What recent MS milestones have been particularly helpful for patient care?
We’ve developed highly effective medications that can stop new symptoms from appearing and keep MS from hurting the brain and spinal cord. We have a few medications for which the efficacy is so much higher than ever before. I have patients who say, I have days where I forget that I have MS. That is something we never used to hear.
What are you learning about how the gut microbiome can influence the severity of MS?
There’s some interesting information about the gut microbiome and brain health, particularly cognition and the risk of Alzheimer’s and Parkinson’s diseases. With MS, the research is really preliminary. We do know there are differences in which bacteria and viruses are present [in the microbiome] of people with MS. The balance is different than in people who don’t have MS. We don’t know whether this difference contributed to their MS or if their medications changed their microbiome. That’s why I emphasize that it’s really preliminary. We still have a lot to learn about this.
Are there links between being overweight or obese and an increased risk of flare-ups, or relapses, in MS?
Both obesity and diet influence disease activity in MS. It seems there are substances in fat tissue that are inflammatory and change immune function. People often think of fat as dormant tissue, but it’s not; it can raise levels of inflammatory markers in the blood. We also now know that obesity increases the risk of pediatric MS, and that, in general, a poor diet with fewer vegetables is associated with more MS relapses.
Have other factors been found to increase the risk of MS relapses, and what should people know or do about them?
We now know that lifestyle really matters for brain health, which is important because our brain is vital to who we are. For example, smoking causes more brain atrophy with MS. We know that stress matters [with MS], and infections like bladder infections can increase symptoms—we call these pseudo-relapses. Exercise and sleep help the immune system, so not getting enough sleep or exercise could increase the risk of relapses.
Most important, you want to be working with a healthcare provider who is watching over your MS closely and can see changes on an MRI before you get symptoms that cause trouble. This is necessary because people can have breakthrough disease on their current medications.
What are the most promising areas of research on relapsing-remitting MS?
For the future, our goals are to find ways to stop MS and to end progression of the disease for those who have it, then to replace or repair the nerve damage MS has done. We’re also looking for ways to prevent MS. I’ve been in this area for over 20 years—we have dreamed of some of this stuff, and now it’s in clinical trials. It’s really a new day for MS. Already we have more medications to choose from than ever before, and stem cell studies are moving along. With injections of stem cells into the spinal cord, we’re trying to reset the immune system so patients don’t need long-term medicines.