Scientists at the University of Nottingham have published new research in JAMA Neurology looking at the effect of helminthic (worm) therapy in people with relapsing MS.
This research, which we funded, was led by Professor Cris Constantinescu. It aimed to discover whether helminthic therapy can impact the number and size of MS lesions, and the number of regulatory T cells (which keep the immune system under control).
Why are scientists studying hookworms?
We know that in MS, there’s an imbalance between inflammatory factors (which cause damage) and immunoregulatory factors (which protect against damage). The damage that results from this imbalance that causes the symptoms of MS.
It might sound a bit gross, but in recent years helminthic therapies have been explored for their potential to treat inflammatory conditions. The ‘hygiene hypothesis’ theory suggests that as improved hygiene conditions have led to the eradication of gut parasites, inflammatory conditions (such as asthma and inflammatory bowel disease) have increased in frequency. And preliminary research has shown that hookworms can dampen down the inflammation that causes MS.
What effect did the hookworms have?
In this Phase 2 trial, researchers’ recruited 73 people with relapsing MS. Half of these participants were given a low dose of Necator americanus (N americanus) via a plaster on their arm. The rest of the participants were given a placebo plaster. N americanus is a type of hookworm that lives in the small intestine of humans and in most cases isn’t harmful.
Researchers found that treatment with hookworms didn’t have a significant effect on the number and size of MS lesions after 9 months, compared to the group who’d been given a placebo. However, they did report that participants who’d been infected with hookworms showed an increase in the number of regulatory T cells present in the bloodstream.
What does this mean for people with MS?
Dr Emma Gray, Our Assistant Director of Research, said: “There are over 130,000 people living with MS in the UK and – though we now have a dozen treatments for people with relapsing MS – we’re always keen to fund novel and exciting research.
“These results indicate that, while helminthic therapy appears to be a safe and well-tolerated treatment, the benefits are modest in comparison to existing treatments for relapsing MS. But although it’s unlikely that worm therapy will replace other options, this study has given us a deeper insight into the effects of helminthic therapy on the immune system.”
Brain organoid study highlights potential role of genetic and environmental interaction in autism
The Autism Science Foundation (ASF), a nonprofit organization dedicated to supporting and funding innovative autism research, today calls attention to the publication of a new Lancet Commission report, which formally recognizes the need for and endorses the use of the term “profound autism” for the first time in a peer-reviewed medical journal.
The Commission reports that the term “profound autism” is critical to distinguish individuals who have high dependency needs. “Profound autism” describes autistic people who are unable to advocate for themselves and are likely to need 24-hour support throughout their lives. The concept is introduced within its new special issue, The Lancet Commission for the Future of Care and Clinical Research of Autism. The Commission was formed in 2018 by international experts who concluded that a new, comprehensive model of autism care and treatment that prioritizes personalized, stepped care approaches is urgently needed.
“As an autism advocate and mother of a child with profound autism, I am thrilled to see The Lancet formally recognize the term profound autism, which provides critical specificity within the extremely broad autism spectrum,” said ASF Co-Founder and President Alison Singer, a member of the Lancet Commission who also just shared an op-ed published in STAT News explaining why normalizing the term ‘profound autism’ is so important.
“The term ‘autism’ is now so broadly applied that it fails to indicate the types of challenges or needs a person faces,” Singer continued. “The goal of adding this new descriptor is to enable countries and communities to plan for the appropriate treatment and service needs of this long-overlooked population, as their needs are dramatically different from those with the milder forms of autism we typically see on television and in the news media. Also, people with profound autism are also often excluded from research on Autism Spectrum Disorder (ASD), resulting in disparity in who benefits from research.
The Lancet Commission proposes that the designation of ‘profound autism’ be adopted for people with autism who are minimally verbal or non‐verbal, are not able to advocate for themselves, and require 24‐hour access to an adult who can care for them. The authors propose that the designation be used to encourage both the clinical and research global communities to prioritize the needs of this vulnerable and underserved population. The authors validated the designation of profound autism against three databases, and found that it would apply to anywhere between 18% to 48% of people with autism.
