Pediatric neurologist J. Nick Brenton, MD, remembers diagnosing his first pediatric multiple sclerosis patient during his training. The experience stuck with him.
"I quickly realized that we lacked the expertise and evidence worldwide to provide the best care for these vulnerable patients," he shares. "When my mentor encouraged me to pursue a clinical research project during residency, it ignited an enduring passion to continue down this path."
Today, Brenton directs the pediatric neuro-immunology program at UVA Health Children's and continues to study MS in kids. He shares more about his research in this video and Q&A.
What are you working on right now?
We're working on two important projects. The first is a multidisciplinary collaborative study to create a tool that predicts the risk of early disease progression of multiple sclerosis in children.
MS can impact cognitive capabilities, physical capacity, and also brain growth/maturation in young people. We are studying all aspects of disease progression and hope to define a clinical marker to identify children at highest risk for progression of MS early in the disease course.
The second is a multi-site study assessing the role of body composition (bone health, muscle mass, and fat tissue mass) on early disease severity in children with MS. We have early evidence that obesity increases the risk for pediatric-onset MS, but there is a paucity of data examining the influence of body composition on the severity of disease.
We're using DEXA scans to quantify body composition in addition to brain imaging metrics, inflammatory serologic profiling, and immune phenotyping to further elucidate the role of adipose tissue on MS severity in kids.
What are the most intriguing potential clinical applications of your work?
Identifying a tool that can be used at the first clinic visit to prognosticate future risk of disability would be huge. It's a tool that we lack in the pediatric MS space. This would enable more tailored discussions around treatment, risk stratification, and early interventions to prevent and/or reduce risk of future disability.
Understanding the role of body composition on disease severity is important and would support future, next-step research assessing the role of interventions aimed at improving body composition (diet, exercise, medical/surgical weight management). These aspects could then be incorporated as an additional facet of treatment in pediatric MS in conjunction with the disease modifying therapies.
What recent discovery has impacted the way you think?
Two large cohort studies out of Swedish national registries inspired my recent research. They show that pediatric-onset MS patients are particularly vulnerable to cognitive deficits and also lower socioeconomic achievements.
While children with MS may look “spared” from cognitive and physical disability early on the disease, this does not appear to remain true as they move through adulthood.
What do you wish more people knew about your area of research?
I study neuro-immunologic diseases that impact children. These diseases are rare and, therefore, can be difficult to study.
Despite this obstacle, I am passionate about the need for clinical research in pediatric-onset MS. Many of the research findings in pediatric MS have important impacts on how we view the more common adult-onset MS.
What made you choose UVA Health as the place to do your research?
UVA Health supported me and believed in me as my research career was at its beginning stages. As a self-proclaimed “late bloomer” to the research stage, UVA Health provided critical resources — notably, the iTHRIV scholars program — that allowed me to achieve early successes that helped propel me forward.