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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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Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
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Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
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Davis GE, Davis MJ, Lowell WE. The effect of ultraviolet radiation on the incidence and severity of major mental illness using birth month, birth year, and sunspot data. Heliyon 2022; 8:e09197. [PMID: 35368522 PMCID: PMC8969152 DOI: 10.1016/j.heliyon.2022.e09197] [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] [Received: 05/16/2021] [Revised: 08/06/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives The evaluation of the severity of patients afflicted with major mental illness (MMI) has been problematic because of confounding variables and genetic variability. There have been multiple studies that suggest several human diseases, especially schizophrenia, are predisposed to be born in certain months or seasons. This observation implied an epigenetic effect of sunlight, likely ultraviolet radiation (UVR), which is damaging to DNA, especially in an embryo. This paper outlines a method to evaluate the severity of schizophrenia (SZ), bipolar disorder (BPD), and schizoaffective disorder (SZ-AFF) using the month/year of birth of those affected compared to the month/year of birth of the general population (GP). Relevance Our previous research found that more intense UVR (equal to or greater than 90 sunspot number (SSN)) had a negative effect on the average human lifespan. Also, human birth rates vary in frequency by month of birth reflecting variables like availability of food, sunlight, and other unknown epigenetic factors. We wanted to see if the patient month of birth varied from the average birth months of the general population and if UVR has an epigenetic effect promoting these diseases. Methods We obtained the month and year of birth of 1,233 patients admitted over a 15-year period to Maine's largest state psychiatric hospital and counted the months of birth for each diagnosis of SZ, BPD, and SZ-AFF, and compared these results to the general population's birth months of 4,265,555 persons from U. S. Census Year 2006. The number of patients in each month was normalized to August and compared with the normalized birth months of the general population (GP). Plots of the normalized months were considered rates of change (e.g., derivatives) and their respective integrals gave domains of each mental illness relative to the GP. Normalizing the GP to unity was then related to the factor 1.28, e.g., 28% more entropy, deduced from the Sun's fractal dimension imprinted on biological organisms. Results The percent of patients meeting our criterion for severity: SZ = 27%; BPD = 26%; SZ-AFF = 100%. Conclusions High UVR intensity or a rapid increase in UVR in early gestation are likely epigenetic triggers of major mental illness. BPD is more epigenetically affected than SZ or SZ-AFF disorders. We found that 52% of 1,233 patients comprised the core function of a tertiary-care psychiatric hospital. Also, mental illness exacerbated when the median SSN doubled. This work also validates the Kraeplinian dichotomy. What is new in this research This paper offers a new paradigm for evaluating the severity of MMI and supports significant epigenetic effects from UVR.
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Affiliation(s)
- George E Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Matthew J Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Walter E Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
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Mai ZM, Byrne SN, Little MP, Sargen MR, Cahoon EK. Solar UVR and Variations in Systemic Immune and Inflammation Markers. JID INNOVATIONS 2021; 1:100055. [PMID: 34909751 PMCID: PMC8659735 DOI: 10.1016/j.xjidi.2021.100055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
The characterization of the effects of solar UVR on a broad set of circulating markers in systemic immunity and inflammation may provide insight into the mechanisms responsible for the UVR associations observed for several benign and malignant diseases. We examined the associations between exposure to solar UVR and circulating levels of 78 markers among 1,819 individuals aged 55–74 years who participated in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial using multiplex assays. Solar UVR was derived by linking the geocoded locations of 10 screening centers across the continental United States and the date of blood draw to the National Solar Radiation Database from 1993 to 2005. We assessed associations between ambient solar UVR and dichotomized marker levels using adjusted weighted logistic regression models and applied a 5% false discovery rate criterion to P-values. UVR exposure was associated (P < 0.05) with 9 of the 78 markers. CCL27, CCL4, FGF2, GM-CSF, IFN-γ, soluble IL4R, IL-7, and IL-11 levels were lower with increasing UVR tertile, with adjusted ORs ranging from 0.66 to 0.80, and the significant association for CCL27 withstood multiple comparison correction. In contrast, CRP levels were elevated with increasing UVR. Solar UVR was associated with alterations in systemic immune and inflammation marker levels.
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Affiliation(s)
- Zhi-Ming Mai
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Scott N Byrne
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Michael R Sargen
- Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
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Mirmosayyeb O, Barzegar M, Afshari-Safavi A, Nehzat N, Heidari A, Emami P, Shaygannejad V. Evaluation of Month of Birth in Neuromyelitis Optica Spectrum Disorders (NMSOD) and Multiple Sclerosis (MS). Mult Scler Int 2021; 2021:8874999. [PMID: 34221508 PMCID: PMC8211531 DOI: 10.1155/2021/8874999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/13/2021] [Accepted: 06/04/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMO) are chronic immune-mediated diseases in the central nervous system (CNS). Environmental factors such as month of birth can be a trigger for these diseases. Therefore, we conducted this study to compare the months of birth in MS and NMOSD patients with the control group. METHODS In this cross-sectional study, 2345 patients with MS, 220 NMOSD patients, and 2174 healthy subjects were enrolled. Demographic information such as age, sex, month of birth, and education in three groups was extracted from the database. The associations between month of birth and MS were studied by binary logistic regression with adjusting for the year of birth. RESULTS There was a reduced birth rate in September-October in NMOSD (OR = 0.309, 95% CI: 0.150-0.636; p < 0.001) and MS patients (OR = 0.470, 95% CI: 0.374-0.591; p < 0.001) compared to the general population. The birth rate in March-April in MS was higher than the control group (OR = 1.613, 95% CI: 1.324-1.964; p < 0.001). There was no difference in the birth month distribution between the NMOSD and MS patients. No significant difference in MOB among different MS types was found. CONCLUSION Our findings showed a decreasing risk of NMOSD and MS in individuals born in the autumn months and an increasing MS risk in spring. More studies are required to elucidate the association between the month of birth and risk of MS and NMOSD and the seasonality factors.
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Affiliation(s)
- Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Heidari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Emami
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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DARVISHI SONIA, HAMIDI OMID, POOROLAJAL JALAL. Prediction of Multiple sclerosis disease using machine learning classifiers: a comparative study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E192-E199. [PMID: 34322636 PMCID: PMC8283630 DOI: 10.15167/2421-4248/jpmh2021.62.1.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Introduction Hamedan Province is one of Iran’s high-risk regions for Multiple Sclerosis (MS). Early diagnosis of MS based on an accurate system can control the disease. The aim of this study was to compare the performance of four machine learning techniques with traditional methods for predicting MS patients. Methods The study used information regarding 200 patients through a case-control study conducted in Hamadan, Western Iran, from 2013 to 2015. The performance of six classifiers was used to compare their performance in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and total accuracy. Results Random Forest (RF) model illustrated better performance among other models in both scenarios. It had greater specificity (0.67), PPV (0.68) and total accuracy (0.68). The most influential diagnostic factors for MS were age, birth season and gender. Conclusions Our findings showed that despite all the six methods performed almost similarly, the RF model performed slightly better in terms of different criteria in prediction accuracy. Accordingly, this approach is an effective classifier for predicting MS in the early stage and control the disease.
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Affiliation(s)
- SONIA DARVISHI
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - OMID HAMIDI
- Department of Science, Hamedan University of Technology, Hamedan, Iran
- Correspondence: Omid Hamidi, Department of Science, Hamedan University of Technology, Hamedan, 65155 Iran - Tel.: +98 81 38411533 - E-mail:
| | - JALAL POOROLAJAL
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran - Modeling of Noncommunicable Disease Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Rowiński PK, Laurila A, Gotthard K, Sowersby W, Lind MI, Richter-Boix A, Eckerström-Liedholm S, Rogell B. Parental effects influence life history traits and covary with an environmental cline in common frog populations. Oecologia 2020; 192:1013-1022. [PMID: 32277360 PMCID: PMC7165185 DOI: 10.1007/s00442-020-04642-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/03/2020] [Indexed: 11/03/2022]
Abstract
Across latitudinal clines, the juvenile developmental rates of ectotherms often covary with the length of the growing season, due to life-history trade-offs imposed by the time-constrained environments. However, as the start of the growing season often varies substantially across years, adaptive parental effects on juvenile developmental rates may mediate the costs of a delayed season. By employing a meta-analysis, we tested whether larval developmental rates across a latitudinal cline of the common frog (Rana temporaria) are affected by fluctuating onsets of breeding, across years. We predicted that larval developmental rate will be inversely related to the onset of breeding, and that northern populations will be more prone to shorten their developmental rate in response to late breeding, as the costs of delayed metamorphosis should be highest in areas with a shorter growing season. We found that the larval period of both northern and southern populations responded to parental environmental conditions to a similar degree in absolute terms, but in different directions. In northern populations, a late season start correlated with decreased development time, suggesting that the evolution of parental effects aids population persistence in time-constrained environments. In southern populations, late season start correlated with increased development time, which could potentially be explained as a predator avoidance strategy. Our findings suggest that local ecological variables can induce adaptive parental effects, but responses are complex, and likely trade-off with other ecological factors.
