Pregnancy & MS

Well, life has been pretty overwhelming lately.  I am now into my 6th month of my pregnancy and although I am very excited to welcome my baby boy into the world, I am definitely not ready/prepared.  Good thing we have 3 more months!  My husband and I are trying to get our basement finished before our little one arrives because right now we don't have an empty room for the nursery.  Due to my "condition," I have not been much help in the basement project.  I feel a little helpless, but I am trying to help in any way that I can.  Unfortunately, this pregnancy (or this pregnancy plus my MS) have me pretty tired!  I seem to make it through the work day ok, but when I get home, all I want to do is sit and/or sleep.  I know that my body is working really hard and it is normal to be tired, but we have SO much to do and SO much going on right now that being tired is not really an option right now during daylight hours.  I have been going to sleep around 9pm each night which helps, but the problem is I feel ready for bed around 7pm (some days even earlier).  Anyway, I just wish I had a little more energy to get everything done that needs to be done.

Speaking of pregnancy, this article was in my last emailer from MSF:

Pregnancy May Cut Risk of Developing MS

New research suggests that pregnancy may decrease women's risk of developing multiple sclerosis.

In an Australian study of 282 people with MS symptoms, having one pregnancy was associated with nearly halving the risk of developing MS symptoms compared to those who were never pregnant. Risk decreased even more with additional pregnancies, according to the study.

Study author Anne-Louise Ponsonby, head of the environmental and genetic epidemiology and research group at Murdoch Children's Research Institute in Melbourne, Australia, and her research team reported they found an association between pregnancy and a lower risk of MS symptoms, not a direct cause-and-effect link.

Previous research has found that pregnancy in women who already have MS is linked with lower rates of relapse. The researchers say this association may help explain why the incidence of MS in women has inched up over the past few decades, as more women delay pregnancy or have fewer babies or none at all.

“In our study, the risk went down with each pregnancy and the benefit was permanent,” said Ponsonby.

Researchers reviewed information about 282 Australian men and women between the ages of 18 and 59 who had a first diagnosis of central nervous system demyelination, which means they had their first symptoms similar to MS but had not yet been diagnosed with the disease. They were compared to 542 men and women with no MS symptoms. For women, the number of pregnancies lasting at least 20 weeks and the number of live births were recorded. For men, the number of children born was recorded.

The study found that women who were pregnant two or more times had a quarter of the risk of developing MS symptoms and women who had five or more pregnancies had one-twentieth the risk of developing symptoms than women who were never pregnant. There was no association between the amount of children and risk of MS symptoms in men.

“The rate of MS cases has been increasing in women over the last few decades, and our research suggests that this may be due to mothers having children later in life and having fewer children than they have in past years,” said Ponsonby.

The researchers couldn't say exactly why pregnancy may lower MS risk, but they speculated it could be the increase in estrogen during pregnancy or the effect pregnancy has on inflammatory genes involved in MS.

The information may lead to future studies looking into hormonal treatment or other treatments that may alter the disease course.

The study was published online in the journal Neurology.

This article really made me wish that I had gotten pregnant earlier on in my life.  I am 28 now, will be 29 when this baby is born (god willing he doesn't come THAT early), and it would appear that had I gotten pregnant in my early 20s or even earlier, maybe I would have significantly decreased my risk of developing MS.  I guess there is no point in dwelling on what might have happened had I gotten pregnant earlier, but it does make me wonder if I ever would have been diagnosed had I had a baby earlier.  I wouldn't have been ready to be a mom in my early 20s, so really it is best that I didn't have a baby then, but sure would be nice to not have MS.  Makes me think of a Shel Siverstien poem called Woulda-Coulda-Shoulda:

All the Woulda-Coulda-Shouldas
Layin' in the sun,
Talkin' bout the things
They woulda-coulda-shoulda done...
But those Woulda-Coulda-Shouldas
All ran away and hid
From one little did.

 We all have woulda-coulda-shouldas, but we have to learn to live with the way things are (the "dids").  Don't get me wrong - I am very happy with the way my life has turned out.  I love my husband, my family, my job, my unborn baby boy, etc.  But who doesn't wonder and who doesn't wish certain aspects of their life was different?

Hello, Again

I know it has been awhile, but there is a reason, I promise!  Mostly exhaustion!  I am pregnant and off my meds so I have pregnancy exhaustion plus MS fatigue.  Overall, however, I have been feeling great!  I have to go to bed earlier, but I, luckily, bypassed most of the early-pregnancy nausea and my MS flare-ups have been minor and few and far between.  I feel very blessed!  I am 19 weeks along now and my husband and I couldn't be more excited to welcome our baby boy to this world sometime around the end of July!  I feel like all I do lately is eat, sleep and work, but it is good! 

We've had a lot going on at the society lately too - we had a booth set up at our local Women's Fair in February, which I worked.  We lost an amazing staff member, which was really sad, but we all understood her reasons for leaving and we wish her the best!  Our Walk MS event is less than a month away - March 31st!  So I have that going on as well.  If you are interested in donating, visit my personal page!  I have a fairly lofty goal this year and am starting to worry that I won't reach it.  I have 5 other team members - my faithful husband, my loving parents, and two great co-workers!  I am hoping that I can rope a few more people into participating, but we'll see. 

And now, MS news from my most recent MSF email:

BG-12 New Drug Application Submitted

Biogen has announced it has submitted a New Drug Application to the U.S. Food and Drug Administration (FDA) for marketing approval of BG-12 (dimethyl fumarate), an investigational oral therapy in late-stage clinical development for the treatment of relapsing-remitting MS. The regulatory submission was based on research in which BG-12 demonstrated significant reductions in MS disease activity coupled with favorable safety and tolerability – the Phase 3 DEFINE and CONFIRM studies.

In 2011, Biogen Idec announced positive data from DEFINE and CONFIRM, two global, placebo-controlled phase III clinical trials that evaluated 240 mg of BG-12, administered either twice a day or three times a day, for two years.
Biogen Idec says there are also plans to submit a Marketing Authorisation Application for BG-12 to the European Medicines Agency (EMA) within the coming days.

“The rapid submissions of our BG-12 regulatory packages, which integrated one of the largest placebo-controlled data sets for a filing in MS, reflect our commitment to bringing additional therapies to patients in need as quickly as possible,” says Douglas E. Williams, Ph.D., Biogen Idec’s executive vice president of Research and Development. “We anticipate hearing from regulatory authorities regarding the status and acceptance of our submissions within the next couple of months.”

 

 

Scientists Dismiss One Hypothesis on How MS Develops
One current hypothesis on how MS develops has recently been refuted by neuroimmunologists who studied myelin damage that was created in a new mouse model of the disease. They concluded that the death of oligodendrocytes (the cells that produce the myelin sheath) does not trigger MS.
With their research, the scientists say they have disproved the so-called "neurodegenerative hypothesis." This was based on their observations that certain patients exhibited characteristic myelin damage without a discernable immune attack. In their new hypothesis, the scientists assume that MS-triggering myelin damage occurs without the involvement of the immune system. In this scenario, the immune response against myelin would be the result – and not the cause – of this pathogenic process.
Using genetic tricks, the scientists induced myelin defects without alerting the immune defense. "At the beginning of our study, we found myelin damage that strongly resembled the previous observations in MS patients," explains Burkhard Becher, a professor at the University of Zurich. "However, not once were we able to observe an MS-like autoimmune disease."
To ascertain whether an active immune defense causes the disease based on a combination of an infection and myelin damage, the researchers conducted a variety of further experiments – without success. "We were unable to detect an MS-like disease – no matter how intensely we stimulated the immune system," says Ari Waisman, a professor from the University Medical Center Mainz. "We therefore consider the neurodegenerative hypothesis obsolete."
The teams involved in the study want to continue researching the cause and origins of MS. "In light of these and other new findings, research on the pathogenesis of MS is bound to concentrate less on the brain and more on the immune system in future," says Professor Thorsten Buch from the Technischen Universität München.

