An international team of researchers led by Karolinska Institutet in Sweden have discovered that a cell type in the central nervous system known as oligodendrocytes might have a different role in the development of multiple sclerosis (MS) than previously thought. The findings, published in the journal Neuron, could open for new therapeutical approaches to MS.
MS is driven by immune cells attacking oligodendrocytes and the myelin they produce, which is an insulating layer ensheathing nerve cells. These attacks disrupt information flow in the brain and spinal cord and causes nerve damage that triggers symptoms associated with MS such as tremors and loss of gait.
Understanding which mechanisms influence the risk of MS is central to finding effective therapies. Previous genetic studies have found regions in the human genome that contain mutations (single nucleotide polymorphisms) associated with increased risk of MS.Many of these regions are localized near genes that are active in immune cells.
Open configuration of the genome
In this study, the researchers show in mice and human brain samples that oligodendrocytes and their progenitors have an open configuration of the genome near immune genes and at MS-risk associated regions. This suggests that the MS risk mutations may have a role in the activation of nearby genes in oligodendrocytes and their progenitors, meaning they could play a more important part than previously thought in the development of MS.
“Our findings suggest that the risk for multiple sclerosis might manifest by misfunction not only of immune cells, but also of oligodendrocytes and their precursor cells,” says Gonçalo Castelo-Branco, professor at the Department of Medical Biochemistry and Biophysics, Karolinska Institutet, who conducted the study with co-first authors Mandy Meijer, a PhD student, and Eneritz Agirre, a researcher. “These findings indicate that these cells can also be targeted for therapeutical approaches for MS, to prevent misfunction that might be caused by these mutations.”
A new grant will allow MUSC doctors and researchers to test several ideas for improving care and outreach to people with lupus or at risk of developing the autoimmune disease.
“I know our whole group is very excited,” said rheumatologist Gary Gilkeson, M.D., who serves as director of the MUSC Improving Minority Health in Rheumatic Diseases (IMHRD) Core Center for Clinical Research (CCCR). “When it came through we were thrilled.”
The two-year, $550,501 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases includes three areas of concentration:
The beginnings of an educational outreach effort on college campuses
Piloting the use of a patient navigator for lupus patients at MUSC Health
A partnership with the University of Alabama at Birmingham to increase understanding of minority health and health disparities among health care providers at both universities.
Lupus typically strikes women between the ages of 15 and 45 and is more common in black, Asian and Native American women. The body’s immune system turns on itself and begins attacking healthy cells, causing joint pain, fever, rashes, fatigue, swelling and sun sensitivity. Managing the disease is critical, because unchecked it can lead to serious complications like kidney failure.
But awareness of the disease, especially in the communities it most affects, lags.
“Some of the things I’ve heard from some of these young people is that this is an old white person’s disease or that it is a disease invented by scientists and hospitals to use them as guinea pigs,” said Edith Williams, Ph.D., who is heading up the educational outreach component.
She’s focusing her efforts on historically black colleges and universities (HBCUs) to try to reach the population at highest risk. Not only are black women more at risk for developing lupus, but they’re also more likely to be sicker, to be admitted to the hospital more often and to die from complications at higher rates, Williams said.
With this grant, she’ll work with focus groups at Claflin University, Voorhees College and South Carolina State University – as well as nonstudents ages 18 to 25 – to understand what young people already know about lupus and myths that are circulating about the disease. She will also determine the most effective way to reach out to them, whether that is flyers on a campus bulletin board, text blasts, postcards in the mail, digital messaging or messages from institutional leadership.
Williams understands why so many black people are skeptical of doctors and researchers, a distrust that stems from horrific research like the Tuskegee experiment.
“There is this very pervasive idea that the medical community is trying to use you, trying to use your body,” she said.
She hopes that her involvement, as an African American investigator, and the involvement of leaders at the HBCUs will encourage students to participate.
“Having a familiar, relatable face goes a long way, especially at this age,” she said.
Long term, she intends to use the insights gathered through the focus groups to develop educational outreach initiatives that could be used at all HBCUs in South Carolina and throughout the Southeast.
She hopes that as students learn about lupus and that such connective tissue diseases tend to run in families, they will share what they learn with their own families and friends.
Once diagnosed, managing lupus is a logistical challenge for many of the patients who Gilkeson and his colleagues see. About 2,000 people from across the state come to MUSC Health for lupus care, said Gilkeson. Many are from rural areas and have transportation problems. They might not be comfortable trying to navigate a big academic medical center. On top of that, their home communities might not have enough primary care doctors or might have lost the local hospital.
