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Disclaimer: 'MS Views and News' DOES NOT endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, for your personal knowledge and to keep you informed of current health-related issues. It is not a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.

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Saturday, October 21, 2017

MS Focus Lending Library

There is a great deal of helpful and inspirational material about MS available today. At MS Focus, we understand that not everyone has access to the wide range of resources out there. That is why we maintain a Lending Library, where books, DVDs, and CDs are all available for loan -- at no charge to you -- through the mail. Items can be sent across the United States, so, no matter where you live, you can benefit from these materials.
You may request as many items for loan as you wish. Requested materials will be sent one item at a time.  When a returned item is received by MS Focus, the next requested item will be mailed to you, if available.  Some items may have a waiting list. To verify availability of an item, call 888-MSFocus (673-6287) or email library@msfocus.org.

MS Focus Lending Library


Books, DVDs, and CDs are available for loan, by mail across the United States.
Learn more

Study uncovers potential risks of common MS treatment


Study finds an increased risk of events such as stroke, migraine, and depression, and abnormalities in the blood with taking beta interferon for MS.
Learn more
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MS Views and News provides beneficial Multiple Sclerosis education, information, resources and services. 
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Looking into cognitive impairment in Primary-Progressive Multiple Sclerosis.

Petracca M, et al. Eur J Neurol. 2017.

Abstract

BACKGROUND: Cognitive impairment in primary-progressive multiple sclerosis (PP-MS) is correlated with global brain atrophy. Unfortunately, brain volumes computation requires processing resources not widely available in clinical practice. Therefore we decided to test the predictive role of retinal atrophy metrics on cognitive decline, applying them as proxy of grey matter (GM) atrophy in PP-MS.
METHODS: Twenty-five PP-MS patients completed the Brief International Cognitive Assessment for MS (BICAMS) and underwent spectral-domain OCT and 3.0 Tesla MRI. Through a stepwise logistic regression we tested whether OCT metrics (retinal nerve fiber layer-RNFL, ganglion cell+inner plexiform layer-GCIPL, total macular volume-TMV) predicted cognitive impairment and explored the role of GM atrophy in mediating these correlations.
RESULTS: Among OCT metrics, only GCIPL was associated with cognitive impairment (rp =.448, p=.036) and predictive of objective cognitive impairment (Wald [1]=4.40, p=.036). Controlling for demographics, normalized brain volume (NBV) and thalamic volume were correlated with GCIPL (respectively rp =.427, p=.047 and rp =.674, p=.001) and cognitive scores (respectively rp =.593, p=.004 and rp =.501, p=.017), with thalamic volume nearly mediating the association between GCIPL and cognition (Sobel z=1.86, p=.063).
CONCLUSIONS: GCIPL thickness is a suitable measure of neurodegeneration. In comparison with brain atrophy, GCIPL offers higher histopathological specificity, being a pure correlate of neuronal loss and may be a noninvasive, easy-to-perform way to quantitatively evaluate and monitor neuronal loss related to cognitive impairment in PP-MS. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.

PMID

 29053884 [PubMed - as supplied by publisher]


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Homecare Assistance Grants

MS Focus understands the daily needs and challenges that must be met by both those with MS and their caregivers. In order to meet these needs in the most timely and efficient way possible, our Homecare Assistance Grant connects you to the best available local services. Should resources within your community not be available, direct support may be provided on a temporary basis.

Available Services include

  • Home Care - Personal hygiene services, light housekeeping, grocery shopping, meal preparation, and transportation to and from appointments are all services that can be provided for a limited time.
  • Therapy Visits - Based upon individual need, an appointment with an occupational, physical, or speech therapist can be arranged. Through education and training, these therapists can help to foster independence, self-esteem, and better quality of life for the person living with MS.
  • Respite Care -  Respite allows primary caregivers the opportunity to tend to themselves, or other family business, with the assurance that their loved one is being cared for by a properly trained individual. This service is provided on a short-term basis for a scheduled period of time. 
  • Coming Home - Returning home from a stay at the hospital can be a difficult time of transition. We offer a four-hour visit from an aide who will meet the patient at the hospital, provide transportation home, and then get the patient settled comfortably at home.
Print Application Online Application 



