Associate Professor Fabienne Brilot-Turville is a cellular immunologist at Kids Neuroscience Centre, where she leads the Brain Autoimmunity Group in their search to understand the role that autoantibodies play in various neurological diseases.
One class of neurological conditions that interest the Brain Autoimmunity Group is demyelinating disorders. Demyelinating disorders occur when myelin, the fatty tissue surrounding nerve fibres, is attacked, leaving the nerve beneath susceptible to damage.
Multiple sclerosis (MS) is the most common and well known demyelinating disorder. Wednesday 30 May marked World MS Day 2018, with this year’s theme focused on research, and how research is bringing us closer to a cure for MS.
The Brain Autoimmunity Group are national leaders in creating tools that can identify biomarkers that differentiate MS from other demyelinating disorders, which can benefit patients by suggesting a disease mechanism which could be used to guide treatment options and improve patient outcomes.
Specifically, the group has been instrumental in identifying antibodies that target a component of myelin called myelin oligodendrocyte glycoprotein (MOG). The group have shown that antibodies targeting MOG is associated with demyelination in both children and adults, which represents a different demyelination mechanism to that seen in MS, requiring different treatment strategies.
Their research in this area has culminated in a laboratory assay that can determine if these MOG antibodies are present in patients, and, if so, rule out demyelination caused by MS.
This molecular characterisation is highly important considering that patients can present to clinicians with symptoms that are consistent with both MS and MOG antibody-associated demyelinating disorder.
These symptoms include vision problems caused by inflammation of the optic nerve or movement problems caused by demyelination in the spinal cord. While the symptoms may be similar, treatments for the two conditions differ, making it essential to differentiate the two for effective treatment.
The Brain Autoimmunity Group initially made their research breakthroughs in MOG antibodies and their role in demyelination in children, working closely with Professor Russell Dale, paediatric neurologist at The Children’s Hospital at Westmead and head of Kids Neuroscience Centre.
They have since extended their studies to adult patients, when in 2013, neuroimmunologist Dr Darshi Ramanathan joined the group with an interest in studying the condition in adults.
This work led to the founding of the ANZ MOG study group, a national network of neurologists and neuro-ophthalmologists working with patients with the condition. Almost one hundred paediatric and adult clinicians from over 40 centres across Australia and New Zealand are now part of the network, which enables quality fundamental and clinical research to be translated into patient care.
While Fabienne and her group have made significant headway in identifying disease-associated antibodies, they are certainly not slowing down their efforts. There is still much to be learned about how the antibodies act to destroy myelin and whether or not the antibodies themselves are pathogenic.
She is also interested in investigating the role of immune cells in the disease, such as B-cells and T-cells. Understanding how multiple components of the immune system and brain interact to cause the disease will help identify more potential targets for innovative therapies, and may help in preventing relapses, which can cause irreversible damage to the nervous system.
Research is truly the cornerstone of medical advances and a suitable theme for MS day; where recent advances such as diagnostic differentiation have enabled patients to receive the best possible treatment and live their healthiest lives.
There is still some way to go, but as MS day's motto reinforces, only through research will we be brought closer to a cure.
Pictured: Philomena Colagiuri, Honours Student, Applied Medical Sciences (first photo), HDR student Fiona Tea and A/Prof Fabienne Brilot-Turville (second photo), Prof Russell Dale, A/Prof Fabienne Brilot-Turville and Dr Darshi Ramanathan (third photo)