Bridging the gap between imaging research and patient care in MS

“In visiting groups around the world, I have often noticed a deficiency in collaboration between technical and clinical departments,” says Dr. Shannon Kolind, Assistant Professor with the UBC Division of Neurology and a magnetic resonance imaging (MRI) physicist with the multiple sclerosis (MS) Clinic at the Djavad Mowafaghian Centre for Brain Health (DMCBH).

“The lack of effective communication and integration may impede the clinical adaptation of innovative technical developments. My goal is to bridge the gap between basic imaging research and patient care.”

MRI is a powerful tool for measuring changes in the brain and spinal cord occurring with neurological disease. Recently, several advanced MRI techniques have been developed that provide measures related to myelin and axon content. Dr. Kolind, whose MS-focused research program is centred on the development and application of myelin- and axon-sensitive MRI techniques, notes that the greater sensitivity and specificity afforded by these advancements may provide critical information regarding the underlying processes occurring in neurological disease.

“The quantitative nature of these techniques may dramatically reduce the number of patients and time period required for testing of new therapies to be successful,” Dr. Kolind says.

A key component of MS is the destruction of myelin, the fatty substance that surrounds the nerve fibres (axons) of the brain and spinal cord to speed up nerve conduction. Myelin loss exposes axons to toxic inflammation, and increases energy demand for transmission, ultimately leading to cellular exhaustion and death.

Axonal damage is irreversible and can lead to disability progression.

“Unfortunately, conventional MRI cannot distinguish between inflammation, demyelination, remyelination, and axonal damage,” says Dr. Kolind. “Our advanced MRI measures increase sensitivity to change as well as specificity to the underlying pathology.”

“For example, we recently demonstrated a significant difference in myelin measurements of non-lesional tissue for MS patients on different treatment arms of an experimental therapy over 2 years, with fewer than 30 patients per treatment arm,” Dr. Kolind says. “This approach has tremendous potential for clinical trials and research studies not only in MS, but countless neurological diseases under investigation at DMCBH.”

Preliminary research has already begun demonstrating encouraging results with clinically applicable outcomes in diseases such as neuromyelitis optica, motor neuron disease, and traumatic brain injury. Investigators with the MS research program at DMCBH are now applying these advanced MRI techniques in several clinical trials, as well as research projects at UBC, and are leading global collaborations to bring these new MRI techniques to centres around the world.

“For patients, this will mean earlier diagnosis, more focused targeting of treatment, more efficient clinical trials, and ultimately greater availability of effective therapies for those living with neurological disease or injury,” says Dr. Kolind.