“It’s a fascinating time in MS research,” says Patricia O’Looney, Ph.D., vice president of biomedical research at the National Multiple Sclerosis Society. “The knowledge is so great now.”

Multiple sclerosis is an unpredictable and often disabling disease of the central nervous system. It is believed to be an autoimmune disease, which means that the immune system reacts against itself. One of its quirks is that its progress, severity, and symptoms are different in everybody.

An estimated 400,000 people in the United States are affected by MS. Someone is diagnosed with MS every hour, every day of the year.

Symptoms that might send someone to a neurologist for tests include: loss of mobility; numbness, tingling, or pain; and sudden, often temporary, blindness. People may have mysterious, erratic symptoms for years before diagnosis. Most people — two to four times as many women as men — are diagnosed between ages 20 and 50.

Not surprisingly, genetics plays a major role in current research. “So far, researchers have found as many as 12 genes (out of about 20,000 in the human genome) that are linked to MS. Most of these are connected to the regulation of the immune system, which is inherited from our parents. In the end, we may find as many as 80 MS genes,” says Dr. O’Looney. “Identifying these genetic markers will help us understand why there’s such variability and unpredictability in the disease. There might even be some genes linked to particular types of MS. When you identify genes, it may lead to targets for new therapies.”

By eating away myelin - the protective nerve coating - MS shorts out the flow of information within the brain and between the brain and body, similar to how a stripped electrical wire can short out an appliance.
Image © 2009 RelayHealth and/or its affiliates

Even with genetic susceptibility, something has to trigger the disease, and researchers are looking for these catalysts. One hypothesis is that a lack of sunlight and vitamin D — which, in part, regulates the immune system — might play that role. One bit of evidence is a higher prevalence of MS the farther you live from the equator in your early years. What complicates this research is that there may be different triggers in different people. If a virus is the culprit, as many suspect, it likely has vanished from the body years before the onset of symptoms.

With more than 130 clinical trials under way around the world, including more than a dozen phase 3 (late-stage) trials in process, nearing completion, or finished, MS research is making huge strides toward solving these unknowns. Many of these trials focus on treatment. The vast majority of people with MS have a type called relapsing-remitting and take one of the FDA-approved disease-modifying therapies. Fifteen years of data demonstrate their effectiveness. “What research has told us is that the disease is much more active than originally thought,” Dr. O’Looney explains. “Even if a person is aware of one or two flareups a year, the disease could still be active, although asymptomatic, particularly in the brain. There are times when a person feels OK, but damage is taking place. That’s why the National MS Society advocates so strongly that people diagnosed with MS should be on drug therapy.” Not everyone responds the same to these medications, so having several to choose among is important. One option we can expect to see within a year or so is an oral medication, which may be offered alongside or as a replacement for the injectable medications.

Another promising line of inquiry is understanding how sex hormones may regulate the immune system in people with MS. For example, levels of the hormone estriol typically rise significantly during late pregnancy. This is also when most women’s MS activity declines, leading some scientists to suspect that estriol may be responsible for the easing of symptoms during pregnancy. Preliminary results in a small pilot trial showed that oral estriol treatment decreased disease activity in women with relapsing-remitting MS. To further explore this, a larger trial has begun at the University of California at Los Angeles and several sites throughout the United States.
“Five or 10 years from now, it is certainly our hope that more and increasingly effective MS therapies will be available,” Dr. O’Looney concludes. “Our goal is to find a cure for everyone, and we will, eventually.”

To learn more, call 800-344-4867 or visit www.nationalmssociety.org.

Terri Garr

Courtesy: National Multiple Sclerosis Society

Garr takes one of the MS disease-modifying therapies, which has slowed the progression, she says. She also exercises for an hour a day on a recumbent bicycle. “It helps strengthen both my arms and legs and is aerobic as well. Plus, I can read or watch TV while I’m on it. In the summer, I swim, which I really love. It’s vital to keep moving.” She eats healthy, balanced meals and “was blessed with a dancer’s metabolism. I eat pretty much what I like, but in moderation.

“I decided to go public with my diagnosis partly because rumors had begun circulating about my health, and I wanted to be the one to set the record straight. Besides, what’s worse? Being disabled or being a woman over 50 in Hollywood? Once I went public about my MS, I quickly realized that I would be able to help people in the same condition, and there was nothing to be ashamed of. If people could relate to me through my work, why not in my real life? I became a spokesperson for MS Lifelines, a patient education program, and traveled the country speaking to people with MS, trying to encourage them to find out everything they could about the available therapies and how they could move forward with their lives. I still receive e-mails and fan letters that thank me for sharing my story and helping take the stigma and mystery away from MS.

