MS Researchers Share Progress at Annual ECTRIMS Conference

More than 5,500 neurologists and other investigators from around the world convened in Gothenburg, Sweden on October 13-16 to present findings at the annual ECTRIMS (European Committee for Treatment and Research in Multiple Sclerosis) conference. More than 900 scientific presentations and display posters covered virtually every aspect of research to stop MS, restore function, and end MS forever. Among these were the latest results from pivotal clinical trials of emerging MS therapies, possible risk factors, underlying disease mechanisms, rehabilitation approaches, CCSVI, and much more.

Here are highlights.

Research Toward Stopping MS
-- Experimental Treatments in the Pipeline
Among studies reported at ECTRIMS were these first results from newly completed trials:

• Teriflunomide (sanofi-aventis) is a novel oral compound that inhibits the function of specific immune cells. Dr. Paul O’Connor, of the University of Toronto, representing the international group of investigators involved, presented positive results from a two-year, phase III trial in 1,088 people with relapsing MS, comparing two doses of teriflunomide against inactive placebo (the TEMSO trial). Both doses significantly reduced the rate of MS relapses (“annualized relapse rates”) by up to 31.5% relative to placebo, and the higher dose was found to reduce the risk of disability progression by 29.8% compared to placebo. (Abstract 79) A separate poster by lead author Dr. Jerry Wolinsky of the University, of Texas Health Science Center in Houston, showed that the therapy also reduced the risk of new MS lesions seen on MRI, and reduced disease activity in a range of other MRI measures. (Abstract P982) Risk of adverse events was the same across all groups, and the most common side effects for active treatment were nausea, diarrhea, mildly elevated liver enzymes and thinning of the hair. Additional clinical trials of teriflunomide are underway.
• Positive results of a phase II safety and effectiveness trial of an oral compound called firategrast (Glaxo Smith Kline) involving 343 people with relapsing-remitting MS were presented by Dr. David Miller of the UCL Institute of Neurology in London. Similar in approach to the approved infused therapy natalizumab, oral firategrast interferes with movement of immune cells into the central nervous system by blocking the molecule known as alpha 4-integrin. Different doses or placebo were taken for 6 months. The primary outcome measure was the cumulative number of active (“enhancing”) new MS brain lesions, detected with MRI scans. The highest dose caused a significant decrease (49%) in the average rate of new lesions. The drug was well tolerated. (Abstract 113)
• Dr. Ludwig Kappos, of University Hospital in Basel, presented positive results of a phase II safety and effectiveness trial of ocrelizumab (Roche and Biogen Idec) involving 220 people with relapsing-remitting MS. Ocrelizumab is a “humanized” version of rituximab, targeting and killing immune B cells. In this 24-week trial, different doses or placebo were given by two infusions on day 1 and day 15. The primary outcome measure was total number of active (“enhancing”) new MS brain lesions, detected with MRI scans, at weeks 12, 16, 20 and 24. Both doses showed significant benefit at each time point, with a relative reduction of new lesions by at least 89% over placebo. The most common side effect was infusion-related reactions, mostly at the first infusion. One person died from a systemic inflammatory response syndrome, which Dr. Kappos explained could possibly be related to therapy but that it wasn’t yet clear. (Abstract 114)
• Dr. Per Soelberg Sorensen of Copenhagen University Hospital Rigshospitalet presented negative results of a large phase II clinical trial testing the safety and effectiveness of adding the cholesterol-lowering treatment simvastatin or placebo to standard therapy with Avonex® (interferon beta-1a, Biogen Idec) for one to three years in people with relapsing-remitting MS. Previous evidence of the potential benefits of statins in MS has been mixed. The results showed no benefit of adding simvastatin to Avonex, and there was some suggestion that this statin might antagonize the benefits of Avonex. (Abstract 134)
• In a platform session related to “Hot Topics” Dr. Antonio Uccelli of the University of Genoa described new attempts to stop MS progression using infusions of an individual’s own bone marrow or blood stem cells, called mesenchymal cells, which has been used safely in people with some blood disorders and to a limited extent in people with MS. In 2009 international consensus was developed on using these cells in clinical trials. In collaboration with Dr. Mark Freedman (Ottawa Hospital) and with an open invitation to other investigators willing to follow a strict protocol, a plan is in place to launch a phase I/II study in people with inflammatory MS, including relapsing-remitting MS, secondary-progressive MS and primary-progressive MS. By “inflammatory” they mean that there are signs of active inflammation on brain MRI scans, even in the absence of clinical relapses. This will be a one-year study with 150 patients at multiple sites, with a “crossover” design in which everyone will receive treatment eventually. Disease activity seen on MRI scans will be the primary outcome measured. Dr. Uccelli explained that the team hopes that the mesenchymal cells will lead to repair of the nervous system, but that so far there is no evidence that they do so. (Abstract 64)

