What if Santa… had MS?

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Dr Mao Zhifeng, MD, PhD



Mao
has just joined BartsMS as an ECTRIMS Clinical Training Fellow to DrK. He has undertaken
research in the field of neuroimmunology since 2008 when he started his MSc at
the Guangxi Medical University, China. After obtaining his MSc in 2010, he
spent three years as a specialist registrar in Neurology.  
He then continued his research interest in demyelinating
diseases with a PhD (awarded in June 2016) at the Multiple Sclerosis Center of
the 3
rd affiliated Hospital of Sun Yat-Sen University. Mao is keen
to learn how to undertake clinical trials of disease modifying drugs in MS,
particularly in people with advanced MS, and will support our #ThinkHand campaign.
  He also wants to
learn more about service and pathway development for people with MS who are often marginalised simply because of the lower prevalence of MS in lower and middle income countries. Mao plans to stay with us until November 2017. 

This is his first BartsMS blog post.


Imagine Dad explaining to his daughter that Father
Christmas is no longer able to deliver toys
on Christmas Eve as he sufferers
from multiple sclerosis. That’s the concept of a recent campaign by Alzheimer’sResearch UK where Santa is living with the effects of dementia.


Dementia
is a syndrome with many potentially underlying diseases, of which cerebral “small
vessel disease” (SVD) is one of the commonest. As we are – hopefully –
contributing to the longevity of people with MS, vascular comorbidity becomes ever
more relevant, and much of the MS Brain Health campaign is just as applicable
to people with vascular risk factors.

This
recent review is quite timely in that it highlights (i) pathological similarities
between MS and SVD, (ii) the contribution of SVD to the overall outcome and
well-being of pwMS, (iii) the chronic inflammatory milieu in MS that may render
the brain more vulnerable for SVD, and (iv) drugs that target the
microvasculature which may have effects beneficial on the overall outcome in
MS.”








Multiple
sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central
nervous system wherein, after an initial phase of transient neurological
defects, slow neurological deterioration due to progressive neuronal loss
ensues. Age is a major determinant of MS progression onset and disability. Over
the past years, several mechanisms have been proposed to explain the key
drivers of neurodegeneration and disability accumulation in MS. However, the
effect of commonly encountered age-related cerebral vessel disease, namely
small vessel disease (SVD), has been largely neglected and constitutes the aim
of this review. SVD shares some features with MS, i.e. white matter
demyelination and brain atrophy, and has been shown to contribute to the
neuronal damage seen in vascular cognitive impairment. Several lines of evidence
suggest that an interaction between MS and SVD may influence MS-related
neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular
reactivity and tissue hypoxia, features seen in MS. Venule and endothelium
abnormalities have been documented in MS but the role of arterioles and of
other neurovascular unit structures, such as the pericyte, have not been
explored. Vascular risk factors (VRF) have recently been associated with faster
progression in MS though the mechanisms are unclear since very few studies have
addressed the impact of VRF and SVD on MS imaging and pathology outcomes.
Therapeutic agents targeting the microvasculature and the neurovascular unit
may impact both SVD and MS and may benefit patients with dual pathology.


About the author

2 comments

  • I argued in those days with a lady, medical student, she claimed not to be dementia a common symptom in MS, which is creating an exaggerated attention to this aspect.
    This medical student even has multiple sclerosis…
    I said that she can't compare the whole thing with her specific case, it's not because she doesn't have dementia as a symptom that no one else with MS will have…

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