Polly: What effect does brain volume loss have on MS progression?
Professor Gavin Giovannoni, Neurologist: Brain volume loss? Well, brain volume loss is kind of, I like to think of it as like the integrator when we did mathematics calculus, it actually adds up all the damage that occurs. So with MS and you’ve got all these lesions coming and going and damaging nerve fibres and those nerve fibres eventually die off, that process causes the brain to shrink, right? So what we do know now is that people with MS who have a shrunken brain, or their brain is shrinking, do a lot, lot worse in the future, they become much more disabled or much more likely to become progressive than those who don’t have a shrunken brain or where the brain is not shrinking. So it’s a very good marker of the disease and it’s a very good prognostic marker, it predicts what happens in the future. So what we really need to do is have treatments that not only switch off all the inflammation, but also stop the brain shrinking, and that’s where we’re moving to our next generation of therapies, have to be what I call neuro-protective, stop the brain from shrinking. So it’s a very important part of our next phase of treatment actually.
Polly: Okay, so there is ongoing research into it?
Professor Gavin Giovannoni: Well, we already have some drugs that can slow down – I say slow down, because we won’t stop the brain shrinking. The reason for that is it’s part of normal ageing. As you hit about 35, everybody’s brain shrinks, it’s part of the ageing process. What we’re trying to do with our therapies is to bring people with MS into the normal range, so their brains shrink as part of normal ageing, rather than in addition to normal ageing, because the brains of people with MS on average shrink two to five times more quickly than normal, so we’d like to bring them back into the normal range.
Polly: Why? Why do they shrink faster?
Professor Gavin Giovannoni: Simply because the inflammation that occurs in the brain is damaging nerve fibres and those nerve fibres are dying and the neurons, the cells are dying, and as they die the brain shrinks. So it’s actually a marker of the neuronal loss that occurs in MS.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.