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Goodin DS, Khankhanian P, Gourraud PA, Vince N. Multiple sclerosis: Exploring the limits and implications of genetic and environmental susceptibility. PLoS One 2023; 18:e0285599. [PMID: 37379505 DOI: 10.1371/journal.pone.0285599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE To explore and describe the basis and implications of genetic and environmental susceptibility to multiple sclerosis (MS) using the Canadian population-based data. BACKGROUND Certain parameters of MS-epidemiology are directly observable (e.g., the recurrence-risk of MS in siblings and twins, the proportion of women among MS patients, the population-prevalence of MS, and the time-dependent changes in the sex-ratio). By contrast, other parameters can only be inferred from the observed parameters (e.g., the proportion of the population that is "genetically susceptible", the proportion of women among susceptible individuals, the probability that a susceptible individual will experience an environment "sufficient" to cause MS, and if they do, the probability that they will develop the disease). DESIGN/METHODS The "genetically susceptible" subset (G) of the population (Z) is defined to include everyone with any non-zero life-time chance of developing MS under some environmental conditions. The value for each observed and non-observed epidemiological parameter is assigned a "plausible" range. Using both a Cross-sectional Model and a Longitudinal Model, together with established parameter relationships, we explore, iteratively, trillions of potential parameter combinations and determine those combinations (i.e., solutions) that fall within the acceptable range for both the observed and non-observed parameters. RESULTS Both Models and all analyses intersect and converge to demonstrate that probability of genetic-susceptibitly, P(G), is limited to only a fraction of the population {i.e., P(G) ≤ 0.52)} and an even smaller fraction of women {i.e., P(G│F) < 0.32)}. Consequently, most individuals (particularly women) have no chance whatsoever of developing MS, regardless of their environmental exposure. However, for any susceptible individual to develop MS, requires that they also experience a "sufficient" environment. We use the Canadian data to derive, separately, the exponential response-curves for men and women that relate the increasing likelihood of developing MS to an increasing probability that a susceptible individual experiences an environment "sufficient" to cause MS. As the probability of a "sufficient" exposure increases, we define, separately, the limiting probability of developing MS in men (c) and women (d). These Canadian data strongly suggest that: (c < d ≤ 1). If so, this observation establishes both that there must be a "truly" random factor involved in MS pathogenesis and that it is this difference, rather than any difference in genetic or environmental factors, which primarily accounts for the penetrance difference between women and men. CONCLUSIONS The development of MS (in an individual) requires both that they have an appropriate genotype (which is uncommon in the population) and that they have an environmental exposure "sufficient" to cause MS given their genotype. Nevertheless, the two principal findings of this study are that: P(G) ≤ 0.52)} and: (c < d ≤ 1). Threfore, even when the necessary genetic and environmental factors, "sufficient" for MS pathogenesis, co-occur for an individual, they still may or may not develop MS. Consequently, disease pathogenesis, even in this circumstance, seems to involve an important element of chance. Moreover, the conclusion that the macroscopic process of disease development for MS includes a "truly" random element, if replicated (either for MS or for other complex diseases), provides empiric evidence that our universe is non-deterministic.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, San Francisco & the San Francisco VA Medical Center, University of California, San Francisco, San Francisco, California, United States of Ameirca
| | - Pouya Khankhanian
- Kaiser Permanente, Walnut Creek Medical Center, Dublin, California, United States of Ameirca
| | - Pierre-Antoine Gourraud
- Center for Neuro-Engineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of Ameirca
| | - Nicolas Vince
- INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
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Hamadi N, Beegam S, Zaaba NE, Elzaki O, Altamimi MA, Nemmar A. Neuroinflammation, Oxidative Stress, Apoptosis, Microgliosis and Astrogliosis in the Cerebellum of Mice Chronically Exposed to Waterpipe Smoke. Biomedicines 2023; 11:biomedicines11041104. [PMID: 37189722 DOI: 10.3390/biomedicines11041104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Waterpipe smoking (WPS) is prevalent in Asian and Middle Eastern countries and has recently gained worldwide popularity, especially among youth. WPS has potentially harmful chemicals and is associated with a wide range of adverse effects on different organs. However, little is known regarding the impact of WPS inhalation on the brain and especially on the cerebellum. Presently, we aimed at investigating inflammation, oxidative stress and apoptosis as well as microgliosis and astrogliosis in the cerebellum of BALB/C mice chronically (6 months) exposed to WPS compared with air-exposed mice (control). WPS inhalation augmented the concentrations of proinflammatory cytokines tumor necrosis factor, interleukin (IL)-6 and IL-1β in cerebellar homogenates. Likewise, WPS increased oxidative stress markers including 8-isoprostane, thiobarbituric acid reactive substances and superoxide dismutase. In addition, compared with the air-exposed group, WPS caused an increase in the oxidative DNA damage marker, 8-hydroxy-2′-deoxyguanosine, in cerebellar homogenates. Similarly, in comparison with the air group, WPS inhalation elevated the cerebellar homogenate levels of cytochrome C, cleaved caspase-3 and nuclear factor-κB (NF-κB). Immunofluorescence analysis of the cerebellum showed that WPS exposure significantly augmented the number of ionized calcium-binding adaptor molecule 1 and glial fibrillary acidic protein-positive microglia and astroglia, respectively. Taken together, our data show that chronic exposure to WPS is associated with cerebellar inflammation, oxidative stress, apoptosis, microgliosis and astrogliosis. These actions were associated with a mechanism involving NF-κB activation.
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Affiliation(s)
- Naserddine Hamadi
- Department of Life and Environmental Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Sumaya Beegam
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Nur Elena Zaaba
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Ozaz Elzaki
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Mariam Abdulla Altamimi
- Department of Life and Environmental Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
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Vasić M, Topić A, Marković B, Milinković N, Dinčić E. Oxidative stress-related risk of the multiple sclerosis development. J Med Biochem 2023; 42:1-8. [PMID: 36819128 PMCID: PMC9920994 DOI: 10.5937/jomb0-37546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/02/2022] Open
Abstract
Background Multiple sclerosis (MS) is characterized by inflammation, demyelination and axonal degeneration. Oxidative stress (OS) plays a significant role in the pathogenesis of the disease. The aim of the study was to examine the association between OS and smoking on the MS development. Methods The study included 175 patients with relapsing-remitting multiple sclerosis (RRMS) (76 males, 99 females) and 254 healthy subjects (81 males and 173 females). Oxidative stress biomarkers in serum, Total Antioxidant Status (TAS) and Total Oxidative Status (TOS) were determined spectrophotometrically. Oxidative Stress Index (OSI) was calculated as the ratio of TOS and TAS. Urinary 8-oxo7,8-dihydro-2'-deoxyguanosine were determined by HPLC-MS/MS and expressed as 8-oxodG/creatinine. Results In females with RRMS were higher TOS, OSI and 8-oxodG/creatinine than in females in control group. The group of males with RRMS had lower level of TAS than the males in control group. Higher levels of 8-oxodG/creatinine was obtained in active, passive and former smokers with RRMS than in control group with the same exposition to tobacco smoke. Independent predictors of MS are passive smoking, increased OSI and increased levels of urinary 8-oxodG/creatinine. Conclusions Our results demonstrate that the OS parameters should be included in the assessment of the risk for MS development. Due to the more sensitivity to oxidative stress, females may be at higher risk of MS development. This data indicates the importance of introducing the antioxidant therapy as a complementary treatment in patients with RRMS.
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Affiliation(s)
- Marija Vasić
- Military Medical Academy, Institute of Medical Biochemistry, Belgrade
| | - Aleksandra Topić
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Bojan Marković
- University of Belgrade, Faculty of Pharmacy, Pharmaceutical Chemistry, Belgrade
| | - Neda Milinković
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Evica Dinčić
- Military Medical Academy, Neurology Clinic, Belgrade
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Sugawara H, Norimoto H, Zhou Z. Methyl vinyl ketone disrupts neuronal survival and axonal morphogenesis. J Toxicol Sci 2022; 47:375-380. [PMID: 36047111 DOI: 10.2131/jts.47.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Methyl vinyl ketone (MVK) is an environmental hazardous substrate which is mainly present in cigarette smoke, industrial waste, and exhaust gas. Despite many chances to be exposed to MVK, the cellular toxicity of MVK is largely unknown. Neurons are the main component of the brain, which is one the most vital organs to human beings. Nevertheless, the influence of MVK to neurons has not been investigated. Here, we determined whether MVK treatment negatively affects neuronal survival and axonal morphogenesis using primary hippocampal neuronal cultures. We treated hippocampal neurons with 0.1 μM to 3.0 μM MVK and observed a concentration-dependent increase of neuronal death rate. We also demonstrated that the treatment with a low concentration of MVK 0.1 μM or 0.3 μM inhibited axonal branching specifically without affecting axon outgrowth. Our results suggest that MVK is highly toxic to neurons.