Thanks for reading!  

From Epstein-Barr to Gilenya Guidelines

News from my latest email from MSF:

Evidence Mounts Regarding Role of Epstein-Barr Virus in MS

New research conducted in the United Kingdom strengthens the hypothesis that the Epstein-Barr virus (EBV) plays a role in MS. Researchers at Queen Mary, University of London, examined the post-mortem brains of people who had MS and found that even though the virus was latent, it had been sending out chemical signals in the form of RNA.

Those signals caused inflammation and turned on the immune system leading to the symptoms of MS, the researchers reported. Previous research has not successfully shown the connection, but that may be due to the fact that the virus hides in immune system cells when not replicating.

While more studies need to be conducted, researchers are optimistic that learning more will lead to better MS treatments. The anticancer drug Rituximab kills the cells EBV uses to hide and is being used in clinical trials.

“We have to be careful and have to study more MS brains but this is potentially very exciting research. Now we understand how EBV gets smuggled into the brain by cells of the immune system and that it is found at the crime scene, right where the attack on our nervous system occurs. Now we know this, we may have a number of new ways of treating or even preventing the disease,”

the researchers noted.

 

Reversing Remyelination in Mice

A new study in mice shows that the age-associated decline in the regeneration of the nerve's myelin sheath, or remyelination, is reversible. The study demonstrates that when old mice are exposed to the inflammatory cells (called monocytes) from young mice, the ageing remyelination process can be reversed.

"For individuals with MS, this means that in theory regenerative therapies will work throughout the duration of the disease. Specifically, it means that remyelination therapies do not need to be based on stem cell transplantation since the stem cells already present in the brain and spinal cord can be made to regenerate myelin -- regardless of the patient's age," says Professor Robin Franklin, Director of the MS Society's Cambridge Centre for Myelin Repair at the University of Cambridge. Researchers at Harvard University also participated in the study.

The study was published in the journal Cell Stem Cell.

 

Looking at MS from a Different Perspective

While the current consensus among scientists is that MS is an auto-immune disease, one researcher from New York has proposed a very different theory: that MS may result from problems with the way the body metabolizes lipids, or fats in the blood. This in turn would cause the inflammation and spark a series of damaging events. 

Angelique Corthals, a forensic anthropologist at the John Jay College of Criminal Justice in New York, conducted a lengthy review and analysis of existing research. She notes that MS shares that underlying mechanism with atherosclerosis. (“Sclerosis” refers to hardening or scarring such as the build-up of plaque in arteries and the development of plaques in the brain associated with MS.)

She concludes that viewing MS in this light helps explain many mysteries that the autoimmune model leaves unanswered, including the role genetics play in MS risk, the environmental elements or pathogens that may trigger disease onset, and the reasons MS strikes twice as many women as men. (Atherosclerosis affects men more commonly than women; Carthals suggests gender differences in lipid metabolism may play a big role in determining who gets which condition.)

Because anti-inflammatory drugs such as statins commonly used to fight cardiovascular disease have also been used to treat symptoms of MS, she writes, such drugs may become part of more comprehensive and effective MS treatments than currently exist.

Carthals’ recently presented her theory in The Quarterly Review of Biology.

 

Vitamin D Levels Linked to Depression

Low levels of vitamin D have been linked to depression, according to UT Southwestern Medical Center psychiatrists working with the Cooper Center Longitudinal Study. It is believed to be the largest such investigation ever undertaken.

UT Southwestern researchers examined the results of almost 12,600 participants from late 2006 to late 2010. Dr. Brown and colleagues from The Cooper Institute found that higher vitamin D levels were associated with a significantly decreased risk of current depression, particularly among people with a prior history of depression.

Low vitamin D levels were associated with depressive symptoms, particularly those with a history of depression, so primary care patients with a history of depression may be an important target for assessing vitamin D levels. The study did not address whether increasing vitamin D levels reduced depressive symptoms.

The scientists have not determined the exact relationship -- whether low vitamin D contributes to symptoms of depression, whether depression itself contributes to lower vitamin D levels, or chemically how that happens. But vitamin D may affect neurotransmitters, inflammatory markers and other factors, which could help explain the relationship with depression, said Dr. E. Sherwood Brown, who leads the psychoneuroendocrine research program at UT Southwestern.

"Our findings suggest that screening for vitamin D levels in depressed patients -- and perhaps screening for depression in people with low vitamin D levels -- might be useful," said Dr. Brown, professor of psychiatry and senior author of the study, done in conjunction with The Cooper Institute in Dallas. "But we don't have enough information yet to recommend going out and taking supplements."

European Medicines Agency Strengthens Gilenya Guidelines While Review Underway

The European Medicines Agency, the agency responsible for the scientific evaluation of medicines for use in the European Union, has undertaken a review of Gilenya following cases of serious cardiac events and death in people who had recently started the medicine. As yet, there is not enough information to determine if Gilenya was the cause of these cases, which is why a review is underway. During the review, the agency has strengthened its recommendations for monitoring patients who receive the drug.

The new guidelines are as follows:

Before starting treatment with Gilenya, all patients should have their heart checked by ECG, a test that measures the electrical activity of the heart.

After receiving the first dose of Gilenya, all patients should have their heart function continuously monitored by ECG for six hours.

All patients should also have their blood pressure and heart rate checked every hour for six hours after the first dose.

If patients develop any clinically relevant heart problem (such as bradycardia or atrioventricular block), doctors are advised to consider extending the monitoring period until it is resolved.

These guidelines apply only within the European Union. FDA guidelines within the U.S. remain unchanged. Those being treated or planning to begin treatment who have questions can call Novartis, the drug's manufacturer, at 1-888-NOW-NOVA.

 

As always, new and exciting research is ongoing!  The most interesting thing here, in my opinion, is looking at MS from a new perspective.  The most exciting thing here is that remyelination is possible!  Hope all is well!

Update

So far, I am doing well with my resolution.  My husband and I have gone to the gym three times per week since signing up at the Y.  Plus, I have done at least 30 minutes of cardio each time! 

In other news, my local NMSS chapter is having a kick-off event for Walk MS season on Tuesday and I have been asked to speak - to tell my story and why I walk.  I have an outline made (not sure I really need it - my story is one that is imbedded in my brain).  I am very excited and honored to speak this year!

Now, in MS news; the following comes from the most recent MSF emailer:

Advanced Technology Makes MS Easier to Track

Using a powerful, triple strength MRI to track increasing levels of iron found in brain tissue, medical researchers at the University of Alberta in Canada have discovered a new way to follow the progression of MS in those living with the disease.
Among their observations: Iron levels in people with MS are increasing in grey matter areas of the brain that are responsible for relaying messages. Also, high iron levels in a specific "relay area" were noted in those who had physical disabilities associated with MS.
Iron is very important for normal function of the brain and the amount of iron is a tightly controlled system by the brain tissue. The discovery suggests there is a problem with the control system. Too much iron can be toxic to brain cells and high levels of iron in the brain have been associated with various neurodegenerative diseases. But to date, no tests have been able to quantify or measure iron in living brain.
Twenty-two people with MS took part in the study, along with 22 people who did not have the condition.
Using this new MRI method would give physicians a new way to measure the effectiveness of new treatments for people with MS by watching the impact on iron levels. This opens up the idea of having a new biomarker, a new way of looking at the disease over time, watching the disease, seeing the progression or lack of progression of the disease, and a new way to track it, the researchers said.
The new MRI method, which uses a machine that is 90,000 times the strength of the earth's magnetic field, will give physicians more detail and information about the impact of MS on the brain, insight that doctors and researchers didn't have before.

