A ground-breaking experimental medicine programme will enable researchers to more rapidly screen potential drugs in people with motor neuron disease (MND, also known as ALS).
The EXPErimental medicine Route To Success, or EXPERTS-ALS programme will screen candidate drugs at a scale not seen before, identifying those that should be tested in larger clinical trials faster. Researchers hope eligible patients can begin taking part in the study in summer 2024.
This is a flagship programme of the new UK MND Research Institute (UK MND RI). EXPERTS-ALS is led by Professor Martin Turner at the University of Oxford and UK MND RI co-director Professor Chris McDermott at the University of Sheffield. It involves 11 MND centres around the UK – including Salford Royal – and is being sponsored by Sheffield Teaching Hospitals NHS Foundation Trust. The programme will also help to develop the next generation of MND researchers.
MND is a neurodegenerative disease affecting the nerve cells in the brain and spinal cord. People progressively lose voluntary movement and need complex care. Around half of those diagnosed with MND will die within two years. The condition affects around 330,000 people around the world and there are currently no treatments to cure it, with the few licensed drugs for MND having only modest effects.
Professor Christopher McDermott, co-lead of EXPERTS-ALS, co-director of the new UK MND Research Institute, Professor of Translational Neurology at the University of Sheffield and Honorary Consultant Neurologist at Sheffield Teaching Hospitals NHS Foundation Trust, said: “MND is a cruel and devastating disease and we need new approaches to identify more effective treatments to help patients. EXPERTS-ALS is a pioneering project to prioritise the drugs which have the best chance of success in halting the progression of this terrible degenerative disease. Over five years, we will be able to screen drugs faster, on a larger scale and identify which ones should proceed into phase 3 trials based on signals found in people living with MND.”
The University of Manchester, through Dr Amina Chaouch at the Manchester Centre for Clinical Neurosciences at Salford Royal and part of Northern Care Alliance NHS Foundation Trust and Professor Stuart Allan, Faculty of Biology, Medicine and Health are part of the EXPERTS-ALS programme. Dr Chaouch is the clinical lead for MND and patients from her clinic will be enrolled in the EXPERTS-ALS clinical trials.
Dr Chaouch said: “The Manchester Motor Neurone Disease Care Centre, based at Salford Royal and part of Northern Care Alliance NHS Foundation Trust, is one of the largest in the country and has a great track record in delivering excellent care. Taking part in this revolutionary research programme, in collaboration with The University of Manchester , gives an opportunity to share Manchester’s world class expertise in neuroinflammation and continue the fight against this devastating disease.”
Professor Allan said: “Manchester has expertise in understanding the role of inflammation in neurological disease and will be able to study this in the EXPERTS-ALS cohorts by gaining access to patient samples. By defining in more detail the changes in immune/inflammatory responses as MND progresses, the Manchester team hope to be able to identify potential new treatments for this devastating disease.
“We have a long track record of success in understanding the role of inflammation in stroke, and being part of this exciting programme gives us the opportunity to extend our work to MND, a devastating condition where breakthroughs in finding new treatments are urgently needed.”
Potential drugs for MND have to be tested in phase 3 clinical trials and this necessarily involves a placebo group to show if they independently benefit patients. Their success rate has been very low so far. This is partly because the drugs put forward for testing have often been chosen largely on data from laboratory studies, rather than from people living with MND. The EXPERTS-ALS programme will screen drugs in patients, looking for early signals of benefit found in blood tests such as lower levels of a protein called neurofilament light (NFL) which can indicate how advanced the condition is. A ‘go’ or ‘no-go’ decision can be reached within a few months and successful drugs prioritised for testing in the larger phase 3 trials, including the innovative MND-SMART platform, with a higher chance of a positive outcome.
“This innovative project to select drugs with the most potential is only possible because of the vision of those who are living with MND who led the United2EndMND campaign, the UK MND Charities and wider UK MND Research Institute partners and funders. We are grateful to the NIHR and Department of Health & Social Care (DHSC) in helping us to deliver an experimental medicine platform in MND.”
Lee Millard, who is living with MND and is also a co-applicant on the grant said: “EXPERTS-ALS will help us find drugs that could help people with MND faster than ever before. Time is one commodity MND patients don’t have much of. Because the platform will only select the drugs with the best chance of success to go on to larger trials, patients will spend more time on trials that are likely to help them. I am so excited by the prospect of this truly amazing science and delighted that the UK is leading the world in improving MND trials.”
The DHSC through the NIHR has awarded £8 million to the project, which will fund the project for 3.5 years (subject to contract signing). Patient charities MND Association, My Name’5 Doddie Foundation, MND Scotland, and medical research charity LifeArc intend to provide additional support to extend the study to 5 years and support additional lab research.