1
|
Arjmandi D, Graeili Z, Mohammadi P, Arshadi M, Jafari Tadi M, Ardekani A, Naeimi R, Abbasi F, Marhoommirzabak E, Mahjour S, Sartip B, Prasa H, Fallah Omrani V, Rostami A. Chlamydia pneumonia infection and risk of multiple sclerosis: A meta-analysis. Mult Scler Relat Disord 2023; 77:104862. [PMID: 37442074 DOI: 10.1016/j.msard.2023.104862] [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: 01/22/2023] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The role of infectious agents, including Chlamydia pneumoniae (Cpn), in the development of multiple sclerosis (MS), is still a matter of major contention. OBJECTIVE This meta-analysis study aimed to assess the actual involvement of Cpn in MS development. METHODS We undertook a search of international scientific databases to identify eligible studies. We used a random-effects meta-analysis model (REM) to generate the pooled odds ratio (OR) and 95% confidence intervals (CIs). Heterogeneity was calculated using the I2 statistic. Sensitivity and subgroup analyses were applied to assess the effects of study characteristics and socio-demographic variables on the pooled OR. RESULTS We identified 37 studies comprising 51 datasets that satisfied the inclusion criteria. Considering diagnostic methods for Cpn, 26 and 25 datasets used PCR- and serological-based methods, respectively. In PCR-based datasets, REM showed a significant positive association between Cpn infection and the development of MS (OR, 5.29; 95% CI, 3.12-8.97), while a non-significant positive association was achieved in serological-based datasets (OR, 1.34; 95% CI, 0.88-2.03). In subgroup analyses on PCR-based datasets, results were significant for both CSF (OR, 5.70) and serum (OR, 4.84) samples; both healthy (OR, 16.11) and hospital-based (OR, 2.88) controls; and both moderate (OR, 5.14) and high (OR, 5.48) quality studies. In serological-based datasets, only those that used CSF samples yielded significant results (OR, 3.41). CONCLUSIONS Our findings verify the significant positive relationship between Cpn infection and MS. We advocate prospective cohort studies with lifelong follow-ups and also experimental studies to better understand the role of Cpn in MS development.
Collapse
Affiliation(s)
- Delaram Arjmandi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Graeili
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Parisa Mohammadi
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Arshadi
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mehrdad Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL 60607, USA
| | - Ali Ardekani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Naeimi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farzaneh Abbasi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Elika Marhoommirzabak
- Department of Neurology, University of Visayas, Gullas College of Medicine, Cebu city, 600 Cebu, Philippines
| | - Sanaz Mahjour
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Behnam Sartip
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Hamid Prasa
- Department of Neurology, University of Visayas, Gullas College of Medicine, Cebu city, 600 Cebu, Philippines
| | - Vahid Fallah Omrani
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
2
|
Hwang S, Garcia-Dominguez MA, Fitzgerald KC, Saylor DR. Association of Multiple Sclerosis Prevalence With Sociodemographic, Health Systems, and Lifestyle Factors on a National and Regional Level. Neurology 2022; 99:e1813-e1823. [PMID: 36002320 DOI: 10.1212/wnl.0000000000200962] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) prevalence varies widely by country and world region, variation that is often attributed to latitude and its association with vitamin D exposure. Given that increasing latitude is also associated with higher national wealth, this study investigated associations between MS prevalence and other factors driving regional differences, with a focus on sociodemographic, health systems, and lifestyle factors on a national and regional level. METHODS Using data from multilateral organizations and scientific literature, an ecological study was conducted to evaluate associations between age- and sex-adjusted MS prevalence and prespecified sociodemographic (gross domestic product [GDP] per capita and gross national income [GNI] per capita), health systems (current health expenditure per capita and by percentage of GDP, universal health coverage [UHC] index, and medical doctors per capita), neurology-specific (MRI unit density and neurologists per capita), and lifestyle (obesity and tobacco use) factors. National, regional, and income-stratified data were aggregated and employed in relevant univariable and multivariable regression models. Stepwise variable selection techniques identified independent predictors of MS prevalence. RESULTS Univariable regression analyses showed significant associations at the national level for all investigated factors, except obesity prevalence and tobacco use. Latitude was significantly associated with MS prevalence in all world regions (β = 0.16-2.16), whereas the UHC index was significantly associated in 5 of 6 world regions (β = 0.18-3.17). MS prevalence was significantly associated with all factors except lifestyle factors and MRI unit density in high-income countries, but no associations were observed in low-income countries. Latitude was associated with MS prevalence for all income strata except low-income countries (β = 0.55-1.62). In multivariable analyses, current health expenditure per capita (β = 0.083, 95% CI 0.048-0.12, p < 0.01) and latitude (β = 1.05, 95% CI 0.63-1.47, p < 0.01) remained significantly associated with MS prevalence. DISCUSSION Health expenditure per capita is strongly associated with national MS prevalence, suggesting that theories that attribute variations in MS prevalence primarily to latitude effects on vitamin D are incomplete. Health care access significantly contributes to the global variations in MS prevalence, especially since national wealth rises with latitude and likely results in significant underestimation of MS prevalence in countries with lower health expenditure.
