Highlights from ACTRIMS Forum 2023

On February 23-25, 2023, the eighth annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum took place in San Diego, California with the theme – MS: Going Viral.

This was one of the largest ACTRIMS meetings to-date with over 1,800 participants in attendance, and over 50 presentations and 460 posters across various areas of multiple sclerosis (MS) research. Canadian-based researchers and trainees showcased their cutting-edge MS research throughout the forum, representing 24% of the speakers. Dr. Ruth Ann Marrie, neurologist and researcher at the University of Manitoba, was named the recipient of the prestigious 2023 Barancik Prize for Innovation in MS Research. She presented her research on understanding comorbidities in MS (other conditions or diseases that are present at the same time).

Below we have captured some research highlights from the forum.

2023 Barancik Prize for Innovation in MS Research

Comorbidities in MS

Dr. Ruth Ann Marrie (University of Manitoba), the 2023 Barancik Prize for Innovation in MS Research recipient, presented her contributions to the field of MS (see news announcement). Dr. Marrie’s research focuses on understanding factors that influence the risk and outcomes of MS, such as comorbidities. Specifically, Dr. Marrie and team have found that hypertension, depression, chronic lung, and anxiety are common comorbidities in MS and are more frequent in people with MS compared to those without MS in Canada. The prevalence of many of these comorbidities increase with age and can adversely affect MS throughout the disease course. Understanding comorbidities in MS can help healthcare professionals better manage people who live with MS and improve their health outcomes. To learn more about Dr. Marrie’s research, listen to:  

• Jon Strum’s podcast RealTalkMS Episode 287: Meet the Winner of the 2023 Barancik Prize for Innovation in MS Research with Dr. Ruth Ann Marrie (February 28, 2023).  
• Marcy Markusa’s Information Radio (CBC): A University of Manitoba researcher has been honoured with a prestigious award for her research on multiple sclerosis (February 21, 2023). 

Viruses and MS

Targeting Epstein-Barr Virus (EBV) in MS 

A recent landmark study reported the strongest evidence to date for Epstein-Barr Virus (EBV) as an initial trigger and leading risk factor for MS, providing a 32-fold increase in risk (read more here). Given over 95% of the population is infected with EBV, but only a small fraction of the population develops MS, EBV infection alone is not believed to be sufficient for MS, and likely requires other factors (i.e., genetics, environmental). If EBV infection can be eliminated or reduced by a vaccine, this would have the potential to prevent MS. EBV has also been identified as a risk factor in certain cancers and a number of other autoimmune diseases in addition to MS. Dr. Jeffrey Cohen from the National Institute of Health (NIH) is currently developing a vaccine targeting EBV, which is in a phase I clinical trial to assess safety in healthy adults (learn more – here). Dr. Peter Calabresi (Johns Hopkins University) offered some considerations around the development of an EBV vaccine and outlined the need to better understand the mechanism for how EBV may be involved as a risk factor for MS. There is a challenge in developing a vaccine that can eliminate infection by a virus. EBV vaccines that do not prevent infection, or partially prevent infection, may only delay infection to a later stage of life and this could result in more severe disease and increased risk of MS (see abstract). 

Learn more about EBV in MS.  

Risk of MS in People with Human Immunodeficiency Virus (HIV)

Dr. Elaine Kingwell (University of College London) presented findings from an MS Canada-funded study that aimed to understand whether there is a reduced incidence of MS in people that are Human Immunodeficiency Virus (HIV) positive and those exposed to HIV anti-retroviral therapy (ART). The study identified and followed 29,149 individuals who were HIV positive in Sweden and Canada over an average 9-year period. The team reported a lower risk of MS in both the HIV positive and ART-exposed populations compared to what would be expected in the general population (see abstract). More research is needed to further understand this newly found association and how it contributes to MS risk.

Learn more about this study here.

Diet in MS

Benefits of Dietary Interventions for MS

Research was presented to understand the effect of modifying diets in people with MS. Dr. Laura Piccio (Washington University, St. Louis) and team examined the benefits of intermittent calorie restriction (iCR) for 12 weeks in people with relapsing-remitting MS (RRMS). They found that individuals on the iCR diet had significant reductions in weight, body mass index (BMI), waist circumference, fat mass, levels of leptin (a hormone that regulates appetite) and showed improved cognitive performance (Symbol Digit Modalities Test; SDMT), in comparison to individuals not on the diet (see abstract).  

Dr. Ilana Katz Sand (Mount Sinai, New York) examined the benefits of a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet in people with relapsing and progressive forms of MS. They found that greater adherence to the diet predicted better outcomes in the MS Functional Composite (MSFC; a disability metric), and patient-reported outcomes for disability, gait disturbance, fatigue, anxiety, and depression. 

Learn more about diet in MS.

Inclusion, Diversity, Equity, and Accessibility (IDEA) in MS

MS in Diverse Populations

Prevalence of MS differs worldwide, with greater prevalence in western countries (120-300 per 100,000 people) compared to non-western countries (0-38 per 100,000 people). Dr. Jorge Correale (Raul Correa Institute for Neurological Research) discussed a number of factors that may contribute to these differences, such as exposure to different environmental influences (i.e., viruses, nutritional deficiencies), genetic backgrounds, and resource limitations (i.e., lack of neurologists and MS specialists, awareness of MS symptoms, and limited expertise and resources such as MRI for diagnosis). 

Dr. Lilyana Amezcua (University of Southern California) presented research on the prevalence of MS in diverse populations in western countries and found that MS prevalence is similar in white and Black adults. Among youth ages 18-24 years, MS prevalence is highest among Black and Hispanic youth. The prevalence of MS in non-white populations have been underrepresented due to a number of factors, including lack of awareness of the MS risk in these populations, impeding timely diagnosis and disease management.

Dr. Leorah Freeman (University of Texas) conducted a systematic review of 44 phase III clinical trial publications of FDA-approved MS disease-modifying therapies (DMTs) between 1995 to 2020. Representation of non-white people with MS in phase III clinical trials was significantly lower than the representation of non-white people in the population. Some barriers to participation in clinical trials are mistrust, language, lack of awareness or knowledge of research, researcher bias, and location of clinical trial. Addressing these barriers are important in understanding the real-world impact of MS therapeutics in diverse populations (see abstract). 

Additional resources 

This article only captures a few of the latest breakthroughs in MS research presented at ACTRIMS 2023. For more information, see the abstract catalog.