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Clinical Studies for those affected by MS in South Florida

CURRENTLY ENROLLING CLINICAL TRIALS - SUNRISE NEUROLOGY
Located in Sunrise, Fl. (Broward County)


For detail of Sunrise Neurology enrolling clinical trials,




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Aging with MS


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Overview

We all grow older- including people with MS. MS is often described as a disease of young and middle aged adults. Yet a significant number of all people living with MS are 65 or older.
Until recently, little attention was paid to the issues or challenges of aging with MS, and very few resources or services specifically designed for older adults with MS were readily available. However, there is a growing interest in aging with MS and recognition that more attention must be paid to this important topic.

Additional resources

Aging Life Care Association- Serves seniors, adults with disabilities (of any age), and families who need assistance with caregiving issues.
Eldercare Locator- information and assistance resources.
National Council on Aging- assists seniors in improving their health, living independently and remaining active.
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National MS Society Response to Executive Order on Health Care


October 12, 2017

“The Executive Order released this morning is absolutely the wrong approach for people living with MS,” said Bari Talente, Executive Vice President of Advocacy for the National MS Society. “This order erodes protections in health insurance that are critically important to people with chronic and high-cost health care needs. 

This Executive Order both undermines bipartisan efforts to find solutions for our nation’s healthcare system and is another step to damage the Affordable Care Act.

Rolling back critical protections will create more health insurance options that shortsightedly may serve the needs of younger or currently healthy people, but at the expense of others like older or sicker people whose costs will be driven up, and those currently healthy who find themselves facing a healthcare crisis. 

The destabilizing effects of this Executive Order will be devastating for the individual insurance market and potentially the entire health insurance system.”

Learn more about the Society’s work on access to affordable, quality health insurance coverage



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Print Global Experts Publish Recommendations for Overcoming Challenges to Improve Clinical Trials in Progressive MS


October 18, 2017

  • special issue of Multiple Sclerosis Journal, sponsored by the International Progressive MS Alliance, has been published, containing ten papers that review the challenges and the potential solutions to improving clinical trials and their outcomes so that new treatments become available for people living with progressive MS.
  • Progressive MS is a form of MS that gets worse over time. Each day, progressive MS takes things away from people: vision, mobility, cognition, ability to work, and their very independence. MS is found in every country where studies have been conducted, and more than 2.3 million people worldwide currently live with the disease; over 1 million people live with a progressive form of MS.
  • The special issue includes articles on many aspects of trial design, lessons learned, and research gaps, and includes a paper by a person living with MS, urging researchers to involve people with MS in every stage of planning and conducting clinical trials so that they are relevant to the treatment needs of people with progressive MS.
  • As a result of the sponsorship by the Alliance, the full content of the special issue, “Advancing Trial Design In Progressive Multiple Sclerosis,” may be read by anyone by following links below.
  • The papers stemmed from participants involved in a workshop convened in Rome in March 2017 under the auspices of the European Committee for Treatment and Research in MS (ECTRIMS) and the International Progressive MS Alliance.
  • Together, the papers provide a comprehensive roadmap for planning and conducting clinical trials and further research needed to develop new therapies that can slow or stop progressive MS. 



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Long-term disability progression in primary progressive multiple sclerosis: a 15-year study.

Rocca MA, et al. Brain. 2017.

Abstract

Prognostic markers of primary progressive multiple sclerosis evolution are needed. We investigated the added value of magnetic resonance imaging measures of brain and cervical cord damage in predicting long-term clinical worsening of primary progressive multiple sclerosis compared to simple clinical assessment. In 54 patients, conventional and diffusion tensor brain scans and cervical cord T1-weighted scans were acquired at baseline and after 15 months.

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Magnetization transfer ratio measures in normal-appearing white matter show periventricular gradient abnormalities in multiple sclerosis.

Magnetization transfer ratio measures in normal-appearing white matter show periventricular gradient abnormalities in multiple sclerosis.

