One goal of the
MSplus Foundation is to educate its members and the public about research on
multiple sclerosis. The following articles feature some of the work being
Wisconsin Researchers Show that Thinly
Repaired Myelin Sheaths Restore Nerve Function and Persist for Years
Myelin sheaths that encase nerve fibers are
vital to nerve function and health. Finding ways to enhance the body’s ability
to repair myelin that has been damaged by the MS disease process is a priority
for restoring function. It has been known that repaired myelin is much thinner
than the original sheath, but it wasn’t clear how well the repaired myelin
could restore function. Now researchers funded by the National MS Society at
the University of Wisconsin show that thinly repaired myelin sheaths are no
lightweights: In fact, in models experiencing myelin damage, these sheaths
persisted for years, and supported restored neurologic function. These findings
may prove important in ongoing and future efforts to evaluate whether
experimental therapies to promote myelin repair in MS are working.
This story can be found on the National MS
Society website at https://www.nationalmssociety.org/About-the-Society/News/Wisconsin-Researchers-Show-that-Thinly-Repaired-My
Global Experts Publish Recommendations for
Overcoming Challenges to Improve Clinical Trials in Progressive MS
A special issue of Multiple Sclerosis
Journal, sponsored by the International Progressive MS Alliance, has been published, containing ten
papers that review the challenges and the potential solutions to improving
clinical trials and their outcomes so that new treatments become available for
people living with progressive MS.
MS is a form of MS that gets worse over time. Each day, progressive MS takes
things away from people: vision, mobility, cognition, ability to work, and
their very independence. MS is found in every country where studies have been
conducted, and more than 2.3 million people worldwide currently live with the
disease; over 1 million people live with a progressive form of MS.
special issue includes articles on many aspects of trial design, lessons
learned, and research gaps, and includes a paper by a person living with MS,
urging researchers to involve people with MS in every stage of planning and
conducting clinical trials so that they are relevant to the treatment needs of
people with progressive MS.
Special Issue: Advancing Trial Design In Progressive Multiple
The evolving role of people with MS in
clinical research— Some progress but more is needed
Progressive MS trials: Lessons learned
Targets of therapy in progressive MS
Fluid biomarker and electrophysiological
outcome measures for progressive
Imaging outcome measures for progressive
multiple sclerosis trials
Clinical outcome measures for
progressive MS trials
Patient selection for trials
Clinical trial design for progressive MS
· Progressive MS – macro views’: The need
for novel clinical trial paradigms to enable drug development for progressive
This story can be found on the National MS
Society website at https://www.nationalmssociety.org/About-the-Society/News/Global-Experts-Publish-Recommendations-for-Overcom
New Device Aims to Use Light to Predict How
Well Chemotherapy Treats Breast Cancer
In his lab at Boston University, Darren
Roblyer, PhD, studies mice, invents new medical devices, and guides a clinical
trial for women getting chemotherapy as their first treatment for breast
cancer. All 3 of these projects are funded by his grant from the American
Cancer Society. They all also have the same goal: To learn how well
chemotherapy is working to destroy a tumor, as quickly as possible after the
treatment is started.
With that information, patients may not have
to cope with side effects of chemotherapy drugs that aren’t helping them.
Oncologists can try another combination of drugs right away. And, women with
breast cancer may survive longer.
Roblyer’s expertise is using light to take
pictures of what’s happening inside a tumor. His field of work is called optical imaging.
How Optical Imaging Works
If you’ve ever put a flashlight against your
palm, you’ve seen how light shines through skin and spreads out on the other
side of your hand. Some health and medical devices make use of these optical
One example is a Fitbit that monitors
heartrate by shining a green light through the skin above the wrist. Another
optical device is a pulse oximeter. That’s the little clamp nurse’s put on a
patient’s finger in the hospital to measure the percentage of blood that’s
carrying oxygen. The oximeter works by shining a red light and an infrared
light through one side of your finger and using a detector on the other side to
measure any light that your finger didn’t absorb.
Roblyer uses near infrared light, which is a
little bit redder than humans can see. “What’s cool about light in the near
infrared is that it can penetrate deep into tissue—centimeters deep,” Roblyer
says. He and his team send light through the skin of the person with cancer,
and photons (particles of light) travel through the tissue and through the
Then, a tiny number of the photons come back
out of the tissue. “We can look at the photons with a camera or sensor,”
Roblyer says, “and based on how they’ve changed—how many were absorbed, how
many scattered—we can tell an amazing amount about the tissue.”
Optical Imaging Shows About a Tumor
A common reason someone has chemotherapy as the first treatment for breast cancer is to shrink a tumor so
it is easier to remove with surgery. That can mean the difference between having the whole breast
removed (mastectomy) and having only the tumor removed (lumpectomy).
To see how effectively chemotherapy is
decreasing the tumor’s size, doctors can use traditional imaging devices
like mammography and ultrasound.
But in up to about 20% of patients, surgeons
find that chemotherapy didn’t shrink the tumor at all. “That means a patient
may have had months of treatment that’s making them feel horrible but that’s
not doing anything to the cancer,” Roblyer says.
In addition to shrinking the tumor, another
big benefit of chemotherapy before surgery can include increasing how long
patients live. And that isn’t related to the tumor’s size or shape.