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Affiliation(s)
| | | | - Zhiwen Zhou
- Graduate School of Medicine, Hokkaido University
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Hamed KA, El-Fiky SA, Gawish AM, Khalil WKB, Mohamed HRH. Alleviation of nicotine-induced reproductive disorder, clastogenicity, and histopathological alterations by fenugreek saponin bulk and nanoparticles in male rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:47488-47501. [PMID: 35182342 PMCID: PMC9232449 DOI: 10.1007/s11356-022-19123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Nicotine is the most abundant ingredient in cigarette smoking and has serious side effects on the lung, heart, reproductive system, and many other human organs. Saponins extracted from many plants exhibit multiple biological actions such as anti-cancer effects. Therefore, the possible protective effect of fenugreek saponin (FS) and nanofenugreek saponin (NFS) against nicotine-induced toxicity in male rats was investigated in this study. Animals were divided into a control group and the nicotine (1.5 mg/kg/day), FS (25, 50, and 100 mg/kg/day), or/and NFS (20, 40, and 80 mg/kg/day) administered groups. Micronucleus assay, histopathological, and sperm abnormality examinations as well as measurement of the acetylcholinesterase (AChE) gene expression were conducted. Our findings revealed that nicotine treatment induced significant increases in the incidence of micronucleus, sperm abnormalities, and expression levels of AChE in addition to inducing histopathological changes in rat testis. On the other hand, administration of FS or NFS with nicotine significantly decreased the incidence of micronuclei and the percentage of sperm abnormalities as well as the expression levels of AChE gene. Moreover, nicotine-induced histological alterations were reduced by given FS or NFS with nicotine. In conclusion, nicotine-induced sperm abnormalities, chromosomal damage, and histological injuries were mitigated by administration of FS or NFS with nicotine, and thus, FS and NFS could be used as ameliorating agents against nicotine toxicity.
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Affiliation(s)
- Karima A Hamed
- Department of Cell Biology, National Research Centre, 33 El-Bohous StDokki, P.O. 12622, Giza, 12622, Egypt
| | - Samia A El-Fiky
- Department of Cell Biology, National Research Centre, 33 El-Bohous StDokki, P.O. 12622, Giza, 12622, Egypt
| | - Azza M Gawish
- Department of Zoology, Faculty of Science, Cairo University, Giza, 12613, Egypt
| | - Wagdy K B Khalil
- Department of Cell Biology, National Research Centre, 33 El-Bohous StDokki, P.O. 12622, Giza, 12622, Egypt
| | - Hanan R H Mohamed
- Department of Zoology, Faculty of Science, Cairo University, Giza, 12613, Egypt.
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Leffler J, Trend S, Gorman S, Hart PH. Sex-Specific Environmental Impacts on Initiation and Progression of Multiple Sclerosis. Front Neurol 2022; 13:835162. [PMID: 35185777 PMCID: PMC8850837 DOI: 10.3389/fneur.2022.835162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 12/28/2022] Open
Abstract
The immunological mechanisms that contribute to multiple sclerosis (MS) differ between males and females. Females are 2–3 times more likely to develop MS compared to males, however the reason for this discrepancy is unknown. Once MS is established, there is a more inflammatory yet milder form of disease in females whereas males generally suffer from more severe disease and faster progression, neural degradation, and disability. Some of these differences relate to genetics, including genetic control of immune regulatory genes on the X-chromosome, as well as immune modulatory properties of sex hormones. Differences in MS development may also relate to how sex interacts with environmental risk factors. There are several environmental risk factors for MS including late-onset Epstein Barr virus infection, low serum vitamin D levels, low UV radiation exposure, smoking, obesity, and lack of physical activity. Most of these risk factors impact males and females differently, either due to biological or immunological processes or through behavioral differences. In this review, we explore these differences further and focus on how the interaction of environmental risk factors with sex hormones may contribute to significantly different prevalence and pathology of MS in males and females.
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Affiliation(s)
- Jonatan Leffler
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- *Correspondence: Jonatan Leffler
| | - Stephanie Trend
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, WA, Australia
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Prue H. Hart
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
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Briggs FB. Nicotinic acetylcholine receptors α7 and α9 modifies tobacco smoke risk for multiple sclerosis. Mult Scler 2021; 27:1166-1174. [PMID: 32924781 DOI: 10.1177/1352458520958361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tobacco smoke exposure is an established risk factor for multiple sclerosis (MS), yet how it confers risk is not known. Evidence from observational studies suggests nicotine may be a protective component. Animal studies further support this hypothesis, demonstrating nicotine's protective effect in MS is mediated by the presence and absence of α7 and α9 nicotinic acetylcholine receptors (nAChRs), respectively. OBJECTIVE To determine if variation in the genes encoding α7 and α9 nAChRs (cholinergic receptor nicotinic alpha 7 (CHRNA7) and alpha 9 (CHRNA9)) will modify MS risk conferred by tobacco smoking. METHODS A multi-stage gene-environment (G×E) framework was utilized, including a case-control analysis (286 cases, 176 controls) with haplotype- and gene-based analyses, followed by an extension case-only (1053 cases) analysis for overlapping variants. RESULTS The results suggest that CHRNA7 and CHRNA9 modifies MS risk conferred by tobacco smoke, where risk among smokers was increased in carriers of the minor CHRNA9 haplotype and in non-carriers the minor CHRNA7 haplotype. The findings are consistent with the pharmacology of these receptors and animal studies of MS. CONCLUSION This study implicates novel processes in MS initiation and demonstrate the need for further G×E studies to advancing our understanding of the missing heritability of MS.
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Affiliation(s)
- Farren Bs Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Angeloni B, Bigi R, Bellucci G, Mechelli R, Ballerini C, Romano C, Morena E, Pellicciari G, Reniè R, Rinaldi V, Buscarinu MC, Romano S, Ristori G, Salvetti M. A Case of Double Standard: Sex Differences in Multiple Sclerosis Risk Factors. Int J Mol Sci 2021; 22:ijms22073696. [PMID: 33918133 PMCID: PMC8037645 DOI: 10.3390/ijms22073696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis is a complex, multifactorial, dysimmune disease prevalent in women. Its etiopathogenesis is extremely intricate, since each risk factor behaves as a variable that is interconnected with others. In order to understand these interactions, sex must be considered as a determining element, either in a protective or pathological sense, and not as one of many variables. In particular, sex seems to highly influence immune response at chromosomal, epigenetic, and hormonal levels. Environmental and genetic risk factors cannot be considered without sex, since sex-based immunological differences deeply affect disease onset, course, and prognosis. Understanding the mechanisms underlying sex-based differences is necessary in order to develop a more effective and personalized therapeutic approach.
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Affiliation(s)
- Benedetta Angeloni
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Rachele Bigi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Correspondence: (R.B.); (G.R.)
| | - Gianmarco Bellucci
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Rosella Mechelli
- San Raffaele Roma Open University, 00166 Rome, Italy;
- Scientific Institute for Research, Hospitalization and Healthcare San Raffaele Pisana (IRCCS), 00166 Rome, Italy
| | - Chiara Ballerini
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Carmela Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Emanuele Morena
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Giulia Pellicciari
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Roberta Reniè
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Virginia Rinaldi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Silvia Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Neuroimmunology Unit, Scientific Institute for Research, Hospitalization and Healthcare Fondazione Santa Lucia (IRCCS), 00179 Rome, Italy
- Correspondence: (R.B.); (G.R.)
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, Italy
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Palladino R, Marrie RA, Majeed A, Chataway J. Evaluating the Risk of Macrovascular Events and Mortality Among People With Multiple Sclerosis in England. JAMA Neurol 2021; 77:820-828. [PMID: 32364569 DOI: 10.1001/jamaneurol.2020.0664] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance People with multiple sclerosis (MS) are associated with an increased risk of cardiovascular disease and mortality; however, evidence from population-based studies is sparse. Objective To assess whether the risk of macrovascular events and mortality differs among people with MS compared with a matched population without MS in England. Design, Setting, and Participants A population-based retrospective matched cohort study was conducted in general practices registered with the Clinical Practice Research Datalink in England between January 1, 1987, and September 30, 2018, with a mean (SD) follow-up of 11.3 (6.5) years. A total of 12 251 patients with MS were matched with up to 6 people without MS (n = 72 572) by age, sex, and general practice. People with 3 or more diagnoses of MS recorded during the study period were included. The first MS diagnosis was considered as index date. Exposures Multiple sclerosis status. Analyses were also stratified by sex. Main Outcomes and Measures Main outcomes were acute coronary syndrome, cerebrovascular disease, any macrovascular disease (including peripheral arterial disease), and mortality (all-cause mortality and cardiovascular disease-specific mortality). Cox proportional hazards regression and Fine and Gray proportional subhazard regression models were used to assess differences in rates. Results A total of 12 251 people with MS (66.9% women; mean [SD] age, 44.9 [13.3] years) were matched with 72 572 people without MS (69.8% women; mean [SD] age, 44.9 [13.3] years). As compared with people without MS, people with MS were associated with a 28% increased hazard of acute coronary syndrome (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51), 59% increased hazard of cerebrovascular disease (HR, 1.59; 95% CI, 1.32-1.92), 32% increased hazard of any macrovascular disease (HR, 1.32; 95% CI, 1.15-1.52), 3.5-fold increased hazard of all-cause mortality (HR, 3.46; 95% CI, 3.28-3.65), and 1.5-fold increased hazard in cardiovascular disease mortality (HR, 1.47; 95% CI, 1.27-1.71). Differences in macrovascular events were more pronounced among women than men. Mortality risk was also higher for women than men. Treatment with lipid-lowering medications (mainly statins) was associated with lower mortality rates among people with MS. Conclusions and Relevance This study suggests that MS is associated with an increased risk of cardiovascular and cerebrovascular disease that is not completely accounted for by traditional vascular risk factors. Given the adverse effects of these comorbidities on outcomes in patients with MS, further investigation is needed.
