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Stridh P, Huang J, Hedström AK, Alfredsson L, Olsson T, Hillert J, Manouchehrinia A, Kockum I. Season of birth is associated with multiple sclerosis and disease severity. Mult Scler J Exp Transl Clin 2021; 7:20552173211065730. [PMID: 35035988 PMCID: PMC8753082 DOI: 10.1177/20552173211065730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The latitude gradient in multiple sclerosis incidence indicates that low sun exposure and therefore vitamin D deficiency is associated with multiple sclerosis risk. OBJECTIVE Investigation of the effect of month of birth, which influences postnatal vitamin D levels, on multiple sclerosis risk and severity in Sweden. METHODS Patients and population-based controls were included from three nationwide cohorts. Differences in month of birth between cases and controls were analyzed using logistic regression and examined for effect modification by calendar year and geographic region at birth. RESULTS Males had a reduced risk of multiple sclerosis if born in the winter and increased risk if born in the early fall. Individuals born before 1960 had an increased risk if born in summer or fall. Being born in late summer and early fall was associated with more severe disease. CONCLUSIONS We identified a birth cohort effect on the association between the month of birth and multiple sclerosis, with a more significant effects for births before 1960. This coincides with a period of lower breastfeeding rates, recommended intake of vitamin D, and sun exposure, resulting in a lower vitamin D exposure during the fall/winter season for infants born in the summer.
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Affiliation(s)
- P Stridh
- Pernilla Stridh, Centrum for
Molecular Medicine, Karolinska University Hospital, Solna, L8:05, SE-171 76
Stockholm, Sweden
| | - J Huang
- Center of Molecular Medicine, Karolinska University
Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden
| | | | - L Alfredsson
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska
Institutet, Stockholm, Sweden
| | | | | | | | - I Kockum
- Center of Molecular Medicine, Karolinska University
Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden
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Walleczek NK, Frommlet F, Bsteh G, Eggers C, Rauschka H, Koppi S, Assar H, Ehling R, Birkl C, Salhofer-Polanyi S, Baumgartner A, Blechinger S, Buchinger D, Sellner J, Kraus J, Moser H, Mayr M, Guger M, Rathmaier S, Raber B, Liendl H, Hiller MS, Parigger S, Morgenstern G, Kempf I, Spiss HK, Meister B, Heine M, Cisar A, Bachler H, Khalil M, Fuchs S, Enzinger C, Fazekas F, Leutmezer F, Berger T, Kristoferitsch W, Aboulenein-Djamshidian F. Month-of-birth-effect in multiple sclerosis in Austria. Mult Scler 2018; 25:1870-1877. [PMID: 30463473 DOI: 10.1177/1352458518810924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The month-of-birth-effect (MoBE) describes the finding that multiple sclerosis (MS) patients seem to have been born significantly more frequently in spring, with a rise in May, and significantly less often in autumn and winter with the fewest births in November. OBJECTIVES To analyse if the MoBE can also be found in the Austrian MS population, and if so, whether the pattern is similar to the reported pattern in Canada, United Kingdom, and some Scandinavian countries. METHODS The data of 7886 MS patients in Austria were compared to all live births in Austria from 1940 to 2010, that is, 7.256545 data entries of the Austrian birth registry and analysed in detail. RESULTS Patterns observed in our MS cohort were not different from patterns in the general population, even when stratifying for gender. However, the noticeable and partly significant ups and downs over the examined years did not follow the distinct specific pattern with highest birth rates in spring and lowest birth rates in autumn that has been described previously for countries above the 49th latitude. CONCLUSION After correcting for month-of-birth patterns in the general Austrian population, there is no evidence for the previously described MoBE in Austrian MS patients.
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Affiliation(s)
- Nina-Katharina Walleczek
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Eggers
- Department of Neurology, Krankenhaus der Barmherzigen Brüder Linz, Linz, Austria
| | - Helmut Rauschka
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria/Department of Neurology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Stefan Koppi
- Department of Neurology, Landeskrankenhaus Rankweil, Rankweil, Austria
| | - Hamid Assar
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christoph Birkl
- Department of Neurology, Medical University Graz, Graz, Austria
| | | | - Anna Baumgartner
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | | | | | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | - Jörg Kraus
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany/Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | | | - Markus Mayr
- Department of Neurology, Bezirkskrankenhaus Kufstein, Austria
| | - Michael Guger
- Clinic for Neurology 2, Kepler University Clinic, Linz, Austria
| | | | - Bettina Raber
- Departement of Neurology, LKH Murtal Standort Knittelfeld
| | - Herburg Liendl
- Departement of Neurology, LKH Murtal Standort Knittelfeld
| | - Maria-Sophie Hiller
- Department of Neurology, Sozialmedizinisches Zentrum Baumgartner-Höhe-Otto-Wagner-Spital, Vienna, Austria
| | | | | | - Ines Kempf
- Department of Gerontoneurology / Neurological Rehabilitation, Haus der Barmherzigkeit, Vienna, Austria
| | | | - Birgit Meister
- Department of Neurology, Landeskrankenhaus Feldbach-Fürstenfeld, Austria
| | - Martin Heine
- Department of Neurology, Landeskrankenhaus Feldbach-Fürstenfeld, Austria
| | | | | | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Siegrid Fuchs
- Department of Neurology, Medical University Graz, Graz, Austria
| | | | - Franz Fazekas
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Kristoferitsch
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Fahmy Aboulenein-Djamshidian
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria/Department of Neurology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
