In this new interview, Pr. Xavier Ayrignac, a leading neurologist at CHU Montpellier, discusses his work on white matter and brain diseases, such as multiple sclerosis and leukodystrophies. He comments on the role of advanced imaging technologies like MRI in diagnostics, the challenges posed by early detection and disease progression, and the exciting potential of new biomarkers and imaging techniques to transform the future of brain health. His research aims not only to deepen our understanding of these complex diseases but also to develop more effective treatments for patients.
Could you explain your expertise around white matter at CHU Montpellier?
X.A.: My expertise focuses on two main areas of white matter diseases: acquired inflammatory diseases such as multiple sclerosis and neuromyelitis optica, and hereditary diseases like leukodystrophies and genetic leukoencephalopathies. We collaborate closely on leukodystrophies with other reference centers in France, notably in Paris and Clermont-Ferrand. The pediatric reference center is located in Kremlin-Bicêtre, and for adults, we mainly work with the Pitié-Salpêtrière in Paris, as well as the center in Lyon, among others. This collaboration allows us to take a global and coordinated approach to diagnosing and treating these diseases.
Can you define what white matter is and explain why it is so important in the context of brain diseases?
X.A.: White matter consists of bundles of nerve fibers that connect different parts of the brain. These bundles are essential for functions such as motor skills, sensory perception, and cognitive processes (memory, reasoning, etc.). Abnormalities in this area can therefore significantly affect various neurological functions.
What motivated you to specialize in the study of white matter, and what technological advances have enabled a better understanding of the brain?
X.A.: My interest in white matter is closely linked to the advent of MRI. This technology allows us to detect and characterize abnormalities with a precision we previously didn’t have. Historically, neurologists like Jean-Martin Charcot made diagnoses based primarily on clinical examination. While that skill remains essential today, MRI imaging allows us to supplement our analysis and make more precise diagnoses. What’s fascinating is MRI’s ability to reveal subtle details about the topography, size, and shape of lesions, helping us identify rare and complex diseases.
What are the main current challenges in researching and diagnosing white matter diseases, and how do current technologies address them?
X.A.: One of the greatest challenges, beyond diagnosis, is the early detection and prediction of disease progression. While standard MRI is very useful for the initial diagnosis, it has its limitations, especially in evaluating prognosis and treatment effectiveness. Advanced techniques like metabolic imaging with PET scans can provide additional information but are not yet accessible in routine clinical practice. This is why we collaborate with startups to develop tools that can provide information on white matter, which can be used for patient care. For instance, Braintale is working on such technologies. These new tools could help us better assess white matter health and predict disease progression risks.
More generally, how do you use biomarkers in your research, and what role do they play in improving diagnostics and treatments?
X.A.: We use several types of biomarkers, including clinical, radiological, and biological biomarkers. Clinical biomarkers come from patient examinations and direct observations, while radiological biomarkers are based on MRI images. They are all useful, and their complementarity allows us to have a more precise and comprehensive view of patients. We are also beginning to integrate biomarkers that analyze specific components of the brain, such as neurons and glial cells. These tools help us better characterize diseases and assess patient prognosis. We hope that new tools developed by companies like Braintale will further improve our ability to diagnose and monitor the progression of white matter diseases more accurately and quickly.
What are the future prospects for white matter research, and how will it impact patients?
X.A.: Future prospects include the development of even more advanced imaging technologies and the integration of new biomarkers for a more refined assessment of diseases. We also hope that more effective treatments can be developed through a better understanding of the underlying mechanisms. The ultimate goal is to detect white matter diseases as early as possible and offer treatments that can slow or halt their progression. It’s an evolving field, and we are optimistic about future progress, which will directly benefit patients.