1 2004 102 EPIGENETIC ASPECTS OF MULTIPLE SCLEROSIS AND FUTURE THERAPEUTIC OPTIONS. MULTIPLE SCLEROSIS (MS) IS A CHRONIC INFLAMMATORY AND NEURODEGENERATIVE DISEASE ACCOMPANIED BY DEMYELINATION OF NEURONS IN THE CENTRAL NERVOUS SYSTEM THAT MOSTLY AFFECTS YOUNG ADULTS, ESPECIALLY WOMEN. THIS DISEASE HAS TWO PHASES INCLUDING RELAPSING-REMITTING FORM (RR-MS) BY EPISODES OF RELAPSE AND PERIODS OF CLINICAL REMISSION AND SECONDARY-PROGRESSIVE FORM (SP-MS), WHICH CAUSES MORE DISABILITY. THE INHERITANCE PATTERN OF MS IS NOT EXACTLY IDENTIFIED AND THERE IS AN AGREEMENT THAT IT HAS A COMPLEX PATTERN WITH AN INTERPLAY AMONG ENVIRONMENTAL, GENETIC AND EPIGENETIC ALTERNATIONS. EPIGENETIC MECHANISMS THAT ARE IDENTIFIED FOR MS PATHOGENESIS ARE DNA METHYLATION, HISTONE MODIFICATION AND SOME MICRORNAS' ALTERNATIONS. SEVERAL CELLULAR PROCESSES INCLUDING APOPTOSIS, DIFFERENTIATION AND EVOLUTION CAN BE MODIFIED ALONG WITH EPIGENETIC CHANGES. SOME ALTERNATIONS ARE ASSOCIATED WITH EPIGENETIC MECHANISMS IN MS PATIENTS AND THESE CHANGES CAN BECOME KEY POINTS FOR MS THERAPY. THEREFORE, THE AIM OF THIS REVIEW WAS TO DISCUSS EPIGENETIC MECHANISMS THAT ARE ASSOCIATED WITH MS PATHOGENESIS AND FUTURE THERAPEUTIC APPROACHES. 2021 2 6021 33 THE BENEFICIAL AND DEBILITATING EFFECTS OF ENVIRONMENTAL AND MICROBIAL TOXINS, DRUGS, ORGANIC SOLVENTS AND HEAVY METALS ON THE ONSET AND PROGRESSION OF MULTIPLE SCLEROSIS. MULTIPLE SCLEROSIS (MS), A CHRONIC INFLAMMATORY DISEASE OF THE CENTRAL NERVOUS SYSTEM IS COMMON AMONGST YOUNG ADULTS, LEADING TO MAJOR PERSONAL AND SOCIOECONOMIC BURDENS. HOWEVER, IT IS STILL CONSIDERED COMPLEX AND CHALLENGING TO UNDERSTAND AND TREAT, IN SPITE OF THE EFFORTS MADE TO EXPLAIN ITS ETIOPATHOLOGY. DESPITE THE DISCOVERY OF MANY GENETIC AND ENVIRONMENTAL FACTORS THAT MIGHT BE RELATED TO ITS ETIOLOGY, NO CLEAR ANSWER WAS FOUND ABOUT THE CAUSES OF THE ILLNESS AND NEITHER ABOUT THE DETAILED MECHANISM OF THESE ENVIRONMENTAL TRIGGERS THAT MAKE INDIVIDUALS SUSCEPTIBLE TO MS. IN THIS REVIEW, WE WILL ATTEMPT TO EXPLORE THE MAJOR CONTRIBUTORS TO MS AUTOIMMUNITY INCLUDING GENETIC, EPIGENETIC AND ECOLOGICAL FACTORS WITH A PARTICULAR FOCUS ON TOXINS, CHEMICALS OR DRUGS THAT MAY TRIGGER, MODIFY OR PREVENT MS DISEASE. 2019 3 2404 41 EPIGENETIC RESEARCH IN MULTIPLE SCLEROSIS: PROGRESS, CHALLENGES, AND OPPORTUNITIES. MULTIPLE SCLEROSIS (MS) IS A CHRONIC INFLAMMATORY AND DEMYELINATING DISEASE OF THE CENTRAL NERVOUS SYSTEM. MS LIKELY RESULTS FROM A COMPLEX INTERPLAY BETWEEN PREDISPOSING CAUSAL GENE VARIANTS (THE STRONGEST INFLUENCE COMING FROM HLA CLASS II LOCUS) AND ENVIRONMENTAL RISK FACTORS SUCH AS SMOKING, INFECTIOUS MONONUCLEOSIS, AND LACK OF SUN EXPOSURE/VITAMIN D. HOWEVER, LITTLE IS KNOWN ABOUT THE MECHANISMS UNDERLYING MS DEVELOPMENT AND PROGRESSION. MOREOVER, THE CLINICAL HETEROGENEITY AND VARIABLE RESPONSE TO TREATMENT REPRESENT ADDITIONAL CHALLENGES TO A COMPREHENSIVE UNDERSTANDING AND EFFICIENT TREATMENT OF DISEASE. EPIGENETIC PROCESSES, SUCH AS DNA METHYLATION AND HISTONE POSTTRANSLATIONAL MODIFICATIONS, INTEGRATE INFLUENCES FROM THE GENES AND THE ENVIRONMENT TO REGULATE GENE EXPRESSION ACCORDINGLY. STUDYING EPIGENETIC MODIFICATIONS, WHICH ARE