tag:theconversation.com,2011:/us/topics/ms-30769/articlesMS – The Conversation2024-01-18T14:31:11Ztag:theconversation.com,2011:article/2213452024-01-18T14:31:11Z2024-01-18T14:31:11ZChristina Applegate has highlighted the challenges of living with MS – and why there’s hope for the future<figure><img src="https://images.theconversation.com/files/569816/original/file-20240117-21-x3m9b9.jpg?ixlib=rb-1.1.0&rect=4%2C9%2C3134%2C2080&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Christina Applegate, diagnosed with MS in 2021, received a standing ovation for her appearance at the Emmys 2024 awards ceremony</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/christina-applegate-and-host-anthony-anderson-speak-onstage-news-photo/1936096713?adppopup=true">Kevin Winter/Getty Images</a></span></figcaption></figure><p>Imagine standing on a stage in front of a live audience – as well as millions of TV viewers around the world. </p>
<p>How would you feel? Excited? Nervous? Scared?</p>
<p>How about if you were recently diagnosed with <a href="https://www.mssociety.org.uk/about-ms?gad_source=1&gclid=Cj0KCQiAtaOtBhCwARIsAN_x-3JG9NiYNGo68RjuKFwu3pN0FqyxxQUl6s9Q4Ra4FFVqZAbgQgCE4TAaAtaiEALw_wcB">Multiple Sclerosis (MS)</a> – an autoimmune condition that affects the nervous system – and this is one of your first public appearances since then? </p>
<p>A thrilling but challenging experience may well feel much more difficult, both physically and emotionally.</p>
<p>That was the case for actor Christina Applegate when she appeared as a presenter and nominee at the <a href="https://www.theatlantic.com/culture/archive/2024/01/christina-applegate-emmys-2024/677136/">75th Primetime Emmy Awards ceremony</a> 15th January 2024.</p>
<p>The <a href="https://www.nytimes.com/2022/11/01/arts/television/christina-applegate-dead-to-me.html">Dead to Me</a> star, who publicly <a href="https://x.com/1capplegate/status/1424982406180704259?s=20">shared her diagnosis</a> in 2021, was visibly moved by the standing ovation she received from her Hollywood contemporaries.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/jOJNgHgKnFs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Christina Applegate at the 2024 Emmy Award Ceremony.</span></figcaption>
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<p>Like her friend and <a href="https://www.vogue.co.uk/article/selma-blair-british-vogue-interview">fellow Hollywood star, Selma Blair</a>, Applegate has been characteristically frank in interviews about her experience of MS – and often highlights the added difficulties faced by those living with the condition. As she told <a href="https://www.vanityfair.com/hollywood/2023/05/christina-applegate-on-ms-and-its-toll-on-her-life-and-iconic-career-it-f-king-sucks">Vanity Fair in 2023</a>:</p>
<blockquote>
<p>With the disease of MS, it’s never a good day. You just have little s***** days. People are like, “Well, why don’t you take more showers?” Well, because getting in the shower is frightening. You can fall, you can slip, your legs can buckle … It’s frightening to me to get in there. There are just certain things that people take for granted in their lives that I took for granted. Going down the stairs, carrying things —- you can’t do that anymore. It f****** sucks. </p>
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<p><a href="https://www.nhs.uk/conditions/multiple-sclerosis/#:%7E:text=Multiple%20sclerosis%20(MS)%20is%20a,it%20can%20occasionally%20be%20mild.">MS is a lifelong condition</a> and there’s currently no cure, but medications and lifestyle interventions can help manage the disease and offer hope to those living with it.</p>
<h2>What is MS?</h2>
<p>MS is a condition that affects the brain and spinal cord. </p>
<p>In a person with MS, the immune system, which usually fights off infections, mistakenly attacks the protective sheath covering nerve fibres, which leads to a breakdown in communication between the brain and the rest of the body. </p>
<p>Over time, this relentless assault can result in permanent damage, causing an array of potential symptoms including fatigue, vision problems, balance and coordination difficulties, muscle weakness, increased muscle tone and stiffness, pain and sensory impairment, cognitive changes, emotional and mood changes, and bladder and bowel problems. </p>
<p>But MS is different for everyone and no two people will experience the same symptoms or progression of the condition. </p>
<p>Generally, however, there are two types of MS, relapsing or progressive, and each affect the body differently.</p>
<p>The most common form is the relapsing remitting type, characterised by periods of symptom exacerbation – attacks – followed by periods of remission – recovery. </p>
<p>Over time, the number of relapses typically decreases, but there’s a gradual worsening that can occur, leading to continuous progression known as secondary progressive MS.</p>
<p>The other type is primary progressive MS, a form marked by a gradual and continuous worsening of symptoms from the outset.</p>
<p>Mobility tends to be a central issue for those living with either type of MS. </p>
<p>Research suggests that <a href="https://pubmed.ncbi.nlm.nih.gov/11078767/">historically</a>, people with relapsing remitting MS often find themselves relying on walking aids approximately two decades after the onset of the disease. </p>
<p>Those with primary progressive MS, however, may need to <a href="https://www.medicalnewstoday.com/articles/315475#outlook">use walking aids earlier</a>.</p>
<p>The root cause of MS remains elusive. Research has shown that a range of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764632/">genetic and environmental factors</a> may contribute to the development of MS, including levels of vitamin D or sunlight exposure, the Epstein–Barr virus infection, obesity, and smoking. </p>
<p>MS can affect people from all backgrounds – including Hollywood stars – and age groups, although it’s typically diagnosed between ages 20 to 40. </p>
<p>The condition is two to three times more common in women than men – and, while it’s an increasing <a href="https://pubmed.ncbi.nlm.nih.gov/30679040/">global</a> challenge, the highest prevalence is in North America, western Europe, and Australasia.</p>
<h2>Hope for those living with MS</h2>
<p>Despite being a lifelong condition with the potential for progressing disability, MS is not without hope. </p>
<p>While a definitive cure remains elusive, a multitude of treatment options exist to manage the condition. </p>
<p>Disease-modifying therapies have proven effective in preventing attacks and slowing progression – and can <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ene.14823">extend the duration</a> before walking assistance becomes a necessity. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32682869/">Many experts</a> now recommend initiating these therapies early in the disease course to guard against disability. </p>
<p>Additionally, when it comes to managing the symptoms of neurological dysfunction, there are treatments that focus on addressing specific symptoms. These treatments often combine both medication and physical therapies. For example, if someone with <a href="https://www.mssociety.org.uk/about-ms/signs-and-symptoms/spasms-and-stiffness/treating-spasms-and-stiffness">MS experiences muscle spasms</a>, therapy could involve taking a particular medication as well as physiotherapy to alleviate that symptom. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8706753/">Scientific evidence</a> strongly suggests that exercise is helpful in managing physical symptoms of MS, as well as fatigue, mood, and cognition.</p>