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Affiliation(s)
- Raffaele Palladino
- Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, United Kingdom.,Department of Public Health, Federico II University, Naples, Italy
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, United Kingdom
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom.,National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, United Kingdom
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10
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Affiliation(s)
- Mattia Rosso
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Alphonsus KB, D'Arcy C. Predictors of people's perceptions of second hand smoke exposure as a risk factor for multiple sclerosis. Mult Scler Relat Disord 2019; 36:101383. [PMID: 31520985 DOI: 10.1016/j.msard.2019.101383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are both environmental and genetic factors which are associated with multiple sclerosis (MS) development. The primary objective of this study was to examine the predictors associated with people's attitudes towards second hand smoke exposure being a risk factor for development of MS. METHODS The data set was drawn from the Health Canada: Smoking Survey conducted in 2004 and 2005 by Environics Research Group in partnership with Health Canada to survey the public in the province of British Columbia (N = 1468), Newfoundland (N = 1442), Quebec (N = 1404), Ontario (N = 1443) and Saskatchewan (N = 1413). A multilevel mixed effects logistic regression model analysis was carried out in order to determine whether people's perceptions of second hand smoking as a risk factor for MS varied based on the province of residence. RESULTS Age, sex, having a household member who smoked inside their home, if respondents were bothered by second hand smoke exposure and smoking status were associated with increased odds of people agreeing to second hand smoke exposure being a risk factor for MS development. The province of residence was also a factor in people's perceptions. CONCLUSION The study results could guide in the development of stop second hand smoking campaigns on social media, TV and bus stop shelters and enforcement of stricter policies on smoking areas. This could help raise awareness about the risk of second hand smoking and its detrimental effect on people living with MS.
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Affiliation(s)
| | - Carl D'Arcy
- School of Public Health, University of Saskatchewan, SK, Canada; Department of Psychiatry, Royal University Hospital, SK, Canada
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12
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Duignan S, Brownlee W, Wassmer E, Hemingway C, Lim M, Ciccarelli O, Hacohen Y. Paediatric multiple sclerosis: a new era in diagnosis and treatment. Dev Med Child Neurol 2019; 61:1039-1049. [PMID: 30932181 DOI: 10.1111/dmcn.14212] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 12/30/2022]
Abstract
Multiple sclerosis is a chronic immune-mediated demyelinating disease of the central nervous system. The diagnosis of multiple sclerosis in children, as in adults, requires evidence of dissemination of inflammatory activity in more than one location in the central nervous system (dissemination in space) and recurrent disease over time (dissemination in time). The identification of myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) and aquaporin-A antibodies (AQP4-Ab), and the subsequent discovery of their pathogenic mechanisms, have led to a shift in the classification of relapsing demyelinating syndromes. This is reflected in the 2017 revised criteria for the diagnosis of multiple sclerosis, which emphasizes the exclusion of multiple sclerosis mimics and aims to enable earlier diagnosis and thus treatment initiation. The long-term efficacy of individual therapies initiated in children with multiple sclerosis is hard to evaluate, owing to the small numbers of patients who have the disease, the relatively high number of patients who switch therapy, and the need for long follow-up studies. Nevertheless, an improvement in prognosis with a globally reduced annual relapse rate in children with multiple sclerosis is now observed compared with the pretreatment era, indicating a possible long-term effect of therapies. Given the higher relapse rate in children compared with adults, and the impact multiple sclerosis has on cognition in the developing brain, there is a question whether rapid escalation or potent agents should be used in children, while the short- and long-term safety profiles of these drugs are being established. With the results of the first randomized controlled trial of fingolimod versus interferon-β1a in paediatric multiple sclerosis published in 2018 and several clinical trials underway, there is hope for further progress in the field of paediatric multiple sclerosis. WHAT THIS PAPER ADDS: Early and accurate diagnosis of multiple sclerosis is crucial. The discovery of antibody-mediated demyelination has changed the diagnosis and management of relapsing demyelination syndromes. Traditional escalation therapy is being challenged by induction therapy.
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Affiliation(s)
- Sophie Duignan
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Wallace Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.,Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
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13
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Chou IJ, Kuo CF, Tanasescu R, Tench CR, Tiley CG, Constantinescu CS, Whitehouse WP. Comorbidity in multiple sclerosis: its temporal relationships with disease onset and dose effect on mortality. Eur J Neurol 2019; 27:105-112. [DOI: 10.1111/ene.14040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- I. J. Chou
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
- Division of Academic Child Health School of Medicine University of Nottingham Nottingham UK
- Division of Paediatric Neurology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - C. F. Kuo
- Division of Rheumatology, Orthopaedics and Dermatology School of Medicine University of Nottingham Nottingham UK
- Division of Rheumatology, Allergy and Immunology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - R. Tanasescu
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
- Division of Neurosciences Department of Neurology Colentina Hospital University of Medicine and Pharmacy Carol Davila Bucharest Romania
| | - C. R. Tench
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
| | - C. G. Tiley
- The Lander Medical Practice Truro Cornwall UK
| | - C. S. Constantinescu
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
| | - W. P. Whitehouse
- Division of Academic Child Health School of Medicine University of Nottingham Nottingham UK
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14
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Azami M, YektaKooshali MH, Shohani M, Khorshidi A, Mahmudi L. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PLoS One 2019; 14:e0214738. [PMID: 30964886 PMCID: PMC6456231 DOI: 10.1371/journal.pone.0214738] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis. METHOD A systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491. RESULTS According to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6-33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and 44.8/ 100,000 (95%CI: 36.3-61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8-6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3-61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001). CONCLUSIONS The results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time.
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Affiliation(s)
- Milad Azami
- Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Hossein YektaKooshali
- Student Research Committee, School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Shohani
- Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Leily Mahmudi
- Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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15
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Wang Z, Xie J, Wu C, Xiao G. Correlation Between Smoking and Passive Smoking with Multiple Sclerosis and the Underlying Molecular Mechanisms. Med Sci Monit 2019; 25:893-902. [PMID: 30703074 PMCID: PMC6367889 DOI: 10.12659/msm.912863] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated disease of the spinal cord and brain. Many studies have shown that smoking and passive smoking are key environmental risk factors for MS. Here, we provide an overview of the human leukocyte antigen (HLA) gene studies on smoking and MS risk, and we discuss recent studies on between epigenetics and smoking-induced MS. In addition, in this review we also summarize current research advances in biological pathways and smoking-induced MS. This review provides an overview of studies on the association between smoking, passive smoking, and MS susceptibility, and the underlying molecular mechanism.
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Affiliation(s)
- Zhaowei Wang
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China (mainland)
| | - Jianpin Xie
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China (mainland)
| | - Chenglong Wu
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China (mainland)
| | - Guirong Xiao
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China (mainland)
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16
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Tadić D, Đajić V, Grgić S, Miljković S. The prevalence of smoking and its impact on disability in multiple sclerosis. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-21828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Mowry EM, Azevedo CJ, McCulloch CE, Okuda DT, Lincoln RR, Waubant E, Hauser SL, Pelletier D. Body mass index, but not vitamin D status, is associated with brain volume change in MS. Neurology 2018; 91:e2256-e2264. [PMID: 30429274 PMCID: PMC6329329 DOI: 10.1212/wnl.0000000000006644] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/27/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To determine whether body mass index (BMI) or vitamin D status is associated with MRI measures of neurodegeneration in a cohort of individuals with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome (CIS). METHODS Expression, Proteomics, Imaging, Clinical (EPIC) is a longitudinal multiple sclerosis (MS) cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. We evaluated patients with CIS or RRMS at baseline. In multivariate repeated-measures analyses adjusted for age, sex, ethnicity, smoking status, and use of MS treatments, annual 25-hydroxyvitamin D levels and BMI were evaluated for their association with subsequent brain volumes (normalized gray matter [nGMV], brain parenchymal [nBPV], and white matter volumes, as determined by Structural Image Evaluation using Normalization of Atrophy-X). RESULTS Among 469 participants, each 1-kg/m2 higher BMI was independently associated with reduced nGMV in multivariate models (-1.1 mL, 95% confidence interval [CI] -1.8 to -0.5, p = 0.001). BMI was likewise independently associated with nBPV (nBPV per 1-kg/m2 greater BMI: -1.1 mL, 95% CI -2.1 to -0.05, p = 0.039). Vitamin D levels did not appear to be meaningfully associated with brain volumes. CONCLUSIONS Higher BMI appears to be associated with greater reductions in nGMV and nBPV, which is relevant because, in particular, nGMV loss portends greater longer-term disability. Because obesity is modifiable, further studies should explore these relationships in detail, and evaluating the effect of reducing BMI on imaging and clinical outcomes in MS may be warranted.
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Affiliation(s)
- Ellen M Mowry
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas.
| | - Christina J Azevedo
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Charles E McCulloch
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Darin T Okuda
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Robin R Lincoln
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Emmanuelle Waubant
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Stephen L Hauser
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
| | - Daniel Pelletier
- From the Department of Neurology (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Epidemiology and Biostatistics (C.E.M.) and MS Center (R.R.L., E.W., S.L.H.), Department of Neurology, University of California, San Francisco; and Department of Neurology (D.T.O.), University of Texas Southwestern, Dallas
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18
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Chou IJ, Kuo CF, Tanasescu R, Tench CR, Tiley CG, Constantinescu CS, Whitehouse WP. Epilepsy and associated mortality in patients with multiple sclerosis. Eur J Neurol 2018; 26:342-e23. [PMID: 30312502 DOI: 10.1111/ene.13821] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to determine the prevalence of epilepsy in patients with multiple sclerosis (MS) at diagnosis, the risk of developing epilepsy after the diagnosis of MS and the relative risk of mortality associated with epilepsy. METHODS We used the UK Clinical Practice Research Data-link to identify 2526 patients with incident MS and 9980 age-, sex- and index year-matched non-MS controls from 1997 to 2006. Logistic regression was used to estimate odds ratios [95% confidence interval (CI)] for epilepsy and Cox regression was used to estimate hazard ratios (HRs) (95% CI) for epilepsy and mortality. RESULTS Patients with incident MS were on average 45 years old and 70.9% were female. At diagnosis, the prevalence of epilepsy in patients with MS was 1.30% compared with 0.57% in non-MS controls. At diagnosis, MS was associated with an adjusted odds ratio (95% CI) of 2.11 (1.36-3.27) for pre-existing epilepsy. Among epilepsy-free patients, the cumulative probabilities of developing epilepsy, first recorded within 10 years of the index date, were 2.77% for patients with MS and 0.90% for controls. MS was associated with an adjusted HR (95% CI) of 6.01 (2.94-12.29) for epilepsy. Among patients with MS, epilepsy was associated with an HR (95% CI) of 2.23 (1.02-4.84) for all-cause mortality. CONCLUSIONS This population-based study found an increased prevalence of epilepsy in patients with MS at diagnosis when compared with non-MS controls and the risk of developing epilepsy was also higher following the MS diagnosis. Patients with MS with epilepsy had a higher risk of mortality compared with those without.
