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- [00:01]
A
I'm john strum, and this is real talk, mississippi. It's May 19, and we have a lot to talk about. When we talk about managing multiple sclerosis, our conversations naturally focus on things like disease modifying therapies, multiple mobility MRI scans, and managing symptoms like fatigue. But today, we're shining a light on a critical aspect of Ms. Wellness that doesn't get nearly enough oral health. Living with Ms. Can introduce a whole host of unexpected challenges to maintaining a healthy mouth. And beyond preventing tooth decay and gum disease, emerging research tells us that chronic oral inflammation, like periodontal disease, can actually trigger systemic inflammation throughout the entire body. And that's the last thing an overactive Ms. Immune system needs. Dr. Anne Spolarich is joining me to break down the science, explain the risks, and most importantly, offer practical strategies for people living with Ms. And their care partners. But before we get to my conversation with Dr. Anne Spolarich, there are a few other things that you should know about. Women are diagnosed with Ms. Almost three times more frequently than men. But why? Well, some experts believe it's hormones, but results of a new study led by researchers in Australia suggest the answer is actually hardwired into our DNA at a cellular level. The research team analyzed over 1.2 million immune cells from nearly 1,000 healthy people using something called single cell sequencing. They were able to look at how genes are switched on or switched off in individual cells with remarkable detail. And they identified more than 1,000 genetic regulatory mechanisms that operate differently in male and female immune cells. In women, the researchers found significantly higher levels of B cells and T cells. These are immune cells that play a significant role in Ms. Importantly, the researchers found that inflammatory pathways were much more active in female cells, and these are the pathways that trigger demyelination. In men, the immune system looks different. Male immune cells showed more activity related to cellular maintenance and protein production. Medical research has often treated biological sex as a footnote. This data proves that a one size fits all approach to treating Ms. And other autoimmune diseases really won't work. By understanding these 1,000 genetic differences, we can move a step closer to precision medicine, where a woman's treatment for Ms. Could be specifically tailored to the way her female immune cells actually function, rather than settling for a generalized treatment. If you'd like to review the details of this study, you'll find that link in today's show. Notes. For years, children and teenager diagnosed with Ms. Had very limited treatment options. But that changed last week when the FDA approved Ocrevus for children and adolescents age 10 and older with relapsing remitting Ms. Now pediatric Ms. Is rare. It affects between 5 and 10,000 kids in the US but it can be incredibly aggressive. Until now, Gilenia was the only disease modifying therapy approved by the FDA for this age group. The FDA approval of Ocrevus was driven by results of the Operetta 2 clinical trial which followed 187 children and teens and those results couldn't be ignored. Ocrevus was shown to reduce the risk of relapses by 48% compared to the existing oral treatment and it was even more effective at stopping new damage. MRI scans showed an 87% reduction in active inflammatory lesions and and a 48% reduction in new or enlarging T2 lesions. If you're a parent or caregiver of a child or teen who's been diagnosed with MS, here's what you need to know. Children 10 years of age and older, weighing at least 55 pounds and diagnosed with relapsing remitting Ms. Are eligible to receive this treatment. It's delivered by intravenous infusion once every six months and the trial showed that the safety profile in kids is consistent with what's been seen in adults for the last decade, with the most common side effects being mild infusion reactions or respiratory infections. Unlike daily pills, this is a twice yearly infusion which can be easier for busy teenagers to manage and Ocrevus is a high efficacy dmt. High efficacy treatment early in life can potentially redefine the future for an individual by stopping lesions before they cause long term disability. This regulatory approval is a huge win for science and an even bigger win for the youngest Ms. Patients and their families. If you or someone you love has ever gone through the process of being diagnosed with ms, you know how painfully slow that process can be. Early symptoms like numbness, fatigue and vision issues are notoriously vague and those symptoms tend to come and go by the time an MRI reveals clear damage in the brain or spinal cord. While Ms. Has often been active under the surface for years, but a new tech partnership announced last week is aiming to change that. Using a combination of artificial intelligence and a very unique type of genetic material, two biotech companies, Decode