Comparison of serum Concentration of Se, Pb, Mg, Cu, Zn, between MS patients and healthy controls

Impact of nutrition counseling on anthropometry and dietary intake of multiple sclerosis patients at Kasr Alainy Multiple Sclerosis Unit, Cairo, Egypt 2019-2020: randomized controlled clinical trial

BACKGROUND

Faulty dietary habits and overnutrition are prevalent among Egyptian patients with multiple sclerosis (MS) who do not receive nutrition care as part of treatment. Thus, this study was conducted to identify the effect of nutrition counseling on the nutritional status of patients with MS. This endeavor might provide evidence for the value of counseling in such a setting and advance the integration of nutrition counseling into the routine management of patients with MS.

METHODS

A single-blinded, parallel-randomized controlled clinical trial was conducted at Kasr Alainy MS Unit on 120 eligible patients with MS from September 2019 to February 2020. Patients were randomly allocated to either the nutrition counseling intervention group (IG) or the control group (CG). Allocation concealment was performed by using sequentially numbered opaque sealed envelopes. All patients were assessed initially and complied with the Kasr Alainy MS Unit standard management protocol for the study period. Only patients in the IG underwent initial nutrition counseling sessions followed by a monthly evaluation. All patients were assessed at the end of the 3-month follow-up period. Sociodemographic data were gathered through a structured interview. Nutritional status was assessed anthropometrically and via 24-h recall. The 2 groups were compared initially and at the end of the follow-up. Both intention-to-treat and per-protocol analyses were conducted.

RESULTS

At baseline assessment, the prevalence of overweight and obesity was 31.7% and 32.5%, respectively, and the mean body mass index was 27.7 ± 5.7 kg/m². Mean waist circumference was 93.5 ± 11.9 and 99.2 ± 13.1 cm for males and females, respectively. Approximately 27.3% of males and 83.9% of females showed abdominal obesity. After 3 months of counseling, weight, body mass index, waist circumference, nutrient intake and adequacy significantly improved in the IG (p < 0.05).

CONCLUSION

Nutrition counseling significantly improved anthropometric measurements, dietary habits, nutrient intake and adequacy.

TRIAL REGISTRATION

The study was registered on ClinicalTrial.gov and was given a code (NCT04217564).

High K+ intake alleviates experimental autoimmune encephalomyelitis (EAE) and increases T regulatory cells

Multiple sclerosis is believed to be triggered by the interplay between the environmental and genetic factors. In contrast to the Paleolithic diet, the modern Western diet is high in Na⁺ and low in K⁺. The present study was undertaken to determine whether high K⁺ intake alleviated experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. Treatment of C57BL/6 or SJL mice for 7 days with a 5 % K⁺ diet prior to induction of EAE and maintaining mice on the diet until the end of experiments delayed the onset, reduced the peak, and accelerated the recovery of EAE in both strains compared with mice on a control diet (0.7 % K⁺), whereas feeding C57BL/6 mice with a 0.1 % K⁺ diet did the opposite. High K⁺ intake increased the splenic Treg cell frequency in the pretreatment and peak EAE. Thus, high K⁺ intake attenuates EAE, possibly by increasing the Treg cells.

Relationship between zinc-related nutritional status and the progression of multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.

OBJECTIVE

To investigate plasma and erythrocyte zinc status and its relationship to MS.

METHODS

Cross-sectional study, including 98 participants, distributed in groups: case (MS, n = 49), diagnosed with MS and control (n = 49), matched by age and sex with the case group. Zinc was analyzed by flame atomic absorption spectrophotometry, and superoxide dismutase (SOD) activity by spectrophotometry.

RESULTS

Mean plasma zinc was 94.6 (22.1) μg/dL for MS patients and 81.5 (31.3) μg/dL for control group, with statistical difference (p = 0.023). The mean erythrocyte zinc was 83.6 (41.6) µg/gHb for case group and 72.6 (31.5) µg/gHb for control. Erythrocyte SOD activity was above reference values, significantly different for MS patients (p = 0.003). There was a significant direct correlation between erythrocyte zinc and SOD (r = 0.835; p < 0.001). SOD showed inverse correlation with MS outbreaks (r = -0.317; p = 0.027).