Other presentations and posters provided designs for new clinical trials and further evaluations and extension results from clinical trials that have been previously reported, including cladribine, alemtuzumab, fingolimod, and dalfampridine, generally supporting their originally reported benefits and safety. For example:

• In a platform session Dr. Giancarlo Comi of the Scientific Institute, H.S. Raffaele in Milan, presented results of a pre-planned 2-year followup study of the 3-year, placebo-controlled “PreCISe” study, which originally tested the ability of Copaxone® (glatiramer acetate, Teva Pharmaceutical Industries, Ltd.) to delay the development of definite MS in people who had experienced a single neurological episode suggestive of MS (CIS). Due to early indications of benefit, the original study was stopped and all participants were offered Copaxone. At five years since originally going on therapy, a significantly lower proportion of those had who originally received active treatment had converted to definite MS, compared to those who had originally received placebo (33% versus 49.6%), a reduction of risk of 41.1%. (Abstract 135)

Research Toward Stopping MS
-- Understanding What Goes Wrong

• Dr. Josa Frischer of the Medical University of Vienna presented results of an international collaboration to study brain tissue from people who had MS in their lifetimes. They focused on the question of whether nerve degeneration in MS occurs independently of the well-known inflammation and immune attacks. A detailed analysis of MS lesions in 67 brains from people with relapsing-remitting, progressive and “benign” MS suggested that there is a surprising amount of inflammation associated with the pathology of progressive stages of MS. They also found signs that axonal damage occurred at the same time as inflammation, and less active immune activity at later stages of disease, with less axonal damage. While additional confirmatory studies are needed, these and other new findings are altering how researchers think about progressive MS, and may have important implications for developing new therapies that address the needs of people with progressive forms of the disease. (Abstract 89)
• Dr. A. T. Argaw of Mount Sinai School of Medicine in New York presented a study related to early events in MS that lead to the breakdown of the protective blood-brain barrier and consequent influx of immune cells into the brain and spinal cord. In this study, funded in part by the U.S. National MS Society, the team was able to block the activity of VEGF-A, a molecule produced by brain cells called astrocytes, in an animal model, supporting the idea that disrupting this pathway may represent a new avenue to block MS relapses. (Abstract 107)
• Conventional MRI brain scans cannot differentiate between different types of tissue damage in people with MS, and while it can detect myelin injury and inflammation in the white matter areas where nerve fibers are coated with myelin, it cannot detect damage in the gray matter of the cortex, where the nerve cell bodies are lodged. Dr. L. Freeman of the Groupe Hospitalier Pitie Salpetriere in Paris and colleagues used positron emission tomography (PET) to detect labeled nerve cells in the cortex as a way to image nerve tissue injury in MS. They found evidence of nerve cell loss in people with relapsing-remitting or progressive MS, and in particular, early loss of nerve cells in the cortex in relapsing-remitting MS which did not appear to be linked to conventional MRI-detected white matter lesions. Further work is needed to verify the findings and to expand on the potential of this PET technique to assess gray matter disease activity. This presentation was chosen as among the best ones given by a young investigator at ECTRIMS this year. (Abstract 117)
• Dr. Shiv Saidha of Johns Hopkins School of Medicine and colleagues conducted a study of the nerve fiber layer and macula in the back of the eyes of people with MS, with partial funding from the U.S. National MS Society. Changes in the back of the eye in MS, such as thinning, have been thought to be an indirect result of damage to the optic nerve. Using OCT (optical coherence tomography) and other imaging technologies, they identified 20 people with MS who had unusual macular thinning, and compared them to people with MS without macular thinning and also to healthy controls. Surprisingly, they found that those with abnormal macular thinning tended to have more rapidly progressive disability and cortical (gray matter) shrinkage (atrophy), but not more typical white matter atrophy. They conclude that this unusual subgroup of people may have pathology directed against nerve cells in the eyes that is different than what usually occurs in MS. This presentation won an award from the MS International Federation for being among the best given by a young investigator at ECTRIMS this year. (Abstract 9)

Research Toward Restoring Function
-- Addressing symptoms

Several teams reported progress in improving quality of life and specific MS symptoms through exercise and rehabilitation.