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<img alt="A group of men and women of varying ages, dressed in sportswear, stretch during a yoga class" src="https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569968/original/file-20240118-23-bb72gg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Regular, gentle exercise can help to manage symptoms of MS.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/yoga-instructor-eric-smalls-class-during-an-adaptive-yoga-news-photo/563568605?adppopup=true">Ricardo Dearatanha/Los Angeles Times via Getty Images</a></span>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/31720862/">Some studies</a> even suggest that exercise may have disease-modifying effects – preventing attacks and progression in a manner comparable to MS medication. </p>
<p>Furthermore, there is potential for exercise and physical activity to reduce the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532251/">risk of developing MS</a>, although, so far, most evidence for the disease-modifying and risk reducing effects of exercise and physical activity comes from animal models of MS, not human studies.</p>
<p>Diet is another crucial factor in managing MS. Vitamin D deficiency and obesity are both potential risk factors in the development of MS so it’s essential to maintain a healthy, varied diet. </p>
<p>For instance, the consumption of fruits and vegetables has been recently linked to <a href="https://pubmed.ncbi.nlm.nih.gov/37851580/">a potential protective effect</a> against MS. </p>
<p>Besides the protective aspects of diet, there is <a href="https://pubmed.ncbi.nlm.nih.gov/28338444/">preliminary evidence</a> to suggest that a healthy diet has potentially positive effects on symptoms of MS. </p>
<p>For those facing the challenges of MS, it’s crucial to adopt a holistic approach, which includes both medication and healthy lifestyle choices, to managing the condition. Physical activity, avoidance of smoking, eating a good diet, and medical interventions are all <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ene.16210">powerful tools</a> in reshaping the story of life with MS.</p><img src="https://counter.theconversation.com/content/221345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Turhan Kahraman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>MS can be a challenging disease but a healthy, active lifestyle and medical therapies can help manage the symptoms – and offer hope to those living with the condition.Turhan Kahraman, Senior Lecturer , Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1759082022-04-24T14:02:38Z2022-04-24T14:02:38ZLink between Epstein-Barr virus and multiple sclerosis is a crucial discovery for people living with MS<figure><img src="https://images.theconversation.com/files/459336/original/file-20220422-12-u04klp.jpg?ixlib=rb-1.1.0&rect=40%2C20%2C5945%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">MS is an autoimmune disease in which elements of the immune system begin to damage the brain and spinal cord.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canada has one of the <a href="https://www.atlasofms.org/map/global/epidemiology/number-of-people-with-ms">highest rates of multiple sclerosis</a> (MS) in the world, with 250 out of every 100,000 people affected. </p>
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<a href="https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of two nerve cells, with one showing damage to the coating on the nerve stem" src="https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=587&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=587&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458497/original/file-20220419-24-bml9ez.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=587&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Multiple sclerosis causes damage to the myelin sheath that protects nerves in the brain and spinal cord.</span>
<span class="attribution"><span class="source">(By Stephanie021299 - Own work)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>MS is an autoimmune disease in which elements of the immune system that are designed to protect us — white blood cells and antibodies — instead <a href="http://dx.doi.org/10.3390/brainsci7060069">begin to damage the brain and spinal cord</a>. This causes <a href="https://doi.org/10.7224/1537-2073.2019-081">acute attacks — also known as relapses — of neurologic dysfunction</a> such as visual loss, trouble walking or urinary and sexual dysfunction.</p>
<h2>Environmental trigger</h2>
<p>But what causes MS? <a href="http://dx.doi.org/10.3390/ijms21134571">The answer is complex</a>. MS is caused by a combination of factors including genetic susceptibility to the disease (being born with genes that cause MS), an abnormal immune system that attacks instead of protects and an environmental trigger. </p>
<p>In a <a href="https://doi.org/10.1126/science.abj8222">study published in the journal <em>Science</em></a>, researchers found that Epstein Barr virus (EBV) – the virus that causes <a href="https://www.cdc.gov/epstein-barr/about-mono.html">mononucleosis</a> – is also an environmental trigger for MS. EBV is common, with more than 95 per cent of people being infected during their lifetime.</p>
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<img alt="Cross section of a virus particle" src="https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=549&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=549&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=549&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=690&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=690&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458940/original/file-20220420-17-mq31na.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=690&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Research suggests Epstein Barr virus is an environmental trigger for multiple sclerosis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In this study, the researchers examined the blood of a large group of adults and continued to monitor their health over a period of 20 years. The results showed that 34 out of 35 people who developed MS, who originally tested negative for EBV, tested positive for the virus prior to being diagnosed with MS. This is in contrast to 57 per cent of controls (those without MS) who tested positive for EBV. </p>
<p>This does not mean that if you had Epstein-Barr virus you will definitely develop MS. However, the study found that a new EBV infection in adults increased risk of developing MS by 32 times. An increase in MS risk was not observed for other viral infections. </p>
<h2>Identifying a major risk factor</h2>
<p>This paper describes the greatest risk factor for MS discovered to date. Importantly, the study did not look at children or teens, so it’s not known if having mononucleosis before age 18 would increase the risk of MS. </p>
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<img alt="Brain scan showing whitish patches on gray brain area" src="https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459379/original/file-20220423-26-ux3bpy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Multiple sclerosis is caused by a combination of factors including genetic susceptibility, an abnormal immune system that attacks instead of protects, and an environmental trigger.</span>