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Watad A, Azrielant S, Bragazzi NL, Sharif K, David P, Katz I, Aljadeff G, Quaresma M, Tanay G, Adawi M, Amital H, Shoenfeld Y. Seasonality and autoimmune diseases: The contribution of the four seasons to the mosaic of autoimmunity. J Autoimmun 2017. [PMID: 28624334 DOI: 10.1016/j.jaut.2017.06.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Autoimmune diseases (ADs) are a heterogeneous groups of diseases that occur as a results of loss of tolerance to self antigens. While the etiopathogeneis remain obscure, different environmental factors were suggested to have a role in the development of autoimmunity, including infections, low vitamin D levels, UV radiation, and melatonin. Interestingly, such factors possess seasonal variation patterns that could influence disease development, severity and progression. Vitamin D levels which reach a nadir during late winter and early spring is correlated with increased disease activity, clinical severity as well as relapse rates in several disease entities including multiple sclerosis (MS), non-cutaneous flares of systemic lupus erythematosus (SLE), psoriasis, and rheumatoid arthritis (RA). Additionally, immunomodulatory actions of melatonin secretion ameliorate the severity of several ADs including MS and SLE. Melatonin levels are lowest during spring, a finding that correlates with the highest exacerbation rates of MS. Further, melatonin is postulated to be involved in the etiopathogenesis of inflammatory bowel diseases (IBD) through it influence on adhesion molecule and therefore transcription factor expression. Moreover, infections can mount to ADs through pro-inflammatory cytokine release and human antigen mimicry. Seasonal patterns of infectious diseases are correlated with the onset and exacerbation of ADs. During the winter, increased incidence of Epstein-Barr virus (EBV) infectious are associated with MS and SLE flares/onset respectively. In addition, higher Rotavirus infections during the winter precedes type 1 diabetes mellitus onset (T1DM). Moreover, Escherichia coli (E. coli) infection prior to primary biliary cirrhosis (PBC) and T1DM disease onset subsequent to Coxachievirus infections are seen to occur during late summer, a finding that correlate with infectious agents' pattern of seasonality. In this review, the effects of seasonality on the onset, relapses and activity of various ADs were discussed. Consideration of seasonal variation patterns of ADs can possibly provide clues to diseases pathogenesis and lead to development of new approaches in treatment and preventative care.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shir Azrielant
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Kassem Sharif
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Paula David
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Itay Katz
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gali Aljadeff
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Mariana Quaresma
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Galya Tanay
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohammad Adawi
- Baruch Padeh and Ziv hospitals, Bar-Ilan, Faculty of Medicine, Zefat, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel.
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4
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Association between seasonal factors and multiple sclerosis. Eur J Epidemiol 2016; 31:1081-1089. [DOI: 10.1007/s10654-016-0165-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/18/2016] [Indexed: 02/06/2023]
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Tolou-Ghamari Z, Shygannejad V, Ashtari F, Chitsaz A, Palizban AA. Preliminary analysis of month of birth in Iranian/Isfahan patients with multiple sclerosis. Adv Biomed Res 2015; 4:166. [PMID: 26436080 PMCID: PMC4581128 DOI: 10.4103/2277-9175.162543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 10/30/2014] [Indexed: 11/06/2022] Open
Abstract
Background: Previous publications reported that an individual's month of birth (MOB) might have an important correlation to that consequent risk of multiple sclerosis (MS). Aim: The aim of this preliminary study was to investigate the distribution of different MOBs inpatients with MS in Isfahan, Iran. Materials and Methods: This investigation was conducted to the Isfahan Neurosciences Research Centre. 1283 patients with MS were studied. Clinical data were recorded in d-Base and analyzed using SPSS (version 18) for Windows. Results: Of the total population studied there were 979 females and 304 males. The mean age of all the patients was 34.6 years (range 10-87 years). Within the total population, the MOBs in the 62% of patients were in the season's spring and summer, and in 38% of patients they were in the season's autumn and winter. As the MOB might be recognized to have a bearing on an individual's risk of contracting MS, the highest and lowest correlations seem to be linked with April, September, May (↑), and November (↓), respectively. Conclusions: The seasonal relationship between MOBs and MS risk might be pointed toward a potential function for vitamin D throughout pregnancy or the early life of the newborn. Further studies are needed to confirm these correlations.
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Affiliation(s)
| | - Vahid Shygannejad
- Isfahan Neurosciences Research Centre, Alzahra Hospital, Isfahan, Iran ; Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Centre, Alzahra Hospital, Isfahan, Iran ; Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Chitsaz
- Isfahan Neurosciences Research Centre, Alzahra Hospital, Isfahan, Iran ; Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Ali Palizban
- Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Simpson S, Taylor BV, van der Mei I. The role of epidemiology in MS research: Past successes, current challenges and future potential. Mult Scler 2015; 21:969-77. [DOI: 10.1177/1352458515574896] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/04/2015] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a multifaceted condition, with a range of environmental, behavioural and genetic factors implicated in its aetiology and clinical course. Successes in advancing our appreciation of the roles of Epstein-Barr virus, vitamin D/UV and the HLA-DRB1 locus; and our greater understanding of these and related factors’ modes of action in MS and other conditions, can be attributed in no small part to the work of generations of epidemiologists. Hardly content to rest on our laurels, however, there are yet a range of unsolved conundrums in MS, including some changes in epidemiological characteristics (e.g. increasing incidence and sex ratio), to say nothing of the unresolved parts regarding what underlies MS risk and its clinical course. There is evidence that epidemiology will continue to play a crucial role in unravelling the architecture of MS causation and clinical course. While classic epidemiological methods are ongoing, novel avenues for research include gene-environment interaction studies, the world of ‘-omic’ research, and the utilisation of mobile and social media tools to both access and track study populations, which means that the epidemiological discoveries of the past century may be but a glimpse of our understanding in the next few decades.