Stimulating Natural Interferon-B Production May Combat MS

Some people with MS have successfully slowed progression of the disease using an FDA-approved interferon-b (INFb) medication. Now researchers in Germany are investigating the use of ribonucleic acid (RNA) to stimulate the body’s own production of the IFNb protein, thereby switching off the MS attack.
RNA is one of the three major macromolecules (along with DNA and proteins) that are essential for all known forms of life.
Marco Prinz at the University of Freiburg, Germany, and colleagues took mice genetically modified to present symptoms of MS and injected them with RNA. The mice showed "rapid improvement" with a decrease in tail weakness and paralysis over the following 48 hours. Increased IFNb appeared to slow the development of T-cells - immune cells that may play a key role in MS, the researchers reported.
Around 80 percent of people with MS treated with injections of IFNb develop antibodies that reduce the efficacy of the protein. Getting the body to generate its own IFNb neatly dodges the antibody problem, according to the researchers.

All for now.  Hope all is well!

Sadness, Bacteria, and Spices

The past few days have been a struggle, but not because of MS.  On Friday, I learned that my grandmother had been taken to the hospital after suffering a heart attack and two brain bleeds.  My husband and I met my mom, dad, and aunt at the hospital and later learned that there was nothing that the doctors could do; they estimated that she would pass within 24 hours.  It was very difficult hearing that news.  My grandmother was a strong woman who always fought through everything and I was initially optimistic that she would fight through this as well; however, it turned out that it was her time.  We said our goodbyes and she passed away Saturday morning.  The weekend was a rough one with many tears and much sadness in my heart.  The funeral was scheduled for Wednesday with a viewing on Tuesday.  I went to work Monday in an attempt to keep my mind off of her death for one day before I took bereavement leave.  However, over my lunch hour, I found her obituary online.  At the end of the obituary, it stated that memorials could be made to her church or the National MS Society.  When I saw that last part, I assumed that the MS Society memorial was an idea of my mom's or something and thought it was a little much.  I inquired of my mom and learned that it was my grandmother's doing; apparently, this past summer, my grandmother had told her pastor that she wanted memorials to go to the MS Society.  When I learned that, I lost it at work; I couldn't believe that my having MS had affected her so much that she would make that request.  My grandmother was one incredibly amazing woman and nothing was more amazing than the immense love that she had for her family.  She will be missed very much, but she will forever be a part of me and she will live on in my heart; for that I am grateful.  I take comfort in knowing that she is in heaven and has been reunited with my grandfather and all those loved ones who went before her.  I think she was ready and I know she led a full life.  Her funeral, while sad, was truly a celebration of her life.  Tuesday and Wednesday was spent among family and it was nice to get together in remembrance.    

Enough of the sadness and onto the MS news . . . . From an MSF mailer:

Friendly Gut Bacteria May Play Role in Triggering MS

Researchers in Germany say they have found evidence that MS is triggered by natural intestinal flora, the so-called friendly bacteria that reside in the gut. Their study involved genetically engineered mice with normal gut bacteria that developed brain inflammation similar to MS in humans. Researchers at the Max Planck Institute of Neurobiology in Martinsried in Munich, Germany published the results of their study in the journal Nature.

The human gut is home to some 100 billion bacteria from 2,000 different species, comprising 10 to 100 times more genes than in our entire genome. These microorganisms not only help us digest food, they are also essential for gut development. And they also play a role in promoting autoimmune disease, say the Max Planck researchers.

In the study, the genetically modified mice were allowed to continue with their normal gut bacteria intact. The intestinal flora were removed in the other mice and they were kept under sterile conditions. The mice that kept their gut bacteria developed MS-like symptoms.

According to the researchers, the bacteria first activated the immune T-cells, then the B-cells, which resulted in an attack on the myelin layer in the brain. The same could happen in humans with a corresponding genetic predisposition, they say.

In their background information, the Max Planck researchers refer to previous research that shows active MS lesions have "inflammatory changes suggestive of a combined attack by autoreactive T and B lymphocytes against brain white matter." (Lymphocytes are the white blood cells of the immune system).

They explain that T and B cells are normally innocuous members of a healthy immune system, but it appears something triggers them to become "autoaggressive"; the cause is commonly assumed to be environmental, with infection being the most common reason given.

One implication of this study is that nutrition may play a key role in the development of MS, since diet largely determines the types of bacteria that colonize the gut. The team now wants to investigate the complete microbial genomes of people with MS and compare them to people without MS.

Neuroprotective Qualities of Indian Spice Studied 

A compound found in saffron, a commonly used Indian spice, is being studied for its potential to help protect brain cells from being damaged in neurological disorders such as MS. Researchers at the University of Alberta in Canada who studied the ingredient, crocin, in lab models and cell cultures found that it appears to prevent damage to cells that make myelin in the brain.

The researchers detailed their study in The Journal of Immunology, noting that they are not yet close to a clinical trial stage. The team discovered that inflammation and a specific type of cell stress are closely linked and lead to inflammation and neurodegeneration, which cause cells to lose their protective coating – a process known as demyelination.

In experiments, they found the use of crocin suppressed both inflammation and this specific type of cell stress, resulting in decreased neurological impairment in lab models and cell cultures with MS.

"There are still many questions to be answered about how crocin exerts these neuroprotective effects, but this research highlights a potential treatment role for crocin in diseases involving chronic neuroinflammation – something that had not been recognized until now," the researchers stated.

Staying optimistic and intrigued by the constant research!  Thanks for reading!

New News from MSF

In this post: How cool would it be if MS could be diagnosed just by exhaling, BG-12 is showing progress, and odd hours may be a increase the risk of MS in teens, and should we be discussing walking problems with our doctors more?

The following is from my most recent email from the Multiple Sclerosis Foundation.

Diagnosing MS from Exhaled Breath

Scientists are reporting the development and successful tests in humans of a sensor array that can diagnose MS from exhaled breath, an advance that they describe as a landmark in the long search for a fast, inexpensive, and noninvasive test for MS. Their report appears in the journal ACS Chemical Neuroscience.

Hossam Haick and colleagues report have identified volatile organic compounds that can be associated with MS from exhaled breath. Based on these findings, the researchers developed a new sensor array that can diagnose MS by analyzing the determined chemical compounds that appear in the breath of people with MS. Using the developed sensors, the researchers carried out a proof-of-concept clinical study on 34 people with MS and 17 healthy volunteers and found that the developed sensors are just as accurate as a spinal tap but without the pain or the risk of side effects. 

"The results presented here open new frontiers in the development of fast, noninvasive, and inexpensive medical diagnosis tools for detection of chronic neurological diseases," the scientists stated. "The results could serve as a launching pad for the discrimination between different subphases of stages of multiple sclerosis as well as for the identification of multiple sclerosis patients who would respond well to immunotherapy." 

A large clinical study with the sensors is underway and will be reported in the future. Haick is a Professor in the Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute at the Technion – Israel Institute of Technology. 