To help these patients, the grant allows for the hiring of a patient navigator to see if having such a person would reduce disease flares and hospital readmission rates.
This is something the lupus doctors have wanted to do for a long time but haven’t had the money for, Gilkeson said.
The patient navigator would become the point of contact for at-risk patients. The navigator would help those patients with transportation issues, make sure they’re getting their labs done and taking their medications and help them decide if their health concerns warrant a trip to the local emergency room or if they should see an MUSC rheumatologist.
Gilkeson said his group suspects the lack of primary care is helping to drive readmission rates. Some patients are in the hospital six or seven times a year. With a patient navigator to guide them, he hopes they can stave off Emergency Department visits for colds or sore throats and also catch and treat issues earlier so people don’t end up in the hospital.
“A lot of the readmissions could be prevented with intervention like this,” he said. “We’re really excited to see what the patient navigator can do.”
Eating more meat, having less of certain bacteria in the gut, and more of certain immune cells in the blood, all link with multiple sclerosis, reports a team of researchers led by UConn Health and Washington University School of Medicine. The work, published in the 27 January issue of EBioMedicine, teased out subtle connections that could lead to a better understanding of the causes of the disease.
Multiple sclerosis (MS) is an autoimmune disease affecting fewer than 3 million people worldwide but costing $28 billion annually in the US alone—and untold suffering. MS is more prevalent in specific regions, particularly the northern mid-latitudes, suggesting that geography is somehow linked to the disease, perhaps involving diet. But teasing out the exact relationships between diet, immune response and MS has been difficult. MS is most obviously an autoimmune disease in which the body attacks the insulation surrounding its nerves. When the insulation is damaged enough, the nerves begin to misfire and malfunction like wires with frayed insulation. But what triggers the body to attack the insulation in the nervous system in the first place is unknown.
More and more evidence has suggested that bacteria might be involved. The bacteria living in our guts can affect our immune system. And what we eat can affect the bacteria in our guts. Dr. Yanjiao Zhou at UConn Health School of Medicine collaborated with Dr. Laura Piccio from Washington University and now at the University of Sydney to study the gut microbiome, immune systems, diet, and blood metabolites in 49 volunteers—25 MS patients and 24 healthy controls—to look for correlations that might be subtle but important.
“We found a number of gut bacteria associated with MS and severity of disability of MS patients. We also found increased autoimmune markers and signature metabolites in MS. But what is really interesting is how these systems connect with each other, and how diet is involved in these connections. Using multi-OMICS approaches, we try to close the loop and show the associations between multiple systems,” says Zhou.
“This is the first study using an integrated approach to analyze the interplay between diet, gut microbiome, the immune system and metabolism and their contribution to disease pathogenesis and progression in people with MS. It opens a new modality to address future scientific questions by not looking at one individual factor, but at their complex interactions. This approach can lead to the identification of relevant networks that could be manipulated for disease prevention or therapeutic intervention,” says Piccio.
The strongest systemic linkage the researchers found involved eating meat. Their analysis linked higher meat consumption to a decrease in the population of Bacteroidesthetaiotaomicron in people’s gut ecology. B. thetaiotaomicron is associated with digesting carbohydrates from vegetables.
Higher meat consumption, which was observed in the MS patients, was also linked to an increase in T-helper 17 cells in the immune system, and an increase in S-adenosyl-L-methionine (SAM) in their blood.
The relationship between meat eating and disability and the other factors was not deterministic; some healthy people eat a lot of meat. But the pattern of all the factors was suggestive that, in MS, something goes wrong with people’s gut bacteria that dissociates them from the immune system, leading to heightened T-helper 17 cells and autoimmune attacks on the nervous system. And it tends to be associated with meat eating.
In the future, the team would like to expand the research to include more people, including those with a more severe form of MS. Eventually they hope to understand more of the cause-and-effect between diet, bacterial ecosystems in the gut, and immune response, and potentially help prevent or mitigate MS symptoms in people suffering from the disease.
Young people with eating disorders may also have underlying and undiagnosed autism spectrum disorder, according to Flinders University researchers.
Led by Professor Robyn Young from the College of Education, Psychology and Social Work, a new study has set out to further understand the link between autism and problematic eating behaviour.