“The most important thing I tell people with MS is to have a positive mental attitude and keep moving! I also advise anyone
recently diagnosed to relax. The status of MS research has never been more exciting. People talk about the ‘war’ against MS; this isn’t a war, but a movement by and for people with MS.

“Together we will create a world free of multiple sclerosis.”

Montel Williams

© Montel Media Group

Without a trace of self-pity, Williams admits he has 24-hour pain in his feet and side, and that it has recently migrated to his face. He’s tried many remedies, from over-the-counter painkillers to opiates, and from acupuncture to biofeedback. He deals with his condition by raising awareness and funds for MS research through the Montel Williams MS Foundation. “MS is a lifelong battle. There’s no wonder drug that arrests it with true efficacy,” he says. “We’re in a battle of time.” He also actively supports the Partnership for Prescription Assistance (pparx.org), which matches patients with free or nearly free prescriptions.

“The most important thing you can do as a patient, no matter the illness, is educate yourself,” he adds. “There is nothing more profoundly assuring and calming than knowledge.”

Helping Hearts

Given that heart disease is the leading cause of death in the country for both men and women, it’s no surprise that researchers are always looking for better procedures and devices to assist people with heart trouble. From the University of Michigan comes the recently approved HeartMate II, a device that’s implanted in the chest to help a failing heart pump blood and keep patients alive until they can receive a transplanted heart. The new device is smaller—about the size of a D-cell battery —than earlier versions of heart-assisting implants, making it more suitable for people with smaller bodies, like women and adolescents. According to research published in The New England Journal of Medicine, the HeartMate II helped 75 percent of 133 patients stay alive —and improved heart function and quality of life—for at least six months or until a donor heart became available. One patient even recovered to the point where a transplant was no longer needed.

Cool It

Folks in cardiac arrest need to be cooled down —and quickly—to improve their chance of recovery and to avoid brain damage. But how? Methods such as packing unconscious patients in ice can take hours, which makes survival dicey. Now, emergency medical personnel have the Thermosuit, a plastic suit filled with cold water that reduces body temperature in approximately 30 minutes. Survival rates have improved in the hospitals where the Thermosuit is in use; a National Institutes of Health-sponsored trial will soon be underway to test the device further.

Get Your Own Cells

The heart muscle tends to become weaker after a heart attack because it doesn’t regenerate itself well. One day, heart patients may be able to use their own skin cells to repair their hearts, using a new type of stem cells called induced pluripotent stem cells (iPS). Like embryonic stem cells, iPS cells have the potential to develop into any type of cell in the body. A team of scientists at University of California, Los Angeles has grown functioning cardiac cells in the lab using cells from mouse skin reprogrammed with iPS cells. Scientists hope that this will lead to heart patients using their own skin cells to create iPS lines that will repair and regener

Suit Smarts

Fabrics are a basic human need. And now, “smart textiles” do more than the ancient functions of protecting us from the environment and making us look good. They can sense certain stimuli and adapt or respond accordingly, explains Tushar K. Ghosh, Ph.D., a textiles professor at North Carolina State University in Raleigh. Among the many purposes are: protective gear for firefighters; garments that monitor patients’ vital signs like blood pressure and temperature; the delivery of drugs; and to serve as antibacterial or artificial skin for people with severe burns. In the works are fibers that mimic human muscle fibers, which hold promise for prosthetics and robotics. Ghosh and his team are researching a “heatingcooling garment, with fibers that get smaller or larger,” he says. “The idea is to create a piece of clothing that can let the wind come through or tune it closed if it gets too windy or cold.”

“No-Stick” Bandages

In the same vein, an electrical engineering researcher at Mississippi State University has developed a “smart” adhesive bandage that can check cholesterol, insulin, and blood chemistry without needles—a boon to people with diabetes who are used to sticking themselves many times per day. The bandage reads people’s biochemistry right through their skin. The inventor, Ray Winton, expects the bandage to be commercially available in one or two years.

Mag-netting Cancer Cells

Magnets: not just for science fair projects anymore! Scientists at the Georgia Institute of Technology have found a way to use magnets to catch cancer cells in the bodies of mice with ovarian cancer. They hope that this will be useful in diagnosing or slowing the spread of this deadly cancer in women. The way it may work: A peptide (a protein-like molecule) designed to attach to ovarian cancer cells is fastened to very tiny magnetic particles and injected into the abdomen. The peptides latch on to the cancer cells, and a magnetic filtering device outside the body pulls them out. Other researchers have developed magnetic nanoparticles that show promise for spotting and getting rid of harmful.

