Archive for category: News

Women are less likely than men to receive drugs for multiple sclerosis (MS) between the ages of 18 to 40, during women’s childbearing years, even when those drugs have been shown to be safe for use during pregnancy or to have a prolonged effect against the disease even when stopped before conception, according to a study published on July 30, 2025, in Neurology®, the medical journal of the American Academy of Neurology.

“We found that women were less likely to be treated with a disease-modifying drug than men with the same level of disease severity, even when we took into account people who stopped taking their drugs during pregnancy or postpartum,” said study author Sandra Vukusic, MD, PhD, of the University of Lyon in France. “When used early, MS drugs can delay the burden of the disease, so women who are not treated could have worse outcomes in the long term and an increased risk of long-term disability. This loss of chance is not acceptable anymore, as there are drugs that are compatible with pregnancy or can continue to fight the disease long after people stop them when they are trying to conceive.”

For the study, researchers looked at more than 27 years of health records for people in France with relapsing-remitting MS that started when they were between 18 and 40 years old. A total of 16,857 women and 5,800 men were included in the study, with an average age of 29, and they were followed for an average of 12 years.

When researchers examined the percentage of person-years that people in the study received a disease-modifying drug, the number was 60.2% for women and 61.3% for men. Person-years represent both the number of people in the study and the amount of time each person spends in the study. For the highly effective drugs, the numbers were 23.5% for women and 25.3% for men.

However, Vukusic said these raw percentages do not take into account differences that might explain a gap in drug exposure between men and women such as disease severity since women tend to have a more active disease, or pregnancy and postpartum periods during which certain therapies may be interrupted.

After adjusting for disease severity, pregnancy and postpartum periods, women had 8% lower odds of receiving a disease-modifying drug compared to men. In the case of newer drugs that are highly effective at reducing MS relapses, women had 20% lower odds of receiving the drugs.

“Anticipation of pregnancy was probably an important factor in this difference between women and men with MS, but there could also be a reluctance to use these treatments when they may actually be the best way to manage the disease and delay disability,” Vukusic said. “Another factor could be that new data continues to be collected on the safety of newer MS drugs, so more work is needed to communicate those findings to people with MS and their doctors.”

A limitation of the study was that information on pregnancies ending in miscarriage or stillbirth as well as unsuccessful attempts at pregnancy was not available, so discontinuations of medications due to these events were accounted for by adjusting the results for sex.

Reference:

Antoine Gavoille, Emmanuelle Leray, Romain Marignier, Fabien Rollot, Sex-Related Gap in the Use of Disease-Modifying Therapies in Multiple Sclerosis, Neurology, https://doi.org/10.1212/WNL.0000000000213907.

Children born by planned C-section have an increased risk of developing acute lymphoblastic leukaemia (ALL) later in life. This is shown by a study conducted by researchers at Karolinska Institutet. The researchers emphasise that the risk remains low.

The study, published in The International Journal of Cancer, covers nearly 2.5 million children born in Sweden during two periods, 1982 to 1989 and 1999 to 2015. Of these, 15.5 per cent were born by C-section, i.e. nearly 376,000 children. In the entire group, 1,495 children later developed leukaemia.

Using the Medical Birth Register, the researchers were able to divide the C-sections into planned and emergency caesarean sections. The children who later developed leukaemia were overrepresented in the group born by planned C-section. In particular, the risk of the most common form of childhood leukaemia, acute lymphoblastic leukaemia (ALL), increased. The risk of ALL was 21 per cent higher in children born by planned C-section compared with children born vaginally.

The risk of developing the most common form of ALL, B-cell acute lymphoblastic leukaemia (B-ALL), was 29 per cent higher in those born by planned C-section. The increased risk remained even when the researchers adjusted for other relevant factors in mothers and children. The increased risk was more pronounced in boys than in girls and among younger children.

The researchers emphasise that the risk remains low, regardless of the mode of delivery. Between 50 and 70 Swedish children per year are diagnosed with B-ALL. The excess risk associated with planned C-sections corresponds to approximately one case of B-ALL per year, according to the researchers behind the study.

“C-sections are an important and often life-saving part of obstetric care. We don’t want mothers to feel anxious about medically indicated C-sections. But when this result is combined with other study results showing that the risk of later asthma, allergies or type 1 diabetes increases in children born by planned C-section, there is reason to discuss C-sections that are not medically indicated,” says Christina-Evmorfia Kampitsi, researcher at the Institute of Environmental Medicine, Karolinska Institutet, and lead author of the study.

