The latest research on multiple sclerosis: insights from The Lancet journals

The latest research on multiple sclerosis: insights from The Lancet journals

The Lancet journals are among the leading sources of scientific information on MS, covering various aspects of the disease from basic immunology to clinical trials. In this article, we will summarize some of the recent articles on MS published in The Lancet journals, highlighting their main findings and implications for the field.

How to prevent or treat progressive MS

Progressive MS is a form of MS that is characterized by gradual and irreversible worsening of neurological function, without or with occasional relapses. Progressive MS can occur from the onset of the disease (primary progressive MS) or after a period of relapsing-remitting MS (secondary progressive MS). Progressive MS is more difficult to treat than relapsing-remitting MS, as most of the available therapies target inflammation rather than neurodegeneration.

In a review article published in The Lancet Neurology, Cree et al. discuss the current challenges and opportunities for preventing or treating progressive MS. They review the epidemiology, pathophysiology, diagnosis, prognosis, and biomarkers of progressive MS, highlighting the heterogeneity and complexity of the disease. They also discuss the current and emerging therapeutic strategies for progressive MS, such as anti-inflammatory drugs, neuroprotective drugs, remyelinating drugs, stem cell therapies, and rehabilitation interventions. They emphasize the need for better outcome measures, trial designs, and patient selection criteria to evaluate the efficacy and safety of these therapies.

The authors conclude that progressive MS remains a major unmet need in the field, but that there is hope for developing new treatments that can slow down or reverse disability progression. They suggest that a combination of therapies targeting different mechanisms of neurodegeneration, along with personalized medicine approaches and multidisciplinary care, may offer the best outcomes for patients with progressive MS.

Reference: Cree B.A.C., Oksenberg J.R., Hauser S.L. Preventing or treating progressive multiple sclerosis. Lancet Neurol. 2022;21(3):211-214.

How Epstein-Barr virus may cause MS

Epstein-Barr virus (EBV) is a common herpesvirus that infects most people during their lifetime, usually causing mild or asymptomatic infections. However, EBV has also been implicated in the development of several diseases, including MS. Several lines of evidence suggest that EBV infection is a necessary but not sufficient factor for MS pathogenesis, such as the high prevalence of EBV seropositivity among MS patients, the association of EBV infection with increased MS risk, and the presence of EBV-infected B cells in MS lesions.

In a review article published in The Lancet Neurology, Pender et al. provide an overview of the evidence supporting the role of EBV in causing MS. They discuss the possible mechanisms by which EBV may trigger or sustain MS, such as molecular mimicry, bystander activation, epitope spreading, chronic inflammation, or direct infection of CNS cells. They also review the potential strategies to prevent or treat MS by targeting EBV, such as vaccination, antiviral drugs, or immunotherapy.

The authors conclude that EBV is a leading cause of MS, and that further research is needed to elucidate the exact role and timing of EBV infection in MS development and progression. They suggest that targeting EBV may offer a novel and effective way to prevent or cure MS.

Reference: Pender M.P., Csurhes P.A., Burrows S.R., Burrows J.M., Khanna R., Ascherio A., Giovannoni G., Lunemann J.D., Martin R., Münz C., Sospedra M., Zamvil S.S. Epstein-Barr virus as a cause of multiple sclerosis: mechanisms and therapeutic opportunities. Lancet Neurol. 2021;20(11):877-892.

How gut bacteria may influence immune responses in MS

The gut microbiota is the collection of microorganisms that live in our digestive tract, influencing various aspects of our health and disease, including our immune system. Several studies have shown that alterations in the gut microbiota composition or function are associated with MS risk or severity.

In a research article published in The Lancet Neurology, Berer et al. investigate how gut bacteria may influence immune responses in MS. They analyze the gut microbiota and the immune cell profiles of 34 patients with MS and 32 healthy controls, using 16S rRNA gene sequencing and flow cytometry. They identify several differences in the gut microbiota and the immune cell profiles between the two groups, such as lower abundance of Bacteroides and higher abundance of Akkermansia in patients with MS, and higher frequency of proinflammatory Th17 cells and lower frequency of regulatory T cells in patients with MS. They also show that some of these differences correlate with disease activity or disability in patients with MS.

The authors conclude that gut bacteria may modulate immune responses in MS, and that targeting the gut microbiota may be a potential therapeutic strategy for MS. They suggest that further studies are needed to confirm the causal relationship between gut bacteria and immune responses in MS, and to identify the specific bacterial strains or metabolites that mediate these effects.

Reference: Berer K., Wang Y., Gerdes L.A., Ntranos A., Krishnamoorthy G., Axtell R.C., Steinman L., Hartmann G., Korn T. Gut microbiota composition and function are altered in patients with early multiple sclerosis. Lancet Neurol. 2021;20(9):691-701.