MS: One Disease or Two?
Research suggests need for individualized treatments
There are many mysteries surrounding multiple sclerosis, an unpredictable, degenerative disease that attacks the brain and spinal cord. Scientists don’t understand why symptoms progress more rapidly in certain patients, or why some patients respond better than others to drugs used to treat MS.
Benjamin Segal, M.D., has devoted his career as a researcher and a physician to finding better ways to help people with multiple sclerosis. Fascinated by how the central nervous system interacts with the immune system, Segal wants to understand the “why” of the body’s abnormal response, what cells are involved, how they get into the central nervous system and what factors they produce that cause damage — all to develop new, more effective treatments for the disease.
Since joining the Medical School faculty in 2007, Segal has already made progress toward this goal. He and his colleagues recently discovered that two immune system T-helper cells, called Th1 and Th17, triggered clinically indistinguishable symptoms in research mice with a form of MS.
Although their symptoms were the same, mice that were exposed to Th1 cells had different inflammatory agents in their central nervous system tissue than mice exposed to Th17 cells. The animals also responded differently to drugs intended to block the inflammatory response, suggesting there could be two different forms of multiple sclerosis. The research findings also might explain why some patients respond better to one medication than another — or don’t respond at all.
As director of the U-M’s new Multiple Sclerosis Center, Segal is all too familiar with the devastating effects MS can have on patients and their families.
“MS usually presents in young adults in their 20s and 30s,” says Segal, the Holtom-Garrett Family Professor of Neurology. “They face living with a chronic, disabling disease that they will have for the rest of their lives.” Segal also directs the Holtom-Garrett Program in Neuroimmunology.
Multiple sclerosis is believed to be an autoimmune disease that begins when cells in the body’s immune system attack the central nervous system (CNS), specifically proteins in the myelin sheath surrounding axons — long filaments extending from nerve cells. The immune system’s misguided attack disrupts the axons’ ability to relay electrical impulses from cell to cell, leading to symptoms that include vertigo, balance and vision problems, tremor, weakness, numbness, loss of bowel and bladder control, and cognitive difficulties.
In future studies, Segal hopes to learn how different T cells move from blood to the CNS and to devise strategies to block those pathways. “The more we understand, the more we can individualize therapies and make them more specific, so we don’t leave patients as vulnerable to side effects,” says Segal.
For patients, the Multiple Sclerosis Center means access to the newest therapies, as well as to specialists with extensive experience diagnosing and treating the disease over time, and staff attuned to patient needs. Patients often need many types of support from a variety of professionals, explains Segal — including speech, occupational and physical therapists, as well as psychological support.
“Ultimately we want to provide care under one roof from all health providers concerned with the diagnosis and treatment of MS patients,” he says.
Segal knows there is a lot of work to do, but he remains driven and optimistic. “To offer patients reasons for hope, and to intervene in the disease process to improve their quality of life, is what it’s all about.”
—KIMBERLEE ROTH
An expanded version of the story
Patient information on multiple sclerosis
