Welcome to Issue 4 of The BIG Brief — a periodic digest of what is top of mind at Project BIG. As you read through the achievements of the team and the promising research underway, despite all the challenges and hardships of this past year, please consider whether you will renew your support of Project BIG for the 2021 year.
Our mission is to unlock the cause and cure for MS and other neurological and autoimmune diseases through a unique clinician-scientist collaboration across disciplines. Our team of scientists, researchers, neurologists, immunologists, radiologists, microbiologists, psychologists, and patient advocates at Stanford are engaged in some of the most high-impact and exciting Brain-Immune-Gut (BIG) research taking place anywhere. The BIG Brief provides a snapshot of their worlds as well as a curated collection of articles that have captured our team's attention.
Spotlighted: 2020 Achievements
For our final issue of the year, we wanted to share a few, among many, key achievements and updates with you, our stakeholders and supporters.
2020 was a year marked by upheaval, loss, and change. The COVID-19 pandemic had especially profound impacts for those living with chronic illnesses as well as those who provide clinical care for and conduct clinical research in chronic illnesses. Many clinical trials have stopped entirely. However, as one researcher noted, there has been a silver lining: “Connections between both basic science and academic research in general and people’s everyday lives can be lost. But this crisis has crystalized the central importance of research…science has never been so important, and clearly everyone is seeing it.” At Project BIG, research has been steadily ongoing. The unique clinical features of Project BIG, for example embedding clinical research coordinators into specialty MS clinics, have enabled real-time assessment and monitoring of key outcomes to continue amidst the backdrop of the pandemic.
The number of patients who have generously agreed to be part of our cohort and contribute to our mission to unlock the cause and cure for MS and other neurological and immunological disease is increasing each day.
We have expanded our brilliant team of clinicians, researchers and collaborators. You can learn more about our team here.
A number of major scientific discoveries have been made using Project BIG tissue samples. As one example, collaborating with scientists Dr. Jing Li and Dr. Mark Davis, Project BIG was able to provide peripheral blood mononuclear cells from patients with MS for immunological analysis contributing to the discovery of increased expression of a cell type with profound implications for autoimmunity. This could prove to be a landmark discovery and is slated for publication in a major scientific journal. A number of other key collaborations have been initiated across disciplines, for example a collaboration with Dr. Ami Bhatt allowing for clinical-scientific correlations into the effect of the gut microbiome on MS and related diseases.
The innovative and one-of-a-kind architecture of Project BIG was put firmly in place in 2020. This is a seamless structure that facilitates every aspect of the clinical research process from subject identification, consent, collection, processing, distribution, to storage in a state-of-the-art facility. We have the ability to collect human tissue including whole blood, packed red blood cells, cerebrospinal fluid, and stool samples, which we can make available to our scientists in a collaborative, interdisciplinary manner.
“These discoveries are remarkable in their magnitude and importance to the scientific community, and speak to the intrinsic strengths of Project BIG and its vision. This makes these findings immediately and profoundly more important for their implications to human disease and potential treatment in clinical medicine...” Dr. Jeffrey Dunn
In 2021, we aim to continue to recruit and expand our study protocols. We plan to disseminate our findings and insights. We will continue to espouse a multidisciplinary approach that involves the Stanford Multiple Sclerosis Center & Neuroimmunology Clinic, the Human Immune Monitoring Center, and the Stanford Center for Human Microbiome Studies.
BOOKMARKED: MS NEWS
The gut insight. A new study has shown that gut immune cells play a role in MS relapse in humans. The team behind the finding had initially explored the role of the microbiome and MS progression in mouse models. Now, they have shown that gut immune cells travel to the human brain during MS flares, potentially playing a protective role in quelling symptoms back to remission. This research offers key insights into the MS and gut connection (You can find the original article here).
Simple sugar found in breastmilk may promote myelin repair. N-acetylglucosamine is a simple sugar found in breastmilk that has been found to promote myelin repair using mouse models. Future research is needed to explore the possibility of using this simple sugar as a therapeutic agent for myelin repair in humans. (You can find the original article here).
DMTs and COVID-19. The decision of whether to initiate or continue disease-modifying therapies (DMTs) for people living with MS has been made even more complex as a result of the COVID-19 pandemic. Considerations such as the potential impacts of a given treatment on the future vaccine or potential protective antiviral effects of certain treatments are discussed. The authors also provide risk mitigation strategies for clinicians to consider.
The (in)efficacy of treatments for fatigue in MS. A recent randomized, placebo-controlled, double-blind trial explored the efficacy of commonly prescribed treatments for fatigue in MS. The authors found that although there were serious adverse events reported, the people with MS randomized to receive these medications fared no better than those given the placebo.
BROADER BIG (BRAIN-IMMUNE-GUT AXIS)
Gut defense. A recent study has identified a specific group of gut microbes that play a defensive role in resistance to viral infections. The study not only demonstrated that gut microbes can cause immune cells to release virus-repelling chemicals, but also that supplementation of a depleted gut microbiota with the key microbial molecule can spur antiviral effects. (You can find the original article here).
A 2-phase theory for degenerative diseases. Rice University biochemists Michael Stern and James McNew have proposed a relatively simple diagram that they hope will influence the understanding and treatment of neurodegenerative diseases. They posit that early and late phases of degeneration are distinct with differential activities of protein signaling pathways. As described by McNew, "The two phases of degeneration haven't been previously recognized, so it hasn't been understood, clinically, that you have two different populations of patients."(You can find the original article here).
A global burden. The global burden of neurological disorders is underscored in this Lancet article. The authors caution that already overburdened medical systems around the world will be ill-equipped to deal with the rising absolute numbers of morbidity and mortality associated with neurological diseases. Thus, they advocate for global policy measures to promote research, preventive efforts, and health care to combat the growing burden of neurological diseases.
[Report] Project BIG co-founder Lily Sarafan serves on the California Governor's Alzheimer's Task Force which recently presented Governor Gavin Newsom with a report including 10 recommendations on how states can lead the way for Alzheimer's prevention and preparedness.
QUOTED
“…That’s the good thing about science: It’s true whether or not you believe in it.” ― Neil deGrasse Tyson
COMMITTED
Will you consider renewing your support for the new year?
We know that you show your generosity by giving your support, advocacy, money, time, and voice to many worthwhile causes and passions. Whether it’s by forwarding our The Big Brief newsletter, telling someone about our mission to unlock the cause and cure for multiple sclerosis and our commitment to high impact research, or making a 100% tax-deductible gift to Project BIG via Stanford Healthcare, we would love to count on your support as this year comes to end. We are grateful for the support from our generous community donors and hope to continue building on this momentum to achieve BIG results. If you know of an individual or foundation that may choose to support this work, please let us know.
Do you have an article or content that you would like to see in the next BIG Brief? Send an email to editor@projectbig.com. Questions? Contact us or visit our FAQs.
Live well,
Shadi Gholizadeh, PhD, MPH & The BIG Brief Editorial Team
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