<span class="attribution"><span class="source">(Michael C. Levin)</span>, <span class="license">Author provided</span></span>
</figcaption>
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<p>The evidence that EBV infection puts someone at high risk for getting MS is a significant discovery. It means researchers can begin to design preventive treatments for MS, such as vaccines and anti-virals, like those that protect against SARS-CoV2 — the virus that causes COVID-19. </p>
<p>Other studies <a href="http://doi.org/10.1038/s41586-022-04432-7">have shown</a> that <a href="https://doi.org/10.1038/ni835">EBV infection</a> in people already diagnosed with MS can change their immune system from one that protects them from disease to one that attacks the brain and spinal cord. This is an immune response that is specific to EBV. This suggests that even in people who have MS, focusing on treatments designed to prevent EBV from altering the immune system would be a novel strategy to prevent progression. </p>
<p>The discovery of the link between EBV and risk for MS is a crucial piece of the MS puzzle, opening up new potential treatments for people living with this condition.</p><img src="https://counter.theconversation.com/content/175908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael C. Levin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The causes of multiple sclerosis (MS) are complex, but recent research found Epstein Barr virus, the same virus that causes mononucleosis, is an environmental trigger for MS.Michael C. Levin, Saskatchewan Multiple Sclerosis Clinical Research Chair and Professor of Neurology, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668612021-08-26T16:51:37Z2021-08-26T16:51:37ZHuntington’s disease: northern Scotland has one of world’s highest rates and rising sharply – here’s why<figure><img src="https://images.theconversation.com/files/418087/original/file-20210826-27-qor6d2.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C995%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Port Soy Harbour in the Grampian region of Scotland which, along with the Highlands, has a high rate of Huntington's, partly due to ancestral susceptibility to the disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunset-portsoy-harbour-on-aberdeenshire-coast-1916561861">Helen Hotson/Shutterstock</a></span></figcaption></figure><p><a href="https://www.nhs.uk/conditions/huntingtons-disease/">Huntington’s disease</a> (HD) is a devastating inherited <a href="https://www.neurodegenerationresearch.eu/what/">neurodegenerative</a> condition that causes a slow but relentless decline in mental health, thinking processes, speech, swallowing and balance, resulting in uncontrollable jerky movements.</p>
<p>Those who have the condition will eventually lose the ability to walk, talk, eat, drink, make decisions or care for themselves. A fatal condition, it typically takes between 15 and 25 years from a person developing symptoms until they die. These symptoms generally begin between the ages of 30 and 60 but can appear before or after this range. </p>
<p>The disease is caused by the faulty Huntingtin gene that expresses a toxic protein, (also called Huntingtin) which builds up and causes early brain-cell death. The child of someone with Huntington’s has a one in two chance of inheriting it, so people at risk grow up experiencing the impact on family members as they become aware of their own likelihood of getting the disease.</p>
<p>Although worldwide research is taking place, there is currently no cure for Huntington’s disease. However, the effects of many of its symptoms can be reduced with a combination of medication, dietary advice and non-medical therapies, including physiotherapy and speech therapy as well as appropriate social care and support.</p>
<p>Nearly 40 years ago, 9.94 per 100,000 people in the north of Scotland had symptoms of Huntington’s, compared to 5.4 per 100,000 elsewhere in the UK. Now our <a href="https://link.springer.com/article/10.1007/s00415-021-10505-w">latest research</a> has revealed that 14.6 people per 100,000 in this northernmost region have Huntington’s. The current figure for rest of the UK is <a href="https://huntingtonstudygroup.org/hd-insights/how-many-people-have-huntington-disease/">12.4 per 100,000</a>, illustrating that rates are rising generally, but remain particularly high in Scotland.</p>
<h2>Revisiting the past</h2>
<p>Our research team decided to re-run a <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/prevalence-and-patterns-of-care-of-huntingtons-chorea-in-grampian/2B2FC63C8CBABFE90FDC176EFE956BBC">1984 study</a> that had examined the prevalence of Huntington’s in the Grampian region. We used medical records from labs and HD clinics across the Highlands and Grampian regions to count the number of people across the north of Scotland tested and diagnosed with the condition in the intervening years. Remarkably, we found that cases have increased by 46% since 1984. </p>
<p>In addition, over the last four years, 23% more people with no symptoms but a personal or family history of HD have had a genetic test to see if they will develop the condition – possibly in the hope of taking part in trials that might slow the disease.</p>
<p>Our findings mean that northern Scotland has among the highest rates of Huntington’s disease in the world. Its prevalence is almost three times greater than reported elsewhere in Europe (4.7 per 100,000); North America (4.1-5.2 per 100,000); Japan (0.1 per 100,000); Australia (5.70 per 100,000 people) – and more than five times the estimated worldwide rate of 2.71 per 100,000 people.</p>
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<h2>History, awareness and support</h2>
<p>Since the identification of the Huntington’s gene in 1993 made testing for the condition possible, awareness has increased and a diagnosis can now be made in people unaware of their family history of the condition. Along with better care and hope of treatment trials, this has led to more people coming forward for testing. </p>
<p>We believe the high rates of HD diagnosis in Grampian and Highland are due to a combination of underlying genetic susceptibility in ancestral populations dating back to the rule of <a href="https://www.bbc.co.uk/scotland/history/articles/kingdom_of_the_picts/">the Picts</a>; increased awareness that diagnosis will lead to better care and support services; and the region having one of the oldest specialist Huntington’s research clinics in the world. Interestingly, there is also a higher incidence of <a href="https://mstrust.org.uk/a-z/prevalence-and-incidence-multiple-sclerosis">of multiple sclerosis</a> (MS) in the north of Scotland, though no equivalent genetic explanation for some of the cases.</p>
<p>We did note that the rates of Huntington’s also vary between the different health board regions in the north of Scotland, with more cases in Highland and fewer in Orkney and Shetland compared with Grampian. This local variation in rates could have major drug cost and service delivery implications for the NHS, especially if expensive, complexly administered therapies prove successful. </p>
