The cure for multiple sclerosis (MS) continues to be elusive — and scientists believe part of the reason progress has been so slow may be due to where they’ve been looking.
Researchers at Rutgers New Jersey Medical School say it now appears that much of the investigation into the chronic disease has focused on the wrong part of the brain.
Until now, most MS research has focused on the brain’s white matter, which contains the nerve fibers. The disease occurs when the body’s immune system attacks a fatty substance called myelin, which coats nerves contained in the white matter. When the nerves are exposed, transmission of nerve impulses can be slowed or interrupted.
But a new study, published in the journal PLOS ONE, found that the brain’s gray matter, which contains the axons, dendrites and synapses that transfer signals between nerves, is far more affected by the disease than previously suspected.
It’s a finding that scientists say could give physicians more effective tools in the treatment of MS.
By taking advantage of a combination of new technologies called proteomics and high-resolution mass spectrometry, Dr. Steven Schutzer and his team were able to analyze patients’ cerebrospinal fluid (CSF); something until recently, they couldn’t do.
“Proteins present in the clear liquid that bathes the central nervous system can be a window to physical changes that accompany neurological disease,” said Schutzer, “and the latest mass spectrometry techniques allow us to see them as never before.”
In his study, Schutzer used that technology to compare the cerebrospinal fluid of newly diagnosed MS patients with that of longer term MS patients, as well as fluid taken from people with no signs of neurological disease.
The proteins in the CSF of the new MS patients suggested physiological disruptions not only in the white matter of the brain, where the myelin damage appears, but also pointed to substantial disruptions in the gray matter. Nine specific proteins associated with gray matter were far more abundant in patients who had just suffered their first attack than in longer term MS patients.
Scientists had hypothesized that there might be gray matter involvement in early MS, but until now, the technology needed to test their theories did not exist.
One of the leading MS clinicians and researchers in the country, Patricia K. Coyle of Stony Brook University in New York, called the groundbreaking study “exquisitely sensitive,” providing solid physical evidence for the very first time.
“This evidence indicates gray matter may be the critical initial target in MS rather than white matter. We may have been looking in the wrong area,” Coyle said.
The hope is that this discovery could lead to more effective treatments for MS with far fewer side effects. Drugs that MS patients currently take slow the body’s destruction of myelin in the brain, but also degrade the immune system’s ability to keep the body healthy in other ways.
Patients who suffer attacks that appear related to MS could have their cerebrospinal fluid tested quickly with a high resolution mass spectrometer. If proteins that point to early MS are found, helpful therapy could begin at once, before the disease can progress further.
But the advanced analysis of cerebrospinal fluid wouldn’t be limited to just MS. Schutzer said he has used the technique to identify physical markers for other neurological ailments, including Lyme disease and chronic fatigue syndrome.
“When techniques are refined, more medical conditions are examined, and costs per patient come down, one day there could be a broad panel of tests through which patients and their doctors can get early evidence of a variety of disorders, and use that knowledge to treat them both more quickly and far more effectively than is possible now. “
MS is a chronic disease which attacks the body’s central nervous system. An estimated 400,000 Americans have the disease; more than 2 million worldwide.
For most people with MS, relapses are initially followed by recovery periods or remissions. Symptoms may be mild or severe, ranging from numbness in the limbs to paralysis or loss of vision.
The progression, severity and symptoms of MS are unpredictable and vary from one person to another. Over time, recovery periods may be incomplete, leading to progressive decline. There is no known cure.