CONCLUSION

Patients with MS have normal plasma and elevated erythrocyte zinc. Erythrocyte zinc showed positive correlation with SOD, which correlated inversely to outbreaks.

Complex Profile of Altered Heavy Metals Accumulation in Multiple Sclerosis, a Relationship with Copper and Zinc Homeostasis

BACKGROUND: Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system white matter. Both of environmental and genetic factors have been implicated in its pathogenesis. Heavy metals generate free radicals causing alteration in genetic material and blood-brain barrier damage. In addition, intracellular accumulation of certain heavy metals can trigger autoimmune reaction against myelin proteins and nerves cytoskeletal proteins. AIM: We aimed to analyse complex profile of altered heavy metals accumulation in multiple sclerosis and relationship with copper and zinc homeostasis. METHODS: The present study was carried out in the period between September 2019 and May 2021 on 86 MS Egyptian patients and 86 age and gender matched healthy controls. Whole blood levels of lead (Pb), mercury (Hg), and Cadmium (Cd) in microgram/liter (μg/L) in addition to Zinc (Zn) and Copper (Cu) in milligram/liter (mg/L) were quantitated using the Agilent ICP-MS-MS. The current study also discussed physiological-toxic metals interactions in these patients. RESULTS: We demonstrated significant relations between toxic heavy metals levels and MS suggested by significantly higher levels of Pb, Hg, and Cd and significantly lower levels of Zn and Cu as well as Cu/ Zn in MS patients than controls. Besides, it could be assumed that; physiological heavy metals homeostasis limits the accumulation of toxic heavy metals that share absorption and transport binding sites, suggested by the significant negative correlations between whole blood levels of Cu and both of Hg and Pb. CONCLUSION: A complex profile of altered elements rather than a single element imbalance in MS pathogenesis is suggested.

Searching for the Relationship between the Concentration of Heavy Metals in the Blood and the Clinical Course of Multiple Sclerosis: A Cross-Sectional Study in Poland

(1) Background: Of all environmental pollutants, heavy metals have the most detrimental effect on public health because they remain in the ecosystem and are not biodegradable. The neurotoxicity of heavy metals, including cadmium and lead, has been well documented, and blood levels of heavy metals serve as a biomarker of exposure, reflecting their content in soft tissues. Multiple sclerosis (MS) is one of the most common chronic neurodegenerative diseases. The pathogenesis of MS is complex and relies on the interaction between genetic and environmental factors. The aim of this study was to search for the relationship between the values of cadmium and lead concentration in the blood and the health history and functional status of patients with MS. (2) Methods: The study group consisted of 151 patients with a clinical diagnosis of MS. Determination of the presence of tested elements in serum was performed using an ELAN DRC-e ICP mass spectrometer. (3) Results: Statistical analysis demonstrated that an increase in the level of cadmium was accompanied by an increase in the level of lead. There was no significant correlation between the blood lead concentration and the functional status assessed by EDSS among patients with MS in Poland. However, a tendency towards worse functional status of patients with higher blood lead concentration (p = 0.07) was demonstrated. Patients who experienced first MS symptoms at older age had higher blood levels of the tested metals. (4) Conclusions: The concentrations of cadmium and lead in the blood of MS patients in Poland were not factors differentiating their functional status and the course of the disease.

