Closer to a cure?

Shock. Disbelief. Euphoria. Choose your emotion. All these feelings washed over Linda Watkins as she huddled in front of the computer last year in her cramped Boulder office.

Months earlier, the CU-Boulder distinguished professor and her colleagues in the psychology and chemistry/biochemistry departments had injected two rats with a drug that induces multiple sclerosis, a chronic, often disabling disease that attacks the central nervous system.

Once the rats developed severe neurological damage, including paralysis, Watkins injected one of them with a compound called XT101, an anti-inflammatory drug that her CU-Boulder laboratory discovered and was being developed by Xalud Therapeutics to treat chronic pain.

When the results came in the untreated rat remained paralyzed, able to do little more than drag his limp body a few inches. Meanwhile, the other rat was not only apparently pain free but appeared symptom free, able to move naturally.

In other words, Watkins’s research team had made a paralyzed rat walk.

In the breathless moments that followed, an intriguing possibility entered her mind: Could a drug originally developed to remedy chronic pain actually be capable of treating and reversing the effects of MS? In the United States approximately 400,000 people live with MS and 200 more are diagnosed per week, according to the National Multiple Sclerosis Society. Symptoms can range from numbness in the limbs to paralysis.

“My reaction was literally, ‘Oh my God. This is huge,’ ’’ she says. “We weren’t looking for a cure to paralysis. We were looking for a way to treat neuropathic pain. It was complete serendipity. There was nothing in the scientific literature at that time that said [the drug] could do this to paralysis.”

Having now seen quite similar results with a second drug, ATL313, that has a similar mechanism of action, there’s additional promise in this new approach.

A possible breakthrough

The news is spreading fast as Watkins now lays the groundwork for further study, including raising funds from venture capitalists.

But the next challenge is more formidable: determining if MS lesions — or scars — are being healed in rats that receive XT101 or ATL313.

Myelin is the protective sheath that surrounds nerve cells in the spinal cord and brain. In a disease of the central nervous system like MS, loss of myelin results in erratic nerve signals that cause weakness or paralysis, impaired sensation, vision problems and lack of coordination. As the disease progresses, myelin develops lesions that result in irreversible damage.

“What happens now with MS drugs is they slow or stop the progression, but they don’t treat it,” she says. “They don’t take people back to normal because they don’t heal the lesions. But if we have a drug that can heal the lesions, this treatment could be a major breakthrough in how we treat the symptoms of MS.’’

Developing a commercial drug to remedy the chronic pain in MS is a more reachable and immediate goal for Watkins, whose remarkable career at CU has combined study of chronic pain and immunology with a maverick’s boldness. The disease is two to three times more common in women and most people are diagnosed between ages 20-50, although it can appear in young children, teens and older adults.

At CU, distinguished professor Linda Watkins has become a pioneer in the study of how glial cells in the central nervous system act as key players in pain enhancement by exciting neurons that transmit pain signals. She received an award for science and technology at the 2010 Prince of Asturias award ceremony, above, in 2010. Iván Martínez/FPA

“The therapies out there for MS — while they’re improving — still don’t provide the relief patients want,” says Jayson Rieger of PGxHealth, a company based in Newton, Mass., that develops drugs for central nervous system disorders and cardiovascular diseases, and who works with Watkins on ATL313. “As with any sort of pain or neurological disease, not every drug will work with all patients. So adding another one for these patients is always very valuable.’’

Rieger emphasizes the importance for scientists to push the envelope to see what is and what isn’t feasible. He notes Watkins listens to and understands the conventional wisdom, thinks about it, then thinks about ways the paradigm can be changed and adapted to look at things differently.

“The integrity of her scientific data has always been profound,” Rieger says. “The approach she has taken to scientific problems has evolved. She’s developed new hypotheses on why pain exists. That led to the MS [study] where there might be an overlap.’’

Battling pain

Originally aiming to become a classical musician, Watkins switched to biology and psychology in the mid-1970s at Virginia Tech.

“I was going to become the next Jane Goodall,’’ says Watkins who then decided to focus on a research career as an undergraduate student at Virginia [Tech]. “I just kind of fell into it. As I started doing it I fell in love with doing research.” She pursued graduate studies, focusing on chronic pain, first at UCLA and then at the Medical College of Virginia.

Following a brief interlude in private business in California, Watkins used a National Science Foundation grant to move to Boulder in 1988.

“I wanted to get retrained in immunology,” she says. “Boulder had a really good lab for that. I could keep my background in pain research but combined with immunology.”

What Watkins and other scientists have known for a long time is that the sensation of pain travels from the site of injury via electrical impulses that hop from one nerve cell to the next, ultimately climbing the spinal cord to the brain, where the pain is perceived.

Pop an aspirin, take a nap and the pain will fade by morning. Break an arm? Morphine will wash away the agony. But imagine the worst possible toothache. Picture the pain spreading throughout your body, pain that persists for years.

That’s chronic pain, a pathological state afflicting between 15 and 30 percent of the population in some form. Unlike ordinary acute pain, which is a function of a healthy nervous system, chronic pain resembles a disease, a pathology of the nervous system that produces abnormal changes in the brain and spinal cord.

