Multiple Sclerosis: a NZ Perspective. Dr Deborah Mason Neurologist Christchurch Hospital

Transcription

1 Multiple Sclerosis: a NZ Perspective Dr Deborah Mason Neurologist Christchurch Hospital

2 Multiple Sclerosis in NZ What is MS Epidemiology of MS in NZ Impact of the disease on PwMS Genetic and Environmental Aspects Future Studies

3 Multiple Sclerosis An inflammatory disease affecting the brain, spinal cord and optic nerves.

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5 Immune Cell Migration into Inflammatory Sites Prostaglandins TNF IL-1 Leukotrienes Chemokines BLOOD VESSEL Inflamed Tissue Free radicals Metalloproteases PAF Nitric Oxide Lipoxins

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7 MRI Brain

8 PATHOLOGICAL DATA Neuropathology in cortical lesions Peterson J et al. Ann Neurol 2001

9 MRI and clinical pattern in MS Progression Disability Disease severity Relapse MRI Active lesions Time (years)

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11 MS Prevalence in NZ Region Study Period Prevalence rate per 100,000 population Bay of Plenty region (Chancellor et al, 2003) Wellington region (Hornabrook,1971) Wellington region (Miller et al, 1986) Wellington region (Miller et al, 1992) Christchurch (Cunningham, 1972) Waikato Otago-Southland (Skegg et al, 1987)

12 MS Prevalence Study The New Zealand MS Prevalence Study Group. A/Prof Bruce Taylor Dr Deborah Mason Dr Ernie Willoughby Dr Glynnis Clarke Dr David Abernethy Dr John Pearson Dr Clive Sabel

13 NZMS Prevalence Study Notifications 13,803 Unique Individuals 5,901 Confirmed MS 2917

14 MS Prevalence Study Prevalence 72.4 per 100,000 F/M ratio of 3:1

15 MS Prevalence Study Prevalence 24.2 per 100,000 F/M ratio of 2.1:1

16 Prevalence and Number of cases by 5yr age groups Number of Cases of MS Prevalence

17 Impact of the Disease MS The Extended Disability Status Score (Kurtzke 1983) An EDSS of <3 denotes mild disability Scores between 3 and 5.5 represent moderate disability (pts still able to walk independently) 6 and 7.5 patients require aids to walk 8 and 9.5 severe disability (restricted to bed or chair)

18 EDSS Grouping <

19 Impact of the Disease MS Not surprisingly this has a large impact on socioeconomic status particular employment status Whilst over 90% of working age MS cohort had a work history Over half not working c.f 22% general population 55% stopped work within 4 years of diagnosis Median annual personal income $20,000 (34,750) 30% receiving an invalid s benefit

20 MS Prevalence Region Prevalence rate per 100,000 population 2006 prevalence ASP rate per 100,000 population (95% CI) Bay of Plenty region ( ) Wellington region ( ) Wellington region Wellington region ( ) Christchurch (95 112) Waikato ( ) Otago-Southland ( )

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22 MS prevalence by region Prevalence w ith 95% CI Prevalence increases by per degree of Latitude South of 37 p< Latitude at Population Weighted Centroid Age standardised prevalence (per 100,000) Nth/Auckland Waikato/BOP Tarnaki/HB Well/Nel/Mar Canterbury/WC Otago/South

23 Cloud corrected Erythemal UV dose Southern HemisphereWinter

24 Cloud corrected Erythemal UV dose Southern Hemisphere Summer

25 Vitamins Casmir Funk Polish biochemist 1912 Isolated thiamine Vital amines molecules not made in the body but vital to it in small amounts Scurvy, Pellagra and rickets. Vitamin D hormone

26 Vitamin D Metabolism

27 Vitamin D It seems logical to consider intervention strategies - Relevant age or timing of the exposure - Dose and type -Safety Impact on MS risk Efficacy in slowing progression

28 PreVANZ Study Randomized, Double-Blind, Placebo-Controlled, Trial of Vitamin D 3 in Patients with a First Demyelinating Event. To determine the efficacy of oral, daily, Vitamin D 3 (1000IU, 5000IU, 10,000IU) compared with placebo Reducing the risk of disease activity in the 12 months following first attack.

29 Infectious agents MS Genetic Factors Environmental Factors

30 What is the gene effect? Twin Studies No single gene has been identified Multiple genes

31 The Australia and New Zealand MS Genetics Consortium 11 institutions 4,500 people with MS 40+ researchers $1.5M MS Research Australia / ARC University of Queensland University of Auckland Griffith University Sir Charles Gardiner Hospital Flinders University University of Melbourne Walter & Eliza Hall Institute University of Newcastle Westmead Millennium Institute University of Otago Menzies Research Institute

32 Conclusions from our study (published 2009) Identified a possible genetic link between vitamin D metabolism and risk of MS can modulation of this pathway be used to treat MS, and other autoimmune diseases?

33 Vitamin D metabolism

34 MS Research: The Future NZ MS Incidence study began June 1 st 2012 MRI study began January 2012

35 A/Prof Bruce Taylor Dr Ernie Willoughby Dr Glynnis Clarke Dr David Abernethy Dr John Pearson Dr Clive Sabel Prof David Miller Dr Sridhar Alla Dr Laetitia Debernard Dr Saskia Van Stockum Ms Jane Eagle Dr John Dalrymple-Alford Dr Tracey Melzer Thank you

36 Ethnicity MS Study 2006 NZ Census Ethnic group 1 N % N % NZ European 1, ,609, Maori , Pacific , Asian , Other , Total 2,019 3,860,163 responses Not stated ,784 Total people 2,896 4,027,947

37 Single Nucleotide Polymorphisms (SNPs) TTCCCTAGGTG TTCCTTAGGTG Human DNA sequence: 3 billion (nucleotides) One SNP every 300 nucleotides Around 10 million SNPs

38 Conclusions from our study (published 2009) Further evidence for genetic overlap between organ specific autoimmune diseases Identified a possible genetic link between vitamin D metabolism and risk of MS can modulation of this pathway be used to treat MS, and other autoimmune diseases? CD40 signalling is important in MS: working in the opposite direction compared to other autoimmune diseases

39 Phase 2: results in two chromosome regions replicated P= CD40 most likely gene

40 Country Prevalence PwMS Denmark Slovakia Belgium + Luxemburg Czech Republic Finland Germany Norway Ireland Russia Switzerland Sweden UK USA Canada Slovenia Austria

41 Country Prevalence PwMS Netherlands France Italy Hungary Australia Israel Spain Portugal Greece Turkey Japan

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43 MS in Maori Prevalence 24.2 per 100,000 F/M ratio of 2.1:1

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45 P=4.1 x 10-6 P= P= CYP27B1

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