Crafty Solutions

Gas prices of late have convinced just about everyone that we need better ways to get around. For Leik Myrabo, Ph.D., an engineer-ing physics professor at Rensselaer Polytechnic Institute, one answer is the Lightcraft. “The Light-craft will move goods and people around the planet in more environmentally friendly ways, using power from renewable energy sources, such as the sun or wind,” he explains. The Lightcraft doesn’t carry its own energy or fuel, instead moving by energy beamed to it from remote laser or microwave power plants, either on Earth or in space (hence the name Lightcraft, a hyperenergetic craft flying on a powerful beam of light). That means it can weigh significantly less than conventional vehicles, such as jet planes and rockets with their massive fuel loads. Myrabo has been working on the concept for more than 30 years, but only in the last few years have power-beaming sources become cheap enough to make the Lightcraft feasible. He estimates that in three to five years, his company, Lightcraft Technologies, Inc., will be able to launch something to the edge of space; moving people will follow within a few more years. “This is species-changing technology,” he says, “sustainable global mobility that will enable you to go anywhere on the planet in 45 minutes or to the moon in a few hours.”

It’s been called a two-way street, a bidirectional arrow, a loop and a vicious circle.

“It” is the complicated connection between two seemingly unrelated conditions: diabetes and periodontal disease. The reason researchers are beginning to understand it as a not-so-merry-go-round is because not only is poorly controlled diabetes a major risk factor for gum disease, but in turn, untreated gum disease can make diabetes worse or even hasten the progression to diabetes in those at high risk of developing the disease.

But whatever you call this relationship, it’s one that’s not well known or understood.

“I never knew there was a connection between oral care and diabetes. No doctor or dentist ever said anything about it,” says Louise Sherby, 61, a college librarian in New York City. Diabetes runs in Sherby’s family, and three years ago, in the course of testing for minor surgery, she was told she had prediabetes.

Like many people, Sherby had no symptoms. (That lack of signs is one reason a third of the almost 24 million people in this country with type 2 don’t yet know they have it.) “Dental care is prominent for me not because of diabetes but because of a childhood of having lots of cavities,” she adds, “but now I intend to be extra vigilant.”

Bacteria that are normally present in the mouth can produce toxins that irritate the gums, leading to infection and inflammation—and inflammation is mixed up in almost all major chronic diseases, from Alzheimer’s to osteoarthritis. Periodontal disease, which starts in a milder form called gingivitis, is a chronic ailment that eventually can destroy tissues and even bone. Despite its destructiveness, it’s often painless and most people don’t know they have it. Smoking and a genetic predisposition, along with diabetes, can make gum disease worse.

So how can diabetes, a disorder of glucose (blood sugar) control, have anything to do with infection in the mouth?

“People who are diabetic tend not to respond well to infection. Whenever you have bacteria and a reduced ability to fight it, you’re liable to have more disease,” explains Michael S. Reddy, D.M.D., chairman of the department of periodontology at the University of Alabama at Birmingham School of Dentistry. “People with diabetes have worse infections in general for this reason, so their periodontal disease might also be worse.” Think of how you always seem to catch a cold when you’re run-down, and you’ll get the idea of how diabetes diminishes the ability to fight off bugs.

“People who have a healthy immune system can have a mouth loaded with plaque, but their immune system can handle that challenge,” says Casey Hein, B.S.D.H., M.B.A., associate professor in dental hygiene at the University of Colorado School of Dental Medicine and a dentistry faculty member at the University of Manitoba, Winnipeg. “But for a patient whose immune system is not as resilient, a little plaque could send them from gingivitis to periodontal disease.”

And periodontal disease increases the risk of losing teeth, “which is not just a quality of life problem,” notes George L. King, M.D., director of research at Joslin Diabetes Center, Boston, and a professor of medicine at Harvard Medical School. “People who have bad teeth or don’t have teeth (even with dentures) have poor nutrition, which leads to more problems. Nutrition is a huge part of diabetes care.”

Treating the mouth is also an important element of managing diabetes. One small study, of Pima Indians in Arizona who had both advanced gum disease and type 2, found that when their gum problems were treated, their diabetes improved. Dr. Reddy is beginning an NIH-funded study to see if these results hold true for a larger population. “It’s worked in small studies and is promising,” he comments.

Also promising is that dentists and physicians are beginning to keep an eye out for each other’s patients. In general, many who treat type 2 have not emphasized good oral hygiene, even though almost a third of people with diabetes have severe gum disease.

In addition, says Hein, health insurers are considering increasing dental benefits as evidence mounts that good oral hygiene can pay off by reducing more severe medical troubles.

“Most adult periodontal disease can be prevented or fixed. So if there is a dental component to diabetes, then that is one aspect of diabetes we can control,” Dr. Reddy says. “That’s the good news: Good dental care can really make a difference.”