54 msfocusmagazine.org Medicine & Research cellular mechanism – an underlying defect in brain cells – that may cause multiple sclerosis, and a potential hallmark that may be a target for future treatment of the disease. Scientists have long suspected that mitochondria, the energy-creating "power- house" of the cell, plays a role in causing MS. The joint Exeter-Alberta research team was the first to combine clinical and laboratory experiments to explain how mitochondria becomes defective in people with MS. Using human brain tissue samples, they found that a protein called Rab32 is present in large quantities in the brains of people with MS, but is virtually absent in healthy brain cells. The study was published in the Journal of Neuroinflammation. Dr.Thrower: Most researchers currently think of multiple sclerosis as an autoimmune conditionwherein the immune system attacks myelin. This damage to myelin then leads to secondary damage to the axons or nerve fibers. Others argue that this paradigm is overly simplistic. These researchers argued that something happened prior to the autoimmune attack on myelin. Mitochondrial dysfunction could be that early event for some with multiple sclerosis. Most current disease-modifying therapies for multiple sclerosis focus on stopping the immune attack. If mitochondrial dysfunction is identified as part of the pathology of multiple sclerosis, this could certainly lead to new treatment avenues. Study: MS begins to affect patients sooner than expected People with multiple sclerosis can show signs of something wrong five years before the onset of disease, according to a new analysis of health records from people with the condition. The findings are a first step to identifying red flags to help doctors screen for the disease and start interventions earlier. This could point researchers in a new direction for finding the root cause of the disease. The findings were published in the journal Lancet Neurology. Dr. Thrower: When does MS really begin? We know that both genetic and environmental factors play roles in the risk of developing MS. Most research suggests that everything is in place for a person to have MS by age 15, even though more obvious symptoms may not develop for years or decades. We also know that MRI changes may occur years before the official diagnosis of MS is made. This has led to the term, Radiographic Isolated Syndrome. This term describes the person who gets an MRI for non-MS reasons, maybe a concussion, and has brain changes typical for MS with no typical symptoms. When the person with RIS is followed closely, many will go on to an eventual MS diagnosis. Many people with MS tell me that they had odd symptoms years before their actual diagnosis. So, are we missing an opportunity to diagnose MS sooner? Can we better categorize and recognize these earlysymptoms and get people treated sooner? That is still an open question. Tell us what you want to see in MS Focus Magazine. Email comments to: editor@msfocus.org or write to: Editor, MS Focus 6520 N. Andrews Ave., Fort Lauderdale, FL 33309