BG-12 Moves Forward with Positive Data from Late-Stage Trials
Positive top-line results have been reported from CONFIRM, the second of two pivotal phase III clinical trials designed to evaluate the investigational oral compound BG-12 (dimethyl fumarate) in people with relapsing-remitting multiple sclerosis (RRMS). Results showed that 240 mg of BG-12, administered twice a day (BID) or three times a day (TID), demonstrated significant efficacy and favorable safety and tolerability profiles. Further analyses of the CONFIRM study are ongoing, and Biogen Idec, the company developing BG-12, anticipates presenting detailed data at a future medical meeting.

BG-12 met the CONFIRM study's primary endpoint by significantly reducing annualized relapse rate (ARR) by 44 percent for BID and by 51 percent for TID versus placebo at two years. The CONFIRM study's reference comparator, glatiramer acetate (GA; 20 mg subcutaneous daily injection), reduced the ARR by 29 percent compared with placebo at two years. 

Initial results showed that BG-12 reduced 12-week confirmed disability progression as measured by the Expanded Disability Status Scale (EDSS) by 21 percent for BID and 24 percent for TID at two years compared to placebo, and GA reduced confirmed disability progression by 7 percent. 

"We now have strong positive results for BG-12 in two robust pivotal clinical trials with more than 2,600 patients," said Doug Williams, Ph.D., Biogen Idec's Executive Vice President of Research and Development. "We are gratified by these strong efficacy and safety results, which, when combined with BG-12's oral route of administration, position it as a potentially important MS therapy. We are working aggressively to prepare our regulatory submissions with the goal of making BG-12 available to MS patients as quickly as possible." 

In CONFIRM, both dose regimens of BG-12 showed favorable safety and tolerability profiles, which were similar to those seen in the previous late-stage study known as DEFINE. Overall, the incidence of adverse events (AEs), serious adverse events (SAEs) including serious infections, and discontinuations due to AEs were similar across all study groups, including placebo. The incidence of hepatic and renal events was also comparable among all study groups. The most common AEs in the BG-12 groups were flushing and GI events. There were no malignancies in the BG-12 groups. 

Biogen Idec presented data from DEFINE, at the 5th Joint Triennial Congress of the European and Americas Committees on Treatment and Research in Multiple Sclerosis (ECTRIMS and ACTRIMS) in October 2011.

 

Working Overnight or Odd Shifts May Increase MS Risk in Teens

Working overnight or odd shifts may increase teenagers' risk of developing MS, according to the results of an observational study. 

Researchers from Sweden who uncovered the link said interruption of circadian rhythms and disruption of normal sleep patterns may be partially responsible for the added risk.

In conducting the study, published in the Oct. 18th issue of Annals of Neurology, researchers examined two population-based studies of Swedish residents aged 16 to 70 (one with incident cases and one with prevalent cases) to compare the number of cases of MS among those who did and did not work overnight or shift hours on a regular or alternating basis during their teens.

Among the incident cases, the investigators found those who worked overnight hours for three years or more before the age of 20 were twice as likely to develop multiple sclerosis as those who never worked night shifts. Among the prevalent cases, they noted, the teens who worked overnight hours were slightly more than twice as likely to develop the disorder.

"Our analysis revealed a significant association between working shift at a young age and occurrence of MS," Dr. Anna Karin Hedstrom, of the Karolinska Institute in Stockholm, said in a journal news release. "Given the association was observed in two independent studies strongly supports a true relationship between shift work and disease risk." 

The researchers explained the sleep restriction associated with working the night shift has already been shown to increase the risk for certain health problems, including heart disease, thyroid disorders and cancer, likely by interfering with melatonin secretion and increasing inflammatory responses. 

The authors pointed out that since MS is a central nervous system autoimmune inflammatory disorder that is linked to a person's environment, other lifestyle risk factors, such as sleep loss due to shift work, should also be considered.

The study authors noted that more research is needed to explain why the disruption of circadian rhythm and sleep loss increase teenagers' risk for developing MS.

 

MS Walking Problems Rarely Discussed

Most people with MS who have difficulty walking say it is the most challenging part of the debilitating disease, U.S. researchers say. However, a survey by Harris Interactive indicated 40 percent of people with MS rarely or never discuss walking problems with their doctor. 

The recent survey of more than 1,200 adults living with MS indicated 65 percent reported having trouble walking, the inability to walk, or difficulty maintaining balance at least twice per week. Seventy percent of those with walking issues say that's the toughest symptom to deal with.

In addition, a majority of people living with MS reported they experienced walking problems within the first few years after diagnosis, while among people diagnosed with MS within the past five years, 58 percent reported experiencing a mobility issue at least twice a week.

On average, people with MS ages 41 or younger who do discuss trouble walking with their doctor initiate the conversation only 46 percent of the time. An estimated 78 percent of these women and 62 percent of these men report that trouble walking makes getting around dangerous, the survey indicated.

In light of the increasing menu of therapeutic options, assistive technology, and medication to aid walking problems, conversations with your doctor may lead to solutions.

 

As always, the ongoing studies and research is much appreciated!  Being able to diagnose MS with just a breath is incredible!  Disruption of normal sleep habits increasing the risk of MS makes me reevaluate my sleeping habits and makes me think back to my teenage sleep patterns (probably not the best, but what teenager truly has good sleeping habits?).  I am always happy to hear that clinical trials are going well for up and coming therapies!  Go BG-12!  

Thanks for reading!  Hope everyone is well!

Follow up - MSF News

Now, more from the MSF email:

FDA Approves Botox to Treat Urinary Incontinence with MS

The U.S. Food and Drug Administration has approved Botox® (onabotulinum toxin A) injection to treat urinary incontinence in people with neurologic conditions such as spinal cord injury and multiple sclerosis who have overactivity of the bladder.

Uninhibited urinary bladder contractions in people with some neurological conditions can lead to an inability to store urine. Current management of this condition includes medications to relax the bladder and use of a catheter to regularly empty the bladder. The approved treatment consists of Botox being injected into the bladder resulting in relaxation of the bladder, an increase in its storage capacity, and a decrease in urinary incontinence.

"Urinary incontinence associated with neurologic conditions can be difficult to manage,” said George Benson, deputy director, Division of Reproductive and Urologic Products. “Botox offers another treatment option for these patients."

Injection of the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder. Cystoscopy may require general anesthesia. The duration of the effect of Botox on urinary incontinence in people with bladder overactivity associated with a neurologic condition is up to 10 months.

The effectiveness of Botox to treat this type of incontinence was demonstrated in two clinical studies involving 691 patients. The participants had urinary incontinence resulting from spinal cord injury or MS. Both studies showed statistically significant decreases in the weekly frequency of incontinence episodes in the Botox group compared with placebo.

In addition to its use to improve the appearance of facial frown lines, Botox also is FDA-approved to treat chronic migraine headaches, certain kinds of muscle stiffness and contraction, severe underarm sweating, abnormal twitch of the eyelid, and a condition in which the eyes are not properly aligned.

The most common adverse reactions observed following injection of Botox into the bladder were urinary tract infection and urinary retention. Those who develop urinary retention after Botox treatment may require self-catheterization to empty the bladder.

Botox is marketed in the United States by Allergan Inc., of Irvine, Calif. 

Laquinimod Faces Hurdles
Teva Pharmaceutical Industries, Ltd. faces growing challenges and uncertainty surrounding its MS treatments, according to an Oppenheimer analyst.

