ACTRIMS 2022 | Factors affecting the risk of relapsing- and progressive-onset multiple sclerosis
Lars Alfredsson, PhD, Karolinska Institutet, Stockholm, Sweden, discusses the factors affecting the risk of relapsing- and progressive-onset multiple sclerosis (MS) and the questions surrounding whether there are similar disease mechanisms underlying the two phenotypes. In a Swedish population-based case-control study, environmental risk factors and their interactions with human leucocyte antigen (HLA) DRB1*15:01 were investigated to determine their association with relapsing-onset and progressive-onset MS and the possible differences between them. It was concluded that relapsing- and progressive-onset MS share the same environmental and lifestyle risk factors and therefore exhibit common etiological mechanisms. This interview took place at the ACTRIMS Forum 2022 in West Palm Beach, Florida.
Transcript (edited for clarity)
The question behind this study is whether it is a similar mechanism that are behind relapsing-onset MS and progressive-onset MS. It has been discussed that whether these are two different diseases or not. We have looked upon whether the environmental factors, smoking, EBV, and also other environmental exposures, snuff use, alcohol and a number of others, to see whether the association between these factors are similar among those with progressive-onset MS and relapsing-onset MS...
The question behind this study is whether it is a similar mechanism that are behind relapsing-onset MS and progressive-onset MS. It has been discussed that whether these are two different diseases or not. We have looked upon whether the environmental factors, smoking, EBV, and also other environmental exposures, snuff use, alcohol and a number of others, to see whether the association between these factors are similar among those with progressive-onset MS and relapsing-onset MS.
And we had done that in a big case-control material we have in Sweden with many thousand persons, both cases and population based controls. These are population based studies and we have also looked a bit on interaction with genetics, but with this first start to look on the results. We see that the associations are fairly similar between these two outcomes. Both for the risk factors that increase the risk – smoking, EBV, sun exposure, low sun exposure – and also for factors that have been previously decrease the risk. Namely, if you have used snuff, for instance, alcohol use is also associated with a decreased risk. And we see this very similar associations between these two outcomes.
After that, we looked also about the interaction between these factors, which we have started before in MS in total, and to see whether the interaction between DRB1*15:01 in each of these environmental factors look different or similar against these two outcomes. And again, we see very similar results. The HLA DRB1*15 interact in a very similar way with each of these environmental factors for both progressive-onset MS and relapsing-onset MS. That leads to the impression that they seem to share the same etiology. That is the main thing of the study.
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