Claire: Is there any connection between remyelination and brain lesions? And can this be done by an MRI?
Dr Anna Williams, Neurologist: Yes. So when you have MS and you look on an MRI scan you see these sort of blocks around, these sort of white lesions and they’re inflammatory lesions, and they’re what we classically think of in MS, they’re the ones that have got lots of inflammatory cells in and they’ve got demyelination. And so those lesions are the ones that we want to remyelinate because they’re the ones that have lost the myelin, so that’s the connection there. The MRI scans are getting better at being able to tell the difference between a demyelinated lesion and a remyelinated lesion, but the problem as always is actually knowing what is remyelinated in a living person. So what people have been doing, some quite neat experiments on post-mortem brains, so people donate their brains to research and we take out the brains, put them in the MRI scanner and then actually section them afterwards so that we can then try matching the MRI scan with the histology.
Claire: What you have in front of you?
Dr Anna Williams: Exactly. And that’s been incredibly helpful, because otherwise, how do you know what you’re seeing on an MRI scan is what you’re seeing when you actually look at the brain. And that’s the problem with MRI scans, it’s like art, you know, it’s a picture and you try and interpret it. But we’re getting better at that, but I think we have to get better still at knowing which ones are remyelinated and which ones aren’t, and then if we can do that robustly, then we can start saying okay, if I give you that drug does that make that lesion look more remyelinated. And that will be much easier.
The same is a problem with neurodegeneration, we can’t see single nerves on an MRI scan, so it’s quite difficult to see whether they’ve degenerated or not, but you can see brain shrinkage, so all of us when we get older our brains get smaller, but if you lose nerves it gets smaller quicker, but that’s a very inexact way of measuring. You could just say well, the brain looks a bit smaller, but you know, that could be millions of neurons lost and we wanted to stop one being lost. So again, the sensitivity is quite difficult, but there’s lots of people working on this, because this is really key. You know, we could have all the best drugs in the world for remyelination, if we can’t measure to see if people are getting better, then it’s not very good, except we go on people. You know, if people look better and if they don’t get worse so quickly, then that’s a good measure as well. So it will be a combination of MRI scans and clinical course. Ideally, we would clone you and have one on treatment and one on not and see how we do.
Claire: I’m not sure we want to do that!
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Dr Anna Williams is Professor of Regenerative Neurology at the Centre for Regenerative Medicine. She has published multiple works focused on MS and its treatment. Her recently research has focused on T Cells effects in myelin and brain lesions. She gained her PhD at the university of Edinburgh.