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Affiliation(s)
- Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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7
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Pakpoor J, Ramagopalan S. Evidence for an Association Between Vitamin D and Multiple Sclerosis. Curr Top Behav Neurosci 2015; 26:105-115. [PMID: 25502544 DOI: 10.1007/7854_2014_358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The cause of MS remains unknown, but a number of genetic and environmental risk factors, and their interactions, are thought to contribute to disease risk. A substantial evidence base now exists supporting an association between vitamin D and MS, primarily illustrated by a latitudinal gradient of MS prevalence, a month of birth effect, an interaction of vitamin D with MS-associated genes and the fact that high vitamin D levels have been associated with a reduced MS risk in longitudinal prospective work. The association is primarily based on epidemiological studies which renders the more elusive question of whether this association truly represents causation, or indeed reverse causality in the light of a potentially uncharacterised pro-dromal phase of the disease. The prospect of vitamin D supplementation preventing MS is a very attractive notion, but a number of areas of inconsistencies and unanswered questions exist. Most notably, future work will need to establish appropriate dosing, timing and method of vitamin D supplementation in optimising any potential clinical benefit. In this chapter, we discuss the strong epidemiological and growing mechanistic evidence supporting an association between vitamin D and MS, and aim to highlight areas of current debate and where future efforts would be well worth targeting. Given that MS is currently the most common, and a rising, cause of neurological disability in young adults in the Western world, elucidating the relationship between vitamin D and MS is a necessary priority in aiming to further develop therapeutic and preventative strategies against this disease.
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Affiliation(s)
- Julia Pakpoor
- Oxford University Medical School, John Radcliffe Hospital, Oxford, UK
| | - Sreeram Ramagopalan
- Medical Research Council Functional Genomics Unit, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
- Evidera, No. 1 Butterwick, London, W6 8DL, UK.
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8
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Zhou Y, Taylor B, van der Mei I, Stewart N, Charlesworth J, Blizzard L, Ponsonby AL, Dwyer T, Pittas F, Simpson S. Genetic variation in PBMC-produced IFN-γ and TNF-α associations with relapse in multiple sclerosis. J Neurol Sci 2014; 349:40-4. [PMID: 25575858 DOI: 10.1016/j.jns.2014.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/17/2014] [Accepted: 12/15/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alterations in peripheral blood mononuclear cell (PBMC) cytokine production have been found in multiple sclerosis (MS) compared to healthy controls. We have previously found that stimulated PBMC-produced TNF-α and IFN-γ modulated MS relapse risk, such that raised TNF-α was protective, while raised IFN-γ increased relapse risk. OBJECTIVE To assess whether SNPs within genes for relevant cytokines and their receptors modulate the associations of TNF-α and IFN-γ with relapse, thus providing additional information about these cytokine effects and the roles of these genes in MS. METHODS Prospective cohort of 91 participants with relapsing-remitting MS and cytokine and genotype data. SNPs (N=361) within a window of 10 kb around each cytokine/cytokine receptor gene (N=84) were selected for analysis. Predictors of PBMC cytokines were evaluated by multilevel mixed-effects linear regression. Predictors of relapse were evaluated by Cox proportional hazards regression. Bonferroni correction was used to adjust for multiple testing; thus p<1.39 × 10(-4) was defined as significant. RESULTS Individuals of GG genotype of rs3218295 (within the gene IL2RB) demonstrated a significant protective effect of TNF-α on relapse while those of GA/AA genotype showed a significant positive association (pinteraction=5.04 × 10(-5)). Carriers of CC genotype of rs522807 (3' region of TNFRSF1B) and the AA genotype of rs25879 (5' region of IL3) showed a strong association between IFN-γ and increased relapse risk (pinteraction=8.21 × 10(-5) and 1.70 × 10(-5), respectively). CONCLUSIONS Our results show novel modulation of TNF-α and IFN-γ associations with relapse by SNPs in major cytokines. These findings suggest the potential for these genes and/or their products as potential therapeutic targets in MS.
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Affiliation(s)
- Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Niall Stewart
- School of Pharmacy, University of Tasmania, Australia; School of Medicine, University of Tasmania, Australia
| | - Jac Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | | | - Terence Dwyer
- Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Fotini Pittas
- School of Medicine, University of Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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Abstract
Autoimmune disease manifests in numerous forms, but as a disease group is relatively common in the population. It is complex in aetiology, with genetic and environmental determinants. The involvement of gene variants in autoimmune disease is well established, and evidence for significant involvement of the environment in various disease forms is growing. These factors may act independently, or they may interact, with the effect of one factor influenced by the presence of another. Identifying combinations of genetic and environmental factors that interact in autoimmune disease has the capacity to more fully explain disease risk profile, and to uncover underlying molecular mechanisms contributing to disease pathogenesis. In turn, such knowledge is likely to contribute significantly to the development of personalised medicine, and targeted preventative approaches. In this review, we consider the current evidence for gene-environment (G-E) interaction in autoimmune disease. Large-scale G-E interaction research efforts, while well-justified, face significant practical and methodological challenges. However, it is clear from the evidence that has already been generated that knowledge on how genes and environment interact at a biological level will be crucial in fully understanding the processes that manifest as autoimmunity.
