More MS news articles for May 1999

In this Dr.'s Q&A session, Dr. Voskuhl discusses an experimental treatment for MS.

Ivanhoe Broadcast News Interview Transcript with Rhonda Voskuhl, M.D., Assistant Professor of Neurology, Scientific Director of MS Research and Treatment Program, UCLA Medical Center, Los Angeles, Calif.


What is multiple sclerosis, or MS, exactly?

Dr. Voskuhl: MS is an autoimmune disease in which lymphocytes from the blood attack the brain and cause stripping of myelin from the nerves in the brain. When you take the myelin off of that wire, the nerve doesn't connect as well. So patients will have symptoms referable to where the myelin got stripped off. So it's an inflammatory lesion that ultimately results in demyelination, or loss of myelin from nerves in the brain.

What are some of the symptoms they experience?

Dr. Voskuhl: They're very broad in range. For example, if the optic nerve is affected, you can have blindness. If it's the motor pathways to the leg, you'll have paralysis. If sensory nerves are affected, you'll have numbness. So it can be a multitude of different symptoms just depending on where the lesions hit.

Where did you get the idea to use estriol for this?

Dr. Voskuhl: The idea came from an interesting observation that clinicians and neurologists have known for quite some time. MS patients tell us they get better during pregnancy. There was a recent New England Journal of Medicine article showing a highly significant reduction in relapse rate in the third trimester of pregnancy as compared to before they were pregnant or after they were pregnant. So there was this clear evidence that something in the third trimester of pregnancy made MS better. We went on to ask why and what hormones are increased in the last trimester of pregnancy. The ones that go to a real high level at that time are progesterone and estriol. Estriol is slightly different than the estrogen of the ovulatory cycle. This particular estrogen is a weak estrogen, and it's made by the fetal placental unit. So instead of being made by the ovary, estriol is made out of the fetal placental unit. Which is why you get such high levels when the baby is large in the last trimester. Based on this information, we gave the estriol, progesterone or placebo treatments to mice with experimental autoimmune encephalomyelitis. It is the animal model most widely used for multiple sclerosis. What we found was that the mice receiving placebo and progesterone looked a lot alike. They were very sick and had a lot of paralysis. The estriol treated mice looked really good -- significantly better. We did the experiment over 20 times, and the estriol always makes the mice a lot better with regard to less disability.

Are there any side effects or risks?

Dr. Voskuhl: That's a good question, and we were fortunate in the sense that estriol had been used before in thousands of women actually in Europe for hormone replacement therapy. It does not prevent osteoporosis. So it was not FDA-approved for use here. You can't get estriol in the United States, but in Europe you can get it. So since it has been used extensively, there's a side effects profile. The side effects are going to be some of the ones you would see with birth control pills or hormone replacement therapy. There can be some irregular menstrual bleeding. There could be some breast tenderness, things you would think about with other estrogens that you would take.

Is there anybody that would never be a candidate to use this?

Dr. Voskuhl: Men. We think that the gender difference is important. Currently this study is for women only, aged 18 to 50. The other important point is that women cannot be on one of the other drugs for MS. We're not trying to show an added effect in this initial trial. We want people who are on nothing else to show that it has an effect by itself. Women may get to that point where we see if it has an additive effect to one of the injection treatments. The beauty of this is that it's a pill it's not an injection. Is that the biggest advantage to the other therapies that we use? Dr. Voskuhl: I think it's a really big advantage because if you talk to the patients, they really don't like taking shots every other day. There are problems associated with antibodies, too. So I think it's kind of nice to use a natural hormone.


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