The University of Arkansas for Medical Sciences was recently awarded a nearly $3 million federal grant to study fetal alcohol spectrum disorders and their associated neurological effects.
The work is in partnership with the University of Rochester Medical Center in New York.
Paul Drew is the lead of the study for UAMS. He's the chair of the Department of Neuroscience with UAMS. He says he previously worked studying multiple sclerosis, and a friend of his was working on FASD many years ago and was discussing some of her findings.
Drew: And she noticed in some of her studies that there was an immune component. This is Cindy Kane, professor emeritus in our department. And she noticed that there was inflammation in these FASD cases. And so I had some expertise in neuroimmunology, and so I started working with her. So we've had a number of grants over the years. She's now emeritus, but we've been working on this, focusing on the inflammation in FASD. And the new grant is kind of an extension from that. It turns out that there's a molecule called myelin, which is kind of a coating on the neurons, which conduct electrical impulses and send signals through the brain. It's kind of like the wire or the rubber around a wire cord, if you will. And if you break that, then you don't have conduction of the impulse. And so our new finding in this new study, the studies are indicating that the cells that produce the myelin are affected in FASD. So we believe that if we can protect those cells and keep that rubber on the cord, we can help with therapies to block FASD. At least that's the goal.
Moore: One of the things that really just kind of I'm thinking about a lot is the reality that a woman may be partaking in alcohol before she even realizes or understands that she's pregnant. And that soon, you know, we may be talking five, six weeks pregnant that that can lead to FASD. And I think that's something that I don't know that there's enough people who understand or realize that.
Drew: Yeah, and that is a critical point. The damage due to the alcohol can occur at any stage of pregnancy. And there are certain times that are more vulnerable than others, but the reality is it can definitely occur before you know you're pregnant. So I think the lesson there is that it is best to abstain from alcohol if you are planning on becoming pregnant or could become pregnant, just for the safety of the child.
Moore: The goal here is not just to think about prevention, which, you know, it sounds simple to say well, prevention is clearly just don't drink, right? But I imagine there's more productive, there's better ways to think about prevention more than just simply telling a woman don't drink, abstain from drinking. Right? How do you think about prevention in a more nuanced or perhaps productive way than to simply just tell someone to abstain?
Drew: Yeah, I mean, so that is, and I think in terms of an educational thing, it is important to recognize that exposure throughout pregnancy could result in FASD. So that is an important message and that is important for prevention. However, again, sometimes people get exposed before they know they're pregnant. Sometimes people have alcohol use disorders or are not controlling their alcohol intake. And we don't want this to be a stigma of a person has done something wrong. It's really important to try to not focus on that, but try to focus on what is causing the damage. How do we protect against that damage? So I think all of that is very important.
Moore: And we talked a little bit about treatment ideas here. You talked about kind of the insulated rubber around the metaphorical metal cable on the inside there. What did treatment look like before this research has really happened? And how are you hoping to grow the research that you've already done for treatments? And what ideas are you hoping might result from this influx of money, which leads to more people being able to research it for a longer period of time and for a more dedicated period of time.
Drew: Yeah, so there truly are no effective treatments for FASD. And there are things that you can do, obviously with therapy and so forth, to try to decrease the level of disability and try to provide as meaningful a life as possible for children with FASD, get them in the workforce, etc. There are a few drugs that show promise. Some of these are a molecule called choline, and that could be important. Choline appears to be a substance that is critical in brain development, and it's reduced through ethanol exposure. So that suggests that this could be a good treatment for FASD. But there are many mechanisms that can result in FASD. And so by targeting this myelin, perhaps this could be a new therapy moving forward. We need to look at this from many different areas. So we have looked into the anti-inflammatory molecules and the potential for those to be effective in therapy as well. But it's important, that's why we do the science, that we try to figure out what is causing the disease. And that will give us targets for therapy moving forward. And this is a relatively new area of focus, this myelin and the effects on myelination in the developing brain.
Moore: When we think about neurological disorders, neurological conditions really, and that can really widen the gap, widen the spectrum to include neurodiversity, autism, ADHD, all of these sorts of things. You know, we're kind of at a place now where this idea is that you're not going to cure autism, you're not going to cure ADHD, you're going to treat it, you're going to do this sort of work to make it as manageable for the person as possible. Is that the case when we think of FASD as well, that we're not necessarily going to cure what happened from FASD, but we're going to treat it and manage it in a way that makes it so that life is more manageable for a person, more typical for a person.
Drew: Yes. I think that it will be hard to develop a true therapy that cures FASD, like autism and ADHD. This type of thing, we never want to give up. We can't cure it today. That doesn't mean that if we learn more about it and how these things come to be, we do have potential for curing, potentially. But the main thing is yes, to try to control it. And it is a combination of not only looking for therapies, but then also looking at, now we have these disorders, how do we give treatment to try to give people their best, most productive lives moving forward? But we never give up on therapy either.
Moore: Yeah, and I imagine, you've got some boots on the ground here. When you think about what MS treatments looked like 15 years ago to where they are today, does that give you hope? When you think about where MS looked like 15 years ago, where it was pretty debilitating and there wasn't necessarily a lot of comfort in life for folks who had pretty debilitating MS. So where now, I'm not here to say that it's manageable and it's okay, but I imagine that treatments have really progressed in such a way that MS doesn't feel like a life sentence quite as much anymore.
Drew: I actually started working on multiple sclerosis over 30 years ago. And at that point the only treatments were steroids, and those are strong anti-inflammatory molecules. They can block that inflammation that is bringing on the multiple sclerosis. But your immune system is there for a purpose. It's there to protect you against infections and cancer and a number of things. So that was not a therapy that was without problems. And so now there's probably 15 to 20 FDA-approved drugs for the treatment of multiple sclerosis, and some work better for some people, others for other people. MS is probably, again, kind of a spectrum, that not all people are the same and not all treatments work as effectively as others. So yes, I do think that moving from no effective therapies 30 years ago to now, giving most people who have the disease under control, and have an effective life if we were better at diagnosing. So you find out earlier that you have MS, and so you can give treatments that will control that. And I think the same thing can be true with FASD, with autism, etc. We always continue to look for those therapies. And then again, have therapies, whether it's occupational therapy, speech therapy, any number of therapies downstream. If a person has this, how do we give them their best life?
Moore: One of the things I'm curious about is how do you do this sort of research and remove the stigma barrier around it? Because I imagine that when you think about FASD, you are potentially dealing with mothers and pregnant people who feel guilty that this is a product of their consumption of alcohol, that they feel responsible in a way that they regret. But you can't undo it at this point. How do you think about that element of the psychological process of doing this sort of research with FASD?
Drew: Well, that is a problem. And, you know, these things do tend to be stigmatized, but it's not productive. Perhaps a woman didn't know that she was pregnant. Perhaps a person has an addictive disorder. It's like mental health. Do we blame people that have mental health disorders? They didn't choose these things. So I think it's important to move beyond the stigma and focus on how we can prevent and treat these types of disorders. That's what's really important. And if people have that in their mind, it doesn't help to say, oh, it's someone's problem. And it certainly wasn't the baby's problem or the person that lives with FASD. So I don't think we should stigmatize and then not move forward with research that doesn't help the mother, doesn't help the child.
Paul Drew is the chair of the Department of Neuroscience at UAMS. We spoke over Zoom late last month.
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