Health and Circular Genomics, have joined forces. Backed by a $1.9 million grant from the National Institutes of Health, they're building an AI powered blood test designed to catch Ms. Much earlier and track its progression in real time. Decode Health brings an AI platform that can sift through massive amounts of patient data to find patterns and circular genomics brings a secret weapon in this circular RNA. So what is circular RNA? Well, we all became familiar with MRNA thanks to the COVID 19 vaccines. Normal MRNA is linear. It's like a straight line of code that tells your cells how to make proteins. Circular RNA is different. It's like a closed loop. And because it's a loop, it doesn't make proteins. Instead, it acts like a control dial, turning other genes on or off. More importantly for medicine, that circular shape of circular RNA is incredibly tough. Linear RNA breaks down very quickly in the human bloodstream, but circular RNA is highly stable. And because circular RNA is so stable, it makes for the perfect biomarker, a measurable sign in the body that shows a disease is developing. However, looking at thousands of those loops to find Ms. Is like searching for a needle in a haystack. That's where the AI comes in. Decode Health's platform is analyzing blood samples to map out specific circular RNA signatures. These signatures are distinct patterns that will act like a molecular fingerprint for Ms. If this AI driven blood test is successful, it could completely change the timeline of Ms. Care in two major ways. First, doctors could potentially catch the molecular warning signs of Ms. Years before a lesion ever shows up on a traditional MRI scan, allowing them to start treatment before irreversible nerve damage occurs. Second, because it's just a simple blood test, doctors could monitor patients much more frequently than they can with expensive MRI scans. If a treatment stops working or an individual's disease starts to progress, the AI analysis will see the shift in the circular RNA signature immediately, allowing for that person's treatment plan to be changed in response. This initiative offers us a glimpse into the future of medicine, where AI isn't just writing our emails or creating cool looking images. It's analyzing our blood to stop chronic diseases in their tracks. We'll keep a close eye on this work as it progresses. When we talk about ms, we often focus on the visible physical symptoms like mobility challenges, balance issues or tremors. But if you talk to people living with ms, they'll often tell you that the most debilitating parts of the disease are completely invisible symptoms like severe depression and overwhelming fatigue. Standard antidepressants like SSRIs usually don't work well for people with Ms. Because, as Dr. Anthony Feinstein explained in last week's episode of the podcast, Ms. Related depression isn't just psychological, it's driven by active physical neuroinflammation in the brain. The good news here is that another AI partnership that was announced last week is hoping to fast track an oral pill specifically designed to manage those biological mechanisms driving Ms. Related depression and fatigue. The drug at the center of this story is an oral pill called Azaleiragon. Now, if that name sounds familiar to some of you, it's because azaliragon was originally developed years ago for Alzheimer's disease. It ultimately failed those clinical trials. But because it was Tested on over 2,000 people, it's already been proven to be safe, well tolerated, and it easily crosses the blood brain barrier. Azaliragon works by blocking a specific protein in the body called the receptor for advanced glycation end products, better known by its acronym, rage. RAGE acts like a master switch for inflammation. By shutting this protein down directly inside the central nervous system, Azaleiragon targets the exact inflammatory pathways that cause Ms. Fatigue and depression. Pathways that traditional antidepressants completely ignore. So if azaleiragon is so promising and we already know it's safe, why aren't we just giving it to everyone right now? Well, it's because symptoms like fatigue and depression are incredibly difficult to study. They fluctuate based on an individual's lifestyle, genetics, and environment. And all of these variable factors make traditional clinical trials a massive gamble. To solve this, Cantex Pharmaceuticals has teamed up with Headlamp Health to use a specialized platform called Lumos AI. Now, Lumos AI isn't your standard chatbot. It's an agentic AI that's specific to precision neuropsychiatry. Lumos AI is fueled by over 100 million longitudinal data points. Its job is to dig through the massive, complex history of azaleiragon's past trials and map out the biological profiles of patients. The goal is to identify the exact biological signature of the patients who will most likely benefit from from this pill. By using AI to pinpoint exactly who this drug works for before new clinical trials even begin, the companies can design a much smarter, hyper targeted study, which dramatically reduces the