Blood Trace Element Status in Multiple Sclerosis: a Systematic Review and Meta-analysis

The aim of this meta-analysis was to investigate whether the blood concentrations of patients with multiple sclerosis (MS) are associated with those of the healthy control group in terms of trace elements including zinc (Zn), iron (Fe), manganese (Mn), magnesium (Mg), selenium (Se), and copper (Cu). A comprehensive search was performed in online databases including PubMed, Scopus, Embase, and Web of Science for studies, which have addressed trace elements in MS up to July 23, 2020. The chi-square test and I² statistic were utilized to evaluate inter-study heterogeneity across the included studies. Weighted mean differences (WMDs) and corresponding 95% CI were considered as a pooled effect size (ES). Twenty-seven articles (or 32 studies) with a total sample comprised of 2895 participants (MS patients (n = 1567) and controls (n = 1328)) were included. Pooled results using random-effects model indicated that the levels of Zn (WMD = - 7.83 mcg/dl, 95% CI = - 12.78 to - 2.87, Z = 3.09, P = 0.002), and Fe (WMD = - 13.66 mcg/dl, 95% CI = - 23.13 to - 4.19, Z = 2.83, P = 0.005) were significantly lower in MS patients than in controls. However, it was found that levels of Mn (WMD = 0.03 mcg/dl, 95% CI = 0.01 to 0.04, Z = 2.89, P = 0.004) were significantly higher in MS patients. Yet, no significant differences were observed in the levels of Mg, Se, and Cu between both groups. This meta-analysis revealed that the circulating levels of Zn and Fe were significantly lower in MS patients and that Mn level was significantly higher than those in the control group. However, it was found that there was no significant difference between MS patients and controls with regard to levels of Mg, Se, and Cu.

Nutritional and Biochemical Parameters Among Multiple Sclerosis Patients: A Case-Control Study

Background

The pathogenesis and prognosis of multiple sclerosis (MS) is an area of active medical research. Dietary and biochemical parameters such as serum 25-dihydroxycholecalciferol, magnesium, and potassium play a role in disease progression. This study aimed to compare the nutritional status and biochemical profile of patients with and without MS.

Methodology

This case-control study included a total of 112 participants (56 in the control group and 56 in the MS group). The participants’ socioeconomic and demographic profiles, nutritional status, and biochemical details were all gathered using history, patient files, and records. The effect of these parameters on the presence of MS was evaluated using a decision tree model. Student’s t-test and Mann-Whitney U test were performed to compare these parameters.

Results

A decision tree model was developed with an accuracy rate of 86.52%. The vitamin and mineral intake of the groups showed significant statistical differences (p = 0.001). The differences were important in terms of biochemical parameters, especially serum levels of 25-dihydroxycholecalciferol and potassium.

Conclusions

The key parameters that varied between MS patients and the control group, according to the constructed decision tree, were serum levels of 25-dihydroxycholecalciferol, magnesium, calcium, potassium, and carbohydrate intake. Nutritional measures against MS can be taken based on the decision tree.

Selenization of S. cerevisiae increases its protective potential in experimental autoimmune encephalomyelitis by triggering an intestinal immunomodulatory loop

Multiple sclerosis is an autoimmune disease that affects the myelinated central nervous system (CNS) neurons and triggers physical and cognitive disabilities. Conventional therapy is based on disease-modifying drugs that control disease severity but can also be deleterious. Complementary medicines have been adopted and evidence indicates that yeast supplements can improve symptoms mainly by modulating the immune response. In this investigation, we evaluated the therapeutic potential of Saccharomyces cerevisiae and its selenized derivative (Selemax) in experimental autoimmune encephalomyelitis (EAE). Female C57BL/6 mice submitted to EAE induction were orally supplemented with these yeasts by gavage from day 0 to day 14 after EAE induction. Both supplements determined significant reduction in clinical signs concomitantly with diminished Th1 immune response in CNS, increased proportion of Foxp3⁺ lymphocytes in inguinal and mesenteric lymph nodes and increased microbiota diversity. However, Selemax was more effective clinically and immunologically; it reduced disease prevalence more sharply, increased the proportion of CD103⁺ dendritic cells expressing high levels of PD-L1 in mesenteric lymph nodes and reduced the intestinal inflammatory process more strongly than S. cerevisiae. These results suggest a clear gut-brain axis modulation by selenized S. cerevisiae and suggest their inclusion in clinical trials.