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Affiliation(s)
- I J Chou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham.,Division of Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan
| | - C F Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - R Tanasescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - C R Tench
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - C G Tiley
- Mevagissey Surgery, Mevagissey, Cornwall.,Lander Medical Practice, Truro, UK
| | - C S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - W P Whitehouse
- Division of Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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Poorolajal J, Bahrami M, Karami M, Hooshmand E. Effect of smoking on multiple sclerosis: a meta-analysis. J Public Health (Oxf) 2018; 39:312-320. [PMID: 27160862 DOI: 10.1093/pubmed/fdw030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Despite our awareness of the significant effect of smoking on multiple sclerosis (MS), there was a serious lack of information about the effect of different types of smoking habit on MS as well as the dose-response relationship between smoking and MS, but this gap was addressed by this meta-analysis. Methods Major electronic databases, including PubMed, Web of Science and Scopus were searched until July 2015. Epidemiological studies addressing the association between smoking and MS were enrolled. The heterogeneity across studies was investigated by Q-test and I2 statistic. The probability of publication bias was explored using Begg's and Egger's tests. The results were expressed as odds ratio (OR) with 95% confidence intervals (CI) using a random effects model. Results We identified a total of 10 687 references and included 34 studies involving 623 852 participants. Compared with nonsmokers, the OR estimate of MS was 1.46 (1.33, 1.59) among ever smokers, 1.57 (1.34, 1.80) among current smokers, 1.36 (1.27, 1.46) among ex-smokers and 1.12 (0.87, 1.36) among passive smokers. In addition, analyzing the effect of cigarette pack-year on MS indicated that the OR estimate of MS was 1.34 (1.06, 1.61) for 1-5 cigarette pack-years, 1.56 (1.15, 1.97) for 6-10 cigarette pack-years, 1.74 (1.16, 2.33) for 11-15 cigarette pack-years and 1.46 (0.49, 2.43) for more than 15 cigarette pack-years. Conclusions Smoking habits are significantly associated with MS, although the association is not very strong. However, there is a dose-response relationship between the smoking habits and MS.
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Affiliation(s)
- Jalal Poorolajal
- Modeling of Noncommunicable Diseases Research Center, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Bahrami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan 651783869, Iran
| | - Manoochehr Karami
- Social Determinants of Health Research Center (SDHRC) and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elham Hooshmand
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan 651783869, Iran
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Impaired Cardiac Function in Patients with Multiple Sclerosis by Comparison with Normal Subjects. Sci Rep 2018; 8:3300. [PMID: 29459794 PMCID: PMC5818507 DOI: 10.1038/s41598-018-21599-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 01/25/2018] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS), neurologic disease affecting young population, may cause cardiovascular dysfunction, due to autonomous nervous dysfunction, physical invalidity, increased oxidative stress, and systemic inflammatory status. However, cardiovascular function is rarely evaluated in these patients. We assessed left and right ventricular (LV and RV) function by 2D, 3D, tissue Doppler, and speckle tracking echocardiography, and vascular function by remodeling, stiffness, and endothelial dysfunction parameters in patients with MS, compared to control subjects. 103 subjects (35 ± 10 years,70 women) were studied: 67 patients with MS and 36 control subjects. Patients with MS had decreased LV systolic function, confirmed by lower 2D and 3D ejection fraction, mitral annular plane systolic excursion, longitudinal myocardial systolic velocities, and 2D and 3D global longitudinal strain. The RV function was also decreased, as demonstrated by lower fractional area change, tricuspid annular plane systolic excursion, longitudinal systolic velocities, and longitudinal strain. Additionally, LV diastolic and left atrial (LA) function were decreased compared to controls. The parameters of arterial and endothelial function were similar between groups. Patients with MS have impaired biventricular function by comparison with normal subjects, with reduced LA function, but normal arterial and endothelial function. The noninvasive echocardiographic techniques might help to determine patients with MS at risk of developing cardiovascular dysfunction.
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21
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Petersen ER, Oturai AB, Koch-Henriksen N, Magyari M, Sørensen PS, Sellebjerg F, Søndergaard HB. Smoking affects the interferon beta treatment response in multiple sclerosis. Neurology 2018; 90:e593-e600. [DOI: 10.1212/wnl.0000000000004949] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/02/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate whether smoking in patients with relapsing-remitting multiple sclerosis (RRMS) treated with interferon beta (IFN-β) is associated with the relapse rate and whether there is an interaction between smoking and human leukocyte antigen (HLA)–DRB1*15:01, HLA-A*02:01, and the N-acetyltransferase-1 (NAT1) variant rs7388368A.MethodsDNA from 834 IFN-β–treated patients with RRMS from the Danish Multiple Sclerosis Biobank was extracted for genotyping. Information about relapses from 2 years before the start of treatment to either the end of treatment or the last follow-up visit was obtained from the Danish Multiple Sclerosis Treatment Register. Smoking information came from a comprehensive questionnaire.ResultsWe found that the relapse rate in patients with RRMS during IFN-β treatment was higher in smokers compared to nonsmokers, with an incidence rate ratio (IRR) of 1.20 (95% confidence interval [CI] 1.021–1.416, p = 0.027) and with an IRR increase of 27% per pack of cigarettes per day (IRR 1.27, 95% CI 1.056–1.537, p = 0.012). We found no association or interaction with HLA and the NAT1 variant.ConclusionIn this observational cohort study, we found that smoking is associated with increased relapse activity in patients with RRMS treated with IFN-β, but we found no association or interaction with HLA or the NAT1 variant.
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22
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Degelman ML, Herman KM. Smoking and multiple sclerosis: A systematic review and meta-analysis using the Bradford Hill criteria for causation. Mult Scler Relat Disord 2017; 17:207-216. [DOI: 10.1016/j.msard.2017.07.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/26/2022]
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24
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Kvistad S, Myhr KM, Holmøy T, Benth JŠ, Løken-Amsrud KI, Wergeland S, Beiske AG, Bjerve KS, Hovdal H, Lilleås F, Midgard R, Pedersen T, Bakke SJ, Torkildsen Ø. No association of tobacco use and disease activity in multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e260. [PMID: 27458599 PMCID: PMC4946773 DOI: 10.1212/nxi.0000000000000260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/02/2016] [Indexed: 01/20/2023]
Abstract
Objective: To study whether tobacco use is associated with MRI and clinical disease activity in patients with multiple sclerosis (MS). Methods: Prospective cohort study of 87 patients with relapsing-remitting MS originally included in a randomized placebo-controlled trial of omega-3 fatty acids in MS (the OFAMS Study). Serum levels of cotinine (biomarker of tobacco use) were analyzed at baseline and every 6 months for 2 years. MRI activity was assessed at baseline and monthly for 9 months and after 12 and 24 months. Results: Fifty-three patients (61%) had serum cotinine levels ≥85 nmol/L on ≥60% of the measurements and were considered tobacco users and 34 (39%) had cotinine levels <85 nmol/L, consistent with non–tobacco use. There was no association between tobacco use and the occurrence of new gadolinium-enhancing T1 lesions, new or enlarging T2 lesions, or their aggregate (combined unique activity). Furthermore, there was no association between cotinine levels and MRI activity for the tobacco users, and tobacco users did not have more relapses or Expanded Disability Status Scale progression. Conclusion: Our results indicate that tobacco use does not directly influence MRI activity or relapse rate in MS. This may implicate that the reported association between smoking and MS disease progression could be mediated through other mechanisms.
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Affiliation(s)
- Silje Kvistad
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kjell-Morten Myhr
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Trygve Holmøy
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Jūratė Šaltytė Benth
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kristin I Løken-Amsrud
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Stig Wergeland
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Antonie G Beiske
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kristian S Bjerve
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Harald Hovdal
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Finn Lilleås
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Rune Midgard
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Tom Pedersen
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Søren J Bakke
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Øivind Torkildsen
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
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Perricone C, Versini M, Ben-Ami D, Gertel S, Watad A, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y. Smoke and autoimmunity: The fire behind the disease. Autoimmun Rev 2016; 15:354-74. [DOI: 10.1016/j.autrev.2016.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
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McKay KA, Jahanfar S, Duggan T, Tkachuk S, Tremlett H. Factors associated with onset, relapses or progression in multiple sclerosis: A systematic review. Neurotoxicology 2016; 61:189-212. [PMID: 27045883 DOI: 10.1016/j.neuro.2016.03.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system with an unidentified etiology. We systematically reviewed the literature on the possible risk factors associated with MS disease onset, relapses and progression from 1960 to 2012 by accessing six databases and including relevant systematic reviews, meta-analyses, case-control or cohort studies. The focus was on identifying modifiable risk factors. Fifteen systematic reviews and 169 original articles were quality assessed and integrated into a descriptive review. Best evidence, which included one or more prospective studies, suggested that lower exposure to sunlight and/or lower serum vitamin D levels were associated with an increased risk of developing MS onset and subsequent relapses, but a similar quality of evidence was lacking for disease progression. Prospective studies indicated that cigarette smoking may increase the risk of MS as well as accelerate disease progression, but whether smoking altered the risk of a relapse was largely unknown. Infections were implicated in both risk of developing MS and relapses, but data for progression were lacking. Specifically, exposure to the Epstein-Barr virus, particularly if this manifested as infectious mononucleosis during adolescence, was associated with increased MS risk. Upper respiratory tract infections were most commonly associated with an increase in relapses. Relapse rates typically dropped during pregnancy, but there was no strong evidence to suggest that pregnancy itself altered the risk of MS or affected long-term progression. Emerging research with the greatest potential to impact public health was the suggestion that obesity during adolescence may increase the risk of MS; if confirmed, this would be of major significance.