Collapse
Affiliation(s)
- Soonmyung Hwang
- From the Department of Neurology (S.H., K.C.F., D.R.S.), Johns Hopkins University School of Medicine, Baltimore; Department of Biostatistics (M.A.G.-D.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia
| | - Maria A Garcia-Dominguez
- From the Department of Neurology (S.H., K.C.F., D.R.S.), Johns Hopkins University School of Medicine, Baltimore; Department of Biostatistics (M.A.G.-D.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia
| | - Kathryn C Fitzgerald
- From the Department of Neurology (S.H., K.C.F., D.R.S.), Johns Hopkins University School of Medicine, Baltimore; Department of Biostatistics (M.A.G.-D.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia
| | - Deanna R Saylor
- From the Department of Neurology (S.H., K.C.F., D.R.S.), Johns Hopkins University School of Medicine, Baltimore; Department of Biostatistics (M.A.G.-D.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia.
| |
Collapse
|
3
|
Rad MJ, Navi Z, Heidari AR, Arab FL, Tabasi N, Rastin M, Khadem Rezaiyan M, Moghaddas E, Mahmoudi M. Evaluation of the immunoregulatory effect of
Dicrocoelium dendriticum
eggs on inflammatory and anti‐inflammatory cytokines in
EAE
model. Parasite Immunol 2022; 44:e12942. [DOI: 10.1111/pim.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Mozhdeh Jafari Rad
- Immunology Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Zahra Navi
- Department of Parasitology and Mycology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Amir Reza Heidari
- Department of Immunology and Allergy, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Fahimeh Lavi Arab
- Immunology Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Nafiseh Tabasi
- Immunology Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Maryam Rastin
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Majid Khadem Rezaiyan
- Clinical Research Development Unit Mashhad University of Medical Sciences Mashhad Iran
| | - Elham Moghaddas
- Department of Parasitology and Mycology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mahmoud Mahmoudi
- Department of Immunology and Allergy, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| |
Collapse
|
4
|
González-Madrid E, Rangel-Ramírez MA, Mendoza-León MJ, Álvarez-Mardones O, González PA, Kalergis AM, Opazo MC, Riedel CA. Risk Factors from Pregnancy to Adulthood in Multiple Sclerosis Outcome. Int J Mol Sci 2022; 23:ijms23137080. [PMID: 35806081 PMCID: PMC9266360 DOI: 10.3390/ijms23137080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by a robust inflammatory response against myelin sheath antigens, which causes astrocyte and microglial activation and demyelination of the central nervous system (CNS). Multiple genetic predispositions and environmental factors are known to influence the immune response in autoimmune diseases, such as MS, and in the experimental autoimmune encephalomyelitis (EAE) model. Although the predisposition to suffer from MS seems to be a multifactorial process, a highly sensitive period is pregnancy due to factors that alter the development and differentiation of the CNS and the immune system, which increases the offspring’s susceptibility to develop MS. In this regard, there is evidence that thyroid hormone deficiency during gestation, such as hypothyroidism or hypothyroxinemia, may increase susceptibility to autoimmune diseases such as MS. In this review, we discuss the relevance of the gestational period for the development of MS in adulthood.
