Le Hua, M.D., Director of the Mellen Program for Multiple Sclerosis at Cleveland Clinic Lou Ruvo Center for Brain Health and the Eric and Sheila Samson Chair for MS Research
Read the Q&A with Dr. Hua below.
WAM: Two out of every 3 cases of Alzheimer’s are in women, as are 78% of other autoimmune diseases, including Multiple Sclerosis (MS). During MS Awareness Month, we want to understand a bit more about what goes wrong in a woman’s neurological system when she develops MS and whether MS and Alzheimer’s disease (AD) share any biological similarities in how they impact the body?
Dr. Hua: Multiple sclerosis is a very complex autoimmune condition that causes damage to the myelin or nerve covering in the central nervous system. These attacks on the myeline can lead to vision problems, muscle weakness, loss of balance or numbness. Over time, these injured areas are vulnerable to additional injury and disability progression. MS is the number one cause of non-traumatic disability in young adults with most people receiving a diagnosis between the ages of 20 and 40.
The injured areas of the central nervous system undergo a process called neurodegeneration which leads to progressive neurological decline over time. The decline can be either physical such as walking or cognitive changes. Alzheimer’s disease is also a neurodegenerative disease where the areas of the brain injured by amyloid plaques also undergo progressive decline and worsening cognition and neurological function. In both diseases, an immune cell in the brain called microglia is implicated in the neurodegenerative processes
WAM: Do you consider both diseases an immune system problem or a problem of inflammation?
Dr. Hua: In MS, the initial disruption is due to the immune system attacking your own brain and spinal cord by mistake. There is ongoing inflammation at the site of attacks due to signals (cytokines) from both brain and immune systems that perpetuate the inflammation. In AD, the plaques can also trigger inflammatory signals (or cytokines) that drive chronic inflammation. Researchers are still trying to understand the role of inflammation in all neurodegenerative diseases such as MS and AD, and exploring these pathways as potential treatment targets.
WAM: We know from research that estrogen and the loss of estrogen during perimenopause and after menopause, may play a significant role in why women are at increased risk for developing AD. What role do hormones and estrogen play when it comes to MS?
Dr. Hua:Women of reproductive age are three times more likely to be diagnosed with MS than men. Children and older adults can get multiple sclerosis, but it’s at a ratio closer to one to one in prepubertal and postmenopausal ages. That has led to research on the role hormones, including estrogen, play in MS. It’s not completely clear yet, but the thought is because puberty is associated with an increase in estrogen and menopause a decrease, estrogen must modify the immune system and how our nerves stay healthy. However, results from studies involving estrogen replacement have been mixed.
Another interesting phenomena we see is that the state of pregnancy is protective in MS. As women get into their second and third trimesters, their relapse rates often completely decrease. Pregnancy increases estrogen levels, so again, there is something about estrogen that we haven’t quite figured out.
WAM: AD and MS are just two neurological diseases that disproportionately impact women. But there are plenty of others like arthritis and lupus. What do you hope research will teach us about the connection between these diseases and how we might develop treatments for them? Is there hope on the horizon?
Dr. Hua: There is currently no cure for MS, but we have made breakthroughs in effective therapies that can control the immune system and stop new injuries from occurring. Our next phase of research is focusing on protecting the brain from previous damage, potentially restoring function and repairing injury to nerves.
Potential breakthroughs in reversing nervous system inflammation or neuroprotection in MS can potentially led to treatment options for similar inflammatory and neuroprotective goals in AD.
WAM:We are learning so much about ways to prevent or delay Alzheimer’s through lifestyle modifications. Do you think that the same lifestyle behaviors around diet, exercise and stress reduction might also minimize women’s risk for developing MS? If so, any tips from an MS expert for women about how best to care for their neurological health?
Dr. Hua: As there is not a single cause of MS, we may not be able to prevent it. There is an interplay between genetic and environmental factors. The environmental factors may be modified such as adequate vitamin D levels, reducing smoking and reducing obesity.
Overall, lifestyle changes that include healthy diet, physical exercise, and stress reduction improve overall health, and can significantly reduce disability progression in MS.
Multiple research studies have indicated that maintaining a healthy lifestyle can help improve disease outcomes and the overall quality of life in patients with MS. Many of the healthy lifestyle habit we see recommended to reduce Alzheimer’s risk are also beneficial in MS. These include: exercise, nutrition, lifestyle choices, health maintenance, sleep pattern, mental health awareness and occupational/social/intellectual health.