Hot topics in MS research: our take on the 2022 MS Australia Scientific conference

L-R: Ms Pia Campagna, Dr Michael Zhong

Ms Pia Campagna and Dr Michael Zhong

Michael and I are third year PhD students in the Multiple Sclerosis and Neuroimmunology (MSNI) Genomics and Prognostics Group, led by Dr Vilija Jokubaitis. We recently attended the 2022 Progress in MS Research Scientific Conference in Hobart, convened by Prof. Helmut Butzkueven, Head of the Department of Neuroscience, Central Clinical School to present some of our work with academic peers and the wider non-academic community. 

The conference was organised by the peak national organisation for MS research, MS Australia. It has become a key forum for researchers and clinicians to come together and learn about the latest research happening around Australia, with the aim of stimulating innovative research and encouraging collaborations. 

MS research in Australia is as broad as it is exceptional. While the program was diverse, as showcased by the conference program and posters, excitement centred on the key themes we highlight below.

 L-R: Ms Linda Nguyen, Ms Pia Campagna

I was fortunate to be awarded the Best Young Investigator Oral Presentation (shared with Ms Linda Nguyen from The University of Melbourne) for my talk on “The impact of pregnancy history on whole-blood methylation in women with relapse-onset multiple sclerosis”.

I summarised in my presentation how women with MS who have given birth have different whole blood and peripheral immune cell methylation patterns, compared to those who have never given birth. These differences were enriched in genes related to neural plasticity and may explain how pregnancy protects against long-term disability accrual in women with MS.

Lifestyle and environmental factors

Yasmine Probst (University of Wollongong) reviewed how nutrition may interplay with the immune system and disability in MS. The variability between people and their gut microbiome was highlighted, and the main recommendation with current understanding is to follow the Australian Dietary Guidelines.  

The role of EBV infection on MS pathogenesis is becoming clearer; Jeremy Keane (Westmead Institute for Medical Research) discussed the possible use of an antisense oligonucleotide to target EBNA2  to reduce this effect.

MRI

MRI is crucial in diagnosing MS and monitoring treatment response. Michael Barnett (University of Sydney) presented state-of-the-art research on AI-captured MRI metrics such as understanding the role of slowly expanding lesions. These slowly expanding lesions are hard to capture with the naked eye but may be excellent predictors of disability and brain volume loss. There are plans to integrate such data with the longitudinal clinical data captured by the MSBase Registry. 

Digital biomarkers

Clinical trial endpoints for relapsing-remitting MS therapies include relapse rate, MRI lesions, and confirmed disability progression. However, these are not translatable to progressive MS for which only two disease-modifying therapies are available. Therefore, reliable digital biomarkers of disability progression are critical in enabling clinical trials of progressive MS therapies. Johan van Beek (Global Head, Medical Science and Digital Biomarkers, Biogen Digital Health) outlined the company’s work on Konnectom, a smartphone application that allows clinical trial participants to self-assess ambulation, dexterity, and cognition. Interestingly, Johan noted that the major challenge with such applications moving forward is ensuring participants stay engaged for the entire clinical trial, particularly in countries where incentives (e.g. payments) are not allowed.

Daniel Merlo (Central Clinical School, Monash University) demonstrated the potential of computerised batteries in improving clinical care decisions. Using MSReactor, a cognitive battery, he was able to identify patients likely to experience confirmed disability progression based on their reaction time. 

Basic research and remyelination

Kalina Kakowiecki (University of Tasmania) showed how inducing demyelination in a transgenic mouse model resulted in neuronal excitability due to the inappropriate strengthening of synapses, which in turn causes irreversible excitotoxic damage. This could represent a novel and targetable mechanism of neuronal loss in MS. 

Mertk is a microglial receptor that mediates immunoregulatory functions, including remyelination. Linda Nguyen (Florey Institute of Neuroscience and Mental Health) won one of two awards for the Best Young Investigator Oral Presentation by demonstrating importance of microglia function in remyelination using Mertk knockout mice. 

Cladribine is a recently approved treatment for relapsing-remitting MS. Mastura Monif (Central Clinical School, Monash University) presented data on the effect of cladribine on immune cell subsets including, interestingly, monocytes. We look with interest to see how these biomarkers could be associated with clinical outcomes. 

Genomics

MS presents initially as a first demyelinating event, though not all people who have such events go on to develop MS. Research presented by Wei Yeh (Central Clinical School, Monash University) showed broad dose-dependent effects on gene expression in immune cells with Vitamin D supplementation following a first demyelinating event. This may inform future studies and recommendations on the use of Vitamin D in MS, or to prevent it. 

Genomics can partially predict the risk of developing MS, but the impact of genetic factors on disability severity in MS is less clear. Vilija Jokubaitis (Central Clinical School, Monash University) presented research that shows that machine learning using genomic data can actually accurately predict MS severity. This represents another step forward in facilitating personalised care in MS, where prognosis is often uncertain. 

Stakeholder engagement/care teams

Ingrid van der Mei (Menzies Institute for Medical Research, University of Tasmania) outlined the essential role of MS specialists nurses ahead of the release of the MS Australia MS Nurse Care in Australia Report. This report was published in collaboration between MS Australia, Menzies Institute for Medical Research and MS Nurses Australasia. Only 31.5% of Australian MS patients have access to one of the 90 existing MS specialists nurses nationwide, despite evidence of their role in improving health outcomes and reducing hospital admissions. For $5 million, an additional 50 MS nurses could be hired, which would reduce national MS care costs by $64.3 million annually.  

You can find out more about the research presented at the Progress in MS Research Scientific Conference at the following links: 

• Progress in MS Research Live Update recording (featuring our Head of Department)
• MS experts meet in Hobart to present latest research article
• MS Australia Twitter feed

Members of the Multiple Sclerosis and Neuroimmunology (MSNI) Genomics and Prognostics Group are also taking part in The May 50k fundraising challenge in which their goal is to reach 400km. Visit the team's fundraising page to make a donation and support the team to reach their goal!