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MSWA Bulletin Magazine Autumn 18

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MS RESEARCH ROUND UP SHARING RESEARCH UPDATES FROM AROUND THE WORLD SUE SHAPLAND RN, BN WA based and MSWA supported MS research: The PhoCIS Study, Professor Prue Hart This WA based study, partly funded by MSWA, seeks to identify if treating people who have had an isolated attack of MS (termed CIS), using UVB narrow band light therapy, can reduce the risk of conversion to MS. Conducted by WA scientists at the Telethon Kids Institute, this project has shown some very promising results, so much so that MS researchers in Scotland would like to replicate the study there. The theory is that sun exposure suppresses the immune system and that the UVB induces synthesis of Vitamin D and other molecules, which positively affect the immune system. In this study UVB narrow band phototherapy is given for CIS within 3 months of the attack. All participants receive Vitamin D supplements initially, and then half cease Vitamin D supplementation and receive UVB treatment, whilst the other half continue both Vitamin D supplements and UVB. The researchers are analysing the results but also exploring possible blood markers that may potentially help predict the time to relapse. Dietary Factors and MS Increasingly, there is a body of evidence that diet affects immune function and plays a part in chronic inflammation and the development of a number of chronic conditions. We know that antioxidants neutralise the free radicals produced in inflammation and there are many people with MS who modify their diet after diagnosis. Until now, there have been several exclusion diets that claim to cure MS and other conditions but overall there has been a lack of scientific evidence to support any of these interventions, some of which have caused other health issues. Thankfully, we are now seeing greater interest in trying to identify dietary recommendations with some level of confidence. Local clinician, researcher, and WA Australian of the Year, Professor Ralph Martins AO, has recently appeared in the news regarding dietary recommendations that can potentially reduce the risk of developing Alzheimer’s by approximately 12%. Some of his work has application across other disease groups and supports Brain Health initiatives and adds to the weight of evidence. Read about some of his work at https://particle. Dr Lucinda Black, MSWA funded researcher at Curtin University is continuing her work analysing information and results obtained through two large MS studies, one in the USA and one in Australia. Lucinda is keen to identify if dietary habits can influence causation of MS and, in the longer term, if dietary changes can influence MS symptoms. From MS Research Australia: Understanding the male vs female difference Summarising research published in the USA, it is acknowledged that women are 70% more likely to develop autoimmune diseases, including systemic lupus erythematous (SLE), rheumatoid arthritis, and MS, whereas infections can cause more serious illness in men. Researchers feel that sex hormones, including estrogen and testosterone, clearly influence disease susceptibility, but the mechanism has remained unexplained. While most studies have focused on what causes the damaging inflammation in females, they believe there is much to be learned by studying the factors that confer protection to males. Using a mouse model of MS, EAE, they identified a testosterone-driven pathway mediated by IL-33, which is a chemical that helps the cells of the immune system signal to one another. It is thought that these results may possibly help explain why females are more likely to have an autoimmune type response than males. It may also help explain males’ susceptibility to developing MS, which increases as they age, and as their levels of testosterone fall. This research could have implications for the development of therapies in the future. 8 | MSWA BULLETIN AUTUMN 2018

Read more at: From the UK MS Trust: Diet quality is associated with disability and symptom severity in multiple sclerosis. This North American study sought to assess the association between diet quality and intake of specific foods with disability and symptom severity in people with MS. The study analysed dietary information surveys from 7,639 (68%) responders, of whom 6,989 had physician-diagnosed MS. Results suggested that those with higher quality diet scores had lower levels of disability, lower reported depression scores, and less severe fatigue and pain. The researchers concluded that this large cross-sectional survey suggested that a healthy diet and a composite healthy lifestyle are associated with lower disability and symptom burden in MS. However, the results do not necessarily confirm that what you eat has a direct impact on your MS symptoms. It has some limitations as this was a one-off survey and it can’t shed further light on whether people with healthy diets continue to have lower levels of disability in the long term. Therefore, it is important that there is further research to help us to understand better the influence of a healthy lifestyle, including a balanced diet. Could textured insoles improve walking? Sensory feedback plays an important role in controlling balance, posture awareness, gait and overall mobility. People with MS often have poor sensation on their soles – thus wearing of insoles, with a bumpy surface, could increase sensory feedback leading to improvements in balance and walking. This investigation pooled the results of three earlier studies, of 85 people with MS, which compared textured insoles with smooth insoles. Overall, the review concluded that textured insoles have no effect on balance or walking. The researcher suggested that sensory feedback from muscles and joints in the lower leg and feedback from other senses such as vision, touch or the semicircular canals of the inner ear may be more important in maintaining balance and walking style. As there were limitations, being only three small studies, some Australian researchers are now recruiting 176 people for a three-month trial to try to identify any benefits. From MSIF Antidepressant drug may treat Progressive MS Funding is now allocated internationally to seek a better understanding of progressive MS and to try to identify potential treatments. A group of Canadian scientists has screened 250 medications, from 1040 potential treatments used in other diseases, as potential therapies for progressive MS; this process identified clomipramine as a potential therapy. The idea was to identify if any of these drugs could influence some of the underlying mechanisms of progressive MS. ‘Drug repurposing’ or ‘drug repositioning’, is where a known drug is used to treat a different disease. The advantage of this repurposing is that the drug has usually already passed safety tests and thus could pass more quickly through the necessary clinical trials and regulatory approval processes. Next, the team tested the ability of these medications to protect neurons against a range of damaging scenarios. From this, they identified 14 medications that could protect neurons and, after further testing, reduced this to four. The next step was to identify whether these four medications could influence certain immune cells that are involved in progressive MS. This narrowed the list down to just one medication: an antidepressant called clomipramine. The research team were then able to take this promising drug forward into the more complex and expensive experiments required to assess whether clomipramine could slow disease progression. The scientists used mice with two different types of progressive MS-like disease. In both models, clomipramine was able to reduce the clinical severity of the disease, including the reduction of disability progression. The results suggested that this may be due to a reduction in the number and activity of immune cells moving into the brain and spinal cord. There was also less degeneration of nerve cells in the animals treated with clomipramine. continued over MSWA BULLETIN AUTUMN 2018 | 9