• In a platform presentation reviewing research into exercise for multiple sclerosis, Dr. Ulrik Dalgas of the University of Aarhus reviewed the changing ideas behind exercise, which was once thought to be bad for people with MS. Growing research suggests the contrary, with some research even suggesting that exercise may alter the disease process. Dr. Dalgas emphasized the need for better-designed and controlled clinical trials of exercise to truly understand and maximize the potential impact of exercise in MS. (Abstract 100)
• Group physical therapy exercises, and supervised aerobics, yoga and resistance training classes were all found to have positive impacts on fatigue, mobility, and health-related quality of life in people with MS with varying degrees of disability (Abstracts P511, P529, P530) In one of the larger studies conducted at the University of Limerick and reported by Dr. Maria Garrett, 242 participants were randomly assigned to one of several one-hour exercise classes for ten weeks, or were put into a control group and asked not to change their exercise habits for the duration of the study. The classes included 1) physical therapist-led progressive resistance training with home aerobic exercise, 2) yoga breathing with range of motion exercises, 3) fitness instructor-led class in progressive resistance training and aerobic exercises. All three classes produced significant reductions of the physical impact of MS (measured by the MS Impact Scale-29, version 2, physical component) compared to before beginning the classes. (Abstract P532)
• Dr. Giampaolo Brichetto presented results from a pilot trial at the Italian MS Society Rehabilitation Center in Genoa involving 36 people with MS with balance disorders. Half received traditional rehabilitation therapy for 12 one-hour sessions, and half received rehabilitation utilizing the Nintendo Wii balance board. Compared to before undergoing treatment, both groups showed significant improvements in measures of fatigue (MFIS) and mobility (Ambulation Index), but those using the balance board also showed significant improvement in measures of balance (Berg Balance Scale) and measures of stability with eyes open and closed. (Abstract 62)
• An open-label (unblinded), company-sponsored multicenter study evaluated the impact of natalizumab (Tysabri, Biogen Idec and Elan) on MS fatigue, using several measures of fatigue and comparing self-reported measures of fatigue in 89 people with relapsing MS before beginning therapy and at several time points up to 48 weeks. Results from 74 individuals who completed the study suggest that the therapy significantly reduced the severity of reported fatigue starting at 12 weeks and continuing thereafter. The first author of the poster was Dr. J. Wilken, Georgetown University Medical Center and Washington Neuropsychology Research Group. (Abstract P207)
• A unique study, chosen as one of the top posters at ECTRIMS this year, suggests that memory training can enhance signs of brain function detected with MRI. The award was given to Dr. Victoria Leavitt, a U.S. National MS Society-supported postdoctoral researcher in training with mentor Dr. John DeLuca at the Kessler Medical Rehabilitation Research & Education Corporation in West Orange, New Jersey. In people with MS who had learning impairment, those who underwent learning using imagery and contextual strategies to code story material had MRI (DTI) signs suggesting significantly enhanced tissue integrity in specific brain areas over those in a control group. (Abstract P328)

Research Toward Restoring Function
-- CCSVI and MS

Two platform presentations and 14 posters focused on issues surrounding CCSVI (chronic cerebrospinal venous insufficiency) and multiple sclerosis, presenting mixed or conflicting results. In addition, the Charcot Foundation convened a Satellite Symposium focused on CCSVI before the official start of ECTRIMS, for which abstracts are not available.

The symposium featured formal short presentations by Drs. Paolo Zamboni (Ferrara, Italy), Robert Zivadinov (Buffalo, New York), Florian Doepp (Berlin, Germany), Omar Khan (Detroit, Michigan) and several others. Among the issues raised were conflicting results from different groups, the lack of “gold standards” for methodology or validated guidelines for what constitutes vein abnormalities, disagreement about which imaging technologies are optimum for evaluating variations in vein flow and structure, and inconclusive results in terms of how or whether vein abnormalities contribute to MS pathology. There was general agreement from those on stage that invasive procedures to correct narrowing of the veins should only be done in the context of controlled clinical trials.