Studies show a woman lives longer when
chemotherapy before surgery leads to a “pathologic complete response.” That
means when the tumor is removed by surgery, doctors don’t see cancer cells
actively growing in the tumor.
“In the infusion center, one major issue for
doctors is that you can’t tell if chemo even gets to the tumor,” Roblyer says.
His team’s optical imaging methods could change this.
Diffuse Optical Spectroscopy (DOS) lets doctors
see the biological changes occurring inside the tumor earlier. The first time
Roblyer and his team use DOS is at the same time patients are receiving
chemotherapy. They also measure patients during the first week after infusion
and at other times during the treatment cycle.
DOS can track a tumor’s blood supply and
metabolism by taking images of how the tumor affects light. These kinds of
changes occur before changes in tumor shape or size do.
The kinds of imaging currently used to check
for a pathologic complete response, include certain types of PET and MRI scans. Because their size makes these
machines unmovable, PET scans and MRIs can’t be used during chemotherapy
infusions. Doctors tend to use these scans after a patient has received 1 or 2
cycles of chemotherapy.
There are several benefits of seeing how the
chemotherapy affects the tumor early on. First, doctors can stop using chemotherapy
drugs that aren’t working on the cancer—maybe before they can cause major side
effects. Plus, doctors may be able to use DOS to predict how well a different
drug or set of drugs will work to help them choose the most promising one(s).
Finding the chemotherapy that leads to a pathologic complete response earlier
might increase a patient’s chance for surviving longer.
Some Early Exciting Findings
“It’s really, really fascinating,” Roblyer
says. Some of the changes his team sees are predictive for how well the
chemotherapy will work. “You’d think that you’d see less oxygen in the tumor as
it starts to die from chemo,” Roblyer says, “But, we found something kind of
weird. In the first 24 hours after a patient’s very first infusion, sometimes
we saw an increase in oxygenated blood, not a decrease.”
“Even more provocatively,” he adds, “in
earlier studies, we discovered that spike was a predictor of whether the
patient would respond to the treatment, weeks and months into the future. It
seems to be a positive indicator that the chemo will work well.”
Roblyer and his team were inspired. “We
started to think, ‘Wow, there’s probably a lot of biology happening during
treatment that hasn’t been studied because the tools haven’t been available to
measure patients at the right time points.”
That’s what stimulated his team to design a
wearable device that would use optics to study chemotherapy’s effect on a
breast tumor. But, as Roblyer says, “You can’t build something and just start
measuring patients. There are many steps in between.” And that’s why Roblyer
and his group simultaneously test optics in both mice and humans.
The Benefits of Studying Mice and
Humans at the Same Time
In text books and journal articles, Roblyer
says, it looks like research happens sequentially—a direct path from working
with cells, then small animals in a preclinical setting, then with people in
clinical trials. “But in our lab, it’s all simultaneous, all the time.” Even
his grant covers 3 distinct, but overlapping projects.
“We don’t just translate what we’ve learned
from the lab to the clinic like you hear about with drug development,” Roblyer
explains. “We translate in both directions—back and forth from the clinic to
the lab. I call it reverse translation.”
The benefit, he says, is that you can do
things using small animals that you can’t do in humans. For instance, you can
try drugs that aren’t FDA approved yet or different doses. “So, we may see
something in clinical studies that raises a question we can only answer with an
Designing a New Wearable Optical Device
For the clinical trial Roblyer’s
co-leading with oncologist Naomi Ko, MD, he uses a handheld probe against the
surface of the skin to measure a tumor with DOS. At the same time, he’s
designing a flexible DOS that women can wear that conforms to the same shape of
It will be the first-ever wearable imaging
pad that can take continuous optical measurements in breast cancer patients.
“It’s been an iterative process.” Roblyer is perfecting his device with the
help of a grant from the American Cancer Society.
The current model has 32 light sources (LEDs)
and 16 photodiodes. Roblyer's team kept modifying the places for light sources
and diodes to find one that would allow the highest sensitivity to measure what
they wanted at different depths. Right now, the device doesn’t store data. It
has to be connected to a computer to download its information.
“It’s hard to measure as frequently as we
want with the device we have,” Roblyer says. “We’re thinking about how to make
it untethered in the future because the chemotherapy infusion center is just
the first place we want to measure the effects of chemo on the tumor. It would
be fantastic if the patient could wear the device at home so we could learn
more about what the most valuable timepoints are. They could be a day, or a
week after treatment.”
In addition to portability, there are some
things to work out with the device—like Roblyer’s team is still looking for the
best way to adhere it to the skin. He still has another year of work through
his American Cancer Society grant, though, so his team has room for more
When the grant's over, Roblyer and his team
likely have several years of work to do before the wearable DOS device will be
ready for doctors to use it with patients. "We still need to test it with
healthy volunteers and with people who have breast cancer," Roblyer says.
"Plus, FDA approval, and much more."
But simultaneous work continues. Receiving
the grant from the American Cancer Society spurred Roblyer’s success with
grants from other sources. He and his team are working on several new projects.
They’re using optical monitoring to explore less toxic treatments for
chemo-resistant breast tumors. They’re also using DOS to monitor the effects of
treatment in children with osteosarcoma, a cancer that starts in the bones.
This article appears on the American Cancer
Society website at https://www.cancer.org/latest-news/new-device-aims-to-use-light-to-predict-how-well-chemotherapy-treats-breast-cancer