Liu Z, et al. Brain. 2015.

Abstract

In multiple sclerosis, there is increasing evidence that demyelination, and neuronal damage occurs preferentially in cortical grey matter next to the outer surface of the brain. It has been suggested that this may be due to the effects of pathology outside the brain parenchyma, in particular meningeal inflammation or through cerebrospinal fluid mediated factors. White matter lesions are often located adjacent to the ventricles of the brain, suggesting the possibility of a similar outside-in pathogenesis, but an investigation of the relationship of periventricular normal-appearing white matter abnormalities with distance from the ventricles has not previously been undertaken. The present study investigates this relationship in vivo using quantitative magnetic resonance imaging and compares the abnormalities between secondary progressive and relapsing remitting multiple sclerosis. Forty-three patients with relapsing remitting and 28 with secondary progressive multiple sclerosis, and 38 healthy control subjects were included in this study. T1-weighted volumetric, magnetization transfer and proton density/T2-weighted scans were acquired for all subjects. From the magnetization transfer data, magnetization transfer ratio maps were prepared. White matter tissue masks were derived from SPM8 segmentations of the T1-weighted images. Normal-appearing white matter masks were generated by subtracting white matter lesions identified on the proton density/T2 scan, and a two-voxel perilesional ring, from the SPM8 derived white matter masks. White matter was divided in concentric bands, each ∼1-mm thick, radiating from the ventricles toward the cortex. The first periventricular band was excluded from analysis to mitigate partial volume effects, and normal-appearing white matter and lesion magnetization transfer ratio values were then computed for the 10 bands nearest to the ventricles. Compared with controls, magnetization transfer ratio in the normal-appearing white matter bands was significantly lower in patients with multiple sclerosis. In controls, magnetization transfer ratio was highest in the band adjacent to the ventricles and declined with increasing distance from the ventricles. In the multiple sclerosis groups, relative to controls, reductions in magnetization transfer ratio were greater in the secondary progressive multiple sclerosis compared with relapsing remitting multiple sclerosis group, and these reductions were greatest next to the ventricles and became smaller with distance from them. White matter lesion magnetization transfer ratio reductions were also more apparent adjacent to the ventricle and decreased with distance from the ventricles in both the relapsing remitting and secondary progressive multiple sclerosis groups. These findings suggest that in people with multiple sclerosis, and more so in secondary progressive than relapsing remitting multiple sclerosis, tissue structural abnormalities in normal-appearing white matter and white matter lesions are greatest near the ventricles. This would be consistent with a cerebrospinal fluid or ependymal mediated pathogenesis.
© The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PMID

 25823475 [PubMed - indexed for MEDLINE]

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Neuroinflammation and its relationship to changes in brain volume and white matter lesions in multiple sclerosis.

Datta G, et al. Brain. 2017.

Abstract

Brain magnetic resonance imaging is an important tool in the diagnosis and monitoring of multiple sclerosis patients. However, magnetic resonance imaging alone provides limited information for predicting an individual patient's disability progression. In part, this is because magnetic resonance imaging lacks sensitivity and specificity for detecting chronic diffuse and multi-focal inflammation mediated by activated microglia/macrophages. The aim of this study was to test for an association between 18 kDa translocator protein brain positron emission tomography signal, which arises largely from microglial activation, and measures of subsequent disease progression in multiple sclerosis patients. Twenty-one patients with multiple sclerosis (seven with secondary progressive disease and 14 with a relapsing remitting disease course) underwent T1- and T2-weighted and magnetization transfer magnetic resonance imaging at baseline and after 1 year.

Positron emission tomography scanning with the translocator protein radioligand 11C-PBR28 was performed at baseline. Brain tissue and lesion volumes were segmented from the T1- and T2-weighted magnetic resonance imaging and relative 11C-PBR28 uptake in the normal-appearing white matter was estimated as a distribution volume ratio with respect to a caudate pseudo-reference region.

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THC/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: a pilot prospective study


Maniscalco GT, et al. Neurol Sci. 2017.