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Affiliation(s)
- Piotr K Rowiński
- Department of Zoology, Stockholm University, 106 91, Stockholm, Sweden.
| | - Anssi Laurila
- Animal Ecology, Department of Ecology and Genetics, Uppsala University, 752 36, Uppsala, Sweden
| | - Karl Gotthard
- Department of Zoology, Stockholm University, 106 91, Stockholm, Sweden
| | - Will Sowersby
- Department of Zoology, Stockholm University, 106 91, Stockholm, Sweden
| | - Martin I Lind
- Animal Ecology, Department of Ecology and Genetics, Uppsala University, 752 36, Uppsala, Sweden
| | - Alex Richter-Boix
- Animal Ecology, Department of Ecology and Genetics, Uppsala University, 752 36, Uppsala, Sweden
| | | | - Björn Rogell
- Department of Zoology, Stockholm University, 106 91, Stockholm, Sweden.
- Department of Aquatic Resources, Institute of Freshwater Research, Swedish University of Agricultural Sciences, 178 93, Drottningholm, Sweden.
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Extra-Skeletal Effects of Vitamin D. Nutrients 2019; 11:nu11071460. [PMID: 31252594 PMCID: PMC6683065 DOI: 10.3390/nu11071460] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
The vitamin D receptor is expressed in multiple cells of the body (other than osteoblasts), including beta cells and cells involved in immune modulation (such as mononuclear cells, and activated T and B lymphocytes), and most organs in the body including the brain, heart, skin, gonads, prostate, breast, and gut. Consequently, the extra-skeletal impact of vitamin D deficiency has been an active area of research. While epidemiological and case-control studies have often suggested a link between vitamin D deficiency and conditions such as type 1 and type 2 diabetes, connective tissue disorders, inflammatory bowel disorders, chronic hepatitis, food allergies, asthma and respiratory infections, and cancer, interventional studies for the most part have failed to confirm a causative link. This review examines available evidence to date for the extra-skeletal effects of vitamin D deficiency, with a focus on randomized controlled trials and meta-analyses.
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Lifestyle and Environmental Factors in Multiple Sclerosis. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a028944. [PMID: 29735578 DOI: 10.1101/cshperspect.a028944] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lifestyle and environmental factors potently influence the risk of multiple sclerosis (MS), because genetic predisposition only explains a fraction of the risk increase. There is strong evidence for associations of Epstein-Barr virus (EBV) infection, smoking, sun exposure/vitamin D, and adolescent obesity to risk of MS. There is also circumstantial evidence on organic solvents and shift work, all associate with greater risk, although certain factors like nicotine, alcohol, and a high coffee consumption associate with a reduced risk. Certain factors, smoking, EBV infection, and obesity interact with human leukocyte antigen (HLA) risk genes, arguing for a pathogenic pathway involving adaptive immunity. There is a potential for prevention, in particular for people at greater risk such as relatives of individuals with MS. All of the described factors for MS may influence adaptive and/or innate immunity, as has been argued for MS risk gene variants.
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Lucas RM, Rodney Harris RM. On the Nature of Evidence and 'Proving' Causality: Smoking and Lung Cancer vs. Sun Exposure, Vitamin D and Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081726. [PMID: 30103527 PMCID: PMC6121485 DOI: 10.3390/ijerph15081726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/20/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
If environmental exposures are shown to cause an adverse health outcome, reducing exposure should reduce the disease risk. Links between exposures and outcomes are typically based on 'associations' derived from observational studies, and causality may not be clear. Randomized controlled trials to 'prove' causality are often not feasible or ethical. Here the history of evidence that tobacco smoking causes lung cancer-from observational studies-is compared to that of low sun exposure and/or low vitamin D status as causal risk factors for the autoimmune disease, multiple sclerosis (MS). Evidence derives from in vitro and animal studies, as well as ecological, case-control and cohort studies, in order of increasing strength. For smoking and lung cancer, the associations are strong, consistent, and biologically plausible-the evidence is coherent or 'in harmony'. For low sun exposure/vitamin D as risk factors for MS, the evidence is weaker, with smaller effect sizes, but coherent across a range of sources of evidence, and biologically plausible. The association is less direct-smoking is directly toxic and carcinogenic to the lung, but sun exposure/vitamin D modulate the immune system, which in turn may reduce the risk of immune attack on self-proteins in the central nervous system. Opinion about whether there is sufficient evidence to conclude that low sun exposure/vitamin D increase the risk of multiple sclerosis, is divided. General public health advice to receive sufficient sun exposure to avoid vitamin D deficiency (<50 nmol/L) should also ensure any benefits for multiple sclerosis, but must be tempered against the risk of skin cancers.
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Affiliation(s)
- Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 2600, Australia.
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth 6009, Australia.
| | - Rachael M Rodney Harris
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 2600, Australia.
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Abstract
PURPOSE OF REVIEW Caring for women with multiple sclerosis (MS), whose first symptoms typically begin during the childbearing years, requires a comprehensive approach to management across a range of reproductive exposures, and beyond through menopause. RECENT FINDINGS This article summarizes what is known about the disease course in women with MS, how it differs from men, and the current state of knowledge regarding effects of reproductive exposures (menarche, childbearing, menopause) on MS-related inflammation and neurodegeneration. Recent findings regarding pregnancy-associated relapses in the treatment era, protective effects of breastfeeding, and care for women during the menopausal transition are reviewed. Then, updated recommendations to guiding women during childbearing-including pre-conception counseling, discontinuation of MS therapies, and management of postpartum relapses-are provided. Whenever possible, areas of uncertainty and avenues for future research are highlighted. From childhood through the postreproductive life stages, gender and hormonal exposures appear to shape an individual's risk for MS, as well as the experience of living with MS.
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Affiliation(s)
- Kelsey Rankin
- Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, USA.
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12
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Botyar M, Khoramroudi R. Ultraviolet radiation and its effects on pregnancy: A review study. J Family Med Prim Care 2018; 7:511-514. [PMID: 30112299 PMCID: PMC6069651 DOI: 10.4103/jfmpc.jfmpc_311_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Seasons and Vitamin D are factors that are directly and indirectly related to ultraviolet (UV) radiations and can affect pregnancy. Therefore, the present study aims at investigating the effects of being exposed to direct UV radiation during pregnancy period and its effects on fetal growth, premature birth, and high blood pressure. This study was conducted by searching different websites such as Medline, Embase, ProQuest, Global Health, Google Scholar, and Scopus. Of the 430 papers found, between 1985 and 2017, seventeen related articles were used. The results showed that being exposed to UV radiation during the first 3 months of pregnancy is associated with improved fetal growth and causes high blood pressure during pregnancy. The literature shows that being women exposure to UV radiation had beneficial effects on fetal growth and blood pressure during pregnancy period. However, since this issue has not been extensively studied in the past, the results from previous studies should be generalized with extreme care and caution. Therefore, it is suggested that further studies be carried out in this area.
