Top 10 MS Stories of 2022
Diet and its effects on gut microbiome are among the most-read topics
This is a list of the top 10 most-read articles we published this past year, with a brief description of each. We look forward to continuing to serve as a resource for the MS community in 2023.
Cholesterol is a critical component of the myelin sheath, the fatty covering around nerve fibers that is damaged in MS. Researchers in Greece measured cholesterol levels in more than 100 people with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome.
Compared with control subjects without MS, these patients had significantly lower cholesterol levels in their blood and in the fluid around the brain and spinal cord, known as cerebrospinal fluid or CSF. Among the MS patients, lower cholesterol levels in the CSF might correlate with a more severe disease course, the researchers noted.
Aubagio (teriflunomide) is an oral therapy that’s been approved for RRMS in the European Union for nearly a decade. Scientists in Italy shared data for more than 300 patients who started on Aubagio at their clinic in the late 2010s.
Among the 204 patients who were on Aubagio for at least two years, more than half (58.8%) showed no signs of disease activity — meaning they didn’t experience a relapse, had no worsening disability, and had no signs of MRI activity. Patients who were younger, with milder disability scores, and fewer relapses before starting on Aubagio had the greatest likelihood of not having disease activity while on treatment.
The first patient has been enrolled in a Phase 2 clinical trial (NCT05131828) testing metformin, a diabetes medication, in combination with the antihistamine clemastine as a potential therapy for MS. The trial seeks to enroll about 50 adults with RRMS, ages 25 to 50, who currently are on stable treatment with an approved disease-modifying therapy and have a delayed response to stimulus in at least one eye.
The main goal is to assess the impact of treatment on visual evoked potential latency after about six months of treatment. This is a measure of how quickly electrical signals pass along nerve fibers from light-sensing cells in the eyes to visual processing centers in the brain, which can be used to assess myelin loss. Results are expected late next year.
Dendritic cells are a class of immune cell that plays a key role in immunological tolerance — the immune system’s ability not to attack the body’s own healthy tissue. Prior research had shown that vitamin D could prime dendritic cells toward a more tolerance-promoting state. Here, researchers demonstrated a molecular mechanism driving this phenomenon.
The team showed that vitamin D alters the way that DNA is packaged inside the cell’s nucleus, which effectively “turns on” a number of tolerance-promoting genes. Results showed that vitamin D binds to a receptor on the cells’ surface, which activates a molecular signaling pathway called JAK2-STAT3 to drive these effects.
The human digestive tract is home to trillions of bacteria and other microorganisms, which affect health outside the gut in ways that are beginning to be understood. Here, scientists analyzed levels of bacteria-related molecules in the CSF from people with RRMS before or after treatment with dimethyl fumarate (sold as Tecfidera or generics).
Results showed that levels of three toxic compounds made by gut bacteria — namely p-cresol-sulfate, indoxyl-sulfate, and N-phenylacetylglutamine — were elevated in MS patients, particularly in patients with evidence of brain damage. Treatment with dimethyl fumarate led to a marked reduction in levels of these compounds.
To gain further insight into the role of gut bacteria in MS, scientists analyzed gut bacteria, immune cell profiles, metabolism, and food intake for 24 adults with untreated RRMS and 25 healthy adults. Both groups were followed for six months.
Overall dietary and microbial profiles were similar in both groups, though MS patients tended to have lower abundances of bacterial species that are known to modulate immune activity. Among the MS patients, levels of certain gut bacteria showed statistical correlations with measures of disability severity. Results also indicated that individuals who ate a diet with plenty of meat tended to have higher levels of pro-inflammatory Th17 cells in their blood, as well as lower levels of a gut bacteria that works to digest carbohydrates called Bacteriodes thetaiotaomicron.
Whether or not alcohol contributes to MS risk has been a matter of debate, with different studies finding conflicting results. Researchers in China conducted a meta-analysis where they pooled data from nine prior studies, covering more than 200,000 people (including over 10,000 with MS), to assess the relationship between alcohol intake and MS risk.
Results overall showed no significant association between alcohol consumption and MS risk. Additional analyses indicated that drinking beer, specifically, was associated with a significantly increased risk of MS, though the researchers stressed that this result was based on findings from only two of the studies that had contradicting results, so further studies are needed to assess this potential relationship.
With increasing availability of cannabis products, there has been interest among patients and clinicians in whether cannabis may offer benefits for MS patients. Scientists conducted an anonymous survey to assess cannabis use among MS patients in Canada, where medical cannabis has been legal since 2001, and recreational cannabis was legalized in 2018.
More than half of the surveyed patients reported currently using cannabis to help manage their symptoms. Most of these patients use cannabis products daily, and the vast majority said these products were helpful for managing MS symptoms such as sleep problems, pain, and spasticity.
Intermittent fasting is a dietary plan where a person switches between significant calorie restriction and a normal diet on a pre-specified schedule. A clinical trial called ATAC-MS (NCT02647502) enrolled 36 people with MS who were assigned to a control diet, a continuous calorie-restricted diet, or an intermittent fasting diet.
Results showed that patients who intermittently fasted had lower levels of certain inflammatory T-cells that contribute to the development and progression of MS. They also had lower levels of several signaling molecules related to fat storage and metabolism. Though limited by the small size, this early study suggests that the effects of diet in MS may be modulated by both immune and metabolic alterations.
The so-called “prodromal” period refers to the years immediately before a person is diagnosed with MS. Accumulating evidence suggests that many patients experience noticeable symptoms, such as pain, emotional changes, or sleep problems, during this period.
Here, scientists at Lithuanian University of Health Sciences surveyed 166 MS patients to learn more about their prodromal symptoms and disease course. Statistical analyses showed that patients with prodromal digestive symptoms like nausea were more likely to develop RRMS, whereas patients with early depression more commonly had primary progressive disease, and prodromal anxiety was associated with less severe MS later on. Researchers urged further study into the association between prodromal symptoms and future disease course.
We at Multiple Sclerosis News Today hope these stories and all of our reporting in 2022 have helped to inform and improve the lives of everyone affected by MS, and we look forward to continuing to be a service for the community in 2023.
We wish all our readers a very happy new year!