Increase in multiple sclerosis activity after assisted reproduction technology – Correale – 2012 – Annals of Neurology – Wiley Online Library

Posted on January 1, 2013 by Maurice Preter MD

Increase in multiple sclerosis activity after assisted reproduction technology

Abstract

Objective:

Our objective was to evaluate risk of exacerbations in multiple sclerosis (MS) patients undergoing assisted reproduction technology (ART) infertility treatment.

Methods:

Sixteen patients with relapsing–remitting MS subjected to 26 ART treatment cycles receiving gonadotropin-releasing hormone (GnRH) agonists and recombinant follicle-stimulating hormone were studied prospectively. The baseline study period encompassed 12 months prior to the first cycle and 9 months after final ART cycle. Neurological examinations, brain magnetic resonance imaging (MRI), and immunology testing were conducted every 3 months. Anti–myelin-oligodendrocyte glycoprotein (MOG) antibody production, interleukin (IL)-4, IL-8, IL-10, IL-12, IL-17, interferon (IFN)-γ, and transforming growth factor (TGF)-β secretion by myelin basic protein- and MOG-peptide–specific T cells, as well as ex vivo isolated peripheral blood mononuclear cells (PBMCs), were studied using enzyme-linked immunospot. vascular endothelial growth factor (VEGF) production by PBMCs was assessed using enzyme-linked immunosorbent assay.

Results:

ART was associated with a 7-fold increase in risk of MS exacerbation, and a 9-fold increase in risk of enhanced disease activity on MRI. Worsening was associated with higher number of cells producing IL-8, IL-12, IFN-γ, and TGF-β, as well as increased VEGF production by CD4+ T cells and CXCL-12 plasma levels, all GnRH-mediated effects. A rise in 17-β estradiol production associated with ART increased anti-MOG antibody titers, as well as B-cell survival factor BAFF (B-cell activating factor) and antiapoptotic molecule Bcl-2 levels from purified CD19+ B cells. Finally, ART facilitated PBMC transmigration across an in vitro blood–brain barrier model, an effect mediated by IL-8, VEGF, and CXCL-12.

Interpretation:

Results indicate a significant increase in MS disease activity in patients receiving ART, a risk that neurologists should be aware of. Reproductive hormones appear to exert an important role in regulating immune responses during the course of autoimmune diseases. ANN NEUROL 2012;72:682–694

via Increase in multiple sclerosis activity after assisted reproduction technology – Correale – 2012 – Annals of Neurology – Wiley Online Library.

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A Systematic Review of Randomized, Double-… [Neuroepidemiology. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

Neuroepidemiology. 2012 Dec 18;40(3):147-153. [Epub ahead of print]

A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Trials Examining the Clinical Efficacy of Vitamin D in Multiple Sclerosis.

Pozuelo-Moyano B, Benito-León J, Mitchell AJ, Hernández-Gallego J.

Source

Department of Neurology, University Hospital ’12 de Octubre’, Madrid, Spain.

Abstract

Background: An association between multiple sclerosis (MS) prevalence as well as MS mortality and vitamin D nutrition has led to the hypothesis that high levels of vitamin D could be beneficial for MS. The purpose of this systematic review is to establish whether there is evidence for or against vitamin D in the treatment of MS. Methods: Systematic literature searches were performed to locate randomized, placebo-controlled, double-blind trials measuring the clinical effect of vitamin D on MS in human participants. Data were extracted in a standardized manner, and methodological quality was assessed by the Jadad score. Results: Five trials were located that met the selection criteria. Of the 5 trials, 4 showed no effect of vitamin D on any outcome, and 1 showed a significant effect, namely by a reduction in the number of T1 enhancing lesions on brain magnetic resonance imaging. Three studies commented on adverse effects of vitamin D, with gastrointestinal adverse effects being the most frequently reported. The literature is limited by small study sizes (ranging from 23 to 68 patients), heterogeneity of dosing, form of vitamin D tested (vitamin D3 in 4 trials and vitamin D2 in 1) and clinical outcome measures. Therefore, a meta-analysis was not performed. Conclusions: The evidence for vitamin D as a treatment for MS is inconclusive. Larger studies are warranted to assess the effect of vitamin D on clinical outcomes in patients with MS. We further encourage researchers to also test the effect of vitamin D on the health-related quality of life experienced by patients and their families.

Copyright © 2012 S. Karger AG, Basel.

PMID:

23257784

[PubMed – as supplied by publisher]

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Vitamin D in Systemic and Organ-Spe… [Clin Rev Allergy Immunol. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

Clin Rev Allergy Immunol. 2012 Dec 14. [Epub ahead of print]

Vitamin D in Systemic and Organ-Specific Autoimmune Diseases.

Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y.

Source

The Zabludowics Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.

Abstract

Lately, vitamin D has been linked with metabolic and immunological processes, which established its role as an essential component of human health preservation. Vitamin D has been defined as natural immune modulators, and upon activation of its receptors (VDRs), it regulates calcium metabolism, cellular growth, proliferation and apoptosis, and other immunological functions. Epidemiological data underline a strong correlation between poor vitamin D status and higher risk for chronic inflammatory illnesses of various etiologies, including autoimmune diseases. Epidemiological, genetic, and basic studies indicated a potential role of vitamin D in the pathogenesis of certain systemic and organ-specific autoimmune diseases. These studies demonstrate correlation between low vitamin D and prevalence of diseases. In addition, VDRs’ polymorphisms observed in some of these autoimmune diseases may further support a plausible pathogenic link. Notably, for some autoimmune disease, no correlation with vitamin D levels could be confirmed. Thus, in the current review we present the body of evidence regarding the plausible roles of vitamin D and VDR’s polymorphism in the pathogenesis of autoimmunity. We summarize the data regarding systemic (i.e., systemic lupus erythematosus, rheumatoid arthritis, etc.) and organ-specific (i.e., multiple sclerosis, diabetes mellitus, primary biliary cirrhosis, etc.) autoimmune diseases, in which low level of vitamin D was found comparing to healthy subjects. In addition, we discuss the correlations between vitamin D levels and clinical manifestations and/or activity of diseases. In this context, we address the rational for vitamin D supplementation in patients suffering from autoimmune diseases. Further studies addressing the mechanisms by which vitamin D affects autoimmunity and the proper supplementation required are needed.

PMID:

23238772

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Mind-body medicine for multiple sclerosis: a … [Autoimmune Dis. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

Autoimmune Dis. 2012;2012:567324. doi: 10.1155/2012/567324. Epub 2012 Nov 22.

Mind-body medicine for multiple sclerosis: a systematic review.

Senders A, Wahbeh H, Spain R, Shinto L.

Source

Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA.

Abstract

Background. Mind-body therapies are used to manage physical and psychological symptoms in many chronic health conditions. Objective. To assess the published evidence for using mind-body techniques for symptom management of multiple sclerosis. Methods. MEDLINE, PsycINFO, and Cochrane Clinical Trials Register were searched from inception to March 24, 2012. Eleven mind-body studies were reviewed (meditation, yoga, biofeedback, hypnosis, relaxation, and imagery). Results. Four high quality trials (yoga, mindfulness, relaxation, and biofeedback) were found helpful for a variety of MS symptoms. Conclusions. The evidence for mind-body medicine in MS is limited, yet mind-body therapies are relatively safe and may provide a nonpharmacological benefit for MS symptoms.

via Mind-body medicine for multiple sclerosis: a … [Autoimmune Dis. 2012] – PubMed – NCBI.

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The month of birth effect in m… [J Neurol Neurosurg Psychiatry. 2012] – PubMed – NCBI

Posted on January 1, 2013 by Maurice Preter MD

J Neurol Neurosurg Psychiatry. 2012 Nov 14. [Epub ahead of print]

The month of birth effect in multiple sclerosis: systematic review, meta-analysis and effect of latitude.

Dobson R, Giovannoni G, Ramagopalan S.

Source

Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, London UK.

Abstract

BACKGROUND:

Month of birth has previously been described as a risk factor for multiple sclerosis (MS). This has been hypothesised to be related to maternal vitamin D levels during pregnancy, although conclusive evidence to support this is lacking. To date, no large studies of latitudinal variation in the month of birth effect have been performed to advance this hypothesis.

METHODS:

Previously published data on month of birth from 151 978 MS patients were compared to expected birth rates. A linear regression model was used to assess the relationship between latitude and observed:expected birth ratio of MS patients for each month.

RESULTS:

Analysis of all reported data demonstrated a significant excess of MS risk in those born in April (observed:expected 1.05, p=0.05) and reduction in risk in those born in October (0.95, p=0.04) and November (0.92 p=0.01). A conservative analysis of 78 488 patients revealed an excess MS risk in those born in April (1.07, p=0.002) and May (1.11, p=0.0006), and a reduced risk in those born in October (ratio 0.94, p=0.004) and November (0.88, p=0.0002). A significant relationship between latitude and observed:expected ratio was demonstrated in December, and borderline significant relationships in May and August.

CONCLUSIONS:

Month of birth has a significant effect on subsequent MS risk. This is likely to be due to ultraviolet light exposure and maternal vitamin D levels, as demonstrated by the relationship between risk and latitude.

PMID:

23152637

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