<p>Although the condition is particularly common in northern Scotland, our data clearly shows that there is far more Huntington’s diagnosed now than the <a href="https://jnnp.bmj.com/content/84/10/1156#ref-4">previous prevalence studies</a> suggest, and more people with the HD gene are testing before the appearance of symptoms to access better care and research trials.</p>
<p>The increased diagnosis rate for Huntington’s is likely to be even greater in regions around the world where there has been no long-term focus on the diagnosis and management of the disease.</p>
<p>Health care providers worldwide should now assess local need for specialist services in the expectation that Huntington’s is more common than previously thought. They also need to plan for therapies that can help with the condition, making them part of routine clinical care by improving local services, providing Huntington’s clinics, and studying the prevalence of the disease in their country.</p><img src="https://counter.theconversation.com/content/166861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zofia Miedzybrodzka receives funding from NHS Grampian Huntington disease endowment fund, CHDI, EHDN and the Chief Scientist Office to support Huntington's disease research. NHS Grampian receives funding on behalf of Prof Miedzybrodzka as reimbursement of expenses for the centre taking part in clinical trials in HD from Roche and Prilenia, and from Novartis for consultancy. </span></em></p>Better awareness of the disease has led to more testing, but there is also an ancestral element to explaining its proliferation in the UK’s far north.Zofia Miedzybrodzka, Personal Chair (Clinical) Medical Genetics, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1443672020-11-10T11:39:05Z2020-11-10T11:39:05ZYour gut microbiome may be linked to dementia, Parkinson’s disease and MS<figure><img src="https://images.theconversation.com/files/368306/original/file-20201109-15-1jbcwpv.jpg?ixlib=rb-1.1.0&rect=48%2C8%2C5423%2C3279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our stomach and brain are connected through the 'gut-brain axis'.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/gutbrain-connection-gut-brain-axis-concept-643543306">Anatomy Image/ Shutterstock</a></span></figcaption></figure><p>Within our body and on our skin, trillions of bacteria and viruses exist as part of complex ecosystems called microbiomes. Microbiomes play an important role in human <a href="https://pubmed.ncbi.nlm.nih.gov/25985709/">health and disease</a> – and even help us maintain a <a href="https://www.bmj.com/content/361/bmj.k2179">healthy metabolism and immune system</a>. One of the most important microbiomes in our body is our gut microbiome. It helps us maintain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924442/">overall wellbeing</a> by helping us to absorb all the vitamins and minerals from the food we eat.</p>
<p>But when our gut microbiome’s balance becomes disrupted (from things like stress, illness, or poor diet), it can not only result in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/">digestion and gut problems</a>, but has even been linked to <a href="https://www.sciencedirect.com/science/article/pii/S1931312817304407">obesity</a>, <a href="https://www.biomodulation.com/attachments/article/123/159.full.pd">diabetes</a>, and surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/16330147/">brain disorders</a>. This shows us that it might be time to look outside the skull to understand the cause of some brain conditions.</p>
<p>Our gut and brain are closely connected. They communicate with each other through the system known as the <a href="https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain-axis/">gut-brain (or brain-gut) axis</a>. This axis influences the digestive system’s activity and plays a role in appetite and the type of food we prefer to eat. It’s made up of brain cells (neurons), hormones, and proteins that allow the brain to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/">send messages to the gut</a> (and vice versa). </p>
<p>The gut-brain axis is known to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371005/">play a role</a> in irritable bowel syndrome, celiac disease, and colitis. <a href="https://www.sciencedirect.com/science/article/pii/S2352289516300509">Stress signals</a> from the brain can influence digestion through this axis, and the gut can also send signals that similarly influence the brain. Gut microbes appear to play a key role in <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2982.2010.01664.x">sending and receiving</a> these signals. </p>
<p>One way they do this is by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999848/">making proteins</a> that carry messages to the brain. The microbiome can also influence brain activity through the vagus nerve, one of the brain’s <a href="https://teachmeanatomy.info/head/cranial-nerves/summary/">12 cranial nerve pairs</a>. This nerve snakes through the body connecting internal organs – including the gut – to the brainstem at the base of the brain. In this way, the vagus nerve provides a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808284/">physical pathway</a> between the gut and brain, enabling a different route to the chemical pathways of the gut-brain axis for communication between brain and gut. Through this connection, an unhealthy microbiome can transmit harmful pathogens and abnormal proteins to the brain, where they may spread. </p>
<h2>Dysbiosis</h2>
<p>When the microbiome becomes unbalanced, the first sign is usually digestive problems – known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315779/">gut dysbiosis</a>. Symptoms can include, intestinal inflammation, leaky gut (where the gut wall begins to weaken), constipation, diarrhoea, nausea, bloating and other gut-based metabolic changes. Immune response and normal bodily functions such as liver, heart and kidney function may also be negatively affected by dysbiosis. Dysbiosis <a href="https://pubmed.ncbi.nlm.nih.gov/30535609/">can be reversed</a> depending upon cause. For example, a stomach bug or poor diet can be more easily fixed than disease a or illness such as cancer, obesity, or diabetes. </p>
<figure class="align-center ">
<img alt="A bowl of healthy foods, including avocado, chickeas, and tomatoes." src="https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368309/original/file-20201109-21-1a2eg45.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A healthy diet may fix gut dysbiosis in some instances.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-eating-healthy-lunch-on-dark-1105520444">Anna Kucher/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Scientists have investigated the impact of dysbiosis on different <a href="https://www.sciencedirect.com/science/article/pii/S2095809918309500">neurological disorders</a>, including Alzheimer’s, Huntington’s and Parkinson’s disease, and multiple sclerosis, with early research finding a link between the two. For example, researchers found that in patients with <a href="https://core.ac.uk/download/pdf/197478001.pdf">Parkinson’s disease</a> gut dysbiosis, often as constipation, is common. Gut problems may be present several decades before typical symptoms appear, with evidence showing the microbiome is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/mds.26069">altered early in the condition</a>. Research also shows that the <a href="https://pubmed.ncbi.nlm.nih.gov/27591074/">mix of bacterial species</a> present in the gut is different compared to people without the disease. </p>