The Israeli drugmaker said that its experimental drug, laquinimod, an oral MS treatment, did not reduce patients' annual relapse rates in a late-stage clinical trial. The study involved 1,331 patients who were treated with one of three options: laquinimod, a placebo, or Avonex, an older MS drug made by Biogen Idec, Inc.

Teva said MRI scans showed the patients in the laquinimod and Avonex groups had more brain lesions, which indicates they had more severe multiple sclerosis, and if study results are adjusted to remove that imbalance, laquinimod met its main goal of lowering the relapse rate.

Teva and its partner Active Biotech still plan to seek approval of laquinimod in the U.S. and the European Union. In December, the companies said the drug met its main goal in its first late-stage trial.

Analyst Christopher Holterhoff said in a research note it is unclear whether the U.S. Food and Drug Administration will accept adjusted data from the latest study as meaningful or require Teva to run another study.

"We are unaware of a precedent case where an MS drug was approved without two statistically significant trials," the analyst wrote.

Free Smartphone App Helps Keep Track of Injections
A free smartphone app, TrackMyShots, is available to help ease the log-keeping of people with MS, diabetes, and other conditions requiring frequent injections.

The app eliminates the need for bulky log books by allowing the user to record each injection, track injection sites, and monitor adverse reactions. Users can set up an ongoing schedule for their injections and get email alerts when it is time for their next shot.

Developed by Linxter, Inc., a software development company in Cooper City, Fla., the app was created to help a family friend with MS, says company CEO and founder Jason Milgram.

“She had carried around a bulky paper logbook for years,” Milgram said. “She and her husband asked if I could help develop an app that would allow her to keep track of the injections.”

The app’s initial release is available for Windows Phone 7 users. An Android version was scheduled to be available in late August, and iPhone users will be able to access the app in late September.

TrackMyShots, http://trackmyshots.com, recently received a Hero of the Week award from Microsoft, which “honors excellence in the field of app development.”

Definitely going to look into that app!  It looks as though Gilenya may continue to be the only available oral treatment for awhile.

Homecoming

This weekend was my 10 year high school reunion.  Got to see a lot of great people and learn what everyone is up to these days.  It was great to see everyone, but I am a little sad that I didn't get to catch up with everyone; there just was not enough time.  It was a lot of fun though and hopefully we can all get together again soon!  And maybe I will do a better job keeping in touch with people.

And now for the MS info :-)  The following comes from my MSF e-mailer:

Number of Genes Linked to MS More than Doubles
The largest-ever gene study of MS has identified 29 new genetic variants associated with the disease, confirmed 23 previously known genetic links, and suggested five more genes that may contribute to the disease.

Scientists regard the findings, recently published in the journal Nature, as significant for two reasons:  Because many of the genes linked to MS are involved in regulating the immune system –  specifically, the development of T cells – this boosts speculation that the disease is primarily an autoimmune disorder. It also gives researchers new targets for future treatment strategies.

For the study, scientists compared DNA from nearly 10,000 people with MS with DNA from more than 17,000 unrelated, healthy individuals. The researchers were affiliated with the International Multiple Sclerosis Genetics Consortium and the Welcome Trust Case Control Consortium.
They said the newly-found links point to the idea that T-cells – a type of white blood cell responsible for mounting an immune response –   and chemicals called interleukins play a key role in the development of the disease.

Drugs that target the immune system include rituximab, sold under the brand name Rituxan® by Roche and Biogen to fight leukemia, Tysabri® from Biogen and Elan, Lemtrada, sold as Campath® by Sanofi's unit Genzyme for cancer, and Abbott and Biogen's Zenapax® or daclizumab. Mid-stage trial data for daclizumab recently showed the drug on a par with other new medicines for MS, but some of the side-effects were worrisome.

Experts think both genetic and environmental factors are equally important in determining who is likely to develop MS, and taken together, the known genetic variants probably explain about 20 percent of the genetic links, they said.
In a second study reported in the Public Library of Science journal PLoS Genetics, researchers found that many of the genes linked to MS are also linked to other autoimmune diseases such as Crohn's disease and Type 1 diabetes. This also points to potential new uses for existing drugs in development, they said.
Previous research has suggested a link between Vitamin D deficiency and an increased risk of MS. Compston's team said that along with the many genes which play a role in the immune system, they had also found two involved in the metabolism of Vitamin D – which mostly comes from sunlight – lending weight to a possible link between genes and the environment.

"We have known for some time that many devastating diseases of the immune system must have common genetic causes," said Chris Cotsapas of Yale University in the United States, who led the PLoS study. "Now we have the outline of a map that tells us where we can look for common treatments."

In 2007, only three genes were linked to MS.

Research Identifies How Vitamin D Combats MS
New research has indicated that vitamin D directly terminates the production of a disease-causing protein, a discovery that may explain the association between levels of vitamin D in a person’s body and the person’s ability to resist or minimize the effects of MS.

According to the investigators, a collaborative team of scientists from the University of Medicine and Dentistry of New Jersey and Stanford University, the mechanism they identify suggests what might be a new path toward pharmaceutical treatment of MS, as well as therapies for other autoimmune diseases. The mechanism identified by the research team works like this:

During MS (“EAE” in mice), a damaging protein called interleukin-17 (IL-17) is produced by immune cells in the brain.

After vitamin D binds to its receptor, the receptor parks itself on the gene that encodes IL-17.

By doing so, the vitamin D receptor occupies a site normally reserved for a protein called NFAT, which is required to turn the IL-17 gene on.

The gene stays off and IL-17 levels plummet.

At the same time, the vitamin D receptor turns on another gene, whose product generates suppressive T cells that combat the destructive action of their IL-17-producing counterparts.

The study is published in the September issue of the journal Molecular and Cellular Biology.

Unique Trial uses Adult Stem Cells to Treat MS
The Cleveland Clinic, the University Hospitals Seidman Cancer Center, and Case Western Reserve University are collaborating on a one-of-a-kind clinical trial in the United States which uses a person’s own adult stem cells to treat MS and perhaps even reverse damage caused by the disease.

Mesenchymal stem cells, or MSCs, are found in the bone marrow and are not the embryonic stem cells that have stirred controversy in political and religious arenas.

In the phase one trial, a person’s MSCs are harvested, carefully cultivated in a special laboratory and then injected intravenously back into the individual. Since June, three people have undergone the entire process. A total of 24 participants with relapsing or progressively worse MS who have moderate to severe disability will take part in the study over the next two to three years.

The primary aim is to test the feasibility and safety of using the body's own stem cells to treat MS. But researchers also are looking closely for any preliminary evidence that the transplanted cells could moderate the over-active immune system, possibly stopping or even repairing tissue damage.

If promising results lead to a larger, multicenter clinical trial that also yields good outcomes then the treatment could be offered in a clinical setting within five to seven years, researchers involved in the study told the Cleveland Plains Dealer.

More than 150 other clinical trials in the United States and around the world are currently testing MSCs' ability to encourage tissue repair as a way to treat a variety of other conditions such as osteoarthritis, diabetes, emphysema, and stroke. Stem cell therapy is already used to treat leukemia, lymphoma, and certain blood disorders.

 The next post will have more from the MSF e-mailer - there is some really interesting stuff in this most recent e-mailer!  I love learning more about vitamin D and stem cell research!  It is so great that this research continues; I am so hopeful that a cure will come in my lifetime!

