Pregnancy is magical, well if you have multiple sclerosis it seems to be. MS patients have reported a virtually symptom-free pregnancy. However, two to three weeks after giving birth, MS sometimes comes back stronger than ever.
Dr. Rhonda Voskuhl of UCLA’s Department of Neurology and the Director of UCLA’s MS Program discovered why. She found that at 20 weeks gestation, the placenta produces estriol in significant amounts by way of androgen steroids made in the fetus’ liver and adrenal glands. The placenta finishes the process and it results in estriol production. It is one of the three main estrogens produced by the body. Estriol’s appearance during pregnancy is to suppress the mother’s immune system to prevent it from attacking the fetus.
Dr. Voskuhl’s theory was that an unexpected benefit of keeping the immune system subdued during pregnancy resulted in additional protection for women with MS and other auto immune diseases.
Estriol is a common hormone replacement therapy for menopausal symptoms. It is usually found in creams or vaginal suppositories but can be made in pill form. While popular in Europe and Asia, it has not been approved for use by either the FDA or HealthCanada.
Dr. Voskuhl conducted a pilot clinical trial in 2002 of estriol in 12 women with RRMS. The results from this study indicated estriol could be helpful and required further study.
The Phase II trial began in 2007. In this study 164 women with RRMS Between the ages of 18-50 participated in the trial at sixteen different sites throughout the US. The study was randomized, double-blind and placebo controlled.
After 12 months of treatment, the relapse rates of the estriol combination therapy patients were 47% lower than the placebo combination group. Additional discoveries were that estriol protects brain cells from new damage and it improves cognition.
The singular major side effect of the treatment was irregular menstrual cycles and the treatment was well tolerated.
The next step for estriol is Phase III testing. This increases the number of participants to a minimum of 300 and it lasts between one to four years. Phase III testing provides most of the safety information on drugs because of the increased size of the test group as well as increased duration of the test.
Dr. Voskuhl seeks funding to conduct this study and continue her work.
“I’m very excited by these results,” said Dr. Voskuhl. Currently, all of the available drugs reduce immune attacks on the brain. Estriol is particularly promising because it both reduces attacks and protects the brain directly. It’s a two-pronged approach — an anti-inflammatory prong to reduce attacks and a neuro protective prong to make the brain suffer less damage in case of an attack.”
The medical community can only benefit by moving estriol into Phase III testing. The potential benefits for women with MS is staggering. Are you hopeful?
Maria Thomas was diagnosed with multiple sclerosis in April of 2015 and documents her journey with a monthly column on Modern Day MS. She has a wonderfully supportive wife, two dogs and lives in New Orleans.