<p>Gut dysbiosis, in the form of diarrhoea and constipation, is also <a href="https://pubmed.ncbi.nlm.nih.gov/24163768/">associated with multiple sclerosis</a> (MS). Researchers have found that patients with MS have a <a href="https://pubmed.ncbi.nlm.nih.gov/27346372/">different microbiome</a> compared to those who don’t have the condition. Other research has found that patients with dementia-like conditions, including mild cognitive impairment and Alzheimer’s disease, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1552526019351234">have dysbiosis</a> compared to those without memory problems. </p>
<p>All of this early research suggests a disrupted microbiome contributes to the development of neurological disorders by negatively affecting the gut-brain axis. It does this by <a href="https://pubmed.ncbi.nlm.nih.gov/24997031/">transmitting abnormal proteins and pathogens</a> along the vagal nerve route. However, the initial cause of microbiome disruption in those with neurological conditions is not yet known. </p>
<p>But on a positive note, our gut microbiome can be modified. A diet <a href="https://www.sciencedirect.com/science/article/pii/S0304394016300775">rich in fibre</a>, <a href="https://www.frontiersin.org/articles/10.3389/fncel.2015.00392/full">limiting stress</a>, alcohol use and smoking, exercising daily, and <a href="https://pubmed.ncbi.nlm.nih.gov/30757920/">using a probiotic</a> can all bolster our gut microbiome’s health.</p>
<p>It’s currently uncertain whether daily probiotic use can help prevent neurological diseases, which is something we’re currently investigating. We are the first team to investigate probiotic use in Parkinson’s disease patients to study their microbiome before and after use.</p>
<p>As our knowledge increases, microbiome-targeted therapies might present a new way of treating or minimising diseases. Probiotic use is a promising approach because there are <a href="https://www.tandfonline.com/doi/pdf/10.1080/11026480410026447">few adverse effects</a>, medications are likely to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045146/">better absorbed</a> in a healthier gut environment, it’s less complicated than changing your diet, and is quick and easy to implement. It s early days, and there is still much to learn, but based on current research it appears that gut microbiome health is more intimately tied to our brain health than we imagine.</p><img src="https://counter.theconversation.com/content/144367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our gut microbes play a key role in sending and receiving signals that influence the brain.Lynne A Barker, Associate Professor in Cognitive Neuroscience, Sheffield Hallam UniversityCaroline Jordan, Psychologist; Centre for Behavioural Science and Applied Psychology, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1482102020-10-28T13:31:12Z2020-10-28T13:31:12ZMultiple sclerosis: some patients may already hold the key to protecting the brain against viruses<figure><img src="https://images.theconversation.com/files/366148/original/file-20201028-19-37e7ta.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4671%2C2729&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In patients with MS, the body's immune system attacks the nerve cells.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/nerve-cells-291476537">adike/ Shutterstock</a></span></figcaption></figure><p>Usually our immune system protects us from harmful microbes such as bacteria or viruses. It does this either by directly attacking a microbe, or producing an antibody which recognises and removes microbes from the body. But, in patients with multiple sclerosis (MS), their <a href="https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS">immune response is overactive</a>, resulting in the body attacking it’s own cells – namely those in the central nervous system (including the brain and spinal cord). This results in damage to the central nervous system, which leads to impaired sensory and motor function. </p>
<p>A lot of <a href="https://pubmed.ncbi.nlm.nih.gov/26250739/">research</a> has gone into determining why the immune cells of MS patients attack the brain. Researchers are especially interested in understanding why MS patients make so many <a href="https://pubmed.ncbi.nlm.nih.gov/30071507/">antibodies</a>, which are important for protecting the body from viral infections. Large quantities of antibodies are found in their <a href="https://pubmed.ncbi.nlm.nih.gov/30071507/">cerebrospinal</a> fluid (the liquid barrier that surrounds the brain). </p>
<p>In researching this phenomenon, we have actually identified that some of these antibodies <a href="https://www.biomedcentral.com/epdf/10.1186/s40478-020-01011-7?sharing_token=yS-J8TofyQWAvXx9twlXzW_BpE1tBhCbnbw3BuzI2RMDzbL_HgsGvFF2Mw0MGZE0b1n0FGZo3Iubs_rCa5YKpFU1gB3AsrTPfXTtIGYMk8czL88GFHitjPjx_AUByzRIZdlPcuwsaI3kYq60zHTPqkKaj-OVdVr-fxH3zUs_sok%3D">can be beneficial</a> as they enhance immunity against viruses. This stronger immune response could help protect these people from certain viral infections. </p>
<p>We don’t yet fully understand all aspects of the abnormal immune response in MS patients. However, many drug treatments now focus on <a href="https://pubmed.ncbi.nlm.nih.gov/29470968/">suppressing</a> this overactive immune system to prevent further brain damage. For many patients, these drugs are very <a href="https://pubmed.ncbi.nlm.nih.gov/28209331/">effective</a>.</p>
<p>But suppressing the immune system can cause other problems. One such problem is that these treatments can leave patients vulnerable to viral infections. Patients are particularly susceptible to infection of the brain by <a href="https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/natalizumab">John Cunningham virus (JCV)</a>. If John Cunningham virus infects the brain, it can cause a disease called <a href="https://www.nejm.org/doi/10.1056/NEJMoa1107829?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">progressive multifocal leukoencephalopathy</a>. This can cause lasting disability or even death. There are currently no antiviral treatments available for it.</p>
<h2>Immunoglobulin M</h2>
<p>Recently, researchers found that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.24345">around 40% of MS patients</a> do not seem to get these viral brain infections, even when taking immunosuppressive drugs. To understand what was protecting these patients, researchers observed that those who didn’t develop any viral brain infections had a particular type of antibody in their cerebrospinal fluid. These antibodies, called immunoglobulin M (or IgM antibodies), can bind to lipids (fat) on cells rather than binding to microbes, as antibodies normally do with viruses. This suggested to us that these antibodies were protecting the brain against viruses in a different way, one that does not involve binding the virus directly.</p>
<p>As such, we wanted to test if these IgM antibodies may be able to prevent viral infections. To do this, we used a unique cell culture system that we call a “brain-in-a-dish”. This contained all the major cell types of the central nervous system that integrated together like a miniature brain. We added the IgM antibodies to these cultures and then infected them with different viruses, such as Semliki Forest virus and Bunyamwera virus, to test whether the antibody would protect against these viral infections.</p>
