Genome wide association studies, performed as co-founders of the International Multiple Sclerosis Genetics Consortium and the Wellcome Trust Case Control Consortium, have identified 23 susceptibility alleles, and a further 72 strongly associated single nucleotide polymorphisms (<px10-6). Most have an immunological 'flavour'. Future work will continue to define the relevant pathways and inform treatment strategies.
Phase III studies of alemtuzumab in early relapsing-remitting multiple sclerosis will be completed in 2011 with fast track application for a product licence already offered by the FDA. Genetic and serum biomarkers for the risk of secondary autoimmunity as a complication of treatment (IL-21 and IL-7), and the immunological mechanisms of that adverse effect, have been defined. Sustained recovery of disability, previously unprecedented in multiple sclerosis, has been characterised clinically and in vitro, and strongly implicates remyelination and neuroprotection. The experience of taking a novel therapeutic agent from phase I to III trials will be used to evaluate other potential therapies especially those that address the issue of repair, as part of work in the Multiple Sclerosis Society Myelin Repair Centre. A phase IIa trial of enriched autologous human bone-marrow derived mesenchymal stem cells in progressive multiple sclerosis using using healthy controls to provide normative data for inter-session variability is soon to be completed. The study adopts a novel strategy for testing neuroprotective agents in multiple sclerosis 'the sentinel lesion approach' in which detailed clinical, physiological, structural and imaging-based studies of the visual pathway serve as proof of principle for the central nervous system as a whole. An international trial is now planned.