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Azary S, Schreiner T, Graves J, Waldman A, Belman A, Guttman BW, Aaen G, Tillema JM, Mar S, Hart J, Ness J, Harris Y, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Rose J, Barcellos LF, Lotze T, Carmichael SL, Roalstad S, Casper CT, Waubant E. Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:28-33. [PMID: 28993476 PMCID: PMC5732893 DOI: 10.1136/jnnp-2017-315936] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers. METHODS This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse. CONCLUSIONS This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.
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Affiliation(s)
- Saeedeh Azary
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Teri Schreiner
- Department of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Graves
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Amy Waldman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anita Belman
- Department of Neurology, SUNY Stony Brook, Stony Brook, New York, USA
| | - Bianca Weinstock Guttman
- Department of Neurology, The Pediatric MS Center at the Jacobs Neurological Institute, SUNY, Buffalo, New York, USA
| | - Gregory Aaen
- Department of Child Neurology, Loma Linda University, Loma Linda, California, USA
| | | | - Soe Mar
- Division of Pediatric Neurology, Washington University, St. Louis, Missouri, USA
| | - Janace Hart
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Jayne Ness
- Department of Neurology, Alabama Pediatric MS Center, Birmingham, Alabama, USA
| | - Yolanda Harris
- Department of Neurology, Alabama Pediatric MS Center, Birmingham, Alabama, USA
| | - Lauren Krupp
- Department of Neurology, New York University, New York City, New York, USA
| | - Mark Gorman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanuja Chitnis
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Lisa F Barcellos
- Division of Epidemiology, UC Berkeley, Berkeley, California, USA
| | - Tim Lotze
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Shelly Roalstad
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Charles T Casper
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Emmanuelle Waubant
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
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Chaitanya GV, Omura S, Sato F, Martinez NE, Minagar A, Ramanathan M, Guttman BW, Zivadinov R, Tsunoda I, Alexander JS. Inflammation induces neuro-lymphatic protein expression in multiple sclerosis brain neurovasculature. J Neuroinflammation 2013; 10:125. [PMID: 24124909 PMCID: PMC3854084 DOI: 10.1186/1742-2094-10-125] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/24/2013] [Indexed: 02/08/2023] Open
Abstract
Background Multiple sclerosis (MS) is associated with ectopic lymphoid follicle formation. Podoplanin+ (lymphatic marker) T helper17 (Th17) cells and B cell aggregates have been implicated in the formation of tertiary lymphoid organs (TLOs) in MS and experimental autoimmune encephalitis (EAE). Since podoplanin expressed by Th17 cells in MS brains is also expressed by lymphatic endothelium, we investigated whether the pathophysiology of MS involves inductions of lymphatic proteins in the inflamed neurovasculature. Methods We assessed the protein levels of lymphatic vessel endothelial hyaluronan receptor and podoplanin, which are specific to the lymphatic system and prospero-homeobox protein-1, angiopoietin-2, vascular endothelial growth factor-D, vascular endothelial growth factor receptor-3, which are expressed by both lymphatic endothelium and neurons. Levels of these proteins were measured in postmortem brains and sera from MS patients, in the myelin proteolipid protein (PLP)-induced EAE and Theiler’s murine encephalomyelitis virus (TMEV) induced demyelinating disease (TMEV-IDD) mouse models and in cell culture models of inflamed neurovasculature. Results and conclusions Intense staining for LYVE-1 was found in neurons of a subset of MS patients using immunohistochemical approaches. The lymphatic protein, podoplanin, was highly expressed in perivascular inflammatory lesions indicating signaling cross-talks between inflamed brain vasculature and lymphatic proteins in MS. The profiles of these proteins in MS patient sera discriminated between relapsing remitting MS from secondary progressive MS and normal patients. The in vivo findings were confirmed in the in vitro cell culture models of neuroinflammation.
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Affiliation(s)
- Ganta Vijay Chaitanya
- Department of Molecular & Cellular Physiology, School of Medicine, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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