This week, the annual meeting of the American Academy of Neurology (AAN) is taking place in Vancouver. For neurologists, this conference is one of the most important events of the year, as clinicians and scientists from the United States and around the world present their latest and most important research findings. Multiple sclerosis, as one of the most common neurological diseases, naturally always occupies an important place and is illuminated from various sides. Over the next few days, I will try to shed light on selected topics and provide a brief overview, although the selection is very limited given the abundance of presented works and of course also represents a subjective selection. In the first poster session on MS on 16.04., risk factors and pathophysiological aspects of multiple sclerosis were discussed. An interesting topic was the correlation between body mass index (BMI) and severity of the disease (P1.37). A research team from New York was able to show in a cross-sectional study of 573 MS patients that those with a BMI > 30 fell ill more severely than the comparison group with a lower BMI. The BMI correlated significantly with the P-MSSS, a score that integrates disability and duration of illness. A poster by an Argentine working group (P.372) could provide an explanation for this observation: The hyperinsulinism found in severely overweight MS patients seems to affect the function of regulatory T cells – a defect in the production of IL-10, an anti-inflammatory messenger, was measured in these modulating cells.
The importance of obesity as a risk factor for MS was also underscored by two studies on childhood MS. A large observational study at 15 MS centers in the United States with almost 400 cases of childhood MS and over 10,000 controls (P1.375) was able to show a correlation between BMI and childhood MS. A Canadian cross-sectional study of 50 patients with childhood onset of multiple sclerosis (P1.376) showed that more than half of the subjects were overweight or severely obese. However, the authors were unable to demonstrate a correlation with the severity of the disease. The number of studies on this topic, however, shows that preventing obesity will be an important issue in MS in the future.
In this context, the topic of nutrition is of course always of great interest. The question for many working groups is not just about preventing overweight, but also about how nutrition and food supplements can possibly modulate the immune system. The work from Bochum and Erlangen (P1.374) on the role of short-chain fatty acids is of great interest here. The research groups of Ralf Gold and Ralf Linker were able to show that a diet supplement of propionic acid is safe and leads to a significant reduction of Th17 cells, a cell population that is largely responsible for the inflammatory response in MS. The authors therefore promote propionic acid as a possible adjunct therapy to established MS medications. An interesting study on the pathophysiology of MS and the importance of oligoclonal bands was presented by a Swedish working group (P1.370). The aim of the study was to determine whether the presence of oligoclonal bands in the cerebrospinal fluid is predictive of the development of secondary chronic progressive MS. The authors found no difference between OKB+ and OKB- patients. More than 4,000 MS patients were included in the study. It was found that a full 10% of patients were OKB negative. This may somewhat relativize the statement of some colleagues “if the bands are negative, MS is questionable”. It turns out that a quite high percentage of MS patients do not show oligoclonal bands.
