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ACTRIMS Meeting Focuses on Factors Influencing MS Susceptibility and Disease Course

March 9, 2017

More than 700 doctors and researchers met at the ACTRIMS (Americas Committee for the Treatment and Research in MS) meeting in Orlando in late February to share their results, including research aligned with this year’s theme: Environmental Factors, Genetics, and Epigenetics in MS Susceptibility and Clinical Course. (Browse meeting presentations here)
 
Many invited speakers provided overviews of what is known about who gets MS and what might trigger the disease. MS is thought to occur in people who have genes that predispose them to be at risk, but other factors play a role as well.
 
Read blogs about some of these studies: Not everyone who has MS has necessarily been exposed to the risk factors identified so far – like low vitamin D, adolescent obesity or smoking – but some present opportunities that people might modify to improve wellness. Read more about living well with MS
 
Following is a small sample of the presentations:
 
Gut microbiome: Evidence has begun to fill in the story of how the bacteria in our intestines (microbiome) influence the brain, immune system and other organs. Dr. Irah King (McGill University) explained how many different factors, like our diets, genes, medications, stress, hygiene, infections and age, can influence the content of our gut bacteria (Read Abstract). Dr. Sergio Baranzini (University of California, San Francisco) and others are building national and global collaborations like the MS Microbiome Consortium to tease out differences in people with MS, and to see how we might alter the microbiome in hopes of turning off disease activity. In one study, his team transplanted gut bacteria from people with MS into lab mice. The mice that received the transplants then had much worse EAE (an experimental MS-like disease) than mice that didn’t receive the transplants. (Read Abstract)
 
What About Probiotics? Dr. Howard Weiner (Brigham & Women’s Hospital) presented his and others’ work investigating the gut microbiome in people with MS and what’s still not known about the potential role of gut bacteria in MS risk and symptoms. He described a short pilot trial of a probiotic called “VSL#3” in a handful of people with MS suggesting some changes in immune responses. He commented, “…we need a lot of science before we know what we’re doing in terms of probiotic treatment” for MS. (Read Abstract) Read more news about microbiome research
          
B Cells and MS: In his keynote lecture (Read Abstract) honoring deceased ACTRIMS founder Dr. Kenneth Johnson, Dr. Stephen Hauser (University of California, San Francisco) traced earlier research and studies that eventually led to successful clinical trials of ocrelizumab (an experimental therapy that depletes immune B cells), which now awaits regulatory action from the U.S. FDA to make it available as a treatment for people with primary progressive or relapsing MS. Dr. Joyce Benjamins and colleagues (Wayne State University and McGill University) continue to explore their finding that B cells from people with relapsing MS release a factor or factors toxic to nerves and myelin-making cells grown in lab dishes. (Read Abstract)
 
MS Risk Genes: More than 200 MS susceptibility genes have been identified through the work of the International MS Genetics Consortium, which was launched with funding from the National MS Society and other organizations. Dr. Jorge Oksenberg (University of California, San Francisco) reported findings to date that show no genetic differences between people with relapsing MS and progressive MS, that most of the identified gene variants relate to immune function, and that there are overlaps with other autoimmune diseases. These genes still can’t be used to help predict who will develop MS. (Read Abstract)
 
Environment and Genes: The list of environmental factors linked to MS – such as smoking, low vitamin D, Epstein-Barr virus and childhood obesity – is growing. But how do genes and the environment interact to make a person susceptible to MS? Dr. Lisa Barcellos (University of California, Berkley) said one answer may lie in “epigenetics” of MS – the study of changes that occur to the way genes are turned on or off. These changes are chemical reactions to outside influences such as environmental exposures and diet, and they don’t alter the underlying genetic code. One type of epigenetic change that turns off genes is called methylation. Using chip technology, her team ran blood samples from people with MS, compared to people without MS, and found a pattern of methylation (turning off) of a gene in immune T cells (CD8) linked to calming immune attacks. (Read Abstract)
 
More Epigenetics: Dr. Patrizia Casaccia (Icahn School of Medicine at Mount Sinai) described research on epigenetic changes in the brain that can turn on and off genes within individual cell types. Her team has identified differences in the brains of people with MS compared to people without MS. Recent research suggests methylation that inhibits certain genes within myelin-making cells is critical to myelin repair. She noted that understanding the complex sequence of epigenetic changes in the brain will require additional research, with the ultimate goal of finding the best targets to promote repair of myelin that’s been lost in MS. (Read Abstract)
 
Diets Tried by People with MS: Society-funded postdoctoral fellow Dr. Kathryn Fitzgerald (Johns Hopkins University) conducted a diet survey that attracted responses from 7,400 people registered with the NARCOMS study. Forty-four percent indicated that they had tried at least one of the 19 diet plans listed in the survey since their MS diagnosis. The most prevalent current diet was a gluten-free diet (listed by 21% of respondents), with the majority citing MS as the reason for trying it and 88% of those finding it helpful. A smaller proportion had tried the Swank diet (15%) and Wahls diet (8%). (Read Abstract) Read more about diet and nutrition in MS
 
Can Surgery or Anesthesia Cause MS Relapses? No, according to Dr. Tiffany Braley and colleagues (University of Michigan), who reviewed outcomes of 624 surgical procedures among 285 people with MS. Looking at records before and 3 months after the procedures, they did not find an increased risk of relapse in the absence of infection or fever, confirming some previous findings. However, they found that the pre-surgery presence of an active brain lesion on MRI or higher relapse rates before surgery may increase the risk of a relapse after surgery. (Read Abstract)  Read more about surgery and anesthesia in MS
 
Childbirth and Anesthesia in MS: Dr. Andrew L. Smith and colleagues (Cleveland Clinic Foundation) reviewed relapse rates and disability after childbirth to ask the question: Did the use or type of anesthesia during delivery have an impact on MS? Looking at 63 pregnancies in 45 women with relapsing MS, they found that the use or type of anesthesia during delivery (epidural, spinal or none) did not increase relapses or worsening of disability in the short term. The researchers noted that larger studies would be needed to confirm these findings. (Read Abstract)  Read more about pregnancy and MS
 
People in iConquerMS: Dr. Robert McBurney (Accelerated Cure Project for MS) and team presented a profile of individuals who have signed up for the iConquerMS patient-powered research network. They found significant differences in self-reported quality of life between those with relapsing MS and secondary progressive MS. They also found that sleep problems and fatigue were the most commonly reported factors impacting quality of life. (Read Abstract)
 
Read more from the ACTRIMS meeting:
Vitamin D and Gut Bacteria: More Clues and Questions
When Genes and the Environment Collide 

Read more about how lifestyle choices may impact MS

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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