Serum Selenium, Iron, Zinc, and Copper Concentrations in Renal Transplant Recipients Treated with Mycophenolate Mofetil

There are data available in the literature on bioelement concentrations in the serum of various groups of patients; however, very little is known about the serum concentration of selenium (Se), iron (Fe), zinc (Zn), and copper (Cu) in renal transplant patients treated with immunosuppressive drugs, including mycophenolate mofetil (MMF). Monitoring of serum bioelement concentrations in renal transplant recipients is of profound importance, as the proper bioelement levels seem to prolong the normal function of the transplanted organ. Thus, the aim of this current study was to examine and carry out comparative analysis involving serum concentrations of Se, Fe, Cu, and Zn of renal transplant recipients treated with MMF and without MMF. The material consisted of blood samples from 115 patients of the Department of Nephrology, Transplantology, and Internal Medicine of Independent Public Clinical Hospital No. 2, Pomeranian Medical University, in the city of Szczecin in the northwestern Poland. Serum Se, Fe, Cu, and Zn levels were quantified by inductively coupled mass spectroscopy (ICP-MS). Taking into account all patients, MMF increases Cu level. Cu and Fe concentrations were significantly higher in women treated with MMF; in group of younger patients treated with MMF, Se level was significantly lower comparing with those whose regimen did not include MMF. Additionally, MMF in combination with prednisone increased Se concentration in blood of transplant recipients. Our study highlights that trace elements should be monitored to allow for an early detection of trace elements deficits, which can easily be corrected for by an adjusted diet or supplemental intake.

A Controlled Descriptive Study to Determine the Nutritional Status and Biochemical Parameters of Multiple Sclerosis Patients

Background

There is an ongoing research on the etiology of multiple sclerosis (MS). It is still unclear whether nutritional status and biochemical parameters such as serum 25(OH)D, magnesium, and potassium influence the development of disease.

Aims

This study aimed to make contributions to the literature in terms of the recognition of MS by comparing nutritional status and biochemical information of people with and without MS.

Materials and Methods

The study was designed as a controlled descriptive study. Total of 112 individuals were included (control group, n = 56 and MS group, n = 56). Socioeconomic and demographic characteristics, nutritional status, and biochemical information were collected from the participants. A decision tree model was built to evaluate the impact of these parameters on the presence of MS. The parameters were compared using Student's t tests and Mann-Whitney U tests.

Results

A decision tree model having an accuracy rate of 86.52% was constructed. Strong statistical differences were observed among the vitamin and mineral intakes of the groups. In terms of biochemical parameters, especially for serum levels of 25(OH)D and potassium, the differences were significantly different (P < 0.001).

Conclusions

Constructed decision tree indicated that the main parameters differed between an MS patient and a healthy person were as follows: serum levels of 25(OH)D, magnesium, calcium, and intakes of potassium and carbohydrate. Based on the findings of this study, nutritional precautions might be taken against MS.

Systems Biology of Selenium and Complex Disease

Selenium is an essential trace element for maintenance of overall health, whose deficiency and dyshomeostasis have been linked to a variety of diseases and disorders. The majority of previous researches focused on characterization of genes encoding selenoproteins or proteins involved in selenium metabolism as well as their functions. Many studies in humans also investigated the relationship between selenium and complex diseases, but their results have been inconsistent. In recent years, systems biology and "-omics" approaches have been widely used to study complex and global variations of selenium metabolism and function in physiological and different pathological conditions. The present paper reviews recent progress in large-scale and systematic analyses of the relationship between selenium status or selenoproteins and several complex diseases, mainly including population-based cohort studies and meta-analyses, genetic association studies, and some other omics-based studies. Advances in ionomics and its application in studying the interaction between selenium and other trace elements in human health and diseases are also discussed.

