Research Advocate
Epidemiology and Multiple Sclerosis: Can MS Be Prevented?
Research Advocate
Epidemiology is the medical discipline that studies people to determine the causes of disease. On March 14, 2009, at the 19th Annual Stanley F. Waterman Research Update, Dr. Alberto Ascherio of the Harvard School of Public Health presented a very revealing look into the current findings of epidemiological research into two health issues that appear to increase risk of multiple sclerosis: Epstein-Barr Virus (EBV) and smoking. He also reviewed the potential benefits of Vitamin D in protecting people from MS.
Stanley F. Waterman lived with severe multiple sclerosis for many years. The Annual Research Update was established in his name to create one opportunity each year to inspire others to persevere in their own fight against MS, and to learn about cutting edge research that is bringing us closer to a world free of MS. Stanley’s greatest wish was that future generations would be spared a life of MS. Stanley’s wife, Elise, and his daughter, Jane, attended the update, and presented Dr. Ascherio with a plaque in appreciation of his dedication and perseverance in identifying risk factors that may trigger the development or impact the progression of MS.
EBV is most commonly associated with mononucleosis, and most people in the U.S. display evidence of exposure to EBV. In one National MS Society-funded study, Dr. Ascherio’s team reported that individuals with signs of significant exposure to EBV were twice as likely to develop MS up to 20 years later. (Archives of Neurology 2006 Jun;63(6):839–44) However, exposure to EBV at a very young age (under age 5) might actually help protect the body from MS. As strong as the evidence is that EBV can trigger the MS auto-immune response, not everyone who has MS experienced exposure to EBV.
Smoking is another health issue that is a suspected trigger of MS. At the 2009 annual meeting of the American Academy of Neurology, a recent study on smoking indicated that those who began smoking before age 17 had a 2.7 percent greater risk of developing MS than non-smokers. The study was conducted by Joseph Finkelstein, MD, PhD, of Johns Hopkins University School of Medicine, in Baltimore, MD, in collaboration with Veterans Affairs MS Center for Excellence. In addition, there is evidence to suggest that individuals exposed to secondary smoking because their parents were smokers also had an increased risk of developing MS. In addition, in a study published in the March 9, 2005 issue of Brain, author Miguel Hernan from the Harvard School of Public Health indicated that cigarette smoking may contribute to the progression of MS. There are also multiple reports of a correlation between smoking and worsening of MS symptoms.
 From left, Dr. Peter Riskind, Dr. Alberto Ascherio, Jane and Elise Waterman |
Dr. Ascherio also reported during the Waterman Update on a study supported in part by the National MS Society (JAMA 2006; 296: 2832-2838) that the risk of developing MS decreased with increasing levels of Vitamin D formed with exposure to sunlight. Vitamin D can alter immune activity and helps the bones absorb calcium. The incidence of MS increases the farther one lives from the equator, where exposure to ultraviolet light is at its greatest. This study did not address the issue of whether Vitamin D can affect the course of MS once it has begun.
It’s important to note that people with MS should not take independent action, such as over-dosing on Vitamin D, or excessive or unprotected sunbathing, or any other action without consulting a physician. High doses of Vitamin D can be harmful to the body. However, these findings are important information for scientists and doctors to use in their continuing investigations of MS. And, they are very encouraging clues for changing behavior, such as stopping smoking, to protect oneself as much as possible from developing MS.
Nervous System Protection and Repair Conference
By Eric Hübler, Staff Writer
Let’s be clear: to the layperson, the presentations at the Nervous System Repair and Protection in MS Conference might not have seemed very clear. The meeting, in New York City in January, consisted of over 70 scientists talking to scientists and showing each other slides with titles like “RXRs and RA signaling.”
So let’s be clear about something else: for anyone interested in MS, the event was historic. The Nervous System Repair and Protection Initiative involves more researchers, at more labs worldwide, than any other MS research initiative. So bringing so many participants together to share their results — and their hopes for continuing the work beyond 2010, when the original grant from the National MS Society concludes — was a milestone in collaboration.
Creating Milestones — Together
Collaboration is at the heart of everything the Society does—including research. “The questions these days are so big, the lone scientist in the corner lab doesn’t cut it anymore,” said Patricia O’Looney, the Society’s vice president of Biomedical Research. “You need collaborations.”
The initiative consists of four projects, each with the common goal of discovering ways to protect and repair brain tissue from the damage caused by MS.
 From left to right: Drs. Peter Calabresi, Gavin Giovannoni, Charles ffrench-Constant, and Ian D. Duncan. |
- Peter Calabresi, MD, and his team at Johns Hopkins University are investigating better ways to detect and quantify tissue injury. They are also testing agents that may protect the nervous system from further damage.
- Ian D. Duncan, BVMS, PhD, FRCPath, FRSE, and his team at the University of Wisconsin at Madison are developing better imaging technologies to follow damage—and detect repair, which is essential for tracking whether repair strategies are working. They are also working on potential cell therapies.