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Eliasdottir O, Hildeman A, Longfils M, Nerman O, Lycke J. A nationwide survey of the influence of month of birth on the risk of developing multiple sclerosis in Sweden and Iceland. J Neurol 2017; 265:108-114. [PMID: 29159463 PMCID: PMC5760596 DOI: 10.1007/s00415-017-8665-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/30/2022]
Abstract
Previous studies have shown that the risk of multiple sclerosis (MS) is associated with season of birth with a higher proportion of MS patients being born in spring. However, this relationship has recently been questioned and may be due to confounding factors. Our aim was to assess the influence from season or month of birth on the risk of developing MS in Sweden and Iceland. Information about month of birth, gender, and phenotype of MS for patients born 1940–1996 was retrieved from the Swedish MS registry (SMSR), and their place of birth was retrieved from the Swedish Total Population Registry (TPR). The corresponding information was retrieved from medical journals of Icelandic MS patients born 1981–1996. The control groups consisted of every person born in Sweden 1940–1996, their gender and county of birth (TPR), and in Iceland all persons born between 1981 and 1996 and their gender (Statistics Iceland). We calculated the expected number of MS patients born during each season and in every month and compared it with the observed number. Adjustments were made for gender, birth year, and county of birth. We included 12,020 Swedish and 108 Icelandic MS patients in the analyses. There was no significant difference between expected and observed MS births related to season or month of birth in Sweden or Iceland. This was even the results before adjustments were made for birth year and birth place. No significant differences were found in subgroup analyses including data of latitude of birth, gender, clinical phenotype, and MS onset of 30 years or less. Our results do not support the previously reported association between season or month of birth and MS risk. Analysis of birth place and birth year as possible confounding factors showed no major influence of them on the seasonal MS risk in Sweden and Iceland.
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Affiliation(s)
- Olöf Eliasdottir
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blåa stråket 7, 41345, Gothenburg, Sweden.
| | - Anders Hildeman
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Marco Longfils
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - O Nerman
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - J Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blåa stråket 7, 41345, Gothenburg, Sweden
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Munger KL, Åivo J, Hongell K, Soilu-Hänninen M, Surcel HM, Ascherio A. Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort. JAMA Neurol 2017; 73:515-9. [PMID: 26953778 DOI: 10.1001/jamaneurol.2015.4800] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Vitamin D has been associated with a decreased risk of multiple sclerosis (MS) in adulthood; however, some, but not all, previous studies have suggested that in utero vitamin D exposure may be a risk factor for MS later in life. OBJECTIVE To examine whether serum 25-hydroxyvitamin D (25[OH]D) levels in early pregnancy are associated with risk of MS in offspring. DESIGN, SETTING, AND PARTICIPANTS Prospective, nested case-control study in the Finnish Maternity Cohort conducted in May 2011. We identified 193 individuals with a diagnosis of MS before December 31, 2009, whose mothers are in the Finnish Maternity Cohort and had an available serum sample from the pregnancy with the affected child. We matched 176 cases with 326 controls on region of birth in Finland, date of maternal serum sample collection, date of mother's birth, and date of child's birth. MAIN OUTCOMES AND MEASURES Maternal serum 25(OH)D levels were measured using a chemiluminescence assay. The risk of MS among offspring and association with maternal 25(OH)D levels were the main outcomes. Conditional logistic regression was used and further adjusted for sex of the child, gestational age at the time of sample collection, and season of sample collection to estimate the relative risks and 95% CIs. RESULTS Of the 193 cases in the study, 163 were female. Of the 331 controls in the study, 218 were female. Seventy percent of serum samples were collected during the first trimester of pregnancy. The mean (SD) maternal vitamin D levels were in the insufficient vitamin D range, but higher in maternal control than case samples (15.02 [6.41] ng/mL vs 13.86 [5.49] ng/mL [to convert to nanomoles per liter, multiply by 2.496]). Maternal vitamin D deficiency (25[OH]D levels <12.02 ng/mL) during early pregnancy was associated with a nearly 2-fold increased risk of MS in the offspring (relative risk, 1.90; 95% CI, 1.20-3.01; P = .006) compared with women who did not have deficient 25(OH)D levels. There was no statistically significant association between the risk of MS and increasing serum 25(OH)D levels (P = .12). CONCLUSIONS AND RELEVANCE Insufficient maternal 25(OH)D during pregnancy may increase the risk of MS in offspring.
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Affiliation(s)
- Kassandra L Munger
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julia Åivo
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland
| | - Kira Hongell
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland
| | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland
| | | | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Gestational bisphenol-A exposure lowers the threshold for autoimmunity in a model of multiple sclerosis. Proc Natl Acad Sci U S A 2017; 114:4999-5004. [PMID: 28439012 DOI: 10.1073/pnas.1620774114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Environmental and hormonal factors are implicated in dysimmunity in multiple sclerosis. We investigated whether bisphenol-A, a prominent contaminant with endocrine-disrupting capabilities, altered susceptibility in an inflammatory model of multiple sclerosis. We found that gestational, but not adult, exposure to bisphenol-A increased the development of experimental autoimmune encephalomyelitis in adulthood in male, but not female, mice when a suboptimal disease-inducing immunization was used. Gestational bisphenol-A in male mice primed macrophages in adulthood and raised granulocyte-colony stimulating factor and neutrophil counts/activity postsuboptimal immunization. Neutralizing granulocyte-colony stimulating factor blocked susceptibility to disease in bisphenol-A mice. Early life exposure to bisphenol-A may represent an environmental consideration in multiple sclerosis.
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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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Reynolds JD, Case LK, Krementsov DN, Raza A, Bartiss R, Teuscher C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis. FASEB J 2017; 31:2709-2719. [PMID: 28292961 DOI: 10.1096/fj.201700062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/21/2017] [Indexed: 12/13/2022]
Abstract
Month-season of birth (M-SOB) is a risk factor in multiple chronic diseases, including multiple sclerosis (MS), where the lowest and greatest risk of developing MS coincide with the lowest and highest birth rates, respectively. To determine whether M-SOB effects in such chronic diseases as MS can be experimentally modeled, we examined the effect of M-SOB on susceptibility of C57BL/6J mice to experimental autoimmune encephalomyelitis (EAE). As in MS, mice that were born during the M-SOB with the lowest birth rate were less susceptible to EAE than mice born during the M-SOB with the highest birth rate. We also show that the M-SOB effect on EAE susceptibility is associated with differential production of multiple cytokines/chemokines by neuroantigen-specific T cells that are known to play a role in EAE pathogenesis. Taken together, these results support the existence of an M-SOB effect that may reflect seasonally dependent developmental differences in adaptive immune responses to self-antigens independent of external stimuli, including exposure to sunlight and vitamin D. Moreover, our documentation of an M-SOB effect on EAE susceptibility in mice allows for modeling and detailed analysis of mechanisms that underlie the M-SOB effect in not only MS but in numerous other diseases in which M-SOB impacts susceptibility.-Reynolds, J. D., Case, L. K., Krementsov, D. N., Raza, A., Bartiss, R., Teuscher, C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis.
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Affiliation(s)
- Jacob D Reynolds
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Laure K Case
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Abbas Raza
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Cory Teuscher
- Department of Medicine, University of Vermont, Burlington, Vermont, USA; .,Department of Pathology, University of Vermont, Burlington, Vermont, USA
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18
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Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 2016; 13:25-36. [PMID: 27934854 DOI: 10.1038/nrneurol.2016.187] [Citation(s) in RCA: 642] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.
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POOROLAJAL J, MAZDEH M, SAATCHI M, TALEBI GHANE E, BIDERAFSH A, LOTFI B, FERYADRES M, PAJOHI K. Multiple Sclerosis Associated Risk Factors: A Case-Control Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1498-505. [PMID: 26744707 PMCID: PMC4703229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/21/2015] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hamadan Province is one of the high-risk regions in Iran for Multiple sclerosis (MS). A majority of the epidemiological studies conducted in Iran addressing MS are descriptive. This study was conducted to assess MS and its associated risk factors in Hamadan Province, the west of Iran. METHODS This case-control study compared 100 patients with MS (case group) and 100 patients with acute infectious diseases (control group) from September 2013 to March 2014. A checklist was used to assess the demographic, medical, and family history of the patients. The Friedman-Rosenman questionnaire was also used to assess personality type. Statistical analysis was performed using logistic regression model with Stata 11 software program. RESULTS The adjusted odds ratio (OR) estimate of MS was 4.37 (95% CI: 2.33, 8.20) for females compared to males; 0.15 (95% CI: 0.06, 0.43) for people aged above 50 years compared to aged 14 to 29 years; 0.44 (95% CI: 0.21, 0.91) for overweight or obese people compared to normal weights. Crude OR indicated a significant association between the occurrence of MS and exclusive breast feeding, season of birth, and smoking. However, the association was not statistically significant after adjustment for other covariates. CONCLUSION The risk of MS is significantly lower in male gender, obese/overweight, and old people. Furthermore, non-smoking, non-exclusive breast-feeding, and born in autumn may increase the risk of MS but need further investigation. However, long-term large prospective cohort studies are needed to investigate the true effect of the potential risk factors on MS.
