Dr Mao Zhifeng, MD, PhD
Mao has just joined BartsMS as an ECTRIMS Clinical Training Fellow to DrK. He has undertaken research in the field of neuroimmunology since 2008 when he started his MSc at the Guangxi Medical University, China. After obtaining his MSc in 2010, he spent three years as a specialist registrar in Neurology. He then continued his research interest in demyelinating diseases with a PhD (awarded in June 2016) at the Multiple Sclerosis Center of the 3rd affiliated Hospital of Sun Yat-Sen University. Mao is keen to learn how to undertake clinical trials of disease modifying drugs in MS, particularly in people with advanced MS, and will support our #ThinkHand campaign. He also wants to learn more about service and pathway development for people with MS who are often marginalised simply because of the lower prevalence of MS in lower and middle income countries. Mao plans to stay with us until November 2017.
This is his first BartsMS blog post.
"Imagine Dad explaining to his daughter that Father Christmas is no longer able to deliver toys on Christmas Eve as he sufferers from multiple sclerosis. That's the concept of a recent campaign by Alzheimer’sResearch UK where Santa is living with the effects of dementia.
Dementia is a syndrome with many potentially underlying diseases, of which cerebral "small vessel disease” (SVD) is one of the commonest. As we are – hopefully – contributing to the longevity of people with MS, vascular comorbidity becomes ever more relevant, and much of the MS Brain Health campaign is just as applicable to people with vascular risk factors.
This recent review is quite timely in that it highlights (i) pathological similarities between MS and SVD, (ii) the contribution of SVD to the overall outcome and well-being of pwMS, (iii) the chronic inflammatory milieu in MS that may render the brain more vulnerable for SVD, and (iv) drugs that target the microvasculature which may have effects beneficial on the overall outcome in MS."
Geraldes R, Esiri MM, DeLuca GC,Palace J. Age-related small vessel disease: A potential contributor to neurodegeneration in multiple sclerosis. Brain Pathol. 2016 Nov 19. doi: 10.1111/bpa.12460. [Epub ahead of print]
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system wherein, after an initial phase of transient neurological defects, slow neurological deterioration due to progressive neuronal loss ensues. Age is a major determinant of MS progression onset and disability. Over the past years, several mechanisms have been proposed to explain the key drivers of neurodegeneration and disability accumulation in MS. However, the effect of commonly encountered age-related cerebral vessel disease, namely small vessel disease (SVD), has been largely neglected and constitutes the aim of this review. SVD shares some features with MS, i.e. white matter demyelination and brain atrophy, and has been shown to contribute to the neuronal damage seen in vascular cognitive impairment. Several lines of evidence suggest that an interaction between MS and SVD may influence MS-related neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular reactivity and tissue hypoxia, features seen in MS. Venule and endothelium abnormalities have been documented in MS but the role of arterioles and of other neurovascular unit structures, such as the pericyte, have not been explored. Vascular risk factors (VRF) have recently been associated with faster progression in MS though the mechanisms are unclear since very few studies have addressed the impact of VRF and SVD on MS imaging and pathology outcomes. Therapeutic agents targeting the microvasculature and the neurovascular unit may impact both SVD and MS and may benefit patients with dual pathology.