ACTRIMS 2023: What to Expect From the Annual Forum

Daniel Ontaneda, MD

The eighth annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum takes place February 23-25, 2023, in San Diego, California, with this year’s theme selected as “MS: Going Viral.” This meeting highlights novel and rigorous scientific discoveries made in multiple sclerosis (MS) that advance the understanding and care for patients with the disease, as well as fosters the careers of young investigators with an interest in the field.

Over the years, the number of attendees at ACTRIMS has grown, and this year is no exception. A total of 1700 individuals have registered, most of whom are expected to attend in-person, including roughly 400 young investigators. Without including platform sessions and oral presentations, there will be a record-setting 469 total posters being presented, and 15 hours of CME credit available for attendees.

"It’s really a venue for a combination of clinicians, scientists, folks who work in industry, and different stakeholders in the MS community to get together and discuss topics of relevance, specifically, topics of relevance to research, and how we’re trying to help cure this disease," Daniel Ontaneda, MD, program committee vice-chair of the forum, told NeurologyLive^®.

The theme for this year’s forum will address the role of different viruses that have been implicated in the ongoing disease process in MS, and in particular, Epstein-Barr virus (EBV), which has been thought to be the leading cause of MS. Kicking off on Thursday, February 23, at 9:15 AM, the meeting will begin with an update on differential diagnosises of suspected MS, with presentations from Andrew Solomon, MD; Eoin Flanagan, MD; Jorge Correale, MD; and Lilyana Amezcua, MD. Working under the auspices of ACTRIMS, this group of experts will cover several aspects of differential diagnosis, including the red flags, how it changes in global populations, as well as how its viewed in underrepresented populations.

Following that symposium at 11:00 AM, Jiwoh Oh, MD, and Daniel Reich, MD, will chair the North American Imaging in MS symposium, which will feature presentations on the use MRI gene expression strategies, accelerating experimentation of viral intelligence through collaborative platforms, and the radiological characterization of cortical lesions in progressive multifocal leukoencephalopathy (PML).

Thursday continues on with several informative sessions, specifically, emerging concepts in MS, which includes the introduction of novel measures to capture disease activity and advance treatment options. All presentations of this session will be given by young investigators.

• 2:45-3:00 PM — A Multi Modular Approach to Characterize Multiple Sclerosis Brain Pathology in Rapid Autopsy Brain Tissue, Stephanie Zandee, PhD
• 3:00-3:15 PM — Genetic Analysis of CNS Autoimmunity Using the Diversity of the Collaborative Cross Reveals Unique Phenotypes and Mechanisms, Emily Holt, PhD candidate
• 3:15-3:30 PM — Psychiatric Morbidity in Multiple Sclerosis During the Prodromal Period, Anibal Chertcoff, MD
• 3:30-3:45 PM — Retinal Synaptic Loss Occurs During Neuroinflammation and is Mediated by Lymphocyte-Microglial-Astrocyte Activity, Thomas Garton, MD
• 3:45-4:00 PM — Identification of Pathogenic Gut Bacteria Underlying Multiple Sclerosis Progression, Daiki Takewaki, MD
• 4:00-4:15 PM — Myelin Abnormalities in the Cervical Spine Cord is Associated with Clinical Disability Across MS Subtypes, Lisa Eunyoung Lee

"The focus on this year’s ACTRIMS Forum was MS: Going viral," Ontaneda said. "We picked that for 2 reasons: on one side, we thought about the amazing data that has come out about Epstein-Barr virus suggesting that the presence of EBV is almost a prerequisite and probably one of the greatest risk factors for the development of the disease. We thought it was only fair to dedicate the theme of the meeting to viral issues in MS. That includes triggers, so viral infections as triggers of the disease, as well as how the disease transects with viral illness. That’s mainly through complications of use of disease-modifying medications, notably PML."

There will also be a handful of presentations on how viruses interact with the gut, an area that is gaining more momentum in the field. The other side to this year’s theme is topics that have gone viral in the MS community, more traditionally through word of mouth. This includes discussion on artificial intelligence, incorporating big data, and a larger focus on underrepresented populations, races, and ethnicities.

On Saturday morning, February 25, starting at 10:40 AM, several presenters will discuss hot topics gone "viral" in MS research, with a focus on lifestyle modification and improving access to care.

• 10:45-11:00 AM — Diet in MS, Ilana Katz Sand, MD
• 11:00-11:15 AM — Exercise in MS, E. Ann Yeh, MD, MA, FRCPC
• 11:15-11:30 AM — Use of AI and MRI for MS Care: How Does This Improve Care and Accessibility, Michael Dwyer, PhD
• 11:30-11:45 AM— Social Determinants – Lessons Learned and How Do We Do Better, Lilyana Amezcua

Another session Ontaneda mentioned clinicians should keep their eye on was Friday morning’s head-to-head debate featuring Peter Calabresi, MD, of Johns Hopkins University, and Jeffrey I. Cohen, MD, of the National Institutes of Health. The will providing the evidence available on vaccinating individuals with EBV to prevent the development of MS as a worthwhile strategy to invest in.

Of note, Tiffany Braley, MD, of the University of Michigan, will be presenting the primary results from the COMBO-MS trial, which will compare the effectiveness of telephone-derived cognitive behavioral therapy, modafinil, and combination therapy of both interventions for fatigue in MS. Additionally, Laura Piccio, MD, PhD, will be presenting findings from a randomized clinical trial of intermittent calorie restriction in people with multiple sclerosis. “We’ve always thought about calorie restriction and understanding that it has beneficial effects on MS,” Ontaneda added.

ACTRIMS differs from other neurology meetings in that it there is only a single session track, putting all the attendees are in the same room. This was done purposely, Ontaneda said, as a way to make attendees feel as though they were not missing out on other presentations. "We strongly believe that we should have everybody in the room at the same time listening to the same talk so that we can generate discussion," he added. "The one differentiating factor that is probably truer for this meeting than any other in MS is that we pick a scientific topic that’s of interest. We pick speakers that have done research in those areas from a variety of different arenas. This is not just a meeting for basic scientists, we try to balance out some basic science with some translational science, with some very clinical science. That ends up providing individuals who come to ACTRIMS with a very rewarding experience."