Revisiting Multiple Sclerosis and Pregnancy
Pregnancy and Multiple Sclerosis have had a complicated history over the last century. Before 1950, doctors advised women with MS against pregnancy, as it was largely believed that it might worsen their symptoms. However, in the past 40 years, both anecdotal and scientific evidence have caused professionals to reject this conclusion. Hundreds of women reported an improvement in their MS symptoms during pregnancy. Subsequent studies examined this effect to determine a strong correlation between pregnancy and relapse of MS symptoms. This evidence has caused researchers, such as Dr. Rhonda Voskuhl from the UCLA Department of Neurology, to devote their careers to explain this phenomenon in an attempt to pinpoint the chemical responsible.
MS is a neurodegenerative and autoimmune disease that results in damage to the myelin sheath of nerve fibers in the central nervous system. It affects about 1 in 1,000 people in the United States, with women- especially those of childbearing age – being affected 2 to 3 times more than men. Unfortunately, current medications for MS such as Avonex®, Betaseron®, Rebif®, or the most commonly used Copaxone®, are not safe to take during pregnancy as they may increase risk of miscarriage or stillbirth. However, recent studies by Voskuhl have shown that estriol, a hormone that undergoes a dramatic increase in production with pregnancy, may serve to mitigate the symptoms of MS.
MS is characterized by the immune system mistaking the myelin sheath for a foreign substance. With estriol’s primary purpose being to protect the body against foreign substances, its increased presence in the body may result in a shift of the mother’s immune system toward protecting the fetus rather than attacking itself.
To further investigate the effects of this pregnancy hormone, Voskuhl conducted a double-blind, randomized control study in which 158 women with remitting-exacerbating MS were prescribed either Copaxone® and a placebo or Copaxone® and estriol pills. After a year of treatment, the study showed not only a 47% greater relapse rate for the Copaxone®-estriol group over the Copaxone®-placebo group, but greater scores on cognitive assessments as well. Voskuhl conducted a follow-up experiment in which 10 non-pregnant women with MS were administered estriol. Remarkably, these women experienced as much as a 70% relapse in symptoms.
“I’m very excited by these results,” said Voskuhl. “Currently, all of the available drugs reduce immune attacks on the brain, but none of them protects the brain. Estriol is particularly promising because it both reduces attacks and protects the brain directly. It’s a two-pronged approach — an anti-inflammatory prong to reduce the attacks, and a neuroprotective prong to make the brain suffer less damage in case of an attack.”
Regarding practical application, estriol is promising in both price and safety. Its ability to be mass distributed as a pill rather than a shot drastically cuts its cost, especially when compared to current medications for MS, which can cost tens of thousands of dollars every year. Despite its established safety record in Europe and Asia, estriol is still in the developmental stages for use in the United States. Dr. Voskuhl recognizes that her findings, although promising, require further validation before hitting the market.
In this video, one of Voskuhl’s patients provides greater insight into the course of her MS during her four pregnancies, as well her hopes for expanding the use of estriol to MS cases beyond pregnancy: https://www.youtube.com/watch?v=91SqKAawDT4
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Wheeler, M. (2014). Preliminary clinical trial shows great promise for new multiple sclerosis treatment. Retrieved October 02, 2016, from http://newsroom.ucla.edu/releases/preliminary-clinical-trial-shows-great-promise-for-new-multiple-sclerosis-treatment