multiple sclerosis

TARGETING VAV1 SCAFFOLDING AND ENZYMATIC FUNCTIONS IN MULTIPLE SCLEROSIS VIA BRAIN-PENETRANT MOLECULAR GLUE DEGRADERS

Abstract Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) with significant unmet medical needs, as current therapies offer limited efficacy against neurodegeneration and can have considerable side effects. VAV1, a key signaling protein predominantly expressed in hematopoietic cells, plays a crucial role in T and B lymphocyte activation and is genetically and functionally validated as a therapeutic target in MS. This project proposes an innovative approach to target VAV1 through the development of brain-penetrant molecular glue (MG) degraders. Distinct from Proteolysis Targeting Chimeras (PROTACs) that require a high- affinity ligand for the target protein, molecular glues can mediate degradation by engaging specific protein surface features, such as loops, without the necessity of a dedicated binder. These degraders aim to induce the proteasomal degradation of VAV1, thereby ablating both its enzymatic and scaffolding functions, which are implicated in neuroinflammation. The research strategy involves three primary aims: 1) To optimize lead VAV1 molecular glue degraders for enhanced potency, brain penetration, and favorable pharmacokinetic properties using advanced computational modeling and medicinal chemistry. 2) To evaluate the in vivo efficacy of the optimized VAV1 degraders in preclinical mouse models of MS (Experimental Autoimmune Encephalomyelitis - EAE), assessing their ability to ameliorate disease severity, reduce CNS inflammation and demyelination, and engage VAV1 in the CNS. 3) To investigate the Structure-Activity Relationship (SAR) of a novel non-canonical VAV1 degron motif, aiming to expand the understanding of molecular glue-mediated degradation and enable the rational design of degraders for other challenging therapeutic targets. Successful completion of this project is expected to deliver preclinical candidate VAV1 degraders with the potential for a novel, effective, and safer treatment paradigm for MS. Furthermore, the insights gained into non-canonical degron recognition will significantly advance the field of targeted protein degradation, broadening the scope of "undruggable" targets for therapeutic intervention in various diseases.

Improving Disease-Modifying Therapy Uptake among Patients with Multiple Sclerosis

Project Summary/Abstract Recent advances in the epidemiology of multiple sclerosis (MS) indicate that its prevalence is similar among White (238 per 100,000) and Black (226 per 100,000) populations. These data challenge historic assumptions about individuals with northern European heritage having higher risk and prevalence of MS. Evidence also suggests that MS incidence may be higher than previously recognized in the United States and increasing over time with more individuals identified and diagnosed year over year. MS continues to impose significant and growing burden on patients, healthcare systems and society. These health differences in the diagnosis, treatment and symptom management of MS in light of the increasing prevalence of MS in the US are an important public health issue that requires broader urgent research and policy attention to reduce the overall disease burden. In this study, we will use real-world data derived from the electronic health records (EHR) from four large academic medical centers (University of Kentucky, University of Virginia, Virginia Commonwealth University, and University of Southern California). Extracted EHR data from these four medical centers will be deidentified, combined, and harmonized. We will use this combined data set to examine (1) whether there are any differences in the timely treatment of disease modifying therapy (DMT) among different MS populations, (2) any disparities in the management of symptoms and comorbidities, (3) how non-medical factors of health such as income, education, and health insurance status (patientlevel), linguistically appropriate care provision (provider-level), and neighborhood factors (system-level) affect these outcomes and influence disparities across populations, and (4) assess whether disparities exist in the risks of cardiovascular disease CVD and mortality in MS subgroups and examine if these disparities can be reduced with improved treatment of MS and vascular comorbidities. In pursuing these objectives, we will identify clinical solutions (e.g., optimal DMT sequences) and non-medical factors such as neighborhood factors such as poverty, educational achievement, crime rates, civic participation, and housing quality, access to care factors, and cultural and linguistic match between providers and patients that substantially contribute to health disparities. For actionable solutions, we will rank-order these factors by their relative importance in addressing disparities, which will guide decision-making at the policy, system, and provider level. Our long-term objective is to develop public health strategies and scalable solutions to reduce overall burden in the management of MS. This project is expected to help policy makers and health system administrators in prioritizing interventions and to have implications for clinical practice in improving care of all patients with MS in neurology clinics, at the healthcare system level, and for national health policy.

