International teams seek ways to repair or protect nerves.

Nearly all of the people involved in the Society s multimillion-dollar, multi-center Repair and Protection Initiative (funded by Promise: 2010) met in Orlando. For 15 hours, the 46 investigators shared problems and insights--including new results that are not likely to be published for at least a year. This means they can skip some potential dead ends and jump-start work on promising leads.

Here are highlights from the public meeting by the four project leaders: Dr. Peter A. Calabresi of Johns Hopkins School of Medicine in Baltimore; Dr. Ian D. Duncan of the University of Wisconsin-Madison; Dr. Robin J. M. Franklin (sitting in for group leader Charles ffrench-Constant of the University of Cambridge); and Dr. Gavin Giovannoni, who recently moved to Queen Mary University of London.

Dr, Calabresi: This is the first time we've taken a breath after a year of intense work and looked at what we've done so far. The news that others are finding similar data is extremely exciting because we can't move on in science if what we find can't be duplicated elsewhere.

Dr. Giovannoni: We have to be able to reproduce results but we all have very individual ways of approaching the problems of nerve protection and nerve repair.

Dr. Duncan: But if our lab can do the same thing your lab is doing and we can do it quicker if we work together, then I'm in favor of it.

Dr. Franklin: Our lab is trying to make the brain's own stem cells start remyelination [myelin repair]. But first we need to know what these cells need to "see" to make them start the process. When we can answer that, we can stimulate the process to work longer or more efficiently.

A good analogy for our work is the kid's game of pick-up sticks. If you can pull one stick out of the pile and nothing happens, it wasn't critical to the process. We're looking for the stick that makes the pile collapse.

Dr. Duncan: Our lab is doing very practical studies to determine which MS lesions are repairable. Some are not. Too much has gone wrong. Myelin is stripped, axons (nerve fibers) have broken, and entire nerve cells have died.

Dr. Franklin: Why does natural repair fail? There won't be a single answer but we think timing of repair strategies will be very important.

Dr. Giovannoni: We also need to measure results. We could measure effects of the disease modifying drugs with MRI's showing how much inflammation is present in the brain. Now we need to see individual axons in the brain.

Dr. Calabresi: Our colleagues in imaging are developing MRI techniques that give us some of that information.

We're also very excited about OCT imaging, using a machine small enough to be in a doctor's office. By simply shining a light into a patient's eye, this machine can measure the thickness of the optic nerve. It can actually see into the brain, using nothing but light. The condition of this nerve may be an excellent indicator of whether a treatment is actually saving axons.

Dr. Duncan: We are going to get many new ideas from working with stem cells, which may be the basis for repair in MS.

Dr. Franklin: MS comes in different shapes and sizes, and I expect we'll develop strategies that will be successful for some, and not work for others. There will be combinations to explore and many problems. But we'll solve them.