Scientists are exploring different possibilities to repair the damage to myelin. (Getty Images)
Can a new medical discovery turn back the clock for multiple sclerosis patients? Scientists are now saying it may be possible with a process known as remyelination. What exactly is that?
We all have insulation called a myelin sheath wrapped around the nerve fibers in our central nervous system. The purpose of this covering is to protect our neurons so signals can be sent from our brain, spinal cord and optic nerve to other areas of our body. But when someone has MS, a process called demyelination takes place, which means the myelin sheath gets damaged. The result? Signals sent from the central nervous system to the rest of the body end up going haywire.
Demyelination creates all kinds of misfiring – resulting in multiple sclerosis symptoms such as vision and cognitive problems, pain, spasticity, imbalance, bowel and bladder malfunction, as well as extreme fatigue, among other issues. Up to a few years ago, it seemed like once the myelin sheath was damaged, there was no turning back. The only way to treat MS was to prevent symptoms that already existed from getting worse. But now new, yet small, clinical trials are showing there may be a way to repair the myelin and even reverse the damage. This process, called remyelination, could be a game changer for MS patients.
In fact, scientists aren’t exploring just one way to repair the damage to myelin, they’re looking at a few possibilities. “Although no specific treatment for remyelination has yet to be approved by the [Food and Drug Administration], there are new drugs in the pipeline,” says Dr. Michael Sy, assistant professor in the department of neurology at UC Irvine School of Medicine.
“UCI is involved with one of the trials looking at an antibody called ‘anti-LINGO-1,’ which is intended to stimulate regrowth of the myelin sheath,” Sy explains. “Anti-LINGO-1 works by blocking the LINGO-1 protein that inhibits the production of myelin. During the first trial, it appeared as if the drug spurred myelin growth and that it might be helpful, particularly with relapsing-remitting MS,” Sy says.
“Unfortunately, a follow-up trial did not prove to be as successful. That said, research on anti-LINGO is continuing,” he adds. The most recent results were published in the April 2017 issue of the journal Neurology.
Sy remains heartened by the ongoing remyelination research. “All our present approved therapies are directed against preventing demyelination attacks. That means essentially our current treatments work by slowing down the progression of the disease,” he explains. “What we’re working on now is not just slowing down myelin damage, but regenerating the sheath. This would be a sea change because modern medicine doesn’t grow things. We typically just focus on preventing more damage.”
TAVIST (clemastine fumarate)
Another treatment that may benefit remyelination in multiple sclerosis patients is coming out of laboratory studies at UC San Francisco. The latest clinical trial is looking at the use of an antihistamine, the same type of medication currently available over-the-counter to help allergy symptoms. Recent research shows that the OTC medicine Tavist might be useful for remyelination, particularly for chronic optic neuropathy, a condition that can cause pain and vision loss in MS patients. “So far the positive results appear to be modest ones,” says Dr. Robert K. Shin, professor in the department of neurology at MedStar Georgetown University Hospital in the District of Columbia. The most recent study of the drug was published online in October in the journal The Lancet.
Although antihistamine treatment seems to help some people whose myelin was damaged for years, Shin remains cautious. “I wouldn’t want people with MS to run out and try to self-medicate with an OTC drug,” he says. “It’s also important to keep in mind that the drug used in the study was administered in a much higher level than the dosage used for common allergy symptoms.”
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