risk of the trial failing due to recruiting an overly broad patient pool. For people living with Ms. Who have spent years swapping one ineffective antidepressant or fatigue medication for another, this represents a massive shift. We're talking about a future where AI ensures the right drug gets to the right patient at the exact right time. It's a remarkable example of how old drugs can find entirely new life when they're paired with modern artificial intelligence. We'll keep you updated as this work continues and the clinical trials get underway. Sometimes participating in Ms. Research can be as easy as completing an online survey from the comfort of your own home. This is one of those times. Researchers at Wayne State University are looking for people living with Ms. Who experience bladder symptoms and balance issues. So if you've been diagnosed with Ms. And you experience bladder related urgency or frequency and you're also experiencing falls near falls or you're worried about the risk of falling, this is your opportunity to participate in a survey that will only take five to 10 minutes of your time. You'll be asked about your Ms. Symptoms, your bladder health, mobility, and your history of falls. It's not hard work, but your participation is what moves the ball down the field when it comes to the kinds of research that ultimately improve the quality of care for people with Ms. If you'd like to learn more about this study or step up to participate, you'll find that link in today's show. Notes While we're talking about participating, there's one area of your health that you can participate in every day, and that's your oral health. Living with Ms. Can introduce a whole host of unexpected challenges to maintaining a healthy mouth. Physical symptoms like hand tremors, muscle weakness, or severe fatigue can make the simple act of brushing and flossing incredibly difficult. On top of that, many of the medications used to manage Ms. Symptoms can cause severe dry mouth, which isn't just uncomfortable, it actually strips away the mouth's natural defense against tooth decay and gum disease. And then there's facial pain like trigeminal neuralgia, which can make even touching your teeth feel unbearable. Dr. Anne Spolarich joins me this week to discuss how we can protect our smiles while managing a complex neurological condition. Dr. Spolarich is a professor, an internationally recognized clinical researcher, and an absolute authority on dental therapies for medically complex patients. In a moment, we'll meet my guest, Dr. Anne Spolarich. Maintaining good oral health is a facet of Ms. Care that's often overlooked. Joining me to discuss the intersection between oral health and Multiple sclerosis is Dr. Anne Spelarich. Dr. Spelarich is a professor and Assistant Dean for Research at at Still University, Arizona School of Dentistry and Oral Health. She holds advanced degrees in dental hygiene and physiology and has extensive training in both laboratory and clinical research. Welcome to the podcast, Dr. Spelarich.
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B
Thanks, John. It's great to be here.
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A
We often think of dental health as just being about our teeth, but how does the health of our mouth impact the rest of our body? Particularly for someone living with a chronic condition like ms, that's a great question.
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B
You know, oral health is certainly important by itself. We all know how Important it is to be able to feel confident with the way we smile, to feel confident when we're talking. We also know how important it is to have comfort, to be able to eat comfortably, to be able to chew and break down our food, and to swallow. But we also know that when people have poor oral health, it really significantly impacts not only their oral health related quality of life, but also their overall quality of life. You know, people living with pain and discomfort in their mouth, it really contributes to difficulties. Like people can have problems not just with eating and swallowing, but even with sleeping, for example. And one of the things certainly that we know is that when people have gum disease in their mouth, it's one of the most common chronic conditions. Most people don't know that in the world, but also it's one of the most common sources of chronic inflammation in the body. And certainly when we talk about a disease like ms, we know that they have shared inflammation as a common denominator. And many people have already heard about how oral health is related to systemic health. And while we don't really see cause, effect, kinds of relationships, we do know that if we can reduce sources of inflammation in the body, it's better for overall health.
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A
Many people with Ms. Deal with symptoms like fatigue, tremor or otherwise limited use of their hands. How can these symptoms make the simple act of brushing or flossing more difficult? And I guess most importantly, are there some workarounds?
