For this month’s ANA Member Highlight, we talk to Dr. Francesca Bagnato, MD, PhD, a dual-board neurology certified physician and faculty member at the Vanderbilt University Medical Center. Dr. Bagnato discusses her work using magnetic resonance imaging (MRI) to study multiple sclerosis (MS), the leap in treatment options for patients, and more.
1. What does the public need to understand about MS that it often doesn’t?
Several facts related to multiple sclerosis still need to be understood by the public. The ones that are sitting in my heart are the following.
The presentation and course of multiple sclerosis are highly heterogenous between patients and quite often even within the same patient over time. This implies that a medication that is optimal for one patient is not appropriate for another one or even for the same patient as their disease phenotype or course change over time.
MS does not equal only physical impairment. There are several other symptoms that may be invisible to the public but not less painful to patients. These symptoms include physical and cognitive fatigue, pain, bladder and bowel urgency, sexual dysfunction, emotional disturbances, and cognitive impairment. These symptoms are source of severe disability, which may lead to an inability to work, pursue a career dream, or feel like an active member of society. It is very important that these symptoms are recognized and appreciated by anyone involved in the life of persons with multiple sclerosis.
There are facts about MS pathogenesis and evolution that are still not clear to doctors and scientists. The disease is much more, and in way different, than what we can see and monitor today using clinically available imaging techniques. The challenges of our, and perhaps future, generation of scientists are: (1) discover those mechanisms as well as ways to identify them using imaging and or other paraclinical tools before they become manifest clinically, as irreversible disability, and (2) tackle them.
2. How are treatment options for MS different today from 10 years ago?
MS 2020 is not MS 2010. The advances in treatment options witnessed over the last 10 years is incredible. Patients can choose among treatments that have different degrees of impact on the immune system. Doctors can be gentle in elderly patients or people whose disease is not very aggressive and more aggressive in those that present with a more active disease course. Patients can choose among treatments with different administration routes and commit to the one to which they can assure the highest degree of compliance. Quality of life in relation to medication choice is now a discussion providers can have with patients; this is a success of therapeutics over the last 10 years. Having options is one of the greatest reliefs a doctor can provide to a patient, e.g., the option to choose among many drugs or the option to switch from one another in case of failure.
3. What promising research is poised to change the standard of treatment for MS?
The MS scientific community counts innumerable bright basic scientists and clinician investigators. Quoting the most promising research is impossible. This is a good problem to have, obviously. Some of the challenges MS poses on the table are still bigger than us but the commitment is there. I would say, though, that research posed to understand and identify mechanisms of neurodegeneration is key to look at patient disability more accurately, ultimately defeating it. Over the last 50 years we have done an incredible job in understanding mechanisms of disease fostering inflammation and blood brain barrier breakdown, e.g., those subtending acute clinical changes. We now need to focus on the scenes behind the resolution of the blood brain barrier which are the ones determining long-term outcome.
4. What work is your lab undertaking to move understanding or treatment for MS forward?
The focus of my lab is using MRI to study an understand multiple sclerosis. The goals of my lab’s work are to: (1) uncover traits of disease progression leading to neurodegeneration and hampering tissue repair and (2) discover biomarkers of disease that can used to predict individual likelihood of progression.
To achieve these goals, we work in collaboration with many colleagues with different expertise, we validate new MRI methods using histologic counterparts whenever possible. We then apply those methods in clinical studies. This way we learn what are the advantages that each newly implemented technique can offer for: (1) a better understanding of the disease and (2) improvement of patient care.
5. How has the ANA supported your career and/or work in this area?
The ANA is an inspirational organization, the work of which is based upon excellence. It’s an honor to be part of this organization and to be inspired by my colleagues at the ANA. My team and I always strive to present work at the ANA and to be one day inspirational for other ANA fellows as well.