Jun 10, 2009
Two Medical Meetings (ACTRIMS and CMSC) Focus on MS Risk Factors and Quality of Life Issues
“Environmental Risk Factors in MS” was the topic of the 14th annual meeting of ACTRIMS (Americas Committee for Treatment and Research in MS) on May 30 in Atlanta. For the second time, ACTRIMS was held in conjunction with the Consortium of MS Centers annual meeting. Chaired by Jerry S. Wolinsky, MD (The University of Texas Health Sciences Center, Houston), the ACTRIMS meeting was jointly sponsored by the National MS Society and the University of Maryland School of Medicine, in collaboration with the MS Society of Canada.
The joint CMSC-ACTRIMS Donald Paty Memorial Lecture was delivered by Alberto Ascherio, MD, DrPH (Harvard School of Public Health, Boston), a world-renowned epidemiologist seeking to identify the causes and factors that influence susceptibility to MS. He spoke about the strong evidence for involvement of three risk factors in MS:
• Infection with the Epstein-Barr virus – EBV is a herpesvirus known to cause infectious mononucleosis and other disorders; most people have been exposed to this virus. Previous studies have suggested a possible link between EBV and MS, and investigators have found traces of EBV in postmortem brains examined from people with different forms of MS, but no direct evidence proves that EBV triggers MS. Because there are no effective ways yet to prevent or eliminate EBV infection, it is very difficult to prove its role in MS.
• Vitamin D – People have increased risk of MS if they live in areas receiving less sunshine. This and other research supports a link between deficiency in vitamin D, which is produced in the body through the action of sunlight, and increased risk of developing MS. Researchers recently found a direct interaction between vitamin D and a genetic variant that increases MS risk. “Because over 80% of young adults have suboptimal vitamin D levels, if vitamin D was truly protective, supplementation could prevent a large proportion of MS cases,” Dr. Ascherio pointed out. “This hypothesis should be tested in a large trial, either in the general population or among individuals at high risk.”
• Cigarette Smoking – Studies have suggested that smoking cigarettes may contribute to the risk of MS and MS progression. These data should provide a strong deterrent for children and siblings of people with MS, Dr. Ascherio said.
Dr. Ascherio concluded that the possibility of preventing MS cases by studying these risk factors further is great motivation to undertake the large studies that would be necessary. (Abstract #1)
In addition to this featured talk, 56 platform and poster presentations were made at the ACTRIMS meeting; 19 were funded by the National MS Society’s research programs. The complete program is soon to be posted to the ACTRIMS Web site at www.actrims.org. Here is a small sample of these studies:
• Dr. Emmanuelle Waubant (University of California, San Francisco) and colleagues from the network of Pediatric Centers of Excellence funded through the Society’s Promise: 2010 campaign reported on a study of how genes might interact with environmental factors in the development of MS. Her team studied 117 children with MS or CIS (a first neurologic episode that indicates increased risk for MS) and 17 healthy controls. Preliminary data indicate that those children that carry the immune system gene called HLA-DRB1*1501, which has been associated with MS, were more likely to have had a recent or previous EBV infection. Whether interactions exist between these factors remains to be determined in a larger prospective cohort. (Abstract #4)
• Previous research has suggested that resveratrol, a component of red wine, enhances the activity of a molecule (SIRT1) that might help to preserve nerve fibers. Dr. Narendra Singh (University of South Carolina School of Medicine, Columbia) and colleagues administered resveratrol and retinoic acid (a derivative of vitamin A that may help regulatory immune cells to develop) to mice with the MS-like disease EAE. Resveratrol treatment alone resulted in a decrease in EAE symptoms, and together with retinoic acid, the decrease was more significant. In-depth lab studies showed that the combination helped immune T cells to develop into regulatory rather than inflammatory cells. This combination warrants further study to determine its usefulness as a potential treatment for MS. (Abstract #9)
• Dr. Robyn M. Lucas (The Australian National University, Canberra) reported results from the “Ausimmune Study,” a project that is tracking sunlight exposure and its potential influence on developing MS, supported in part by the National MS Society (USA) and MS Research Australia. In an analysis of a subsample of 259 people with MS and 454 controls, those with the lowest levels of vitamin D had a 68% increased risk of experiencing a CIS, often the first sign of MS. The investigators are continuing further detailed analyses of this group. (Abstract #13)
• Dr. Jill Norris (University of Colorado Denver) provided insight from diabetes research on how genes and environmental factors interact in MS. Like MS, diabetes is associated with HLA genes. “The increasing incidence of type 1 diabetes over time is strong evidence of an increasing prevalence of an environmental factor,” she said. Dr. Norris also pointed out that this increase appears in cases with less influence from HLA genes, suggesting “an increasing environmental pressure over time.” The large-cohort studies necessary to investigate interactions of genes and environmental factors are underway, (e.g., The Environmental Determinants of Diabetes in the Young, or TEDDY study). Much can be learned from comparing these diseases, concluded Dr. Norris. (Abstract #14)
Report from the CMSC annual meeting
The CMSC focuses on the clinical care of people with MS. A poster session held on May 29 featured both ACTRIMS and CMSC papers, facilitating networking among the many professionals – basic and clinical researchers, neurologists, and allied health professionals – attending these meetings. Full program highlights are available at http://www.mscare.org/cmsc/index.php. Here is just a small sample of more than 100 reports on research to improve the care of people with MS:
• MS and related disorders in children and adolescents may affect academic performance. Exploring how is a key goal of the six Pediatric MS Centers of Excellence funded through the Society’s Promise: 2010 campaign. Laurie Smith, EdS, NCSP and Jayne Ness, MD, PhD (Center for Pediatric-Onset Demyelinating Disease at the Children's Hospital of Alabama) investigated how many children seen at the Centers required educational interventions. They evaluated 119 school-age patients; one third of this group required educational assistance. Among a subgroup of 51 children with MS, half required educational assistance of different degrees, including “504” plans (designed to remove barriers, such as providing preferred seating to a student with an attention disorder) and individualized education plans (IEPs, which add services, such as providing a child with speech therapy.) This study underscores the need for evaluating and addressing the educational needs of children with MS and similar diseases. (Abstract P16)
• Fatigue is among the most common symptoms reported by people with multiple sclerosis, and often the most troublesome. The National MS Society developed a video-based group therapy program entitled, “Fatigue: Take Control” to help people with MS make the behavioral changes necessary to manage fatigue. Cindy Hugos, MS, PT (Oregon Health and Science University) tested the effectiveness of this program in 30 people with MS with funding from the Society’s pilot research program. Her team evaluated participants using scales that measure fatigue, immediately after the six-week intervention, and then again three months later. Fatigue decreased significantly more in the group using the program, compared with controls who did not. The team is planning a multicenter trial to confirm these results. Individuals interested in the “Fatigue: Take Control” program should contact their local chapter of the National MS Society. (Abstract S28)
• Clearly one of the most exciting aspects of MS research today is the number of experimental therapies in the late stages of clinical studies. But the process of recruiting the tens of thousands of people with MS needed to participate in these trials is a difficult task. Investigators Cornelia Mihai, MD (State University of New York at Buffalo) and colleagues questioned 55 people, of whom 32% agreed to enroll in clinical studies. Of those who enrolled, 82% were female. The factor most associated with enrolling in a trial was insurance status: 29% of those who enrolled were uninsured or on Medicaid. The team is investigating these findings further to determine if better communication with physicians could affect referrals to clinical trials. (Abstract S31)