The researchers discuss possible mechanisms that could explain why it is planned and not emergency C-sections that carry an increased risk of certain diseases, all of which are related to immunological factors. The reasoning is that emergency caesarean sections usually begin as a vaginal delivery. This causes stress for the baby and exposure to vaginal bacteria if the amniotic sac has ruptured.

However, in planned C-sections, which are usually performed before labour has started naturally, the baby does not experience this stress and is not exposed to vaginal bacteria. The researchers suggest that this difference may help explain the increased risk of ALL, and believe that the study may contribute to a better understanding of what causes ALL in children.

Some of the results did not reach the threshold for statistical significance, meaning that chance cannot be entirely ruled out.

“Fortunately, ALL is rare. This means that many C-deliveries are needed to obtain a statistically significant result, and it is difficult to obtain such a large sample in a Swedish registry study. However, the results are close to significant, are in line with what previous studies have shown, and remain when we adjust for other relevant factors, which still makes them relevant,” says Christina-Evmorfia Kampitsi.

Reference:

Christina-Evmorfia Kampitsi, Hanna Mogensen, Mats Heyman, Maria Feychting, Giorgio Tettamanti, Mode of delivery and the risk of lymphoblastic leukemia during childhood—A Swedish population-based cohort study, International Journal of Cancer, https://doi.org/10.1002/ijc.70027.

A diet high in foods with the potential to promote low grade inflammation during pregnancy may raise that child’s risk of developing type 1 diabetes, suggests Danish research published online in the Journal of Epidemiology & Community Health.

This dietary pattern was associated with a 16% heightened risk for every unit increase in a dietary measure of inflammatory food intake, the findings show.

Type 1 diabetes is an autoimmune disorder characterised by the destruction of insulin-producing β-cells in the pancreas, necessitating lifelong insulin treatment.

New cases of type 1 diabetes have been rising steadily, increasing by an average of 3-4% every year, especially in developed nations, strongly suggesting a major role for environmental factors, note the researchers.

And since the immune system develops and establishes in early life, and to a certain degree before birth, there is a strong case for exploring the role of the mother’s diet during her pregnancy, especially as mounting evidence suggests that diet is a modifiable contributory factor to low grade systemic inflammation, they explain.

To explore this further, the researchers drew on pregnant women in The Danish National Birth Cohort (DNBC) (January 1996 to October 2002).

They calculated a score based on the inflammatory potential of the mother’s usual dietary intake (EDII score) in mid-pregnancy from a comprehensive food frequency questionnaire, covering 38 food groups (360 separate items), which was completed at around 25 weeks of pregnancy.

Foods that are often reported to have inflammatory properties include: red/processed meats; sugar sweetened drinks: commercial baked goods; refined grain products, such as white bread and pasta; deep fried foods; foods high in added sugar; and trans fats found in non-dairy creamers and some margarines.

In all, 67,701 mother-child pairs were included in the final analysis.

Information on type 1 diabetes diagnoses in the children was obtained through registry linkage to the Danish Registry of Childhood and Adolescent Diabetes. Some 281 (nearly 0.5%) developed the condition during an average tracking period of 17 years. Their average age at diagnosis was 10.

The mothers’ average EDII scores ranged from −5.3 to 4.1, with higher scores indicating higher dietary intake of inflammatory foods.

Higher EDII scores were associated with younger maternal age, lower alcohol consumption, shorter breastfeeding period, and less favourable socioeconomic circumstances. They were also associated with higher BMI (weight) and a tendency to smoke beyond the first 12 weeks of pregnancy.

There was no significant difference in total energy intake between those women with the highest and lowest EDII scores. But higher daily intake of red meats, dairy low fat, pizza, margarine, potatoes, low energy drinks, French fries, and savoury snacks was reflected in higher EDII scores.

On the other hand, higher daily intake of alliums (onions and garlic), tomatoes, whole grains, coffee, green leafy vegetables, fruit juice, dark meat fish, tea, and fruits was reflected in lower EDII scores.

The risk of a child’s type 1 diabetes was associated with their mother’s EDII score, rising by 16% for each unit increase in score up to the age of 18, after accounting for potentially influential factors. Put simply, 1 unit of EDII, which is one standard deviation of the distribution of EDII, corresponds approximately to going from the bottom 3rd to the top 3rd of the population.

This risk wasn’t affected by the child’s sex or weight at birth, but it did seem to be affected by the mother’s intake of gluten, and whether she smoked during her pregnancy.

