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!

Blog Anniversary!

Today is my blog's one year anniversary!  It has been a great ride so far and I hope to continue giving updates and reporting on the ongoing research.  Things are going well for me right now - I have been in remission for about a year now (with a few slight flare ups here and there).  I am very pleased with my condition at this point and hope that I can continue feeling this well.

I have signed up for Walk MS which will occur in March - click here to visit my personal page.  I hope to surpass my fundraising goal from last year - I hope that I make it (I am fearful that my goal is too lofty). My local MS Society chapter has already had two events this year and both have been really great!  I am excited about what this year will bring!

And now, MORE news on Vitamin D from the NMSS website:

Researchers and clinicians from around the globe gathered recently in Chicago to develop strategies for testing whether vitamin D supplements can prevent the development of MS. Participants discussed the latest findings relevant to vitamin D and MS and potential clinical trial designs, taking the first steps to making these exciting studies a reality. “Vitamin D and MS Prevention: An International Workshop,” was chaired by Colleen E. Hayes, PhD (University of Wisconsin-Madison) and Anne-Louise Ponsonby, PhD (Murdoch Children’s Research Institute, Canberra Australia), and was funded by the National MS Society.
Background: Research is increasingly pointing to a reduced level of vitamin D in the blood as a risk factor for developing MS. Years ago, MS researchers wondered why MS occurs less often in regions of the world where exposure to sunlight is high. Dr. Hayes – a professor of biochemistry and microbiology – and colleagues suggested that vitamin D, which is made by cells in the skin in response to sunlight, may suppress the immune response involved in MS. She and others have since shown that in lab mice, vitamin D can reduce the effects of EAE, an MS-like disease.
Epidemiologic studies (studies of who gets MS) have backed up laboratory studies. Dr. Ponsonby – an epidemiologist and public health physician – was a co-author of the Ausimmune Study, a comprehensive Australian study that showed that higher levels of sun exposure and higher blood levels of vitamin D were both associated with decreased risk of having a first demyelinating event, often the first indicator of subsequent MS.
The National MS Society has led the way in pursuing this avenue of MS research, funding much of Dr. Hayes’ work, first funding the Ausimmune study, and now, a new clinical trial testing whether vitamin D can reduce disease activity in people who have MS. Read more on clinicaltrials.gov.
The Meeting: Participants included experts in vitamin D studies, immunology, statistics, epidemiology, clinical MS research, pediatric MS, and MS biomarkers. The group began by bringing its vast experience to bear in discussing the promise and potential pitfalls of conducting “primary prevention studies” using vitamin D to potentially prevent MS before it occurs.
“We are people from all over the world and we have one common purpose – to stop this disease,” noted Dr. Hayes. “The research that has been done by the people in this room and others provides us with strong evidence that vitamin D may help.”
Alberto Ascherio, MD, DrPH (Harvard School of Public Health) and colleagues have published pivotal studies relating to several MS risk factors. His 2006 study  – supported by the Society – compared levels of vitamin D in blood serum stored from military personnel during their service, and found that those with higher levels of vitamin D were at lower risk for later developing multiple sclerosis. Dr. Ascherio noted a major concern about designing vitamin D studies, based on his research. “Compliance is likely to be a major obstacle,” he said. “You have to worry about people in the placebo group that might take vitamin D anyway, and make the study powerful enough to account for that.”
George Ebers, MD, FRCP(C) (University of Oxford) reported on findings “hot off the press” – his team recently confirmed an association between MS and a gene linked to vitamin D. Dr. Ebers cautioned that before beginning a study, “You absolutely need to know what the rate of MS is in your country,” noting that the reported rates of MS is increasing in some areas.
Dr. Hayes reviewed basic research that could have a strong impact on planned studies. For example, female mice treated with vitamin D are protected from MS-like disease, but not male mice. “Normal estrogen may be essential for vitamin D benefits,” she said. Also, her research points to the immune messenger protein interleukin-10 as being essential for vitamin D protection from MS-like disease in mice. “Anything that destroys that pathway may undermine a treatment trial,” said Dr. Hayes.
Jorge Correale, MD (Raul Carrea Institute for Neurological Research Argentina) discussed his research on the immune response and vitamin D. “Vitamin D is particularly reduced during relapses in people with MS,” he said, noting that administering vitamin D to cells isolated from people with MS resulted in modulation of immune “T cells” which have been previously implicated in MS activity. He noted that cells that reduce inflammation are activated by vitamin D and those that promote inflammation are suppressed.
Reinhold Vieth, PhD, FCACB (University of Toronto) has been studying vitamin D for decades. His team’s findings show that this vitamin is associated with decreased PSA (a marker for prostate cancer), and a decreased risk of breast cancer. His experience provided numerous important considerations for conducting vitamin D prevention trials in MS. “Vitamin D binding protein [a protein that helps to transport the vitamin within the body] acts as a safety buffer to prevent toxicity,” he said. “It protects the body from having too much vitamin D.” Dr. Vieth works with the team that found vitamin D supplements to be safe in small, early study of people with MS.
Co-chair Dr. Ponsonby encouraged participants with her review of similar efforts undertaken to combat other diseases such as folate supplementation to mothers in pregnancy to prevent spina bifida. “I remember being at a primary prevention meeting in the early 1990’s ,like this one, to talk about sudden infant death syndrome prevention, which was taking one in 250 children in Tasmania at that time,” she said. “I thought, ‘How are we going to get this done?’ Five years later, it felt so good to be at another meeting, talking about how, after changes in health recommendation, the rate of SIDS had decreased by up to 70% in several countries.”
Future Steps: After reviewing data and hearing from statisticians and clinicians about the feasibility and expense of primary prevention studies, participants agreed to look at three study designs. The next steps are to submit a report based on the summit to a peer reviewed journal, and to begin the process of designing and seeking funding for the proposed prevention trials.
Timothy Coetzee, PhD, chief research officer of the National MS Society, complimented Drs. Hayes, Ponsonby, and colleagues on the “audaciousness” of their efforts. “Can we end MS by something as simple as vitamin D supplementation? This goal is as big as they come, but it fits right into the Society’s bold commitment to do everything possible to free the world of MS.”

