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Arabipoor A, Moini A, Nabavi SM, Mohiti S, Mashayekhi M, Zolfaghari Z. Evaluation of ovarian reserve and the assisted reproductive technology (ART) cycles' outcome as well as the relapse rate within one year after ART in women with multiple sclerosis: a case-control study. J Ovarian Res 2024; 17:165. [PMID: 39138488 PMCID: PMC11323676 DOI: 10.1186/s13048-024-01483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To compare the ovarian reserve and the results of infertility treatment, as well as to investigate the relapse rate in the first year after the assisted reproductive technology (ART) cycle in patients with multiple sclerosis (MS) referred to Royan Institute. MATERIALS AND METHODS This retrospective study was carried out to evaluate all women diagnosed with MS and referred to Royan Institute for assessment and treatment of possible infertility between 2011 and 2022. The control group consisted of randomly selected healthy women with tubal factor infertility who were referred for treatment during the same time period and matched in terms of age. A comparison was made between groups in terms of ovarian reserve and infertility treatment outcomes. Additionally, patients with MS who met the criteria were monitored via telephone to evaluate the symptoms, disability and relapse rate both pre- and post-ART. RESULTS Over the course of a decade, the database documented a total of 60 cases diagnosed with MS. Upon examination of the records, it was found that in 27 patients only admission was done without any hormonal assessment or infertility treatment cycle and 5 patients proceeded with the intrauterine insemination cycle. Eventually, 28 women with MS underwent the ART cycle and all of them were treated with interferon beta, glatiramer acetate, or some oral disease modifying therapies. No statistically significant difference in terms of the basal levels of luteinizing hormone, follicle-stimulating hormone and anti-Müllerian hormone was found between the MS and control groups (P > 0.05). Two groups were comparable in terms of menstrual status. The study revealed that both groups exhibited similarities in terms of the controlled ovarian stimulation protocol and duration, the dosage of gonadotropin administered, as well as the ovarian response type, clinical pregnancy rate, and live birth rate (P > 0.05). After follow up, only 2 patients (9.5%) reported relapse of symptoms within one year after ART. CONCLUSION The ovarian reserve and ovarian stimulation cycle and pregnancy outcomes following the ART cycle in MS patients were similar to the age-matched control group. The relapse rate of multiple sclerosis did not show a significant increase within a year following the ART cycle.
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Affiliation(s)
- Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
- Department of Gynecology and Obstetrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Massood Nabavi
- Department of Regenerative Medicine, Neurology and MS group, Royan Institute, Tehran, Iran.
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | - Shima Mohiti
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehri Mashayekhi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Basic and Population Based Studies in NCD, Reproductive Epidemiology Research Center, Royan Institute, ACECR, Tehran, Iran
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Wang Y, Wang J, Feng J. Multiple sclerosis and pregnancy: Pathogenesis, influencing factors, and treatment options. Autoimmun Rev 2023; 22:103449. [PMID: 37741528 DOI: 10.1016/j.autrev.2023.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated degenerative disease of the central nervous system, characterized by inflammatory demyelination. It is primarily found in women of childbearing age, making pregnancy a significant concern for both patients with MS and clinicians. To assist these patients in achieving their desire for pregnancy, reducing MS relapses during all stages of pregnancy, preventing the progression of MS, mitigating the impact of MS treatment on the course and outcome of pregnancy, and a thorough understanding of the relationship between pregnancy and MS, as well as specific management and the application of relevant medications for MS patients at each stage of pregnancy, are essential. This article provides an update on pregnancy-related issues in women with MS, including the general recommendations for management at each stage of pregnancy.
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Affiliation(s)
- Yinxiang Wang
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China
| | - Jue Wang
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China.
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3
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Gasperi C, Hapfelmeier A, Schneider A, Kuhn KA, Donnachie E, Hemmer B. Association of pregnancies with risk of multiple sclerosis. Mult Scler 2022; 28:1630-1640. [PMID: 35301890 PMCID: PMC9315178 DOI: 10.1177/13524585221080542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Pregnancies have an impact on the disease course of multiple sclerosis (MS),
but their relationship with MS risk is yet unclear. Objective: To determine the relationships of pregnancies and gynecological diagnoses
with MS risk. Methods: In this retrospective case–control study, we assessed differences in
gynecological International Classification of Diseases, 10th Revision
(ICD-10) code recording rates between women with MS
(n = 5720), Crohn’s disease (n = 6280), or
psoriasis (n = 40,555) and women without these autoimmune
diseases (n = 26,729) in the 5 years before diagnosis. Results: Twenty-eight ICD-10 codes were recorded less frequently for women with MS as
compared to women without autoimmune disease, 18 of which are
pregnancy-related. After adjustment for pregnancies, all codes unrelated to
pregnancies were still negatively associated with MS. In a sensitivity
analysis excluding women with evidence for possible demyelinating events
before diagnosis, all associations were more pronounced. In comparison to
women with psoriasis, most associations could be confirmed; that was not
true in comparison to women with Crohn’s disease. Conclusion: Our findings provide evidence for a possible protective effect of pregnancies
on MS risk likely independent of or in addition to a previously suggested
reversed causality. The negative associations of gynecological disorders
with disease risk need further investigation. The associations might be
shared by different autoimmune diseases.
