Posted on Multiple Sclerosis

Improving MS Treatment with a Simple Algorithm: Bridging the Gap for Hispanic and Black Patients

Disparities exist within this population, with Black children having lowest screening rate

Multiple sclerosis (MS) is a challenging disease that affects individuals differently. Unfortunately, studies show that Hispanic and Black people with MS often experience higher levels of disability compared to white people, yet they are less likely to receive prescriptions for newer, more effective treatments. However, a recent study from Kaiser Permanente Southern California, presented at the American Academy of Neurology’s 77th Annual Meeting, introduces a promising solution to reduce these disparities through a straightforward treatment algorithm.

The Study’s Objective

The study aimed to identify a method to increase the use of highly effective disease-modifying treatments among all racial and ethnic groups, thereby improving health outcomes for people with MS. Dr. Annette Langer-Gould, MD, PhD, the study’s author, expressed excitement about the potential of the algorithm to rapidly increase medication use across diverse populations, ultimately enhancing their health.

How the Algorithm Works

The treatment algorithm utilizes readily available clinical factors such as weakness and bladder dysfunction and considers social factors like out-of-pocket costs, transportation barriers, childcare, and work schedules. Importantly, it does not take race and ethnicity into account. By focusing on these factors, the algorithm helps match individuals to newer treatments that are highly effective in reducing MS relapses, such as natalizumab, rituximab, and ofatumumab.

Key Findings

The study involved 1,741 Hispanic people, 978 Black people, and 3,400 white people with MS who were receiving disease-modifying therapies. Researchers discovered notable differences in relapse rates among these groups before the implementation of the algorithm. Hispanic people had a higher annual relapse rate than white people, with 245 relapses compared to 156 relapses per 1,000 person-years. Black people also had higher relapse rates than white people during one year of the study.

Impact of the Algorithm

Over the 12-year study, the researchers observed an increased use of highly effective therapies across all three groups, particularly rituximab, which is more affordable and can be administered less frequently. For Hispanic people, there was an 89% increase in the use of highly effective therapies, an 87% increase for Black people, and an 83% increase for white people.

After adjusting for age and sex, the researchers reported a significant decline in the annual relapse rate for each group. Hispanic people experienced a 90% reduction in relapses, white people saw an 86% reduction, and Black people had an 82% reduction. By the end of the study, there was no longer a significant difference in the annual relapse rate among Hispanic, Black, and white people.

Encouraging Results

Dr. Langer-Gould highlighted the success of the program, stating, “It is encouraging that our program led to more effective treatments for people with MS resulting in a large reduction in relapse rates among Hispanic, Black, and white people.” The study demonstrated that using an algorithmic approach to increase the use of highly effective medications, particularly affordable ones like rituximab, can reduce racial and ethnic disparities in MS and greatly improve outcomes for all individuals with relapsing forms of MS.

Limitations and Future Directions

While the study showed promising results, it did not assess long-term disability or the benefits of starting highly effective treatments at diagnosis compared to delaying them until later in the disease course. Further research is needed to explore these aspects and continue improving MS treatment strategies.

Conclusion

The introduction of a simple treatment algorithm marks a significant step forward in reducing treatment disparities for Hispanic and Black people with MS. By leveraging clinical and social factors, this approach ensures that more individuals receive the best possible care, ultimately leading to better health outcomes for all.

Posted on A to Z of Medical Conditions, Gastrointestinal disorders

The Surprising Connection Between Crohn’s Disease and the Epstein-Barr Virus

Epstein Barr Virus
Epstein Barr Virus

Crohn’s disease, a debilitating inflammatory bowel disease, has long been known to have several contributing factors, including bacterial changes in the microbiome that foster an inflammatory environment. However, new research from Boston Children’s Hospital has uncovered a surprising link between Crohn’s disease and a virus—specifically, the Epstein-Barr virus (EBV), best known for causing infectious mononucleosis (mono).

The Chicken and Egg Problem

Researchers had previously observed increased levels of EBV in the intestines of patients with Crohn’s disease and had found associations between EBV and other autoimmune diseases, such as lupus, multiple sclerosis, and rheumatoid arthritis. However, it was unclear which came first: EBV or Crohn’s disease. According to Anubhab Nandy, PhD, a research fellow in the Division of Gastroenterology, Hepatology, and Nutrition at Boston Children’s Hospital, “It was a classic chicken and egg problem.”

