Chitnis Makes Strides in Research and Care for Patients with Multiple Sclerosis
Physician-scientist Tanuja Chitnis, MD, FAAN, is devoted to helping patients with multiple sclerosis at every age and stage of life
Tanuja Chitnis, MD, FAAN, a neurologist at Brigham and Women’s Hospital and Mass General for Children, has devoted her career to helping patients with multiple sclerosis (MS). MS is a chronic disease in which an individual’s immune system mistakenly attacks the protective lining of nerves found in the central nervous system and causes a disruption between the brain and body. The diverse symptoms of MS can significantly complicate daily life for individuals living with this condition.
Chitnis’ interest in MS was sparked during her Neurology residency when she encountered a patient who had just given birth and was experiencing a terrible first attack of MS. Witnessing the patient’s struggle with MS-induced paralysis while caring for her newborn was devastating, but it served as a catalyst for Chitnis’ career. “I decided I wanted to make an impact on this disease, and work toward treatments that could change a person's outcome, especially a young person's outcome,” says Chitnis.
After her residency, Chitnis pursued an MS fellowship at the Brigham and Women’s Hospital MS Center, where she was encouraged to ask questions, challenge paradigms, and utilize the center’s vast research and patient care resources.
Twenty-three years later, Chitnis continues her work as the co-director of the Brigham MS Center and senior neurologist, where she conducts clinical research related to MS as the principal investigator of her lab, the Translational Neuroimmunology Research Center (TNRC). Outside of the lab, she can be found treating both adult and pediatric patients with MS and training fellows. Additionally, she is the founding director of the Mass General Brigham Pediatric MS Center at Mass General for Children. Through these roles, Chitnis continues to pursue new therapies to help her patients and patients around the world.
Progress for Pediatric Patients
At the beginning of her career, Chitnis recognized the significant gap in specialized care for pediatric MS patients. “Twenty years ago, when I was starting as a clinician, there was no one taking care of kids with MS in the city of Boston, which led me to start the Pediatric MS Center,” she reflects. Pediatric MS is rarer, more inflammatory, and causes more frequent attacks than adult MS, thus requiring specialized care.
Chitnis plays a large role in the pediatric MS community: she served as the chair of the International Pediatric MS study group for eight years, and, recently, helped launch clinical trials leading to the approval of fingolimod, one of the first drugs for Pediatric MS. The oral drug traps central memory T cells, which are involved in regulating the body’s immune response. By stopping these cells from attacking myelin, the protective lining surrounding nerves, the drug lessens the frequency of MS attacks that could lead to disability down the road. “It was heartening to see that we could prevent new attacks and shut down the multiple attacks in these young people,” says Chitnis. “Some of these kids were having two or three attacks per year. Then, on the drug, they had none.”
Clinical care for pediatric patients with MS presents unique challenges, Chitnis notes. “Having MS at any age is difficult, but especially when you're a teenager, going through high school, studying for the SATs and thinking about graduation,” she says. “Imagine having to deal with chronic disease on top of all that.” Luckily, patients and families at the Pediatric MS Center can find support from Chitnis and her colleagues, who assure them, “We’re here with you on your team.”
Transforming Care Through Research
MS relapses and attacks often lead to challenging symptoms, including balance problems, memory and mood changes, bladder and bowel dysfunction, and deteriorating vision. Chitnis is dedicated to alleviating these burdens for patients through her research efforts.
Chitnis has served as the principal investigator of several clinical trials, including those for children with MS as well as several early-stage trials to evaluate novel treatments for MS and autoimmune disorders in adults. Chitnis and her colleagues at the Brigham recently completed a phase 1 trial of Foralumab, a lab-made antibody protein that can be delivered via nasal spray. Foralumab is designed to encourage the immune system to fight diseases while reducing inflammation. “Early studies show that people with MS have better physical function and less fatigue when taking nasal Foralumab,” says Chitnis. The drug also shows potential to help other conditions involving inflammation, such as COVID-19 and Alzheimer’s disease.
In addition to her work with clinical trials, Chitnis serves as the principal investigator of the CLIMB Natural History study, which follows more than 2,000 patients with MS over time to identify predictors of disease course and monitor the effects of treatment. Chitnis and her colleague at the TNRC are developing models to identify biomarkers of MS relapses and symptoms, potentially providing valuable insights for patient care and treatment.
Chitnis’ work with MS has led her to study other conditions, such as the MOGAD (myelin oligodendrocyte glycoprotein) family of diseases — neuro-immunological conditions that share some characteristics with MS but have distinct clinical, radiologic, and laboratory features. Last year, her team published a review paper to help clinicians better diagnose and treat these conditions.
MS Research in Women
Using data and samples from the CLIMB study and pediatric MS cohorts, Chitnis aims to understand the relationship between sex hormones and MS. Her extensive clinical work with pediatric patients with MS gives her a unique insight into this area of study: 90 percent of pediatric patients with MS are post-pubertal.
“Hormones, likely estrogens, play an important role in the onset of disease,” said Chitnis.
The sex ratio of females to males with MS has increased over the past 50 years, and women, who are three times as likely to have MS as men, tend to have a more frequent relapsing phase of the disease and somewhat more relapses as well. The relapsing phase of the disease lasts until menopause, making up much of a female patient’s life. Chitnis takes a thoughtful approach to the unique needs of female patients with MS, noting two concerns: feasibility of pregnancy and the safety of disease-modifying treatments during pregnancy, postpartum, and breastfeeding.
“Today, we have good ways of managing and treating women with MS who are considering pregnancy and who are pregnant, compared to where the field was when I was first starting out. And many women with MS do go on to have fulfilling lives in terms of being able to have children if that’s what they hope for,” says Chitnis.
This was originally posted in Brigham Clinical Research News.
