Collaboration between Canadian and American health networks allows for greater pediatric MS data collection and the opportunity to validate findings.
Vancouver Coastal Health Research Institute scientist Dr. Helen Tremlett’s favourite discovery during her year-long sabbatical spent studying the microbiome – that constellation of trillions of bacterial microbes that reside mostly in the gut (but also all over the body) – is that baby elephants practice coprophagia. In other words, they eat their herd’s feces. Although the elephants’ behaviour, common in many animal species, may be unseemly to humans, one vital purpose of eating dung is to provide good, foreign bacteria to the young elephants missing them from their digestive systems. Coprophagia highlights the microbiome’s significant role in maintaining health and wellness for some animals, although as humans, we obtain our initial friendly gut microbiomes from our mothers (depending on how we were born) as well as from the people around us. Studying this intimate connection between the microbiome and the immune system may offer a better understanding of autoimmune diseases such as multiple sclerosis (MS).
Dr. Tremlett’s research is part of a novel study that will examine the gut microbiomes of children with MS to find clues as to what causes the disease. Enrolment of children in the study is about to begin, and more than 1,000 stool sample collection kits will be distributed to participants over the course of the study. The stool collected will give Dr. Tremlett’s team and collaborators access to study the gut’s microbiome.
“With MS, the microbiome may be important for a number of reasons, for instance there is a constant dialogue at work between your gut, your brain and your immune system. Your immune system will shape the gut microbes and in turn the microbes will shape your immune system,” says Dr. Tremlett, who is a professor and Canada Research Chair in the Department of Medicine, Division of Neurology, at the University of British Columbia.
“We’re hoping that if we can find any differences between the gut microbes in these children with very early onset MS compared to healthy controls, that it might give us insight into what triggers the disease.”
MS is a long-lasting autoimmune disease that damages the brain and spinal cord, disrupting the ability for the brain to properly help the body move and feel, resulting in symptoms such as loss of balance, numbness, thinking problems, and arm or leg weakness.
Pediatric MS is, thankfully, a very unique and rare condition. Fewer than five per cent of people with MS will have symptom onset and be diagnosed in childhood. But children with MS could hold valuable information that may help us better understand the condition. Trying to identify causes of MS in adults can be challenging because symptoms on average present around the age of 30, but how long ago the disease actually started is unknown. Asking an adult to recall potentially useful details of their life, possibly dating back decades – such as types and dates of vaccinations, different foods they have eaten, various infections they have had, etc. – is extremely challenging. Children, on the other hand, have shorter life histories and parents or guardians who are more likely able to provide details.
“I’m not saying it’s super-easy but it’s certainly much easier than an adult, and children are much closer to the disease’s onset whenever that was,” says Dr. Tremlett.
“If you wonder what causes MS, the closest you’re ever going to get to finding an answer is through studying children.”
“From the studies that have been done, for example looking at the factors that may be associated with onset of MS in kids, these factors that come up are pretty similar to what you see in adults, such as Epstein-Barr virus infection,” adds Dr. Tremlett. “That gives us validation that if you find something that triggers MS in a child, it might be the same factors as in an adult.”
The study is funded by the Multiple Sclerosis Scientific Research Foundation and the MS Society of Canada and is part of a wider Canadian Pediatric Demyelinating Disease Network project that has been studying children with MS and healthy controls for the past 10 years, led by Dr. Brenda Banwell from The Hospital for Sick Children and Children’s Hospital of Philadelphia (CHOP). The US Network of Pediatric Multiple Sclerosis Centers is also a study partner, led by Dr. Emmanuelle Waubant at the University of California, San Francisco.
Dr. Tremlett and her colleagues will be using a validation cohort from the ongoing US Network of Pediatric Multiple Sclerosis Centers study that is also collecting stool samples.
“We will be comparing our findings against the U.S. cohort,” explains Dr. Tremlett. “And you know, validating all these findings is so important. For me that’s also really exciting.”