Collapse
Affiliation(s)
- Enrique González-Madrid
- Laboratorio Endocrinología-Inmunología, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8320000, Chile; (E.G.-M.); (M.A.R.-R.); (M.J.M.-L.); (O.Á.-M.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
| | - Ma. Andreina Rangel-Ramírez
- Laboratorio Endocrinología-Inmunología, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8320000, Chile; (E.G.-M.); (M.A.R.-R.); (M.J.M.-L.); (O.Á.-M.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
| | - María José Mendoza-León
- Laboratorio Endocrinología-Inmunología, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8320000, Chile; (E.G.-M.); (M.A.R.-R.); (M.J.M.-L.); (O.Á.-M.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
| | - Oscar Álvarez-Mardones
- Laboratorio Endocrinología-Inmunología, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8320000, Chile; (E.G.-M.); (M.A.R.-R.); (M.J.M.-L.); (O.Á.-M.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
| | - Pablo A. González
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
- Departamento de Endocrinología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Ma. Cecilia Opazo
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
- Instituto de Ciencias Naturales, Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Manuel Montt 948, Providencia 7500000, Chile
| | - Claudia A. Riedel
- Laboratorio Endocrinología-Inmunología, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8320000, Chile; (E.G.-M.); (M.A.R.-R.); (M.J.M.-L.); (O.Á.-M.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8320000, Chile; (P.A.G.); (A.M.K.); (M.C.O.)
- Correspondence:
| |
Collapse
|
5
|
Childhood pet ownership and multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 53:103046. [PMID: 34090130 DOI: 10.1016/j.msard.2021.103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many studies have been conducted investigating a range of environmental factors which have been implicated in the pathogenesis of multiple sclerosis (MS). We collated available data about exposure to domestic animals before symptom onset in MS to perform a systematic review and meta-analysis. METHODS Medline, Embase and Cinahl were searched for relevant articles, based on pre-defined inclusion and exclusion criteria and reference lists were hand-searched. Data were extracted and critical analysis was conducted using the Newcastle-Ottawa criteria. Meta-analysis used random effects. RESULTS Study heterogeneity was high and study quality was variable. Random effects meta-analysis showed no associations with any pet ownership and development of MS. CONCLUSION It is not possible to draw definitive conclusions from this work. The studies included had a high level of heterogeneity. There are many variables involved in pet ownership and exposure and the nature of the way these have been studied makes the analysis challenging.
Collapse
|
6
|
The impact of Opisthorchis felineus infection and praziquantel treatment on the intestinal microbiota in children. Acta Trop 2021; 217:105835. [PMID: 33485871 DOI: 10.1016/j.actatropica.2021.105835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
The presence of some species of helminths is associated with changes in host microbiota composition and diversity, which varies widely depending on the infecting helminth species and other factors. We conducted a prospective case-control study to evaluate the gut microbiota in children with Opisthorchis felineus infection (n=50) before and after anthelmintic treatment and in uninfected children (n=49) in the endemic region. A total of 99 children and adolescents aged between 7 and 18 years were enrolled to the study. Helminth infection was assessed before and at 3 months after treatment with praziquantel. A complex examination for each participant was performed in the study, including an assessment of the clinical symptoms and an intestinal microbiota survey by 16S rRNA gene sequencing of stool samples. There was no change in alpha diversity between O. felineus-infected and control groups. We found significant changes in the abundances of bacterial taxa at different taxonomic levels between the infected and uninfected individuals. Enterobacteriaceae family was more abundant in infected participants compared to uninfected children. On the genus level, O. felineus-infected participants' microbiota showed higher levels of Lachnospira, Escherichia-Shigella, Bacteroides, Eubacterium eligens group, Ruminiclostridium 6, Barnesiella, Oscillibacter, Faecalitalea and Anaerosporobacter and reduction of Blautia, Lachnospiraceae FCS020 and Eubacterium hallii group in comparison with the uninfected individuals. Following praziquantel therapy, there were significant differences in abundances of some microorganisms, including an increase of Faecalibacterium and decrease of Megasphaera, Roseburia. Enterobacteriaceae and Escherichia abundances were decreased up to the control group values. Our results highlight the importance of the host-parasite-microbiota interactions for the community health in the endemic regions.