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10
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Interactions of environment and genes in multiple sclerosis. J Neurol Sci 2013; 334:161-3. [PMID: 24007873 DOI: 10.1016/j.jns.2013.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/07/2013] [Indexed: 11/22/2022]
Abstract
MS susceptibility is comprised of both genetic and environmental factors and it has become increasingly clear that these interact. The major histocompatiblity complex is the major site of the interactions which determine MS risk.
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Becker J, Callegaro D, Lana-Peixoto MA, Ferreira MLB, Melo A, Diniz da Gama P, Souza DG, Teixeira CA, Kaimen-Maciel DR, Gonçalves MV, Matta AP, Abraham R, Furtado LET, Lino A, Hauck L, Barreira AA, Gomes I. Season of birth as a risk factor for multiple sclerosis in Brazil. J Neurol Sci 2013; 329:6-10. [DOI: 10.1016/j.jns.2013.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 02/01/2013] [Accepted: 03/05/2013] [Indexed: 11/25/2022]
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12
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Verheul F, Smolders J, Trojano M, Lepore V, Zwanikken C, Amato MP, Grand'Maison F, Butzkueven H, Marrosu M, Duquette P, Comi G, Izquierdo G, Grammond P, Lus G, Petersen T, Bergamaschi R, Giuliani G, Boz C, Coniglio G, Van Pesch V, Lechner-Scott J, Cavalla P, Granella F, Avolio C, Fiol M, Poehlau D, Saladino ML, Gallo P, Deri N, Oleschko Arruda W, Paine M, Ferro M, Barnett M, Cabrera-Gomez JA, Slee M, Moore F, Shaw C, Petkovska-Boskova T, Rutherford M, Engelsen O, Damoiseaux J, Hupperts R. Fluctuations of MS births and UV-light exposure. Acta Neurol Scand 2013; 127:301-8. [PMID: 22970985 DOI: 10.1111/ane.12007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) are more frequently born in spring when compared to autumn. Fluctuation of UV-light has been hypothesized to drive this phenomenon. AIM To assess the correlation between fluctuation of sunlight and birth season in persons with MS. METHODS For this record-linkage study, we collected from the international MSBase and the Italian MS iMed-web databases the dates of birth of 11,415 patients with MS from 36 centres from 15 countries worldwide and compared these to dates of live-births from national registries. From all participating sites, we collected data on UV-light fluctuation and assessed its correlation with seasonal fluctuation in MS births. RESULTS Compared with the reference cohort, an increased proportion of persons with MS were born in spring and a decreased proportion in autumn (odds ratio (OR) to be born in spring versus autumn = 1.158, χ² = 36.347, P < 0.001). There was no significantly increased fluctuation of MS births with increased quartile of ambient UV-light fluctuation (Ptrend = 0.086). CONCLUSION Seasonal fluctuation of MS births as found in this worldwide cohort of patients with MS did not correlate with variation in seasonal fluctuation of UV-light. Most likely, it results from a complex interplay between fluctuation of sunlight, behavioural factors, other environmental factors and (epi)genetic factors.
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Affiliation(s)
- F. Verheul
- Groene Hart Ziekenhuis; Gouda; The Netherlands
| | | | | | - V. Lepore
- Consorzio Mario Negri Sud; Santa Maria Imbaro; Italy
| | | | | | | | - H. Butzkueven
- Department of Medicine; Melbourne Brain Centre; University of Melbourne; Melbourne; Vic.; Australia
| | | | | | - G. Comi
- University of Milan; Milan; Italy
| | | | | | - G. Lus
- Second University of Naples; Naples; Italy
| | | | | | | | - C. Boz
- Karadeniz Technical University; Trabzon; Turkey
| | | | - V. Van Pesch
- Cliniques Universitaires Saint-Luc; Brussels; Belgium
| | | | | | | | | | - M. Fiol
- FLENI; Buenos Aires; Argentina
| | | | | | - P. Gallo
- University of Padova; Padova; Italy
| | - N. Deri
- Hospital Fernandez; Buenos Aires; Argentina
| | | | - M. Paine
- St Vincent's Hospital; Melbourne; Vic.; Australia
| | | | - M. Barnett
- Brain and Mind Research Institute; Sydney; NSW; Australia
| | | | - M. Slee
- Flinders Medical Centre; Bedford Park; SA; Australia
| | - F. Moore
- Jewish General Hospital; Montreal; Canada
| | - C. Shaw
- Geelong Hospital; Geelong; Vic.; Australia
| | | | | | - O. Engelsen
- Norwegian Institute for Air Research; Tromsø; Norway
| | - J. Damoiseaux
- Maastricht University Medical Center; Maastricht; The Netherlands
| | - R. Hupperts
- Orbis Medical Center; Sittard; The Netherlands
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Hewer S, Lucas R, van der Mei I, Taylor BV. Vitamin D and multiple sclerosis. J Clin Neurosci 2013; 20:634-41. [PMID: 23540892 DOI: 10.1016/j.jocn.2012.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 12/19/2022]
Abstract
The role of vitamin D supplementation in preventing multiple sclerosis (MS) and/or treating MS progression is an area of significant research interest. We detail the current status of the ongoing research in this field, and note the lack of class 1 evidence from well-conducted, large, double-blind, placebo-controlled studies of vitamin D supplementation in the prevention and/or treatment of MS. We have been able to provide some guidelines for practitioners based on the substantial burden of supportive evidence for the use of vitamin D in MS as summarised here. These guidelines may provide some support to those clinicians who treat people with MS and their families.
