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MSWA Bulletin Magazine Summer 2019

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RESEARCH RESEARCH ROUND

RESEARCH RESEARCH ROUND UP SUE SHAPLAND RN, BN, MSCN GENERAL MANAGER STRATEGIC SUPPORTS AND RESIDENTIAL OPTIONS FROM MS RESEARCH AUSTRALIA Full articles are available at msra.org.au New genetic map shows different immune cells involved in MS onset Whilst there has been much research into the contribution of genes to the risk of MS and the immune cells involved in MS onset, there is still a lot that remains unknown. Australian and international researchers have developed a genetic map of MS, which has more than doubled the gene changes known to play a role in MS. These studies shed light on the role of the adaptive immune system in MS onset. The adaptive immune system is the part of the immune system that reacts to specific attacks and gains memory after being attacked the first time, allowing it to react faster to future attacks. Recent studies, including this new one, suggest that other parts of the immune system may also be involved in MS. Published in the prestigious journal, Science, Australian and international researchers, as part of the International MS Genetics Consortium, looked at 47,429 people with MS and 68,374 people without MS to determine any further genetic changes that play a role in how MS starts and the cells that might be involved. The researchers found a total of 233 independent gene changes linked to MS risk – 32 were located in a genetic region called the major histocompatibility complex (MHC), the area of the genome which contains the most significant risk MS genes. This new MS genetic map has doubled the previously known MS risk genes. It is exciting that a genetic change was identified on the X chromosome, although it’s unlikely this is the only factor contributing to the higher MS incidence in women. This is a first step towards understanding the genetic contributions of this strong bias. These exciting findings show that a variety of immune cells contribute to MS risk and that both the adaptive and innate arms of the immune system play a role. This research sets the stage for further studies to uncover the sequence of events that lead to disease onset and may pave the way for new effective therapies. What determines conversion to secondary progressive MS? Secondary progressive MS (SPMS) usually follows on from relapsingremitting MS (RRMS), but it’s not easy to determine when this might happen to an individual, if at all. Thus, there is an urgent need to identify risk factors that influence conversion of RRMS to SPMS. A large international study led by an Australian researcher studied cohorts with RRMS to identify demographic and clinical features that may be linked to a higher risk of developing SPMS. The study found several factors influencing conversion to SPMS, paving the way for clinicians to identify those at risk earlier. Of the 15,717 people in the first analysis, 85% received disease modifying therapies (DMT) and 10% converted to SPMS. The average time to convert was 32.4 years. The results show greater disability, rapid disability progression, higher number of relapses in the previous year, longer disease duration and older age were each linked to increased risk of SPMS. DMT and an improvement in disability based on the expanded disability status score (EDSS), were linked to a reduced risk of SPMS. 8

HERE WE PROVIDE SUMMARIES OF RESEARCH SOURCED FROM WEBSITES IN AUSTRALIA AND AROUND THE WORLD. READ MORE AT MSWA.ORG.AU/RESEARCHUPDATE They also show that DMTs may reduce the risk of conversion to SPMS, which is supported by other studies. This study confirmed that the average time from MS onset to SPMS has increased from 15 years to 30 years over the last two decades, highlighting the efficiency of treatment options available. These findings will be important for clinicians to help those who are at high risk of developing SPMS at an earlier stage. This means that interventions can be started earlier, reducing people’s chances of ever developing SPMS. FROM MS NEWS TODAY DAILY DIGEST Full articles are available at https://multiplesclerosisnewstoday Interleukin-22 may be biomarker to monitor how well RRMS patients respond to therapy. Abdel-Dayem MA, Shaker ME, Gameil NM. A new study shows that levels of the inflammatory molecule interleukin-22 (IL-22) may be a potential biomarker to evaluate disease severity and the effectiveness of treatments in patients with relapsing-remitting multiple sclerosis (RRMS). IL-22, IL-32α, and IL-34 are three different cytokines detected in patients with various inflammatory diseases and are thought to have either pro-inflammatory or antiinflammatory properties. Very few studies have investigated the role of these cytokines in MS. In this study, researchers evaluated the levels of IL-22, IL-32α, and IL-34 in the serum of RRMS patients, to assess how well these cytokines correlate with the level of MSassociated disability – evaluated through the expanded disability status score (EDSS). The researchers assessed the changes in these interleukins after treatment with three diseasemodifying therapies: interferon beta-1b; interferon beta-1a; and fingolimod. Results showed a higher concentration of IL-22, but not IL-32α or IL-34, in untreated patients with RRMS compared to healthy individuals. Treatments with both types of interferon and Gilenya led to a significant decrease in levels of IL- 22 and IL-32α, but not IL-34, after six and 12 months of treatment, compared to initial concentrations before treatment. Further analysis revealed levels of serum IL-22 and, to a lesser extent, IL-32α correlated positively with the EDSS score. Those results suggest that the lower the IL-22 levels, the lower the disability score. Thus, the team believes that IL-22 can be used as a tool to monitor how well patients are responding to treatment. Researchers wrote: “IL-22 and, to a lesser extent IL-32α, may be potential markers for MS disease severity and efficacy of DMDs [diseasemodifying drugs]. Meanwhile, there is no relation between the therapeutic mechanism of the used DMDs and the concentration of IL- 34 in the blood circulation.” Higher intellectual ability, early-life physical activity may protect against cognitive impairment in MS, study suggests. Maria Pia Amato et al. The aim of this small Italian study was to assess risk factors for Cognitive Impairment (CI) in MS patients, focusing on environmental exposures, lifestyle and comorbidities. One hundred and fifty MS patients with RRMS, and primary and secondary progressive MS were included. CI was identified in 30% of the participants and was associated with older age onset of MS, higher EDSS score, progressive disease course and lower pre-morbid IQ. 9