15 Feb 22. FutureMS-2 imaging begins

FutureMS Phase 1 was a Scotland-wide study for people who have recently been diagnosed with relapsing-remitting multiple sclerosis (RRMS).

The research study began in 2016 and has recruited 440 participants across five locations across Scotland:

• Edinburgh
• Glasgow
• Aberdeen
• Dundee
• Inverness

FutureMS-2, the next phase of the research project began in Edinburgh in October 2021 and as of the end of January, the study team have now have acquired brain images for 15 participants. The scanning is taking place at the Edinburgh Imaging Facility RIE on the 3T Siemens MR scanner.

The Glasgow study team began scanning in January, and protocols are currently being set up in the Dundee and Aberdeen study sites, where participant visits will commence in the spring.

 

FutureMS-2 MR protocol

The FutureMS-2 MR protocol is identical to the FutureMS-1 protocol and includes standard structural brain images, allowing for lesion detection and brain volume measurements. However, based on a FutureMS-1 sub-study, the study team have now added an additional scanning sequence: susceptibility weighted imaging (SWI).

Late in FutureMS-1, after completion of baseline visits and with 1-year follow-up already ongoing, the study team had the opportunity to acquire SWI sequences as a pilot study. This allowed the team to detect and examine the rim of MS lesions. Rim lesions are associated with iron deposition and activated myeloid cells, indicative of inflammation. Rim lesions undergo increased growth in comparison with lesions without rims. Rim lesions may therefore be a potential marker of chronic inflammation and disease progression in MS.

FutureMS-1 SWI data was collected as a sub-study in those participants who agreed to having the extra scan in Edinburgh, Glasgow and Dundee. This pilot study was successful, and so the core protocol has been expanded to include SWI to the core protocol for FutureMS-2, again in Edinburgh, Glasgow and Dundee. Scanning across three centres allows the team to increase the sample size.

Results from the small sample of FutureMS-1 SWI data (found here) showed that rim lesions were detectable in early-stage RRMS using a qualitative approach. The study’s aim is to investigate further, the use of rim lesions as a biomarker of inflammation through quantitative, and less subjective, methods. FutureMS-2 provides the opportunity to pursue this using a larger dataset.

 

FutureMS sub-study

FutureMS-1 included a sub-study in Edinburgh, in which the study team acquired advanced MR imaging, including diffusion MRI (dMRI) and magnetisation transfer imaging (MTI). These images provide measures of brain changes at a microstructural level (e.g. myelin and/or axonal damage), which may be important biomarkers of disease progression in MS.

The study team successfully recruited approximately 80 participants into the FutureMS-1 sub-study, but given the importance of this work, would like to increase the sample size. In this context, the team have now expanded the sub-study to include the Glasgow and Dundee sites, which the team hopes will lead to a large amount of data that will aid the study of biomarkers of disease progression in MS.  

Dr Beth York, a former PhD student on the SPRINT-MND/MS, successfully defended her PhD thesis based on the FutureMS sub-study. Beth’s thesis aimed to advance understanding of in vivo quantitative MR biomarkers of demyelination in people with relapsing-remitting MS (RRMS). The aim is to improve early stratification of patients and predict clinical progression. In particular, Beth’s research focused on the comparison between two magnetisation transfer imaging techniques: MTR (magnetisation transfer ratio); and MTsat (magnetisation transfer saturation). Her work further explored how these techniques might be combined with other advanced neuroimaging techniques, such as dMRI, to improve specificity to MS neuropathology.

Beth will continue her work as a post-doc, also working on the sub-study data.

 

For any further information about FutureMS, please contact the study team at: ms-imaging@ed.ac.uk