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Affiliation(s)
- Sarah Hewer
- Royal Hobart Hospital, Department of Neurology, Hobart, Tasmania, Australia
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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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Hollis BW, Wagner CL. Vitamin D and pregnancy: skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int 2013; 92:128-39. [PMID: 22623177 DOI: 10.1007/s00223-012-9607-4] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/10/2012] [Indexed: 02/08/2023]
Abstract
The function and requirement of vitamin D during pregnancy for both mother and fetus have remained a mystery. This fact was highlighted by The Cochrane Review in 2000, which reported a lack of randomized controlled trials (RCTs) with respect to vitamin D requirements during pregnancy. Unfortunately, during the past decade only a single RCT has been performed with respect to vitamin D requirements during pregnancy. In this review we will discuss vitamin D metabolism during pregnancy as well as the consequences of vitamin D deficiency on skeletal, nonskeletal, and birth outcomes using birth observational data and data from our recent RCT. New RCT data strongly support previous observational studies in that improving nutritional vitamin D status will improve birth outcomes. The new RCT data indicate that 4,000 IU/day vitamin D(3) during pregnancy will "normalize" vitamin D metabolism and improve birth outcomes including primary cesarean section and comorbidities of pregnancy with no risk of side effects.
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Affiliation(s)
- Bruce W Hollis
- Department of Pediatrics, Darby Children's Research Institute, Medical University of South Carolina, 173 Ashley Ave., Room 313, Charleston, SC 29425, USA.
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Grytten N, Torkildsen Ø, Aarseth JH, Benjaminsen E, Celius EG, Dahl OP, Holmøy T, Løken-Amsrud K, Midgard R, Myhr KM, Risberg G, Vatne A, Kampman MT. Month of birth as a latitude-dependent risk factor for multiple sclerosis in Norway. Mult Scler 2012; 19:1028-34. [PMID: 23257620 DOI: 10.1177/1352458512471094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine if the risk of Multiple Sclerosis (MS) is associated with month of birth in Norway and to explore a possible latitudinal gradient. METHODS All patients with MS born between 1930 and 1979 registered in the Norwegian MS Registry or ascertained in Norwegian prevalence studies were included (n = 6649). The latitude gradient was divided in Southern, Middle and Northern Norway, according to the estimated regional yearly mean vitamin D effective UV dose. RESULTS Risk of MS was 11% higher for those born in April (p = 0.045), and 5% higher for those born in May (p = 0.229), 5% lower for those born in November (p = 0.302) and 12% lower for those born in February (p = 0.053) compared with the corresponding population, unaffected mothers and siblings. In Southern Norway the odds ratio of MS births in April and May was 1.05 (0.98-1.24), in Middle Norway 1.11 (0.97-1.27) and in Northern Norway 1.28 (1.0-1.63) compared with the other months. CONCLUSIONS This study confirms previous reports of increased MS births in spring and decreased MS births in the winter months. This could support the role of decreased sunlight exposure during pregnancy and vitamin D deficiency in prenatal life in MS.
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Affiliation(s)
- Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Waubant E, Mowry EM, Krupp L, Chitnis T, Yeh EA, Kuntz N, Ness J, Belman A, Milazzo M, Gorman M, Weinstock-Guttman B, Rodriguez M, James JA. Antibody response to common viruses and human leukocyte antigen-DRB1 in pediatric multiple sclerosis. Mult Scler 2012; 19:891-5. [PMID: 23232601 DOI: 10.1177/1352458512469693] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As remote infections with common herpes viruses are associated with modulation of the risk of multiple sclerosis (MS), we hypothesized that antibody concentrations against these viruses may further modify risk. As many common viruses are first encountered during childhood, pediatric MS offer a unique opportunity to investigate more closely their influence on susceptibility. Our aim was to determine if MS patients who were positive for these viruses had higher levels of antibodies to these viruses. We also assessed whether human leukocyte antigen (HLA)-DRB1*1501 genotype influenced viral antibody levels. METHODS Antibody response levels toward Epstein Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV)-1, and HLA-DRB1*1501 status were determined in pediatric MS patients (n=189) and controls (n=38). Multivariate analyses were used, adjusted for age, gender, race, ethnicity and use of disease-modifying therapies. RESULTS The antibody concentrations against EBV (Epstein-Barr nuclear antigen 1 (EBNA-1), viral capsid antigen (VCA) and early antigen (EA)), CMV and HSV-1 were similar between pediatric MS patients and controls positive for seroconversion against the virus of interest. EBNA-1 humoral responses were higher in HLA-DRB1 positive individuals (p=0.005) whereas other viral humoral responses were similar in HLA-DRB1 positive and negative individuals. CONCLUSION Among those positive for EBNA-1, MS patients did not have higher levels of antibody response to EBNA-1: however, titers for EBNA-1 were higher in those who were HLA-DRB1 positive. This suggests that genotype might influence the humoral response to EBV. Whether other genotypes influence antibody response to other viruses remains to be determined.
