Pregnancy Hormone Holds Hope for Treatment
by Rachel Adelson
Pregnant women with
MS may have done the larger MS community a big favor, simply by feeling
pretty good. Noting how exacerbations are rare during the last two trimesters,
MS researchers, notably UCLA's Rhonda Voskuhl, MD, wondered what caused
the protective effect of pregnancy.
Dr. Voskuhl's team
focused on estriol, a form of the hormone estrogen that rises to high
levels during pregnancy. Estriol is known to alter the immune system.
"There's a natural shift," Dr. Voskuhl explained, "so the
mother's immune system won't reject the 'foreign' baby. This shift also
means the immune system is not as likely to attack the mother's central
In a pilot study funded
by the National MS Society, Dr. Voskuhl gave six months of estriol-which
can be taken orally-to 12 non-pregnant women, half with relapsing-remitting
and half with secondary-progressive MS. The trial had a "crossover"
design, so all 12 received the treatment. MRI images revealed a striking
80% drop in inflammatory lesions in the six women with relapsing-remitting
MS while they were on the active treatment. "This is within the realm
of the beta interferon and glatiramer acetate drugs," said Dr. Voskuhl.
Inflammatory protein levels also went down. The six women with secondary-progressive
MS did not improve significantly.
Dr. Voskuhl plans
a longer trial for 70 women, starting this summer. If the results confirm
estriol's benefit on MRI results and immune responses, then researchers
will conduct still larger studies for three to five years. Only longer
studies can establish whether estriol can also reduce relapse rates and
whether or not it is safe for long-term use. If it proves both effective
and safe, it would be an oral treatment for MS.
That delivery method
is crucial. "The beauty of this is that it's not given as a shot.
It's a pill a day," Dr. Voskuhl said. A pill could be more readily
accepted by more patients, more quickly-meaning more would begin treatment
right after diagnosis. "Ultimately, earlier treatment would be expected
to lead to less disability," Dr. Voskuhl said.