New MSF Mailer - Part II

Happy Labor Day!  I hope everyone has enjoyed the long weekend!  Now, for more from the MSF mailer:

New Research on Breastfeeding with MS Contradicts Previous Findings

Despite previous research suggesting otherwise, breastfeeding does not appear to protect against MS relapses, according to researchers from the University of Florence in Italy. Their study found that the likelihood of relapse after pregnancy was tied to relapses before and during pregnancy but not to whether the mothers in their study breastfed or not. They concluded breastfeeding may not be a feasible option for mothers at high risk of relapse after pregnancy, because they may need to resume drug treatments straight away.
Study author Dr. Emilio Portaccio and colleagues conducted a prospective study of 298 women recruited from 21 Italian MS centers and followed up their pregnancies from 2002 to 2008. During this time, 302 out of 423 pregnancies resulted in full-term delivery, and follow ups continued for at least one year after delivery. About 34 percent of the mothers breastfed for at least two months after delivery, while the remaining mothers breastfed for less than this or not at all and were considered as not breastfeeding. During the 12 months following delivery, 37 percent of the mothers had one relapse and 6.6 percent had two or more.
Using a statistical tool to look at several measures at once to see which have the strongest influence on relapse rate after pregnancy, they found that "the only significant predictors of postpartum relapses were relapses in the year before pregnancy ... and during pregnancy."
The data indicated women who had relapses in the 12 months leading up to their pregnancy were 50 percent more likely to have a relapse after delivery than women who did not have a relapse in the year before pregnancy. And women who had relapses during pregnancy were more than twice as likely to have a relapse after delivery as the women who did not experience relapses during pregnancy.
This was after taking into account influencing factors like age at onset of MS, age at pregnancy, duration of the disease, level of disability, and exposure to drugs, including any MS drugs. There was nothing to suggest breastfeeding worsened the relapse rate.
The researchers also suggested the link between breastfeeding and lower risk of relapses after pregnancy that previous studies have reported may "simply reflect different patient behavior, biased by the disease activity."

"Women who have fewer relapses before and during pregnancy may be more likely to breastfeed and then continue to have fewer relapses in the postpartum period," Portaccio says. However, he said that a course of steroids taken after pregnancy might protect against later attacks, and adds, "Approaches of this type were not assessed in this study and might, in consultation with the treating neurologist, enable breastfeeding."  The study was published in the journal Neurology.

Author Brings Cool Thoughts on Cognition when Heat Meets MS

The fact that heat can cause MS physical symptoms to flare has been well-established, but recent research has shed more light on the problems, confirming what people with MS already know:  Heat can further complicate the cognitive difficulties caused by the disease. Jeffrey Gingold, an award-winning author with MS and volunteer advocate on MS and cognitive disability, recently described his reactions to the research and to the “cognitive sludge” created by rising temperatures. You can read his article, “Cool Thoughts” in the Men and MS column in the summer issue of the MSFocus.
The second edition of Gingold’s popular book Facing the Cognitive Challenges of Multiple Sclerosis (Demos Health, 2011) was recently released. In it, he candidly describes his personal journey from MS diagnosis to learning how to cope with the many challenges the disease brings.  In Mental Sharpening Stones: Manage the Cognitive Challenges of Multiple Sclerosis (Demos Health, 2008) Gingold provides more real-life techniques that have been used with success by people with MS and their medical providers to pushing back against the disruptive and potentially disabling cognitive symptoms.
For a limited time, a 30 percent discount is being offered for those who buy the books at www.demoshealth.com.  Just enter the discount code SSGINGOLD30 during checkout and the percentage will automatically be deducted before checking out. There is an expiration date of 5/31/2013 for the discount.  
One hundred percent of the author’s royalties from the two books are donated to MS research and education.

A Study of Ocrelizumab in People with Primary Progressive MS

This randomized, parallel group, double-blind, placebo controlled study will evaluate the efficacy and safety of ocrelizumab in people with primary-progressive MS. Eligible patients will be randomized 2 to 1 to receive either ocrelizumab (300 mg intravenously, 2 infusions separated by 14 days in each treatment cycle) or placebo. The blinded treatment period will be at least 120 weeks, followed by open label treatment for people in both groups who, in the opinion of the investigator, could benefit from further or newly initiated ocrelizumab treatment. Anticipated time on study treatment is up to five and a half years.
For information on study locations and inclusion criteria go to www.clinicaltrials.gov and search for identifier number NCT01194570.

 I am amazed at the immense impact MS has on the body and mind.  MS truly affects every aspect of life, maybe not all day every day, but it sticks its nasty head in whenever it feels like it and in whatever way it wants.  It can affect balance, coordination, ability to walk, feeling, sleep, thought processes, memory, etc, etc, etc.  The list goes on and on and on.  Don't you just wish that there was something that it couldn't touch?  Hopefully all this great research will lead to a cure!  Continuing to be optimistic although some days that isn't easy.

New MSF Mailer - Part I

More news to be excited about!  This post (and the next post) contains information set forth in my latest MSF mailer.

First, interesting stuff about Myelin:

Myelin Influences How Brain Cells Send Signals

Myelin is well-known for its protective role in the central nervous system, but recent research suggests that myelin also plays a role in regulating a key protein involved in sending long-distance signals. The development of a new cell-culture system that mimics how specific nerve cell fibers in the brain become coated with protective myelin led to the discovery.

Ohio State University researchers have created a system in which two types of cells interact in a dish as they do in nature: neurons from the hippocampus and other brain cells, called oligodendrocytes, whose role is to wrap myelin around the axons.

MS has long been considered a disease of white matter, a reference to the white-colored bundles of myelin-coated axons that project from the main body of a brain cell. But researchers have discovered that the condition also affects myelinated axons scattered in gray matter that contains main bodies of brain cells, and specifically the hippocampus region, which is important for learning and memory.

Up to half of the people who have MS experience cognitive deficits in addition to physical symptoms. Researchers suspect that cognitive problems are caused by abnormal electrical activities of the demyelinated axons extending from hippocampal cells, but until now have not been able to test myelin's role in this part of the brain.

Now that the researchers can study how myelination is switched on and off for hippocampal neurons, they also can see how myelin does more than provide insulation – it also has a role in controlling nerve impulses traveling between distant parts of the nervous system. Identifying this mechanism when myelin is present will help improve understanding of what happens when axons in this critical area of the brain lose myelin as a result of MS, researchers say.

 Second, bone health is important and more about vitamin D:

Bone Health a Factor in Early MS

Osteoporosis and low bone density are common in people in the early stages of MS, according to a new study.
“We’ve known that people who have had MS for a long time are at a greater risk of low bone density and broken bones, but we didn’t know whether this was happening soon after the onset of MS and if it was caused by factors such as their lack of exercise due to lack of mobility, or their medications or reduced vitamin D from lack of sun exposure,” said study author Stine Marit Moen, M.D., of Oslo University Hospital Ulleval in Norway.
Low vitamin D levels are associated with an increased risk of MS. Low vitamin D levels can lead to reduced calcium absorption and bone mineralization, or the process the body uses to turn minerals into bone structure.
“Our hypothesis was that if vitamin D exerts a major effect on the risk of MS, then the effects of low vitamin D levels on bone density would be apparent soon after the onset of MS,” Moen said.
The study involved 99 people with an average age of 37 who were recently diagnosed with MS or clinically isolated syndrome, which means they had a first episode of symptoms like those in MS but have not yet been diagnosed with the disease. All had no or minor physical disability from the disease.
The participants had bone density tests an average of 1.6 years after the first time they had any symptoms suggestive of MS. Their tests were compared to bone tests of 159 people of similar age, gender, and ethnicity who did not have the disease.
A total of 51 percent of those with MS had either osteoporosis or osteopenia, compared to 37 percent of those who did not have the disease. Osteoporosis is a disease where low bone density causes the bones to become thin and brittle, making them more likely to break. Osteopenia is low bone density that is less severe than osteoporosis but puts a person at risk for osteoporosis.
The results remained the same after researchers adjusted for other factors that can affect bone density, such as smoking, alcohol use, and hormone treatment.
“These results suggest that people in the early stages of MS and their doctors need to consider steps to prevent osteoporosis and maintain good bone health,” Moen said. “This could include changing their diet to ensure adequate vitamin D and calcium levels, starting or increasing weight-bearing activities and taking medications.”