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Affiliation(s)
- Emmanuelle Waubant
- Regional Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA 94158, USA.
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Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is a chronic inflammatory neurological condition typically affecting women of childbearing age. This review addresses questions that often arise in this patient group during pregnancy including the effects of pregnancy on relapse rates and long-term disease course, up-to-date advice on the use of disease-modifying MS treatments during pregnancy, the management of relapses in pregnancy and postpartum and current advice on breast feeding. RECENT FINDINGS Pregnancy is associated with a reduction in relapse frequency most marked in the final trimester with a comparable increase in relapse risk in the first 3 months postpartum. Studies examining exposure to MS therapies glatiramer acetate and interferon-beta during pregnancy have produced few negative outcomes offering the possibility of offering treatment until conception. Although initial data suggested breast feeding reduced MS relapses, the latest study demonstrated no significant benefit. SUMMARY Pregnancy is safe in most MS patients and does not negatively influence MS disease course overall. Use of disease-modifying treatments around conception should be considered on a case-by-case basis, weighing risks of drug exposure against risks of relapses. Whether breast feeding produces beneficial effects on MS relapses remain inconclusive.
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Kipp M, Amor S, Krauth R, Beyer C. Multiple sclerosis: neuroprotective alliance of estrogen-progesterone and gender. Front Neuroendocrinol 2012; 33:1-16. [PMID: 22289667 DOI: 10.1016/j.yfrne.2012.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/19/2011] [Accepted: 01/04/2012] [Indexed: 12/19/2022]
Abstract
The potential of 17β-estradiol and progesterone as neuroprotective factors is well-recognized. Persuasive data comes from in vitro and animal models reflecting a wide range of CNS disorders. These studies have endeavored to translate findings into human therapies. Nonetheless, few human studies show promising results. Evidence for neuroprotection was obtained in multiple sclerosis (MS) patients. This chronic inflammatory and demyelinating disease shows a female-to-male gender prevalence and disturbances in sex steroid production. In MS-related animal models, steroids ameliorate symptoms and protect from demyelination and neuronal damage. Both hormones operate in dampening central and brain-intrinsic immune responses and regulating local growth factor supply, oligodendrocyte and astrocyte function. This complex modulation of cell physiology and system stabilization requires the gamut of steroid-dependent signaling pathways. The identification of molecular and cellular targets of sex steroids and the understanding of cell-cell interactions in the pathogenesis will offer promise of novel therapy strategies.
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Affiliation(s)
- Markus Kipp
- Institute of Neuroanatomy, RWTH Aachen University, 52074 Aachen, Germany
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Abstract
PURPOSE OF REVIEW The topic of vitamin D supplementation during pregnancy is very controversial. This review attempts to provide balanced knowledge with respect to this topic gained in the past 18 months. RECENT FINDINGS Two recent reports, one by the Institute of Medicine, and one by The Endocrine Society are greatly divergent with respect to the nutritional requirement for vitamin D, as well as, the level of circulating 25-hydroxyvitamin D that is desirable. These recommendations will be discussed along with recent observational data and a recently completed randomized controlled trial dealing with vitamin D requirements during pregnancy. SUMMARY Current evidence supports the concept that circulating 25-hydroxyvitamin D should be 40-60 ng/ml (100-150 nmol) during pregnancy and a daily intake of 4000 IU vitamin D3 is required to attain that circulating level.
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Affiliation(s)
- Bruce W Hollis
- Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Saastamoinen KP, Auvinen MK, Tienari PJ. Month of birth is associated with multiple sclerosis but not with HLA-DR15 in Finland. Mult Scler 2011; 18:563-8. [PMID: 22041092 DOI: 10.1177/1352458511426814] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Spring birth has been found to be associated with increase in the risk of MS. However, this effect is reportedly found particularly in HLA-DR15 positive patients. OBJECTIVE Examine the month of birth (MOB) effect in Finnish MS patients and its association with HLA-DR15. METHODS Using the national register on hospitalizations during 1979-2004 we identified 8359 MS patients. We used a χ(2)-analysis to compare the distribution of MOB in MS patients versus age-adjusted controls. Patients were subdivided into 10-year birth cohorts to analyse temporal variations in MOB. A subgroup of HLA-typed MS patients (n = 657) and a population sample of healthy donors from the Finnish Bone Marrow Donor Registry (n = 19,805) were included to analyse connections between HLA-DR15 and MOB. RESULTS An April birth was associated with a 9.4% increased risk of MS (p = 0.008), whereas November birth was associated with an 11.1% decreased risk (p = 0.004) compared with the expected birth distribution. No temporal clustering in the MOB effect was found during 1900-1988. Both HLA-DR15 positive (34% increase, p = 0.043) and DR15 negative (48% increase, p = 0.0095) MS patients exhibited an increase in spring births (in May). HLA-DR15 in healthy subjects was not associated with MOB. CONCLUSIONS We confirm that spring birth increases MS risk. This phenomenon was not associated with HLA-DR15 and there was no evidence of temporal clustering. The MOB effect suggests that early developmental processes may modulate MS risk.