The ECTRIMS presentations related to CCSVI are summarized here:

• In a platform presentation, Dr. Claudio Baracchini presented results of a study at the University of Padua to investigate the prevalence of CCSVI at the time of clinical onset of MS. The study involved 50 consecutive people who had clinically isolated syndrome (CIS, meaning they had experienced a single neurological episode and had brain lesions on MRI suggestive of MS, but for which there was insufficient evidence to diagnose definite MS). Also included as controls were 50 age-matched healthy controls, 50 people who had transient global amnesia (TGA), and 50 controls age-matched to those with transient global amnesia. All underwent sonography of the veins in the brain (transcranial color-coded venous sonography- TCCvS) and outside (extracranial color-coded venous sonography - ECCVS) of the brain, and those who showed abnormalities in sonography underwent venography. TCCvS was normal in all with CIS, and abnormal ECCvS findings were found in 52% of CIS, in 32% of healthy controls, and in 68% of TGA. Eight out of 50 CIS, or 16%, met CCSVI criteria. Of those, venography was normal in 6, one had a hypoplasia (incomplete development) of the right internal jugular vein, and one developed tachycardia (rapid heart beat) and the exam was stopped. (Abstract 81)
• In a platform presentation, Dr. Robert Zivadinov described a study at the University of Buffalo using powerful 3T MRI (“susceptibility-weighted imaging or SWI) of brain tissues (parenchyma) and veins of 59 people with MS and 33 age and sex-matched healthy controls to investigate the relationship between CCSVI and altered visibility of the venous vasculature of the brain. Using Doppler sonography, the team also determined that 79.7% of those with MS fulfilled criteria for CCSVI, as did 18.2% of healthy controls. They measured absolute venous volume (AVV) for total vein vasculature, and relative venous intracranial fraction (VIF) to correct for head size and brain atrophy. They also measured the size of individual veins, and calculated “distance from vein maps,” with the higher distance indicating lower density or fewer veins. They found that compared to healthy controls, people with MS had lower AVV, lower volume of veins with a diameter less than 0.3mm, higher distance from the veins, and lower VIF. They found that this loss of smaller veins was related to lower venous vasculature visibility and was linked with subjects that fulfilled their criteria for CCSVI. They also found (perhaps paradoxically, see Abstract P265 below) that the relationship between altered vasculature and CCSVI was stronger for relapsing-remitting MS than for secondary-progressive MS. (Abstract 82)
• Reporting in a poster (Abstract P321) on the same group of 59 patients and 33 age-matched controls, the Buffalo team found that reduced venous vasculature visibility seen in people with MS was related to changes in spinal fluid flow and hypoperfusion, or lower blood flow, in the brain. In another poster related to the same group of 59 patients and controls, (Abstract P775), the team used conventional brain MRI scans (with a 3T magnet) and found that reduced venous vasculature visibility in MS was related to higher volume of T1-type lesions (these types of MS plaques are thought to represent “black holes” or areas of tissue destruction).
• In a study described in a poster (Abstract P324), Dr. M. P. Wattjes and colleagues at the VU University Medical Center in Amsterdam examined 20 people with MS and 20 healthy controls using 3T magnetic resonance venography (3D phase contrast angiography and multi-phase 3D contrast-enhanced MR angiography) in an attempt to evaluate venous obstructions using a technology that, unlike Doppler sonography, provides consistent results which do not vary according to the individual operator. Phase contrast MRI was used to quantify flow of the internal cerebral veins and straight sinus. Images were analyzed by two neuroradiologists who were blinded as to the status of the patients. They found intracranial venous stenosis (narrowing) in 4 people with MS and 1 healthy control. Extracranial stenosis was found in 8 MS patients and 7 healthy controls, and no venous backflow was found in any patients or controls.
• In several posters, more data was shared from a large-scale prevalence study at the University of Buffalo involving 499 people, including 289 people with MS, 21 people with CIS, 26 people with other neurological disorders (OND) and 163 healthy controls. The team reiterated previously released results suggesting that 54.8% of people with MS fulfilled criteria for CCSVI, compared to 25.4% of the combined controls. Further, they noted that CCSVI was more frequent in people with progressive MS (69.6%) versus non-progressive MS (48.6%). For this poster (Abstract P265), they evaluated whether there was any relationship between a gene variation associated with increased MS progression (HLA 1501) and the presence of CCSVI. They reported no significant association between HLA 1501 and people with MS and CCSVI.
• In 70.3% of the same group of 499 people, the Buffalo team used conventional MRI scans to evaluate differences in those meeting the criteria for CCSVI and those who did not meet those criteria. Those considered to have CCSVI were found to have a higher average number of classic MS brain lesions (T2, thought to detect established, scarred plaques) and also a higher average volume of T2 lesions than those classified as not having CCSVI. Those with CCSVI also had signs of having more brain atrophy, as measured by ventricle volume, parenchymal volume and cortical volume, than those without CCSVI. (Abstract P318) The team also evaluated clinical characteristics of the same group of 499 people (Abstract P653), reporting that CCSVI was more prevalent in people with more advanced MS, ranging from 89.5% of those with relapsing secondary-progressive MS to 49.2% in relapsing-remitting MS and 38.1% of those with CIS. The team also reported that those meeting CCSVI criteria tended to have more severe motor, cerebellar and brainstem involvement.
