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Herpes virus ‘one of main causes of MS’

Tackling Epstein-Barr virus (EPV) – one of the most common viruses in humans – could lead to MS prevention, researchers say

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A herpes virus has been found to be a leading cause of Multiple Sclerosis (MS) in a new study. 

MS affects 2.8million people worldwide, and one of its causes has been found to be the Epstein-Barr virus (EBV), which is one of the most common viruses among humans. 

“The hypothesis that EBV causes MS has been investigated by our group and others for several years, but this is the first study providing compelling evidence of causality,” said Professor Alberto Ascherio, professor of epidemiology and nutrition at Harvard Chan School and senior author of the study. 

“This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection, and that targeting EBV could lead to the discovery of a cure for MS.”

MS is a chronic inflammatory disease of the central nervous system that attacks the myelin sheaths protecting neurons in the brain and spinal cord. Its cause is not known, yet one of the top suspects is EBV, a herpes virus that can cause infectious mononucleosis and establishes a latent, lifelong infection of the host. 

Establishing a causal relationship between the virus and the disease has been difficult because EBV infects approximately 95 per cent of adults, but MS is a relatively rare disease and the onset of MS symptoms begins about ten years after EBV infection. 

To determine the connection between EBV and MS, the researchers conducted a study among more than 10 million young adults on active duty in the US military and identified 955 who were diagnosed with MS during their period of service.

The team analysed serum samples taken biennially by the military and determined the soldiers’ EBV status at time of first sample and the relationship between EBV infection and MS onset during the period of active duty. 

In this cohort, the risk of MS increased 32-fold after infection with EBV but was unchanged after infection with other viruses. Serum levels of neurofilament light chain, a biomarker of the nerve degeneration typical in MS, increased only after EBV infection. 

The findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.

Prof Ascherio says that the delay between EBV infection and the onset of MS may be partially due to the disease’s symptoms being undetected during the earliest stages and partially due to the evolving relationship between EBV and the host’s immune system, which is repeatedly stimulated whenever latent virus reactivates.

“Currently there is no way to effectively prevent or treat EBV infection, but an EBV vaccine or targeting the virus with EBV-specific antiviral drugs could ultimately prevent or cure MS,” said Prof Ascherio.

MS

MS treatments ‘may reduce effect of COVID vaccine’

Some DMTs could reduce the effectiveness of vaccines, a study finds, meaning ‘all possible measures’ must be taken so people with MS feel safe

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Treatments used to help people with multiple sclerosis (MS) manage their condition can reduce the effectiveness of COVID-19 vaccines, a new study has found. 

Disease-modifying therapies (DMTs) are a group of treatments for people with MS and affect the immune system. As vaccines work by triggering the body to produce an immune response, it was suspected that some DMTs could reduce the effectiveness of COVID-19 vaccines.

The study provides the largest peer-reviewed, published evidence of the effect of DMTs on immune responses to COVID-19 vaccines. 

Researchers, from Cardiff University and Queen Mary University of London, said they hoped the new insight will better equip clinicians to provide guidance to people with MS on treatment options.

“People with MS have faced uncertainty during the COVID-19 pandemic as a direct result of their condition and the treatments they take to manage it,” says Dr Ruth Dobson, clinical senior lecturer in neurology at Queen Mary.

“Our study provides high-quality evidence that will support clinicians to advise people with MS on treatment options considering the COVID-19 pandemic. 

“However, further trials are essential to help us understand how best to balance the risks of potentially suspending or delaying MS treatment with the need to effectively vaccinate people with MS against COVID-19.”

The research team studied almost 500 people with MS and used a technique known as dried blood spot sampling to investigate the effects of DMTs on COVID-19 vaccine effectiveness. This approach reduced study costs as well as the need for potentially vulnerable patients to attend the clinic during the pandemic.

The findings show that people with MS taking either of two particular DMTs, fingolimod and ocrelizumab, were less likely to produce antibodies in response to AstraZeneca and Pfizer vaccines than people with MS not taking any DMT. 

If they did produce antibodies, the levels were lower than those found in people taking other DMTs, or not taking any DMT at all.  

However, the researchers found that other DMTs, including some that are highly effective for MS treatment, had no detrimental effect on COVID-19 vaccine response.