At CU Watkins has become a pioneer in the study of how glial cells in the central nervous system act as key players in pain enhancement by exciting neurons that transmit pain signals. Glial cells don’t send signals to the brain, but they do release substances that amplify the pain message, like the crowd egging a bully on. Watkins also found glial cells impair the abilities of opiates like morphine to suppress pain.

“What has become evident is that glial cells have a Dr. Jekyll and Mr. Hyde personality,” Watkins says. “Under normal circumstances they do all these really good things for the neurons, but when they shift into the Mr. Hyde formation they release a whole host of chemicals that cause problems like neuropathic pain and other chronic pain conditions.

“That’s why we think glial cells are very, very critical. That’s why we think all the drugs out there fail. They’re targeting neurons.”

Watkins says that blaming drug failure on the wrong target — neurons — was a pretty heretical view for a long time But she says it has gone from a very out-there thing 10 years ago to being very much accepted.

Gene therapy to control pain

In 2010 CU signed an option agreement with biotech company Xalud Therapeutics allowing Watkins’ research team to work jointly with the California company to move forward with her laboratory’s discovery of a novel non-viral gene therapy to control chronic pain. The therapy involves giving patients the DNA for interleukin-10, which calms down the “Mr. Hyde” glia back to “Dr. Jekyll” through a nonsurgical lumbar puncture injection once every few months. This is XT101, which Xalud Therapeutics is trying to move into clinical trials once sufficient investment funding is raised. It is hoped that ATL313 will also move into clinical trials for pain and MS.

The secret to both XT101 and ATL313 is that they are delivered by a simple injection right where they are needed around the spinal cord.

“That keeps it localized,’’ Watkins says. “That’s what’s so amazing. It’s a single injection and it completely resolves neuropathic pain for three months. Your back pain would go away for three months. We moved into MS after that. Seventy to 80 percent of MS patients have chronic pain that drugs don’t treat.’’

Because rats are inoculated with their own myelin protein, they create antibodies that attack their nervous system after developing MS symptoms. Progressive paralysis begins at the tip of the tail and, when full tail paralysis occurred Watkins’ staff injected some of them with the XT101 or ATL313 treatment with the aim of remedying pain.

Watkins’s team not only saw that MS pain went away with drug treatment but also came up with a different finding — namely arrest and reversal of paralysis. This infused her and her team spearheaded by senior research associate Lisa Loram with a sense of urgency.

“[Linda] is a very strategic collaborator,’’ Rieger says. “She finds ways of bringing people together and asking questions of the right people at the right time so that new opportunities can be tested.

Sitting in her office in jeans, a wool shirt and running shoes, Watkins is surrounded by plaques and awards, including Spain’s 2010 Prince of Asturias Award, which recognizes world leaders in science and technology.

But waiting down the road could be her signature moment.

“You don’t have many discoveries like this,’’ she says.

Get involved with Watkins’ research and its potential to transform lives by giving to the Linda Watkins Research Support Fund at www.cufund.org. You can find the fund by typing it in the “search” box.

Clay Latimer is a freelance writer for the Coloradan.

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16 Responses to Closer to a cure?

  1. Jason Reed says:

    It’s very exciting to think the end of MS might be in the near future. I pray it is so.

  2. PAT KRAMER says:

    I would like to have more info on this. I have high levels of pain from a botch surgery and I am not ready to give up yet. I would gladly offer myself as a guinea pig for this research.

  3. Relita says:

    Is the NMSS interested in or planning to get involved in funding trials of this compound?

  4. Martha says:

    although I am often skeptical of the newly developed medication , this seems to be an amazing discovery. it is interesting that some people with MS do not have any pain, would this work for them? I have always had chronic pain in my legs since my diagnosis in 1984. I would be interested in hearing of any additional findings on this treatment approach and any side effects.

  5. D says:

    This is very interesting & different from so much of what is being developed drug wise for MS. As someone young, who has this disease, I can only hope that this further proves the point that MS DOES cause pain, which isn’t always acknowledged in the medical community.

    It is indeed time to look outside the box & “push the envelope”, to get a better handle of managing the disease. While there are more options now, than 15 years ago, we still have to so far to go to improved quality of life, let alone a cure. I hope this proves to be something that will improve the quality of life for those with MS, who battle chronic pain. FOr that matter, I hope that this is something that can help a number of other conditions/ailments.

  6. Joan Beal says:

    What Dr. Watkins induced in the mice was EAE, experimental autoimmune encephalomyelitis. This disease is not like MS in humans…it is much more akin to ADEM in humans, since it is monophasic and not relapsing remitting. Sadly, this model has not been challenged until recently. Dr. Peter Behan speaks to the problem of EAE as the model of MS in this review: The Futility of the Autoimmune Orthodoxy in MS Research http://www.mednat.org/vaccini/sclerosi.pdf The immune system activates in the same way in MS in humans as it does in stroke and neurodegenerative disease. There is no need for a foreign antigen. Ischemic injury is enough to induce the immune response. The EAE mouse model is flawed and will not bring us any closer to understanding multiple sclerosis in people.

