The increasing incidence and prevalence of female multiple sclerosis-A critical analysis of potential environmental factors

Johann Sellner, Jörg Kraus, Amer Awad, Ron Milo, Bernhard Hemmer, Olaf Stüve

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Multiple sclerosis (MS) is the most common acquired inflammatory demyelinating disorder of the central nervous system (CNS). Not unlike many inflammatory diseases with a presumed autoimmune pathogenesis, it has been established that there is a female preponderance in prevalence. While in the past it was shown that there are two women for every man with a diagnosis of MS, recent serial cross-sectional assessments provide compelling evidence for an increase of the female to male sex ratio in patients with relapsing-remitting MS over the last decades. An understanding of this phenomenon might provide key insights into the pathogenesis of the disease but also may have implications for health-care strategies and further research efforts.We review possible etiologies for the gender disparity in MS, and we discuss possible underlying causes. We determined that the biologically most plausible explanations for a disproportional increase of MS among women in some population may be the role of vitamin D in MS pathogenesis. Decreased sun exposure may be a critical factor in diminished vitamin D levels in many recent cohort studies. Vitamin D insufficiency or deficiency has been shown to affect T cell differentiation and regulation, which may affect cellular immune responses against autoantigens and pathogens that have been associated with the etiology of MS. Vitamin D also appears to impact B cell activation and differentiation, another cell type that has been implicated in the inflammatory cascade underlying CNS autoimmune disease.

Original languageEnglish (US)
Pages (from-to)495-502
Number of pages8
JournalAutoimmunity Reviews
Volume10
Issue number8
DOIs
StatePublished - Jun 2011

Fingerprint

Multiple Sclerosis
Vitamin D
Incidence
Cell Differentiation
Autoimmune Diseases of the Nervous System
Avitaminosis
Relapsing-Remitting Multiple Sclerosis
Central Nervous System Diseases
Sex Ratio
Autoantigens
Demyelinating Diseases
Solar System
Cellular Immunity
B-Lymphocytes
Cohort Studies
Central Nervous System
Delivery of Health Care
T-Lymphocytes
Research
Population

Keywords

  • Environmental trigger
  • Female preponderance
  • Multiple sclerosis
  • Pathogenesis
  • Sex ratio

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

The increasing incidence and prevalence of female multiple sclerosis-A critical analysis of potential environmental factors. / Sellner, Johann; Kraus, Jörg; Awad, Amer; Milo, Ron; Hemmer, Bernhard; Stüve, Olaf.

In: Autoimmunity Reviews, Vol. 10, No. 8, 06.2011, p. 495-502.

Research output: Contribution to journalArticle

Sellner, Johann ; Kraus, Jörg ; Awad, Amer ; Milo, Ron ; Hemmer, Bernhard ; Stüve, Olaf. / The increasing incidence and prevalence of female multiple sclerosis-A critical analysis of potential environmental factors. In: Autoimmunity Reviews. 2011 ; Vol. 10, No. 8. pp. 495-502.
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