Abstract

Lower urinary tract dysfunctions (LUTDs) are commonly reported in multiple sclerosis (MS) patients and are mainly related to neurogenic overactive bladder (OAB). The aim of this observational study was to assess the effect of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray on resistant OAB by means of clinical and instrumental tools. Twenty-one MS patients were screened, and 15 cases have been evaluated. They underwent a specific clinical assessment (overactive bladder symptom score, OABSS) and a urodynamic assessment evaluating the maximal cystometric capacity (CCmax), bladder compliance (Qmax), maximum detrusor pressure (Pdet max), detrusor pressure at the first desire (Pdet first), bladder volume at the first desire (BVFD), leakage volume (LV), and post-void residual volume (PVR), before and after 4 weeks of THC/CBD administration. 

A complete neurological evaluation, including the assessment of their spasticity using the Modified Ashworth Scale (MAS) and the spasticity 0-10 numerical rating scale (NRS), was performed at the same times. Mobility was evaluated through the 25-ft walking-time test (T25-WT). The THC/CBD treatment successfully reduced the OAB symptoms (p = 0.001). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016), while BVFD and CCmax were increased although the difference was not statistically significant. THC/CBD oromucosal spray has shown to be effective in improving overactive bladder symptoms in MS patients demonstrating a favorable impact on detrusor overactivity.

PMID

 29052091 [PubMed - as supplied by publisher]


https://www.ncbi.nlm.nih.gov/m/pubmed/29052091/?i=10&from=multiple%20sclerosis 




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Sexual dysfunction levels in Iranian women suffering from multiple sclerosis.

Dehghan-Nayeri N, et al. Mult Scler Relat Disord. 2017.

Abstract

OBJECTIVE: Sexual dysfunction (SD) is a common complaint in women who suffer from Multiple Sclerosis (MS), which has been categorized in three levels (primary, secondary, and tertiary) in previous studies. This study was conducted to assess the prevalence of sexual dysfunction (SD) at each level, and to identify associated factors and their impacts on SD in married women who suffer from Multiple Sclerosis. This study was conducted in Iran where the cultural barriers are recognized as important challenges in sexual function.
METHODS: This is a single center study that was carried out in Iran MS Society. A total of 182 married women with MS (aged between 18 and 49 years) were participated in this study. We used the structured and self-report questionnaires including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), together with socio-demographic and clinical questions, such as Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS) and Beck Depression Inventory (BDI) to collect the data. Pearson's correlation coefficients and analysis of variance (ANOVA) were performed for data analysis.
RESULTS: Sexual dysfunction was reported in 149 patients (81.9%), including 136 (74.7%) women with primary SD, 70 (38.5%) women with secondary SD and 81 (44.5%) with tertiary SD. The most prevalent symptoms at each level of SD were orgasmic problems, spasticity and worries about sexual satisfaction of partners, respectively. The total score of MSISQ-19 was associated with education (P<0.001), income status (P<0.001), age (P<0.001), number of children (P<0.05), marriage duration (P<0.05), EDSS score (P<0.01), fatigue (P<0.01), depression (P<0.001), length of disease (P<0.01) and length of drug medication therapies (P<0.01).
CONCLUSION: According to this study, sexual dysfunction, especially primary SD was one of the most prevalent problems among women with MS. In addition, this study showed a complex and multifactorial nature for SD among these women. In order to provide an appropriate treatment and management of SD, associated factors and their impacts should be considered.
Copyright © 2017 Elsevier B.V. All rights reserved.