Immune cells, such as T-cells, are also an important part of the immune response to vaccines or viruses. The researchers studied T-cell responses in a small group of study participants who failed to mount an adequate antibody response to COVID-19 vaccination. They found that overall, 40 per cent of this group were able to produce a strong T-cell response, despite having a poor antibody response.

Dr Emma Tallantyre, clinical senior lecturer in neurology at Cardiff University, says: “Questions about the COVID vaccine are among the most common we are currently facing from people with MS in our clinics. 

“Highlighting groups who have mounted an inadequate COVID vaccine response has already been helpful in guiding who should receive additional doses of the vaccine, and who may need to continue to take additional infection-prevention precautions over the winter. 

“We hope further work will allow us to individualise our management, to protect people with MS from Covid, while keeping their MS under control.”

Dr Clare Walton, head of research at the MS Society, adds: “While this doesn’t mean these patients are necessarily at higher risk of severe illness if they catch COVID-19, it will be worrying for some. 

“It’s vital that people with weakened immune systems are better supported to protect themselves from the virus, including a right to work from home and feeling assured that the general public are doing everything they can to help keep them safe. 

“We also advise people with MS on these DMTs not to alter their treatment without speaking to someone from their MS healthcare team.”

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Sunshine ‘can help protect against MS’

New research shows exposure to sun in children and young people can help reduce their risk

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Exposure to sunshine for children and young adults may protect against multiple sclerosis (MS), new research has revealed. 

In questionnaires filled in by 332 participants with MS or their parents, 19 per cent stated that they spent less than 30 minutes daily outdoors during the previous summer, compared to six per cent of those who did not have MS. 

When the researchers adjusted for MS risks, like smoking and female sex, they found that the participants – aged between three and 22 – who spent an average of 30 minutes to one hour outdoors daily had a 52 per cent lower chance of MS, compared to those who spent an average of less than 30 minutes outdoors daily.

“Sun exposure is known to boost vitamin D levels,” said co-senior author Dr Emmanuelle Waubant, professor in the UCSF department of neurology and of the Weill Institute for Neurosciences. 

“It also stimulates immune cells in the skin that have a protective role in diseases such as MS. Vitamin D may also change the biological function of the immune cells and, as such, play a role in protecting against autoimmune diseases.

“Advising regular time in the sun of at least 30 minutes daily especially during summer, using sun protection as needed, especially for first degree relatives of MS patients, may be a worthwhile intervention to reduce the incidence of MS.”

The study follows previous work by other researchers that has demonstrated an association between increased ultraviolet exposure in childhood and lower odds of adult MS. The positive impact of sunshine has also been shown in a host of other conditions, including Long COVID.

While MS usually strikes adults between the ages of 20 to 50, statistics show that up to five per cent of the one million patients in the United States with the condition begin experiencing symptoms in childhood. 

Paediatric-onset MS is initially highly inflammatory, but takes longer than adults to advance, with symptoms of secondary progression, such as moderate to severe weakness, poor coordination and bowel and bladder control, occurring on average 28 years after disease onset, according to experts. 

However, these disability landmarks are reached approximately ten years earlier than in adult MS.

The researchers also found an association with the intensity of sunlight and estimated that residents of Florida would be 21 per cent less likely than residents of New York to have MS. 

They noted that sun exposure was “dose-dependent,” the longer the exposure the lower the risk. And even exposure in the first year of life seemed to protect against MS, they said.

Clinical trials are needed to determine if “increasing sun exposure or vitamin D supplementation can prevent the development of MS or alter disease course post-diagnosis,” said Professor Waubant, also director of the UCSF Regional Pediatric Multiple Sclerosis Center.

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How the PoNS is redefining rehab for MS patients

Through stimulation of the tongue, people with MS are overcoming symptoms to rediscover valuable aspects of their life

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Helius Medical Technologies is playing an increasingly central role in the growth of the neurostimulation market globally. Its PoNS device is changing the lives of MS patients in North America and helping to demonstrate the impact of non-invasive technology in neurological disorders. NR Times speaks to Helius’ CEO Dane Andreeff about its pioneering work

Through stimulation of the tongue, people living with Multiple Sclerosis (MS) are being supported to overcome symptoms and rediscover valuable aspects of their life. 