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Affiliation(s)
- Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute for AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany/Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany
| | - Klaus A Kuhn
- Institute for AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany/ Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Ucciferri CC, Dunn SE. Effect of puberty on the immune system: Relevance to multiple sclerosis. Front Pediatr 2022; 10:1059083. [PMID: 36533239 PMCID: PMC9755749 DOI: 10.3389/fped.2022.1059083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Puberty is a dynamic period marked by changing levels of sex hormones, the development of secondary sexual characteristics and reproductive maturity. This period has profound effects on various organ systems, including the immune system. The critical changes that occur in the immune system during pubertal onset have been shown to have implications for autoimmune conditions, including Multiple Sclerosis (MS). MS is rare prior to puberty but can manifest in children after puberty. This disease also has a clear female preponderance that only arises following pubertal onset, highlighting a potential role for sex hormones in autoimmunity. Early onset of puberty has also been shown to be a risk factor for MS. The purpose of this review is to overview the evidence that puberty regulates MS susceptibility and disease activity. Given that there is a paucity of studies that directly evaluate the effects of puberty on the immune system, we also discuss how the immune system is different in children and mice of pre- vs. post-pubertal ages and describe how gonadal hormones may regulate these immune mechanisms. We present evidence that puberty enhances the expression of co-stimulatory molecules and cytokine production by type 2 dendritic cells (DC2s) and plasmacytoid dendritic cells (pDCs), increases T helper 1 (Th1), Th17, and T follicular helper immunity, and promotes immunoglobulin (Ig)G antibody production. Overall, this review highlights how the immune system undergoes a functional maturation during puberty, which has the potential to explain the higher prevalence of MS and other autoimmune diseases seen in adolescence.
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Affiliation(s)
- Carmen C Ucciferri
- Department of Immunology, The University of Toronto, Toronto, ON, Canada
| | - Shannon E Dunn
- Department of Immunology, The University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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5
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Nguyen AL, Vodehnalova K, Kalincik T, Signori A, Havrdova EK, Lechner-Scott J, Skibina OG, Eastaugh A, Taylor L, Baker J, McGuinn N, Rath L, Maltby V, Sormani MP, Butzkueven H, Van der Walt A, Horakova D, Jokubaitis VG. Association of Pregnancy With the Onset of Clinically Isolated Syndrome. JAMA Neurol 2021; 77:1496-1503. [PMID: 32926074 DOI: 10.1001/jamaneurol.2020.3324] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Multiple sclerosis (MS) is usually diagnosed in women during their childbearing years. Currently, no consensus exists on whether pregnancy can delay the first episode of demyelination or clinically isolated syndrome (CIS). Objective To investigate the association of pregnancy with time to CIS onset. Design, Setting, and Participants This multicenter cohort study collected reproductive history (duration of each pregnancy, date of delivery, length of breastfeeding) on all participants between September 1, 2016, and June 25, 2019. Adult women being treated at the MS outpatient clinics of 4 tertiary hospitals in 2 countries (Charles University and General University Hospital in Prague, Czech Republic; Royal Melbourne Hospital in Melbourne, Australia; Alfred Hospital in Melbourne, Australia; and John Hunter Hospital in Newcastle, Australia) were recruited to participate in the study. Preexisting data (date of CIS onset, date of birth, sex, date of clinical onset, and Expanded Disability Status Scale result) were collected from MSBase, an international registry of long-term prospectively collected data on patients with MS. Data analyses were performed from June 1, 2019, to February 3, 2020. Exposures Gravida (defined as any pregnancy, including pregnancy that ended in miscarriage and induced abortion) and parity (defined as childbirth after gestational age of more than 20 weeks, including livebirth and stillbirth) before CIS onset. Main Outcomes and Measures Time to CIS onset. The following were assessed: (1) whether women with previous pregnancies and childbirths had a delayed onset of CIS compared with those who had never been pregnant and those who had never given birth, and (2) whether a dose response existed, whereby a higher number of gravidity and parity was associated with a later onset of CIS. Results Of the 2557 women included in the study, the mean (SD) age at CIS onset was 31.5 (9.7) years. Of these women, before CIS onset, 1188 (46%) had at least 1 pregnancy and 1100 (43%) had at least 1 childbirth. The mean (SD) age at first pregnancy was 23.3 (4.5) years and at first childbirth was 23.8 (4.5) years. Women with previous pregnancies and childbirths had a later onset of CIS compared with those who had never been pregnant (HR, 0.68; 95% CI, 0.62-0.75; P < .001), with a median delay of 3.3 (95% CI, 2.5-4.1) years. Women who had given birth also had a later CIS onset compared with women who had never given birth (HR 0.68; 95% CI, 0.61-0.75; P < .001), with a similar median delay of 3.4 (95% CI, 1.6-5.2) years. A higher gravidity and parity number was not associated with delay in CIS onset. Conclusions and Relevance This study suggests an association between previous pregnancies and childbirths and timing of CIS onset, but having more pregnancies or childbirths did not appear to be associated with a later CIS onset. Further studies are needed to help explain the mechanisms behind the associations between pregnancy and onset of multiple sclerosis.