 Always amazed at all of the Vitamin D correlations and continued research.  Guess I will continue taking Vitamin D supplements!

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 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!

Genetics and MS

From the NMSS website:

Studying human cells isolated in the laboratory, researchers reveal a novel interaction between two genes that influence susceptibility to developing MS, certain environmental factors, and a chemical process (called N-glycosylation) that modifies the structure of molecules, which together may contribute to our understanding of how complex interactions lead to the development of MS. Michael Demetriou, MD, PhD (University of California, Irvine) and colleagues have published these findings in Nature Communications (May 31, 2011, Volume 2, Article #334). The team was funded in part by the National MS Society.
Background: The cause of MS is still not known, but scientists believe that a combination of several factors may be involved to trigger the immune attack that is launched on the brain and spinal cord. While MS is not directly inherited, genes are known to make people susceptible to developing the disease. Researchers also are working to understand how MS gene variations may interact with some environmental triggers that have been linked to MS, such as viral infection, cigarette smoking and low levels of vitamin D/sunlight to increase the risk of MS.
Michael Demetriou, MD, PhD, has previously shown that changes in the addition of specific sugars to proteins involved in the MS attack (N-glycosylation) trigger a spontaneous MS-like disease in mice, which could be suppressed by interfering with the process with a dietary supplement. The current study aimed at translating this finding to the development of human disease.
The Study: In this study, Dr. Demetriou’s team examined DNA samples from about 13,000 people with MS or controls. They looked at how four previously reported susceptibility genes that are involved in immune system activities (interleukin-7 receptor-alpha, interleukin-2 receptor-alpha, MGAT1 and CTLA-4) affect N-glycosylation. Then they examined how a particular environmental factor such as vitamin D affected this interaction.
The results suggest that these genes do alter N-glycosylation in cells isolated in the laboratory, but that both vitamin D and a dietary supplement called N-acetylglucosamine (GlcNAc) were able to suppress this process in cells and in mouse models of MS.
Comment: This study provides new evidence for a link between genes and the environment in the development of MS. However, additional research is needed before it is possible to generalize these findings to all cases of MS, since this study focused on just a few of the many genetic susceptibility factors linked to MS. More research is also needed to determine whether administering vitamin D and G1cNAc will be helpful in MS. A new clinical trial getting underway with support from the National MS Society will test the ability of vitamin D supplements to alter MS disease activity. 

This is an area that interests me.  MS does not "run" in my family (I am aware of one other person in my family with MS who is a distant relative), but the susceptibility of developing MS being genetic scares me because I would like to have children, but I worry that they could develop MS because they will have a higher probability of developing MS because of their genetic disposition.  Scary!  I am, however, glad to continue to read that MS is not 100% genetic.

