A to Z of MS Neuroprotection

Neuroprotection is an area of research in multiple sclerosis.

The permanent symptoms of MS develop when nerve cells are destroyed. This is thought to occur when nerve fibres are exposed to chemicals produced by the inflammation of tissue the MS causes. The theory of neuroprotection is that, if the nerve cells can be protected from these chemicals, destruction of nerve cells - and thus further permanent problems - can be lessened or prevented.

Neuroprotective drugs will not be able to reverse progression or restore lost function. However, if suitable drugs can be developed, it is hoped that this will mean that the progression of MS can be significantly slowed down - something that is not possible with existing medication.

Research

Different aspects of neuroprotection are being examined, concentrating of different elements that lead to loss of nerve cells.

Glutamate receptor blockers are aimed at controlling one of the chemicals involved in transmitting messages from nerve cell to nerve cell. Excessive glutamate can lead to the loss of nerve fibres and early research is looking at the effects of trying to control this.

• Riluzole is a glutamate inhibitor that is used in the treatment of amyotrophic lateral sclerosis (ALS), a form of motor neurone disease. A small study involving 16 people with primary progressive multiple sclerosis did not show any definite effect. There was a trend for a reduction in MRI changes but not in clinical measures of disability.

Inflammation leads to the increase in levels of nitric oxide and sodium, both of which can damage nerve cells. Research is underway to examine the effect of blocking these chemicals.

• Lamotrigine is a sodium channel blocker sometimes used to treat pain in MS that has been studied as a potential neuroprotective drug, though the results did not differ from placebo.

Other drugs that have been used in other conditions are being investigated for their neuroprotective effect in MS:

• Eliprodil has been investigated for Parkinson's disease and trials for MS are in very early stages.
• A study of the neuroprotective effects of cannabis began in 2006. This trial, called CUPID, involves almost 500 people around the UK and is expected to report in 2012.

Research in this area is at a relatively early stage and these studies are exploring the potential of neuroprotection as a strategy rather than the possibility of making particular drug available to people with MS in the short-term. That said, if this work does lead to drugs that can slow down the progression of multiple sclerosis, this will be a major step forward in an aspect of MS for which there are currently no treatments.

References

Palace J.
Neuroprotection and repair.
Journal of Neurological Sciences 2008;265(1-2):21-25.
abstract

Aktas O, et al.
Neuroprotection, regeneration and immunomodulation: broadening the therapeutic repertoire in multiple sclerosis.
Trends in Neuroscience 2010;33(3):140-152.
abstract

Kapoor R.
Neuroprotection in multiple sclerosis: therapeutic strategies and clinical trial design.
Current Opinion in Neurology 2006;19(3):255-259.
abstract

Killestein J, et al.
Glutamate inhibition in MS: the neuroprotective properties of riluzole.
Journal of Neurological Science 2005;233(1-2):113-115.
abstract

Kapoor R, et al.
Lamotrigine for neuroprotection in secondary progressive multiple sclerosis: a randomised, double-blind, placebo-controlled, parallel-group trial.
Lancet Neurology 2010;9(7):681-688.
abstract

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