PMID

 28283107 [PubMed - indexed for MEDLINE]

Full text





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Friday, October 20, 2017

Corrona and the National Multiple Sclerosis Society announce intent to collaborate on a multiple sclerosis registry to study the comparative effectiveness and safety of approved therapies


WALTHAM, Mass.Oct. 20, 2017 /PRNewswire/ -- Corrona, LLC and the National Multiple Sclerosis Society have announced their intent to collaborate on the launch of the Corrona Multiple Sclerosis (MS) Registry to study the comparative safety and effectiveness of approved MS therapies. The first patient has been enrolled, with initial recruitment goals to register approximately 5,000 people with MS. This national, observational registry will collect and analyze longitudinal outcomes associated with multiple sclerosis therapies.
The MS registry is Corrona's sixth patient registry, adding to existing North American registries in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis, psoriasis, inflammatory bowel disease, and a rheumatoid arthritis registry in Japan. The registry collects data from patients with MS and their treating neurologists through questionnaires and includes both physician assessments and patient-reported outcomes.  Corrona's team of biostatisticians and epidemiologists will collaborate with the National MS Society, participating academic and private practice neurologists, as well as supporting pharmaceutical companies, to study the comparative safety and effectiveness of approved MS therapies.
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Wednesday, October 18, 2017

MS could be reversed with existing allergy drug

By Tim Newman - Published

Nerve firing

A drug used to treat allergies has been shown to increase nerve speed in MS patients.

In a recent phase II clinical trial, an over-the-counter allergy drug was shown to improve nervous system function in patients with multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune disease affecting more than 2.3 million people around the world. The condition attacks myelin, or the waxy coat around nerves, and compromises the nerves' ability to transmit messages.
Over time, as the nerves' function is steadily reduced, a range of symptoms - including problems with vision, muscle weakness, difficulty walking, and issues with balance and coordination - develop.
Current treatment focuses on preventing the immune system from causing further damage, and as it stands, no drugs can repair the damaged myelin.
Discovering a medication capable of rebuilding the damaged myelin would be a huge step forward. And according to the latest study, this may be just around the corner.
New MS drug on the horizon?
In 2014, studies carried out by Prof. Jonah R. Chan at the University of California, San Francisco showed that clemastine fumarate may be a candidate for the treatment of MS.
Because of the potential importance of the findings, the drug quickly progressed to clinical trials. This week, the results from a phase II clinical trial on clemastine fumarate are published in The Lancet.
Clemastine fumarate was first approved by the Food and Drug Administration (FDA) in 1977. It is an antihistamine medication for allergies and has been available over the counter since 1993. Its potential to treat MS is therefore as surprising as it is welcome.

According to principal investigator Dr. Ari Green, "To the best of our knowledge, this is the first time a therapy has been able to reverse deficits caused by MS. It's not a cure, but it's a first step toward restoring brain function to the millions who are affected by this chronic, debilitating disease."

The team studied the effects of clemastine fumarate on 50 individuals with long-standing MS over a 5-month period. Because the visual system is often one of the first to be affected, the researchers measured so-called visual evoked potentials (VEPs). This is a well-established method of assessing how quickly nerves conduct messages.

VEPs were measured by showing participants flickering patterns on a screen. Electrodes placed over the visual areas of the brain detected how long it took signals to travel from the eye to the relevant area of the brain.

For 90 days, half of the participants were given clemastine fumarate, and the other half received a placebo. Next, the groups were switched: the placebo group was given the drug and vice versa. Neither the participants nor the researchers knew which individuals were receiving the active treatments.

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Consortium of Multiple Sclerosis Centers (CMSC) Updates Proposed 2017 Guidelines for Standardized Brain and Spinal Cord MRI Protocols

Updated Guidelines Offer Recommendations for Use of Gadolinium Based Contrast Agents
CMSC Logo
​The Consortium of Multiple Sclerosis Centers (CMSC), in collaboration with the CMSC Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-up of Multiple Sclerosis (MS) updated the standardized MRI protocol useful when evaluating people suspected of having MS and for following individuals undergoing treatment for MS.  These guidelines evolved from a meeting of the task force comprised of an international group of neurologists, radiologists and imaging scientists with expertise in MS.  The group met in Newark, NJ, January 11-12, 2017 to revise and update the guidelines and indications for standardized brain and spinal cord MRI for MS including attention to the use of gadolinium, based on new data, survey results and expert opinion. These proposed recommendations are currently under review in preparation for a manuscript.  
Clinical guidelines from the CMSC for the diagnosis and follow-up of MS had previously recommended the routine use of gadolinium based contrast agents (GBCA) in brain magnetic resonance imaging (MRI) for the diagnosis and follow-up of patients with MS. Soon after the publication of these recommendations in 2015, the CMSC became aware of the concerns regarding gadolinium deposition in the brain and the recommendations of the FDA to limit GBCA use to appropriate clinical circumstances.
The proposed 2017 revised guidelines that are posted on the CMSC website, now state, “While there is no know central nervous system toxicity, these agents should be used judiciously, recognizing that gadolinium continues to play an invaluable role in specific circumstances related to the diagnosis and follow-up of individuals with MS.” This is an important change compared to the earlier recommendation. Other key changes to the MRI protocols since the 2009 include emphasis on 3D sequences for brain MRI, Progressive Multifocal Leukoencephalopathy (PML) specific monitoring protocol, and optional orbit MRI protocol for severe optic neuritis.