Collapse
|
7
|
Kazemi Moghadam V, Dickerson AS, Shahedi F, Bazrafshan E, Seyedhasani SN, Sarmadi M. Association of the global distribution of multiple sclerosis with ultraviolet radiation and air pollution: an ecological study based on GBD data. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:17802-17811. [PMID: 33403633 DOI: 10.1007/s11356-020-11761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
Given the growing global trend of multiple sclerosis (MS), this study was designed to evaluate environmental determinates of the worldwide distribution of MS in the presence of socioeconomic and geographic indices. MS data was obtained from the Institute for Health Metrics and Evaluation website. The air pollution parameters, including particles with aerodynamic diameter less than 2.5 μm (PM2.5), tropospheric ozone, and solid fuel use, were acquired from global burden of disease resources and the World Health Organization. Ultraviolet index (UVI) values were obtained from the Tropospheric Emission Monitoring Internet Service website. Correlation and linear regression analyses were used to investigate the relationship between air pollution and environmental parameters with MS variables. The average prevalence and incidence rates in countries with high UVI were 5.17 and 0.25 per 100,000, respectively, and in countries with low UVI were 101.37 and 0.78, respectively. The results showed negative associations between prevalence, incidence and mortality of MS with ozone concentrations (β = - 1.04, - 0.04, and - 0.01 respectively; P < 0.01). Also, the fully adjusted model showed significant negative correlation of UVI with the MS variables in the presence of other variables (P < 0.01). Our findings demonstrated that UVI had the strongest significant inverse association with MS distribution. Consequently, vitamin D intake may be a major contributor to MS development. However, this study showed a slight influence of air pollution on the prevalence of MS in the presence of other parameters. Given the inconsistent results of previous studies, further studies may be required.
Collapse
Affiliation(s)
- Vahid Kazemi Moghadam
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fateme Shahedi
- Department of Radiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Edris Bazrafshan
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Seyedeh Nahid Seyedhasani
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Sarmadi
- Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| |
Collapse
|
8
|
Alkhawajah NM, Hussain-Alkhateeb L, Alshamlan YA, Almohaini MO, Aleissa GA, Muayqil TA, Aljarallah S. Shared breastfeeding & other early multiple sclerosis risk factors: A case-control study. Mult Scler Relat Disord 2021; 50:102812. [PMID: 33581612 DOI: 10.1016/j.msard.2021.102812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease. Etiology is thought to be multifactorial with genetic and environmental factors interplay. Our objective in this study is to evaluate culture specific and other early life risk factors for MS. We examined the association between MS and breastfeeding including shared breastfeeding, parental consanguinity, being born abroad or living abroad during childhood, prematurity, vaccination, tonsillectomy, rank among siblings, number of siblings, number of household members (HHM) at birth, and age first time joining school. METHODS This is an age and sex matched case-control study that was conducted in Riyadh, Kingdom of Saudi Arabia (KSA). We enrolled 300 cases and 601 controls. A structured questionnaire about demographics, consanguinity and potential environmental factors was answered by participants. Data was analyzed using logistic regression adjusting for covariates occurring later in life such as waterpipe smoking and performing Hajj. RESULTS About two thirds of the cases and the controls were females. Mean age was 34.8 (9.2) for the cases and 33.6 (10.6) for the controls. We found that shared breastfeeding (OR=0.58; 95% CI, 0.35-0.96, p = 0.033), and older age first joining school (OR=0.83; 95% CI, 0.73-0.94, p = 0.005) were associated with decrease risk of MS. While longer duration of breastfeeding by biological mother (OR=1.03; 95% CI, 1.01-1.04, p = 0.001), rank among siblings of ≥6 (OR=1.69; 95% CI, 1.11-2.56, p = 0.014), and larger number of HHM at birth (OR=2.32; 95% CI, 1.64-3.28, p = 0.001) were associated with increased risk. Patients with MS were less likely to receive formula with breastfeeding than controls (OR=0.72; 95% CI, 0.51-0.99, p = 0.046). No association was found with breastfeeding by biological mother, number of siblings, prematurity, being born abroad or living abroad during childhood, vaccination, consanguinity, or tonsillectomy. CONCLUSION The findings of this case-control study add to the accumulating evidence that early life factors could modify the risk of developing MS. Among these, novel associations with shared breastfeeding and number of HHM at birth are suggested. Future studies are needed to verify the observed results.