Longitudinal Study Findings

A recent longitudinal study published in Gastroenterology has provided strong evidence that EBV infection predisposes individuals to develop Crohn’s disease. Nandy and colleagues analyzed data from a cohort of initially healthy military recruits, aged 20 to 24, who provided periodic serum samples throughout their service. Using VirScan, a high-throughput assay developed by study coauthor Stephen Elledge, PhD, at Harvard Medical School, the researchers were able to detect antibodies against a wide range of viruses, offering insights into viral exposures.

Compared with healthy controls, military personnel whose samples tested positive for anti-EBV antibodies were three times more likely to eventually develop Crohn’s disease. Intriguingly, evidence of EBV exposure preceded their Crohn’s diagnosis by five to seven years. “We went into this study not looking for EBV; we were looking for any virus that might elicit inflammatory bowel disease,” says Scott Snapper, MD, PhD, the study’s senior investigator and director of the Inflammatory Bowel Disease Center at Boston Children’s. “Then, when EBV was a hit, we looked very specifically at immune responses to EBV with more detailed tests.”

Additional Insights

To further validate their findings, the team examined a second cohort of over 5,000 children (median age: 11 years) who were first-degree relatives of individuals with Crohn’s disease. In this cohort, EBV was not a statistically significant predictor of a subsequent Crohn’s disease diagnosis. Snapper speculates that having first-degree relatives with Crohn’s might already put these children at increased risk due to shared genetic or environmental factors, which could obscure the association with EBV.

EBV and the Immune System

Another possibility is that EBV affects children’s immune systems differently, as children are less likely to develop infectious mono when exposed. “Responding to certain organisms early in life may boost the immune system in a way that prevents immune-mediated disease,” Snapper explains.

Nandy and Snapper now aim to uncover the molecular mechanisms by which EBV increases susceptibility to Crohn’s disease. One hypothesis is that the virus has certain genes or molecules that interact with human genes involved in autoimmune susceptibility. Another possibility is related to an anti-inflammatory protein produced by EBV, which is remarkably similar to mammalian IL-10. Individuals exposed to this protein might produce antibodies against it, preventing their own IL-10 from working and making them susceptible to inflammatory disease.

Conclusion

“Mechanistically, we need to understand exactly how EBV alters the immune system leading to Crohn’s disease,” Snapper emphasizes. “If you could figure out the mechanisms, you could come up with new therapies.” This groundbreaking research not only highlights a surprising link between EBV and Crohn’s disease but also opens new avenues for understanding and potentially treating autoimmune conditions.

Posted on Diabetes, Obesity, Weight Loss

Unveiling Metabolism’s Secrets: How to Trick Your Body into Burning More Calories

Many of us who have embarked on a weight loss journey know the frustration all too well: at some point, the pounds stop shedding. Despite our best efforts to cut calories, our bodies seem to betray us by slowing down metabolism, burning fewer calories than before. But why does this happen, and can we outsmart our metabolism? A new study from the University of Southern Denmark offers some promising insights.

The Metabolic Paradox

When we reduce our calorie intake, our body perceives a potential threat of starvation. In response, it adapts by conserving energy, ensuring essential functions can still be carried out. Unfortunately, this adaptation works against our weight loss goals, causing our metabolism to slow down and hold on to calories.

A Glimpse of Hope: New Research Findings

Researchers at the University of Southern Denmark have identified a potential way to maintain calorie burning even when consuming fewer calories. This discovery could be significant for patients using weight-loss or diabetes medicines like Wegovy and Ozempic, who often find their weight loss plateaus after shedding about 20-25% of their body weight.

According to Kim Ravnskjaer, a Principal Investigator and associate professor at the Department of Biochemistry and Molecular Biology, University of Southern Denmark, this stall is likely due to the body’s natural response. “It usually goes well at first, but as people lose some of the weight they aim to shed, their progress stalls because the body’s metabolism adapts,” he explains.