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Affiliation(s)
- Kari-Pekka Saastamoinen
- Department of Neurology, Helsinki University Central Hospital and Program for Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland
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Simon KC, Munger KL, Ascherio A. XVI European Charcot Foundation lecture: nutrition and environment: can MS be prevented? J Neurol Sci 2011; 311:1-8. [PMID: 21975017 DOI: 10.1016/j.jns.2011.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 09/08/2011] [Accepted: 09/08/2011] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is a relatively common debilitating neurologic disease that affects people in early adulthood. While the characteristic pathology of MS has been well described, the etiology of the disease is not well understood, despite decades of research and the identification of strong genetic and environmental candidates for susceptibility. A question central to all diseases, but posed specifically for MS at the XVI European Charcot Foundation Lecture, was 'Can MS be prevented?' To address this question, we have evaluated the available data regarding nutritional and environmental factors that may be related to MS susceptibility and suggest the extent to which a potential intervention may reduce disease burden. It is our opinion that intervention, particularly supplementation with vitamin D, could have a dramatic impact on disease prevalence. Understanding that any intervention or behavioral modification will surely act in the context of genetic susceptibility and unidentified stochastic events, it is likely that not all MS is 'preventable'. Epidemiologic observation has provided key insights into environmental and nutritional factors that may alter one's susceptibility to MS, however, there are still many questions in unraveling the etiology of this complex disease.
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Affiliation(s)
- Kelly Claire Simon
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Waubant E, Mowry EM, Krupp L, Chitnis T, Yeh EA, Kuntz N, Ness J, Chabas D, Strober J, McDonald J, Belman A, Milazzo M, Gorman M, Weinstock-Guttman B, Rodriguez M, Oksenberg JR, James JA. Common viruses associated with lower pediatric multiple sclerosis risk. Neurology 2011; 76:1989-95. [PMID: 21646624 DOI: 10.1212/wnl.0b013e31821e552a] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Because common viruses are encountered during childhood, pediatric multiple sclerosis (MS) offers a unique opportunity to investigate the influence of these viruses on disease susceptibility and the interactions between seroprevalence and select HLA genotypes. We studied seroprevalence for Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV) type 1 and HLA-DRB1*1501/1503 status as predictors of pediatric MS. METHODS This was a retrospective analysis of prospectively collected demographic, clinical, and biologic data in subjects up to 18 years of age with early MS, control subjects seen at the same regional referral pediatric MS clinics, and additional healthy pediatric control subjects. RESULTS Patients with early pediatric MS (n=189) and pediatric control subjects (n=66) were tested. Epstein-Barr nuclear antigen-1 seropositivity was associated with an increased odds of MS (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.52-9.38, p=0.004) in analyses adjusted for age, sex, race, ethnicity, and HLA-DRB1*1501/1503 status. In multivariate analyses including EBV status, a remote infection with CMV (OR 0.27, 95% CI 0.11-0.67, p=0.004) was associated with a lower risk of developing MS. Although a remote infection with HSV-1 was not associated with an increased odds of MS, a strong interaction was found between HSV-1 status and HLA-DRB1 in predicting MS (p<0.001). HSV-1 was associated with an increased risk of MS in those without a DRB1*15 allele (OR 4.11, 95% CI 1.17-14.37, p=0.03), whereas the effect was reversed in those who were DRB1*15-positive (OR 0.07, 95% CI 0.02-0.32, p=0.001). CONCLUSIONS These findings suggest that some infections with common viruses may in fact lower MS susceptibility. If this is confirmed, the pathways for risk modification remain to be elucidated.
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Affiliation(s)
- E Waubant
- UCSF Regional Pediatric Multiple Sclerosis Center, 350 Parnassus Ave., Suite 908, San Francisco, CA 94117, USA.
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van der Mei I, Simpson S, Stankovich J, Taylor B. Individual and Joint Action of Environmental Factors and Risk of MS. Neurol Clin 2011; 29:233-55. [DOI: 10.1016/j.ncl.2010.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hanwell HE, Banwell B. Assessment of evidence for a protective role of vitamin D in multiple sclerosis. Biochim Biophys Acta Mol Basis Dis 2011; 1812:202-12. [DOI: 10.1016/j.bbadis.2010.07.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 07/05/2010] [Accepted: 07/26/2010] [Indexed: 12/28/2022]
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Chao MJ, Ramagopalan SV, Herrera BM, Orton SM, Handunnetthi L, Lincoln MR, Dyment DA, Sadovnick AD, Ebers GC. MHC transmission: insights into gender bias in MS susceptibility. Neurology 2011; 76:242-6. [PMID: 21209377 DOI: 10.1212/wnl.0b013e318207b060] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Major histocompatibility complex (MHC) genes dominate genetic susceptibility factors in multiple sclerosis (MS). Given the general consensus that incidence and prevalence of MS has been rising and specifically in women, we evaluated MHC-gender interactions. METHODS In a large family-based cohort consisting of 7,093 individuals (2,127 affected individuals) from 1,055 MS families, we examined MHC transmission by family structure and gender stratified by genetic distance of affected relatives from the MS proband. RESULTS We found that affected individuals with HLA-DRB1*15-positive genotypes have higher female-to-male ratios as compared with affected individuals with HLA-DRB1*15-negative genotypes (χ(2) = 9.97, p = 0.0015) with the exception of multiplex families with 3 or more affected across 2 generations. Transmission disequilibrium test results show that HLA-DRB1*15 transmission was more distorted in collateral families vs nuclear families (χ(2) = 8.030, p = 0.0046), exclusively in affected female-female pairs (χ(2) = 7.81, p = 0.0051), but not in mixed gender pairs (χ(2) = 1.58, p = 0.21) or matched male pairs (Fisher p = 0.21). CONCLUSIONS These observations implicate the MHC as the site of interactions and modifications mediating the female-to-male gender ratio in MS and its progressive increase. They further suggest this occurs via gene-environment interactions and epigenetic modifications in this region. The difference between collateral and nuclear families provides some insight into the inheritance, decay, and gender specificity of putative epigenetic marks.