New Insights on the Nutrition Status and Antioxidant Capacity in Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is a multifactorial disease with unknown etiology. It is assumed to result from interplay between genetic and environmental factors, including nutrition. We hypothesized that there are differences in nutritional parameters between MS patients and healthy controls. Methods: We examined 63 MS patients and 83 healthy controls. Nutritional status was determined by a dietary questionnaire, blood tests, quantification of cell membrane fatty acids, and serum antioxidant capacity. Results: We found that MS patients consumed a more limited diet compared with the healthy group, indicated by a lower average of 31 nutrients and by consumption levels of zinc and thiamine below the recommended daily intake. Both consumption and measured iron values were significantly lower in MS patients, with the lowest measures in the severe MS group. Long saturated fatty acids (>C16) were significantly lower in MS patients, while palmitic and palmitoleic acids were both higher. Serum total antioxidant capacity was significantly lower in the MS group compared with healthy controls, with the lowest measures in patients with severe MS. Conclusions: This study points to a possible correlation between nutritional status and MS. Understanding the clinical meaning of these findings will potentially allow for the development of future personalized dietary interventions as part of MS treatment.

Blood lead levels and multiple sclerosis: A case-control study

BACKGROUND

Multiple sclerosis (MS) is a debilitating disease of the central nervous system, with disseminating demyelination of nerve fibers and spinal cord. Exposure to heavy metals seems to be associated with a higher incidence of MS. Few studies have assessed the correlation of the incidence of MS with heavy metal concentrations. The present study aimed to assess the relationship between blood lead levels and MS.

METHODS

This case-control study was conducted on 29 MS patients and 29 healthy control persons. The controls were age, gender and occupation matched at the time of blood sampling. Blood lead levels were measured using the atomic absorption spectrometry method. Data were analyzed using Student t-test, Mann-Whitney U, and multiple logistic regression, using a significance level of p ˂ 0.05.

RESULTS

According to the result of this study, the mean blood lead level (BLL) was 75.6 ± 9.35and33.8 ± 28.8 µg/L in patients with MS and control group, respectively. Median blood lead levels were significantly higher in MS patients (38 µg/L, range: 27-67), compared to the controls (30 µg/L, range: 11-49) (p = 0.03). The risk of MS increased 1.17 times per one µg/L increment of blood lead level, using the multiple logistic regression analysis on the present results.

CONCLUSION

In conclusion, based on our results, BLL was higher in MS patients, compared with healthy individuals. The risk of MS increased 1.17 times per one µg/L increment of blood lead level.

Lower Serum Zinc Levels in Patients with Multiple Sclerosis Compared to Healthy Controls

OBJECTIVE

Diminished blood levels of zinc have been reported to be associated with T-cell-mediated autoimmunity, which has been implicated in multiple sclerosis (MS). We aimed to compare the distribution of serum zinc status in MS patients with that in healthy controls (HCs) and to investigate a potential correlation with clinical state, through analysis of serum zinc concentration in MS patients suffering from different disease subtypes.

METHODS

Serum zinc concentrations of 133 patients with relapsing (RMS) and 18 patients with the progressive form of MS (PMS), according to the McDonald criteria of 2010, were measured. Clinical status was quantified using the Expanded Disability Status Scale (EDSS). Zinc concentrations were also determined in the sera of 50 HCs, matched for age and sex at a group level.

RESULTS

MS patients showed significantly lower zinc concentrations (mean (SD)) than HCs (12.5 (2.1) µmol/L vs. 14.6 (2.3) µmol/L, p < 0.001). In contrast, we did not find any difference between RMS (12.4 (2.0) µmol/L) and PMS (13.0 (3.0) µmol/L) cases (p = 0.8). Patients receiving disease-modifying treatment showed lower mean (SD) serum zinc levels than untreated cases (12.3 (1.9) µmol/L vs. 13.5 (3.2) µmol/L, p < 0.03). Zinc levels were not related to disease duration, EDSS, annual relapse rate, or the median number of relapses.

CONCLUSIONS

The data suggest that a diagnosis of MS is related to lower serum zinc concentrations than in HCs, and concentrations were lower still under disease-modifying therapy. However, zinc levels did not predict disease subtypes or disability status.