• The Buffalo team presented a poster (Abstract P774) investigating the presence of iron concentrations in the brain in 93 consecutive people with MS and 51 age- and sex-matched healthy controls. Using Doppler sonography they found that 66.7% of people with MS met criteria for CCSVI, and 27.5% of healthy controls. They used MRI imaging to assess venous insufficiency and susceptibility-weighted imaging of the deep gray matter and found that those with CCSVI and MS who had the greatest signs of venous insufficiency also had the highest concentrations of iron in specific areas of the brain.
• Dr. Florian Doepp of Humboldt University in Berlin presented a poster that expanded on his recently published findings in which the team was unable to find evidence of CCSVI in MS in 56 people with MS and 20 controls, using extra- and transcranial Doppler sonography of veins and blood flow. Expanding the study to 59 people with MS, the team confirmed previous results, including that blood flow in the internal jugular veins and vertebral veins was normal in all those tested except for one patient. The team found that turning from the supine to the upright position resulted in less pronounced decrease of total jugular blood volume flow in people with MS, and suggested that future studies should elucidate this difference seen in blood flow regulation. (Abstract P579)
• Dr. B. Yamout and colleagues at the American University of Beirut reported in a poster (Abstract P663) a study using selective extracranial venous angiography in 42 people with MS of varying duration of disease; no controls were noted. Stenosis (narrowing) of at least one vein was detected 24% of people classified as having early MS, and in 92% of those classified as having late MS, with 7%, all in the late MS group, having two veins blocked. They report that disease duration was the strongest predictor of stenosis.
• Drs. K. Alikhani and M.C. Kremenchutzky presented a poster from the MS Clinic in London, Ontario, studying the frequency of abnormal magnetic resonance venography (MRV) of the great cervical veins in 46 people (21 with MS, 6 with CIS, 5 with possible MS, and 14 with non-MS). They identified MRV abnormalities in 5 (23.8%) of those with MS, 3 (21.4%) of those with non-MS, in 1 with CIS, and none with possible MS. The feature that most distinguished people with MS who had MRV abnormalities was older age (average age of 54.8 years in those with abnormal MRV, versus 44.14 years in those with normal MRV.) (Abstract P778)
• In a poster presentation, Dr. Marian Simka and colleagues of Katowice, Poland presented findings from 331 people with MS who had previously been determined to meet criteria for CCSVI, who were evaluated for duration and severity of MS, fatigue and other factors. They found no correlation between the severity of venous obstacles and age or duration of disease. They reported that those with narrowed azygous veins tended to have the most aggressive clinical course. No controls were noted. (Abstract P641)
• In another poster, Dr. Simka and colleagues reported on safety and complications of endovascular procedures (balloon angioplasty and stenting) in 347 people with MS and CCSVI whom they had treated. The amount of followup time after the procedures was not provided. They conducted 414 balloon angioplasties and 173 stent implantations during 361 interventions in 347 people with MS and CCSVI. Complications noted included 2 cases of stent thrombosis, 1 case of surgical removal of a balloon, 4 cases of bleeding from the groin, 1 case of minor gastrointestinal bleeding, 2 cases of transient cardiac arrhythmia, 4 cases of difficulty removing balloon or its delivery system, 4 problems with placement of stents, and 4 unsuccessful catheterization of the stenosed internal jugular vein. (Abstract P914)
• Dr. Zamboni of the University of Ferrara, and colleagues from Italy and the U.S., including the University of Buffalo, presented a poster related to safety and tolerability of endovascular treatment (percutaneous transluminal angioplasty, without stenting) for people with MS meeting criteria for CCSVI. In this pilot study, 15 people who remained on disease-modifying therapy were randomly assigned to two treatment groups: 8 people received immediate treatment, and 7 received treatment after a delay of 6 months. The treatment consisted of selective venography and balloon dilation when stenoses (narrowing) were detected, with followup imaging and clinical exams for 12 months. They report that the treatment was well tolerated, and that no serious adverse events occurred except one transitory vasovagal syndrome (irregular heartbeat or faintness) one hour after treatment. Restenosis occurred at a rate of 26.7%, exclusively in the jugular vein. They conclude that further and larger studies are needed to determine the effect of endovascular treatment for CCSVI in MS. (Abstract P508)
• Related to this treatment study, team members presented a poster (Abstract P773) focusing on their use of different imaging techniques to evaluate blood flow and narrowing of the internal jugular veins in 10 of the people treated as noted above and followed over 12 months, plus 6 healthy controls. They reported poor agreement of findings of stenosis and flow between Doppler sonography and magnetic resonance venography.

