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Davis GE, Davis MJ, Lowell WE. Triggering multiple sclerosis at conception and early gestation: The variation in ultraviolet radiation is as important as its intensity. Heliyon 2023; 9:e16954. [PMID: 37346332 PMCID: PMC10279836 DOI: 10.1016/j.heliyon.2023.e16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
Background and objectives Medical science needs to further elucidate the role of ultraviolet radiation (UVR), geographic latitude, and the role of vitamin D in the autoimmune disease multiple sclerosis (MS). We separated several papers into categories out of the thousands published and used their conclusions to explore the relationship between UVR and MS. Relevance MS is increasing in incidence, particularly in women where MS is two to three times that in men and particularly severe in African Americans. Methods We collected UVR data at our observatory in Central Maine and calculated the average coefficient of variation (CVUVR) for each month for 15 years (2007-2021, inclusive). Results The month of conception (MOC) is more important than the month of birth (MOB) in explaining how UVR triggers the variable genetic predisposition to MS. We hypothesize that the rapidly increasing CVUVR is important in preventing an increase in the activity of the vitamin D receptor (VDR) from August to December, which then requires a higher intensity of UVR later in life to suppress the immune system, therefore predisposing to more MS. Limitations One observatory at about 44° latitude. Conclusions While variation in UVR is important at the MOC if UVR exceeds a threshold (e.g., if the sunspot number equals or is greater than 90, usually at a solar cycle MAX, or at elevations above approximately 3,000 feet above sea level), the MS mitigating vitamin D-VDR mechanism is overwhelmed and the genotoxic effects of higher-intensity UVR promote MS in those with a genetic predisposition. What is new in this research This paper offers a new concept in MS research.
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Affiliation(s)
- George E. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Matthew J. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Walter E. Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
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Cárdenas-Robledo S, González-Caicedo P, Carvajal-Parra MS, Guío-Sánchez CM, López-Reyes L. No seasonality in the risk of multiple sclerosis in an equatorial country: A case-control ecological study. Mult Scler 2023; 29:343-351. [PMID: 36250508 DOI: 10.1177/13524585221130020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis risk has been shown to have seasonal variations that are more pronounced in higher latitudes. However, this phenomenon has not been adequately studied near the Equator. OBJECTIVE To explore the risk of multiple sclerosis associated with month, season of birth, and sunlight exposure variables in Colombia. METHODS In this case-control study, 668 multiple sclerosis cases were matched to 2672 controls by sex and age. Association of multiple sclerosis with each month/season of birth and sunlight exposure variables was estimated with multilevel mixed-effects logistic regression and ecological regression models, respectively. Seasonality in the births of multiple sclerosis was assessed with a non-parametric seasonality test. RESULTS We found a higher probability of multiple sclerosis in September (0.25; 95% confidence interval (CI) = 0.21-0.31) and lower in March (0.15; 95% CI = 0.10-0.18), which turned non-significant after a multiple comparisons test. Sunlight exposure variables had no significant effect on the risk of MS, and the tests of seasonality in the births of MS did not show significant results. CONCLUSION Our results show no seasonality in the risk of multiple sclerosis near the Equator, supporting the hypothesis that this phenomenon is latitude dependent.
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Affiliation(s)
- Simón Cárdenas-Robledo
- Centro de Esclerosis Múltiple (CEMHUN), Deparatmento de Neurología, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Unidad de Neurología, Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Paula González-Caicedo
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia/Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | | | - Claudia Marcela Guío-Sánchez
- Centro de Esclerosis Múltiple (CEMHUN), Deparatmento de Neurología, Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Lorena López-Reyes
- Centro de Esclerosis Múltiple (CEMHUN), Deparatmento de Neurología, Hospital Universitario Nacional de Colombia, Bogotá, Colombia
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Vitamin D in early life and later risk of multiple sclerosis-A systematic review, meta-analysis. PLoS One 2019; 14:e0221645. [PMID: 31454391 PMCID: PMC6711523 DOI: 10.1371/journal.pone.0221645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/12/2019] [Indexed: 12/27/2022] Open
Abstract
The study examined results from previous studies of early life vitamin D exposure and risk of MS in adulthood, including studies on season or month of birth and of migration. A systematic review was conducted using PubMed and Web of Science databases as well as checking references cited in articles. The quality of studies was assessed using the Newcastle-Ottawa scale and the AMSTAR score. Twenty-eight studies were selected for analysis. Of these, six population studies investigated early life vitamin D exposure and risk of MS, and three found inverse while the remaining found no associations. A consistent seasonal tendency for MS seemed evident from 11/15 studies, finding a reduced occurrence of MS for Northern hemisphere children who were born late autumn, and late fall for children born in the Southern hemisphere. This was also confirmed by pooled analysis of 6/15 studies. Results of the migration studies showed an increased risk of MS if migration from high to low-MS-risk areas had occurred after age 15 years, while risk of MS was reduced for those migrating earlier in life (<15years). A similar, but inverse risk pattern was observed among migrants from low to high-MS-risk areas. One study found an increased risk of MS in the second generation of migrants when migrating from low to high-MS-risk areas. An association between early life vitamin D and later risk of MS seems possible, however evidence is still insufficient to conclude that low vitamin D exposure in early life increases the risk of MS in adulthood. PROSPERO register number: CRD 42016043229.