And across the “pond”:
- Gavin Giovannoni, MBBCh, FCP, PhD, of Queen Mary University of London, and his team are attempting to turn cells into vehicles that can deliver “repair” molecules to injured areas.
- Charles ffrench-Constant, PhD, FRCP, of the universities of Cambridge and Edinburgh, and his team are working on identifying and amplifying natural repair factors in the brain.
Each has spawned new experiments and swept in more researchers. At Johns Hopkins, 22 people were receiving Promise: 2010 funding, yet 62 people were participating — meaning, in effect, 40 free brains for the MS movement.
Supporters and Researchers Connect
Several donors also attended the conference to learn where their aid is going.
“It’s just great to see this kind of progress. You can get a sense of the enthusiasm, the magnitude of it,” said longtime Society supporter and Honorary Life Director Charlie Goodyear.
“It was remarkable this morning, seeing someone from London ask a question of someone from California and establish an immediate rapport,” said the San Francisco-based architect and architecture professor Peter Thaler, who lives with MS. “It’s not unlike teaching architecture: talking about what happened in the past and what could happen in the future.”
E.J. Levy, an active fundraiser who lives with MS and closely monitors research progress, said she was grateful for so many scientists trying to cure her, but she also wished the initiative had yielded more clinical trials by now.
“I realize that research can be a tortoise, but I’d rather have the hare,” she said.
As if in answer, researchers at the conference announced several small trials on cell therapy, two years ahead of the original plan of Promise: 2010.
Cambridge’s Siddharthan Chandran, MD, PhD, described one such trial involving the optic nerve, which he hopes will benefit the “missing tribes” of MS — those with advanced disease who have few medical options.
“It would be terrific to come back here in two years’ time and tell you the final outcome of that,” he said.
More trials are coming, the project leaders promised. “I’m a big believer in getting your feet wet. As we get into these clinical trials, we’ll learn,” Dr. Calabresi said.
Motivation to Keep Moving
Volunteers are essential to clinical trials; without them, clinical trials either take years to complete or are not completed at all. Dr. Chandran wished MS patients could be enrolled in trials routinely, as has been done in oncology for decades. Some existing drugs that could be tested in MS are off-patent and “cheap as chips,” he said.
Dr. Calabresi spoke about a patient who was diagnosed at 17 after experiencing foot drop while jogging, and who at 26 uses a wheelchair.
“She looks at me and says, ‘Can’t you do anything for me?’ It just makes me sick, but it’s also an incredible motivator to take that energy and put it back into the work.”
For the latest research developments visit nationalMSsociety.org/Research and click on Research News.
Research in Central New England
The National MS Society is the largest private sponsor of MS research in the world. We support research and training projects aimed at finding the cause of MS, better treatments, and a cure. The MS Society also identifies promising areas of research and promotes activity in those areas.
To find a clinical trial that is recruiting near you, go to www.nationalmssociety.org/research
Local Clinical Trials Recruiting Patients
Please note: To participate, you may have to reside near the facility, as treatment and follow-up visits will be necessary throughout the course of the study. Also, please keep in mind that clinical trials often have strict criteria for enrollment, specifying the type of people (disease type, duration, age, etc.) they are seeking to participate. These help to ensure that the results will be as reliable and as effective as possible. If you are interested in participating in a clinical trial we encourage you to discuss the possibility with your personal physicians. Additional studies are listed at the chapter website or our national website.
Agent: Interferon (IFN) B-1a weekly and glatiramer acetate (GA) daily
Study Purpose: Immune function.
Type of MS: RR
Questions and Enrollment Information:
- Site: UMass Memorial Medical Center, Mass.
Contact: Kathleen O’Leary 508.793.6561
- Site: Tufts-New England Medical Center, Mass
Contact: Amanda Dow 617.636.7671
- Site: Dartmouth Medical School, N.H.
Contact: Mary Ann Conrad 603.653.9947
Agent: AVP-923 (Zenvia)
Study Purpose: To treat pseudobulbar affect.
Type of MS: All types, with pseudobulbar affect.
Questions and Enrollment Information:
- Site: Baystate Medical Center, Springfield, Mass.
Contact: Elaine Reich 413.794.5856
- Site: Mass. General Hospital, Boston, Mass.
Contact: Darlene Pulley 617.726.6190
Agent: Oral Estriol
Study Purpose: To affect immune function.
Type of MS: Women, 18-50 with RRMS
Questions and Enrollment Information:
- Site: Dartmouth Medical School, N.H.
Contact: Kathleen Ryan 603.653.9919
Agent: Descriptive balance study
Study Purpose: To identify factors involved in the balance problems experienced by people with MS.
Type of MS: All types
Questions and Enrollment Information:
- Site: UMass Amherst
Contact: Stephanie Jones 413.545.6007