Multiple sclerosis (MS) is something of a mysterious disease. The demyelinating condition affects more than two million people around the globe—often with debilitating symptoms—yet has no known cure and the cause of the disease is still unknown. Recent research advances, including an effort from the National Institutes of Health (NIH) in the U.S., are trying to better understand the disease in order to find a treatment solution.
The aforementioned NIH-led project recently had a breakthrough thanks to a high-powered brain scanner and a 3D printed model. In the simplest terms, the NIH researchers were able to analyze the brains of hundreds of MS patients using the scans and 3D printing, and identified dark rimmed spots among the patients who had a more aggressive and disabling form of the disease.
The dark rimmed spots found in the brain scans represent ongoing “smoldering” inflammation called chronic active lesions. Now, the researchers believe these lesions may be indicative of the more aggressive forms of MS.
“We found that it is possible to use brain scans to detect which patients are highly susceptible to the more aggressive forms of multiple sclerosis,” explained Daniel S. Reich, M.D., Ph.D., senior investigator at the NIH’s National Institute of Neurological Disorders and Stroke and the senior author of the study. “The more chronic active lesions a patient has the greater the chances they will experience this type of MS. We hope these results will help test the effectiveness of new therapies for this form of MS and reduce the suffering patients experience.”
Understanding multiple sclerosis
Up until recently, MRI scanning was used to diagnose patients with MS, as the imaging technology could capture lesions that appear on the patient’s brains. Though effective, the technology was limited in terms of identifying ongoing or chronic lesions. In 2013, however, a high-powered, 7-tesla MRI scanner started being used by Dr. Reich’s team, enabling them to find chronic active lesions—distinguishable by their darkened outer rims.
As Martina Absinta, M.D., Ph.D., the post-doctoral fellow in Dr. Reich’s lab who performed these studies, said: “Figuring out how to spot chronic active lesions was a big step and we could not have done it without the high-powered MRI scanner provided by the NIH. It allowed us to then explore how MS lesions evolved and whether they played a role in progressive MS.”
In the research project, the NIH team scanned the brains of 192 multiple sclerosis patients that had signed up for a trial at the NIH’s Clinical Center. The team them compared the brain scans to the neurological examinations that the patients first received upon enrolment and found that patients that had four or more rimmed lesions were 1.6 times more likely have progressive MS than those without. The patients with more rimmed lesions also developed motor and cognitive disabilities at a younger age than those without any.
“Our results point the way towards using specialized brain scans to predict who is at risk of developing progressive MS,” said Dr. Reich.
3D printed brain model
The researchers also used a 3D printer to compare a brain scan to the brain tissue samples autopsied from a patient that had died during the trial. The 3D printed brain model helped the team learn that all expanding rimmed spots on the scans had the features of chronic active lesions when looked at under the microscope.
“Our results support the idea that chronic active lesions are very damaging to the brain,” concluded Dr. Reich. “We need to attack these lesions as early as possible. The fact that these lesions are present in patients who are receiving anti-inflammatory drugs that quiet the body’s immune system also suggests that the field of MS research may want to focus on new treatments that target the brain’s unique immune system—especially a type of brain cell called microglia. At the NIH, we are actively seeking patients who want to participate in studies like these.”
The recent study, which could lead to new avenues for multiple sclerosis treatment research and better diagnostics, was published in the Journal of the American Medical Association Neurology.