BrainMap: Daniel S. Reich, MD/PhD. Imaging the Lesion in Multiple Sclerosis

Wednesday, February 24, 2016 - 12:00 to 13:00
149 13th Street (Building 149), main second floor seminar room (2204)

Daniel S. Reich, MD, PhD

Chief, Translational Neuroradiology Unit

Division of Neuroimmunology and Neurovirology

National Institute of Neurological Disorders and Stroke

National Institutes of Health

Talk title: Imaging the Lesion in Multiple Sclerosis

Abstract: How, and how well, do acute white matter lesions heal in multiple sclerosis (MS)? Can tissue repair be characterized in vivo? And how might we test emerging treatments to promote such repair in early phase clinical trials? After more than a century of research into the pathology of MS, and 35 years since MRI was first applied in the disease, the answers to these questions still elude us. Yet emerging data from epidemiological studies seem to confirm our intuition that tissue destruction within lesions may be highly relevant to the long-term accumulation of disability that occurs in progressive MS. At the same time, treatments that are most effective in reducing the chance of new lesion formation can also be dangerously immunosuppressive. Fortunately, there is now convincing experimental evidence that extensive endogenous repair, including remyelination, can occur soon after a lesion first appears, raising the possibility that therapeutic promotion of such repair might have both short-term and long-lasting benefits. In this talk, I will present data from our group’s studies in the radiology and pathology of active MS1,2 and primate experimental autoimmune encephalomyelitis3 that together provide a framework for the spatiotemporal evolution of new white matter lesions. I will discuss how the blood-brain barrier is altered in distinct ways at different stages of lesion formation, and in particular how these alterations are reflected in magnetic susceptibility changes detectable using ultra-high-field (7 tesla) MRI. I will further show how such changes can be used to monitor and predict the extent of lesion repair, even over periods of several months. The ability to image these processes leads naturally to a set of efficient trial designs for short-term, proof-of-concept clinical trials to assess lesion repair,4 potentially opening the way for the development of add-on agents that may limit the amount of tissue damage that occurs within new white matter lesions.