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Information for Researchers

To learn more about the study and the study team, please click on the relevant section below.

About the study

There are many disease modifying treatments (DMTs) for patients with Multiple Sclerosis (MS).  Currently, there is no clinical tool to help patients select the medication that will work best for them and the decision is often made according to factors such as drug administration, frequency of drug administration and risk of side effects.  If patients continue to suffer from relapses or have serious side effects, they can switch to another DMT.  The consequences of this policy that requires a DMT to “fail” before prescribing another one include continuous relapses, accumulation of disability and unnecessary side effects.

We aim to collect all manifestations of MS that may influence individual treatment response and translate machine learning techniques into clinical practice in order to generate a tool which will predict treatment response, thereby guiding the choice of DMT and reducing the risk of adverse events given by unnecessary treatments.

Study Schedule

This is an observational study, where patients with MS initiating a DMT in the NHS will undergo clinical and MRI assessments and blood tests.  We will recruit adult patients and children with MS from the MS clinics at UCLH and the UK Paediatric Neuroinflammation Services (Great Ormond Street Hospital, Evelina Children’s Hospital London and Birmingham Women & Children’s Hospital).

Participants will be seen at three timepoints: baseline, 6 months and 18 months.  At each visit they will undergo a standardised clinical assessment, blood tests for neurofilaments levels, safety data and MRI scans.  


 Clinical Assessment

The clinical assessment will comprise scales for physical disability, such as the EDSS, and the Brief International Cognitive Assessment for MS (BICAMS).  Participants will also be asked to complete some patient reported outcome measures (PROMs), as well as providing information on their medical history, demographics, comorbidities, diet, education and employment.

Magnetic Resonance Imaging (MRI)

MRI will include standard-of-care protocols, which include 3D-FLAIR and T2-TSE axial imaging and research sequences such as a volumetric brain sequence (3D-T1).

Genetics

Genetic factors may enable us to identify patients who are at higher risk of accumulation of brain pathology.

The genetic testing will identify those variants previously associated with MS susceptibility and will be undertaken at the UCL Institute of Neurology by Professor Henry Houlden, Professor of Neurogenetics, and his team. 

Neurofilaments in Serum

Neurofilament levels in serum act as a blood biomarker of axonal damage, allowing for reliable, clinical monitoring of axonal damage in MS patients.  They will be measured at each time point.

The concentration of neurofilaments in serum will be determined at the UCL Institute of Neurology by Professor Henrik Zetterberg, Professor of Neurochemistry, and his team, with the neurofilament-light assay. 

Machine Learning

Machine learning will be employed to segment MS lesions.  Additionally, high-dimensional models will be constructed to predict individual treatment response, using all the characteristics that define the disease in an individual. 

A positive treatment response will be defined as no evidence of disease activity or NEDA (no relapses, no progression of disability and no MRI activity.  All predictions will be probabilistic.  The high-dimensional models will be constructed in a tiered approach and the most parsimonious, efficient, predictive model will be created.  Overfitting will be minimised and model training, validation and testing using external datasets will be performed. 

pitms_machine_learning
PITMS Research Team & Partners

UCL and UCLH

Professor Olga Ciccarelli, Principal Investigator

Dr Yael Hacohen, Co-Investigator

Professor Parashkev Nachev, Co-Investigator

Professor Daniel Alexander, Co-Investigator

Professor Henry Houlden, Co-Investigator

Professor Henrik Zetterberg, Co-Investigator

Dr Sarmad Al-Araji, Clinical Research Fellow

Dr Alessia Bianchi, Clinical Research Fellow

Alvin Zapata, Research Nurse

Dr Le Zhang, Research Associate – Computational Imaging

Dr Baris Kanber, Senior Research Fellow – Machine Learning

Amber Strang, Study Coordinator

 

Great Ormond Street Hospital

Dr Cheryl Hemingway, Site Principal Investigator

Dr Omar Abdel-Mannan, Clinical Research Fellow

Katie Hanson, Clinical Nurse Specialist

 

Evelina Children’s Hospital

Dr Ming Lim, Site Principal Investigator

 

Birmingham Women’s & Children’s Hospital

Dr Evangeline Wassmer, Site Principal Investigator

Publications

Financial Times, June 2019

NIHR UCLH BRC News, June 2019

Contact Us

uclh.pitms@nhs.net

(07976) 846695