In MS, the immune system becomes confused and attacks the protective myelin coating around our nerves by mistake. If myelin is damaged by the immune system, the nerve can’t communicate properly and may eventually die.
To stop MS, we need to stop the immune system attacking myelin.
What goes wrong with the immune system in MS?
The immune system is your body's defence against infection. In MS, the immune system treats the protective myelin coating around nerves like an infection. This leads to myelin being destroyed.
Myelin plays a really important role in making sure messages can be sent from the brain to the rest of the body efficiently, as well as protecting the nerve from damage. So when myelin is damaged, the nerve stops working properly. We don't yet know exactly why the immune system attacks myelin in MS.
Can we stop immune attacks in MS?
Because we don't know why the immune system goes wrong in MS, most treatments focus on reducing the number of immune cells moving around the body. This should reduce the frequency of immune attacks. All the current treatments available for MS (referred to as disease modifying therapies or DMTs) work by targeting immune cells. This process is called immunomodulation.
We also know that vitamin D plays a role in immune system function. But, the evidence isn’t yet clear whether changing vitamin D levels could be beneficial for people with MS.
How do DMTs prevent immune attacks in MS?
DMTs work by changing how the immune system behaves. They reduce the number of immune cells moving around the blood by removing them from the body, stopping them from being able to get into the brain or trapping them in specific areas of the body (like the lymph nodes). This can make it less likely for the immune system to attack myelin in the brain and spinal cord.
Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your own blood stem cells.
Although DMTs work by helping to control immune attacks, they do not directly help repair the damage caused to myelin.
Can DMTs stop progression?
Treatments that target the immune system can reduce the frequency and severity of relapses, and the symptoms caused by relapses. Recent research also shows that DMTs can also help to slow the progression of relapsing MS and extend life expectancy.
But current treatments aren't able to reverse damage already done. So many people living with progressive MS still do not have access to treatments.
Why is early treatment important in MS?
In October 2014, a study looked at 3,060 people with MS and the long-term risk of disability. The researchers found that DMTs delayed long-term disability in people with MS and were more effective at doing so when used at the early stages of the condition. So early treatment is considered to be better than late treatment, but late is better than never.
In England, 56% of those who could potentially benefit from taking a DMT were doing so in 2016, even though there are multiple benefits to their use. The CARE-MS II trial, in 2016, showed that early treatment with more intensive therapies – which have more side effects – may be beneficial for MS. Research led by Professor Neil Robertson, which showed that early intensive treatment with DMTs lead to better disability outcomes over 5 years, than less intensive, first line DMTs.
This adds to the growing body of evidence that early treatment leads to better outcomes for people with MS.
The DELIVER-MS trial will explore this further by comparing progression in people with who’ve recently developed relapsing MS. One group will start off with a milder treatment and only move on to a more intensive treatment if the first one doesn't effectively control their MS. Another group will start with a more intensive treatment.
The trial will help people with MS make the right treatment decision for them. We’re funding the MRI scans that will tell us what affect the different treatments approaches are having on the brain.