The Study and Its Implications

The study, published in the prestigious journal Cell Metabolism, explores the function of a gene called Plvap in certain mouse liver cells. The researchers discovered that the Plvap gene enables the body’s metabolic shift from burning sugar to fat when fasting. When Plvap is turned off, the liver does not recognize that the body is fasting and continues burning sugar.

“If we could develop a medication that helps maintain fat or sugar burning at its original high level alongside weight-loss treatments, people could continue losing weight beyond the usual plateau,” says Ravnskjaer.

Unexpected Discoveries

The researchers’ discovery was unexpected while investigating the role of the Plvap gene. They found that turning off this gene in mouse liver cells prevented the liver from shifting to fat burning during fasting, keeping the metabolism in sugar-burning mode. This shift resulted in the mice experiencing improved insulin sensitivity and lower blood sugar levels without negative effects.

Beyond the intriguing ability to “trick” the liver into thinking it is not fasting, the study made several other important observations:

  • The signal that triggers metabolic changes during fasting comes from the liver’s stellate cells rather than hepatocytes, suggesting a new mode of cell-to-cell communication.
  • Fat was redirected to the muscles instead of the liver, improving insulin sensitivity and lowering blood sugar levels.

Potential for Future Treatments

This discovery could have far-reaching implications—not just for obesity treatments, but also for improving our understanding of how fat and sugar are processed in metabolic diseases. In the long run, it may open new avenues for treating conditions like type 2 diabetes and steatotic liver disease.

“It’s well known that elevated blood sugar may lead to chronic complications for people with type 2 diabetes. Understanding Plvap could help diabetics better regulate their blood sugar in the future,” says Ravnskjaer.

Conclusion

The findings of this study underscore the complexity of our metabolism and the potential for groundbreaking treatments. While human trials and potential treatments are still a long way off, this research offers a promising glimpse into the future of weight loss and metabolic health. Understanding and controlling our metabolism may one day help us achieve our weight loss goals more effectively and improve overall health.

Posted on ADHD, Autism, Diet

The Link Between Western Diet During Pregnancy and ADHD in Children

Autism and Pregnancy
ADHD and Pregnancy

New research from Denmark sheds light on the impact of a mother’s diet during pregnancy on the risk of neurodevelopmental disorders such as ADHD and autism in children. The study reveals that a Western dietary pattern, high in fat and sugar and low in fresh ingredients, may increase this risk. This discovery emphasizes the importance of targeted dietary interventions during pregnancy to potentially reduce these risks.

The Study and Its Findings

A comprehensive clinical study conducted by the University of Copenhagen and the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) at the Danish Paediatric Asthma Centre has found a significant association between maternal diet during pregnancy and the development of ADHD and autism in children.

Dr. David Horner, MD, PhD, the lead author, explains, “The greater a woman’s adherence to a Western diet in pregnancy – high in fat, sugar, and refined products while low in fish, vegetables, and fruit—the greater the risk appears to be for her child developing ADHD or autism.” The study identified this Western dietary pattern using data-driven analysis, showing that moderate shifts towards a Western diet significantly increase the risk. Small dietary adjustments away from this pattern could reduce the risk of neurodevelopmental disorders.

Extensive Analysis

To reach these conclusions, researchers analyzed dietary patterns, blood samples, and ADHD diagnoses across four large independent cohorts in Denmark and the United States, encompassing over 60,000 mother-child pairs. Metabolomics was used to analyze blood samples, providing insights into the biological mechanisms linking diet to neurodevelopmental disorders and validating the results.

The link between Western dietary patterns and ADHD was observed across all four cohorts and validated using three different methods. This reinforces the study’s credibility, according to David Horner. The study draws on a robust dataset where nearly 600 children were clinically assessed for neurodevelopmental disorders at age 10. Despite accounting for a range of factors, including genetics, a clear association between a maternal Western diet and the risk of ADHD and autism remained.

Publication Details

The study, titled “A Western dietary pattern during pregnancy is associated with neurodevelopmental disorders in childhood and adolescence,” has been published in the prestigious journal Nature Metabolism. You can access the full study here.