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B
Yeah, absolutely. Because you know, if you're having a hard time gripping something or holding something, or maybe your dexterity has been affected, it's gonna be really hard to be effective with your toothbrushing. Certainly gonna be really hard with trying to floss your teeth, which takes a lot of dexterity. And also if you have fatigue, it may mean that you're not having a really strong interest in doing all kinds of self care activities. And mouth care is a big one. So some of the workarounds we can do is to invest in some tools that can help you to perform good daily oral hygiene. An easy switch is to use a toothbrush that has a wider handle. Many of the manufacturers that make dental products today, and you probably know the big companies that make toothpastes, and toothbrushes, they make wide handle toothbrushes, and I like them because they're molded and they're easier to keep clean. As opposed to sticking your toothbrush in a tennis ball or a bicycle grip that can get a little nasty over time. You can use an electric toothbrush, a power toothbrush that naturally, by design has a Wider handle and it's easier to hold. And you have to really kind of try out these devices. Many dental offices will have kind of sample products to look at and to hold to see if that might work for you. There's also even things like water flossers, which can be really terrific as long as you're not high risk for choking. If you're somebody and your Ms. Has progressed where you're having significant swallowing problems, you have to be careful with water devices because we, we don't want to increase your risk for choking. And John, you know, many, many people with Ms. May be familiar with weighted gloves, right, to help to offset the tremor. And feel free to use those when you're doing your oral hygiene as well.
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A
You know, one of the significant symptoms when it came to impacting quality of life for my wife was tremor in both hands. And the tremors were quite significant. So we went through the phase of wide handled toothbrushes and weighted gloves and all the rest. And really what it ended up being was I would hold an electric toothbrush and brush her teeth for her every morning.
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B
Yes, yes. And it's okay to ask for help and support with whatever you need. And this is why I love these power devices because they naturally do a lot of the work for you anyway. And it's really helpful if a caregiver's using it to hold it to help to clean your mouth. I love that example.
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A
Many Ms. Medications can cause dry mouth. Why is saliva so important for protecting our teeth? And what can someone do if their mouth constantly feels dry?
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B
Oh, yeah. Dry mouth is the most common complaint in this population. But in lots of populations of people with medical problems and medication use is the leading culprit for causing dry mouth. So saliva is so essential, first of all for comfort. It helps us with lubrication so it makes our mouth feel good. If you don't have good lubrication, you find that your cheeks get kind of torn up when you're eating. You can bite your cheeks because your, your cheeks will stick to your teeth. It can also increase hazards for choking because you need saliva to actually break down food. It's really kind of one of the first sources of the enzymes that break down food for digestion. So you have sort of the comfort function component of saliva. But saliva is also protective in that it's antibacterial, it's antifungal, and it's antiviral. So if you don't have as much saliva in your mouth, you're much more prone to having bacterial overgr growth in your mouth, and that's going to increase your risk for tooth decay. It will also increase risk for gum disease and increase risk for other kinds of infections. So fungal infections are really common in people with dry mouth. And also if you're on ms, medications that change your immune system, right, to try to keep your relapses more minimized, that will contribute to risk for reactivation of viruses. So like if you're somebody gets cold sores, herpes viruses, you may get more breakouts from that. But also saliva is a buffer and that means that you have a more neutral environment in your mouth. When you have dry mouth, your, your mouth actually becomes more acidic and that contributes to tooth sensitivity and weakening of the tooth enamel and contributes again, another risk factor for tooth decay. So dry mouth is hugely problematic.
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A
Some people with Ms. Experience facial pain like trigeminal neuralgia. How should they navigate dental visits when their mouth or face is just hypersensitive?
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B
Yeah, that's a great question. About a third of people with Ms. Have some type of orofacial pain. And sometimes people feel that with trigeminal neuralgia, which is more kind of like a, like a nerve shock kind of pain. And we have orofacial pain specialists in dentistry, so it might be really helpful to go and see one of them. There are certain medications that we can try. Your neurologist can also recommend some medications to help to manage that. Also, people can have problems with their joint up here, their temporomandibular joint, and so that can make chewing difficult. If you are in an active phase of that with pain, it's probably not a good idea to go in where you have to keep your mouth open for a long time for an exam maybe, plus getting your teeth cleaned at the same appointment. So sometimes people can wear appliances if they have joint issues. Certain medications to help to reduce the trigeminal neuralgia. It's a combination of things. So those orofacial pain specialists are really helpful to manage that.
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A
I'm wondering, are there specific foods or drinks that people with Ms. Should be especially mindful of to protect their oral health?