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Affiliation(s)
- Jalal POOROLAJAL
- Modeling of Noncommunicable Diseases Research Center, Dept. of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehrdokht MAZDEH
- Dept. of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad SAATCHI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh TALEBI GHANE
- Dept. of Biostatistics, School of Paramedical Sciences, Student’s Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam BIDERAFSH
- Dept. of Social Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Bahar LOTFI
- Dept. of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad FERYADRES
- Dept. of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khabat PAJOHI
- Dept. of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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20
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Cortese M, Riise T, Bjørnevik K, Holmøy T, Kampman MT, Magalhaes S, Pugliatti M, Wolfson C, Myhr KM. Timing of use of cod liver oil, a vitamin D source, and multiple sclerosis risk: The EnvIMS study. Mult Scler 2015; 21:1856-64. [PMID: 25948625 PMCID: PMC4657387 DOI: 10.1177/1352458515578770] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/28/2015] [Indexed: 11/24/2022]
Abstract
Background: Low vitamin D levels have been associated with an increased risk of multiple sclerosis (MS), although it remains unknown whether this relationship varies by age. Objective: The objective of this paper is to investigate the association between vitamin D3 supplementation through cod liver oil at different postnatal ages and MS risk. Methods: In the Norwegian component of the multinational case-control study Environmental Factors In Multiple Sclerosis (EnvIMS), a total of 953 MS patients with maximum disease duration of 10 years and 1717 controls reported their cod liver oil use from childhood to adulthood. Results: Self-reported supplement use at ages 13–18 was associated with a reduced risk of MS (OR 0.67, 95% CI 0.52–0.86), whereas supplementation during childhood was not found to alter MS risk (OR 1.01, 95% CI 0.81–1.26), each compared to non-use during the respective period. An inverse association was found between MS risk and the dose of cod liver oil during adolescence, suggesting a dose-response relationship (p trend = 0.001) with the strongest effect for an estimated vitamin D3 intake of 600–800 IU/d (OR 0.46, 95% CI 0.31–0.70). Conclusions: These findings not only support the hypothesis relating to low vitamin D as a risk factor for MS, but further point to adolescence as an important susceptibility period for adult-onset MS.
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Affiliation(s)
- Marianna Cortese
- The KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Norway/Department of Global Public Health and Primary Care, University of Bergen, Norway/Department of Nutrition, Harvard T.H. Chan School of Public Health, USA
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Norway/Department of Nutrition, Harvard T.H. Chan School of Public Health, USA/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine, University of Oslo, Norway/Department of Neurology, Akershus University Hospital, Norway
| | | | - Sandra Magalhaes
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Canada
| | - Maura Pugliatti
- Department of Global Public Health and Primary Care, University of Bergen, Norway/Department of Clinical and Experimental Medicine, University of Sassari, Italy/Division of Medicine, McGill University, Canada
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Canada/Research Institute of the McGill University Health Centre, Canada
| | - Kjell-Morten Myhr
- The KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
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21
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Abstract
Vitamin D deficiency has been linked to an increased risk of a wide range of adverse health outcomes. The active form of vitamin D has an important role in calcium metabolism and in bone mineralisation, but the evidence for other health outcomes is mixed, with the strongest effects seen in the weakest epidemiological study designs. There are plausible pathways whereby vitamin D deficiency can impair immune function, resulting in both overactivity and increased risk of autoimmune disease, as well as immune suppression with poorer resistance to infection. Vitamin D status may influence the bacterial flora that constitute the microbiome and affect immune function through this route. Exposure of the skin to ultraviolet radiation causes the production of a range of chemicals, including vitamin D, and new research is exploring possible vitamin D-independent immunomodulatory pathways.
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Affiliation(s)
- Robyn M. Lucas
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
- National Centre for Epidemiology and Population Health, The Australian National UniversityCanberraAustralia 0200
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
| | - Sian Geldenhuys
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
| | - Prue H. Hart
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
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22
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Swaminathan A, Lucas RM, Harley D, McMichael AJ. Will Global Climate Change Alter Fundamental Human Immune Reactivity: Implications for Child Health? CHILDREN (BASEL, SWITZERLAND) 2014; 1:403-23. [PMID: 27417487 PMCID: PMC4928742 DOI: 10.3390/children1030403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/07/2014] [Accepted: 10/12/2014] [Indexed: 12/31/2022]
Abstract
The human immune system is an interface across which many climate change sensitive exposures can affect health outcomes. Gaining an understanding of the range of potential effects that climate change could have on immune function will be of considerable importance, particularly for child health, but has, as yet, received minimal research attention. We postulate several mechanisms whereby climate change sensitive exposures and conditions will subtly impair aspects of the human immune response, thereby altering the distribution of vulnerability within populations-particularly for children-to infection and disease. Key climate change-sensitive pathways include under-nutrition, psychological stress and exposure to ambient ultraviolet radiation, with effects on susceptibility to infection, allergy and autoimmune diseases. Other climate change sensitive exposures may also be important and interact, either additively or synergistically, to alter health risks. Conducting directed research in this area is imperative as the potential public health implications of climate change-induced weakening of the immune system at both individual and population levels are profound. This is particularly relevant for the already vulnerable children of the developing world, who will bear a disproportionate burden of future adverse environmental and geopolitical consequences of climate change.
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Affiliation(s)
- Ashwin Swaminathan
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
- Departments of General Medicine and Infectious Diseases, Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory 2605, Australia
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory 0200, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, Australia
| | - David Harley
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
| | - Anthony J. McMichael
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
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Visser E, Milne D, Collacott I, McLernon D, Counsell C, Vickers M. The epidemiology of infectious mononucleosis in Northern Scotland: a decreasing incidence and winter peak. BMC Infect Dis 2014; 14:151. [PMID: 24650116 PMCID: PMC3999936 DOI: 10.1186/1471-2334-14-151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/06/2014] [Indexed: 02/07/2023] Open
Abstract
Background Infection with Epstein-Barr virus (EBV) is almost ubiquitous in humans and generally occurs at two ages: infantile, which is usually asymptomatic and associated with poorer socioeconomic conditions, and adolescent, which causes infectious mononucleosis (IM) in ~25% cases. The determinants of whether the infection causes IM remain uncertain. We aimed to evaluate seasonality and temporal trends in IM. Methods Data from all Monospot tests, used as a marker for IM, were collected from the Grampian population over 16 years. Results Positive Monospot test results peaked at 17 years in females and 19 in males. Females had 16% more diagnoses, although 55% more tests. IM was ~38% more common in winter than summer. The annual rate of positive tests decreased progressively over the study period, from 174/100 000 (95% CI 171–178) in 1997 to 67/100 000 (95% CI 65–69) in 2012. Conclusions IM appears to be decreasing in incidence, which may be caused by changing environmental influences on immune systems. One such factor may be exposure to sunlight. Words 168. Funding The Medical Research Council and NHS Grampian-MS endowments.
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Affiliation(s)
- Elizabeth Visser
- Division of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Room 1:015, Polwarth Building, Foresterhill, Aberdeen AB252ZD, UK.