Dr. Catherine Lord, a professor at UCLA’s Center for Autism Research & Treatment, Lancet Commission co-Chair and a member of ASF’s Scientific Advisory Board, first publicly introduced the term “profound autism” at ASF’s 2020 Day of Learning, explaining that the goal was to create “useful categories that might bring attention to the different needs of different people.”
“This is not an ideological subtype. It just reflects the degree of services,” said Lord. “We hope that this will move us forward to different ways of looking at different aspects of autism.”
New research from Purina and Mayo Clinic brings a pet-centered treatment option to the forefront for patients with fibromyalgia, a chronic centralized pain sensitivity disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. A newly published study by Mayo Clinic and Purina researched the impact of animal-assisted activity sessions in patients with fibromyalgia and found benefits of the interaction to patients and the therapy dogs working to help them.
Alta, a Mayo Clinic Caring Canines therapy dog, prepares for a saliva swab to measure her cortisol and oxytocin levels as key indicators of her emotional state. The methodology was used by Purina and Mayo Clinic scientists during the Better Together study, which researched the impact of animal-assisted activity on patients with fibromyalgia and the therapy dogs working to help them.
The National Fibromyalgia Association estimates 10 million Americans and between 3 and 6 percent of the world population suffers from fibromyalgia. Purina and Mayo Clinic designed the Better Together study to investigate the direct effects of animal-assisted activity in patients with fibromyalgia. At the same time, the study measured the emotional state of the therapy dogs during the treatment session to better understand the impacts on these specially trained canine companions. For both patients and the therapy dogs, researchers used multiple non-invasive physiological biomarkers, including salivary oxytocin and cortisol concentrations, tympanic membrane temperatures and various cardiac parameters.
“The Better Together study showed therapy animals could be an evidence-based treatment option, and healthcare professionals should strongly consider utilizing animal-assisted activity in the care of their patients with fibromyalgia,” said Arya Mohabbat, M.D., assistant professor of medicine in the Division of General Internal Medicine at Mayo Clinic, and lead Mayo Clinic researcher on the project.
While fibromyalgia has some effective treatment strategies, most individuals live with chronic symptoms and look for non-conventional treatments in search of relief. For 221 patients, each enrolled in the Mayo Clinic Fibromyalgia Treatment Program, an outpatient program staffed by physicians from the Mayo Clinic Division of General Internal Medicine, the Better Together study provided reprieve for those in the treatment group and hope for those in the control group.
The Better Together study found the patients in the treatment group were in a more positive emotional-physiologic state as a result of the animal-assisted activity session compared to the control group. People who interacted with therapy dogs saw their oxytocin levels increase significantly, while their heart rates decreased. They reported less negative emotions and more positive emotions. The results suggest a 20-minute therapy dog visit can significantly and positively impact the physical and mental health of patients with fibromyalgia.
Therapy Dogs Calmer
Despite the widespread use of therapy dogs in clinical settings, there’s a lack of understanding of the impact of animal-assisted activity sessions on the emotional state of the dogs. In addition to interacting with patients of all ages in varying physical and emotional states as part of their work, therapy dogs are exposed to novel environments that may include new sights, sounds and textures that require ongoing focus and adaptation.
The study found the dogs – all members of the Mayo Clinic Caring Canines program, which varied in breed, age and size – did not show signs of stress during the animal-assisted activity session and may have been in a more relaxed state at the end of the session. For most parameters, there were no changes in the dogs, signaling contentment; however, for those that did change, they pointed to a more positive emotional and physiological state, such as a significantly lower heart rate, at the end of the session. This signals the dogs were not only good at their jobs, but in many cases, enjoyed the work they were doing with patients.
“We need to expand our understanding of how animal-assisted activity impacts therapy dog’s wellbeing, and this sizeable study with 19 dogs of various breeds provided solid evidence that animal-assisted activity done in the right condition does not have negative impacts on well-trained therapy dogs,” said François Martin, M.A., Ph.D., Applied behavior and welfare research section leader at Purina, and lead Purina scientist on the project. “This only encourages us to do more research to continue to demonstrate the power of the human-animal bond on people while ensuring assistance animals also experience positive wellness as a result of their work.”