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B
Yeah. So number one, try to avoid alcohol and caffeine containing beverages because it will worsen your dry mouth. And smoking is another that's not a food or beverage, but sort of falls. I lump it into that category. What can you avoid? Right, to make your dry mouth worse? Also, I think watch really acidic things like I don't want you sucking on lemons. Maybe you put a nice fresh wedge of lemon in your iced Tea, I don't want you sucking on it afterwards because it will again, remember, your mouth, if you have dry mouth, is more acidic. And so the last thing we need to do is put more acid on top of that. We don't want to weaken the enamel and increase your risk for tooth decay. I would also say spicy foods sometimes, if your mouth is sore, can really worsen your symptoms. Many people will get oral ulcerations as a result of the medications they're on and also trauma from dry mouth. So some of these are just some of the more common and practical things. And making sure you're having good nutritious foods because your body needs that. Right. You need the support from good nutrition.
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A
You know, when I talk about people living with Ms. Going to see their neurologist, I always mention that they ought to be more than the receiver of care. They should be a partner in their care. And I'm wondering, how does that translate to the dentist office? How can a dental patient be a good partner in their care?
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B
Oh, I love this question because I actually talk a lot about this very same issue. You didn't even know that, John, when you asked me the question. So, you know, participatory healthcare is a huge way of thinking. In healthcare, where we are partners together, right. With the patient and the provider, we work together. I can talk at you and give you all kinds of recommendations, but you have a voice in that relationship and what you're willing to do, not able to do. And I want to partner with my patients. So part of this is you need to have good conversations with your providers. Right? Talk with them about what your needs are, talk with them about what your concerns are. Talk about anything that makes you anxious or stressed about coming to the dentist. What can we do to make this experience more comfortable for you? And let's try to find solutions together. I love the idea of my patients as my partner. I think it's the only way to go.
- [26:58]
A
Honestly, I could not agree more. And I hope everybody else, if they haven't already, starts getting that message, because it changes everything. Quite honestly, I have found that when the patient becomes a partner in their care, it is actually very empowering for that patient.
- [27:17]
B
Sure, right. Because I only get this much time with you. Right. And so we have to maximize our time together, but also have really good lines of communication, you know, And I love to really get to know my patients so that also when I see you're on my schedule, I can be thinking about things that we've talked about and plan ahead so that we have a good, productive and successful appointment together and that you would should feel comfortable, right, contacting your provider and having a chat about what's going on with you. Right. Because look, we care about everybody and their whole body, not just the mouth. Right? The mouth is connected to the rest of the body. And sometimes in dentistry, like a lot of people think, oh, that's over there and the rest of my healthcare is over here. But we do work together. We're a part of your team.
- [28:11]
A
If there is one thing you want people living with Ms. To understand about the relationship between their neurological health and their oral health, what would it be?
- [28:22]
B
Well, I think, again, remember that your whole body is tied together and this shared inflammatory burden can be reduced by reducing inflammation in your mouth. It's important to do that anyway, not only for, for your oral health by itself, but also for your general health. So taking care of your teeth, especially your gum health, where gum inflammation and gum disease again, really common around the world. Right. Let's do some things that we can do together to help to reduce that inflammatory burden because I think it's really critical to your overall health and function and wellbeing. And then remember, we wanna understand what's happening with you neurologically and how that might impact us. Like, so that we need to understand, are you having orofacial pain? Are you having numbness in your tongue? Are you having difficulties swallowing? Because we wanna treat you safely and provide recommendations for you that work for you.
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A
Well, Dr. Ann Spilarench, I wanna thank you for all you do to improve the health and wellbeing of people living with Ms. And I'll add people who aren't living with Ms. Thanks so much for talking with me today.
- [29:37]
B
Thanks, John.
- [29:39]
A
That's going to wrap up this episode of Real Talk Ms. Real Talk Ms. Is powered by the National Ms. Society. And you can share this episode of the podcast by letting your friends or family members know that all they have to do is point their web browser@realtalkms.com 455. You'll find that link in today's show notes, so you can easily copy and paste it right into an email or a text. World Ms. Day is May 30th and this year's theme is focused on diagnosis. So next week, Dr. Nancy Saikot is joining me to share the things you should know, the things you should be thinking about, and the things you should be doing during the first 100 days following an Ms. Diagnosis. I hope you're planning to join us for our World Ms. Day conversation. I'M John Strums. Thanks for listening. Stay safe and make healthy choices.
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B
Sa.