Noninvasive Neuromodulation to Improve Hand Motor Function in Multiple Sclerosis

Project Summary/Abstract Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, and degenerative disease that affects nearly one million Americans. Although more than 75% of persons with MS (PwMS) experience hand motor impairments that reduce independence and quality of life, current treatments primarily aim to slow disease progression through pharmacological approaches and rehabilitation and often do not improve motor function. Recent evidence shows that reduced corticospinal transmission is strongly associated with motor impairment severity in PwMS, highlighting the need for targeted strategies to strengthen residual corticospinal pathways. Therefore, this project aims to evaluate the therapeutic potential of paired corticospinal-motoneuronal stimulation (PCMS) in improving hand dexterity in PwMS. PCMS, a noninvasive mechanism-driven neuromodulation approach, enhances corticospinal transmission by producing long-term potentiation-like effects at the corticospinal-motoneuronal synapse by precisely pairing transcranial magnetic stimulation (TMS) with peripheral nerve stimulation (PNS). This project first aims to examine the effects of a single PCMS session on corticospinal transmission and hand motor function in PwMS. Using a randomized, crossover design, 25 PwMS will complete two sessions: (1) PCMS and (2) sham-PCMS. Each session will deliver 180 paired TMS-PNS stimuli over 30 minutes. The primary outcome is performance on the 9-Hole Peg Test (9HPT). Secondary outcomes include pinch grip force, maximal voluntary contraction (MVC), MEP amplitude and latency, F-wave parameters, and M- max amplitude. It is hypothesized that PCMS will enhance corticospinal transmission and improve hand motor performance compared to sham stimulation. Second, this project will examine the effects of PCMS combined with hand motor training in PwMS. Forty-eight PwMS will be randomized to receive either PCMS or sham-PCMS combined with motor training over 10 sessions in 3–4 weeks. Outcomes will be assessed at baseline, post- intervention, and one-month follow-up. It is hypothesized that PCMS participants receiving PCMS with motor training to show greater functional gains than those receiving sham-PCMS with motor training and the functional gains will be better maintained in the PCMS with motor training group at follow-up. This project is the first to apply PCMS in PwMS, leveraging a noninvasive neuromodulation strategy to specifically enhance corticospinal output for improving manual dexterity. Findings will establish proof-of-concept for this intervention in PwMS and guide future studies optimizing stimulation protocols and evaluating clinical efficacy on a larger scale. Ultimately, this work may lead to a new therapeutic approach to improve dexterity, independence, and quality of life for people living with MS.

The role of real-word data in scientific evidence. Experiences from the Danish Multiple Sclerosis Registry

How the brain barriers ensure CNSimmune privilege”

Britta Engelhard’s research is devoted to understanding thefunction of the different brain barriers in regulating CNS immunesurveillance and how their impaired function contributes toneuroinflammatory diseases such as Multiple Sclerosis (MS) orAlzheimer’s disease (AD). Her laboratory combines expertise invascular biology, neuroimmunology and live cell imaging and hasdeveloped sophisticated in vitro and in vivo approaches to studyimmune cell interactions with the brain barriers in health andneuroinflammation.

Development of a small molecule to promote neuroprotection and repair in progressive multiple sclerosis

The role of CNS microglia in health and disease

Microglia are the resident CNS macrophages of the brain parenchyma. They have many and opposing roles in health and disease, ranging from inflammatory to anti-inflammatory and protective functions, depending on the developmental stage and the disease context. In Multiple Sclerosis, microglia are involved to important hallmarks of the disease, such as inflammation, demyelination, axonal damage and remyelination, however the exact mechanisms controlling their transformation towards a protective or devastating phenotype during the disease progression remains largely unknown until now. We wish to understand how brain microglia respond to demyelinating insults and how their behaviour changes in recovery. To do so we developed a novel histopathological analysis approach in 3D and a cell-based analysis tool that when applied in the cuprizone model of demyelination revealed region- and disease- dependent changes in microglial dynamics in the brain grey matter during demyelination and remyelination. We now use similar approaches with the aim to unravel sensitive changes in microglial dynamics during neuroinflammation in the EAE model. Furthermore, we employ constitutive knockout and tamoxifen-inducible gene-targeting approaches, immunological techniques, genetics and bioinformatics and currently seek to clarify the specific role of the brain resident microglial NF-κB molecular pathway versus other tissue macrophages in EAE.