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Torkildsen O, Aarseth J, Benjaminsen E, Celius E, Holmøy T, Kampman MT, Løken-Amsrud K, Midgard R, Myhr KM, Riise T, Grytten N. Month of birth and risk of multiple sclerosis: confounding and adjustments. Ann Clin Transl Neurol 2014; 1:141-4. [PMID: 25356394 PMCID: PMC4212485 DOI: 10.1002/acn3.37] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 11/11/2022] Open
Abstract
A month of birth effect on multiple sclerosis (MS) risk has been reported from different countries. Recent critics have suggested that this finding is caused by confounding and that adequately adjusting for year and place of birth would markedly reduce this effect. All inhabitants in Norway are registered in the Norwegian Population Registry (Statistics Norway), making this an ideal area for performing adjusted analyses. Using the entire Norwegian population born between 1930 and 1979 (n = 2,899,260), we calculated the excess between observed and expected number of births for each month for 6649 Norwegian MS patients, 5711 mothers, 5247 fathers, and 8956 unaffected siblings. The analyses were adjusted for year of birth and place of birth according to the 19 counties in Norway. An unadjusted analysis revealed 13% fewer MS births than expected in February (P = 0.0015; Bonferroni corrected P = 0.018), 10% more in April (P = 0.0083; Bonferroni corrected P = 0.0996) and 15% more in December (P = 0.00058; Bonferroni corrected P = 0.007). Adjustments for both year and place of birth significantly altered our results for February and December, but even after these adjustments there were still 10% more MS births than expected in April (P = 0.00796; Bonferroni corrected P = 0.096). MS patients had a higher incidence of April births than their siblings (Fisher-exact test; P = 0.011), mothers (Fisher-exact test; P = 0.004), and fathers (Fisher-exact test; P = 0.011) without MS. Adjustments for confounding significantly affected our results. However, even after adjustments, there appears to be a persistent higher than expected frequency of April births in the MS population.
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Affiliation(s)
- Oivind Torkildsen
- The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital Bergen, Norway ; Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen Bergen, Norway
| | - Jan Aarseth
- The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital Bergen, Norway ; Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen Bergen, Norway
| | | | - Elisabeth Celius
- Department of Neurology, Oslo University Hospital, Ullevål Oslo, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo Oslo, Norway
| | - Margitta T Kampman
- Department of Neurology, Institute of Clinical Medicine, University of Tromsø Tromsø, Norway ; Department of Neurology, University Hospital of North Norway Tromsø, Norway
| | - Kristin Løken-Amsrud
- Institute of Clinical Medicine, University of Oslo Oslo, Norway ; Department of Neurology, Innlandet Hospital Trust Lillehammer, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital Molde, Norway
| | - Kjell-Morten Myhr
- The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital Bergen, Norway ; Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen Bergen, Norway
| | - Trond Riise
- Department of Public Health and Primary Health Care, University of Bergen Bergen, Norway
| | - Nina Grytten
- The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital Bergen, Norway ; Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen Bergen, Norway
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Fiddes B, Wason J, Sawcer S. Confounding in association studies: month of birth and multiple sclerosis. J Neurol 2014; 261:1851-6. [PMID: 24413643 PMCID: PMC4192561 DOI: 10.1007/s00415-014-7241-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/02/2014] [Indexed: 11/28/2022]
Abstract
Association studies form the backbone of biomedical research, with almost every effort in the field ultimately boiling down to a comparison between groups, coupled with some form of statistical test intended to determine whether or not any observed difference is more or less than would be expected by chance. Unfortunately, although the paradigm is powerful and frequently effective, it is often forgotten that false positive association can easily arise if there is any bias or systematic difference in the way in which study subjects are selected into the considered groups. To protect against such confounding, researchers generally try to match cases and controls for extraneous variables thought to correlate with the exposures of interest. However, if seemingly homogenously distributed exposures are actually more heterogeneous than appreciated, then matching may be inadequate and false positive results can still arise. In this review, we will illustrate these fundamental issues by considering the previously proposed relationship between month of birth and multiple sclerosis. This much discussed but false positive association serves as a reminder of just how heterogeneous even easily measured environmental risk factors can be, and how easily case control studies can be confounded by seemingly minor differences in ascertainment.
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Affiliation(s)
- Barnaby Fiddes
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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Abstract
Multiple sclerosis (MS) is universally found to be more prevalent in women than men. This has led to extensive studies of differences in the immune system or nervous system between women and men, which might be caused by the effects of gonadal hormones, genetic differences, and different environmental exposures and modern lifestyle in men and women. We review the effects of sex and gender from a genetic, immunological and clinical point of view. We discuss the effects of sex on the clinical expression of MS and responses to therapy, as well as issues concerning pregnancy.
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Affiliation(s)
- Hanne F Harbo
- Department of Neurology, Oslo University Hospital, Ullevål and University of Oslo, 0407 Oslo, Norway
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Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis. Ther Adv Neurol Disord 2013; 6:81-116. [PMID: 23483715 PMCID: PMC3582312 DOI: 10.1177/1756285612473513] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis (MS) is reviewed. Among the multiple recently discovered actions of vitamin D, an immunomodulatory role has been documented in experimental autoimmune encephalomyelitis and in humans. This action in the peripheral immune system is currently the main known mechanism through which vitamin D might influence MS, but other types of actions could be involved within the central nervous system. Furthermore, vitamin D insufficiency is widespread in temperate countries and in patients with MS at the earliest stages of the disease, suggesting that the deleterious effects related to vitamin D insufficiency may be exerted in these patients. In fact, many genetic and environmental risk factors appear to interact and contribute to MS. In genetics, several human leukocyte antigen (HLA) alleles (more particularly HLA-DRB1*1501) could favour the disease whereas some others could be protective. Some of the genes involved in vitamin D metabolism (e.g. CYP27B1) also play a significant role. Furthermore, three environmental risk factors have been identified: past Epstein-Barr virus infection, vitamin D insufficiency and cigarette smoking. Interactions between genetic and environmental risk or protective factors may occur during the mother's pregnancy and could continue during childhood and adolescence and until the disease is triggered in adulthood, therefore possibly modulating the MS risk throughout the first decades of life. Furthermore, some clinical findings already strongly suggest that vitamin D status influences the relapse rate and radiological lesions in patients with MS, although the results of adequately powered randomized clinical trials using vitamin D supplementation have not yet been reported. While awaiting these incontrovertible results, which might be long in coming, patients with MS who are currently in vitamin D insufficiency should be supplemented, at least for their general health status, using moderate doses of the vitamin.
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Affiliation(s)
- Charles Pierrot-Deseilligny
- Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
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Rezaali S, Khalilnezhad A, Naser Moghadasi A, Chaibakhsh S, Sahraian MA. Epidemiology of multiple sclerosis in Qom: Demographic study in Iran. IRANIAN JOURNAL OF NEUROLOGY 2013; 12:136-43. [PMID: 24250923 PMCID: PMC3829303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies have demonstrated controversial results and somewhat increased frequency of multiple sclerosis (MS). We reevaluated the files of MS patients from Qom Province of Iran in order to investigate the epidemiology of the disease. METHODS Demographic and clinical records of 592 MS patients were reviewed, which included; age, sex, date of birth, marital and occupation status, presenting symptoms, time of onset, type and family history of MS, and history of autoimmune or other diseases. RESULTS At the time of our study, 11 patients had died, and 581 were alive with a total female-to-male ratio of 3.4. The mean age of onset of the disease was 34.25 ± 9.01 for all the patients. 11.2% of patients had positive family history of MS. The majority of patients (80.1%) showed relapsing-remitting (RR) pattern. The prevalence of MS was calculated as 50.4/100000 for Qom. CONCLUSION Qom is located within a high risk zone of MS. Although we found evidences about the role of environmental factors, geographical distribution, and etcetera, many more studies need to be performed in this respect.