Greatest Risk in Early Pregnancy

One of the study’s key strengths is the high quality of the biological samples, which included repeated metabolomic measurements throughout pregnancy and childhood. This allowed researchers to demonstrate that the association of diet on ADHD risk was strongest in early and mid-pregnancy.

Professor Morten Arendt Rasmussen from the University of Copenhagen explains, “When comparing across cohorts, we observed the strongest associations in the first and second trimesters, suggesting that brain development during this period is particularly sensitive to maternal nutritional influences.”

Metabolites and Dietary Influence

Researchers identified 43 specific metabolites in maternal blood linked to a Western diet that could help explain the connection between diet and neurodevelopmental disorders. Dr. David Horner notes, “We found that 15 of these 43 metabolites were particularly linked to the increased risk of ADHD. Many of these metabolites are derived from dietary intake and play key roles in regulating inflammation and oxidative stress—factors believed to be critical in early neurodevelopment.”

Implications for Dietary Guidelines

This study raises important questions about the adequacy of current dietary guidelines for pregnant women. In Denmark, dietary recommendations for pregnant women largely mirror those for the general population, emphasizing a balanced diet rich in vegetables, fruit, whole grains, and fish rather than red meat.

Dr. David Horner points out, “Our study highlights just how crucial dietary composition is for foetal development. While the Nordic diet is often considered healthy, our data show that many pregnant women follow dietary patterns that could be optimized to better support their child’s development. This study raises the question of whether existing dietary recommendations are sufficiently followed during pregnancy—and whether they have the desired impact on child health.”

He adds that the study not only demonstrates an association between diet and ADHD risk but also provides insights into specific nutrients and food groups that could play a vital role in foetal brain development. “By understanding how maternal diet influences foetal development, we can better identify the key nutrients and dietary adjustments needed to reduce the risk of neurodevelopmental disorders. This opens new possibilities for refining dietary recommendations and promoting healthier outcomes for future generations,” says David Horner.

Conclusion

The findings of this study underscore the critical importance of a balanced diet during pregnancy. As more research continues to unfold, it will be essential for healthcare professionals and expectant mothers to stay informed about the best dietary practices to support healthy foetal development.

Posted on Dementia, Exercise, Sleep disorders

Shocking Discovery: Regular Exercise Could Be Your Secret Weapon Against Dementia and Sleep Disorders!

Revolutionary Study Uncovers the Power of Physical Activity

Prepare to be amazed! Groundbreaking research reveals that getting off the couch and moving could be the key to avoiding dementia, sleep disorders, and a host of other diseases. If you’ve been looking for a reason to lace up those sneakers, this is it!

The Incredible Link Between Exercise and Brain Health

A jaw-dropping preliminary study released today, and set to be presented at the American Academy of Neurology’s 77th Annual Meeting, shows that moderate to vigorous physical activity can slash your risk of developing dementia, stroke, anxiety, depression, and sleep disorders. Researchers analyzed data from over 73,000 people and found that those who stayed active were significantly less likely to develop these serious conditions.

Sitting Could Be Your Silent Enemy

But wait, there’s more! The study also found that the more time you spend sitting, the higher your risk of developing these diseases. Yes, you read that right. Sitting could be silently sabotaging your health!

“This research highlights the role of physical activity and sedentary behavior as modifiable factors that may enhance brain health and reduce the incidence of these diseases,” says study author Dr. Jia-Yi Wu from Fudan University in Shanghai, China.

How Active Do You Need to Be?

According to the study, activities that burn at least three metabolic equivalents (METs) can make a huge difference. Whether it’s walking, cleaning, or cycling, staying active could lower your risk by 14% to 40%! People who didn’t develop any of the diseases had higher daily physical activity energy expenditure compared to those who did.

The Takeaway: Move More, Sit Less!

These findings are a game-changer. They suggest that by simply moving more and sitting less, you can take control of your health and potentially avoid some of the most debilitating diseases.

“Encouraging people to make these lifestyle changes could potentially lessen the burden of these diseases in the future,” Dr. Wu adds.

The Next Steps

The study was supported by grants from the Scientific and Technological Innovation 2030 – “Brain Science and Brain-inspired Artificial Intelligence” Major Project. While the majority of participants were white, and further research is needed to see if these findings apply to other groups, the message is clear: get moving!