ResearchSpeak: preventing MS

Shame on us; why haven't we started any MS prevention trials? #ResearchSpeak #MSBlog #MSResearch

"One the research themes to come out of the MS Society's James Lind Alliance scoping exercise was 'MS prevention'. Can we prevent MS? The UK MS Society is hosting a MS Prevention meeting tomorrow at Heathrow (see programme below).  We know an increasing amount about the causal pathways in MS and other autoimmune diseases and it is becoming increasingly clear that targeting the known environmental factors in MS is the obvious way to go. 

The big questions are:

  1. How do we stop the population smoking, or at least people who are at high-risk of getting MS from smoking?
  2. Is it vitamin D deficiency, or lack of sunlight exposure, the risk factor for developing MS and other autoimmune diseases? Is low vD levels simply a surrogate of low sunlight exposure and it is the latter that is the risk factor?
  3. How do we design a vitamin D prevention trial? Should we focus on the general population or high-risk groups (1st and 2nd generation family members of MSers)? What dose of vD should we use or do we need to supplement to a target (e.g. >100nmol/L)? Is it ethical to do a placebo controlled trial? Could we use 400IU of vD (the current RDA) as the comparator? What about the timing of vD supplementation; should it be started in utero, childhood, adolescence or early adulthood? Can we simply supplement the population and look at disease trends?
  4. Should we be partnering with other disease groups; for example the type 1 diabetes community? If we use type 1 diabetes as a surrogate prevention  trials will report out decades earlier than with MS.
  5. EBV; how good are the current EBV vaccines? Do we need new vaccines? Is it safe to prevent the population from acquiring EBV? EBV is one of our most co-evolved viruses, it is part of our metagenome. Preventing people getting EBV may have consequences. What role does EBV play at the population level? I suspect it may play a role in immunological memory and that stopping the general population from being infected with the virus will have consequences.
  6. Would simply preventing people getting infectious mononucleosis (IM) be sufficient to lower the risk of developing MS? Is the EBV-IM MS link simply an association and not causal? In other words the observation that people who develop IM are at increased risk of MS may simply indicate that these people have something wrong with their immune systems that also happens to predispose them to getting MS. I don't buy into this latter argument, but it is out there, nevertheless.
  7. Should we developing a treatment for IM? Will treating IM successfully lower their risk of someone getting MS? What happens to the immune system post-IM that predisposed people to getting MS?
  8. What about EBV itself? Is there a mutant EBV variant that causes MS and/or other autoimmune diseases? 

As you can see there are more questions than answers. What I do know is that if we don't act now  the next generation of MSers will look back at us and say 'why didn't you do something about it, if had done I may not have MS today'. In 2015 we know enough about MS and its risk factors to be starting prevention trials. Doing nothing is simply not acceptable."

"It is a great pity George Ebers is not attending this meeting. George and I have had many a long conversation about MS prevention. George is a deep thinker and has some brilliant ideas about how to do vD MS prevention trials at a population level." 

MS Society Prevention Meeting Programme from Gavin Giovannoni

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