The annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) took place from September 11th to 13th, 2020 and on September 26th, 2020 – completely virtual for the first time due to the Corona pandemic. The ECTRIMS conference (this year also as a joint meeting with the American colleagues) is the most important scientific MS congress and the driving force in terms of basic research, diagnostics, and therapy in Multiple Sclerosis. More than 1,000 lectures and posters focused on the latest topics and trends in MS. Given the abundance of data, it is naturally difficult to impossible to provide a comprehensive overview of current research activities. I therefore want to focus on some topics that I believe are trend-setting and will probably be discussed intensively in the future.
In this article, I will briefly touch on the topic of “risk factor obesity”. There will then be contributions on the topics of disease progression, prodromal stage of MS, and biomarkers. On the last day of ECTRIMS, there was also a special symposium on the topic of MS and COVID19, the results of which I have already reported.
The identification of risk factors for the development of Multiple Sclerosis often generates great interest, even among medical laypersons. For example, the role of Vitamin D has been intensively discussed in recent years, including in a therapeutic context. At least as interesting is the factor of obesity, mainly because it is a modifiable risk factor that also plays a role in many other diseases. For more than 10 years, evidence from clinical-epidemiological studies has been increasing that obesity in adolescence, especially in women, is a risk factor for the later development of MS and that obesity is also associated with an earlier onset of disease and a more unfavorable course (for more details, see the review article by Gianfrancesco MA, Barcellos LF. Obesity and Multiple Sclerosis Susceptibility: A Review. J Neurol Neuromedicine. 2016;1(7):1-5 is freely available on the Internet).
At this year’s ECTRIMS, this important topic was deepened again. Data were presented that underline that pathological obesity can adversely affect the course and response to MS therapy. Overweight patients showed a poorer response to a basic therapy of Multiple Sclerosis and a higher need for second-line therapies to control the disease. Furthermore, a correlation of an increased Bodymass Index with the atrophy of retinal fibers was found (the retina is part of the brain where the loss of nerve fibers can easily be studied). And an association of an increased Bodymass Index with a reduction in brain volume could also be confirmed in studies. One explanation for the severe courses is the fact that especially the metabolic activity of visceral fat (“beer belly”) leads to chronic systemic inflammation. This systemic inflammation is already a confirmed risk factor for many internal diseases, such as diabetes, arteriosclerosis or tumor growth, and is also likely to play an important role in the context of autoimmune diseases.
Interestingly, it was already shown a few years ago that the treatment of a metabolic syndrome (i.e., the complex of symptoms that includes obesity) can lead to a reduction in inflammatory activity in MS patients – fewer new foci were found in the cerebral magnetic resonance imaging of treated overweight patients.
These results show that the treatment and especially the prevention of pathological obesity must play an important role in the care of MS patients in the future.
