Drugs called interferon betas are common treatments for multiple sclerosis (MS), reducing relapses and slowing motor function decline. Interferon beta, a protein known to contain a zinc-binding pocket, is thought to reduce proinflammatory molecules and even increase production of anti-inflammatory species in MS patients. But researchers now report in ACS Chemical Neuroscience that the molecule reduces the binding of three components — zinc, C-peptide and albumin — to red blood cells.

According to the National Multiple Sclerosis Society, almost a million people in the U.S. and about 2.8 million people worldwide live with MS. This autoimmune disease damages the myelin sheath, an insulating layer of proteins and fats wrapped around nerves, leads to impaired neuronal signalling. People with MS typically have pain, numbness and mobility issues that worsen over time.

Cells that make myelin are sensitive to adenosine triphosphate (ATP) and nitric oxide (NO), molecules that are in high amounts in the blood and brain lesions of MS patients. Red blood cells can release NO directly, but they can also stimulate NO production in the lining of blood vessels by releasing ATP. NO can then go on to damage nerves in MS patients. Zinc, C-peptide — secreted by the pancreas and insulin — and albumin are key players in the latter process, and they can latch onto red blood cells. Because interferon beta can bind zinc, it seemed possible that the drug helped patients by sopping up this mineral, so Dana Spence and colleagues wanted to investigate further.

In lab tests, the researchers found that red blood cells from MS patients bound more zinc, C-peptide and albumin than cells from control subjects. Treatment with interferon beta reduced this interaction in MS samples to control levels. Albumin boosted zinc and C-peptide binding to MS red blood cells, and this effect went away with interferon beta treatment. From these data, the researchers conclude that it’s likely the drug is inhibiting albumin binding, keeping it from delivering its cargo of C-peptide and zinc to red blood cells so that NO can be made.

Quality of life is a measure of a person’s level of comfort, health and happiness. For people with multiple sclerosis (MS), a new study has found there are specific factors that may affect a person’s physical and mental quality of life. The study is published in the August 10, 2022, online issue of Neurology^®, the medical journal of the American Academy of Neurology.

Multiple sclerosis is a disease of the central nervous system which is made up of the brain, spinal cord and optic nerves. It is chronic and can be unpredictable and disabling. Symptoms may include fatigue, numbness and tingling, loss of balance, weakness and problems with vision. While there is currently no cure for MS, there are medications to modify the course of the disease and delay its progress as well as treat the symptoms.

“People with multiple sclerosis report a lower quality of life when compared to people without the disease, and even those with other chronic conditions,” said study author Julia O’Mahony, PhD, of the Health Sciences Centre Winnipeg in Winnipeg, Canada. “There are several factors that may play a role. Our research sought to identify such factors so they can be addressed early in the course of the disease.”  

The study involved 4,888 people participating in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, 81% women, who had an average age of 42 years when diagnosed with MS. All had been diagnosed within three years of the start of the study.

Each person was assessed at least three times for health-related quality of life and filled out an average of 12 quality-of-life questionnaires over up to 27 years.

For physical quality of life, researchers divided participants into five groups. The first group, 26% of participants, had consistently low and stable quality of life. The second group, 29%, had moderately low and stable quality of life. The third group, 13%, had moderate to low quality of life within the first years after diagnosis followed by normal quality of life thereafter. The fourth group, 17%, had early decline and then an increase to moderate to normal quality of life. The fifth group, 14%, had normal quality of life for 20 years and then a decline.

Researchers found people who were older when diagnosed with MS and those with worse physical impairments or  worse fatigue had an increased risk of being in  the group with the worst physical quality of life. The people in the lowest group had an average age of 46 years at diagnosis, compared to an average age of 38 years for the group with the highest quality of life. The people in the worst group had moderate disability, such as problems with their gait and mobility or were starting to use a cane for walking, while those in the best group had normal functioning or mild disability.

For mental quality of life, researchers divided participants into four groups. The first group, 19% of participants, had chronically low quality of life. The second group, 33%, had moderately low and stable quality of life. The third group, 22%, reported moderately low quality of life with the first 10 years after diagnosis followed by normal mental health. The fourth group, 26%, reported chronically normal quality of life.

Researchers found people who had an annual income of $50,000 or less or no post-secondary education had an increased risk of being in the group with the worst mental quality of life. A total of 62% of the people in the lowest group had incomes of $50,000 or less, compared to 44% of those in the highest group. And 38% of those in the lowest group had no post-secondary education, compared to 22% of those in the highest group.  

The subtype of a person’s disease, that is relapsing remitting or primary progressive at onset, did not affect their membership in any of the physical or mental quality of life groups.

“There are early risk factors for those who will end up in the groups with the worst health-related quality of life that are easily identifiable by doctors and other health professionals,” said O’Mahony. “For example, socioeconomic factors such as less education and income can be easily identified. This could provide an opportunity for early interventions that could help people with MS live better lives.”

A limitation of the study was that participants were volunteers, so the results may not be the same for the general population.

