Inside the Push for Myelin Repair: Riley Bove, MD

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“One of the real challenges we have in the field of myelin repair is the need to figure out which population is the best for testing potentially helpful treatments for how long and using what measures.”

Over the last several years, multiple sclerosis (MS) research has undergone a noticeable shift to include trials investigating remyelination and demyelination in patients with MS. Remyelination is the body’s natural repair process in which new myelin sheaths are formed around previously demyelinated axons in the central nervous system (CNS).¹ Myelin is the insulating layer that allows nerve impulses to travel rapidly and efficiently along neurons. In MS, the immune system mistakenly attacks and destroys this myelin, disrupting neural communication. Remyelination involves recruitment and differentiation of oligodendrocyte precursor cells (OPCs) into mature oligodendrocytes that rebuild the myelin sheath.

Despite strong biological rationale, developing remyelinating therapies has proven challenging with a major obstacle in clinical trial design. Unlike MS immunotherapies, remyelination trials lack standardized outcome measures. Researchers are forced to decide which patients to enroll (early vs progressive disease), when to intervene (acute vs chronic demyelination), how long to treat, and how to reliably measure myelin repair.²

Remyelination was a consistent theme throughout the 2026 Americas Committee for treatment and research in Multiple Sclerosis (ACTRIMS) Forum, held February 5–7 in San Diego, California, with late-breaking evidence highlighting new approaches to myelin repair in patients with MS. To gain deeper insight into this evolving field, NeurologyLive^® sat down with Riley Bove, MD, for an exclusive interview to discuss her featured presentation. During the meeting, Bove, an associate professor of neurology at the University of California, San Francisco, shared findings from eWrap: A Phase II Delayed-Start study testing bazedoxifene acetate (BZA), to promote remyelination in people with MS.

In the interview, Bove discussed an experimental myelin repair approach using BZA, a selective estrogen receptor modulator (SERM), and the unique challenges of developing remyelination therapies in MS. She explained that SERMs are designed to “dial up” the beneficial effects of estrogen while “dialing down” unwanted effects in breast and endometrial tissue. She also emphasized that one of the greatest hurdles in the myelin repair field is determining the optimal patient population, treatment timing, duration, and outcome measures for clinical trials—questions that remain largely unanswered.

Click here for 2026 ACTRIMS Forum coverage.

REFERENCES
1. Franklin R, French-Constant C. Regenerating CNS myelin—from mechanisms to experimental medicines. Nat RevNeurosci. 2017;18(12):753–769. doi:10.1038/nrn.2017.136
2. Lubetzki C, Zalc B, Williams A, Stadelmann C, Stankoff B.
Remyelination in multiple sclerosis: from basic science to clinical translation.
Lancet Neurol. 2020;19(8):678–688. doi:10.1016/S1474-4422(20)30140-X