  7. shoshi says:

    i’m always surprised when i see such ideas as to “sicking the light” in a place that obviously is not there. i need to explain. i’m an official ms patient, ten years diagnosed and ten years previoucle i lived ms without being diagnosed. during those ten previous years, since i was not aware i have any kind of disease what so ever, *thougt eventualy after being diagnosed i find i had situations ms reminders) i ride a bycke in a very busy town as tel aviv for 15 years. i born a daughter (now 25) and twins (now 15). i travel abroad and have a very demanding life. so living with ms before and after and being aware of “live and death” evidence (my mom died from breast cancer) and since the ccsvi discovered two years ago, i have no other alternative then to say , words today are not the main problem, the main is the interpratation. so, what is ms? not a disease, but a situation that can be caused by modern life to the brain, i’ve just got an enlightment while just writing to you. yeah…. ms is a condition caused to the brain by modern society. i will be more explicit with time. i invite you to be in touch with me if you find interest to develope this idea.

  8. Denise Baillie says:

    I find it amazing that they are singing the praises of this drug on the basis of the results with two rats; yet they refuse to admit the efficacy of a simple, safe venoplasty procedure to open the veins and improve bloodflow from (and therefore also bloodflow to) the central nervous system that has been done on over 10,000 people worldwide! The most debilitating symptoms I have that have been attributed to my MS are actually the result of impaired bloodflow from my Chronic Cerebrospinal Venous Insufficiency. I have seen many people who no longer need a wheelchair or cane most of the time! My biggest issues are fatigue, dizziness, headache and tinnitis; all of which are more likely the result of inadequate oxygenation of the brain. Why is this seen as a possible breakthrough, but a simple outpatient procedure that has already helped thousands is almost completely ignored?

    • Maggie says:

      Thank you for your post about CCSVI. I think more than anything else that this is a huge breakthrough. I have had MS for 10 years and I have yet to receive the venoplasty but I am waiting it out another year for them to perfect the procedure and get somewhere closer to home to have it done and treated afterwards.

  9. John Hovious says:

    The rats did not have MS. They were given EAE, which mimics some of the findings with MS, but is a totally different condition. To say that EAE equals MS is totally unscientific. These results are meaningless for MS.
    300 years ago, when a disease had no obvious cause, it was called a “bad humor” and was treated by blood-letting. Now when a disease has no obvious cause it is called “autoimmune” and is treated with steroids or other immunosuppressants.

  10. Catherine Somerville says:

    The EAE model does NOT replicate MS in humans. The human applicable research should be putting the research dollars in CCSVI / vascular / endothelial research ! CCSVI already has been proven to exist, to cause brain hypoperfusion, and iron deposits. Subsequent venoplasty relieves this environment and in most cases offers symptom relief AND stops progression. Let’s not go off on some wild goose chase for yet another drug company.
    Put your donations to good work and fund CCSVI research! Watch “CCSVI before and after” YOUTUBE videos !

  11. Sammi Nielsen says:

    I was diagnosed with MS 31 year’s ago but was able to play tennis, jog 8 miles 3 day’s a week and ski. I did pretty much everything until about 14 year’s ago I had to give up tennis because of balance problem’s and then skiing went 10 year’s ago. Jogging was gone too. Now my leg’s are so stiff and my balance is so bad I use crutches or a walker to get anywhere. What I don’t have is pain so I would seem like the perfect candidate if this goes to trail. My symptom’s are numbness, stiffness and lack of balance.

  12. Math says:

    funny to see how easy it is to call a new drug a breakthrough!
    2 rats with a disease looking like ms because we dont know what is causing ms so how could they say their rats have ms??
    and to call ccsvi a breakthrough, look like neuros need to put their fingers in the holes!!!

    If at the end, if it’s proven that this drug is working, Fine, but I dont trust anything in relation with drugs companies anymore.

  13. Dustin says:

    Why is it then I have no need for CCSVI? I was dx with MS a little over 2 years ago yet my blood flow THROUGHOUT my entire body is perfect, or open if you will. Though this was 2 rats with EAE and not MS it is promissing. Hopes should never be steped on. If this is stops and reverses damage then so be it, I for one will not complain. I’m sure the 400k plus others with MS wont either.

  14. Pat Thayer says:

    I was diagnosed with MS in 2004. By April of this year I finally had to quit and apply for disability. Amazingly, even the government said that I wouldn’t be able to return to work and approved me the first time.

    This is going to be a hard one to prove. I really wish Linda Watkins the best of luck. If you are on the right track, don’t ever give up – I’d really like to go back to work! Seriuosly though, I hope this goes somewhere.

  15. I am 7 years diagnosed, lived with symptoms for at least 2 years pre-diagnosed. I pray that these meds can offer a cure for MS. I so miss working & having even a little “mad” money! I currently have 25+ lesions on my brain. I am treated with Tysabri, it seems to be keeping everything steady; however, I am positive for the antibody that could cause PML, a brain infection. If Ms. Watkins and her colleagues have a drug that could grant me & others remission it would change the face and future of those already diagnosed & those facing the future diagnoses forever! Please don’t give up!

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