Areas of Research
Biological Aging, Genetic and Environmental factors in MS
Our neuro-immunology research group is focused on studying the factors that drive disease severity in multiple sclerosis and related diseases. The host matters in autoimmune disease. We have demonstrated that somatic and reproductive aging markers are associated with disability accumulation and brain volume loss. In the youngest of patients with MS, with disease onset in childhood, we have demonstrated that environmental risk of MS may extend back to the perinatal period. Genetic polymorphisms shape the risk of the disease and we have begun to identify genetic factors that may influence disease outcomes.
Biosensing in Neurology
The common tools of neurology, the reflex hammer and tuning fork, were introduced in 1888 and 1889. Our research team is invested in leveraging modern technology and biosensors to enhance neurological assessments. We envision a 21st century exam with neurological 'vital signs' that can capture function quickly and cheaply in routine clinic visits.
Visual System in Neuroimmunological Disease
The visual system provides an opportune and elegant window into the inflammatory and degenerative aspects of MS. We can identify precise relationships between structural damage and functional outcomes that are difficult to achieve in other aspects of nervous system injury.
Clinical Trials Program
With a commitment to bring new therapies to our patients, we run a clinical trials program for MS and related diseases. Please contact Miryam Palomino or Annalise Miner for up-to-date information on enrolling studies.
Our research group has collaborated with Octave Bioscience Inc. in order to implement their Octave Care Platform in a research trial. The MOVING MS study investigates the impact of a Care Platform, complete with medication and symptom tracking, as well as access to a Care Partner, on patient satisfaction and healthcare utilization. Participation in this trial includes access to the Octave Care mobile app, as well as the completion of blood-draws and questionnaires over a 12-month period. This study is currently open for enrollment to MS patients. If you are interested in learning more, please contact Annalise Miner.
International Multiple Sclerosis Microbiome Study
Our neuroimmunology team is participating in the International Multiple Sclerosis Microbiome Study (iMSMS). The cause of Multiple Sclerosis is yet unclear, but it is evident that it includes a combination of genetic factors and environmental factors. One standout environmental factor is the microbiome, or the genetic material of bacteria inside the GI tract. This study aims to understand how the environment influences MS risk, by studying microbiome of MS patients in comparison to their healthy cohabitants. We are collecting stool and blood samples from MS patients and a genetically unrelated healthy counterpart living in the same household (i.e a spouse, roommate or adoptive parent). This study is open for enrollment.
We are working with Johns Hopkins University and the Patient Centered Outcomes Research Institute (PCORI) to help identify the most efficacious treatment strategies for relapsing-remitting Multiple Sclerosis. In the last few decades, we have developed new, stronger and more aggressive therapies to prevent relapse and disability in MS. Since the advent of new therapies, it is important to investigate if new patients benefit from the older, milder therapies or if the risk of relapse and disability are best addressed with stonger therapies early in the disease course. The TREAT-MS study follows volunteer patients for the first few years of their MS therapy, and tracks their disease progression, disability risk and satisfaction. We will be accepting new volunteers until June of 2020.
The NOVA study is aimed at assessing the efficacy of Natalizumab (Tysabri) in Multiple Sclerosis patients at an interval of 6 weeks between doses, in contrast with the traditional 4 week interval. The study aims to test if the risk of developing Progressive Multifocal Leukoencephalopathy, a fatal progressive neurological disease caused by the John Cunningham Virus, is decreased by extending the interval of dosage. We will be following patients for 72 months, tracking their health and disease outcomes. Enrollment for this study has closed.
Our BioAging study investigates the association of biological aging of senescenct cells and aging in multiple sclerosis patients. This study aims to identify potential pathways through which relapsing forms of MS advance into progressoive forms of MS. This study consists of a single blood-draw, and is now actively recruiting both MS and healthy control participants.
TRAC MS, or The Repository of Advanced Clinical Metrics in MS, is a research study that aims to find out more about the development, diagnosis, treatment and long-term outcomes of MS and related diseases. This database study will help us see how MS impacts our patient population as a whole, which may lead to a better understanding of MS disease course and treatment. This study is actively recruiting patients with MS or a related disease.
Pediatric Research Program
Our Neuroimmunology Research Group has partnered with Rady Children's Hospital, where Dr. Jennifer Graves runs a pediatric MS neurology clinic, to investigate MS and related diseases in children.
The PAW study aims to investigate physical activity and wellness in pediatric neuroimmunological diseases through the use of physical activity questionnaires. This study will continue over the coming few years and consists of a few questionnaires completed at the time of a regularly-scheduled neurology visit. PAW is currently actively recruiting pediatric subjects.
The PERCEPTION study is an observational, multi-site pediatric research collaboration that investigates tests in ocular neuroimmunology. This study aims to analyze current methods of ocular testing in pediatric neuroimmunology, in order to determine better physiological markers and early identifiers of neuroimmunological diseases in children, as well as to better understand the progression of these diseases. PERCEPTION is currently actively recruiting pediatric subjects.
The Diet and Relapses Study is a pediatric study exploring the connection between rate of relapse and diet through the gut microbiome and amino acids found in the digestive tract. We hope to uncover the role that 25 (OH) vitamin D levels, fat and vegetable intake, and other nutrients take in the pediatric disease course, and to investigate the biological pathways relevant to this association. Optional: By filling out a set of questionnaires, and a small blood draw, patients can help us to further understand pediatric MS.
PeMSDD is a database registry study linked to the Diet and Relapses study. This registry strives to describe the number and characteristics of patients with suspected early onset demyelinating disases. This database will help investigators allied with the National Pediatric MS Center to support hypothesis generation, and study design development.
Partners, Collaborators and Resource Links
UCSD Multiple Sclerosis Clinical Center
Altman Clinical and Translational Research Institute
Center for Multimodal Imaging and Genomics
National Multiple Sclerosis Society
International Pediatric Multiple Sclerosis Study Group