Study suggests possible inside-out origin for MS

A new study suggests an inside-out theory of multiple sclerosis in which the disease may be triggered by the death of brain cells that make the insulation around nerve fibers, according to a new study from Northwestern Medicine and the University of Chicago researchers. Creating a mouse-model of progressive MS, scientists also used a specially developed nanoparticle that prevented MS even after the death of those brain cells.

The new study shows the possibility that MS can begin from the inside out, in which damage to oligodendrocytes in the central nervous system can trigger an immune response directly. Oligodendrocytes can possibly be destroyed by developmental abnormalities, viruses, bacterial toxins or environmental pollutants. Oligodendrocytes are responsible for the maintenance of myelin. If they die, the myelin sheath falls apart. The death of these cells can activate the autoimmune response against myelin, which is the main feature of MS. The inside-out hypothesis suggests that when myelin falls apart, the immune system interprets the products of its degradation as foreign bodies or antigens, erroneously viewing them as invaders and beginning a full-scale attack on myelin, initiating MS.

"Protecting oligodendrocytes in susceptible individuals might help delay or prevent MS from initiating. It's likely that therapeutic strategies that intervene early in the disease process will have greater impact," said Brian Popko, the Jack Miller Professor of Neurological Disorders at the University of Chicago and one of the lead investigators in the study.

The scientists also developed the first mouse model of the progressive form of the autoimmune disease, which will enable the testing of new drugs against progressive MS. In the study, nanoparticles creating tolerance to the myelin antigen were administered and prevented progressive MS from developing. The nanoparticles are being developed for clinical trials that could lead to new treatments – without the side effects of current therapies – in adults.

The study was published in Nature Neuroscience.

New Study Suggests People with MS are at Increased Risk for Depression, Anxiety and other Psychiatric Disorders

Summary

• A large-scale study from Canada suggests that people with MS have increased rates of anxiety, bipolar disorder, depression, and schizophrenia compared to people without MS.
• Among people with MS, women were more likely than men to develop depression, anxiety disorder, and bipolar disorder, while men were more likely than women to develop schizophrenia. Although women with MS were more likely to develop depression than men, men developed depression at a much higher rate compared to men without MS. 
• This study provides new information about the risks of psychiatric disorders in people with MS. Recognizing and addressing issues related to mental and emotional health can greatly improve quality of life for individuals and families.
• The National MS Society is focusing a light on psychosocial issues and emotional health in MS as part of its commitment to drive research and programs in wellness.  
• The team (Ruth Ann Marrie, MD, PhD) published their results in Neurology (2015;85:1–8).

Details
Background: In scientific terms, having two chronic medical conditions at once is called “comorbidity.” There is growing recognition that comorbidities may complicate the diagnosis of MS and also influence disease progression, as well as an individual’s wellness and quality of life.  It has long been known that depression and bipolar disorder are more common among people with MS than in the general population. In a recent study from Dr. Marrie and others, psychiatric disorders (depression and anxiety) were among the five most prevalent disorders occurring alongside MS. The current study specifically looks at psychiatric comorbidities in people with MS.
  
The Study: The team identified 44,452 persons with MS and 220,849 controls without the disease in administrative medical data from four Canadian provinces. They examined medical records to determine the incidence (new cases) and prevalence (all existing cases) of depression, anxiety, bipolar disorder, and schizophrenia from 1995 to 2005 among these groups.

The results show that the incidence and prevalence of anxiety, bipolar disorder, depression, and schizophrenia were all higher in people with MS than in people without MS in the control population. Among people with MS, women were more likely than men to develop depression, anxiety disorder, and bipolar disorder, while men were more likely than women to develop schizophrenia. Although women with MS were more likely to develop depression than men, men developed depression at a much higher rate compared to men without MS.

Results were published in Neurology (2015;85:1–8).

Next Steps: This study adds to a growing body of evidence on conditions that occur alongside MS. The National MS Society is focusing increased attention on psychosocial conditions in MS as part of its commitment to drive research and programs in wellness. Read more

In the face of a chronic, often progressive illness like MS, people may tend to focus primarily on their physical health and neglect their emotional health -- which is an essential component of overall health and wellness. Recognizing and addressing  issues related to mental and emotional health can greatly improve quality of life for individuals and families. Read more about emotional health and MS