In this video, Eva Feldman, MD, PhD, Russell N. DeJong Professor of Neurology; Director, ALS Center of Excellence; Director, NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, discusses her presentation at the 146^th Annual Meeting of the American Neurological Association titled “Recent Advances in ALS.” Dr Feldman was part of the plenary session “Advances in Amyotrophic Lateral Sclerosis.”

Read the Transcript:

Dr Eva Feldman:  Hello. My name is Dr Eva Feldman. I'm Professor of Neurology at the University of Michigan and Director of the ALS Center of Excellence. I had the great pleasure of recently speaking at the American Neurological Association Meeting on the recent advances that have occurred in ALS.

What I did in my talk is, I recap 2 major recent advances that my own laboratory has been very involved in. First, I discussed what's known as the ALS exosome. What is that? The exposome, in its simplest definition, is what we're all exposed to every day, so what we eat, what we drink, what we breathe in.

What the ALS exposome is how those exposures can affect your risk of developing ALS? What we have found in our own research is that individuals who have ALS have a fivefold higher degree of what are known as legacy pesticides in their blood.

We also have discovered that individuals have a much higher level of persistent organic pollutants from plastics and industrial compounds and toxins in their blood in those individuals who have ALS when compared to age and gender-matched controls.

This led us to take these data together and create what we call an environmental risk score, where we look at all the pollutants together. What we have found is, the higher your environmental risk score, the more likely you are to develop ALS. For those patients who have a very high environmental risk score, those ALS patients have a very short survival.

What we're currently doing now is trying to understand how genetics connects with the environmental risk score so that we can understand who is at risk at ALS and come up with the idea that maybe ALS could, in part, be a preventable disease.

We can come up with both public health initiatives in terms of cleaning up the environment as well as understanding that interception of genetic risk and the environment to forewarn people that they could be at risk of developing the disease.

The second advance that I discussed was the role of immunity in ALS. As you know, we have our peripheral immune cells that circulate throughout our body. What's very interesting is that, in ALS, peripheral immunity does change.

What we find is, during the course of the disease, a certain segment of peripheral cells, known as T lymphocytes, decrease as disease progresses. These are anti-inflammatory cells that try to block disease. As disease progresses, these anti-inflammatory T cells decrease, while pro-inflammatory neutrophils significantly increase.

Indeed, what we've shown is, there's a fourfold increase in neutrophils in patients who have more progressive disease. We've also found a very interesting sex difference in that individuals, females, who have very low neutrophil counts live much longer than females who have higher neutrophil counts.

We've identified two subsets of immune cells that correlate with ALS progression and risk. Our goal there is to target and repurpose new immunotherapies, or existing immunotherapies that are FDA-approved in ALS to see if we can then use the immune system as a new therapeutic target and try to either block the progression of the disease or at least slow the progression of the disease.

Those are the two major updates that I discussed. It was a very exciting meeting, and I look forward to following the research advances of others in the field. Thank you so much.