Hurdles in Combatting Neurodegeneration in Multiple Sclerosis: Bruce Bebo, PhD

WATCH TIME: 4 minutes

"There are emerging biomarkers like neurofilament light chain or glial fibrillary acidic protein that might help accelerate the development of therapies for that neurodegenerative phase in progressive forms of MS."

Patients with progressive-relapsing phenotypes of multiple sclerosis (MS) can be grouped in 4 subgroups: active with progression, active but without progression, inactive with progression, and stable without disease activity and progression. In general, MS starts between the age of 20-30 years, and after 10-15 years, it converts into progressive phase. In some cases, the progression of disability starts from the beginning of the disease, with a higher age at onset.

Promoting neuroprotection, synaptic plasticity, and strategies to limit neurodegeneration have been considered promising approaches for reducing disability and restoring function in MS. Recent work shows that central nervous system inflammation affects synaptic transmission and that immune-mediated alterations to synaptic plasticity may be a contributing factor to the pathogenesis of MS-related cognitive impairment. Other studies have shown that in MS, exercise is safe, can improve strength, cardiorespiratory fitness, walking, symptomatic fatigue, and cognition, and overall is an effective symptomatic treatments in MS.

As it stands, ocrelizumab (Ocrevus; Genentech) remains the only FDA-approved therapy to treat progressive MS. In 2022, the launch of the Cures for MS Roadmap, developed through engagement of scientific thought leaders and people affected by MS, focused on 3 distinct but overlapping cure pathways: stopping the MS disease process, restoring lost function by reversing damage and symptoms, and ending MS through prevention.

After the National MS Society recently announced a $19.4 commitment toward the roadmap, Bruce Bebo, executive vice president of the organization, sat down to discuss the challenges with tackling these pathways. Bebo specifically talked about the neurodegenerative issues patients continue to face, including the lack of standardized tools to measure this decline, and the emerging concepts being incorporated into clinical care. Overall, he provided greater perspective on the current limitations in care for progressive MS and the steps needed to overcome the barriers in place.