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).
Chitnis is the co-director of the Brigham MS center, a unique institution with the potential to change the future of multiple sclerosis treatment through clinical trials and research to discover of new therapeutic targets.
The center's approach is based in precision medicine, which seeks to identify the best treatment path for each patient through studies looking at different biomarkers, genetic testing and asking each patient what is most important to them.
Early Experiences with Multiple Sclerosis
Multiple sclerosis is a chronic disease in which an individual’s immune system mistakenly attacks myelin, the protective lining that coats nerve cells and assists with communication throughout the nervous system.
According to the National Institutes of Health, the diverse symptoms of MS range from vision troubles to muscle weakness, tingling, numbness, dizziness and loss of bladder control, among others. In some cases MS can lead to complete or partial paralysis.
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,” says Chitnis.
After her residency, Chitnis pursued an MS fellowship at the Brigham and Women’s Hospital MS Center.
Twenty-three years later, Chitnis continues her work at the Brigham MS Center, 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. She is also the founding director of the Mass General Brigham Pediatric MS Center.
Through these roles, Chitnis continues to pursue new therapies to help her patients and patients with multiple sclerosis around the world.
Progress for Pediatric Patients with Multiple Sclerosis
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.
The clinic was the first in New England to address the clinical care of children with MS and other demylinating disorders. Pediatric MS is rarer, more inflammatory, and causes more frequent attacks than adult MS, thus requiring specialized care.
Through her work at the clinic, Chitnis helped to launch clinical trials leading to the approval of fingolimod, one of the first drugs for pediatric MS that was effective in reducing symptomatic attacks.
“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.”
Despite these advances, there is still work to be done to allieviate symptoms for young MS patients.
“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,” Chitnis says. “Imagine having to deal with chronic disease on top of all that.”
Transforming Multiple Sclerosis Care Through Research
Chitnis is dedicated to alleviating the burdens of MS patients through her research efforts.
She is first author of a recent review in Lancet Neurology looking at biomarkers of multiple sclerosis that could help in screening at-risk individuals, predicting the onset of disease, assessing treatment response and predicting long-term outcomes.
She has also served as the principal investigator of several clinical trials looking at new MS treatments for children and adults.
Chitnis and 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.
Multiple Sclerosis 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: Ninety percent of pediatric patients with MS are post-pubertal. “Hormones, likely estrogens, play an important role in the onset of disease,” she says.
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 relapses of the disease.
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. Many women with MS do go on to have fulfilling lives in terms of being able to have children, if that’s what they're hoping for.”
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