<p>We were able to show that indeed the antibodies <a href="https://rdcu.be/b8Inh">prevented these virus from replicating</a> in the cultures, effectively stopping the viral infections in their tracks. To further investigate how this works, we looked at the ways the immune response was affected by these antibodies. We found that the antibodies specifically activated parts of the immune system that are involved in developing immunity to viruses. </p>
<p>To see which brain cells might be protected by these antibodies, we used a microscope to look at the different cells that make up the central nervous system. At the same time, we used fluorescent probes (a type of molecule that absorbs light, and is used to study biological samples) that bound to the specific parts of the immune response that we had identified. Fluorescent probe molecules absorb light of a specific wavelength and emit it in a different, longer wavelength. This allows researchers to study changes in biological samples and detect antibodies in cells. </p>
<p>By merging the two images – of the cell types and the immune response – we could see that this protective antiviral immune response was activated in <a href="https://rdcu.be/b8Inh">all the major cell types</a> of the central nervous system. This is very important, as many different viruses can infect the brain, each by attacking different cell types within the central nervous system. Our findings suggest that this specific type of antibody protects some MS patients against many different viruses that infect the brain by enhancing their immune response. This finding has a major impact for those with MS, and for future antiviral research and treatment.</p>
<p>Caution is taken when prescribing immunosuppresive therapies to MS patients to prevent the patient from developing a potentially life-threatening viral infection. Using these specific IgM antibodies, we can understand which patients may be more vulnerable to viral infections, while allowing more patients to use these drugs, especially those who have this protective antibody. </p>
<p>The antibodies identified in this study highlight an alternative way of protecting the brain against viruses. Most antiviral drugs target a specific virus. These antibodies act by enhancing the brain’s own antiviral defences, offering protection to all major cell types of the central nervous system. This mechanism can pave the way for the generation of new antiviral therapies that can treat and prevent viral brain infections. But more investigation will be needed to see how these antibodies work.</p><img src="https://counter.theconversation.com/content/148210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marieke Pingen receives funding from the BBSRC, the MRC, and the Multiple Sclerosis Society. </span></em></p><p class="fine-print"><em><span>Lorna Hayden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This antibody protects patients from viruses, even while on immunosuppressant drugs.Lorna Hayden, PhD Candidate in Neuroimmunology, University of GlasgowMarieke Pingen, Research Associate in Immunology, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1230672019-09-19T22:13:55Z2019-09-19T22:13:55ZResearchers develop a promising new ‘Trojan horse’ treatment for multiple sclerosis<figure><img src="https://images.theconversation.com/files/293095/original/file-20190918-187951-1n40669.jpg?ixlib=rb-1.1.0&rect=0%2C88%2C6698%2C4814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In research studies, treated mice were quickly able to regain the ability to walk.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>We often take our immune and nervous systems for granted. We assume that our immune system will protect us from diseases and when pathogens invade our body. Likewise, we assume that our nervous system will take information from the environment, relay it to our brain and then allow our brain to move muscles. </p>
<p>But what happens when the immune system thinks your nervous system is the enemy and attacks your body? This autoimmune response is the sad reality of those afflicted with multiple sclerosis (MS).</p>
<p>MS is a debilitating disorder affecting millions of people worldwide. MS involves progressive paralysis, pain, memory impairment and often results in death. Canada has the dubious distinction of having the <a href="https://mssociety.ca">highest rate of MS in the world</a>. The reason for this high rate of MS is not known.</p>
<p>As a neuroscientist, I have a profound interest in understanding the function of the nervous system as well as the various diseases and injuries that plague it. The nervous system is indeed the last frontier of science, with vast unexplored realms. Also, diseases of this system have a profound effect on both patients and their families. </p>
<p>Thus, my goal is to not only understand these diseases from a scientific perspective, but to also devise treatments and new approaches to improve quality of life. When it comes to MS, I have a very personal connection, as I have several close friends who have been diagnosed with the disease.</p>
<h2>A Trojan horse for immune cells</h2>
<p>The nervous system consists of millions of connections, similar to bundles of wire. Like wires in your house, they are insulated, protecting them from the environment and allowing for rapid communication between cells. </p>
<p>Unlike wires in your house, this insulation is made of a fatty material called myelin. In MS, this myelin sheath is destroyed, leaving the neural connections bare. This results in neurons failing to send signals, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31497864">leading to paralysis and eventual death</a>.</p>
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<figcaption><span class="caption">Symptoms of MS can range from fatigue and difficulty walking to bowel dysfunction and sexual dysfunction.</span></figcaption>
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<p>Currently there are few treatment options for MS, with most <a href="https://www.ncbi.nlm.nih.gov/pubmed/31450158">treating symptoms and not the disease itself</a>. Some front-line therapies attempt to modify the immune system, but do so by suppressing the entire immune system, thus <a href="https://www.ncbi.nlm.nih.gov/pubmed/31354720">rendering the patient susceptible to infections</a>.</p>
<p>The approach that we have developed is to target specifically the cells that are causing disease. By removing the cells that cause the disease, it is hypothesized that this will allow the body to repair itself, and thus improve quality of life outcomes in patients.</p>
<p>We have a novel approach to directly eliminating the cells that cause MS, akin to the <a href="https://www.britannica.com/topic/Trojan-horse">Trojan horse employed by the Greeks</a>. We trick the defective immune cells into thinking they are attacking the body, when they are in fact being attacked themselves.</p>
<h2>Mice regain ability to walk</h2>
<p>We use a protein construct built from three proteins. The first protein mimics the fatty insulation that surrounds the neurons (myelin). This should, in theory, cause immune cells that are searching for this protein to bind to our drug. The second protein is an internalization sequence, that causes any cell that binds to the first protein, to take up our drug. </p>
<p>The third protein is a death cue. Thus any immune cell that binds to our construct will take up the entire protein sequence and then die. In the healthy individual, there should be no immune cells that recognize this protein. In the MS patient, the aberrant immune cells are specifically eliminated.</p>
