55 msfocusmagazine.org Neural Repair In MS, the myelin (the protective covering to our nerves) is damaged within various parts of the central nervous system and it is this damage that results in impaired neural transmission and subsequent disability. As such, the repair of previously damaged myelin (i.e. neural repair) is a significant area of interest as it relates to MS treatment. Our current therapies consist of acute treatments (given in attempt to shorten relapses) and long-term immunomodulatory treatments (given in attempt to reduce chance of MS relapse, reduce MRI lesions, and reduce disability). Neural repair, on the other hand, involves the concept of remyelination, which could then result in functional improvement of prior deficits. Clemestine fumarate is an antihistamine that was recently examined in a phase 2 clinical trial to assess its effectiveness as a remyelinating agent. In the study, individuals withMSshowedimprovedneuraltransmission as measured byvisual evoked potentials after taking clemestine fumarate. Although these results are promising, there are still unanswered questions, such as if there are any long-term effects related to taking the study dose, or whether the improvements seen are maintained in the long term. An alternative agent previously investigated for its effect on myelin repair is opicinumab (anti-LINGO-1). A phase 2 clinical trial assessing the efficacy and safety of opicinumab is set to start soon and will hope- fully provide some additional insight into drug-induced neural repair. Stem Cells Autologous hematopoietic stem cell transplantation is another evolving area of interest in the treatment of MS. Although stem cell transplantation for the treatment of MS has been explored for many years, there is a lot of variability with regard to the regimens used and there are no specific guidelines on which patients are most likely to benefit from this procedure. A recent meta-analysis, published in the journal Neurology, examined various studies between 1995 and 2016. The findings suggest that patientswith a relapsing and/oraggressive clinical course who have a low level of disability are more likely to benefit from stem cell transplantation compared to those individuals with a progressive course and/or high level of disability. More importantly, this meta-analysis suggests that more recent treatment protocols in carefully selected individuals are typicallysafe andwell-tolerated. Completion of a phase 3 clinical trial is pending and the addition of stem cell transplantation to our list of approved MS treatments looks promising. At present, stem-cell transplant remains investigational and so individuals with MS who are interested should only seek treatment at experienced academic centers.