The study was published in Neurology, the medical journal of the American Academy of Neurology.

Third, more on understanding MS:
 

MS-Like Disease in Monkeys may Yield Helpful Clues 

The discovery of a naturally occurring disease in monkeys that is very much like MS in humans could have a major impact on efforts to understand the cause of the disease. The disease that researchers from Oregon Health & Science University (OHSU) discovered in monkeys at the Oregon National Primate Research Center is associated with a herpes virus that could give significant clues into how MS develops in humans. MS researchers have long believed that a type of herpes virus may trigger multiple sclerosis in people who are genetically susceptible to the disease.  

"These findings could have a huge impact on our understanding of MS and could be a landmark in someday developing more effective treatments for the disease, or even methods to prevent the onset of MS," said Scott Wong, Ph.D., senior author of the study and a scientist at the Vaccine and Gene Therapy Institute and the Oregon National Primate Research Center.
Before the OHSU findings, researchers had been able to study MS-like diseases in nonhuman primates only after the disease had been artificially induced. A naturally occurring disease, such as the one discovered at OHSU, can give researchers many more clues into the causes and development of the disease.
"Now, we may be able to tease apart what's triggering the onset of the disease," Wong said.
And the fact that the disease, found in a small percentage of the Japanese macaques at OHSU each year, came from a herpes virus could prove hugely important to MS researchers worldwide. Researchers can now search for a similar virus in people with MS.
From 1986 through 2010, 56 of the Japanese macaque monkeys at the Oregon National Primate Research Center at OHSU spontaneously developed paralysis in their hind limbs, along with other symptoms. The monkeys were humanely euthanized because they could not have been returned to the monkey colony safely. Researchers later did necropsies on their bodies and performed MRI scans on eight of the animals.
That work and other testing allowed researchers to discover that an MS-like disease called Japanese macaque encephalomyelitis was causing the paralysis. While the disease typically afflicted young adult animals, it also was present in juveniles and older animals, and was present in both males and females.
About 1 to 3 percent of the more than 300 Japanese macaques at the primate center develop the disease each year, according to the researchers.
With this discovery, MS researchers now will be able to move toward trying to prevent or treat the virus in monkeys, which might help scientists make progress in treating MS in humans. The OHSU researchers' findings were published online in the Annals of Neurology.

Always nice to know that they have found a possible cause of MS - maybe a virus is to blame!

More on Vitamin D and Other Interesting News

The following is from a Multiple Sclerosis Foundation email:

Research Examines Cellular Events that May Lead to MS

While it has often been suspected that MS is the result of inherent risk factors ignited by an environmental trigger, a group of researchers from the UC Irvine MS Research Center have recently published data that points to the possible combination of events that causes the disease, and includes a theory that defines the importance of Vitamin D.

Using blood samples from about 13,000 people, study author Michael Demetriou, M.D., and colleagues identified the way environmental factors (including metabolism and vitamin D3 obtained through either sunlight exposure or diet) interact with four genes to affect how specific sugars are added to proteins regulating the disease. Those genes are interleukin-7 receptor-alpha, interleukin-2 receptor-alpha, MGAT1, and CTLA-4.

Earlier work on mice by Demetriou revealed that changes in the addition of these specific sugars to proteins creates a spontaneous MS-like disease. They also found that N-acetylglucosamine (GlcNAc), a dietary supplement and simple sugar related to glucosamine, is able to suppress this process.

The current research shows that both vitamin D3 and GlcNAc can reverse the effects of four human MS genetic factors and restore the normal addition of sugars to proteins. "This suggests that oral vitamin D3 and GlcNAc may serve as the first therapy for MS that directly targets an underlying defect promoting disease," Demetriou said.

 Next, more research to show that certain viruses can increase one's risk of developing MS.

Study Suggests Shingles Nearly Quadruples MS Risk in Asia 

A shingles outbreak can nearly quadruple the risk of developing MS in the following year, but the overall risks remain small, according to research conducted in China. Viruses are thought to play a role in triggering MS, and herpes zoster virus, which causes shingles, is one of the viruses previously implicated. But the new results reported in the Journal of Infectious Diseases are the first to quantify the risk.

Shingles is an exceptionally painful, blistering skin rash caused by the herpes zoster virus, the same virus that causes chickenpox. In many patients who suffer chickenpox in childhood, the virus is not eradicated from the body, but lies dormant for years or decades, until it is prompted to start replicating by environmental conditions, stress or infectious diseases.

Epidemiologist Herng-Ching Lin of Taipei Medical University in Taiwan and colleagues studied 315,550 adults with herpes zoster and a control group of 946,650 healthy controls, tracking them for a year to monitor for the development of MS. After adjusting for family income and geographic region,both of which are known to play a role in MS, the researchers found that the group with herpes zoster outbreaks was 3.96 times more likely to develop MS than the control group. On average, MS developed about 100 days after the shingles episode.

The authors noted, however, that MS has a lower incidence in Asian populations than in Western ones, so it may be difficult to extrapolate their findings to the rest of the world.

Could cinnamon be the answer???  If so, I think I could add more cinnamon to my diet :)

Cinnamon Investigated as MS Prevention Treatment

Could cinnamon offer a non-toxic way to stop myelin sheath destruction from MS? Preliminary animal studies have suggested so. Now scientists may be closer to finding out the answer.

Rush University Medical Center has received a $750,000 grant from the National Institutes of Health (NIH) to see if the common household spice used for centuries to ease inflammatory conditions such as arthritis and sore throat, can also inhibit pro-inflammatory molecules that trigger MS.

Kalipada Pahan, Ph.D., a professor of neurology at Rush and principal investigator of the study, says the grant will be used to conduct further studies in mice.

Glial cell activation in the brain has been implicated in the development of a variety of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and MS. Activated glial cells accumulate and secrete different neurotoxin factors that cause various autoimmune responses that lead to brain injury.

"These autoimmune reactions in the brain ultimately kill oligodendrocytes, which are a certain type of brain cell that protects the nerve cells and myelin sheath," said Pahan. "However, cinnamon has an anti-inflammatory property to counteract and inhibit the glial activation that causes brain cell death."

Bad news for Cladribine:

Cladribine Approval Bid Halted

Merck Germany has announced that it is abandoning current efforts to gain approval of the prescription Cladribine, anticipating the drug would never pass global clinical trials. Cladribine was in the pipeline as another possible oral medication for treatment of relapsing-remitting MS.

Merck said it intends to withdraw applications from regulatory review in the limited number of countries where procedures are ongoing.

The decision was made after discussing cladribine with international organizations, including the U.S. Food and Drug Administration (FDA). The plan calls for current clinical trials to be completed for the sake of participants and to add knowledge for the scientific community.

In Australia and Russia, where cladribine tablets are approved and available under the trade name Movectro™, Merck said it will withdraw the product from the market and will discuss the timelines and other details with the local regulatory agencies to determine the best solutions for people currently on Movectro therapy.