Groundbreaking technology developed by Helius Medical Technologies – the Portable Neuromodulation Stimulator (PoNS™) – is changing the reality for so many people with MS by helping them to vastly improve their balance and gait dysfunction. 

In people with mild to moderate MS, the PoNS has been proven in clinical studies and trials to be highly effective. One vocal advocate of the technology is legendary US television Montel Williams, who lives with relapsing remitting MS and helped to co-found Helius in 2013, credits the PoNS with changing his life.

Designed for use over a 14-week period for 20 minutes twice a day, initially under supervision in a specialist clinic but then can be used at home, the 143 gold-plated sensors on the tongue plate stimulate two major cranial nerves in the brain to help amplify its ability to heal itself. The translingual neurostimulation (TLNS) technique creates a flow of neural impulses which are delivered directly to the brain stem, which can then travel through the brain and activate or re-activate neurons and structures. 

The PoNS system, which is already commercially available in Canada, has also been given approval in Australia and is set to launch for MS patients in the US in Q1 of 2022 and is helping to lead fast-developing global efforts to devise and develop non-invasive and non-implantable neurostimulation techniques which can significantly benefit the lives and futures of patients. 

And while its operation currently is in addressing MS gait and balance issues, Helius is actively looking to widen its application into stroke and TBI, helping people with such conditions to recover lost function and improve their quality of life.

The business has recently secured its second Breakthrough Designation from the FDA in dynamic balance and gait deficit due to symptoms from stroke, recommending its use in patients aged 22 and over as part of a supervised therapeutic exercise programme – hailed as an “Important milestone” in its journey to changing lives of people living in the US. 

“This is completely new and innovative technology, with a design that Steve Jobs would be proud of,” says Dane Andreeff, who first became involved with Helius as an investor and took over as CEO last August, leading the rapid development of the revitalised business and raising new capital to drive its expansion forward. 

“Our clinical data in MS shows that PoNS gives two times the benefit of physical therapy alone. We have seen some stunning improvements in their gait – we have seen movement of eight points on the Dynamic Gait Index, where a movement of four points is considered significant.

“We have a very large and proactive audience of MS patients, who live with a very uncomfortable chronic illness, and this helps to meet their unmet needs in gait deficit. It’s amazingly innovative and doesn’t require the two or three-hour surgery for an implantable device. 

“We are ready to move into the US in the first quarter of 2022 and have a fantastic MS advisory board to support us. 

“This is exciting and most importantly, it’s happening. We have clinical data and real-world evidence on TBI and stroke, too. I have a big heart and for too long I have seen patients living with these conditions and I think ‘I wish I could help you’. Hopefully that can be the next step for us in our advancement of the technology.” 

Helius’ pioneering application of neuroplasticity to rehabilitation is the brainchild of scientists at the University of Wisconsin-Madison Tactile Communication and Neurorehabilitation Laboratory (TCNL), building on decades of previous research into the field of neuromodulation. 

The company went on to be granted Breakthrough Device Designation in MS, becoming one of only 5.6 per cent of businesses given this status to then secure FDA clearance. 

With the impact of the PoNS continuing to be proven, both through clinical data and real world experience, co-founder Montel Williams is still the longest-serving user of the device following his MS diagnosis in 1999, living with its effects for over ten years before the discovery of the device which would change his life. 

“You wouldn’t even know he has MS now from his balance or gait. But before PoNS, he was misdiagnosed four or five times and at times couldn’t even walk, you’d have to hold him up. Now he’s skiing and snowboarding and in terrific shape,” says Dane. 

“I saw him recently and he continues to beat it, he’s an amazing human being and he shows how life-changing the effect can be. We can see through examples like this, as well as through our clinical data, the improvement the PoNS can help deliver, and we hear of improvement with depression, anxiety and quality of life issues too, although we don’t have any clinical claims on that.” 

Going forward, expansion into the EU is on the agenda following Helius’ successful launch in the US, with brain injury and stroke patients also set to be supported by PoNS. 

“What we do is critical to quality of life, to helping people improve their gait, and it really excites us,” says Dane. 

“This is a whole new industry, it’s completely innovative, and we can’t wait to be able to help more people living with MS, and eventually those living with stroke and TBI, across North America.” 

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