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Affiliation(s)
- M J Chao
- Department of Clinical Neurology, University of Oxford, Level 3 West Wing, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Kampman MT, Steffensen LH. The role of vitamin D in multiple sclerosis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2010; 101:137-41. [DOI: 10.1016/j.jphotobiol.2010.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 02/12/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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Pierrot-Deseilligny C, Souberbielle JC. Is hypovitaminosis D one of the environmental risk factors for multiple sclerosis? Brain 2010; 133:1869-88. [PMID: 20584945 DOI: 10.1093/brain/awq147] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The role of hypovitaminosis D as a possible risk factor for multiple sclerosis is reviewed. First, it is emphasized that hypovitaminosis D could be only one of the risk factors for multiple sclerosis and that numerous other environmental and genetic risk factors appear to interact and combine to trigger the disease. Secondly, the classical physiological notions about vitamin D have recently been challenged and the main new findings are summarized. This vitamin could have an important immunological role involving a number of organs and pathologies, including autoimmune diseases and multiple sclerosis. Furthermore, human requirements for this vitamin are much higher than previously thought, and in medium- or high-latitude countries, they might not be met in the majority of the general population due to a lack of sunshine and an increasingly urbanized lifestyle. Thereafter, the different types of studies that have helped to implicate hypovitaminosis D as a risk factor for multiple sclerosis are reviewed. In experimental autoimmune encephalomyelitis, vitamin D has been shown to play a significant immunological role. Diverse epidemiological studies suggest that a direct chain of causality exists in the general population between latitude, exposure to the sun, vitamin D status and the risk of multiple sclerosis. New epidemiological analyses from France support the existence of this chain of links. Recently reported immunological findings in patients with multiple sclerosis have consistently shown that vitamin D significantly influences regulatory T lymphocyte cells, whose role is well known in the pathogenesis of the disease. Lastly, in a number of studies on serum levels of vitamin D in multiple sclerosis, an insufficiency was observed in the great majority of patients, including at the earliest stages of the disease. The questionable specificity and significance of such results is detailed here. Based on a final global analysis of the cumulative significance of these different types of findings, it would appear likely that hypovitaminosis D is one of the risk factors for multiple sclerosis.
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Affiliation(s)
- Charles Pierrot-Deseilligny
- Service de Neurologie 1, Hôpital de la Salpêtrière, 47 bd de l'Hôpital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, 75653, Paris Cedex 13, France.
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Chao MJ, Herrera BM, Ramagopalan SV, Deluca G, Handunetthi L, Orton SM, Lincoln MR, Sadovnick AD, Ebers GC. Parent-of-origin effects at the major histocompatibility complex in multiple sclerosis. Hum Mol Genet 2010; 19:3679-89. [DOI: 10.1093/hmg/ddq282] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Oksenberg JR, Baranzini SE. Multiple sclerosis genetics—is the glass half full, or half empty? Nat Rev Neurol 2010; 6:429-37. [DOI: 10.1038/nrneurol.2010.91] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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32
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Handel AE, Giovannoni G, Ebers GC, Ramagopalan SV. Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol 2010; 6:156-66. [PMID: 20157307 DOI: 10.1038/nrneurol.2010.1] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Multiple sclerosis (MS) is a common, complex neurological disease. Epidemiological data implicate both genetic and environmental factors in the etiology of MS, with various factors interacting with one another. Environmental exposures might occur long before the disease becomes clinically evident, as suggested by the wide range in onset age. In this Review, we examine the key time periods during which the environment might contribute to MS susceptibility, as well as the potential environmental factors involved. Understanding the nature of environmental influences in MS is highly relevant to the development of public health measures that are aimed at preventing this debilitating disease.
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Affiliation(s)
- Adam E Handel
- University Department of Clinical Neurology, Level 3, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Ramagopalan SV, Ebers GC. Multiple sclerosis: major histocompatibility complexity and antigen presentation. Genome Med 2009; 1:105. [PMID: 19895714 PMCID: PMC2808740 DOI: 10.1186/gm105] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS), like many putative autoimmune diseases, has been known to be associated with the human leukocyte antigen (HLA) class II region for more than 3 decades. However, exactly how HLA class II alleles increase the risk of MS is not yet conclusively known. Recent work in large human cohorts has highlighted the fact that nearly all common HLA-DRB1 allelotypes are either positively or negatively associated with the disease, detracting from allele-specific antigen presentation as the sole mechanism of MHC associated disease susceptibility. Here, we put into context recent data on the HLA class II region in MS, including allelic heterogeneity, gene-environment interactions and epigenetics. It is clear that a complete understanding of the epistatic interactions and epigenetic features of this region will be crucial to comprehending disease pathogenesis.
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Affiliation(s)
- Sreeram V Ramagopalan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, OX3 7BN, UK
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