TB Vaccine May Work Against Multiple Sclerosis: Study

More brain lesions seen in people who got dummy injection

Wednesday, December 4, 2013

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WEDNESDAY, Dec. 4, 2013 (HealthDay News) -- A vaccine normally used to thwart the respiratory illness tuberculosis also might help prevent the development of multiple sclerosis, a disease of the central nervous system, a new study suggests.
In people who had a first episode of symptoms that indicated they might develop multiple sclerosis (MS), an injection of the tuberculosis vaccine lowered the odds of developing MS, Italian researchers report.
"It is possible that a safe, handy and cheap approach will be available immediately following the first [episode of symptoms suggesting MS]," said study lead author Dr. Giovanni Ristori, of the Center for Experimental Neurological Therapies at Sant'Andrea Hospital in Rome.
But, the study authors cautioned that much more research is needed before the tuberculosis vaccine could possibly be used against multiple sclerosis.
In people with MS, the immune system attacks healthy cells in the central nervous system, which includes the brain and spinal cord.
One of the first signs of MS is what's known as "clinically isolated syndrome." Symptoms include numbing and problems with vision, hearing and balance. About half of people who experience clinically isolated syndrome develop MS within two years, Ristori said.
The study, published online Dec. 4 in the journal Neurology, included 73 people who'd had clinically isolated syndrome. Thirty-three received the tuberculosis vaccine and the remaining 40 were given a placebo, or dummy, injection. The tuberculosis vaccine is a live vaccine called the Bacille Calmette-Guerin vaccine, which isn't widely used in the United States. The same vaccine also is being studied as a treatment for type 1 diabetes.
The participants had monthly MRI scans of their brains for the first six months of the study to look for lesions associated with multiple sclerosis. For the next year, they received a drug (interferon beta-1a) given to people with MS. After that, they received the treatment recommended by their own neurologist. After five years, the participants were reexamined to see if they had developed MS.
After the first six months, the researchers found an average of about eight brain lesions (a potential sign of MS) in people who received a placebo, compared to an average of three lesions in those who received the vaccine.
After five years, 70 percent of those who received the placebo had developed MS, compared to 42 percent of those given the vaccine, the researchers said. No major side effects were reported during the study.
Ristori said it's not clear how the vaccine is protecting against multiple sclerosis. "There seems to be complex, multiple effects on brain inflammation," he said.
Because lesions were reduced in people who received the vaccine, Ristori said, it might also be helpful for people who already have MS.
The authors of an accompanying journal editorial said this study's findings lend support to the "hygiene hypothesis." This theory suggests that a lack of infections during childhood may affect the development of the immune system, and that vaccinating with a live vaccine may help induce a "protective immunity" against MS.
Nicholas LaRocca, vice president of health care delivery and policy research for the National Multiple Sclerosis Society, said this is the latest in a number of studies that have looked at what environmental factors contribute to the development of MS.
"What we're learning is that the immune system isn't a self-contained entity, but that it has a lot of interactions with other things in the body," LaRocca said.
"This study adds to what we know about MS," he said. "But it's just one piece of a big puzzle."
For now, the editorial authors recommend against using the vaccine to treat clinically isolated syndrome or full-blown MS because the long-term safety and effectiveness of the treatment is unknown.
The tuberculosis vaccine often is given to infants and small children in countries where the disease is common. U.S. health officials recommend it only when tuberculosis is likely.

SOURCES: Giovanni Ristori, M.D., Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Rome; Nicholas LaRocca, Ph.D., vice president, health care delivery and policy research, National Multiple Sclerosis Society; Dec. 4, 2013, online, Neurology

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