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Affiliation(s)
- Kyla A McKay
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Shayesteh Jahanfar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tom Duggan
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Stacey Tkachuk
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
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Zhang P, Wang R, Li Z, Wang Y, Gao C, Lv X, Song Y, Li B. The risk of smoking on multiple sclerosis: a meta-analysis based on 20,626 cases from case-control and cohort studies. PeerJ 2016; 4:e1797. [PMID: 27014514 PMCID: PMC4806598 DOI: 10.7717/peerj.1797] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/22/2016] [Indexed: 12/31/2022] Open
Abstract
Background. Multiple sclerosis (MS) has become a disease that represents a tremendous burden on patients, families, and societies. The exact etiology of MS is still unclear, but it is believed that a combination of genetic and environmental factors contribute to this disease. Although some meta-analyses on the association between smoking and MS have been previously published, a number of new studies with larger population data have published since then. Consequently, these additional critical articles need to be taken into consideration. Method. We reviewed articles by searching in PubMed and EMBASE. Both conservative and non-conservative models were used to investigate the association between smoking and the susceptibility to MS. We also explored the effect of smoking on the susceptibility to MS in strata of different genders and smoking habits. The association between passive smoking and MS was also explored. Results.The results of this study suggest that smoking is a risk factor for MS (conservative model: odds ratio (OR) 1.55, 95% CI [1.48–1.62], p < 0.001; non-conservative model: 1.57, 95% CI [1.50–1.64], p < 0.001). Smoking appears to increase the risk of MS more in men than in women and in current smokers more than in past smokers. People who exposed to passive smoking have higher risk of MS than those unexposed. Conclusion.This study demonstrated that exposure to smoking is an important risk factor for MS. People will benefit from smoking cessation, and policymakers should pay attention to the association between smoking and MS.
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Affiliation(s)
- Peng Zhang
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Rui Wang
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Zhijun Li
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Yuhan Wang
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Chunshi Gao
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Xin Lv
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Yuanyuan Song
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
| | - Bo Li
- Department of Epidemiology and Biostatistics, Jilin University School of Public Health , Changchun , China
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Weston M, Constantinescu CS. What role does tobacco smoking play in multiple sclerosis disability and mortality? A review of the evidence. Neurodegener Dis Manag 2016; 5:19-25. [PMID: 25711451 DOI: 10.2217/nmt.14.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is increasing evidence of tobacco smoking as an associative factor in multiple sclerosis (MS). Numerous studies have been conducted investigating the effects of smoking before the onset of MS as well as its impact on disease course. This special report reviews the available evidence and summarizes the contribution of smoking to increased mortality in patients with MS. It also explores some putative mechanisms for the involvement of tobacco constituents in the pathology of MS and the effects of smoking on disease-modifying treatments.
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Affiliation(s)
- Mikail Weston
- Academic Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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29
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Goodin DS. The epidemiology of multiple sclerosis: insights to a causal cascade. HANDBOOK OF CLINICAL NEUROLOGY 2016; 138:173-206. [PMID: 27637959 DOI: 10.1016/b978-0-12-802973-2.00011-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
MS-pathogenesis involves both genetic-susceptibility and environmental determinants. Three (or more) sequential environmental-factors are implicated. The first acts near birth, the second acts during childhood/adolescence, and the third acts subsequently. Two candidate factors (vitamin D deficiency and Epstein-Barr viral infection) seem particularly well-suited to the first two environmental-events but other factors (e.g., obesity and smoking behavior) seem also to be involved in the causal scheme. MS-pathogenesis can be modeled by incorporating both the environmental and genetic-factors into a causal scheme, which can then help to explain some of the changes in MS-epidemiology (e.g., increasing disease-prevalence, changing sex-ratio, and regional-variations in monozygotic-twin-concordance-rates), which have been taking place recently. This model suggests that genetic-susceptibility is overwhelmingly the most important determinant of MS and that, at least, 92.5% of individuals (and likely much more) are, essentially, incapable of developing MS, regardless of their specific environmental-exposures. Nevertheless, the genetics is complex and the contribution of any specific gene to MS-susceptibility seems to be quite modest. Thus, even for the DRB1*1501 allele (the strongest known MS-susceptibility marker), most carriers are not in the genetically-susceptible group. Moreover, 45-50% of individuals with MS lack this allele entirely and some of the haplotypes that carry this allele don't also confer any disease-risk. Finally, because the prevalence of genetic-susceptibility seems to be so similar throughout North America and Europe, and despite the crucial importance of a person's genetic make-up to disease pathogenesis, it is the environmental-factors, which largely responsible for the observed regional variations in disease-characteristics. Thus, despite MS being more common in women, men are more likely to be genetically-susceptible. This apparent paradox seems to relate to the fact that women are much more responsive than men to the recent changes in environmental-exposure (whatever these have been). These gender-differences may help to explain changes in the sex-ratio and the increasing disease-prevalence, which have both been observed recently. The potential importance of these conclusions regarding the role of environment in MS-pathogenesis is that they open the door to the possibility of pursuing strategies for primary primary disease prevention in the future.
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Affiliation(s)
- D S Goodin
- Multiple Sclerosis Center at the University of California, San Francisco, San Francisco, CA, USA.
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The Role of Environment and Lifestyle in Determining the Risk of Multiple Sclerosis. Curr Top Behav Neurosci 2015; 26:87-104. [PMID: 25707369 DOI: 10.1007/7854_2015_372] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
MS is a complex disease where both genetic and environmental factors contribute to disease susceptibility. The substantially increased risk of developing MS in relatives of affected individuals gives solid evidence for a genetic base for susceptibility, whereas the modest familial risk, most strikingly demonstrated in the twin studies, is a very strong argument for an important role of lifestyle/environmental factors in determining the risk of MS, sometimes interacting with MS risk genes. Lifestyle factors and environmental exposures are harder to accurately study and quantify than genetic factors. However, it is important to identify these factors since they, as opposed to risk genes, are potentially preventable. We have reviewed the evidence for environmental factors that have been repeatedly shown to influence the risk of MS: Epstein-Barr virus (EBV) infection, ultraviolet radiation (UVR) exposure habits /vitamin D status, and smoking. We have also reviewed a number of additional environmental factors, published in the past 5 years, that have been described to influence MS risk. Independent replication, preferably by a variety of methods, may give still more firm evidence for their involvement.
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Munger KL, Fitzgerald KC, Freedman MS, Hartung HP, Miller DH, Montalbán X, Edan G, Barkhof F, Suarez G, Radue EW, Sandbrink R, Kappos L, Pohl C, Ascherio A. No association of multiple sclerosis activity and progression with EBV or tobacco use in BENEFIT. Neurology 2015; 85:1694-701. [PMID: 26453645 DOI: 10.1212/wnl.0000000000002099] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether Epstein-Barr virus (EBV) immunoglobulin G (IgG) antibody levels or tobacco use were associated with conversion to multiple sclerosis (MS) or MS progression/activity in patients presenting with clinically isolated syndrome (CIS). METHODS In this prospective, longitudinal study, we measured EBV IgG antibody and cotinine (biomarker of tobacco use) levels at up to 4 time points (baseline, months 6, 12, and 24) among 468 participants with CIS enrolled in the BENEFIT (Betaferon/Betaseron in Newly Emerging Multiple Sclerosis for Initial Treatment) clinical trial. Outcomes included time to conversion to clinically definite or McDonald MS, number of relapses, Expanded Disability Status Scale (EDSS) changes, brain and T2 lesion volume changes, and number of new active lesions over 5 years. Analyses were adjusted for age, sex, treatment allocation, baseline serum 25-hydroxyvitamin D level, number of T2 lesions, body mass index, EDSS, steroid treatment, and CIS onset type. RESULTS We found no associations between any EBV IgG antibody or cotinine levels with conversion from CIS to MS or MS progression as measured by EDSS or activity clinically or on MRI. The relative risk of conversion from CIS to clinically definite MS was 1.14 (95% confidence interval 0.76-1.72) for the highest vs the lowest quintile of EBNA-1 IgG levels, and 0.96 (95% confidence interval 0.71-1.31) for cotinine levels >25 ng/mL vs <10. CONCLUSIONS Neither increased levels of EBV IgG antibodies, including against EBNA-1, nor elevated cotinine levels indicative of tobacco use, were associated with an increased risk of CIS conversion to MS, or MS activity or progression over a 5-year follow-up.