<p>In our studies, we have tested this in mice with surprising results. We found that the aberrant immune cells were specifically eliminated. But more important were the changes in the mice’s ability to move. <a href="https://globalnews.ca/news/4463560/university-of-regina-researchers-test-potential-ms-treatment/">Treated mice were quickly able to regain the ability to walk.</a> </p>
<p>We have replicated this study several times with the same result each time. We are currently investigating what the upper dose limit of this compound is, to determine safety ranges.</p>
<h2>Potential for autoimmune diseases</h2>
<p>While we are quite excited with the results, there remains quite a bit of work to be completed. We intend to test our compound on blood obtained from MS patients. By isolating their blood, we would be able to test our compound in a petri dish and observe the effects on their immune cells. </p>
<p>By combining our animal models with human test subjects, our intention is to rapidly translate our study into humans in the near future.</p>
<p>An interesting application of our technology is that it can also be used in a variety of other autoimmune diseases. In such cases, the protein that is being attacked by the body can be easily swapped out for another — then the drug will work on those aberrant cells as well.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/123067/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josef Buttigieg receives funding from Saskatchewan Health Research Foundation</span></em></p>A promising new approach to treating MS tricks defective immune cells into thinking they are attacking the body, when they are in fact being attacked themselves.Josef Buttigieg, Associate Professor of Biology, University of ReginaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923172018-02-27T17:06:36Z2018-02-27T17:06:36ZThe key to treating multiple sclerosis could be inside sufferers’ own bodies<figure><img src="https://images.theconversation.com/files/208110/original/file-20180227-36686-1dyi84f.jpg?ixlib=rb-1.1.0&rect=0%2C29%2C5000%2C3218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/nerve-cell-anatomy-detailed-illustration-on-645801253">Tefi/Shutterstock</a></span></figcaption></figure><p>Fat often gets a bad press, but if it didn’t coat the cables that connect our neurons, we’d be in a lot of trouble. Sufferers of multiple sclerosis and a host of other nervous system diseases have first-hand experience of this, with few safe and effective treatment options available. Only now are new treatments appearing on the horizon that might just make a big difference.</p>
<p>In order for us to think, feel and move, information must move around the brain accurately and rapidly. Vital in this process are long wire-like structures called axons, which conduct the electrical currents that encode our thoughts from neuron to neuron.</p>
<p>Most of our axons are sheathed in a fatty substance called <a href="https://www.nationalmssociety.org/What-is-MS/Definition-of-MS/Myelin">myelin</a> which, like the plastic coating on a wire, provides insulation for efficient conduction and protects the axon from damage.</p>
<p>Unfortunately, many diseases damage these myelin sheaths. For example, in <a href="https://theconversation.com/explainer-multiple-sclerosis-32662">multiple sclerosis</a> (MS), the immune system – usually our body’s defence against disease – attacks its own myelin in the brain and spinal cord, leaving the underlying axons exposed. Like a worn-down phone charger, these bare axons can no longer conduct electricity effectively, and are vulnerable to damage. Depending on which cables are damaged, this can cause tingling, weakness, visual problems, and eventually difficulty moving, speaking and swallowing.</p>
<figure> <img src="https://upload.wikimedia.org/wikipedia/commons/4/48/Saltatory_Conduction.gif"><figcaption> An unmyelinated axon and a myelinated axon, side-by-side. Source: www.docjana.com</figcaption></figure>
<p><a href="https://www.mssociety.org.uk/dmts">Most current therapies</a> for MS attempt to stop the immune system from attacking the myelin sheaths. This can reduce damage, but it can’t reverse it. So the condition of many patients deteriorates even while on these drugs. Stem cell transplantation therapy has shown recent promise in treating MS, but such treatments are aggressive and can <a href="https://theconversation.com/can-stem-cell-therapy-really-treat-multiple-sclerosis-63162">seriously endanger patients’ health</a>, requiring chemotherapy to almost completely eliminate the patient’s immune system before attempting to reboot it to an earlier, more healthy stage.</p>
<p>Now, a different kind of stem cell offers exciting potential for a raft of new treatments that could reverse symptoms of MS and other myelin diseases, rather than just slow them – and without the need for transplantation.</p>
<h2>A new hope</h2>
<p>After myelin damage, stem cells called <a href="https://en.wikipedia.org/wiki/Oligodendrocyte_progenitor_cell">OPCs</a> can create specialised brain cells called oligodendrocytes, which send octopus-like arms to wrap new myelin around damaged axons. OPCs are already scattered throughout the brains of MS sufferers, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/23595275">only in some people</a> do they produce enough of the specialised brain cells that regenerate myelin, and therefore <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006855/">reduce symptoms</a>.</p>
<p>Recent years have seen <a href="https://www.nature.com/articles/nrn.2017.136">great advances</a> in our understanding of how to influence OPC stem cells to respond properly to myelin damage. We can now grow them in hundreds of tiny artificial wells, each containing a different drug and several microscopic axon-mimicking cables, and examine which drugs best kick-start the OPCs into re-myelinating action. <a href="http://www.msdiscovery.org/news/new_findings/12139-novel-remyelination-assay-allows-high-throughput-drug-screening">This innovative lab technique</a> is helping researchers to fast identify the most promising concoctions to take to clinical trials.</p>
<p>Surprisingly, recent discoveries also show that the same immune system responsible for attacking and damaging myelin can also play a beneficial role in regenerating it. For example, immune cells called microglia can gobble up the debris of the old myelin sheaths, clearing the way for new myelin to regenerate. Drugs targeting this process have already <a href="https://www.ncbi.nlm.nih.gov/pubmed/25609628">helped mice to regenerate mylein</a> and will likely be seen in clinical trials soon. What’s more, new <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006855/">medical imaging technologies</a> will allow us to monitor how well all of these new drugs regenerate myelin inside patients in real time.</p>
