Finding a drug capable of reconstituting myelin in Multiple Sclerosis. A disease which, the experts point out, is no longer a sentence to a wheelchair
Multiple sclerosis (MS), also called multiple sclerosis, is a chronic demyelinating autoimmune disease that affects the central nervous system causing a broad spectrum of symptoms. Physiologically, our nerve cells transmit electrical signals through nerve fibers called “axons”, which are covered by an insulating substance: the myelin sheath. In disease, the patient’s immune defenses attack and damage this sheath, which is why sclerosis is referred to as a “demyelinating” disease. When this happens, the axons are no longer able to effectively transmit electrical signals and impulses. The name multiple sclerosis derives from the scars (sclerosis, better known as plaques or lesions) that form on the myelin (or also called white matter) of the spinal cord and brain.exact causes of occurrence are still unknown. The different theories propose genetic and infectious causes and correlations with environmental risk factors have been highlighted.
As of 2022 there is no known cure. But there are some drug treatments available to avoid new attacks and prevent disabilities. The news that emerged in Amsterdam from the thirty-eighth Congress of the European Committee for Treatment and Research in Multiple Sclerosis bodes well. It is estimated that around 2.8 million people worldwide suffer from multiple sclerosis. «It is a disease that today is kept under control with increasingly personalized therapies. Choosing the right treatment is complicated: the balance of the immune system is very delicate and requires reactivity and balance, except in rare cases, on the one hand, heavy immunosuppression cannot be exceeded because the patient is exposed to the risk of infections or tumours; on the other hand, a mild cure cannot be prescribed because when the immune system is too “lively”,turn off the answer – explains Luca Battistini, director of the Neuroimmunology laboratory at the Santa Lucia IRCCS Foundation in Rome.
Innovative therapies and treatments that regenerate
Today there are about twenty effective licensed therapies available, with different mechanisms of action. We need to find the most advantageous one by evaluating the risk-benefit costs depending on the patient we are dealing with. There are many variables that influence: age, medical history, environment and lifestyles. It seems that exposure to the sun to develop vitamin D, physical activity, a healthy diet and compliance with the sleep-wake rhythm are associated with a reduced risk of developing multiple sclerosis, while obesity, improper use of antibiotics, smoking and alcohol are all potentially involved in the development of autoimmune diseases.
Among the therapies that appear promising and which, still in the experimental stage, are showing long-term benefits (in patients with the relapsing form treated for more than three and a half years) is a new class of drugs, including evobrutinib , whose mechanism of action is peculiar. «It inhibits the action of the cells responsible for the immune function of the nervous tissue which have the antigen that triggers the disease – explains Francesco Patti, associate professor of Neurology at the University of Catania.
Much attention has been devoted to “regenerative” or remyelinating therapies, i.e. capable of reconstituting myelin. «It is the new frontier of therapeutic research in multiple sclerosis. Promising preliminary data have been presented on the possibility of promoting remyelination with drugs that have the ability to reach the central nervous system and activate microglial cells – explains Maria Pia Amato, professor of Neurology at the University of Florence and director of the Rehabilitation Division neurology at the Careggi University Hospital and IRCCS Don Carlo Gnocchi Foundation in Florence and president of ECTRIMS. Finally, the revision of the European guidelines for rehabilitation has been announced by 2024, with the help also of people with multiple sclerosis.
Among the main innovations there will be the integration of digital therapies and patient monitoring with sensors to understand the evolution of the disease; the insertion of indications on where to carry out the rehabilitation between clinic, home and hospital based on the effectiveness and level of disability. The future in this area of research will also try to respect the care and dignity of the sick person, focusing on a holistic approach that affects both the health sector and the patient’s social sphere.