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Affiliation(s)
- Kassandra L Munger
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany.
| | - Kathryn C Fitzgerald
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Mark S Freedman
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Hans-Peter Hartung
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - David H Miller
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Xavier Montalbán
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Gilles Edan
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Frederik Barkhof
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Gustavo Suarez
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Ernst-Wilhelm Radue
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Rupert Sandbrink
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Ludwig Kappos
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Christoph Pohl
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Alberto Ascherio
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
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Moccia M, Lanzillo R, Palladino R, Maniscalco GT, De Rosa A, Russo C, Massarelli M, Carotenuto A, Postiglione E, Caporale O, Triassi M, Brescia Morra V. The Framingham cardiovascular risk score in multiple sclerosis. Eur J Neurol 2015; 22:1176-83. [PMID: 25912468 DOI: 10.1111/ene.12720] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Cardiovascular risk factors can increase the risk of multiple sclerosis (MS) and modify its course. However, such factors possibly interact, determining a global cardiovascular risk. Our aim was to compare the global cardiovascular risk of subjects with and without MS with the simplified 10-year Framingham General Cardiovascular Disease Risk Score (FR) and to evaluate its importance on MS-related outcomes. METHODS Age, gender, smoking status, body mass index, systolic blood pressure, type II diabetes and use of antihypertensive medications were recorded in subjects with and without MS to estimate the FR, an individualized percentage risk score estimating the 10-year likelihood of cardiovascular events. RESULTS In total, 265 MS subjects were identified with 530 matched controls. A t test showed similar FR in cases and controls (P = 0.212). Secondary progressive MS presented significantly higher FR compared to relapsing-remitting MS (P < 0.001). Linear regression analysis showed a direct relationship between FR and Expanded Disability Status Scale (P < 0.001) and MS Severity Scale (P < 0.001). CONCLUSION The FR, evaluating the global cardiovascular health by the interaction amongst different risk factors, relates to MS disability, severity and course.
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Affiliation(s)
- M Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - R Lanzillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - R Palladino
- Department of Public Health, Federico II University, Naples, Italy.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - G T Maniscalco
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Neurology Clinic, AORN 'Antonio Cardarelli', Naples, Italy
| | - A De Rosa
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - C Russo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - M Massarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Carotenuto
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - E Postiglione
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - O Caporale
- Department of Public Health, Federico II University, Naples, Italy
| | - M Triassi
- Department of Public Health, Federico II University, Naples, Italy
| | - V Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
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Mallucci G, Peruzzotti-Jametti L, Bernstock JD, Pluchino S. The role of immune cells, glia and neurons in white and gray matter pathology in multiple sclerosis. Prog Neurobiol 2015; 127-128:1-22. [PMID: 25802011 PMCID: PMC4578232 DOI: 10.1016/j.pneurobio.2015.02.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/24/2014] [Accepted: 02/27/2015] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis is one of the most common causes of chronic neurological disability beginning in early to middle adult life. Multiple sclerosis is idiopathic in nature, yet increasing correlative evidence supports a strong association between one's genetic predisposition, the environment and the immune system. Symptoms of multiple sclerosis have primarily been shown to result from a disruption in the integrity of myelinated tracts within the white matter of the central nervous system. However, recent research has also highlighted the hitherto underappreciated involvement of gray matter in multiple sclerosis disease pathophysiology, which may be especially relevant when considering the accumulation of irreversible damage and progressive disability. This review aims at providing a comprehensive overview of the interplay between inflammation, glial/neuronal damage and regeneration throughout the course of multiple sclerosis via the analysis of both white and gray matter lesional pathology. Further, we describe the common pathological mechanisms underlying both relapsing and progressive forms of multiple sclerosis, and analyze how current (as well as future) treatments may interact and/or interfere with its pathology. Understanding the putative mechanisms that drive disease pathogenesis will be key in helping to develop effective therapeutic strategies to prevent, mitigate, and treat the diverse morbidities associated with multiple sclerosis.
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Affiliation(s)
- Giulia Mallucci
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, CB2 0PY, UK
- Department of Brain and Behavioural Sciences, National Neurological Institute C. Mondino, University of Pavia, 27100 Pavia, Italy
| | - Luca Peruzzotti-Jametti
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, CB2 0PY, UK
| | - Joshua D. Bernstock
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, CB2 0PY, UK
- National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bldg10/Rm5B06, MSC 1401, 10 Center Drive, Bethesda, MD 20892, USA
| | - Stefano Pluchino
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, CB2 0PY, UK
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Ramesh T, Sureka C, Bhuvana S, Begum VH. Oxidative stress in the brain of cigarette smoke-induced noxiousness: neuroprotective role of Sesbania grandiflora. Metab Brain Dis 2015; 30:573-82. [PMID: 25217401 DOI: 10.1007/s11011-014-9614-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/25/2014] [Indexed: 12/20/2022]
Abstract
Cigarette smoking is concerned as a major risk factor in the development of various neurological disorders. Oxidative stress is suggested as a possible contributing factor in the pathogenesis of cigarette smoking-induced toxicity. Therefore, the present study was intended to evaluate the neuroprotective role of Sesbania grandiflora (S. grandiflora) against chronic cigarette smoke induced oxidative damage in rat brain. Adult male Wistar-Kyoto rats were exposed to cigarette smoke for a period of 90 days and consecutively treated with S. grandiflora aqueous suspension (SGAS, 1,000 mg/kg body weight per day by oral gavage) for a period of 3 weeks. Lipid peroxidation and antioxidants status were analyzed in the brain. Rats exposed to cigarette smoke showed significant increase in conjugated diens (CD), hydroperoxides (HP) and malendialdehyde (MDA) levels with concomitant decrease in superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione-S-transferase (GST) and glucose-6-phosphate dehydrogenase (G6PDH) activities and the levels of reduced glutathione (GSH), vitamin C and vitamin E. Also cigarette smoke-exposure resulted in a marked increase in copper and decrease in zinc, manganese and selenium levels in brain. Administration of SGAS attenuates lipid peroxidation, enhanced the antioxidant status, restored the levels of micronutrients and retained the brain histology. The results of our study indicate that chronic cigarette smoke-exposure accelerates oxidative stress, thereby disquieting the brain defensive mechanism and S. grandiflora protects the brain from the oxidative damage through its biopotency.
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Affiliation(s)
- Thiyagarajan Ramesh
- Department of Biochemistry, College of Medicine, Salman Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia,
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Dunn SE, Gunde E, Lee H. Sex-Based Differences in Multiple Sclerosis (MS): Part II: Rising Incidence of Multiple Sclerosis in Women and the Vulnerability of Men to Progression of this Disease. Curr Top Behav Neurosci 2015; 26:57-86. [PMID: 25690592 DOI: 10.1007/7854_2015_370] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It is well known that a number of autoimmune diseases including multiple sclerosis (MS) predominantly affect women and there has been much attention directed toward understanding why this is the case. Past research has revealed a number of sex differences in autoimmune responses that can account for the female bias in MS. However, much less is known about why the incidence of MS has increased exclusively in women over the past half century. The recency of this increase suggests that changing environmental or lifestyle factors are interacting with biological sex to increase MS risk predominantly in females. Indeed, a number of recent studies have identified sex-specific differences in the effect of environmental factors on MS incidence. The first part of this chapter will overview this evidence and will discuss the possible scenarios of how the environment may be interacting with autoimmune mechanisms to contribute to the preferential rise in MS incidence in women. Despite the strong female bias in MS incidence, culminating evidence from natural history studies, and imaging and pathology studies suggests that males who develop MS may exhibit a more rapid decline in disability and cognitive functioning than women. Very little is known about the biological basis of this more rapid deterioration, but some insights have been provided by studies in rodent models of demyelination/remyelination. The second part of this chapter will overview the evidence that males with relapsing-onset MS undergo a more rapid progression of disease than females and will discuss potential biological mechanisms that account for this sex difference.
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Affiliation(s)
- Shannon E Dunn
- Department of Immunology, University of Toronto, Toronto, ON, Canada. .,General Research Institute, University Health Network, Women's College Research Institute, Toronto, ON, Canada.
| | - Eva Gunde
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - Hyunwoo Lee
- Montreal Neurological Institute, McGill University, Montreal, Canada.
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Gold J, Goldacre R, Maruszak H, Giovannoni G, Yeates D, Goldacre M. HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study. J Neurol Neurosurg Psychiatry 2015; 86:9-12. [PMID: 25091370 PMCID: PMC4283699 DOI: 10.1136/jnnp-2014-307932] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Even though multiple sclerosis (MS) and HIV infection are well-documented conditions in clinical medicine, there is only a single case report of a patient with MS and HIV treated with HIV antiretroviral therapies. In this report, the patient's MS symptoms resolved completely after starting combination antiretroviral therapy and remain subsided for more than 12 years. Authors hypothesised that because the pathogenesis of MS has been linked to human endogenous retroviruses, antiretroviral therapy for HIV may be coincidentally treating or preventing progression of MS. This led researchers from Denmark to conduct an epidemiological study on the incidence of MS in a newly diagnosed HIV population (5018 HIV cases compared with 50,149 controls followed for 31,875 and 393,871 person-years, respectively). The incidence rate ratio for an HIV patient acquiring MS was low at 0.3 (95% CI 0.04 to 2.20) but did not reach statistical significance possibly due to the relatively small numbers in both groups. Our study was designed to further investigate the possible association between HIV and MS. METHODS We conducted a comparative cohort study accessing one of the world's largest linked medical data sets with a cohort of 21,207 HIV-positive patients and 5,298,496 controls stratified by age, sex, year of first hospital admission, region of residence and socioeconomic status and 'followed up' by record linkage. RESULTS Overall, the rate ratio of developing MS in people with HIV, relative to those without HIV, was 0.38 (95% CI 0.15 to 0.79). CONCLUSIONS HIV infection is associated with a significantly decreased risk of developing MS. Mechanisms of this observed possibly protective association may include immunosuppression induced by chronic HIV infection and antiretroviral medications.