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Affiliation(s)
- Saeed Rezaali
- Researcher, MS Research Center, Neuroscience institute, Sina Hospital, Tehran University of Medical Sciences AND Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Ahad Khalilnezhad
- Department of Immunology, School of Medical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Neurologist, Researcher, Department of Neurology AND MS Research Center, Neuroscience institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Associate Professor, Department of Neurology AND MS Research Center, Neuroscience institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Principi N, Bianchini S, Baggi E, Esposito S. Implications of maternal vitamin D deficiency for the fetus, the neonate and the young infant. Eur J Nutr 2012; 52:859-67. [PMID: 23224056 DOI: 10.1007/s00394-012-0476-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 11/23/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND It has recently been demonstrated that vitamin D (VD) deficiency during pregnancy and lactation can give rise to problems in mothers and their children. AIM To discuss the implications of VD deficiency during pregnancy and the best VD supplementation to use in order to avoid risks for the mother and child. METHODS PubMed was used to select all of the clinical studies published in the last 15 years concerning VD deficiency in pregnant women and its impact on the fetuses, neonates and infants, as well as the use of VD supplementation during pregnancy. RESULTS Several studies have suggested that VD deficiency is associated with possible major outcomes in the preconception period, during pregnancy, perinatally and in childhood. A 25(OH)D concentration of >32 and <50-60 ng/mL seems to be associated with the lowest risk of disease, and the administration of 2,000 IU/day to pregnant and breastfeeding women seems to maintain adequate 25(OH)D levels. However, not all the experts agree with these conclusions because some of them do not think that VD deficiency can really cause extraskeletal manifestations and consider that the traditionally suggested 400-600 IU/day can be enough to permit an adequate bone development. CONCLUSIONS Despite an increasing amount of data seems to suggest that pregnant women need a greater amount of VD than recommended in the past, further studies are needed to determine how much VD has to be given to assure a regular evolution of the pregnancy and an adequate development of the fetus and the young child.
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Affiliation(s)
- Nicola Principi
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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Abstract
Although strong genetic determinants of multiple sclerosis (MS) exist, the findings of migration studies support a role for environmental factors in this disease. Through rigorous epidemiological investigation, Epstein-Barr virus infection, vitamin D nutrition and cigarette smoking have been identified as likely causal factors in MS. In this Review, the strength of this evidence is discussed, as well as the potential biological mechanisms underlying the associations between MS and environmental, lifestyle and dietary factors. Both vitamin D nutrition and cigarette smoking are modifiable; as such, increasing vitamin D levels and smoking avoidance have the potential to substantially reduce MS risk and influence disease progression. Improving our understanding of the environmental factors involved in MS will lead to new and more-effective approaches to prevent this disease.
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Affiliation(s)
- Alberto Ascherio
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Sajedi SA, Abdollahi F. Geomagnetic disturbances may be environmental risk factor for multiple sclerosis: an ecological study of 111 locations in 24 countries. BMC Neurol 2012; 12:100. [PMID: 22998435 PMCID: PMC3488506 DOI: 10.1186/1471-2377-12-100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We noticed that a hypothesis based on the effect of geomagnetic disturbances (GMD) has the ability to explain special features of multiple sclerosis (MS). Areas around geomagnetic 60 degree latitude (GM60L) experience the greatest amount of GMD. The easiest way to evaluate our hypothesis was to test the association of MS prevalence (MSP) with angular distance to geomagnetic 60 degree latitude (AMAG60) and compare it with the known association of MS with geographical latitude (GL). We did the same with angular distance to geographic 60 degree latitude (AGRAPH60) as a control. METHODS English written papers with MSP keywords, done in Europe (EUR), North America (NA) or Australasia (AUS) were retrieved from the PubMed. Geomagnetic coordinates were determined for each location and AMAG60 was calculated as absolute value of numerical difference between its geomagnetic latitude from GM60L. By an ecological study with using meta-regression analyses, the relationship of MSP with GL, AMAG60 and AGRAPH60 were evaluated separately. MSP data were weighted by square root of number of prevalent cases. Models were compared by their adjusted R square (AR2) and standard error of estimate (SEE). RESULTS 111 MSP data were entered in the study. In each continent, AMAG60 had the best correlation with MSP, the largest AR2 (0.47, 0.42 and 0.84 for EUR, NA and AUS, respectively) and the least SEE. Merging both hemispheres data, AMAG60 explained 56% of MSP variations with the least SEE (R = 0.75, AR2 = 0.56, SEE = 57), while GL explained 17% (R = 0.41, AR2 = 0.17, SEE = 78.5) and AGRAPH60 explained 12% of that variations with the highest SEE (R = 0.35, AR2 = 0.12, SEE = 80.5). CONCLUSIONS Our results confirmed that AMAG60 is the best describer of MSP variations and has the strongest association with MSP distribution. They clarified that the well-known latitudinal gradient of MSP may be actually a gradient related to GM60L. Moreover, the location of GM60L can elucidate why MSP has parabolic and linear gradient in the north and south hemisphere, respectively. This preliminary evaluation supported that GMD can be the mysterious environmental risk factor for MS. We believe that this hypothesis deserves to be considered for further validation studies.
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Affiliation(s)
- Seyed Aidin Sajedi
- Neurology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Prenatal vitamin D deficiency induces an early and more severe experimental autoimmune encephalomyelitis in the second generation. Int J Mol Sci 2012; 13:10911-10919. [PMID: 23109828 PMCID: PMC3472720 DOI: 10.3390/ijms130910911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/18/2012] [Accepted: 08/22/2012] [Indexed: 01/20/2023] Open
Abstract
In a previous study, we demonstrated that mouse adult F(1) offspring, exposed to a vitamin D deficiency during pregnancy, developed a less severe and delayed Experimental Autoimmune Encephalomyelitis (EAE), when compared with control offspring. We then wondered whether a similar response was observed in the subsequent generation. To answer this question, we assessed F(2) females whose F(1) parents (males or females) were vitamin D-deprived when developing in the uterus of F(0) females. Unexpectedly, we observed that the vitamin D deficiency affecting the F(0) pregnant mice induced a precocious and more severe EAE in the F(2) generation. This paradoxical finding led us to assess its implications for the epidemiology of Multiple Sclerosis (MS) in humans. Using the REFGENSEP database for MS trios (the patient and his/her parents), we collected the parents' dates of birth and assessed a potential season of birth effect that could potentially be indicative of the vitamin D status of the pregnant grandmothers. A trend for a reduced number of births in the Fall for the parents of MS patients was observed but statistical significance was not reached. Further well powered studies are warranted to validate the latter finding.
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Cocco E, Meloni A, Murru MR, Corongiu D, Tranquilli S, Fadda E, Murru R, Schirru L, Secci MA, Costa G, Asunis I, Cuccu S, Fenu G, Lorefice L, Carboni N, Mura G, Rosatelli MC, Marrosu MG. Vitamin D responsive elements within the HLA-DRB1 promoter region in Sardinian multiple sclerosis associated alleles. PLoS One 2012; 7:e41678. [PMID: 22848563 PMCID: PMC3404969 DOI: 10.1371/journal.pone.0041678] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/24/2012] [Indexed: 12/22/2022] Open
Abstract
Vitamin D response elements (VDREs) have been found in the promoter region of the MS-associated allele HLA-DRB1*15:01, suggesting that with low vitamin D availability VDREs are incapable of inducing *15:01 expression allowing in early life autoreactive T-cells to escape central thymic deletion. The Italian island of Sardinia exhibits a very high frequency of MS and high solar radiation exposure. We test the contribution of VDREs analysing the promoter region of the MS-associated DRB1 *04:05, *03:01, *13:01 and *15:01 and non-MS-associated *16:01, *01, *11, *07:01 alleles in a cohort of Sardinians (44 MS patients and 112 healthy subjects). Sequencing of the DRB1 promoter region revealed a homozygous canonical VDRE in all *15:01, *16:01, *11 and in 45/73 *03:01 and in heterozygous state in 28/73 *03:01 and all *01 alleles. A new mutated homozygous VDRE was found in all *13:03, *04:05 and *07:01 alleles. Functionality of mutated and canonical VDREs was assessed for its potential to modulate levels of DRB1 gene expression using an in vitro transactivation assay after stimulation with active vitamin D metabolite. Vitamin D failed to increase promoter activity of the *04:05 and *03:01 alleles carrying the new mutated VDRE, while the *16:01 and *03:01 alleles carrying the canonical VDRE sequence showed significantly increased transcriptional activity. The ability of VDR to bind the mutant VDRE in the DRB1 promoter was evaluated by EMSA. Efficient binding of VDR to the VDRE sequence found in the *16:01 and in the *15:01 allele reduced electrophoretic mobility when either an anti-VDR or an anti-RXR monoclonal antibody was added. Conversely, the Sardinian mutated VDRE sample showed very low affinity for the RXR/VDR heterodimer. These data seem to exclude a role of VDREs in the promoter region of the DRB1 gene in susceptibility to MS carried by DRB1* alleles in Sardinian patients.
