#CMSC16 – Patricia Coyle, an MS Expert, Talks About Vitamin D, Fatigue and Other Key Issues

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Dr. Patricia Coyle

The Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting began today, June 1. Multiple Sclerosis News Today is providing extensive on-site coverage of the meeting, reporting on presentations, and conducting exclusive interviews with top researchers in the field of multiple sclerosis (MS) and with biopharmaceutical representatives on the latest advances in MS therapies.

Among several opening-day activities was an Independently Supported Symposium, titled “A 3 Dimensional View of A Personalized Approach to Multiple Sclerosis: Effective Current and Emerging Therapy.” The symposium was provided by Med Learning Group and co-provided by Ultimate Medical Academy/CCM, and supported by educational grants from Biogen, Genentech, and Teva Pharmaceuticals.

Dr. Patricia Coyle, an internationally recognized MS expert, and founder and director of the Stony Brook MS Comprehensive Care Center, discussed several concepts and findings related to MS.

Dr. Coyle opened her symposium address by noting that MS etiology, or origin, is the result of genetics, environmental factors, and the immune system. Concerning potential risk factors for MS development, she emphasized that “vitamin D deficiency increases the risk of MS,” and that its “levels may be associated with disease activity.” Vitamin D levels in the body are linked to sunlight exposure. Interestingly, geographic regions with low sunlight/UV radiation exposure have a higher number of MS cases, while regions near the equator have fewer cases. It is as if MS “increases as you move away [from the equator],” Dr. Coyle said.

Smoking also increases the risk for MS, and it can contribute to the transition from relapsing MS to the more debilitating progressive disease form, she said. In addition, factors like high salt intake and a Western (inflammatory) diet, adolescent obesity, and a permissive gut microbiome may also contribute to MS development.

The gut microbiome affects the inflammatory response, and is linked to the immune system. According to Dr. Coyle, the gut microbiome is known to be influenced by diet, vitamin D, exercise, stress, smoking, and alcohol, and is thought to play a role in MS pathogenesis, as the microbiome of a mouse model of human MS (known as the experimental autoimmune encephalomyelitis [EAE] model) has been reported to differ from that found in healthy control animals.

Dr. Coyle also mentioned infection with the Epstein Barr virus (EBV) as a risk factor for MS, as “all adult MS and 83 percent of pediatric MS [patients] are EBV seropositive.”

Concerning MS neuropathology, she noted that the focus is on “inflammation (focal and diffuse), demyelination, and neurodegeneration,” and that “both innate and adaptive immune-mediated inflammatory mechanisms are involved,” with immune cells penetrating into the central nervous system (CNS) and causing tissue injury.

Dr. Coyle made the observation that progressive MS can be considered an age-related condition, with clinical expression occurring in women around menopause and in men similarly in their mid-40s to early 50s. She also pinpointed age-related factors at play in this form of the disease, namely the loss of central nervous system (CNS) reserve, and a decrease in neuroprotective/repair mechanisms involved in diffuse low-grade inflammation, microglial activation, oxidative injury, mitochondrial injury, iron accumulation, and glutamate excitotoxicity.

In terms of disease symptoms, Dr. Coyle emphasized fatigue as a serious symptom that should be properly addressed. “Prevalence of fatigue in MS is extremely high, more than 80 percent,” she said.

She also observed that “MS does not remit, we need to alter this notion.”

Regarding MS therapies, Dr. Coyle reported that therapeutic approaches not based on myelin targets are evolving, focusing on other relevant players such as the gut microbiome, immune B cells, astrocytes (specialized cells involved in the repair and scarring process of the brain and spinal cord), and oligodendrocytes (cells producing myelin).

Multiple Sclerosis News Today had the opportunity to interview Dr. Coyle after the symposium, where questions such as the biggest challenges in MS and switching between MS therapies were discussed. Dr. Coyle emphasized that decisions regarding MS treatment “should be a mutual decision between the physician and the patient, hopefully a knowledgeable physician that can truly guide the patient with best recommendations.”

She also suggested that greater collaboration would aid MS research. “There should be more of a kind of consortium between clinicians, between pharma, between governments, to try to push forward collectively, to try to optimize our resources to get to answers for MS.”

The complete interview with Dr. Coyle can be accessed through this link, or viewed below.


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