Present and Future of the diagnostic work-up multiple sclerosis: the imaging perspective

Valentine’s Day for people with multiple sclerosis: promoting brain repair through remyelination

Current disease-modifying therapies in multiple sclerosis are all focused on suppressing the inflammatory phase of the disease. This has been extremely successful, and it is doubtful that significantly more efficacious anti-inflammatory treatments will be found. However, it remains the case that people with relapsing-remitting multiple sclerosis acquire disability on treatment, and enter the secondary progressive phase. I argue that we now need treatments that prevent neuronal degeneration. The most promising approach is to prevent axons degenerating by remyelination. Since the discovery that the adult brain contains stem cells which can remyelinate, the problem now is how to promote endogenous remyelination, and how to know when we have achieved this! We have successfully identified one drug which promotes remyelination but unfortunately it is too toxic for use in the clinic. So the hunt continues.

Pro-regenerative functions of microglia in demyelinating diseases

Our goal is to understand why myelin repair fails in multiple sclerosis and to develop regenerative medicines for the nervous system. A central obstacle for progress in this area has been the complex biology underlying the response to CNS injury. Acute CNS damage is followed by a multicellular response that encompasses different cell types and spans different scales. Currently, we do not understand which factors determines lesion recovery. Failure of inflammation to resolve is a key underlying reason of poor regeneration, and one focus is therefore on the biology of microglia during de- and remyelination, and their cross talk to other cells, in particular oligodendrocytes and the progenitor cells. In addition, we are exploring the link between lipid metabolism and inflammation, and its role in the regulation of regeneration. I will report about our recent progress in our understanding of how microglia promote regeneration in the CNS.

Autologous hematopoietic stem cell transplantation as a highly effective treatment for multiple sclerosis - clinical and mechanistic observations

Modulation of oligodendrocyte development and myelination by voltage-gated Ca++ channels

The oligodendrocyte generates CNS myelin, which is essential for normal nervous system function. Thus, investigating the regulatory and signaling mechanisms that control its differentiation and the production of myelin is relevant to our understanding of brain development and of adult pathologies such as multiple sclerosis. We have recently established that the activity of voltage-gated Ca++ channels is crucial for the adequate migration, proliferation and maturation of oligodendrocyte progenitor cells (OPCs). Furthermore, we have found that voltage-gated Ca++ channels that function in synaptic communication between neurons also mediate synaptic signaling between neurons and OPCs. Thus, we hypothesize that voltage-gated Ca++ channels are central components of OPC-neuronal synapses and are the principal ion channels mediating activity-dependent myelination.

Regenerative Neuroimmunology - a stem cell perspective

There are currently no approved therapies to slow down the accumulation of neurological disability that occurs independently of relapses in multiple sclerosis (MS). International agencies are engaging to expedite the development of novel strategies capable of modifying disease progression, abrogating persistent CNS inflammation, and support degenerating axons in people with progressive MS. Understanding why regeneration fails in the progressive MS brain and developing new regenerative approaches is a key priority for the Pluchino Lab. In particular, we aim to elucidate how the immune system, in particular its cells called myeloid cells, affects brain structure and function under normal healthy conditions and in disease. Our objective is to find how myeloid cells communicate with the central nervous system and affect tissue healing and functional recovery by stimulating mechanisms of brain plasticity mechanisms such as the generation of new nerve cells and the reduction of scar formation. Applying combination of state-of-the-art omic technologies, and molecular approaches to study murine and human disease models of inflammation and neurodegeneration, we aim to develop experimental molecular medicines, including those with stem cells and gene therapy vectors, which slow down the accumulation of irreversible disabilities and improve functional recovery after progressive multiple sclerosis, stroke and traumatic injuries. By understanding the mechanisms of intercellular (neuro-immune) signalling, diseases of the brain and spinal cord may be treated more effectively, and significant neuroprotection may be achieved with new tailored molecular therapeutics.