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Affiliation(s)
- Ai-Lan Nguyen
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Kalincik
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Biostatistics Unit, University of Genoa, Genoa, Italy
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Brain and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Olga G Skibina
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alana Eastaugh
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lisa Taylor
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Josephine Baker
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nicola McGuinn
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Rath
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Vicki Maltby
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Brain and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), Biostatistics Unit, University of Genoa, Genoa, Italy
| | - Helmut Butzkueven
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anneke Van der Walt
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vilija G Jokubaitis
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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6
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Azimi A, Hanaei S, Sahraian MA, Mohammadifar M, Ramagopalan SV, Ghajarzadeh M. Age at menarche and risk of multiple sclerosis (MS): a systematic review and meta-analysis. BMC Neurol 2019; 19:286. [PMID: 31727014 PMCID: PMC6854684 DOI: 10.1186/s12883-019-1473-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some studies have looked at the age at menarche and risk of Multiple Sclerosis (MS).We aimed to conduct a systematic review and meta-analysis to estimate a pooled odds ratio of developing MS by increasing age at menarche. METHODS We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, google scholar and gray literature (references of references, congress abstracts) up to 10th April 2019. RESULTS The literature search found 312 articles. After eliminating duplicates, reviews, case reports and trials, 18 articles remained. Three articles were ultimately included in the final analysis. Two studies were from Iran, and one from Canada. The pooled odds ratio (OR) for increasing 1 year of age at menarche was 0.88 (95% CI:0.82-0.94), with no significant heterogeneity (I2 = 49%, p = 0.1). Mean age at menarche was significantly different between case and control groups (mean difference = - 0.22, 95% CI = -0.42,-0.02). CONCLUSION The result of this systematic review showed that the risk of MS decreases by increasing age at menarche.
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Affiliation(s)
- Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Hanaei
- Research Center for Immunodeficiencies (RCID), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Universal Scientific Education and Research Network (USERN),Tehran university of medical sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadifar
- Department of Radiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Mahsa Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
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7
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Somers EC. Pregnancy and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2019; 64:3-10. [PMID: 32173263 DOI: 10.1016/j.bpobgyn.2019.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 01/29/2023]
Abstract
Autoimmune diseases (AID) are more prevalent in women than in men, and pregnancy-related factors such as hormonal modulation and fetal microchimerism may influence the future risk of maternal AID. For women with AID, optimizing reproductive health requires a continuum of multidisciplinary care that initiates well before the desire for pregnancy is articulated. Family planning is essential so that pregnancy can be timed when disease is stable and to allow for appropriate medication adjustments. When contraception is used, the choice of method needs to take into consideration underlying disease and laboratory features. For females undergoing gonadotoxic therapy, options for preserving ovarian health and fertility warrant consideration, even among those who are not contemplating future pregnancy. Both maternal and fetal outcomes are optimized with multispecialty care as well as close monitoring during pregnancy and the postpartum period and when treatment regimens compatible with pregnancy are maintained to control underlying disease activity.
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Affiliation(s)
- Emily C Somers
- University of Michigan Schools of Medicine & Public Health, Departments of Internal Medicine, Environmental Health Sciences and Obstetrics and Gynecology, 2800 Plymouth Rd, NCRC B14-G236, Ann Arbor, MI 48109-2800, USA.
