Adjunct Professor Merja Soilu-Hänninen is a long-standing professional in the research and treatment of MS. Merja’s interest in MS was sparked as a young doctor.

“My first job in neurology was at Masku Neurological Rehabilitation Center, which was searching for a young doctor interested in rehabilitation in the early 1990s. There I met young MS patients and got involved in virology and MS research at the Turku University Central Hospital’s Neurology Clinic.”

Since 2017, Merja has been General Neurology Section Head at the Turku University Central Hospital, so administrative work takes up a large part of the time. Still, there is enough time for her own research work and supervising dissertations. Three of the students she supervised have already defended their dissertations and a fourth dissertation is due in June this year. The supervision of the fifth dissertation has just begun.

From basic research to epidemiology

Merja did her dissertation on basic research in a virology research group in the 90’s and after her dissertation, she left for Australia to conduct experimental animal research on the mechanism of action of drugs for MS. Throughout her career, Merja has been involved in many clinical trials of MS medications.

In recent years, Merja has focused mainly on epidemiological research into MS. Epidemiological research has gained new momentum in Finland with the establishment of the National MS Treatment Register. Merja has been involved in this development work from the beginning and the register was first introduced in Turku in 2014. Since then, the register has expanded nationwide and now about 90% of MS patients in Finland are included, which means that the coverage is already really good, although a few hospital districts are still missing from the register. Since 2016, Merja has chaired the expert group of the national MS register.

Read more about the register at: https://www.neurorekisteri.fi/

The latest research results

Last autumn, Anna-Leena Pirttisalo defended her dissertation under Merja’s supervision, and this study confirmed that the prevalence of the disease varies regionally in Finland; the prevalence is high especially in the western and southwestern parts of our country. This may be explained, at least in part, by genetic differences. Finland belongs to the high-risk area of MS and the incidence of the disease has increased since the 1990s. At present, there are an estimated 12,000 MS patients in Finland, compared to about 5,000 in the 1990s.

Although the disease is somewhat hereditary and children of parents with MS are at higher risk of developing the disease than the rest of the population, genetic factors are not the main risk factor for the disease. There are many environmental risk factors on the background of the disease, which have also been studied by Merja’s research team. Regarding vitamin D, they found that low levels of vitamin D during pregnancy are a risk factor for MS.

“Vitamin D deficiency, smoking and Epstein-Barr virus (EBV) infection together explain most of the environmental risk.”

The MS registry has allowed us to study the long-term efficacy and safety of medicines. According to the latest results, it would seem that the treatment of the disease should be started quickly with effective drugs.

“Last year, we published a study which found that starting immediately with the most effective intravenous drugs administered in a hospital is associated with a lower long-term prognosis for the progression of the disease.”

Within a couple of years, new high-potency tablets have been introduced alongside intravenous drugs, but their long-term efficacy has not yet been assessed due to the short follow-up period.

In another study, they used a method of measuring brain volume to identify patients who were at risk for their disease to progress. Even the slightest brain atrophy in the early stages of the disease compared to controls predicted that the disease would progress. Detection of brain atrophy at an early stage of the disease can help identify those patients for whom the most effective medications should be started immediately after diagnosis. It is also important that the disease is diagnosed quickly after the first symptoms so that treatment can be started as quickly and optimally as possible before brain atrophy has developed.

Cooperation and future research

The MS register covering the entire Finland has enabled even better international research cooperation.  An agreement has just been signed with the Karolinska Institutet for an international study of the MS registry.

Merja collaborates a lot with Adjunct Professor Jussi Sipilä on epidemiological research. They are currently launching a study examining the use of antibiotics and other drugs before the onset of MS using the drug registry data of the Social Insurance Institution. The aim of the study is to find out what role the use of antibiotics and antihistamines could play in the onset of MS.

Gut microbiota research has also been under discussion, and in the future, it would be important to study the association between MS and the composition of gut microbiota. Merja believes that in the future, EBV vaccinations and antiviral drugs will also be an important research topic.

Merja considers co-operation with patients’ organizations important and has co-operated extensively with Finnish Neuro Society, the organization for people with MS in Finland. The patient’s self-reporting application, My MS, included in the MS registry, has been developed in collaboration with the Finnish Neuro Society. In the application, the patient can record an assessment of the hindrance caused by the disease and report on quality of life and symptoms. Merja previously worked as the chief physician of the MS Guidance Center of the MS Association of Southwest Finland and was previously a member of the association’s board.

So Merja’s journey from a young doctor to an expert in MS has been interesting.

“It has been an amazing journey: -In the early 1990s there were no medications for MS yet and now we have about 15 different medicinal products. It was great to be involved in the first international drug trials for MS and to see how drugs that affect the course of the disease have changed patients’ lives since their introduction into clinical use.”