Safe form of estrogen helped multiple sclerosis patients avoid relapses

http://www.eurekalert.org/pub_releases/2015-11/uoc--sfo113015.php

Public Release: 30-Nov-2015
Safe form of estrogen helped multiple sclerosis patients avoid relapses in UCLA led clinical trial
University of California - Los Angeles Health Sciences

Taking the pregnancy hormone estriol along with their conventional medications helped patients with relapsing-remitting multiple sclerosis (RRMS) avoid relapses, according to results of a Phase II randomized, placebo-controlled study led by UCLA researchers.

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It's long been observed that during the second half of pregnancy, women with RRMS have reduced relapses, but the reason was unclear. It is also during this period that the fetal placenta produces estriol, increasing the hormone levels in the blood. This protection during pregnancy occurs not only in MS, but also in other autoimmune diseases such as psoriasis and rheumatoid arthritis.

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"The beauty of estriol is that it is not a shot and can be taken in pill form, and also that it's not a new drug. It has decades of safety behind it," said Voskuhl, who holds the Jack H. Skirball Chair for Multiple Sclerosis in the UCLA Department of Neurology. "Also, current MS treatments are very complex to manufacture. These findings hopefully will pave the way for oral, safe treatments that are more widely accessible, since estriol is simple and naturally occurring."

Multiple sclerosis is an autoimmune disease of the central nervous system where immune cells from the blood attack the tissue surrounding the brain's nerve fibers. Called myelin, this tissue is like the insulation wrapped around an electrical wire. When the myelin is damaged, it interferes with the ability of the nerves to send signals to and from the brain, resulting in symptoms including cognitive problems, difficulty with walking, poor vision and other disabilities.

In RRMS, there are clear episodes of inflammatory activity, or relapses. During a relapse, there are new or worsening symptoms, accompanied by inflammatory lesions in the brain. A relapse can continue anywhere from several days to months. Relapses are usually followed by remission, or improvement. However, some residual symptoms may remain, and after many years people with RRMS often transition to a progressive form of the disease. During the progressive phase, there are no longer relapses, but instead gradual worsening of permanent disabilities and loss of brain volume or atrophy.

In the lab, Voskuhl and her team discovered that estriol potentially provides a one-two punch against the disease, both reducing the ability of immune cells to attack the brain, while also making brain cells more resistant to damage if any immune cells do make it through. Specifically, they showed that estriol treatment improved cognition and prevented atrophy of the cognitive region of the brain. It seems that during pregnancy, estriol can both suppress the immune system and protect the brain, for not only is it important to avoid rejection of the fetus as foreign, it is also critical to protect the developing fetal brain. While these two effects may be designed to protect the fetus, they may also be exactly what the doctor ordered for women with MS.

In 2002, Voskuhl completed the pilot study, in which 10 non-pregnant women with MS were given estriol, yielding a greater than 70 percent drop in inflammatory lesions in the brain within only six months of treatment.

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