Effect of endocrine disrupting chemicals on early disease course in Multiple sclerosis
Tzu-ying Chuang1, Talia Feldman1, Brian Healy1, Shrishti Saxena1, Eunnindy Sanon1, Taylor Saraceno2, Tanuja Chitnis1
1Brigham and Women's Hospital, 2Brigham and Women'S Hospital
Objective:
Analyze whether endocrine disrupting chemicals (EDCs) correlate with initiation of Multiple sclerosis (MS) in females
Background:
MS is the most common neuroinflammatory disease with a female predominant ratio of 3:1. Sex hormones are implicated, as most pediatric MS cases occur after puberty, and pregnancy is protective against disease activity. EDCs including phenols, parabens, and phthalates are found ubiquitously in the modern lifestyle. They interfere with natural hormone homeostasis in the body via estrogen receptor signaling. This study focuses on whether exposure to EDCs affect MS initiation.
Design/Methods:
30 female patients were recruited from the Brigham MS Center. Enrollment criteria included diagnosis with MS within the past 5 years, and consent to provide a blood and urine sample and completed a questionnaire about potential EDC exposures. Exclusion criteria were intravenous steroids in the past 30 days. Samples were analyzed by NSF International (Ann Arbor, Michigan) by LC-MS for phenols, parabens, and phthalates. Statistical results were obtained using R.
Results:
We find that females with higher levels of the phthalates mECPP and mEOHP had higher annualized relapse rates (ARR) from onset of disease (Spearman coefficient, R=0.55, p=0.0014; R=0.65, p=7.8e-05). mECPP and mEOHP levels also correlated with increased number of T2 lesions on MRI (R=0.51, p=0.0033; R=0.57, p=8e-04). mECPP levels were inversely correlated with fish intake (R=-0.38, p=0.02. mEOHP was non-significantly inversely correlated with fish intake (R=-0.30, p=0.06). None of the EDCs analyzed were correlated with use of dishwashers, personal care products, or exposure to microplastics.
Conclusions:
Higher serum levels of phthalates mECPP and mEOHP are correlated with increased lesion burden and disease activity in female MS patients within the first five years of disease onset. Fish intake was inversely correlated with serum levels of these phthalates. This study highlights how diet and exposures to environmental EDCs might partly explain sex differences in disease course in MS.