May offer easy, safe approach to persistent symptom, if confirmed in larger studies, suggest researchers

Cocoa may help curb the fatigue that is typically associated with multiple sclerosis (MS), suggest the results of a small feasibility trial, published online in the Journal of Neurology Neurosurgery & Psychiatry.

Cocoa, like dark chocolate, is rich in flavonoids––substances found abundantly in fruit and vegetables and associated with anti-inflammatory properties.

If the findings are confirmed in larger studies, it may offer a simple dietary approach to a persistent and hard to treat symptom, which affects nine out of 10 people with MS, suggest the researchers.

The causes of mental and physical fatigue experienced by people with MS are complex, and likely to include neural, inflammatory, metabolic, and psychological factors. None of the currently available approaches offers long term relief, say the researchers.

Previous research suggests that dark chocolate, containing between 70 and 85 per cent cocoa solids, is associated with an improvement in subjectively assessed fatigue in people with chronic fatigue syndrome (ME).

This prompted the researchers to see if it might also be worth exploring its potential in helping to tackle the fatigue associated with MS.

They randomly assigned 40 adults recently diagnosed with the relapsing remitting form of MS and fatigue to drink a cup of either high flavonoid cocoa powder mixed with heated rice milk (19) or a low flavonoid version (21) every day for six weeks.

Participants were instructed to wait 30 minutes before taking any prescribed medication or eating or drinking anything else, but otherwise to stick to their usual diet.

Fatigue and fatigability–the speed with which mental and physical fatigue set in–were formally assessed before the start, at the mid-point, and at the end of the trial.

And participants also subjectively rated their fatigue on a scale of 1 to 10, at 10.00, 15.00, and 20.00 hours each day, and monitored their activity with a pedometer.

After six weeks there was a small improvement in fatigue in 11 of those drinking high flavonoid cocoa compared with eight of those drinking the low flavonoid version.

And there was a moderate effect on fatigability, with those drinking high flavonoid cocoa able to cover more distance during the 6 minute walk test.

Those drinking the high flavonoid version showed a 45 per cent improvement in subjectively assessed fatigue and an 80 per cent improvement in walking speed.

Although not objectively measured, pain symptoms also improved more in the high flavonoid group.

“Our study establishes that the use of dietary interventions is feasible and may offer possible long-term benefits to support fatigue management, by improving fatigue and walking endurance,” write the researchers.

Given the anti-inflammatory properties of flavonoids, they could be used alongside other approaches, such as exercise, drug treatment, and physiotherapy, to treat fatigue, they suggest.

“The use of dietary approaches to reduce fatigue and associated factors in people with MS may be an easy, safe, and cost-effective way to have an impact on quality of life and independence, allowing people to feel more in control of their condition.

“A full evaluation, including wider geography, longer follow up and cost effectiveness is now indicated,” they conclude.

In a linked editorial, Dr Paolo Ragonese, University of Palermo, points out that the treatment and management of MS related fatigue “still represents a challenge…because its mechanisms are multifactorial.”

And diets rich in flavonoids are linked to longer life and a lower risk of cardiovascular disease as well as positive changes to the volume and diversity of gut bacteria (the microbiome), he points out.

“Although [this] study is an exploratory trial, it adds further interesting suggestions to the possible positive effects of flavonoid intake on the management of fatigue in patients with MS,” he concludes.

Multiple Sclerosis (MS) can cause various symptoms, but every person with MS is affected differently. One of the most common symptoms of MS is fatigue, which is very different to the tiredness people without MS may have. In this video, you can get some ideas about how you can try to reduce your fatigue. Have you got any good tips?

The National Multiple Sclerosis Society has committed $19 million to launch 40 new multi-year research awards to drive progress toward stopping MS, restoring function, and ending MS forever – the goals of the widely endorsed Pathways to Cures for MS to better align the global MS research community around the most promising areas to cure MS for every single person as fast as possible.

The new awards include research training fellowships, early career awards, research grants and special initiatives. Just a few of the new cutting-edge projects include: 

• Oregon Health & Science University researchers will investigate signals that cause nerve cells to die when nerve-insulating myelin is lost in MS, and how to block those signals;
• Case Western Reserve researchers will seek new targets for treatments to repair the damage that occurs to the nervous system in people with MS;
• A team at Johns Hopkins will test a potential treatment for MS-related fatigue;
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• and University of California, San Francisco researchers will determine the targets recognized by immune cells in the spinal fluid of people with MS for clues to what triggers this nervous system disease.

“The comprehensive nature of these new research awards is exciting and critical,” noted Cyndi Zagieboylo, President and CEO of the National MS Society. “Investments in research accelerate progress on our Pathways to Cures roadmap journey to stop MS disease activity, reverse symptoms and end MS forever. Through leadership, influence and funding, we will cure MS while empowering people affected by MS to live their best lives.”

This latest financial commitment is part of a projected total investment of nearly $30 million in 2022 to support more than 250 new and ongoing MS research studies around the world, including support and leadership for the International Progressive MS Alliance – a global effort to accelerate the development of effective treatments for people with progressive MS to improve quality of life worldwide.

Learn more about Pathways to Cures for MS