Magnetic Resonance Measures of Brain Blood Vessels, Metabolic Activity, and Pathology in Multiple Sclerosis

The normally functioning blood-brain barrier (BBB) regulates the transfer of material between blood and brain. BBB dysfunction has long been recognized in multiple sclerosis (MS), and there is considerable interest in quantifying functional aspects of brain blood vessels and their role in disease progression. Parenchymal water content and its association with volume regulation is important for proper brain function, and is one of the key roles of the BBB. There is convincing evidence that the astrocyte is critical in establishing and maintaining a functional BBB and providing metabolic support to neurons. Increasing evidence suggests that functional interactions between endothelia, pericytes, astrocytes, and neurons, collectively known as the neurovascular unit, contribute to brain water regulation, capillary blood volume and flow, BBB permeability, and are responsive to metabolic demands. Increasing evidence suggests altered metabolism in MS brain which may contribute to reduced neuro-repair and increased neurodegeneration. Metabolically relevant biomarkers may provide sensitive readouts of brain tissue at risk of degeneration, and magnetic resonance offers substantial promise in this regard. Dynamic contrast enhanced MRI combined with appropriate pharmacokinetic modeling allows quantification of distinct features of BBB including permeabilities to contrast agent and water, with rate constants that differ by six orders of magnitude. Mapping of these rate constants provides unique biological aspects of brain vasculature relevant to MS.

The immunopathology of advanced multiple sclerosis

We recently analyzed a large cohort of multiple sclerosis (MS) autopsy cases of the Netherlands Brain Bank (NBB) and showed that 57% of the lesion in advanced MS is active (containing activated microglia/macrophages). These active lesions correlated with disease severity and differed between males and female MS patients.1 Already in normal appearing white matter microglia show early signs of demyelination.5 T cells are also frequently present in advanced stages of MS and have a tissue resident memory (Trm) phenotype, are more frequently CD8+ then CD4+, are located perivascular, enriched in active and mixed active/inactive MS lesions and correlated with lesion activity, lesion load and disease severity.2-4 Like Trm cells, B cells are located perivascular and were also enriched in active MS lesions but in lower numbers and a proportion of the MS patients had almost no detectable B cells in the regions analyzed. MS patients with limited presence of B cells had less severe MS, and less active and mixed active /inactive lesions. We conclude that advanced MS is characterize by a high innate and adaptive immune activity which is heterogeneous and relates to the clinical disease course.

Electrophysiology application for optic nerve and the central nervous system diseases

Electrophysiology of eye and visual pathway is useful tool in ophthalmology and neurology. It covers a few examinations to find out if defect of vision is peripheral or central. Visual evoked potentials (VEP) are most frequently used in neurology and neuroophthalmology. VEP are evoked by flash or pattern stimulations. The combination of these both examinations gives more information about the visual pathway. It is very important to remember that VEP originate in the retina and reflect its function as well. In many cases not only VEP but also electroretinography (ERG) is essential for diagnosis. The seminar presents basic electrophysiological procedures used for diagnosis and follow-up of optic neuropathies and some of central nervous system diseases which affect vision (mostly multiple sclerosis, CNS tumors, stroke, traumas, intracranial hypertension).

Aptamers to remyelinate multiple sclerosis: effects of ApTOLL© treatment in preclinical models and detection of mechanisms in human samples

Assessment of IL-38 levels in Multiple Sclerosis

Chemogenetic locus coeruleus activation alleviates experimental multiple sclerosis

Comparison of motion correction strategies for task-fMRI studies in Multiple Sclerosis

Contribution of ambient glutamate and glutamate transporters to retinal ganglion cell vulnerability in experimental multiple sclerosis

Deciphering the impact of myeloid-derived suppressor cell function on disease progression and neural tissue damage in Multiple Sclerosis

The emerging role of microRNAs in experimental and clinical multiple sclerosis: implications for inflammation-driven synaptic dysfunctions and disease course