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Tuesday, October 17, 2017

One More Small Piece of the Puzzle on the Role of Gut Micro-organisms in MS

October 16, 2017  ----  by Ana Belo van Wijk, PhD

Researchers found a significant increase in some types of gut bacteria and lower levels of an anti-inflammatory factor in untreated multiple sclerosis twins.
The study offered working evidence that components of gut microbiota contribute to autoimmune diseases like MS.
One More Small Piece of the Puzzle on the Role of Gut Micro-organisms in MS

Researchers published their article in the journal Proceedings of the National Academy of Sciences.It was titled “Gut microbiota from multiple sclerosis patients enables spontaneous autoimmune encephalomyelitis in mice.”

Our gut contains millions of good bacteria, fungi, bacteria-like archaea, and viruses that we can’t live without. Although there are 300 to 1,000 species of bacteria in our gut, most of our intestines is populated with 30 or 40 species.

Recent increases in knowledge and technical advancements have made it possible for scientists to measure the equilibrium between different species in the gut, and analyze their influence on our health.

One discovery was a link between the balance of bacteria in the intestines and autoimmune diseases like MS.

A team of researchers decided to see if differences in gut microbiota play a role in MS progression and perhaps its onset.

They analyzed the feces of 34 identical twins, one of each who had MS and one of each who didn’t. They used twins to try to reduce genetic and environmental differences’ influence on the onset of the disease.

All of those with MS were Caucasian and had grown up with their healthy twin to adulthood.

Researchers analyzed the type and abundance of microorganisms in the feces of both the MS-affected and healthy twins.

They found no differences in species or amount of bacteria between siblings. What they did find was a significant increase in some types of bacteria, such as Akkermansia, in untreated twins with MS.

The team transplanted fecal samples from MS-affected and healthy twins into a mice model of MS called experimental autoimmune encephalomyelitis. These animals have an inflammatory myelin-destroying disease of the central nervous system that is comparable to human MS. Myelin is a protective coating around neurons whose loss is associated with MS.

MS twin-derived gut microbiota caused a significantly higher amount of mice to develop a relapsing–remitting autoimmunity similar to MS than healthy twin-derived microbiota.

When researchers measured the microbial profiles of the mice’s feces, they found significant differences in amounts of bacteria. The most important difference was in Sutterella, an organism that helps protect against inflammation. Sutturella levels were significantly reduced in the feces of mice transplanted with MS twin-derived microbiota compared with feces from healthy twins.

The team also measured the mice’s immune cells and the proteins they release.

They discovered that immune cells in mice with MS-twin feces transplants produced less of the anti-inflammatory factor IL-10 than immune cells from mice colonized with healthy-twin samples. IL-10, or interleukin 10, is an important immune protein.

When researchers transplanted the feces of healthy twins into the mice, then gave them an antibody that blocks the function of IL-10, they also became sick. This indicated that IL-10 may temper autoimmunity in the central nervous system.

The team then measured the twins’ immune blood components. They found that the healthy twin had higher quantities of IL-10 than the MS-affected one.

“These findings provide evidence that MS-derived microbiota contain factors that precipitate an MS-like autoimmune disease” in a mouse model, the researchers wrote.

continued


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