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Published: Jan. 26, 2016, 11:58 p.m.

Full Transcript

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Host \u2013 Dan Keller

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Hello, and welcome to Episode Sixty-Seven of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I\u2019m Dan Keller.

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We\u2019ll hear from Neda Razaz, a doctoral candidate at the University of British Columbia in Vancouver, Canada, on her research looking at what it means for child development when a parent has MS. The findings may help parents and health care professionals define strategies and services for children when needed.

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\xa0First, let\u2019s check out a few of the 70 new research papers we found in the last week. You cn see each week\u2019s list of curated papers at msdiscovery.org.

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There\u2019s a large and confusing cast of players in demyelinating diseases, such as MS and neuromyelitis optica spectrum disorders. But if the central nervous system was a stage set in a spaghetti Western movie, at least everyone knows the bad guys wearing black hats would be the T cells, right? Hold your horses, say the German and U.S. authors of a review paper in the journal Trends in Immunology. New findings in the last year reframe the story. Some T cells wear white hats. In fact, the central nervous system may need T cells to limit opportunistic infection, inflammation, and damage. Some MS drugs may work by redirecting T cell behavior. Side effects of other MS drugs may come from blanket suppression of all T cells.

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Now is the time to cue the theme from the movie Jaws. In the history of life on Earth, the kind of myelin that researchers are trying to protect and restore in people with MS and related disorders first showed up in a family of shark-like fish and skates and rays. The first true myelin basic protein seems to have originated in this family of cartilaginous fish, called chondrichthyans, or their ancestors. This information comes from an article in a special issue on myelin evolution in the journal Brain Research.

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A third paper that caught our attention looks at modern myelin. Almost every cell in the body has little energy packs called mitochondria. That\u2019s true with brain cells, including the oligodendrocytes that make the myelin membrane that wraps around axons. Researchers from Norway say they have shown, for the first time, mitochondria moving into the myelin wrap. They also report that oligodendrocyte mitochondria are smaller, slower, and move less often than those in astrocytes and neurons.

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Now, to our drug development database. The drugs with important updates this week are fingolimod, glatiramer acetate, interferon beta-1a, mitoxantrone, and natalizumab. One update summarizes a press release indicating that a generic version of fingolimod has been launched in Russia.

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And now to our interview. The University of British Columbia in Vancouver, Canada, has a strong program in MS. We spoke with several of their researchers at the ECTRIMS meeting in Barcelona last fall. Today Neda Razaz, a PhD candidate, fills us in on her work on the impact of living with a parent with MS on child development or wellbeing

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Interviewee \u2013 Neda Razaz

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I study a group of parents with MS and their children, and we actually use health administrative databases to capture our cohort of interest.

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Interviewer \u2013 Dan Keller

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And what were the outcomes of interest, and how did you assess them?

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Razaz

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So, for one particular study that was actually published recently, we were interested in child developmental outcome at kindergarten. So I used the Early Child development instrument, which is a routinely collected database by kindergarten teachers in their classroom. And the specific instrument measured children\u2019s wellbeing from social, emotional, and physical wellbeing. And that was our outcome of interest for that particular study.

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MSDF

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What did you find?

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Razaz

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I actually found that children who have a parent with MS were doing as well as children without a parental MS, so having a parent with MS was not associated with adverse developmental outcome.

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MDSF

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Was any aspect of parental mental health associated with children\u2019s outcomes?

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Razaz

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Actually, yes. In the study, when we did a sensitivity analysis, we found that, in parents who had mental health condition, children were at higher risk of developing some adverse developmental outcomes, specifically in their social and emotional domains of their development.

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MSDF

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Could you tell if these parental mental health aspects had anything to do with the MS

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Razaz

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We didn\u2019t specifically look at that, but it is very well-known in the literature that mental health is highly associated with MS. So we kind of feel that it\u2019s not the MS particular; it\u2019s the comorbidities that come with MS that might have an impact on the child.

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MSDF

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Did it matter whether it was the father or the mother with the issues?

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Razaz

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We did look at gender specifics, and in one study we did find that having a father with MS who had a coexisting mental health morbidity was also having an impact on child developmental outcome. Specifically for the fathers, it was their emotional wellbeing. But, however, for most of our studies we probably didn\u2019t have enough fathers to be able to see a meaningful difference.

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MSDF

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Could you get a handle on alcohol use?

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Razaz

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No, I \u2013 we didn\u2019t specifically at that, no.

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MSDF

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In the case of maternal MS, did it matter whether the disease was present during pregnancy, or if it arose sometime later in childhood development?

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Razaz

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We didn\u2019t specifically examine the timing of the maternal MS onset, so I can\u2019t comment on that specifically, but our inclusion criteria was that MS had to occur some time before the child reached five years of age. And 60% of our MS cohort had their first onset of MS after their pregnancy

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MSDF

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Does that give you any clue into the child\u2019s duration of exposure to these issues?

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Razaz

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We did look at that, and in one study we found that there was a significant association between the duration of the child\u2019s exposure to parental MS and adverse developmental outcome. And I actually feel that\u2019s a very important question, and I\u2019m exploring this further in my future studies as well.

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MSDF

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Can you put this into context? How does it compare to parental issues in other diseases?

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Razaz

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Some of our findings are broadly consistent with other chronic illnesses and is actually a specific meta-analysis looking at children who have parents with medical illnesses found that, overall, these children higher rates of internalizing behavior such as anxiety, depression, compared to children who don\u2019t have parents with MS. However, most of these studies, their study population were adolescents, and it\u2019s kind of different from ours kindergarten-aged children. So that might explain some of the differences in the findings that we found. So maybe being that young, at age five, is too early to have any impacts. And also maybe the parents with MS, their disease is not as advanced

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MSDF

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Are you or someone else going to follow these children as they age?

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Razaz

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I am interested in actually \u2013 you know, my future studies I would like to do a longitudinal study of following these children until older ages; so at least until the time they are 18, and see whether they have a different rates of mental health disorder compared to children who don\u2019t have a parent with MS. I\u2019m interested in, like, specifically living with a parent with a chronic illness.

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MSDF

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What are the implications of your findings, and can you make any recommendations?

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Razaz

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While other studies are needed to confirm our findings, we believe that health professional need to be aware of the effect of mental health morbidity that is commonly associated with MS and its impact on their families. And we believe that mental illness such as anxiety and depression among MS patients should suggest the need for appropriate support for their children, because these children seem to be at higher risk of having some adverse developmental outcomes.

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MSDF

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What have we missed or is important to add?

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Razaz

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So I just want to say that these studies represent the first important steps in making a difference in MS. We are describing and exploring association, however; we and others in the field need to know if intervention at any way can make a real difference in the lives of parents and their kids.

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MSDF

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Whom would the intervention involve?

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Razaz

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The intervention should be family-centered intervention, having the MS patient and also the other parent and other children in the household. So it shouldn\u2019t be individualistic, and it should be the whole family as well.

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MSDF

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Very good! I appreciate it. Thanks.

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Razaz

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Thank you very much.

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MSDF

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Two months after this interview, in late December, the findings were published in the journal Multiple Sclerosis. The paper is free and open to non-subscribers, and you can find a link to it on the podcast page on msdiscovery.org. There you can also find links to be papers and drug development database.

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MSDF

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Thank you for listening to Episode Sixty-Seven of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF\u2019s executive editor is Carol Cruzan Morton. Heather McDonald curated the MSDF drug database updates. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations.

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Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances.

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We\u2019re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org.

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For Multiple Sclerosis Discovery, I'm Dan Keller.

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