The Better Together study is the first one to utilize physiologic parameters to provide scientific evidence that animal-assisted activities is a valid option for the management of fibromyalgia. The authors of the study believe that animal-assisted activity should become a standard treatment strategy to help patients manage this chronic condition.
Today, the Centers for Disease Control released the Autism and Developmental Disabilities, Monitoring (ADDM) Network report. This report estimates how many autistic 8 year olds there are in certain areas of the country. The report shows that better recognition of autism and continued efforts to reduce racial and gender disparities have caused rates of diagnosis to continue to rise. There is still more work to do to address the remaining disparities in diagnosis, and more work to do to ensure autistic people in all communities receive the support we need.
The report released today uses data gathered in 2018. This research reviewed records of 8-year-old children in 11 communities across the United States. The report released today shows that the rate of autism diagnosis has increased to 1 in 44children, or 2.3percent of the children surveyed. This is an increase from earlier reports, which estimated that 1 in 54 children were diagnosed with autism.
ASAN is not surprised to see the diagnosis rate increase. We believe this increase reflects better recognition and diagnosis of autism across the U.S. We know that many disparities in diagnosis have become smaller, and we know that children were evaluated earlier in some places and later in others. We expect that diagnosis rates will continue to rise as we work to address diagnostic disparities and improve access to diagnosis and support.
Unfortunately, the report shows that while some improvements have been made, diagnostic disparities continue to be a major issue for autistic people of marginalized races, ethnicities, and genders. The report showed that Hispanic children were less likely to be diagnosed than white children. Black children were more likely to also be diagnosed with an intellectual disability compared to white or Hispanic children, reflecting a longstanding history of racism in how Black children with disabilities are labelled. Children assigned female at birth were less likely to be diagnosed than children assigned male at birth. Researchers, clinicians, and policymakers must work to end these disparities and remove bias from the diagnostic process.
The results of this report also make clear the need for improved study of rates of autism diagnosis in adults. While improvements in early diagnosis are important, substantial disparities remain. Autistics of color and those who are assigned female at birth are less likely to receive early diagnoses, meaning that a survey of 8-year-olds gives an incomplete picture of the autistic community. Surveying adults can provide a clearer picture of how frequently early diagnoses are missed, demonstrate the need for adult services, and help to correct misconceptions by demonstrating that autism is just as common among adults as children.
Autism is not a bad thing, and autistic people, of all races, genders, and ages have always been here. The ADDM report represents an encouraging sign that our diagnosis practices are catching up to that reality. This is good news for the many autistic people who have been overlooked in the past, and can now get the recognition and support they need.
The study focused on predicting the response to methotrexate, one of the most common rheumatoid arthritis medications. Applying patient data that included genomic, clinical and demographic information, researchers used AI to determine an initial response to methotrexate in patients with early-stage rheumatoid arthritis. Data used in the study came from a collaboration between Mayo Clinic and the Pharmacogenetics of Methotrexate in Rheumatoid Arthritis (PAMERA) consortium, that led to early genome-wide association studies.
This work evolved from the union of AI and pharmacogenomics co-led by Liewei Wang; M.D., Ph.D., Arjun Athreya, Ph.D. and Richard Weinshilboum, M.D. “This approach began by developing tools to predict drug treatment outcomes in major depressive disorder, but we are delighted to see that it can potentially be applied widely, in this case to the drug therapy of rheumatoid arthritis,” says pharmacogenomics leaders Drs. Wang and Weinshilboum.
“In my everyday practice, patients frequently ask, ‘What medication will be most effective for me’ or ‘What is the chance this medication will help?’ This is a study that seeks to address these questions,” says Elena Myasoedova, M.D., Ph.D., a Mayo Clinic rheumatologist and lead author. By predicting a response to methotrexate, researchers identified which patients are most likely to benefit from this medication in the first three months of treatment.
More research is needed to understand how these findings can be used in practice. The study, which is part of a series looking at the roles of AI and pharmacogenomics in treating rheumatoid arthritis, was performed in collaboration with Mayo Clinic’s Center for Individualized Medicine.
“Predicting a response to rheumatoid arthritis medication can be challenging, but this approach is very promising and is an exciting development in treating the disease,” Dr. Myasoedova says.
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