Collapse
Key Words
- Abbreviations Multiple sclerosis (MS), household members (HHM), central nervous system (CNS), Kingdom of Saudi Arabia (KSA), institutional review board (IRB), King Saud University Medical City (KSUMC), Bacillus Calmette-Guerin (BCG), odds ratios (OR), 95% confidence interval (95% CI), standard deviation (SD), Epstein-Barr virus (EBV), infectious mononucleosis (IM)
- Consanguinity
- Multiple sclerosis
- Risk factors
- Shared breastfeeding
- Vaccination
Collapse
Affiliation(s)
- Nuha M Alkhawajah
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 463, 40530 Gothenburg, Sweden.
| | - Yafa A Alshamlan
- Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Mohammad Osama Almohaini
- Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Ghadah A Aleissa
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA.
| | - Taim A Muayqil
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Salman Aljarallah
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| |
Collapse
|
9
|
Molazadeh N, Mohebi F, Altafi D, Sahraian MA. Prevalence and incidence of multiple sclerosis in Ardabil, Northwest of Iran. Mult Scler Relat Disord 2020; 47:102605. [PMID: 33217696 DOI: 10.1016/j.msard.2020.102605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/17/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) epidemiology is studies in many populations; however, studying populations with unique characteristics could provide opportunities to deepen the understanding of the underlying reason of the disease. In this regard, we aimed to study the epidemiology of MS in Ardabil, a province in northwest Iran, where the majority are of Iranian Azerbaijanis. METHOD A retrospective population-based study was conducted from 2008 to 2018 in Ardabil, based on the data of Iran's Ministry Of Health. Collected information includes sex, age, age at disease onset, education and type of MS. We used t-test to compare means and chi-square test to analyze the association among variables. RESULTS The total number of patients was 760 with 533 (70.13%) females and 227 (29.87%) males. The crude prevalence was 59.37 per 100,000 in 2018 (95% CI: 55.31, 63.73). The crude incidence rate was 7.65 per 100,000 in 2018 (95% CI: 6.28, 9.32). The most frequent educational level was high school diploma (38.36%). The relapsing-remitting (RR) form was the most frequent type of MS (48.16%). The F/M ratio was 2.92:1 and the mean onset age was 33.14 (95% CI: 31.56, 34.72) in 2018, significantly higher in males (P value= 0.01). CONCLUSION Ardabil is a medium risk zone of MS. The different ethnicity of its population, climate and environmental features, may explain the factors modulating the risk of MS in similar areas and present windows of opportunity to understand the causes of MS.
