.
In addition, it will probably also be important to observe the development of CAR-T cells for the treatment of autoimmune diseases – if you believe the experts, this highly individualized form of immunotherapy also has great potential for MS.
Overall, it was therefore an encouraging start to this year’s conference, giving hope that the dynamic developments to combat the disease Multiple Sclerosis will continue.
