Helicobacter pylori infection may influence prevalence and disease course in myelin oligodendrocyte glycoprotein antibody associated disorder (MOGAD) similar to MS but not AQP4-IgG associated NMOSD.

Background: Helicobacter pylori (Hp) persists after colonizing the gut in childhood, and potentially regulates host immune system through this process. Earlier studies have shown that Hp infection in childhood, may protect against MS in later life. Such an association was not seen with AQP4-IgG positive NMOSD, while the association with MOGAD is unclear. Objective: To evaluate frequency of Hp IgG among patients with MOGAD, MS, NMOSD and matched controls and its effect on disease course. To ascertain whether childhood socio economic factors were linked to prevalence of Hp infection. Methods: In all, 99 patients diagnosed to have MOGAD, 99 AQP4 IgG+ NMOSD, 254MS and 243 matched controls were included. Patient demographics, diagnosis, age at disease onset, duration and the last recorded expanded disability status scale (EDSS) were obtained from our records. Socioeconomic and educational status was queried using a previously validated questionnaire. Serum HpIgG was detected using ELISA kits (Vircell, Spain). Result: Frequency of Hp IgG was significantly lower among MOGAD (28.3% vs 44%, p-0.007) and MS (21.2% vs 44%, p-0.0001) but not AQP4-IgG+ NMOSD patients (42.4% vs 44%, p-0.78) when compared to controls. Frequency of Hp IgG in MOGAD & MS patients combined (MOGAD-MS) was significantly lower than those with NMOSD (23.2% vs 42.4%, p- 0.0001). Seropositive patients with MOGAD- MS were older (p-0.001. OR -1.04, 95% CI- 1.01- 1.06) and had longer disease duration (p- 0.04, OR- 1.04, 95% CI- 1.002- 1.08) at time of testing. Educational status was lower among parents/caregivers of this study cohort (p- 0.001, OR -2.34, 95% CI- 1.48-3.69) who were Hp IgG+. Conclusions: In developing countries Hp infection may be a significant environmental factor related to autoimmune demyelinating CNS disease. Our preliminary data suggests that Hp may exert a differential influence - a largely protective role for MS-MOGAD but not NMOSD and may influence disease onset and course. This differential response maybe related to immuno-pathological similarities between MOGAD and MS in contrast to NMOSD. Our study further underscores the role of Hp as a surrogate marker for poor gut hygiene in childhood and its association with later onset of autoimmune diseases.

Environmental factors related to multiple sclerosis in Indian population.

BACKGROUND: Multiple sclerosis (MS) is less prevalent among Indians when compared to white populations. Genetic susceptibility remaining the same it is possible that environmental associations may have a role in determining disease prevalence. AIMS: To determine whether childhood infections, vaccination status, past infection with Helicobacter pylori (H.pylori), diet, socioeconomic and educational status were associated with MS. MATERIAL AND METHODS: 139 patients and 278 matched control subjects were selected. A validated environmental exposure questionnaire was administered. Estimation of serum H.pylori IgG antibody was done by ELISA. Patients and controls were genotyped for HLA-DRB1*15:01. RESULTS: In our cohort a significant association was seen with measles (p < 0.007), vegetarian diet (p < 0.001, higher educational status (p < 0.0001) and urban living (p < 0.0001). An inverse relationship was seen with H.Pylori infection and MS (p < 0.001). Measles infection (OR 6.479, CI 1.21-34.668, p < 0.029) and high educational status (OR 3.088, CI 1.212-7.872, p < 0.018) were significant risk factors associated with MS. H.pylori infection was inversely related to MS (OR 0. 319, CI 0.144- 0.706, p < 0.005). CONCLUSIONS: Environmental influences may be important in determining MS prevalence.

Association of Epstein-Barr virus infection with multiple sclerosis in India.

OBJECTIVES: Epstein-Barr virus (EBV) seroprevalence is high from early childhood in Indian populations, though multiple sclerosis (MS) is uncommon. The present study aims to evaluate the association of EBV infection with MS in Indian patients. METHOD: In this study 140 MS patients and equal number of matched controls were included. Estimation of serum Immunoglobin G (IgG) for EBV Nuclear antigen 1 (EBNA1), viral capsid antigen (EBV-VCA) and early antigen (EB-EA) were obtained by quantitative enzyme linked immunosorbent assay (ELISA). Patients and controls were genotyped for the human leukocyte antigen (HLA) DRB1*1501 allele. RESULTS: A modest difference was observed for EBNA1 (p=0.02) and EBV-VCA (p=0.03) titres in MS patients as compared to healthy controls. There was no association between EBNA1 titres and MS. High EBNA1 titre (>99.75U/l) was significantly associated with HLA DRBI*15:01 (OR=4.92. CI=1.07-22.57) status in MS patients but not in healthy controls (OR=1.19, CI=0.53-2.63). CONCLUSION: Evidence for a strong association with remote EBV infection was lacking in this study of Indian patients with MS. Patients who are carriers of HLA DR15 allele may have high EBNA1 titres. These preliminary results need to be reproduced in an independent and larger dataset.