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Advances in Understanding Myelin Repair and Impacts of Lifestyle, Diet, and Aging Featured at ACTRIMS 2021 Virtual Meeting

March 9, 2021

The pandemic did not stop ACTRIMS Forum 2021 -- the popular research conference held at the end of February by the Americas Committee for Treatment and Research in MS. Like many conferences these days, it was held virtually.  ACTRIMS-2021-Virtual-LobbySmaller.jpg
The ACTRIMS Forum is a prime example of how global collaborations are helping to drive research progress by breaking down geographic barriers in the MS research community. The Forum provided opportunities for research consortiums to virtually meet, share results, and plot next steps to advance MS research on many different fronts. A sister society to ACTRIMS, the Latin American Committee for Treatment and Research in Multiple Sclerosis (LACTRIMS) also participated, sponsoring a session focused on MS and people in the Caribbean, and Central and South America. Although the prevalence of MS in these regions is relatively moderate, it appears to be increasing, and researchers are investigating what may be behind this surge.
 
The theme for ACTRIMS Forum 2021 was “The Spectrum of Multiple Sclerosis,” emphasizing how varied MS can be between people, and even within individuals at different stages of life. Presentations covered many aspects of MS. Here are a few highlights – follow the links provided below to read the scientific summaries.
 

Discoveries to Promote Myelin Repair

The Barancik Prize for Innovation in MS Research was presented to Dwight E. Bergles, PhD (Johns Hopkins University School of Medicine) for advances in understanding how nerve-insulating myelin is repaired. His talk outlined his work studying immature cells in the brain that can regenerate myelin-making cells after myelin is destroyed in MS. These cells, oligodendrocyte precursor cells (OPCs), hold the key to finding ways to promote myelin repair and restore function for people living with MS. (Read more about his work)
 
Exercise is good for myelin, too: Exercise has been shown to be beneficial for people with MS, including improving fitness and nervous system function, but its optimal dose and timing remain unclear. To look at the impacts of exercise on a molecular level, Dr. Brian M. Lozinski (University of Calgary) and team applied sophisticated tools to analyze the amalgam of proteins that were turned on or turned off in the spinal cord and blood when mice were allowed to run on a wheel immediately after they sustained myelin damage. This profile of proteins, called the proteome, was compared to that of mice that were sedentary after damage. There were distinct differences after exercise, including upticks of proteins related to removing toxins and facilitating repair, and reductions of proteins known to contribute to damage. This study provides new avenues for promoting myelin repair in MS. (Poster 151)
 

Diet and MS

Several presentations focused on studies that add to our knowledge of how a person’s diet may influence their disease activity and their gut bacteria (microbiome). Dr. Laura Piccio (Washington University in St. Louis) reviewed the potential benefits of intermittent fasting, shown in mice, and now being tested in a National MS Society-funded clinical trial in people with MS (View Abstract). Read more about diet and MS
 
Methionine: A team led by Dr. Catherine Larochelle (Université de Montréal) has been exploring a dietary amino acid, called methionine, which appears to fan inflammatory processes in the brain. The team has explored reducing methionine in the diet of mice with MS-like disease, and found it to be beneficial against immune activity and symptoms, similar to diets that restrict calorie intake, but possibly easier to tolerate. She explained that methionine is found at high levels in the typical Western diet, and lower in vegan and other less meat-based diets. Additional research will be needed to determine the potential benefits of a low-methionine diet in people with MS. (View Abstract)
 
Vitamin D levels impact MS activity? Based on records of individuals with MS who are followed at their clinic, Dr. Ahmad Mahadeen and team (Cleveland Clinic’s Mellen Center for Multiple Sclerosis) reported differences in people whose vitamin D levels were sufficient vs. those with vitamin D deficiency. Those with sufficient vitamin D experienced fewer relapses, and those who were deficient had slower walking scores. The researchers say that this study adds to a body of evidence suggesting that vitamin D supplements may improve outcomes for people with MS who have a vitamin D deficiency.  (Poster 174)
 

Biomarkers to Track MS and Improve Care

Many presentations focused on testing the ability of various biomarkers – such as something that can be detected in the blood, spinal fluid, or through imaging the brain, spinal cord, or back of the eye – that would help detect MS activity below the surface, help predict disease severity, and detect response to specific therapies.
 
