ECTRIMS: Risks and Triggers for MS

There’s a lot of progress being reported this week at ECTRIMS on the topic of MS risk factors and triggers. I think this is really important because if we knew exactly what causes MS, we might be able to prevent anyone from ever getting the disease again. But even more relevant to people who already live with MS is new evidence for risk factors that are within a person’s control and which may make their disease worse – or better.
For example, in a large population study by Dr. A.K. Hedström and team from Stockholm, Sweden, they confirmed that cigarette smoking increased the risk for developing MS at any age, and climbed with the amount smoked. They also found that quitting smoking completely flattened out that risk back to normal within a decade. 
The same team reported that smoking could increase a person’s risk of developing the kind of antibodies in their blood – called neutralizing antibodies – that can block the ability of interferon beta to reduce MS disease activity. All good reasons to quit.
We know genes contribute to MS risk, but that’s not the end of the story. Dr. H. Westerlind reported on a study by a team from Solna, Sweden, taking advantage of MS patient registries in Sweden, one of which dates back to the 1800’s. They took a fresh look at how much having a family member with MS increases a person’s chances of getting the disease, and they focused on identical and fraternal twins. Comparing the risk of these two groups is important because identical twins are thought to share the same genes whereas fraternal twins do not.
Using sophisticated analyses,  they found that the risk of an identical twin getting MS if the other twin has the disease was lower than in prior reports, but still much higher than in fraternal twins. This study suggests that that the role of genes may be more complicated than previously suspected. (Read more about genetic risks) This mystery is driving more studies looking at the interaction of genes with a person’s environment and lifestyle.
For example, Danish researchers Dr. A.B. Oturai and colleagues from Copenhagen looked at a group of potential risk factors, including known MS susceptibility genes, obesity in early adulthood, previous mononucleosis and high teenage alcohol consumption. They found that each of these factors contributed to lowering the age at which an individual was diagnosed with MS. A related study suggested that preventing teen obesity in people with MS susceptibility genes may reduce their risk of developing MS.
Recent studies have pointed to salt intake as a possible risk factor for developing MS or for making mice with MS-like disease worse. (Read more here) But new evidence presented this week by Drs. M.F. Farez and colleagues in Buenos Aires and Boston suggest that high salt intake may also increase MS exacerbation rates and MRI-detected disease activity in people who have the disease. It will be important to do further research in this area to confirm these results in larger numbers of people and to figure out what levels of salt in the diet might be considered OK for people with MS. 
Also discussed this week were clinical trials getting underway to test whether increasing an individual’s vitamin D levels can delay the development of MS. And the National MS Society is supporting a trial to see whether vitamin D supplements can reduce MS activity in people already diagnosed. (Read more on vitamin D)
Another emerging area of research is the gut microbiome – colonies of trillions of bacteria that inhabit our intestinal tracts, most of which are beneficial. The immune activity that occurs in the gut and which is related to the immune system, may help dictate other aspects of health, including the activity of an individual’s MS. A lecture by Dr. O. Borbye Pedersen of Copenhagen made it clear to me that this is a very promising field of study. If we could decipher the influence of the gut microbiome, we have the potential of altering it to treat or even prevent MS.  
Taken together, maybe there’s some truth to the old adage, “You are what you eat.”

**You can read abstracts for all the studies mentioned in this article by visiting the ECTRIMS 2013 Online Library**
Tags Healthy Living, Research      1

Nicholas LaRocca, PhD

Dr. Nicholas LaRocca is a consultant to the National MS Society. He is a clinical psychologist who has worked in the field of MS for over 30 years. He was an associate professor at Albert Einstein College of Medicine and New York Medical College before joining the Society in 1997. Dr. LaRocca served as vice president of health care delivery and policy research in the research programs department of the Society. In this role, he was responsible for Society funding of research to address the symptoms of MS, and the rehabilitation, epidemiology and psychosocial aspects of MS, as well as health policy studies.