In Part 2 of this podcast, Robert Zivadinov MD, PhD, Professor of Neurology, Professor of Biomedical Informatics, Department of Neurology, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York continues the discussion on his presentations at the Consortium for Multiple Sclerosis Centers Annual Meeting titled Detecting Demyelination and Remyelination by MRI in the CNS and Imaging Remyelination in Clinical Trials of Multiple Sclerosis.

Dr Zicandinov explains detecting demyelination and remyelination beyond magnetic resonance imaging (MRI).

Read the Transcript:

Dr Zivadinov: Beyond the MRI, another very promising instrument is PET or positron emission tomography. It uses different carbon-11 or 18-fluorine-based radiotracers. Specifically, 18-fluorine are promising like some amyloid-based agents as florbetapir because they can be delivered in somewhat longer half and shelf life, which would make possible scanning for multicenter trials.

The visual function has been also, and related imaging outcomes have been discussed., particularly, many of the previous studies have used multi evoked visual potential and optical coherence tomography. These are very sensitive, specifically evoked potentials, to changes in myelin changes.

With that said, these techniques, both instrumental and clinical, have been applied to a number of agents that have been studied in the recent years, including some monoclonal antibodies against the human endogenous retrovirus, ant-LINGO-1 or opicinumab. A huge trial development that at the end was discontinued.

Included RENEW, SYNERGY, and AFFINITY studies. Currently ongoing studies with clemastine fumarate, both phase II and now phase III studies. Some more experimental agents, like for example, GSK 23951. To conclude, I would say that clearly the treatment of MS has to move beyond just immunomodulatory therapies that are decreasing inflammation and may delay neurogeneration.

The treatments have to go in a direction when there is no immune component of the disease. How can we ultimately, and if demyelination is halted, how can we ultimately…in some of the functions? That will be only possible by doing and stimulating remyelination.

That's why discovery of a host of treatments in depth, and it's extremely important, promising, and should be the next goal of modern treatment in MS. Still, the instrumental techniques that I briefly discussed are improving and should be tailored better to this remyelination studies to be much more specific, sensitive, and robust.

Additional work is needed. I think there is a real sense of hope that a researcher may get closer to successful remyelination treatment strategies. Thank you.