The current methods available to clinicians and researchers to measure the progression of disease and disability in people with MS are relatively insensitive and must be measured over relatively long periods of time to detect changes. However, people with early MS often have changes to their brains which do not result in symptoms, so called ‘sub-clinical changes’ which can affect disability later in the disease. Clinical trials for medications that aim to slow or halt disability progression are also hampered by this lack of sensitive measures for progression.
Dr Barton, a clinician currently receiving advanced training in neurology, will undertake a postgraduate scholarship to develop a tablet based tool that will track sub-clinical changes in real-time.
The tests, which can be easily administered on a tablet device in the clinic or for the first time, in a person’s home, will measure aspects of the visual system - the eyes and the parts of the brain that process vision. The tablet based testing will be recorded over time and compared with more traditional MRI scanning measures of relapse activity and clinical measurements of disability and disturbance to the visual pathway.
Dr Barton will also determine whether these visual measurements also show improvement in people who improve clinically after commencing highly effective disease modifying therapy for their MS. It is expected this research will yield a novel tool for use in clinical trials and in the clinic to monitor disease progression and the effectiveness of therapies for MS in the real world setting.
The first stage of Dr Massey’s research has collated detailed information and tracking of people who are undergoing AHSCT at St Vincent’s Hospital in Sydney to be included in this study as well as national and international registries. Dr Massey has also streamlined the clinical approach for these patients as well as incorporated perspectives from neurology and haematology departments from the hospital to ensure the best outcomes for patients. Dr Massey has also established collaborations with the neuroradiology department at the Sydney Neuroimaging Analysis Centre at the University of Sydney and conducted a retrospective analysis of all imaging undertaken on AHSCT patients.
Dr Massey has collated the clinical data of MS patients undergoing AHSCT at St Vincent's Hospital and analysed the outcomes. The results of this study have been published in the Journal of Neurology, Neurosurgery and Psychiatry. A separate commentary on the results of this study can be found here.
Dr Massey has also investigated the role of the thymus, a gland important for the development of the immune system, in immune reconstitution following AHSCT. Following AHSCT, she found that the thymus continued to produce immune cells for a sustained period (24-36 months post-transplant). Also, those people who had sustained disease remission had a higher thymic output than those people who experienced a relapse.
Immune blood cells have been collected from people with MS who have undergone AHSCT. Dr Massey has analysed the composition of the immune cells before and after AHSCT and is monitoring how different populations of immune cells respond and recover following AHSCT. She is also looking specifically at a subset of immune cells known as T cells and is using advanced DNA sequencing technologies to develop an in-depth view of changes in T cells during AHSCT and other MS therapies which deplete the immune system. The DNA sequencing and data analysis is complete, and Dr Massey has found significant changes in the population of immune cells following AHSCT. She also found T cell signatures that may be specific to MS. While this work will require validation using a larger number of people, these differences may shed light on the pathogenesis of MS and inform us about immune cell turnover following AHSCT.
Dr Massey has presented her findings at a number of national and international conferences. Dr Massey continues as an active neurology trainee and has published a range of journal papers related to her clinical work over above those related to this project (listed below).
Updated; 11 June 2020
Updated: 03 February, 2017