#186: Protecting nerve cells in multiple sclerosis: A new path toward neuroprotection with Prof. Manuel Friese

Why can multiple sclerosis progress even when relapses are well controlled? In episode 186, I speak with Prof. Manuel Friese about the next challenge in MS research: protecting nerve cells from damage and preserving function over time.

Read the full interview on my blog: https://ms-perspektive.de/en/186-manuel-friese/

Manuel is a neurologist and clinician scientist who directs the Institute of Neuroimmunology and Multiple Sclerosis in Hamburg. His team's research explores why some nerve cells withstand inflammation while others degenerate. One unexpected finding was a protective role for complement factor H inside neurons, beyond its familiar role in regulating the immune system.

We discuss how smoldering inflammation can keep nerve cells under stress, why oxidative damage matters and how ferroptosis, an iron-dependent form of cell death, fits into the picture. Manuel explains possible ways to strengthen the cells' own defenses and why getting a promising mechanism into a treatment remains a major challenge.

We also talk about alpha-lipoic acid, the Octopus trial and the importance of careful clinical testing. Early research signals can be encouraging, but they do not yet prove that a treatment safely slows disability progression.

Table of contents

• Opening & introduction
• Understanding neurodegeneration in MS
• The new discovery: Complement factor H
• From discovery to potential therapy
• The bigger picture: Protecting the brain in progressive MS
• Looking ahead
• Closing

Introduction: Who is Prof. Manuel Friese?

Prof. Manuel Friese: I'm a clinician scientist based in Hamburg, Germany, and I direct an institute for neuroimmunology and multiple sclerosis. The main focus of my research nowadays is to understand why progression in MS happens. That is also why we want to understand in much more depth how nerve cells react to inflammation. It is not so much about how inflammation occurs in the central nervous system. I think we have a fairly good understanding of that, but we still have not understood why neurons die.

This extract has been edited for readability.

Links and resources

• INIMS: follow the team's research
• Prof. Manuel Friese's UKE profile
• Study: Intracellular complement factor H protects neurons during CNS inflammation, Nature, 2026
• Related paper: STING orchestrates the neuronal inflammatory stress response in multiple sclerosis
• Octopus interim results: alpha-lipoic acid moves to the next stage
• Octopus trial information
• Manuel Friese's research post on LinkedIn

Related episodes

• #146: Chronic smoldering inflammation in MS with Dr. Klarissa Stürner
• #148: Recognizing silent progression in MS with Prof. Heinz Wiendl
• #050: The future of MS treatment with Prof. Tjalf Ziemssen

Time stamps

• 00:32 Episode introduction
• 00:45 Opening & introduction
• 03:39 Understanding neurodegeneration in MS
• 15:14 The new discovery: Complement factor H
• 25:36 From discovery to potential therapy
• 31:55 The bigger picture: Protecting the brain in progressive MS
• 37:35 Looking ahead
• 39:41 Closing
• 41:11 Where to follow Manuel's research
• 42:02 Next episode and farewell

The contents are for information and do not replace individual medical advice.

See you soon and try to make the best out of your life,

Nele

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