<p>The next few years will be an exciting time, as we begin to see clinical data on how these new drugs can help people living with MS. After years of struggle to find an effective treatment, we may just find that the key was inside our bodies all along.</p><img src="https://counter.theconversation.com/content/92317/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris McMurran receives funding from MedImmune, and the Jean Shanks Foundation. </span></em></p>All multiple sclerosis sufferers have stem cells with the potential to heal them, but scientists are only just figuring out how to kick them into action.Chris McMurran, MB/PhD Candidate, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/644052016-09-01T09:05:26Z2016-09-01T09:05:26ZMultiple sclerosis survivors swear by hyperbaric oxygen – but does it work?<figure><img src="https://images.theconversation.com/files/135530/original/image-20160825-6604-m3202w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-372222991/stock-photo-pocatello-idaho-usa-july-22-2010-hyperbaric-chambers-in-a-wound-care-centerto-sped-healing.html?src=QWomzBGTmTc12487VVZilg-1-3">B Brown/Shutterstock</a></span></figcaption></figure><p>There is no cure for multiple sclerosis (MS) yet. As a complex neurodegenerative disease of the brain, it is incredibly difficult to treat. Despite the development of new and sophisticated therapies to control the inflammation and physical symptoms of the disease, these treatments don’t work for everyone. This is because MS comes in many guises and one treatment does not fit all. Perhaps for this reason people with MS are turning to alternative means of controlling their condition. </p>
<p>Many of the 100,000 people with MS in the UK have taken charge of managing their treatment. With the assistance of 60 or more independent charitable MS therapy centres, people with the disease regularly enter a chamber and breathe oxygen under moderate pressure (<a href="https://www.hyperbaricoxygentherapy.org.uk">hyperbaric oxygen</a>). Some people have done so for <a href="http://www.jpands.org/vol10no4/maxfield.pdf">more than 20 years</a>. </p>
<p>The air we breathe contains 21% oxygen, but 100% oxygen is considered a drug and is prescribed in hospitals to aid people’s recovery. In the case of MS, people <a href="http://www.oxygenunderpressure.com/category/multiple-sclerosis/">self-prescribe the hyperbaric oxygen</a>, which is delivered to them by trained operators. But does breathing pure oxygen under pressure on a weekly basis do them any good? </p>
<p>The idea to use oxygen as a treatment for MS began over 45 years ago. In 1970, two Romanian doctors, Boschetty and Cernoch, treated patients with brain injuries with pressurised oxygen <a href="http://www.ncbi.nlm.nih.gov/pubmed/4314654">to help more oxygen enter their tissues</a> – oxygen helps protect nerve cells from damage and maintains the integrity of the <a href="http://www.brainfacts.org/brain-basics/neuroanatomy/articles/2014/blood-brain-barrier">blood-brain barrier</a>. In a study of MS patients, they found that symptoms in 15 out of 26 volunteers improved. This led to further interest in the use of hyperbaric oxygen to treat MS specifically. </p>
<p>Since Boschetty and Cernoch’s discovery, around 14 clinical trials have been conducted. The trials have been on relatively small numbers of people and have reported conflicting results, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5949.2009.00129.x/full">ranging from great improvements to none at all</a>. This has led to a dilemma: should clinicians endorse the use of hyperbaric oxygen for MS or not? </p>
<h2>Not officially sanctioned</h2>
<p>The clinical regulatory bodies in the US and the UK, <a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm">the FDA</a> and <a href="https://www.nice.org.uk/donotdo/interventions-affecting-disease-progression-hyperbaric-oxygen-should-not-be-used-in-patients-with-multiple-sclerosis-because-research-evidence-does-not-show-beneficial-effects-on-the-course-of-the">NICE</a> respectively, do not feel the clinical trial evidence is strong enough to endorse the procedure, yet thousands of people in the UK and elsewhere continue to treat themselves with hyperbaric oxygen. Between 1982 and 2011, over 20,000 people with MS in the UK used hyperbaric oxygen <a href="http://www.hjernebarnet.dk/fileadmin/_temp_/Philip_James_-110405.pdf">over 2.5m times</a>. </p>
<p><a href="http://www.nhs.uk/conditions/Multiple-sclerosis/Pages/Introduction.aspx">Multiple sclerosis</a> is a chronic inflammatory disease of the brain. It is usually diagnosed between the ages of 20 and 40. Lesions in the brain develop as a result of inflammatory autoimmune cells crossing the blood-brain barrier and destroying the protective protein coat (myelin) that surrounds the axon of some nerve cells. Over time MS develops into a neurodegenerative disease, leading to problems with vision, bladder control and mobility. </p>
<p>The brain’s ability to repair some of this damage helps people with MS to feel better for a while before relapsing once more. Eventually the disease becomes chronic and the ability to repair the damage and undergo remission declines. Most conventional treatments focus on the early phases of the disease. Unfortunately, there are few treatments for the later stages of MS. </p>
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<img alt="" src="https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135521/original/image-20160825-6625-11w4vb8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Perhaps the inability of prescribed drugs that work for all people with MS, or indeed work for some but <a href="http://www.ncbi.nlm.nih.gov/pubmed/15596735">produce unpleasant side-effects</a>, has driven people to seek other treatments. Despite the scepticism of some doctors, many people with MS claim that hyperbaric oxygen therapy <a href="http://www.express.co.uk/life-style/health/452441/Oxygen-therapy-Fresh-air-relief-for-Multiple-Sclerosis-patients">has benefits</a>. The <a href="http://www.msntc.org.uk/downloads/Perrins_and_James_IJNN_vol_2_issue_1_2005.pdf">benefits</a> include improvements in mobility, bladder control, pain relief and gait. However, since the treatment is transient, regular exposure to pressurised oxygen is required to sustain any benefit. </p>
<p>The increase in oxygen to the brain may lead to a number of effects such as speeding repair to damaged tissue, or inhibiting the ability of immune cells to cross the blood-brain barrier and cause damage. These possibilities are <a href="https://www.dovepress.com/safety-and-efficacy-of-hyperbaric-oxygen-therapy-in-chronic-wound-mana-peer-reviewed-fulltext-article-CWCMR">being investigated</a>. </p>
<h2>Poorly designed trials</h2>
<p>So why are many clinicians sceptical of hyperbaric oxygen? The main reason is various MS disability-status scores are used to judge improvement. In the former clinical trials, hyperbaric oxygen was not used over a sustained periods of time (only a few weeks) and often people with irreversible damage were used, so no or <a href="http://www.nejm.org/doi/full/10.1056/NEJM198301273080402">very little improvement in scores was seen</a>. </p>
<p>So are poorly controlled clinical trials to blame for the conflict of opinion? Probably, yes. Until we understand more at the molecular level about how oxygen under pressure can make sustained changes to various biological processes in the brain, people with MS will continue to use the treatment and the majority of the medical community will remain unconvinced of its merits.</p><img src="https://counter.theconversation.com/content/64405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Eggleton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is conflicting medical evidence.Paul Eggleton, Senior lecturer in Immunology, University of ExeterLicensed as Creative Commons – attribution, no derivatives.