Research at the new Center for Multiple Sclerosis and Neurosciences

Improving the lives of MS patients

The essential goals for future work at the TUM Center for Multiple Sclerosis and Neurosciences include understanding MS in detail, being able to treat it better than before and at the same time improving quality of life for the patient. The Center building, under construction at the university hospital TUM Klinikum rechts der Isar, is set to open its doors in about three years. The Center will be a single location hosting further research into the disease as well as patient examination and treatment based on the latest state-of-the-art knowledge. Patients will also find meeting space at the Center where they will be able to help one another deal with the illness in everyday life.

Although the primary focus will be on multiple sclerosis, the scientists working at the Center will also conduct research on other diseases of the nervous system. "Especially in the later stages of the illness, when nerve cell mortality rises, in many respects MS resembles for example a stroke or Alzheimer's disease," says Prof. Thomas Misgeld of the TUM Institute of Neuronal Cell Biology. "We therefore plan to generate synergies by working together with experts on these other diseases," says Misgeld.

"It's important to us that the researchers constantly focus on our patients and their needs and that new findings make their way as quickly as possible to those suffering from the disease," says Prof. Bernhard Hemmer, Director of the Clinic for Neurology at the university hospital TUM Klinikum rechts der Isar. Important questions which Hemmer would like to devote more effort to involve the reasons and possible indications for the wide variety of forms the course of MS can follow. "Whether or not the illness breaks out and how quickly it progresses is the result of the interaction of a large number of partially unknown factors," the medical researcher points out.

Genes are known to play a role; furthermore variable aspects such as vitamin D deficiencies, smoking, obesity or a prior infection with the Epstein-Barr virus can affect the development and course of MS as well, as can other diseases such as diabetes or high blood pressure. "Our goal is to capture a widely varied range of information on the patients," says Hemmer. "We want to develop biomarkers which can be detected in the bloodstream, in cerebrospinal fluid and with imaging methods – and which can tell us reliably how intensive and how long we should treat a given patient in order to keep the individual symptom-free for as long as possible."

Recent years have seen the development of a variety of highly efficacious pharmaceuticals which work particularly well in the early stages of MS, usually characterized by recurring waves of inflammatory illnesses. "Both the desired and undesirable effects of these medications, which are aimed at the immune system, vary in intensity," says Hemmer. "And it would mean great progress if from the very beginning we could use biomarkers for every person with MS to find the optimally matching active ingredient."

Identification of this kind of biomarker requires enormous amounts of patient data, which Hemmer and his colleagues have in some cases been collecting for years in the course of various studies. "In order to collect and analyze this data with the most modern methods, we'll be working together closely with the Center for Digital Medicine and Health (ZDMG), which is planned for completion as an expansion next to the MS building by 2027," says Hemmer. This will make it possible for research staff to work together optimally with data analysis experts.

Several years ago Nadja Birkenbach-von Kuzenko learned first-hand how long it can take to find exactly the medication which is best for the individual in question. She was diagnosed with MS in 2015. "I suddenly started seeing double and when I walked, the image of my surroundings would shake back and forth," she recalls. Her immune system had already started to attack the two optic nerves which connect each eye to the brain. After a visit to the clinic's emergency room, Birkenbach-von Kuzenko went to Prof. Hemmer's office hours.

"After the first round of cortisone pulse therapy, the search began for the right long-term treatment for me with an immunomodulatory active ingredient," she recalls. She didn't handle the first three medications very well. "After that I needed to take a break," she says. But it wasn't long until the illness flared up again. "Then I tried out another medication, which it turns out has kept me free of symptoms and side-effects for four years now."

Birkenbach-von Kuzenko will have a meeting space for herself and other patients at the Center for Multiple Sclerosis and Neurosciences. "One day in December 2021 I came out of the MS outpatient clinic and I met a young woman on the street who was absolutely distraught; she had just received her MS diagnosis," she recounts. "She had so many questions and so many fears – exactly the ones I had in the initial stages of my own illness." Birkenbach-von Kuzenko then decided to share all her positive experiences of the past years with other patients: Together with Prof. Hemmer, whom she told of her plan several days later by e-mail, she launched a mentoring program for MS patients.

"The idea is that in the early stages after diagnosis, patients should be accompanied by an individual who has already had MS for a longer period of time," says Birkenbach-von Kuzenko. "The mentor can help the patient deal independently with illness-related situations that arise in everyday life and can help them live the most care-free and active life possible." Of course these two individuals can meet up wherever they like – but space will be available for them at the new Center.

"In the meantime we can treat the initial phase of MS, which can sometimes last for decades, so well that many patients can lead an almost completely normal life," Hemmer continues. But up to now there are significantly fewer therapeutic possibilities for the phase in which the disease no longer flares up in waves, but rather progresses constantly. "We know that acute inflammation in the nervous system, which in the meantime we can monitor and suppress fairly well, then becomes less frequent," the physician explains. "However, we still don't really know why more and more nerve cells die off in the later chronic phase, under which some patients suffer from the very beginning, and we don't know how this process can be slowed or even stopped."

Prof. Misgeld and his team want to join forces with a group led by Angelika Harbauer, Professor for Neurons and Metabolism, to find out what exactly makes the nerve cells die off. "There are increasing indications that in the end the cells' energy metabolism fails," says Misgeld. "In order to overcome this cellular energy crisis, among other things we'll have to ensure that the long nerve cell axons receive adequate energy both from the cell body and via the neighboring glial cells, something like energy care-packages."

It's well known that energy crises are often difficult to fight: This calls for the joint efforts of a large number of individual people. "And this will be exactly the focus at the Center for Multiple Sclerosis and Neurosciences," says Prof. Hemmer. "We're all working together so that in the not too distant future people with MS will be able to look forward to long, impairment-free lives."

More stories of issue 1/2023 of the magazine TUMcampus