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Dobrakowski P, Bogocz M, Cholewa K, Rajchel M, Kapica-Topczewska K, Wawrzyniak S, Bartosik-Psujek H, Kułakowska A, Koziarska D, Adamczyk-Sowa M. Month of birth and level of insolation as risk factors for multiple sclerosis in Poland. PLoS One 2017; 12:e0175156. [PMID: 28384281 PMCID: PMC5383232 DOI: 10.1371/journal.pone.0175156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/21/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Many studies have shown that people born in the spring are at a higher risk of developing multiple sclerosis (MS). This may be associated with lower levels of sun exposure, and consequently, lower levels of vitamin D3 during pregnancy. However, these relationships have not been verified thus far in any countries in Central Europe. OBJECTIVE The aim of our study was to determine the frequency distribution of births for each calendar month in patients suffering from MS in Poland. METHODS We analyzed data for 2574 patients diagnosed with MS (1758 women, 816 men) living in Poland for an extended period. We added corrections resulting from the frequency distribution of births for the years in which the patients were born. We applied the Hewitt test for seasonality with Rogerson modification for 3-, 4-, or 6-month pulses or periods. Moreover, we examined the average number hours of sunshine in every month of the year. RESULTS The rank-sums for successive 3- and 4-month segments indicated the period from September to December and from October to December as having a significantly lower incidence (p = 0.027 and p = 0.054, respectively). We did not find a correlation between with hours of sunshine in the first trimester of pregnancy, the child's birth month, and the child developing MS. CONCLUSIONS We were able to confirm a seasonal variation in the risk of MS in Poland. However, these findings did not correlate with hours of sunshine during the first trimester of pregnancy.
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Affiliation(s)
- Paweł Dobrakowski
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Michał Bogocz
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Kamil Cholewa
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Mateusz Rajchel
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | | | - Sławomir Wawrzyniak
- Department of Neurology, 10 Military Hospital with Policlinic, Bydgoszcz, Poland
| | | | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Dorota Koziarska
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
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Environmental factors in multiple sclerosis. Presse Med 2015; 44:e113-20. [PMID: 25744944 DOI: 10.1016/j.lpm.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 12/29/2022] Open
Abstract
Although multiple sclerosis (MS) is recognized as a disorder involving the immune system, the interplay of environmental factors and individual genetic susceptibility seems to influence MS onset and clinical expression, as well as therapeutic responsiveness. Multiple human epidemiological and animal model studies have evaluated the effect of different environmental factors, such as viral infections, vitamin intake, sun exposure, or still dietary and life habits on MS prevalence. Previous Epstein-Barr virus infection, especially if this infection occurs in late childhood, and lack of vitamin D (VitD) currently appear to be the most robust environmental factors for the risk of MS, at least from an epidemiological standpoint. Ultraviolet radiation (UVR) activates VitD production but there are also some elements supporting the fact that insufficient UVR exposure during childhood may represent a VitD-independent risk factor of MS development, as well as negative effect on the clinical and radiological course of MS. Recently, there has been a growing interest in the gut-brain axis, a bidirectional neuro-hormonal communication system between the intestinal microbiota and the central nervous system (CNS). Indeed, components of the intestinal microbiota may be pro-inflammatory, promote the migration of immune cells into the CNS, and thus be a key parameter for the development of autoimmune disorders such as MS. Interestingly most environmental factors seem to play a role during childhood. Thus, if childhood is the most fragile period to develop MS later in life, preventive measures should be applied early in life. For example, adopting a diet enriched in VitD, playing outdoor and avoiding passive smoking would be extremely simple measures of primary prevention for public health strategies. However, these hypotheses need to be confirmed by prospective evaluations, which are obviously difficult to conduct. In addition, it remains to be determined whether and how VitD supplementation in adult life would be useful in alleviating the course of MS, once this disease has already started. A better knowledge of the influence of various environmental stimuli on MS risk and course would certainly allow the development of add-on therapies or measures in parallel to the immunotherapies currently used in MS.