“Research has shown that eating disorders and autism may co-occur, with persons with eating disorders being referred for consideration of an autism diagnosis with increasing frequency,” says Professor Young.
“When we consider the behavioural characteristics of autism, such as being selective about food and textures, food refusal or being particular with the type or colour of the utensils used, it is plausible to suggest that these behaviours may eventually lead to an eating disorder.”
The researchers say that clinicians who may be primed to diagnose one condition, given the salience of particular behaviours, may miss the co-occurring condition.
“This could create an issue in terms of treatment. If in fact autism is the cause of the disordered eating and the autism is identified, intervention will need to be modified with this diagnosis in mind,” says Professor Young.
Published in the journal Advances in Neurodevelopmental Disorders, Professor Young and her team surveyed 74 autistic and 40 non-autistic young adults aged between 18 and 25 years on their eating behaviour to better understand the relationship between autism and eating disorders.
The study found autistic individuals self-reported higher levels of problematic eating behaviour than non-autistic individuals, and also reported higher weight and shape concerns.
The authors say the latter finding was somewhat unexpected, suggesting that while autism may underpin the disordered eating in some cases, other behaviours more unique to anorexia, such as concerns around body image and shape, are also present.
“Our results suggest that autistic individuals are likely to experience autism-focused eating behaviours alongside, rather than instead of, typical eating disorder behaviours,” says Professor Young.
The researchers say what is needed is for the development of best-practice guidelines for the treatment of eating disorders among people on the autism spectrum, as no such guidelines currently exist, although further research will be required.
“We know that the presence of co-occurring autism and anorexia nervosa has been associated with poorer mental health and a poorer prognosis, which suggests that existing treatments for anorexia may need to be adapted in order to be effective among an autistic population,” says Professor Young.
“Further research is needed to identify and measure autism-driven eating behaviours so that guidelines for treatment can be developed to address the unique combination of symptoms in individuals with co-occurring autism and eating disorders.
“Health practitioners should be mindful that these conditions co-occur and consider both diagnosis prior to commencing treatment.”
Regular physical activity significantly changes the body’s metabolite profile, and many of these changes are associated with a lower risk of type 2 diabetes, a new study from the University of Eastern Finland shows. The study population included more than 7,000 men who were followed up for eight years. Men in the highest physical activity category had a 39% lower risk of type 2 diabetes than men who were physically inactive. Physical activity was associated with the levels of a total of 198 metabolites, i.e., compounds formed as a result of the body’s metabolism, and increased physical activity had an impact on some of the same metabolites that have previously been associated with a health-promoting diet. In addition, the study showed that increased physical activity improves insulin secretion.
A total of 1,260 metabolites were analysed from the study participants’ fasting glucose samples. The association of physical activity with the metabolite profile hasn’t been studied this comprehensively nor in such an extensive cohort before. Indeed, published in Metabolites, this study is the first to establish an association between many metabolites and physical activity.
The researchers investigated the association of physical activity with metabolite profile, insulin sensitivity, insulin secretion and risk of type 2 diabetes in men participating in the METabolic Syndrome In Men (METSIM) study. None of the participants had diabetes at the onset of the study. A physical activity questionnaire was conducted among the participants at the onset of the study and again eight years later, and they also underwent an oral glucose tolerance test and had their metabolites analysed from a fasting glucose sample.
Men were classified into four categories based on their physical activity: those who were physically inactive, those who were physically active only occasionally, those who were physically active regularly but no more than twice a week, and those who were physically active regularly at least three times a week. The duration of a single session of physical activity was defined as at least 30 minutes.
Physical activity was associated with the levels of a total of 198 metabolites. Among other things, physical activity changed the levels of several lipids in a manner that in previous studies has been associated with a lower risk of type 2 diabetes. In previous studies, a health-promoting diet has also been observed to have some similar associations with unsaturated fatty acid levels, for example. As completely new metabolic biomarkers associated with physical activity, the researchers identified in particular steroids, amino acids, imidazoles, carboxylic acids, and hydroxy acids.
During the follow-up, the risk of developing type 2 diabetes was 39% lower for men who were physically the most active, and 30% lower even for men who were physically active no more than twice a week, when compared to men who were physically inactive. Lower fasting glucose and insulin levels, and better insulin sensitivity and insulin secretion, were observed in men who increased their physical activity during the follow-up.
The association of physical activity with insulin secretion has remained unclear, despite several studies on the matter. The study published now confirms that increased physical activity improves insulin secretion.
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