Clyde E. Markowitz, MD: This meeting was really quite intriguing. There were a number of basic science ideas that are coming out. Over the next 5 years, I will guarantee that we’re going to see a shift in our emphasis on certain pathology or pathophysiology of the disease that’s going to really help us with the questions of remyelination and neuroprotection.
Overall, the field over the last decade has been moving toward a more aggressive stance. We have B cells that are now being treated. We’re going to start entering conversations about microglia in the central nervous system. I think there are a number of targets and agents that are currently looking to target microglia. The BTK [Bruton tyrosine kinase] inhibitors are a whole area that I think would really make a difference here in hitting the microglia, the microglia being the antigen-presenting cells in the central nervous system.
I think you’re going to hear more about how the microbiome that lives in our gut is contributing to what’s happening in the central nervous system. There are a lot of very nice data being presented at this meeting [Americas Committee for Treatment and Research in Multiple Sclerosis Forum 2020] about small molecules that are being released, whether it is by the gut microbiome or the immune cells that are resonant in the gut, and how these can travel up to the central nervous system and activate blood-brain barrier disruption and migrate into the central nervous system. I think this is an area we’ll be spending the next 5 years really investigating. There are some very intriguing targets that were presented on as well.