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Liguori M, Qualtieri A, Tortorella C, Direnzo V, Bagalà A, Mastrapasqua M, Spadafora P, Trojano M. Proteomic profiling in multiple sclerosis clinical courses reveals potential biomarkers of neurodegeneration. PLoS One 2014; 9:e103984. [PMID: 25098164 PMCID: PMC4123901 DOI: 10.1371/journal.pone.0103984] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/04/2014] [Indexed: 12/21/2022] Open
Abstract
The aim of our project was to perform an exploratory analysis of the cerebrospinal fluid (CSF) proteomic profiles of Multiple Sclerosis (MS) patients, collected in different phases of their clinical course, in order to investigate the existence of peculiar profiles characterizing the different MS phenotypes. The study was carried out on 24 Clinically Isolated Syndrome (CIS), 16 Relapsing Remitting (RR) MS, 11 Progressive (Pr) MS patients. The CSF samples were analysed using the Matrix Assisted Laser Desorption Ionisation Time Of Flight (MALDI-TOF) mass spectrometer in linear mode geometry and in delayed extraction mode (m/z range: 1000–25000 Da). Peak lists were imported for normalization and statistical analysis. CSF data were correlated with demographic, clinical and MRI parameters. The evaluation of MALDI-TOF spectra revealed 348 peak signals with relative intensity ≥1% in the study range. The peak intensity of the signals corresponding to Secretogranin II and Protein 7B2 were significantly upregulated in RRMS patients compared to PrMS (p<0.05), whereas the signals of Fibrinogen and Fibrinopeptide A were significantly downregulated in CIS compared to PrMS patients (p<0.04). Additionally, the intensity of the Tymosin β4 peak was the only signal to be significantly discriminated between the CIS and RRMS patients (p = 0.013). Although with caution due to the relatively small size of the study populations, and considering that not all the findings remained significant after adjustment for multiple comparisons, in our opinion this mass spectrometry evaluation confirms that this technique may provide useful and important information to improve our understanding of the complex pathogenesis of MS.
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Affiliation(s)
- Maria Liguori
- National Research Council of Italy, Institute for Biomedical Technologies, Bari, Italy
- * E-mail:
| | - Antonio Qualtieri
- National Research Council of Italy, Institute of Neurological Sciences, Mangone (CS), Italy
| | - Carla Tortorella
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Vita Direnzo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Angelo Bagalà
- National Research Council of Italy, Institute of Neurological Sciences, Mangone (CS), Italy
| | - Mariangela Mastrapasqua
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Patrizia Spadafora
- National Research Council of Italy, Institute of Neurological Sciences, Mangone (CS), Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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Grytten N, Torkildsen Ø, Aarseth JH, Benjaminsen E, Celius EG, Dahl OP, Holmøy T, Løken-Amsrud K, Midgard R, Myhr KM, Risberg G, Vatne A, Kampman MT. Month of birth as a latitude-dependent risk factor for multiple sclerosis in Norway. Mult Scler 2012; 19:1028-34. [PMID: 23257620 DOI: 10.1177/1352458512471094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine if the risk of Multiple Sclerosis (MS) is associated with month of birth in Norway and to explore a possible latitudinal gradient. METHODS All patients with MS born between 1930 and 1979 registered in the Norwegian MS Registry or ascertained in Norwegian prevalence studies were included (n = 6649). The latitude gradient was divided in Southern, Middle and Northern Norway, according to the estimated regional yearly mean vitamin D effective UV dose. RESULTS Risk of MS was 11% higher for those born in April (p = 0.045), and 5% higher for those born in May (p = 0.229), 5% lower for those born in November (p = 0.302) and 12% lower for those born in February (p = 0.053) compared with the corresponding population, unaffected mothers and siblings. In Southern Norway the odds ratio of MS births in April and May was 1.05 (0.98-1.24), in Middle Norway 1.11 (0.97-1.27) and in Northern Norway 1.28 (1.0-1.63) compared with the other months. CONCLUSIONS This study confirms previous reports of increased MS births in spring and decreased MS births in the winter months. This could support the role of decreased sunlight exposure during pregnancy and vitamin D deficiency in prenatal life in MS.
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Affiliation(s)
- Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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