Living with MS means living with uncertainty. We don’t understand why some people’s symptoms progress with no new lesions. What is happening that we can’t see?
A groundbreaking new research project is examining “smouldering inflammation” as a cause of this unexplained symptom progression. Professor Klistorner is using advanced MRI technology and current treatments to measure this hidden inflammation and, excitingly, identify existing treatments that can stop it. Could this be the breakthrough we are looking for?
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Research creates hope: Nigel's story
Nigel Caswell, 82, has had multiple sclerosis for most of his life. He wasn’t officially diagnosed until he was 49 in 1993, when MRI scans were hard to access, and diagnosis was far less precise. Looking back, he believes the early signs were there from his late teens, with coordination and walking difficulties gradually getting worse over time.“My MS has always been progressive.” Nigel explains. “I’ve never had a major attack, it’s just been a steady, fairly slow decline.”
Since his diagnosis, Nigel has seen his world gradually narrow. Walking first became tiring, then increasingly difficult. One walking stick turned into two. Eventually, a wheelchair became essential for longer distances. More recently, the “invisible” damage has begun to affect his memory, something his support team believes is closely tied to the ongoing progression of his MS.
"There has never been a single, clear point where I could say exactly how or why things changed," Nigel explains. "Only that, over time, they did."
Due to this life of gradual disease progression, Nigel has become a strong advocate for MS research, believing that while treatments have helped slow the disease, we still don’t fully understand why MS happens, and that finding those answers is crucial for improving lives and protecting future generations.“There’s an enormous amount of research into MS, but the truth is we still know bugger all about what actually causes it.”
With MS for most of his life, Nigel believes in the incredible benefit of research and the potential it has to change the course of this disease. “Research feeds hope, and hope is something we all need.”
Could hidden inflammation be a key driver in MS disease progression?
Many people with MS report symptoms getting worse, despite scans showing no new lesions. Could smouldering inflammation be the cause of this slow, irreversible progression?
Professor Alexander Klistorner and his team are focussing their research on “chronic lesions”—areas of old damage once thought inactive. Using advanced MRI scans over a ten-year period, they’ve discovered that for many people, these lesions keep on growing, continuing to create scarring and nervous system damage.
“People come in and say, ‘I haven’t had any new lesions—why am I getting worse?’ The answer is that the damage hasn’t stopped. It’s just become invisible to the tools we’ve been using.”
This slow, ongoing process, known as smouldering inflammation, is now considered a driver of disease progression, quietly damaging the brain over time. Even small changes each year can add up, helping explain why people may worsen even when their scans appear stable. By using advanced MRI to track these changes, Professor Klistorner and others are changing how progression is detected and how it could be treated.
“If we can identify which treatments slow or stop this smouldering process, we can change the trajectory of the disease. We’re not just managing MS; we’re aiming to stop progression.”
By studying large groups of patients using current therapies, Professor Klistorner and his team are testing whether existing drugs can target this hidden inflammation. This could mean getting effective treatments to people faster, and a real possibility of stopping progression of this disease.
“If you've got a disease that's progressing and there's a whole bunch of medicines in your cupboard, what if one of them could stop your progression?” - Professor Klistorner