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8
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Waubant E, Lucas R, Mowry E, Graves J, Olsson T, Alfredsson L, Langer‐Gould A. Environmental and genetic risk factors for MS: an integrated review. Ann Clin Transl Neurol 2019; 6:1905-1922. [PMID: 31392849 PMCID: PMC6764632 DOI: 10.1002/acn3.50862] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Recent findings have provided a molecular basis for the combined contributions of multifaceted risk factors for the onset of multiple sclerosis (MS). MS appears to start as a chronic dysregulation of immune homeostasis resulting from complex interactions between genetic predispositions, infectious exposures, and factors that lead to pro-inflammatory states, including smoking, obesity, and low sun exposure. This is supported by the discovery of gene-environment (GxE) interactions and epigenetic alterations triggered by environmental exposures in individuals with particular genetic make-ups. It is notable that several of these pro-inflammatory factors have not emerged as strong prognostic indicators. Biological processes at play during the relapsing phase of the disease may result from initial inflammatory-mediated injury, while risk factors for the later phase of MS, which is weighted toward neurodegeneration, are not yet well defined. This integrated review of current evidence guides recommendations for clinical practice and highlights research gaps.
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Affiliation(s)
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralia
| | - Ellen Mowry
- Department of Neurology and EpidemiologyJohns Hopkins UniversityBaltimoreMaryland
| | | | - Tomas Olsson
- Department of NeurologyKarolinska Institutet, Department of Clinical NeuroscienceStockholmSweden
| | - Lars Alfredsson
- Department of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Annette Langer‐Gould
- Clinical & Translational NeuroscienceKaiser Permanente/Southern California Permanente Medical GroupLos AngelesCalifornia
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9
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Nguyen AL, Eastaugh A, van der Walt A, Jokubaitis VG. Pregnancy and multiple sclerosis: Clinical effects across the lifespan. Autoimmun Rev 2019; 18:102360. [PMID: 31401345 DOI: 10.1016/j.autrev.2019.102360] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 01/10/2023]
Abstract
Multiple sclerosis (MS) is commonly diagnosed in women of childbearing age. Having a greater understanding of the effects of pregnancy on the course of MS will lead to improved family-planning counselling for women. We found well-established evidence for a protective effect of pregnancy on relapse occurrence in historical cohorts. More recent studies suggest that the protective effect of pregnancy against relapse may be lost in those women with more active disease treated with high efficacy therapies. Furthermore, a strong body of evidence suggests that gravidity after diagnosis of MS does not lead to worse long-term outcomes. More contentious however, is whether pregnancy can delay a first episode of demyelination or a confirmed diagnosis of MS. This review provides a detailed analysis of the literature relating to the clinical effects of pregnancy on MS outcomes across a woman's reproductive lifespan.
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Affiliation(s)
- Ai-Lan Nguyen
- Department of Medicine, University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.
| | - Alana Eastaugh
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| | - Anneke van der Walt
- Department of Medicine, University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
| | - Vilija G Jokubaitis
- Department of Medicine, University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
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10
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Jiang X, Olsson T, Alfredsson L. Age at Menarche and Risk of Multiple Sclerosis: Current Progress From Epidemiological Investigations. Front Immunol 2018; 9:2600. [PMID: 30483262 PMCID: PMC6243025 DOI: 10.3389/fimmu.2018.02600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disorder of the brain and spinal cord in which focal lymphocytic infiltration leads to the damage of myelin and axons. As a multi-factorial complex trait, both genetic background and environmental factors are involved in MS etiology. The disease is more prevalent among women, and an overall female-to-male sex ratio of around 3 is usually reported. The fact that the female preponderance is only apparent among patients with disease onset after age 12 points toward a role of puberty in MS. A key marker of female pubertal development is menarche, however, evidence from previous epidemiological investigations has been sparse and conflicting: although some studies have linked earlier age at menarche (AAM) to an increased risk of MS, others have found no association or an inverse association. Understanding the effect of AAM in MS could increase our knowledge to the disease etiology, as well as deliver meaningful implication to patients' care by aiding clinical diagnosis. Therefore, we reviewed all the currently available epidemiological studies conducted for AAM and risk of MS in adult human populations. We found evidence supporting a possible favorable role of late AAM on MS risk, but this should be further confirmed by well-designed large-scale epidemiological studies and meta-analysis. Future work may be focused on Mendelian randomization analysis incorporating genetic markers to provide additional evidence of a putative causal relationship between AAM and MS. More work should be conducted for non-European populations to increase generalizability, and among the males to complementary with results from females. Future work may also be conducted focusing on hormonal reproductive factors other than menarche, and their effects in MS prognosis, severity, and drug response.
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Affiliation(s)
- Xia Jiang
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Neuroimmunology Unit, Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Tomas Olsson
- Neuroimmunology Unit, Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lars Alfredsson
- Cardiovascular group, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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