Last Post about Recent MSF Mailer

Ok, so this will be the last (but not least) installment of the recap of the recent MSF mailer I received.  First, mono + vitamin D deficiency may = MS:

New research suggests that people who are exposed to low levels of sunlight coupled with a history of having a common virus known as mononucleosis may be at greater odds of developing MS than those without the virus.
"MS is more common at higher latitudes, farther away from the equator," said George C. Ebers, M.D., with the University of Oxford in the United Kingdom and a member of the American Academy of Neurology. "Since the disease has been linked to environmental factors such as low levels of sun exposure and a history of infectious mononucleosis, we wanted to see whether the two together would help explain the variance in the disease across the United Kingdom."
Infectious mononucleosis is a disease caused by the Epstein-Barr virus, which is a Herpes virus that is extremely common but causes no symptoms in most people. However, when a person contracts the virus as a teenager or adult, it often leads to infectious mononucleosis.
The body makes vitamin D when exposed to ultraviolet B (UVB) light.
For the study, researchers looked at all hospital admissions to National Health Service hospitals in England over seven years. Specifically, they identified 56,681 cases of MS and 14,621 cases of infectious mononucleosis. Scientists also looked at NASA data on ultraviolet intensity in England.
The study found that adding the effects of sunlight exposure and mononucleosis together explained 72 percent of the variance in the occurrence of MS across the United Kingdom. Sunlight exposure alone accounted for 61 percent of the variance.
"It's possible that vitamin D deficiency may lead to an abnormal response to the Epstein-Barr virus," Ebers said.
He noted that low sunlight exposure in the spring was most strongly associated with MS risk.
"Lower levels of UVB in the spring season correspond with peak risk of MS by birth month. More research should be done on whether increasing UVB exposure or using vitamin D supplements and possible treatments or vaccines for the Epstein-Barr virus could lead to fewer cases of MS."
The research is published in the April 19, 2011, print issue of Neurology, the medical journal of the American Academy of Neurology.

If having mono as a teen and having low levels of vitamin D do equate to an MS diagnosis, then that would help to explain my diagnosis.  I had a pretty severe case of mono when I was a junior in high school (so bad that my spleen had enlarged to the point that the doctor was worried that the slightest blow to that area of my body would rupture my spleen).  Also, I recently got my vitamin D levels checked after learning about the potential impact of vitamin D on MSers and my levels were low.  I have been taking supplements and hopefully in a year, my levels will be up.  I find this "discovery" to be so interesting; I would love to know how many people living with MS had mono when they were younger.

For those MSers who have issues with balance, this BalanceWear vest may be the answer (or at least helpful):

Have balance and walking difficulty? The newly introduced BalanceWear® Therapeutic Garment utilizes Balance-Based Torso Weighting® (“BBTW®”), a novel technique used by some physical therapists to improve balance and mobility. The technique, which requires you to wear a customized, strategically weighted garment utilizing small, unobtrusive weights, is adjusted specifically to your body. BalanceWear is currently available in California, New York, Wisconsin, Delaware, Connecticut, and North Dakota with additional states being added constantly.
Individuals for whom the BalanceWear vest is recommended by a physical therapist certified in its use, can apply for funding through the MSF to pay for the entire cost of the garment.

To find a certified therapist near you, contact Motion Therapeutics, Inc., developers of the BalanceWear Therapeutic Garment, at 805-278-BBTW (2289).
To learn more about how this technology may help you, visit http://www.motiontherapeutics.com/.

Last, but not least, the makers of teriflunomide are recruiting patients for their clinical trials (Phase III - Teiflunomide vs. Placebo), the qualifications are listed below:

This study is recruiting in locations nationwide. The primary objective of this study is to demonstrate the effect of teriflunomide (14 mg/day and 7 mg/day) compared to placebo for reducing conversion of patients presenting with their first clinical episode consistent with MS to clinically definite MS.
It is an international, multi-center, randomized, double-blind, placebo-controlled, parallel group study and is designed to evaluate the efficacy and safety of two year treatment with teriflunomide.
Qualified participants will be between the ages of 18 and 55, male and female. Other inclusion criteria:
People with a first acute or subacute, well-defined neurological event consistent with demyelination (such as optic neuritis confirmed by an ophthalmologist, spinal cord syndrome, brainstem/cerebellar syndromes.)
Onset of MS symptoms occurring within 60 days of randomization.
A screening MRI scan with two or more T2 lesions at least 3 mm in diameter that are characteristic of MS.
For more information go to http://click.icptrack.com/icp/relay.php?r=28288047&msgid=399143&act=X8WI&c=263560&destination=http://www.clinicaltrials.gov/ and search for identifier number NCT00622700.