It will be interesting to see if Merck develops a new oral therapy. 

I hope everyone learned something, I know I did.  I will continue to take Vitamin D supplements and I may have to start adding cinnamon to more foods!

MS Variety Show

This post is just a variety of interesting topics.  This first topic is a bit morbid, but if a cure doesn't happen in my lifetime, then I would definitely be willing to donate my organs to science in the hopes of a cure being found someday.

Donate to MS Tissue Banks – People living with MS may hold the key to curing this disease. One way they can make a difference is to arrange to donate their brain and spinal cord tissues when they die. The decision to participate in this very special research area is truly appreciated by all who are involved in moving toward a world free of MS.
For tissue banks and more information visit: http://www.nationalmssociety.org/research/researchers-need-you/donate-to-tissue-banks/index.aspx

This next topic is interesting because it may help to explain why more women are diagnosed with MS than men.  Also, this research may help to develop new treatment options!

Estrogen Receptors Play Anti-Inflammatory Role in the Brain

Researchers have uncovered an unexpected role for estrogen receptors (ERs) in the brain in keeping inflammation under control. The findings from a University of California (UC) study may have important implications for the treatment of multiple sclerosis and many other neurodegenerative diseases. They might also help to explain why women are three times more susceptible to developing MS than men are, researchers say. 

"We've really discovered an alternative pathway for estrogen receptors in the brain," said Christopher Glass of UC, San Diego. 

ERs are primarily known to activate programs of gene expression, but in this case estrogen receptors are critical for turning off genes that would otherwise lead to chronic inflammation.

Although MS is a very complicated disease, the findings suggest drugs targeted at certain ERs might effectively shut down the inflammation that goes along with the disease, the researchers suggest. The findings might also help to explain the strong sex bias in MS, which disproportionately affects relatively young women.

"Although the estrogen receptors (ERs) have been implicated in the etiology of MS, no clear molecular mechanisms link them to relapsing-remitting MS," wrote David Gosselin and Serge Rivest in an accompanying commentary, noting that the recent research may fill that gap. In addition to explaining why females develop MS more often than males, Gosselin and Rivest continued, the findings also suggest that birth control medications and environmental factors such as estrogen analogs derived from plants might also promote development of the disease.

These findings were reported in the May 13 issue of the Cell Press journal Cell.

The third topic is more about Tysabri's scary side-effect, PML, and the number of deaths reported.  Apparently three years into taking Tysabri is when the risk of PML is highest.  Yikes!

FDA Updates Tysabri's Timeline Warning for PML

The brain infection risk from Biogen Idec's multiple sclerosis drug Tysabri appears highest during the third year of treatment, according to U.S. health officials who issued an updated warning.

The potentially fatal infection, known as progressive multifocal leukoencephalopathy (PML), occurs in an estimated 1.5 per 1,000 patients treated with Tysabri during months 25 to 36, the Food and Drug Administration (FDA) said. The drug is given through a monthly infusion.

Biogen withdrew the drug in 2005 after the first reports of the brain infection. Tysabri returned to the market with restrictions in 2006.

In its latest statement, the FDA said the PML risk was 0.3 per 1,000 patients during the first two years of treatment. After three years, the rate was 0.9 per 1,000. Limited data is available beyond four years.

The estimates have been added to the prescribing instructions for Tysabri, which Biogen makes with Irish drugmaker Elan Corp Plc.

The FDA said it was the first time it had estimated the chances of PML for specific time intervals rather than providing a cumulative risk over years. The new estimates "will allow prescribers to better assess risk based on duration of treatment," the agency said.

The total number of cases worldwide stands at 111 as of April 1, according to Biogen.

My fourth topic is good news for getting a better look at the damage done to the myelin sheaths of the MS-affected nerve cells.

New Technology Allows Better Look at Myelin Destruction

A new method for making detailed X-ray images of brain cells can map the myelin sheaths of nerve cells, which are important for conditions such as multiple sclerosis and Alzheimer's disease. Researchers, including members from the Niels Bohr Institute at the University of Copenhagen, have developed  the method called SAXS-CT. For the first time, myelin layers can be viewed in 3-D X-ray images.

"We can see the myelin sheaths of the neuronal axons and we can distinguish the layers which have a thickness of 17.6 nanometers." explains Torben Haugaard Jensen. "Up until now, you had to cut out a little sample in order to examine the layers in one area and get a single measuring point. With the new method we can examine 250,000 points at once without cutting into the sample. We can get a complete overview over the concentration and thickness of the myelin and this gives us the ability to determine whether the destruction of the myelin is occurring in spots or across the entire sample," he explains.
The research provides new opportunities for collaboration with doctors at Copenhagen University Hospital and the Panum

Researchers say that by following the development of the disease and discovering how the brain is being attacked, they may be gathering knowledge that could one day be used to develop a treatment.

The results of their work have been published in the scientific journal, NeuroImage. 

The next topic in the Variety Show is for those who are looking for a new workout - apparently kickboxing is the key to improving balance and mobility of the MS-affected.

Study Shows Benefits of Kickboxing in MS

Dr. Kurt Jackson, a physical therapist and the neurology coordinator of the University of Dayton's doctor of physical therapy program, recently completed a second research study on the safety, feasibility and effectiveness of kickboxing for people with multiple sclerosis. He found kickboxing is safe, may improve the balance and mobility of people with MS and can be adapted for people with varying degrees of the disorder.

"Ideally, a person with MS needs to perform exercises that target balance, aerobics, strength and flexibility," Jackson said. "Kickboxing lets a person do all of these in a single activity."

He published the results of a pilot study last year in the Journal of Bodywork and Movement Therapies, which showed meaningful improvements in participants' balance, walking ability, and posture. While he is still analyzing the data from this second study, he said he has already observed similar results.

Jackson recruited 13 people with varying degrees of MS for his research study. He divided them into three groups and had them exercise three times a week for five weeks with local kickboxing instructors. The research team conducted the study at Kettering Health Network's NeuroRehab and Balance Center on the campus of Southview Hospital.

The program progressed gradually, eventually adding combinations of punches, kicks and footwork, first using imaginary targets and then heavy bags.

"The participants are showing the most improvement in the tests that measure the higher levels of balance, likely because kickboxing requires these higher skills," Jackson said. The exercises specifically target the participants' core trunk control, which is needed for basic tasks such as walking, getting dressed while sitting on the edge of a bed, getting on and off a toilet, and preventing falls.

A community-based exercise program like kickboxing may be just what the doctor ordered. Jackson recommends if people with a chronic neurological condition want to enroll in a community kickboxing program, they should consult a physician or physical therapist to check their balance and determine if they would be safe to participate and if any special equipment or precautions are needed.

The final topic - forget Bike MS, for the extreme cyclists, you can bike across the United States all while fundraising and raising awareness for MS!

Bike across the US for MS

About 60 cyclists will soon dip their bicycles in the Atlantic Ocean to signify the start of a two-month-long ride across the United States to fundraise and increase awareness for multiple sclerosis on behalf of Bike Across the US for MS. Not only have past rides raised about $300,000 for the MS cause, but cyclists have stopped along their journey to help with home modification projects to assist those living with MS. This year’s cyclists would like to connect with anyone in the MS community as they make their way across the US. To view the three different routes, the cities they pass through, and the schedule, go to www.biketheusforms.org. 

All of this material came from my most recent mailer from the Multiple Sclerosis Foundation, so thanks to MSF for the great information!