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McMurran C, Mukherjee T, William Brown J, Michell A, Coles A, Cunniffe N. 095 Remyelination in people with MS due to an RXR agonist is age-dependent. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Remyelination is a promising strategy to prevent axonal degeneration and progressive disability in people with multiple sclerosis (MS). In animal models, remyelination becomes inefficient with advancing age and much preclinical research is focused on interventions to reverse cellular hallmarks of ageing in remyelinat- ing lesions. However, there is currently limited evidence that human remyelination also declines with age.We investigated the effect of patient age on treatment response among participants of the CCMR One trial (ISRCTN14265371): a double-blind, placebo-controlled phase 2a study (n=52) that demonstrated the ability of bexarotene, a retinoid-X receptor agonist, to promote remyelination in people aged 25–50 with relapsing remitting MS. For eyes with chronic optic neuropathy (baseline latency >118ms), bexarotene shortened the full-field visual-evoked potential P100 latency maximally in younger patients. The treatment effect diminished by approximately 0.5ms per year, such that older patients receiving bexarotene had a similar P100 latency change to controls. Furthermore, MRI scans of the same patients demonstrated an age-dependent treatment effect on lesion magnetisation transfer ratio, a radiological correlate of remyelination.These results provide evidence that bexarotene promotes remyelination best in younger patients, rein- forcing the need to address the age-associated decline in remyelination capacity to develop successful remyelinating therapies.cem73@cam.ac.uk|NIHR Bursary
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Cunniffe N, Vuong KA, Ainslie D, Baker D, Beveridge J, Bickley S, Camilleri P, Craner M, Fitzgerald D, de la Fuente AG, Giovannoni G, Gray E, Hazlehurst L, Kapoor R, Kaur R, Kozlowski D, Lumicisi B, Mahad D, Neumann B, Palmer A, Peruzzotti-Jametti L, Pluchino S, Robertson J, Rothaul A, Shellard L, Smith KJ, Wilkins A, Williams A, Coles A. Systematic approach to selecting licensed drugs for repurposing in the treatment of progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2021; 92:295-302. [PMID: 33184094 DOI: 10.1136/jnnp-2020-324286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish a rigorous, expert-led, evidence-based approach to the evaluation of licensed drugs for repurposing and testing in clinical trials of people with progressive multiple sclerosis (MS). METHODS We long-listed licensed drugs with evidence of human safety, blood-brain barrier penetrance and demonstrable efficacy in at least one animal model, or mechanistic target, agreed by a panel of experts and people with MS to be relevant to the pathogenesis of progression. We systematically reviewed the preclinical and clinical literature for each compound, condensed this into a database of summary documents and short-listed drugs by scoring each one of them. Drugs were evaluated for immediate use in a clinical trial, and our selection was scrutinised by a final independent expert review. RESULTS From a short list of 55 treatments, we recommended four treatments for immediate testing in progressive MS: R-α-lipoic acid, metformin, the combination treatment of R-α-lipoic acid and metformin, and niacin. We also prioritised clemastine, lamotrigine, oxcarbazepine, nimodipine and flunarizine. CONCLUSIONS We report a standardised approach for the identification of candidate drugs for repurposing in the treatment of progressive MS.
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Affiliation(s)
- Nick Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Debbie Ainslie
- Research Network, Multiple Sclerosis Society, London, UK
| | - David Baker
- Blizard Institute, Queen Mary University of London, London, UK
| | - Judy Beveridge
- Research Network, Multiple Sclerosis Society, London, UK
| | | | | | - Matthew Craner
- Department of Neurology, University of Oxford, Oxford, UK
| | - Denise Fitzgerald
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's Univeristy, Belfast, UK
| | - Alerie G de la Fuente
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's Univeristy, Belfast, UK
| | | | - Emma Gray
- Multiple Sclerosis Society, London, UK
| | | | - Raj Kapoor
- Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Ranjit Kaur
- Research Network, Multiple Sclerosis Society, London, UK
| | | | | | - Don Mahad
- Centre for Clinical Brain Sciences, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Björn Neumann
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alan Palmer
- University of Reading, Reading, Berkshire, UK
| | | | - Stefano Pluchino
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alan Rothaul
- Independent consultant, Woodstock, Oxfordshire, UK
| | | | - Kenneth J Smith
- Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | | | - Anna Williams
- MS Centre, Centre for regenerative medicine, University of Edinburgh, Edinburgh, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Abstract
The greatest unmet need in multiple sclerosis (MS) are treatments that delay, prevent or reverse progression. One of the most tractable strategies to achieve this is to therapeutically enhance endogenous remyelination; doing so restores nerve conduction and prevents neurodegeneration. The biology of remyelination-centred on the activation, migration, proliferation and differentiation of oligodendrocyte progenitors-has been increasingly clearly defined and druggable targets have now been identified in preclinical work leading to early phase clinical trials. With some phase 2 studies reporting efficacy, the prospect of licensed remyelinating treatments in MS looks increasingly likely. However, there remain many unanswered questions and recent research has revealed a further dimension of complexity to this process that has refined our view of the barriers to remyelination in humans. In this review, we describe the process of remyelination, why this fails in MS, and the latest research that has given new insights into this process. We also discuss the translation of this research into clinical trials, highlighting the treatments that have been tested to date, and the different methods of detecting remyelination in people.
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Affiliation(s)
- Nick Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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