Meet The Researcher

When not studying treatment of MS, I enjoy climbing rocks in beautiful Australian outback with my family.

There were a number of factors that have attracted me to study outcomes in MS: the rapidly evolving therapeutic possibilities, the dramatic improvement in the outcomes among patients living with MS over the last two decades, the growing volume of data that were to be translated into evidence with exciting analytical methods, and my former clinical mentors Dana Horakova and Helmut Butzkueven.

MS is an incredibly exciting field to work in. Every year, we see a break-through discovery. A few examples include the discovery of the central role that B cells play in orchestrating autoimmune cascade in patients with MS, epitope spreading in early MS, microglial control of astrocytes in response to microbial metabolites, the key role of Epstein-Bar virus in the pathogenesis of MS... Even more exciting is to see the novel findings being translated into more effective and safer therapies for all forms of MS.

Continued treatment with disease modifying therapies (DMTs) is the mainstay of MS management. DMTs reduce inflammation within the central nervous system in order to prevent exacerbations of MS (attacks, relapses) and worsening of disability. The risk of attacks is reduced by 60-75% and the rate of disability worsening is reduced by up to 40% by most potent DMTs. However, up to 15% of patients experience MS activity and accrue disability despite trialling several high-efficacy DMTs. Chemotherapy used to ablate the immune system and followed by autologous hematopoietic stem cell transplantation (AHSCT) is a potent therapy reserved for patients with poorly controlled relapsing MS. While it is capable of eliminating any signs of MS activity or progression over 2 or more years in 70-90% of patients, it is also associated with 1-2% risk of death. AHSCT is presently not reimbursed as a therapy for MS in Australia, and is accessible only to a small number of patients enrolled in open-label clinical studies. Many Australians seek AHSCT through commercial programs overseas. A number of these programs are of dubious quality and patients often pursue this path against medical advice. This project will define the role of AHSCT in the MS treatment algorithm. It will establish the effectiveness of AHSCT against two DMTs with distinctive mechanisms of action: B-cell depletion and immune reconstitution. The project will compare AHSCT with DMTs in various clinical contexts, including relapsing and progressive MS forms. It will help identify patients who will benefit from AHSCT most.

The results of this project will establish whether AHSCT is superior to the most potent disease modifying therapies (DMTs) and in what situations. In particular, it will help us understand, whether AHSCT is justified in relapsing MS with failure of response to the most potent therapies, and if it has any place in the management of progressive MS.

I love bringing pieces of knowledge together - whether that is in the form of linking discoveries into new research ideas, working with a wonderful team of brilliant clinicians and researchers, contributing to research initiatives across multiple collaborating teams - often across several countries, or being inspired by patients, their carers and advocates.