I have been getting a lot of information lately that I want to share.  The newest Momentum magazine has an interesting article about Vitamin D and everyone seems to be reporting about the promising progress BG-12 and Laquinimod are making in their clinical trials.  I will try to post again soon! 

Research Research Research!

I have been pretty tired lately, but I am determined to continue to post at least once per week!

I just got around to reading emails that have been accumulating for the past few days and I learned that recently the National MS Society (NMSS) committed $17.5 million to support 50 new MS research projects.  This is all "part of its comprehensive strategy to stop MS in its tracks, restore function that has been lost, and end the disease forever."  The following is from the NMSS website:

To find the best research projects, the National MS Society relies on more than 70 world-class scientists. These scientists volunteer their time to carefully evaluate hundreds of proposals every year.
The new projects support the comprehensive research goals outlined in the Society’s five-year Strategic Response, including an increased focus on understanding and stopping disease progression, supporting development of new therapies, identifying rehabilitation and other strategies to restore function, and getting more researchers and scientists focusing on MS. The new projects include:

• clinical trials testing whether vitamin D can stop MS activity
• a clinical trial to evaluate whether a repurposed drug, phenytoin, can protect the nervous system from MS damage;
• investigations of mechanisms that may lead the immune system to turn against the nervous system;
• studies of natural molecules that may stimulate repair of the nervous system to restore function; 
• studies exploring novel exercise programs to combat MS symptoms; and
• a study comparing the activity of several viruses, including Epstein-Barr virus, that may be involved in triggering immune attacks in people with MS, which may lead to clues to ending MS through prevention. 

This is so great!  I am so happy to know that so much research is ongoing!  I am also glad to know that all of that money we all raise every year for Walk MS, Bike MS and a number of other NMSS events is going toward all of this exciting research!  I am especially excited to learn more about this Vitamin D theory.  Personally, I have been taking Vitamin D supplements since the Valentine's Day teleconference and I would love to know if those are helping in any way.

I also learned that the oral drug BG-12, which I previously posted about here, which is in clinical trials recently reported some positive results.  The following are excerpts from the NMSS website:

Biogen Idec announced that the experimental oral therapy BG-12 significantly reduced the proportion of people with MS who experienced relapses in a two-year study of more than 1200 people with relapsing-remitting MS. Although its exact mode of action is not known, BG-12 is thought to inhibit immune cells and molecules involved in MS attacks on the brain and spinal cord. The results were announced in an April 11 press release. Data analysis is ongoing and the company expects to provide a full report at an upcoming medical meeting. Another trial of BG-12 is currently underway.
In an earlier phase 2 study, compared to inactive placebo, the highest tested BG-12 dose led to a 69% reduction in active inflammation on MRI scans from weeks 12 to 24. Side effects (formally known as adverse events) included abdominal pain, flushing, headache, fatigue, and feeling hot.
The primary goal of the DEFINE study was to determine whether BG-12 could decrease the proportion of participants experiencing relapses and whether the agent was safe and well tolerated. Secondary objectives included assessing BG-12’s effects on the frequency of relapses, disability progression, and disease activity detected by MRI.
Participants were randomly assigned to one of two treatment groups receiving different doses, or a group receiving placebo. According to the press release, in both groups taking BG-12, the primary endpoint was met, meaning a significant reduction in the proportion of people experiencing relapses at 2 years. All secondary endpoints were met as well in these groups, with significant reductions in relapse rate, disease activity on MRI scans, and in disability progression as detected by the EDSS, a standard scale that measures disability. According to the press release, adverse events were similar to those experienced during the Phase 2 study (those included abdominal pain, flushing, headache, fatigue, and feeling hot):
These positive results are the first reported from this large, Phase 3 study of BG-12. Full details and evaluation of this study, and from another Phase 3 study now underway, should help define the safety and promise of BG-12 as a potential therapy for relapsing MS.

More good news!  Maybe soon a second oral therapy will be available!  That is enough news for one night, but everyone should also check out the Emerging Therapies Collaborative at this website.  Also, if you have a chance, you should check out this MS blog.

Hope everyone reading is well!  Look forward to another post by the end of the weekend!