The chief research and medical affairs officer at the National MS Society discussed AI-enabled imaging, biomarkers of progression, women's health across the lifespan, and the Society's Campaign to End MS.
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Nearly 1 million patients in the United States live with MS, and there is currently no cure. The Society currently invests more than $100 million in active research across more than 200 projects worldwide, and it announced nearly $8.9 million in new funding for 15 projects aligned with its Pathways to Cures roadmap at the launch.1 The day concluded with the Campaign to End MS Gala, where nearly 500 guests raised more than $12 million toward MS research.2
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Bruce Bebo, PhD: I think what we discussed is that probably the greatest near-term opportunity we have is combining advanced MRI biomarkers, for example, the central vein sign, with AI-enabled analysis. The central vein sign is now part of the revised McDonald diagnostic criteria, and it can really help distinguish MS from other conditions that can sometimes have similar MRI findings. This supports greater diagnostic specificity and could potentially result in earlier diagnosis.
Of course, one of the challenges we have right now, and this was discussed on the symposium panel, is implementation. For example, making sure that patients have access to the appropriate MRI sequences, that there's consistent image interpretation, and that the necessary expertise is available across diverse clinical settings, so that we can really realize the full potential of those advances.
I think the potential impact for patients is really significant. A delayed or incorrect diagnosis can postpone treatment, or it can expose people to unnecessary testing and extended periods of uncertainty and anxiety. If we can combine more precise imaging with AI-assisted analysis, we may be able to shorten the path to an accurate diagnosis and help people begin the right treatment sooner, and I suspect that would improve long-term outcomes. These technologies still require more validation and broader implementation, but I think they really represent an important step toward earlier and more accurate diagnosis.
One of the greatest challenges we have in MS is predicting who is most likely to experience gradual disability progression. Today, clinicians rely on neurologic exams, MRI findings, and clinical history, but those tools often provide, I'd say, an incomplete picture of the biological processes driving progression underneath the surface.
We discussed recent research suggesting that progression may leave distinct biological signatures that can potentially be detected long before meaningful disability accumulates. Recent studies have identified glial fibrillary acidic protein (GFAP), as a particularly promising biomarker of progression. We are using the term progression independent of relapse activity (PIRA), which is increasingly being recognized as a major driver of long-term disability in MS, and elevated GFAP levels have been associated with a higher risk of future progression. It may provide information that complements some of the traditional measures of disease activity I mentioned.
Researchers are also increasingly looking at multimodal biomarkers that combine markers of neurodegeneration, potentially glial activation, immune activity, and maybe even repair biology. When integrated with advanced imaging measures, such as brain atrophy, chronic active lesions or iron rim lesions, retinal imaging, and other indications of tissue damage, these biomarker profiles may provide a much richer understanding of an individual's disease trajectory.
This is where AI might come in again. AI might be especially important in this context because it can recognize complex patterns across large numbers of biological, imaging, and even clinical variables, all at the same time. Rather than relying on a single test result, AI-driven models could help identify combinations of factors that signal a higher risk of progression and disability accumulation, perhaps years before those changes become obvious in routine clinical care.
The ultimate goal is to move from reacting to progression after it occurs to predicting it early enough to change its course. In the future, clinicians may use these integrated biomarker, imaging, and AI-based risk profiles to identify patients who need closer monitoring or earlier intervention, and to make more informed decisions about treatment. Much more research and validation is still needed, but I think these advances could get us closer to truly predictive and personalized care for MS.
It's a great question. Women account for about three-quarters of patients diagnosed with MS, making women's health a critically important area of research and care. Evidence increasingly shows us that MS cannot be managed in isolation from the other major life transitions and hormonal changes that women experience throughout their lives.
For women considering pregnancy, questions about disease-modifying therapies, fertility, pregnancy outcomes, and breastfeeding need to be integrated into MS care. Research has shown that relapse activity often declines during pregnancy but increases during the months following childbirth, which highlights the importance of coordinated treatment planning before, during, and after pregnancy.
Later in life, the transition through perimenopause and menopause creates a new set of challenges. Symptoms like fatigue, cognitive changes, sleep disturbance, mood changes, and bladder dysfunction can overlap with MS symptoms, making careful assessment in the clinic really important. Emerging evidence also suggests that menopause may influence disease progression and disability accumulation, although a lot of important questions remain there.
I think the broader lesson is that care must evolve alongside a woman's changing needs. Effective MS care increasingly requires collaboration among neurologists, primary care providers, OB/GYNs, rehabilitation specialists, and others. The Society is actively investing in research in this area to try to close some of these critical knowledge gaps and ensure that women with MS have evidence-based guidance and support at every stage of life.
I think one of the biggest barriers is that we still have a great deal to understand about the underlying biology driving the clinical presentation of MS. We've made really amazing progress over the last 3 decades, transforming MS from a disease that had no treatment options to one with more than 20 approved disease-modifying therapies. Those therapies have reduced relapses and MRI activity tremendously for a lot of patients, but a lot of unmet needs remain.
Patients living with MS continue to struggle with issues such as disability progression, as we discussed. They struggle with cognitive changes, fatigue, pain, mobility challenges, and symptoms that really affect their quality of life, even when inflammatory disease activity appears to be well controlled. For many patients, especially those with progressive forms of MS, current treatments do not adequately address the processes driving ongoing disability.
One challenge is that MS is not a single biologic process. To develop better treatments, we first need a deeper understanding of the mechanisms that contribute to disease progression, to neurodegeneration, to failure of repair, and to the symptoms that matter most to people living with MS. Once those mechanisms are better understood, we can develop therapies specifically designed to target them and rigorously test them in clinical trials.
Then, to your question, translating those therapies into approved and accessible treatments requires sustained investment. It requires strong partnerships across academia, industry, and patient organizations like the Society, and a commitment to keeping patient priorities at the center of research. The encouraging news is that advances in neuroscience, imaging, data science, and precision medicine are giving us unprecedented insights into this disease. The more we understand the biology driving MS, the greater our ability to develop treatments that not only reduce relapses, as we've gotten pretty good at, but also prevent progression, restore function, and improve quality of life.
The research symposium was held in the morning, and in the evening we had an amazing gala to celebrate the Society's 80th anniversary and kick off the Campaign to End MS. This is our most ambitious fundraising effort in the history of the Society: a 5-year, $1 billion campaign that aims to accelerate the research breakthroughs I just talked about, expand access to high-quality care, and improve outcomes for everyone affected by MS.
The campaign is designed to power the Society's Pathways to Cures roadmap, a global strategic plan endorsed by more than 30 MS societies around the world. The roadmap focuses on 3 goals: stopping disease progression, restoring lost function, and ending MS before it even starts.
We've made a lot of progress over the last decades, but as I've said, patients with MS still face uncertainty about diagnosis, progression, disability, and access to care. The Campaign to End MS is about accelerating the pace of discovery and ensuring that promising advances reach patients faster. We believe the scientific opportunities in front of us are extraordinary, and that this campaign will provide the resources we need to fully seize them.
Transcript edited for clarity.