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Affiliation(s)
- Julian Gold
- The Albion Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia Centre for Neuroscience and Trauma, The Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK
| | - Raph Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Hubert Maruszak
- The Albion Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia Centre for Neuroscience and Trauma, The Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Centre for Neuroscience and Trauma, The Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK
| | - David Yeates
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:231-66. [PMID: 24507521 DOI: 10.1016/b978-0-444-52001-2.00010-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of studying the epidemiology of multiple sclerosis (MS) is twofold. First, it is important to understand clearly the natural history of the illness in order to assist patients in making decisions about their future with respect to issues such as family planning, the importance of securing lifelong healthcare, their ability to get and maintain employment, and making appropriate choices of therapy for their particular circumstances. This is not to suggest that, even with the best possible information, the ultimate prognosis for any individual can be predicted with absolute accuracy. It cannot. Nevertheless, accurate information can be very helpful both to reassure patients that many individuals with MS do remarkably well in the long term (perhaps, especially, with current and future therapies) and also to empower individuals with respect to their ability to make their own life choices. Second, and arguably the more important purpose for studying the epidemiology of MS, is to gain insights to the underlying causes of the disease. Indeed, if the principal mechanisms of disease pathogenesis were to be understood clearly, then it might be possible to entertain notions of either a cure for existing disease or the primary prevention of future disease. Much of our current understanding of disease pathogenesis, as discussed in other chapters of this volume, has been derived from basic science investigations of animal models of MS such as experimental autoimmune encephalomyelitis (EAE), and these models have provided considerable insight both to the complexity of the mammalian immune system and to the mechanisms underlying its dysfunction in inflammatory autoimmune conditions. Nevertheless, MS is a disease of humans without any known, naturally occurring, counterpart in any nonhuman species. For this reason, the clues to disease pathogenesis provided by a study of basic epidemiologic facts regarding MS (and by a systematic consideration of their implications) are essential to a comprehensive understanding of the human illness we call MS.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, University of California, San Francisco, USA.
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Abstract
Although genetic susceptibility explains the clustering of multiple sclerosis (MS) cases within families, the changes in MS risk that occur with migration can be explained only by changes in the environment. The strongest known risk factor for MS is infection with Epstein-Barr virus (EBV). Compared with uninfected individuals, the hazard of developing MS is approximately 15-fold higher among individuals infected with EBV in childhood and about 30-fold higher among those infected with EBV in adolescence or later in life. Although the mechanisms underlying this association remain unclear, the data provide strong evidence of a causal relation between EBV infection and MS risk. Relevant aspects of MS epidemiology beyond genetics are not explained by EBV involvement, however, implying the involvement of other factors. Modifiable factors for MS risk include smoking and childhood obesity. Increased risk of MS in individuals with vitamin D insufficiency has been proposed to explain the strong latitude gradient in MS prevalence. Results of case-control studies that relied on prevalent MS cases have been mixed, however, and potentially influenced by selection and recall biases. In a recent case-control study of individuals presenting with a first demyelinating episode, higher levels of vitamin D, sun exposure or actinic damage were found to be associated with reduced MS risk. Two longitudinal studies have thus far been completed. In the first, based on assessment of vitamin D intake from diet and supplements, the risk of MS was found to be 30% lower among women in the highest quintile compared with those in the lowest quintile. In the second study, conducted among young adults in the US military, vitamin D status was assessed by averaging multiple season-adjusted measures of 25-hydroxyvitamin D (25[OH]D). During an average of 5 years' follow-up, MS risk among healthy young adults with serum levels of 25(OH) vitamin D >100 nmol/l was about 60% lower than in individuals of the same age and sex with serum 25(OH) vitamin D levels <100 nmol/l. If confirmed, these findings suggest that a high proportion of MS cases could be effectively prevented by vitamin D supplementation. Furthermore, there is growing evidence that vitamin D insufficiency is a risk factor for conversion from clinically isolated syndrome to MS and for MS progression. Both prevention and treatment trials with vitamin D are needed to confirm these findings and to determine optimal levels of vitamin D.
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Affiliation(s)
- Alberto Ascherio
- Harvard School of Public Health, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Smoking and multiple sclerosis: evidence for latitudinal and temporal variation. J Neurol 2014; 261:1677-83. [DOI: 10.1007/s00415-014-7397-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 11/26/2022]
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Sadovnick AD. Differential effects of genetic susceptibility factors in males and females with multiple sclerosis. Clin Immunol 2013; 149:170-5. [DOI: 10.1016/j.clim.2013.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/01/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
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Weinstock-Guttman B, Zivadinov R, Horakova D, Havrdova E, Qu J, Shyh G, Lakota E, O'Connor K, Badgett D, Tamaño-Blanco M, Tyblova M, Hussein S, Bergsland N, Willis L, Krasensky J, Vaneckova M, Seidl Z, Ramanathan M. Lipid profiles are associated with lesion formation over 24 months in interferon-β treated patients following the first demyelinating event. J Neurol Neurosurg Psychiatry 2013; 84:1186-91. [PMID: 23595944 DOI: 10.1136/jnnp-2012-304740] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the associations of serum lipid profile with disease progression in high-risk clinically isolated syndromes (CIS) after the first demyelinating event. METHODS High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were obtained in pretreatment serum from 135 high risk patients with CIS (≥ 2 brain MRI lesions and ≥ 2 oligoclonal bands) enrolled in the Observational Study of Early Interferon β-1a Treatment in High Risk Subjects after CIS study (SET study), which prospectively evaluated the effect of intramuscular interferon β-1a treatment following the first demyelinating event. Thyroid stimulating hormone, free thyroxine, 25-hydroxy vitamin D3, active smoking status and body mass index were also obtained. Clinical and MRI assessments were obtained within 4 months of the initial demyelinating event and at 6, 12 and 24 months. RESULTS The time to first relapse and number of relapses were not associated with any of the lipid profile variables. Higher LDL-C (p=0.006) and TC (p=0.001) levels were associated with increased cumulative number of new T2 lesions over 2 years. Higher free thyroxine levels were associated with lower cumulative number of contrast-enhancing lesions (p=0.008). Higher TC was associated as a trend with lower baseline whole brain volume (p=0.020). Higher high density lipoprotein was associated with higher deseasonalised 1,25-dihydroxy vitamin D3 (p=0.003) levels and a trend was found for deseasonalised 25-hydroxy vitamin D3 (p=0.014). CONCLUSIONS In early multiple sclerosis, lipid profile variables particularly LDL-C and TC levels are associated with inflammatory MRI activity measures.
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Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis. Ther Adv Neurol Disord 2013; 6:81-116. [PMID: 23483715 PMCID: PMC3582312 DOI: 10.1177/1756285612473513] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis (MS) is reviewed. Among the multiple recently discovered actions of vitamin D, an immunomodulatory role has been documented in experimental autoimmune encephalomyelitis and in humans. This action in the peripheral immune system is currently the main known mechanism through which vitamin D might influence MS, but other types of actions could be involved within the central nervous system. Furthermore, vitamin D insufficiency is widespread in temperate countries and in patients with MS at the earliest stages of the disease, suggesting that the deleterious effects related to vitamin D insufficiency may be exerted in these patients. In fact, many genetic and environmental risk factors appear to interact and contribute to MS. In genetics, several human leukocyte antigen (HLA) alleles (more particularly HLA-DRB1*1501) could favour the disease whereas some others could be protective. Some of the genes involved in vitamin D metabolism (e.g. CYP27B1) also play a significant role. Furthermore, three environmental risk factors have been identified: past Epstein-Barr virus infection, vitamin D insufficiency and cigarette smoking. Interactions between genetic and environmental risk or protective factors may occur during the mother's pregnancy and could continue during childhood and adolescence and until the disease is triggered in adulthood, therefore possibly modulating the MS risk throughout the first decades of life. Furthermore, some clinical findings already strongly suggest that vitamin D status influences the relapse rate and radiological lesions in patients with MS, although the results of adequately powered randomized clinical trials using vitamin D supplementation have not yet been reported. While awaiting these incontrovertible results, which might be long in coming, patients with MS who are currently in vitamin D insufficiency should be supplemented, at least for their general health status, using moderate doses of the vitamin.
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Affiliation(s)
- Charles Pierrot-Deseilligny
- Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
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Horakova D, Zivadinov R, Weinstock-Guttman B, Havrdova E, Qu J, Tamaño-Blanco M, Badgett D, Tyblova M, Bergsland N, Hussein S, Willis L, Krasensky J, Vaneckova M, Seidl Z, Lelkova P, Dwyer MG, Zhang M, Yu H, Duan X, Kalincik T, Ramanathan M. Environmental factors associated with disease progression after the first demyelinating event: results from the multi-center SET study. PLoS One 2013; 8:e53996. [PMID: 23320113 PMCID: PMC3540021 DOI: 10.1371/journal.pone.0053996] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives To investigate the associations of environmental MS risk factors with clinical and MRI measures of progression in high-risk clinically isolated syndromes (CIS) after the first demyelinating event. Methods We analyzed 211 CIS patients (age: 28.9±7.8 years) enrolled in the SET study, a multi-center study of high-risk CIS patients. Pre-treatment samples were analyzed for IgG antibodies against cytomegalovirus (anti-CMV), Epstein Barr virus (EBV) early nuclear antigen-1 (EBNA-1), viral capsid antigen (VCA), early antigen-diffuse (EA-D), 25 hydroxy-vitamin D3 and cotinine levels and HLA DRB1*1501 status. The inclusion criteria required evaluation within 4 months of the initial demyelinating event, 2 or more brain MRI lesions and the presence of two or more oligoclonal bands in cerebrospinal fluid. All patients were treated with interferon-beta. Clinical and MRI assessments were obtained at baseline, 6, 12, and 24 months. Results The time to first relapse decreased and the number of relapses increased with anti-CMV IgG positivity. Smoking was associated with increased number and volume of contrast-enhancing lesions (CEL) during the 2-year period. The cumulative number of CEL and T2 lesions during the 2-year period was greater for individuals in the highest quartile of anti-EBV VCA IgG antibodies. The percent loss of brain volume was increased for those in the highest quartile of with anti-EBV VCA IgG antibodies. Conclusions Relapses in CIS patients were associated with CMV positivity whereas anti-EBV VCA positivity was associated with progression on MRI measures, including accumulation of CEL and T2 lesions and development of brain atrophy.