Extracellular circulating miRNAs as potential biomarkers in multiple sclerosis and epilepsy

Identification of functional biomarkers of demyelination in two animal models of Multiple Sclerosis with functional Ultrasound Imaging

Impact of vagal nerve stimulation on the progression of demyelinated lesions in a murine model of multiple sclerosis

Inhibition of Chondroitin Sulfate Proteoglycans (CSPGs) to Promote Regeneration in the CNS in Multiple Sclerosis

Olfactory dysfunction and pronounced gliosis in the olfactory bulb precede motor impairment in the rat model of multiple sclerosis

Peripheral Myeloid Derived Suppressor Cells are good biomarkers of response and efficacy for Fingolimod treatment in multiple sclerosis

Plasma concentration of IFNα2, MCP-3, IL-6 and IL-8 is differentially decreased in non-active primary progressive multiple sclerosis

The prevalence and topography of demyelination and inflammatory activity in the multiple sclerosis spinal cord

Proteomic Alteration and Morphological Changes of Sibling NG2 Glial Cells in Response to Two Experimental Models of Multiple Sclerosis

Purkinje cell fusion dynamics in a mouse model of multiple sclerosis

The S100B protein as a therapeutic target for multiple sclerosis processes

Role of adenosine A2B receptors in myelination processes: new challenge in treating multiple sclerosis

Role of Netrin-1 in experimental model of multiple sclerosis

Vagus nerve stimulation reduces disease in rodent model of multiple sclerosis

Validation of IHC markers antibody panel in rat Experimental Autoimmune Encephalomyelitis (EAE) model of multiple sclerosis

Validation of nanoparticle-peptide targeting biomarker in the blood-brain barrier under neuroinflammation related to multiple sclerosis

Application of single-cell CRISPRi/a screen to characterize multiple sclerosis-associated single nucleotide polymorphisms in oligodendrocytes

FENS Forum 2024

B cell reconstitution and the alteration of immune cell landscape in ocrelizumab-treated patients with multiple sclerosis

FENS Forum 2024

Use of high-tech eye gaze augmentative and alternative communication system to enhance communication and quality of life in multiple sclerosis: A single case study

FENS Forum 2024

The immediate effect of lumbar transcutaneous spinal cord stimulation in patients with multiple sclerosis: Preliminary results of a sham-controlled study

FENS Forum 2024

Inflammasomes, M2 cells, long non-coding RNAs and nanoparticles: The four wheels of multiple sclerosis?

FENS Forum 2024

Interleukin-9 protects from microglia- and TNF-mediated synaptotoxicity in experimental multiple sclerosis

FENS Forum 2024

Melatonin reduces neuroinflammation and ameliorates gut dysbiosis in the preclinical mouse model of progressive multiple sclerosis

FENS Forum 2024

Metabolomic profiling unveils novel insights into multiple sclerosis pathogenesis

FENS Forum 2024

miR-145 depletion promotes myelin regeneration in a novel mouse model of multiple sclerosis

FENS Forum 2024

Modulation of mouse hippocampal lipidomic signature by FTY720, a sphingosine-1-phosphate analogue used for treating relapsing-remitting multiple sclerosis

FENS Forum 2024

N-aglycosylated extracellular loop of the potassium channel KCNJ10 as contributor to autoimmunity in multiple sclerosis

FENS Forum 2024

Novel potential biomarkers for multiple sclerosis: Evaluating the expression levels of miR-141, miR-9, MEG3, IFNG-AS1 and their relationship to different LINC00513 polymorphisms

FENS Forum 2024

Olfactory dysfunction as a common denominator in multiple sclerosis and Parkinson’s disease – Evidence from animal models

FENS Forum 2024

Re-emergence of T lymphocytes-mediated synaptopathy in progressive multiple sclerosis

FENS Forum 2024

Role of complement in regulating glutamate transmission in an experimental model of multiple sclerosis

FENS Forum 2024

Selective behavioral alterations after acute particulate matter exposure in a pre-symptomatic multiple sclerosis mouse model

FENS Forum 2024

Toll-Like Receptor 4 (TLR4), a target for cytoprotection and (re)myelination in multiple sclerosis

FENS Forum 2024