NfL: One blood (and spinal fluid) marker on its way to becoming useful in the clinic is called neurofilament light chain (NfL), a fragment that is part of the debris that enters the spinal fluid and blood when axons are damaged by MS and other causes. Dr. Elias Sotirchos, a National MS Society Career Transition Postdoctoral Fellow, presented on behalf of researchers involved in MS-PATHS (Multiple Sclerosis Partners Advancing Technology and Health Solutions), who have examined NfL blood levels in nearly 7,000 people with MS. They found that NfL blood levels were elevated in 17% of the participants, and higher levels were linked to more disability, more brain atrophy, and in those with MS who smoked or had diabetes. Additional work is underway to understand how to use NfL, possibly in combination with other biomarkers, to better track and treat MS. (View Abstract) Read more about NfL
 

Health Disparities and Comorbidities

There’s growing evidence that having MS and other conditions, or “comorbidities,” can make MS worse and reduce quality of life, making it important to tease out who is more likely to experience them and to raise awareness of the need to address these conditions.
 
Differences in MS outcomes: One study by Alena Sorensen (Case Western Reserve University) and team looked at the health records of 1,178 people with MS followed by the Cleveland Clinic’s Mellen Center for MS Treatment and Research, examining health and socio-demographic factors for links to high blood pressure, high cholesterol, and asthma. They found that being older, or having higher body mass index (BMI), or lower income, or being African American increased odds that an individual with MS had high blood pressure. They also found that being male, or older, or higher BMI, or being white increased odds that an individual with MS had high cholesterol. The study’s findings suggest that comorbidities, which may be medically manageable, should be a central part of comprehensive care for people with MS. (Poster P085)
 
Health disparities: A team represented by Dr. Eleni Vasileiou (Johns Hopkins University School of Medicine) investigated links between MS progression and socioeconomic status by comparing imaging findings of nerves at the back of the eye (retina) in people from different neighborhoods. They found that people with lower household incomes had higher rates of retinal thinning than those with higher income levels. This wasn’t necessarily accounted for by lack of access to care, as they also were moved to stronger MS medications faster due to progression in the severity of symptoms. People from lower income areas also had higher risk of developing comorbidities. The researchers noted that preventing and managing comorbidities may help reduce the risk of worse MS outcomes and progression in people with lower household incomes. (View Abstract)
 
Veterans with PTSD and MS: Psychiatric conditions are more common in people with MS than in the general population, but little information is available on the prevalence of posttraumatic stress disorder (PTSD) in people with MS. This disorder sometimes develops after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. Dr. Mark Leekoff (VA Medical Center, Baltimore) and colleagues reviewed the charts of 96 veterans who had MS and PTSD, and 95 veterans who had MS alone. Relapse rate, disease activity on MRI scans, and disability progression all were increased in people with PTSD. The authors recommend close mental health follow-up in this population to minimize the effects of PTSD. (Poster P086)  Learn more about treating PTSD 
 

Aging and MS

There’s emerging evidence of some unique impacts of aging on people with MS. Inflammation is one way the immune system fights infection, but it’s also a culprit in MS. Researchers are investigating how inflammation increases with age, and searching for ways to neutralize its impacts on people with MS.
 
Inflammaging: Giving the Kenneth P. Johnson Memorial Lecture, Dr. Ben Segal (The Ohio State University) described changes that occur to the immune system as everyone ages, such as “inflammaging,” in which people have elevated levels of inflammatory proteins circulating in their bodies and brains. Meanwhile, some protective processes lose steam during aging, such as the beneficial effects of well-balanced gut bacteria. These factors may contribute to MS progression. “Interventions that slow or reverse inflammaging and other age-related changes to the immune system should be explored as a novel strategy to ameliorate progressive forms of MS,” he concluded. (View Abstract)
 
Progression and aging:  Dr. Jennifer Graves (University of California, San Diego) also noted that progressive MS is an aging-related disease, citing the fact that progressive MS virtually never appears in children and adolescents with MS. But chronological age is not the only important number, she notes. “Biological age” describes the physiological condition of the body, and does not depend on your birthdate. Studies have shown, for example, that in a large group of people in their 30s, biological age ranged from 25 to 60. “This may have an impact on progression, and many factors can contribute to biological age,” she said, citing lifestyle factors such as smoking and exercise. “Exercise currently is the best fountain of youth that we have!”
 
Enhancing myelin-making cells: Dr. Tal Iram (Stanford University) noted that aging affects the health of the cells that make nerve-insulating myelin (oligodendrocytes). Exciting studies in mice have shown that these cells can be rejuvenated with interventions including calorie restriction and agents such as the diabetes treatment metformin and the antihistamine clemastine – both of which are in clinical testing. Dr. Iram’s team found that introducing spinal fluid from young mice into older mice rejuvenated their myelin-making cells in a specific part of the brain (hippocampus), and even improved memory. The team is now developing a model to study one molecule that appears to be essential to this process, for clues to developing a treatment strategy for restoring function in people with MS. (View Abstract)

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. Symptoms range from numbness and tingling to blindness and paralysis, and there is currently no cure for MS. 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. An estimated 1 million people live with MS in the United States. Most people with MS are diagnosed between the ages of 20 and 50, and it affects women three times more than men.

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