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Affiliation(s)
- Eleonora Cocco
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Alessandra Meloni
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Cagliari, Italy
| | - Maria Rita Murru
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Daniela Corongiu
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Stefania Tranquilli
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Elisabetta Fadda
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Raffaele Murru
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Lucia Schirru
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Maria Antonietta Secci
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Gianna Costa
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Isadora Asunis
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Cagliari, Italy
| | - Stefania Cuccu
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Lorena Lorefice
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Nicola Carboni
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Gioia Mura
- Centro di Psichiatria e Psicosomatica Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Maria Cristina Rosatelli
- Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Centro Sclerosi Multipla, Dipartimento di Sanità pubblica, Medicina clinica e molecolare, University of Cagliari, Cagliari, Italy
- * E-mail:
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Disanto G, Chaplin G, Morahan JM, Giovannoni G, Hyppönen E, Ebers GC, Ramagopalan SV. Month of birth, vitamin D and risk of immune-mediated disease: a case control study. BMC Med 2012; 10:69. [PMID: 22764877 PMCID: PMC3395583 DOI: 10.1186/1741-7015-10-69] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/06/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A season of birth effect in immune-mediated diseases (ID) such as multiple sclerosis and type 1 diabetes has been consistently reported. We aimed to investigate whether season of birth influences the risk of rheumatoid arthritis, Crohn's disease, ulcerative colitis and systemic lupus erythematosus in addition to multiple sclerosis, and to explore the correlation between the risk of ID and predicted ultraviolet B (UVB) light exposure and vitamin D status during gestation. METHODS The monthly distribution of births of patients with ID from the UK (n = 115,172) was compared to that of the general population using the Cosinor test. Predicted UVB radiation and vitamin D status in different time windows during pregnancy were calculated for each month of birth and correlated with risk of ID using the Spearman's correlation coefficient. RESULTS The distributions of ID births significantly differed from that of the general population (P = 5e-12) with a peak in April (odds ratio = 1.045, 95% confidence interval = 1.024, 1.067, P < 0.0001) and a trough in October (odds ratio = 0.945, 95% confidence interval = 0.925, 0.966, P < 0.0001). Stratification by disease subtype showed seasonality in all ID but Crohn's disease. The risk of ID was inversely correlated with predicted second trimester UVB exposure (Spearman's rho = -0.49, P = 0.00005) and third trimester vitamin D status (Spearman's rho = -0.44, P = 0.0003). CONCLUSIONS The risk of different ID in the UK is significantly influenced by the season of birth, suggesting the presence of a shared seasonal risk factor or factors predisposing to ID. Gestational UVB and vitamin D exposure may be implicated in the aetiology of ID.
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Martinez NE, Sato F, Omura S, Minagar A, Alexander JS, Tsunoda I. Immunopathological patterns from EAE and Theiler's virus infection: Is multiple sclerosis a homogenous 1-stage or heterogenous 2-stage disease? ACTA ACUST UNITED AC 2012; 20:71-84. [PMID: 22633747 DOI: 10.1016/j.pathophys.2012.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is a disease which can presents in different clinical courses. The most common form of MS is the relapsing-remitting (RR) course, which in many cases evolves into secondary progressive (SP) disease. Autoimmune models such as experimental autoimmune encephalomyelitis (EAE) have been developed to represent the various clinical forms of MS. These models along with clinico-pathological evidence obtained from MS patients have allowed us to propose '1-stage' and '2-stage' disease theories to explain the transition in the clinical course of MS from RR to SP. Relapses in MS are associated with pro-inflammatory T helper (Th) 1/Th17 immune responses, while remissions are associated with anti-inflammatory Th2/regulatory T (Treg) immune responses. Based on the '1-stage disease' theory, the transition from RR to SP disease occurs when the inflammatory immune response overwhelms the anti-inflammatory immune response. The '2-stage disease' theory proposes that the transition from RR to SP-MS occurs when the Th2 response or some other responses overwhelm the inflammatory response resulting in the sustained production of anti-myelin antibodies, which cause continuing demyelination, neurodegeneration, and axonal loss. The Theiler's virus model is also a 2-stage disease, where axonal degeneration precedes demyelination during the first stage, followed by inflammatory demyelination during the second stage.
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Affiliation(s)
- Nicholas E Martinez
- Department of Microbiology and Immunology, Center for Molecular and Tumor Virology, LSU Health, School of Medicine, Shreveport, LA 71130, USA
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Menni C, Lowell WE, Bentzen J, Bergamaschi R, Martinelli Boneschi F, Martinelli V, Bernardinelli L, Stenager E, Davis GE, Foco L. Short and long term variation in ultraviolet radiation and multiple sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:685-97. [PMID: 22690156 PMCID: PMC3367270 DOI: 10.3390/ijerph9030685] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 12/23/2022]
Abstract
We examined the role of ultraviolet radiation (UVR) in persons diagnosed with multiple sclerosis (MS) in four different populations, Italians, Danish, White and African Americans. We tested whether variation in UVR as determined by seasons (short term variation) and solar cycles (long term variation) is related to MS birth month and to survival as measured by lifespan. Cases were selected from three Italian MS Case Registries (2,737); from the United States National Center for Health Statistics (56,020); and from the Danish Multiple Sclerosis registry (15,900). Chi-square tests were used to study the pattern of month of birth distribution in patients with MS comparing with general population data. T-tests were employed to study solar cycles association with lifespan. A surplus of births was observed in June for White Americans. A decrease of births in October and November, though not significant after multiple testing correction, was observed in the three populations. In White American with MS overall, males and females, we found that solar cycle is associated with lifespan. We found that season and solar cycles have some role in MS susceptibility and life duration. However, this is an exploratory analysis and further work is needed to discern the association.
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Affiliation(s)
- Cristina Menni
- Department of Applied Health Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (L.B.); (L.F.)
| | - Walter E. Lowell
- Psybernetics Research Group, 04330 Augusta, Maine, USA; (W.E.L.); (G.E.D.)
| | - Joan Bentzen
- The Danish Multiple Sclerosis Registry, National Institute of Public Health, 1353 Copenhagen, Denmark; (J.B.); (E.S.)
| | - Roberto Bergamaschi
- Neurological Institute Casimiro Mondino, Interdepartment Research Center for Multiple Sclerosis, 27100 Pavia, Italy;
| | | | - Vittorio Martinelli
- Department of Neuro-Rehabilitation, Scientific Institute San Raffaele, 20100 Milan, Italy; (F.M.B.); (V.M.)
| | - Luisa Bernardinelli
- Department of Applied Health Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (L.B.); (L.F.)
- Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, CB3 0WA Cambridge, UK
| | - Egon Stenager
- The Danish Multiple Sclerosis Registry, National Institute of Public Health, 1353 Copenhagen, Denmark; (J.B.); (E.S.)
- Institute of Regional Health Services, University of Southern Denmark, 5000 Odense, Denmark
- MS-Clinic of Southern Jutland (Sonderborg, Vejle, Esbjerg), Department of Neurology, 6400 Sonderborg, Denmark
| | - George E. Davis
- Psybernetics Research Group, 04330 Augusta, Maine, USA; (W.E.L.); (G.E.D.)
| | - Luisa Foco
- Department of Applied Health Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (L.B.); (L.F.)