Research Toward Restoring Function
-- Exploring nervous system repair

• In a platform session related to nervous system repair, Dr. L. Lau of Hotchkiss Brain Institute in Calgary described a series of studies, supported by the MS Society of Canada, that uncovered a group of molecules that reside in structural tissues (extracellular matrix) that may be among several that block the ability of the myelin-making oligodendrocytes to repair damage caused by MS. The molecules, CSPGs (chondroitin sulfate proteoglycans) contribute to scarring, and in lab dishes they reduced the number of oligodendrocyte progenitor cells that matured into myelinating cells. By selectively turning off CSPGs in lab mice with myelin damage, they were able to increase myelin repair. More research should determine whether this approach could be useful for encouraging myelin repair in people with MS. (Abstract 108)

Research Toward Ending MS Forever
-- Risk Factors

• In a platform session related to nervous system repair, Dr. L. Lau of Hotchkiss Brain Institute in Calgary described a series of studies, supported by the MS Society of Canada, that uncovered a group of molecules that reside in structural tissues (extracellular matrix) that may be among several that block the ability of the myelin-making oligodendrocytes to repair damage caused by MS. The molecules, CSPGs (chondroitin sulfate proteoglycans) contribute to scarring, and in lab dishes they reduced the number of oligodendrocyte progenitor cells that matured into myelinating cells. By selectively turning off CSPGs in lab mice with myelin damage, they were able to increase myelin repair. More research should determine whether this approach could be useful for encouraging myelin repair in people with MS. (Abstract 108)
• In a platform session, Dr. Trond Riise of the University of Bergen reviewed a growing list of factors that may contribute to an individual’s susceptibility to developing MS, but none of which are sufficient alone to cause the disease. These include a group of genes that control certain immune activity (called HLA), and environmental/lifestyle factors such as smoking, low vitamin D status, and exposure to the Epstein-Barr virus. He described a promising approach of looking at how modest risk factors interact to produce higher risks. For example, he cited a recent study from Harvard that found the risk of MS was multiplied in people who smoked and who had also been exposed to Epstein-Barr virus. Dr. Riise pointed to current, worldwide studies that were likely to bring new insight into interactions of risk factors that should lead to better understanding of the cause of MS and disease mechanisms. (Abstract 52)
• During the same platform session, Dr. Heather Hanwell presented data from the Canadian Pediatric Demyelinating Disease Network, which is supported by the MS Society of Canada and others. For this study they enrolled 135 children under 16 years of age who initially came to them having experienced a single neurological episode and were at risk for developing MS. Their levels of circulating vitamin D were measured, and it was determined whether they carried a specific gene (HLA-DRB1*15) that had previously been shown to increase risk of developing MS. The children were monitored prospectively, and 24% were eventually diagnosed with MS. The team found that those carrying the HLA gene were more likely to develop MS, as were those with the lowest blood levels of vitamin D, but that both risk factors operated independently of one another. (Abstract 54) Dr. Hanwell won a Young Investigator award for this presentation.
• During a platform session devoted to MS genetics, Dr. Steven Sawcer, University of Cambridge, briefly presented a new list of some 50 common gene variations, most immune in nature, that still need to be validated with an additional genome-wide association screen being done by the International MS Genetics Consortium, funded in part by the U.S. National MS Society, and being done in collaboration with other consortia. He explained that these genes cannot necessarily be used to determine any person’s risk for inheriting MS, but they will deepen our understanding of what goes wrong in MS new pathways for fixing it. (Abstract 31)

These and many other presentations reflect the rapid pace of MS research today.

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