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Affiliation(s)
- Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Robert Zivadinov
- Department of Neurology, State University of New York, Buffalo, New York, United States of America
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Bianca Weinstock-Guttman
- Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jun Qu
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Miriam Tamaño-Blanco
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Darlene Badgett
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Michaela Tyblova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Sara Hussein
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Laura Willis
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Jan Krasensky
- Department of Radiology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Petra Lelkova
- Department of Pediatrics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Michael G. Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Ming Zhang
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Haoying Yu
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Xiaotao Duan
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Tomas Kalincik
- Melbourne Brain Centre, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Murali Ramanathan
- Department of Neurology, State University of New York, Buffalo, New York, United States of America
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
- * E-mail:
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Salzer J, Hallmans G, Nyström M, Stenlund H, Wadell G, Sundström P. Smoking as a risk factor for multiple sclerosis. Mult Scler 2012; 19:1022-7. [DOI: 10.1177/1352458512470862] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Smoking has been associated with an increased risk for multiple sclerosis, but no studies have measured levels of the nicotine metabolite cotinine in prospectively collected samples to assess exposure. Objective: To investigate the effects of laboratory defined tobacco use on the risk for multiple sclerosis using prospectively collected biobank blood samples. Methods: Levels of cotinine were measured in n=192 cases, and n=384 matched controls, using an immunoassay. The risk for multiple sclerosis was estimated using matched logistic regression. Results: Elevated cotinine levels (≥10 ng/ml) were associated with a significantly increased risk for multiple sclerosis, (odds ratio, OR 1.5, 95% confidence interval, CI 1.0–2.1). This association was only present in young individuals (below median age at blood sampling, <26.4 years), (OR 2.2, 95% CI 1.3–3.8). Conclusions: This study confirms that smoking is a risk factor for multiple sclerosis. It has the advantage of using analyses of cotinine levels in samples that were collected several years before disease onset, thus excluding any risk for recall bias and minimising the risk for reversed causation. Our results also suggest that the smoking related immunological events that contribute to the development of multiple sclerosis occur early in life.
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Affiliation(s)
- Jonatan Salzer
- Department of Pharmacology and Clinical Neuroscience, Section of Neurology at Umeå University, Sweden
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Maria Nyström
- Department of Pharmacology and Clinical Neuroscience, Section of Neurology at Umeå University, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Göran Wadell
- Department of Clinical Microbiology, Umeå University, Sweden
| | - Peter Sundström
- Department of Pharmacology and Clinical Neuroscience, Section of Neurology at Umeå University, Sweden
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Mowry EM, Waubant E, McCulloch CE, Okuda DT, Evangelista AA, Lincoln RR, Gourraud PA, Brenneman D, Owen MC, Qualley P, Bucci M, Hauser SL, Pelletier D. Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis. Ann Neurol 2012; 72:234-40. [PMID: 22926855 DOI: 10.1002/ana.23591] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We sought to determine whether vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain magnetic resonance imaging (MRI) in relapsing multiple sclerosis (MS). METHODS EPIC is a 5-year longitudinal MS cohort study at the University of California at San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, we evaluated patients with clinically isolated syndrome or relapsing-remitting MS at baseline. In univariate and multivariate (adjusted for age, sex, ethnicity, smoking, and MS treatments) repeated measures analyses, annual 25-hydroxyvitamin D levels were evaluated for their association with subsequent new T2-weighted and gadolinium-enhancing T1-weighted lesions on brain MRI, clinical relapses, and disability (Expanded Disability Status Scale [EDSS]). RESULTS A total of 2,362 3T brain MRI scans were acquired from 469 subjects. In multivariate analyses, each 10ng/ml higher 25-hydroxyvitamin D level was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], 0.76-0.95; p = 0.004) and a 32% lower risk of a gadolinium-enhancing lesion (IRR, 0.68; 95% CI, 0.53-0.87; p = 0.002). Each 10ng/ml higher vitamin D level was associated with lower subsequent disability (-0.047; 95% CI, -0.091 to -0.003; p = 0.037). Higher vitamin D levels were associated with lower, but not statistically significant, relapse risk. Except for the EDSS model, all associations were stronger when the within-person change in vitamin D level was the predictor. INTERPRETATION Vitamin D levels are inversely associated with MS activity on brain MRI. These results provide further support for a randomized trial of vitamin D supplementation.
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Affiliation(s)
- Ellen M Mowry
- Multiple Sclerosis Center, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA.
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Abstract
Although strong genetic determinants of multiple sclerosis (MS) exist, the findings of migration studies support a role for environmental factors in this disease. Through rigorous epidemiological investigation, Epstein-Barr virus infection, vitamin D nutrition and cigarette smoking have been identified as likely causal factors in MS. In this Review, the strength of this evidence is discussed, as well as the potential biological mechanisms underlying the associations between MS and environmental, lifestyle and dietary factors. Both vitamin D nutrition and cigarette smoking are modifiable; as such, increasing vitamin D levels and smoking avoidance have the potential to substantially reduce MS risk and influence disease progression. Improving our understanding of the environmental factors involved in MS will lead to new and more-effective approaches to prevent this disease.
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Affiliation(s)
- Alberto Ascherio
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Khanna A, Guo M, Mehra M, Royal W. Inflammation and oxidative stress induced by cigarette smoke in Lewis rat brains. J Neuroimmunol 2012; 254:69-75. [PMID: 23031832 DOI: 10.1016/j.jneuroim.2012.09.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 01/24/2023]
Abstract
Exposure to cigarette smoke has been associated with an increased risk of neurological diseases such as stroke, Alzheimer's disease and multiple sclerosis. In these studies, serum and brain sections from Lewis rats or those exposed to cigarette smoke and control rats were examined for evidence of increased inflammation and oxidative stress. Immunocytochemical staining of brain sections from CS-exposed rats showed increased expression of class II MHC and, in ELISA, levels of IFN-gamma and TNF-α were higher than for non-exposed rats. In polymerase chain reaction assays there was increased interferon-gamma, TNF-α, IL-1α, IL-1β, IL-23, IL-6, IL-23, IL-17, IL-10, TGF-β, T-bet and FoxP3 gene expression with CS exposure. There was also markedly elevated MIP-1α/CCL3, less prominent MCP-1/CCL2 and no elevation of SDF-1α gene expression. Analysis of samples from CS-exposed and control rats for anti-oxidant expression showed no significant difference in serum levels of glutathione and, in brain, similar levels of superoxide dismutase and decreased thioredoxin gene expression. In contrast, there was increased brain gene expression for the pro-oxidants iNOS and the NADPH components NOX4, dual oxidase 1 and p22(phox). Nrf2 expression, which is typically triggered as a secondary response to oxidative stress, was also increased in brains from CS-exposed rats with nuclear translocation of this protein from cytoplasm demonstrated in astrocytes in association with increased expression of the aryl hydrocarbon receptor gene, an Nrf2 target. These studies, therefore, demonstrate that CS exposure in these animals can trigger multiple immune and oxidative responses that may have important roles in the pathogenesis of CNS inflammatory neurological diseases.
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Affiliation(s)
- A Khanna
- Department of Pathology, The University of Maryland School of Medicine, Baltimore, MD, United States
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Environmental risk factors for multiple sclerosis: a review with a focus on molecular mechanisms. Int J Mol Sci 2012; 13:11718-11752. [PMID: 23109880 PMCID: PMC3472772 DOI: 10.3390/ijms130911718] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 08/31/2012] [Accepted: 09/06/2012] [Indexed: 12/15/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system commonly affecting young adults. Pathologically, there are patches of inflammation (plaques) with demyelination of axons and oligodendrocyte loss. There is a global latitude gradient in MS prevalence, and incidence of MS is increasing (particularly in females). These changes suggest a major role for environmental factors in causation of disease. We have reviewed the evidence and potential mechanisms of action for three exposures: vitamin D, Epstein Barr virus and cigarette smoking. Recent advances supporting gene-environment interactions are reviewed. Further research is needed to establish mechanisms of causality in humans and to explore preventative strategies.
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van Rensburg SJ, Kotze MJ, van Toorn R. The conundrum of iron in multiple sclerosis--time for an individualised approach. Metab Brain Dis 2012; 27:239-53. [PMID: 22422107 PMCID: PMC3402663 DOI: 10.1007/s11011-012-9290-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/23/2012] [Indexed: 11/21/2022]
Abstract
Although the involvement of immune mechanisms in multiple sclerosis (MS) is undisputed, some argue that there is insufficient evidence to support the hypothesis that MS is an autoimmune disease, and that the difference between immune- and autoimmune disease mechanisms has yet to be clearly delineated. Uncertainties surrounding MS disease pathogenesis and the modest efficacy of currently used disease modifying treatments (DMTs) in the prevention of disability, warrant the need to explore other possibilities. It is evident from the literature that people diagnosed with MS differ widely in symptoms and clinical outcome--some patients have a benign disease course over many years without requiring any DMTs. Attempting to include all patients into a single entity is an oversimplification and may obscure important observations with therapeutic consequences. In this review we advocate an individualised approach named Pathology Supported Genetic Testing (PSGT), in which genetic tests are combined with biochemical measurements in order to identify subgroups of patients requiring different treatments. Iron dysregulation in MS is used as an example of how this approach may benefit patients. The theory that iron deposition in the brain contributes to MS pathogenesis has caused uncertainty among patients as to whether they should avoid iron. However, the fact that a subgroup of people diagnosed with MS show clinical improvement when they are on iron supplementation emphasises the importance of individualised therapy, based on genetic and biochemical determinations.
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Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, National Health Laboratory Service and University of Stellenbosch, Tygerberg Hospital, PO Box 19113, 7505 Tygerberg, South Africa.
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