Multiple Sclerosis

Posted on Multiple Sclerosis

New research identifies 3 distinct multiple sclerosis types for personalized treatment

Research team at the University of Münster

Heinz Wiendl, Luisa Klotz and Andreas Schulte-Mecklenbeck from the University of Münster performed high-dimensional flow cytometry to describe MS in unprecedented detail CREDIT Uni MS/Wibberg.

In a transformative study published in the Journal Science Translational Medicine, an international team of researchers, led by the University of Münster and the Department of Neurology at the University Hospital of Münster, Germany, in collaboration with the German Competence Network Multiple Sclerosis (KKNMS), has made a significant breakthrough in the understanding and potential treatment of Multiple Sclerosis (MS). Their findings reveal the identification of three distinct immunological endophenotypes of MS, defined by specific blood immune signatures associated with different disease trajectories. This discovery opens new avenues for personalized treatment strategies, addressing the long-standing challenge of individualized treatment selection in MS therapy.

MS is a complex and unpredictable disease, affecting more than 2.8 million people worldwide. It has long been recognized for its varied clinical manifestations and progression, making effective treatment a significant challenge. Traditional treatment approaches have often been a one-size-fits-all solution, not considering the underlying distinct immunopathology in each patient.

The study, which analyzed data from over 500 early MS patients across two independent cohorts, utilized high-dimensional flow cytometry and serum proteomics to map the immune system’s complexity in unprecedented detail. The researchers’ sophisticated analysis identified three distinct immunological endophenotypes, each associated with specific disease pathways and responses to treatment.

Prof. Heinz Wiendl, one of the study’s lead authors, stated, “These findings represent a pivotal shift towards precision medicine in MS. “By understanding the individual immune system variations among patients, we can move closer to personalized treatment plans that are more effective and have fewer side effects.

The endophenotypes, named based on their primary characteristics—’inflammatory’, ‘degenerative’, and a third yet to be fully characterized—show distinct responses to common MS treatments. Notably, patients within the ‘inflammatory’ endophenotype showed limited benefit from interferon-beta treatment, suggesting that alternative therapies might be more effective for this group.

“Our study not only challenges the current treatment paradigm but also helps to provide a practical tool for clinicians to predict disease progression and treatment response,” added Prof. Luisa Klotz, co-lead author. “This could significantly improve the quality of life for individuals living with MS.”

Further, the study highlighted the potential for using these endophenotypes as markers for disease prognosis and treatment efficacy. This insight could guide the development of new therapeutic agents targeted at specific pathways within these endophenotypes.

The neurology and neuroimmunology communities have welcomed the findings as a major step forward in the fight against MS. They underscore the importance of individualized care and the potential for significantly improving treatment outcomes by tailoring therapies to the patient’s specific immune signature.

Posted on Multiple Sclerosis

Do Covid-19 Vaccines Cause Multiple Sclerosis? (Neurologist Reviews Observational Evidence)

In this video, I review an excellent observational study of people with radiologically isolated syndrome (people who have multiple sclerosis lesions on MRI but no symptoms who are at risk of developing clinical multiple sclerosis). Do people with RIS who received covid-19 vaccines have an increased risk of MS?

Posted on Diet, Multiple Sclerosis

MS Diets (Wahls, Swank, OMS, Best Bet, Healing MS)

A description of 5 popular diets purported to treat multiple sclerosis: Wahls Protocol, Swank Diet, Overcoming Multiple Sclerosis (OMS), Best Bet Diet, Healing multiple sclerosis

Posted on Multiple Sclerosis, Obesity

Study shows obesity in childhood associated with a more than doubling of risk of developing multiple sclerosis in early adulthood

Obesity
Obesity

New research to be presented at this year’s European Congress on Obesity in Venice, Italy (12-15 May) shows that having obesity in childhood is associated with a more than doubling of the risk of later developing multiple sclerosis. The study is by Professor Claude Marcus and Associate Professor Emilia Hagman, Karolinska Institutet, Stockholm, Sweden, and colleagues.

Emerging evidence implies a link between high BMI in adolescence and an increased risk of Multiple Sclerosis (MS). Yet, most studies evaluating this association are cross-sectional, have retrospective design with self-reported data, have used solely genetic correlations, or use paediatric weight data before the obesity epidemic. Therefore, the authors aimed to prospectively evaluate the risk of developing MS in a large cohort of patients with paediatric obesity compared with the general population.

They included patients aged 2 – 19 years with obesity enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) between 1995 – 2020 and a matched comparison group from the general population. Matching criteria included sex, year of birth, and residential area. Exclusion criteria were secondary obesity (e.g. brain tumours such as craniopharyngioma), genetic syndromes (e.g. Prader Willi, Morbus Down), and MS diagnosis before 15 years of age (that is, already developing in childhood). MS was identified through Sweden’s National Patient Register. Individuals were followed from obesity treatment initiation, or 15 years of age if treatment was initiated earlier, until MS diagnosis, death, emigration, or August 2023, whichever came first. The authors use computer and statistical modelling to calculate any potential association. Due to previously reported genetic associations of MS, the authors also assessed levels of parental MS, which was present in 0.99% of the obesity cohort and 0.68% in the general population comparators.

The data included 21 661 patients (54% boys) from the paediatric obesity cohort with a median age of obesity treatment initiation (behaviour and lifestyle modification) of 11.4 years (years and 102 230 general population comparators. The median follow-up time was 5.6 years, corresponding to a median age of 20.8 years in the follow-up population (and 50% of the population were aged between 18 and 25 at the point analysis, with the highest age in the cohort 45 years).

During follow-up, 0.13% [n=28, 18 (64%) female, 10 (36%) male] developed MS in the obesity cohort, whereas the corresponding number in the general population was 0.06% [n=58, 38 (66%) female, 20 (34%) male]. The mean (SD) age of MS diagnosis was comparable between the groups: 23.4 years in the obesity cohort versus 22.8 years in the general population comparators. (see graph in full abstract). The small number who have developed MS so far means that the study was not sufficiently statistically powered to state the increased risk of females developing MS – however, the results follow the general increased risk to females (the estimated ratio of females: males affected by MS in the general population is 4:1).

The crude incidence rate of MS per 100,000 person-years was 19.3 in the obesity cohort and 8.3 in the general population cohort. Analyses adjusted for the presence of parental MS (heredity) (which was more prevalent in the obesity cohort, as above) revealed that the risk of developing MS was 2.3 times higher than in the paediatric obesity cohort, with both these findings statistically significant.

The authors say: “Despite the limited follow-up time, our findings highlight that obesity in childhood is associated with an increased susceptibility of early-onset MS more than two-fold. Given that paediatric obesity is prevalent, it is likely to serve as a critical etiological contributor to the escalating prevalence of MS. Paediatric obesity is associated with several autoimmune diseases, and the leading hypothesis is that the persistent low-grade inflammatory state, typically observed in obesity, is mediating the association. Understanding these pathways is crucial for developing targeted prevention and intervention strategies to normalise the risk for MS in children and adolescents with obesity.”

They add: “Several studies are showing that MS has increased over several decades, and obesity is believed to be one major driver for this increase. Thanks to our prospective study design, we can confirm this theory.”*

“Even though the risk for MS is more than double among children and adolescents with obesity, the absolute risk for MS remains lower than for many other comorbidities associated with obesity. Nevertheless, our study adds to the evidence that obesity in early life increases the risk for a plethora of diseases, including MS, and not only the well-known cardiometabolic conditions such as heart disease and diabetes.”