Collapse
Affiliation(s)
- Negar Molazadeh
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Davar Altafi
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
10
|
Hughes AM, Ponsonby AL, Dear K, Dwyer T, Taylor BV, van der Mei I, Valery PC, Lucas RM. Childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020; 42:102062. [PMID: 32305688 DOI: 10.1016/j.msard.2020.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection. OBJECTIVE To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination. METHODS Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination. CONCLUSIONS Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
Collapse
Affiliation(s)
- A M Hughes
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia
| | - A-L Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - K Dear
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
| |
Collapse
|
11
|
Wasko NJ, Nichols F, Clark RB. Multiple sclerosis, the microbiome, TLR2, and the hygiene hypothesis. Autoimmun Rev 2020; 19:102430. [DOI: 10.1016/j.autrev.2019.102430] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
|
12
|
Al Wutayd O. Association of infections with multiple sclerosis in Gulf Cooperation Council countries: a review. J Int Med Res 2019; 48:300060519884151. [PMID: 31880177 PMCID: PMC7607054 DOI: 10.1177/0300060519884151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, causing inflammation, demyelination, and neurodegeneration. Infection can play a role in its etiology. Herein, a review is presented of studies that have reported an association between infection and MS risk in countries of the Arabian Gulf region. Searches of the PubMed, Google Scholar, and Science Direct databases were carried out using various search terms, and relevant studies published through January 2019 on the epidemiology of MS in Gulf Cooperation Council countries identified. MS has been found to be associated with measles in Saudi Arabia and Epstein–Barr virus in Kuwait whereas no association has been identified between risk of MS and varicella-zoster virus, mumps, or human herpesvirus-6. However, few epidemiological studies on this topic have been conducted in countries of the Gulf region. Longitudinal and serological studies to establish robust evidence between infection and risk of MS are highly recommended, and a regional MS registry is needed.
Collapse
Affiliation(s)
- O Al Wutayd
- O Al Wutayd, Department of Family and Community Medicine, Unaizah College of Medicine, Qassim University, P.O. Box 3174, Unaizah 51911, Saudi Arabia.
| |
Collapse
|
13
|
Sakkas GK, Giannaki CD, Karatzaferi C, Manconi M. Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:4. [DOI: 10.1007/s11940-019-0544-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
14
|
Micronized Cells of the Probiotic Strain Bifidobacterium lactis BS01 Activate Monocyte Polarization: A New Approach. J Clin Gastroenterol 2018; 52 Suppl 1, Proceedings from the 9th Probiotics, Prebiotics and New Foods, Nutraceuticals and Botanicals for Nutrition & Human and Microbiota Health Meeting, held in Rome, Italy from September 10 to 12, 2017:S57-S61. [PMID: 29864069 DOI: 10.1097/mcg.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS The aim of this research was to evaluate whether micronized cells (MCs) from selected biotherapeutic bacteria have the ability to effectively modulate the polarization of monocyte/macrophage subpopulations to advantageously provide a first line of defense against infections. BACKGROUND Inflammation is a reaction of the host to viral and bacterial infections with the physiological purpose of restoring tissue homeostasis. However, uncontrolled or unresolved inflammation can lead to tissue damage, giving rise to a plethora of chronic inflammatory diseases. The monocytes/macrophages play a key role in the initiation and resolution of inflammation through different activation programs. STUDY MCs were obtained from Bifidobacterium lactis BS01 strain using a Bioimmunizer extraction protocol. Monocytes were stimulated with the probiotic strain and/or MCs (10 mg/mL) for 24 hours and 5 days. Monocyte/macrophage differentiation was evaluated by cytometry analysis of surface markers and the activity of the 2 subpopulations on oxidative stress was assessed in an in vitro oxidative stress model with a spectrophotometric test. RESULTS The MCs have been shown to modulate considerably the 2 subpopulations of human monocytes/macrophages, both the "patrolling subpopulation" and the "inflammatory subpopulation," thus highlighting a strong immunostimulatory effect. In addition, MCs are able to mitigate significantly the oxidative stress induced by homocysteine in an in vitro model. CONCLUSIONS Our findings suggest that MCs derived from the biotherapeutic strain BS01 could represent a possible therapy aimed to effectively prevent and/or cure viral, bacterial, fungal, or protozoal diseases, as well as prevent and/or treat inflammatory processes triggered by external pathogenic agents.
Collapse
|