A 10 g increase in estimated intake of gluten was associated with a 36% increase in risk.

This is an observational study, and as such, can’t establish cause and effect. And the researchers weren’t able to account for the child’s diet.

But they write: “A low-grade inflammatory state secondary to an altered immune cell profile, which triggers pro-inflammatory pathways, is increasingly acknowledged as a critical early-life factor influencing offspring health.”

They caution: “The precise mechanisms by which diet modulates the immune response remain elusive, although some clues can be offered for specific dietary components.”

They add: “Of particular note is the fact that three factors during mid pregnancy, a pro-inflammatory dietary pattern, gluten, and smoking, seemed to independently predict the child’s risk of type 1 diabetes. This suggests that mid-pregnancy may be a critical period during which the fetus is particularly susceptible to maternal lifestyle influences in relation to the individual’s later risk for developing type 1 diabetes during childhood or adolescence.”

Reference:

Noorzae R, Bjerregaard AA, Halldorsson TI, et alAssociation between a pro-inflammatory dietary pattern during pregnancy and type 1 diabetes risk in offspring: prospective cohort studyJ Epidemiol Community Health Published Online First: 01 July 2025. doi: 10.1136/jech-2024-223320

Sucralose is a popular sugar substitute for people who are cutting calories or managing blood sugar levels, but new research by the University of Pittsburgh and UPMC Hillman Cancer Center suggests that the artificial sweetener may not be the best choice for patients undergoing cancer immunotherapy.

Publishing today in Cancer Discovery, a publication of the American Association for Cancer Research, the study found that patients with melanoma and non-small cell lung cancer who consumed high levels of sucralose had worse response to immunotherapy and poorer survival than those with diets low in the artificial sweetener.

Strikingly, supplements that boosted levels of the amino acid arginine mitigated the negative effects of sucralose on immunotherapy in mice, an approach that could now be tested in clinical trials.

“It’s easy to say, ‘Stop drinking diet soda,’ but when patients are being treated for cancer, they are already dealing with enough, so asking them to drastically alter their diet may not be realistic,” said lead author Abby Overacre, Ph.D., assistant professor in the Department of Immunology at Pitt and UPMC Hillman. “We need to meet patients where they are. That’s why it’s so exciting that arginine supplementation could be a simple approach to counteract the negative effects of sucralose on immunotherapy.”

Senior author Diwakar Davar, M.D., associate professor of medicine at Pitt and a medical oncologist and hematologist at UPMC Hillman, collaborating with Overacre and their team, used mouse models to show that the negative impacts of sucralose are driven by disruption to gut bacteria.

Sucralose shifted the composition of the mouse gut microbiome, increasing bacterial species that degrade arginine, which reduced levels of this amino acid in the blood, tumor fluid and stool.

Immune checkpoint inhibitor immunotherapies such as anti-PD1 work by ramping up T cell activity so that they can more effectively kill cancer cells. Arginine is essential for T cell function, especially in cancer.

“When arginine levels were depleted due to sucralose-driven shifts in the microbiome, T cells couldn’t function properly,” said Overacre. “As a result, immunotherapy wasn’t as effective in mice that were fed sucralose.”

In mouse models of adenocarcinoma and melanoma, adding sucralose to the diet inhibited anti-PD1 therapy, leading to larger tumors and poorer survival. But when the researchers gave sucralose-fed mice arginine or citrulline, which is metabolized into arginine in the body, the effectiveness of immunotherapy was restored.

To assess the relevance of these findings for humans, the researchers looked at 132 patients with advanced melanoma or non-small cell lung cancer who received anti-PD1 therapy alone or in combination with chemotherapy. Patients filled out detailed diet history questionnaires that included questions about how often they consumed artificial sweeteners in coffee, tea and diet soda.

“We found that sucralose impeded the effectiveness of immunotherapies across a range of cancer types, stages and treatment modalities,” said Davar. “These observations raise the possibility of designing prebiotics, such as targeted nutrient supplementation for patients who consume high levels of sucralose.”

The researchers hope to launch a clinical trial investigating whether citrulline supplements — which boost arginine levels more than arginine itself — affect the gut microbiome and anti-tumor immune response in patients.

They are also interested in looking at how other sugar substitutes, such as aspartame, saccharin, xylitol and stevia, impact the immune system and response to immunotherapy.

Reference:

Kristin M. Morder, Madison Nguyen, Sucralose consumption ablates cancer immunotherapy response through microbiome disruption, Cancer Discovery, https://doi.org/10.1158/2159-8290.CD-25-0247.