Dr. Yinan Zhang leads research examining how aging changes the course of MS. Credit: Courtesy of The Ohio State University Wexner Medical Center
After discovering that aging changes the development of multiple sclerosis, or MS, researchers at the Ohio State Wexner Medical Center and College of Medicine began customizing care in their clinics to improve the quality of life for aging patients, making life easier for patients with MS.
MS is an inflammatory disease of the immune system that attacks different parts of the central nervous system, including the brain, spinal cord and optic nerves, which convey visual information to the brain, according to the Wexner Medical Center. It is a lifelong diagnosis and, as patients age, MS often changes from a manageable condition to a progressive decline with few effective treatments.
“It’s the most common cause of nontraumatic neurological disability among young adults in the western hemisphere,” Dr. Benjamin Segal, chair of Ohio State’s Department of Neurology, said. “There are about a million people who are afflicted with multiple sclerosis in the United States alone.”
MS begins in young adulthood, generally in the 20s and 30s. At that stage, it usually manifests as a relapsing-remitting course, meaning that people with MS will have clearly defined episodes, Segal said.
“It could include different patterns of weakness and numbness, affecting half of the body or both legs,” Segal said. “It could present with imbalance, vertigo, double vision, but early on those symptoms usually come on over hours to days, and then last weeks to months and then resolve.”
For the relapsing-remitting stage in younger individuals, there are over 20 drugs that are effective at decreasing the risk of an MS attack, Segal said.
But over time, the nature of the disease changes.
Segal said MS can transition into a more unavoidable, relentless decline, which generally occurs in midlife when drugs are less effective for patients. This stage is known as progressive MS.
“When you are older, you are less likely to respond to the drugs and, also, these drugs carry side effects,” Segal said. “As you get older, you may be more vulnerable to the side effects.”
According to Segal, drug side effects may include high blood pressure and heart attacks.
Segal said he and other researchers have discovered that the change from relapsing to progressive types of MS is mostly driven by biological age.
“Chronological aging is just how many years you have lived,” Segal said. “Biological aging refers to the collective damage that is done to cells in the body, and the rate of biological aging could differ from one person to another.”
According to Dr. Yinan Zhang, assistant professor of neurology, their research is focused on understanding the role of biological aging in MS progression.
“As we get older, there’s an underlying change in our cellular molecular genetic processes that dictate the aging process,” Zhang said. “In MS, this is particularly important.”
Segal and Zhang conduct research at Ohio State’s Multiple Sclerosis Center, one of the largest and most comprehensive MS programs in the country.
Researchers have identified new biomarkers to measure the acceleration of biological aging. Based on this, they can determine whether people with MS age faster or slower than people without MS, Zhang said.
Biomarkers are objective measures that capture what is going on in a cell at any moment and can serve as early indications of declining health, according to the National Institute of Environmental Health Sciences website.
“A biomarker that we are looking at — a marker of cellular senescence — as we get older, our cells inside our body also get older, and this marker, called P16, can help us quantify the senescence burden in cells,” Zhang said.
Cellular senescence refers to cells that are damaged, but resist being removed, causing the cells to continue releasing chemicals that can cause inflammation, according to the National Institute of Environmental Health Sciences. The number of these cells in a person’s body increases with age due to the fact that an aging immune system becomes less efficient at removing senescent cells.
“Basically, the lab allows us to measure how old certain cells are,” Zhang said. “By looking at that, we can get a sense of the underlying mechanism and figure out whether people with MS also have accelerated senescence.”
To understand aging with MS, Zhang leads the Aging with MS Clinic, a multidisciplinary clinic that provides personal care by considering not only questions related to MS but also questions related to aging.
The care in the clinic is provided by a collaborative team, including neurologists, neuropsychologists, social workers, pharmacists, physical therapists, nurse practitioners and more. The team manages issues related to functional capacity, cognition, balance, mood, nutrition, social support and medications, Zhang said.
Karen Kostelac, a patient who was diagnosed with MS 49 years ago, said her participation in the clinic let her become more aware of all the things that can help her manage and take care of MS as she ages.
“I think they improve the quality of my life because they are making sure that I have got the best treatment that I need,” Kostelac said. “I learned a lot of information and I think it is something that I’m going to utilize.”