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Simon KC, Munger KL, Ascherio A. XVI European Charcot Foundation lecture: nutrition and environment: can MS be prevented? J Neurol Sci 2011; 311:1-8. [PMID: 21975017 DOI: 10.1016/j.jns.2011.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 09/08/2011] [Accepted: 09/08/2011] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is a relatively common debilitating neurologic disease that affects people in early adulthood. While the characteristic pathology of MS has been well described, the etiology of the disease is not well understood, despite decades of research and the identification of strong genetic and environmental candidates for susceptibility. A question central to all diseases, but posed specifically for MS at the XVI European Charcot Foundation Lecture, was 'Can MS be prevented?' To address this question, we have evaluated the available data regarding nutritional and environmental factors that may be related to MS susceptibility and suggest the extent to which a potential intervention may reduce disease burden. It is our opinion that intervention, particularly supplementation with vitamin D, could have a dramatic impact on disease prevalence. Understanding that any intervention or behavioral modification will surely act in the context of genetic susceptibility and unidentified stochastic events, it is likely that not all MS is 'preventable'. Epidemiologic observation has provided key insights into environmental and nutritional factors that may alter one's susceptibility to MS, however, there are still many questions in unraveling the etiology of this complex disease.
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Affiliation(s)
- Kelly Claire Simon
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Mirzaei F, Michels KB, Munger K, O'Reilly E, Chitnis T, Forman MR, Giovannucci E, Rosner B, Ascherio A. Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol 2011; 70:30-40. [PMID: 21786297 DOI: 10.1002/ana.22456] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Vitamin D may have a protective role in the etiology of multiple sclerosis (MS), but the effect of gestational vitamin D on adult onset MS has not been studied. METHODS In 2001, 35,794 mothers of participants of the Nurses' Health Study II completed a questionnaire inquiring about their experiences and diet during pregnancy with their nurse daughters. We studied the association of maternal milk intake, maternal dietary vitamin D intake, and predicted maternal serum 25-hydroxyvitamin D (25(OH)D) during pregnancy and their daughters' risk of developing MS. RESULTS MS was diagnosed in 199 women. The relative risk of MS was lower among women born to mothers with high milk or vitamin D intake during pregnancy. The multivariate adjusted rate ratio (RR) of MS was 0.62 (95% confidence interval [CI], 0.40-0.95; p trend = 0.001) for nurses whose mothers consumed 2 to 3 glasses of milk per day compared with those whose mothers consumed <3 glasses per month, and 0.57 (95% CI, 0.35-0.91; p trend = 0.002) for nurses with mothers in the highest quintile of dietary vitamin D intake compared with those in the lowest. The predicted 25(OH)D level in the pregnant mothers was also inversely associated with the risk of MS in their daughters. Comparing extreme quintiles, the adjusted RR was 0.59; (95% CI, 0.37-0.92; p trend = 0.002). INTERPRETATION Higher maternal milk and vitamin D intake during pregnancy may be associated with a lower risk of developing MS in offspring.
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Affiliation(s)
- Fariba Mirzaei
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Modulation of the immune system by UV radiation: more than just the effects of vitamin D? Nat Rev Immunol 2011; 11:584-96. [PMID: 21852793 DOI: 10.1038/nri3045] [Citation(s) in RCA: 294] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Humans obtain most of their vitamin D through the exposure of skin to sunlight. The immunoregulatory properties of vitamin D have been demonstrated in studies showing that vitamin D deficiency is associated with poor immune function and increased disease susceptibility. The benefits of moderate ultraviolet (UV) radiation exposure and the positive latitude gradients observed for some immune-mediated diseases may therefore reflect the activities of UV-induced vitamin D. Alternatively, other mediators that are induced by UV radiation may be more important for UV-mediated immunomodulation. Here, we compare and contrast the effects of UV radiation and vitamin D on immune function in immunopathological diseases, such as psoriasis, multiple sclerosis and asthma, and during infection.
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Disanto G, Handel AE, Morahan JM, Ramagopalan SV. Comment on “Epigenetic Reduction in Invariant NKT Cells following In Utero Vitamin D Deficiency in Mice”. THE JOURNAL OF IMMUNOLOGY 2011; 186:3803-4. [DOI: 10.4049/jimmunol.1190005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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The epidemiology of multiple sclerosis in Scotland: inferences from hospital admissions. PLoS One 2011; 6:e14606. [PMID: 21298053 PMCID: PMC3029296 DOI: 10.1371/journal.pone.0014606] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 01/02/2011] [Indexed: 11/22/2022] Open
Abstract
Background Multiple sclerosis (MS) is a neurological disorder with a highly characteristic disease distribution. Prevalence and incidence in general increase with increasing distance from the equator. Similarly the female to male sex ratio increases with increasing latitude. Multiple possible risk factors have been hypothesised for this epidemiological trend, including human leukocyte antigen allele frequencies, ultraviolet exposure and subsequent vitamin D levels, smoking and Epstein-Barr virus. In this study we undertook a study of medical records across Scotland on an NHS health board level of resolution to examine the epidemiology of MS in this region. Methods and Results We calculated the number and rate of patient-linked hospital admissions throughout Scotland between 1997 and 2009 from the Scottish Morbidity Records. We used weighted-regression to examine correlations between these measures of MS, and latitude and smoking prevalence. We found a highly significant relationship between MS patient-linked admissions and latitude (r weighted by standard error (rsw) = 0.75, p = 0.002). There was no significant relationship between smoking prevalence and MS patient-linked admissions. Discussion There is a definite latitudinal effect on MS risk across Scotland, arising primarily from an excess of female MS patients at more Northerly latitudes. Whether this is a true gradient or whether a threshold effect may apply at particular latitude will be revealed only by further research. A number of genetic and environmental factors may underlie this effect.
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Leifer CA, Dietert RR. Early life environment and developmental immunotoxicity in inflammatory dysfunction and disease. TOXICOLOGICAL AND ENVIRONMENTAL CHEMISTRY 2011; 93:1463-1485. [PMID: 26146439 PMCID: PMC4486307 DOI: 10.1080/02772248.2011.586114] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Components of the innate immune system such as macrophages and dendritic cells are instrumental in determining the fate of immune responses and are, also, among the most sensitive targets of early life environmental alterations including developmental immunotoxicity (DIT). DIT can impede innate immune cell maturation, disrupt tissue microenvironment, alter immune responses to infectious challenges, and disrupt regulatory responses. Dysregulation of inflammation, such as that observed with DIT, has been linked with an increased risk of chronic inflammatory diseases in both children and adults. In this review, we discuss the relationship between early-life risk factors for innate immune modulation and promotion of dysregulated inflammation associated with chronic inflammatory disease. The health risks from DIT-associated inflammation may extend beyond primary immune dysfunction to include an elevated risk of several later-life, inflammatory-mediated diseases that target a wide range of physiological systems and organs. For this reason, determination of innate immune status should be an integral part of drug and chemical safety evaluation.
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Affiliation(s)
- Cynthia A. Leifer
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Rodney R. Dietert
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Munger KL, Chitnis T, Frazier AL, Giovannucci E, Spiegelman D, Ascherio A. Dietary intake of vitamin D during adolescence and risk of multiple sclerosis. J Neurol 2010; 258:479-85. [PMID: 20945071 DOI: 10.1007/s00415-010-5783-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 09/27/2010] [Accepted: 09/29/2010] [Indexed: 10/19/2022]
Abstract
Adolescence may be an important etiological period in the development of multiple sclerosis (MS), and studies suggest that adequate vitamin D nutrition is protective. Here, the authors examined whether dietary intake of vitamin D during adolescence decreases the risk of MS in adulthood. In 1986 in the Nurses' Health Study and in 1998 in the Nurses' Health Study II (NHSII), women completed a food frequency questionnaire regarding their dietary intake during adolescence. From this, daily intake of vitamin D was calculated. Adolescent diet was available for 379 incident MS cases confirmed over the combined 44 years of follow-up in both cohorts, and for 67 prevalent cases in the NHSII who had MS at baseline (1989). Cox proportional hazards models were used to calculate relative risk estimates and 95% confidence intervals. Total vitamin D intake during adolescence was not associated with MS risk. Intake of ≥ 400 IU/day of vitamin D from multivitamins was associated with a non-statistically significant reduced risk (RR compared to no intake = 0.73, 95% CI: 0.50-1.07, P = 0.11), whereas intake of whole milk, an important source of dietary vitamin D, was associated with an increased risk. The possibility of opposite effects of vitamin D and milk intake on MS risk should be considered in future studies.
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Affiliation(s)
- Kassandra L Munger
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Bldg. 2, 3rd Fl., Boston, MA 02115, USA.
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