"I
have multiple sclerosis. Will I become crippled in the future? Or is it
going to be the ‘mild’ form? Of the dozen medications out there to
treat MS, which one is the best therapy for me?”
Stanford
neurologist May Han, MD, who specializes in MS, encounters questions
like these from her patients on a daily basis. MS is an autoimmune
disease of the brain and spinal cord that causes paralysis, blindness
and other disabling symptoms. Over a million people, most of them young
adults in the prime of life, suffer from MS worldwide.
While
there’s currently no cure for MS, by the end of 2013 there will be 10
FDA-approved MS therapies. The wealth of choices creates a daunting task
for physicians: How can they pick the most appropriate therapy for MS
patients?
Despite these therapies’ overall efficacy in
preventing MS attacks, any one of them can simply fail to work in a
particular patient, or cause debilitating and, sometimes, fatal side
effects. Right now, physicians lack tools to predict who would respond
well to a specific therapy. That’s largely because, Han told me,
different patterns of immune mechanisms go awry in different patients:
Despite
great strides in MS research over the past 50 years, these differences
in immune response from one patient to the next remain poorly
understood. As a result, MS still is a disease where the term “only time
will tell” perfectly applies. We do not have methods that allow us to
predict responses to a selected therapy.
But Han and
her colleagues have achieved an important step toward the goal of
finding ways to do just that, as reported in a new study in Nature
Immunology. Using cutting edge technology to analyze
autopsy
samples from MS patients, the study authors (including Stanford
geneticist Michael Snyder, PhD) identified more than 2,000 proteins that
were activated in MS lesions. One of those proteins,
sphingosine-1-phosphate receptor 1, was activated only in the MS brain
samples, suggesting its importance in MS pathogenesis.
In
fact, Gilenya, the first oral medication ever approved for MS, targets
that very receptor. Gilenya wards off MS attacks by preventing immune
cells from leaving the spleen and lymph nodes. But some patients on the
drug, paradoxically, develop worsening MS attacks.
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