STABLE AND REVERSIBLE, MAY PROVIDE AN ALTERNATIVE APPROACH TO BETTER UNDERSTAND AND MANAGE DISEASE. WE HERE AIM TO REVIEW FINDINGS FROM EPIGENETIC STUDIES IN MS AND FURTHER DISCUSS THE CHALLENGES AND CLINICAL OPPORTUNITIES ARISING FROM EPIGENETIC RESEARCH, MANY OF WHICH APPLY TO OTHER DISEASES WITH SIMILAR COMPLEX ETIOLOGY. A GROWING BODY OF EVIDENCE SUPPORTS A ROLE OF EPIGENETIC PROCESSES IN THE MECHANISMS UNDERLYING IMMUNE PATHOGENESIS AND NERVOUS SYSTEM DYSFUNCTION IN MS. HOWEVER, DISPARITIES BETWEEN STUDIES SHED LIGHT ON THE NEED TO CONSIDER POSSIBLE CONFOUNDERS AND METHODOLOGICAL LIMITATIONS FOR A BETTER INTERPRETATION OF THE DATA. NEVERTHELESS, TRANSLATIONAL USE OF EPIGENETICS MIGHT OFFER NEW OPPORTUNITIES IN EPIGENETIC-BASED DIAGNOSTICS AND THERAPEUTIC TOOLS FOR A PERSONALIZED CARE OF MS PATIENTS. 2017 4 4536 35 MULTIPLE SCLEROSIS - RISK FACTORS. MULTIPLE SCLEROSIS (MS) IS A CHRONIC AUTOIMMUNOLOGICAL CONDITION OF THE CENTRAL NERVOUS SYSTEM (CNS) AFFECTING MAINLY YOUNG ADULT INDIVIDUALS. THE PREVALENCE RANGES APPROXIMATELY BETWEEN 50 AND 300 PER 100000 INDIVIDUALS. IT IS CHARACTERIZED BY AN INFLAMMATORY PROCESS, DEMYELINATION AND AXONAL LOSS. IMMUNOLOGICAL MECHANISMS RESULTING IN THE DAMAGE TO THE MYELIN SHEATH EFFECTING THEN IN IMPAIRED NERVE IMPULSE CONDUCTION HAVE THE KEY ROLE IN MS PATHOGENESIS. THE ROLE OF INFLAMMATORY FACTORS HAS ALSO BEEN PROVED. HOWEVER, IT HAS NOT BEEN EXPLICITLY SHOWN WHETHER SUCH AN INFLAMMATORY PROCESS IS THE TRIGGERING FACTOR OR SECONDARY TO A YET UNKNOWN INFECTIOUS FACTOR OR A DEGENERATIVE PROCESS OF THE CNS. THEREFORE, RECOGNITION OF THE EPIGENETIC RISK FACTORS, SUCH AS: GEOGRAPHICAL LATITUDE, VITAMIN D LEVEL, HYGIENE HYPOTHESIS, EPSTEIN-BARR VIRUS (EBV) INFECTION AND OTHERS MAY CONTRIBUTE TO BETTER UNDERSTANDING OF THE MECHANISM UNDERLYING MULTIPLE SCLEROSIS. ADDITIONALLY, THEY MAY PROVIDE GUIDELINES FOR MORE EFFICIENT THERAPIES AND BETTER PREVENTION OF THE DISEASE. AIM OF THIS REVIEW IS TO PRESENT MOST CURRENT DATA ON MULTIPLE SCLEROSIS RISK FACTORS, CONSIDERING THOSE LESS KNOWN. 2020 5 1914 35 ENVIRONMENTAL AND GENETIC RISK FACTORS FOR MS: AN INTEGRATED REVIEW. RECENT FINDINGS HAVE PROVIDED A MOLECULAR BASIS FOR THE COMBINED CONTRIBUTIONS OF MULTIFACETED RISK FACTORS FOR THE ONSET OF MULTIPLE SCLEROSIS (MS). MS APPEARS TO START AS A CHRONIC DYSREGULATION OF IMMUNE HOMEOSTASIS RESULTING FROM COMPLEX INTERACTIONS BETWEEN GENETIC PREDISPOSITIONS, INFECTIOUS EXPOSURES, AND FACTORS THAT LEAD TO PRO-INFLAMMATORY STATES, INCLUDING SMOKING, OBESITY, AND LOW SUN EXPOSURE. THIS IS SUPPORTED BY THE DISCOVERY OF GENE-ENVIRONMENT (GXE) INTERACTIONS AND EPIGENETIC ALTERATIONS TRIGGERED BY ENVIRONMENTAL EXPOSURES IN INDIVIDUALS WITH PARTICULAR GENETIC MAKE-UPS. IT IS NOTABLE THAT SEVERAL OF THESE PRO-INFLAMMATORY FACTORS HAVE NOT EMERGED AS STRONG PROGNOSTIC INDICATORS. BIOLOGICAL PROCESSES AT PLAY DURING THE RELAPSING PHASE OF THE DISEASE MAY RESULT FROM INITIAL INFLAMMATORY-MEDIATED INJURY, WHILE RISK FACTORS FOR THE LATER PHASE OF MS, WHICH IS WEIGHTED TOWARD NEURODEGENERATION, ARE NOT YET WELL DEFINED. THIS INTEGRATED REVIEW OF CURRENT EVIDENCE GUIDES RECOMMENDATIONS FOR CLINICAL PRACTICE AND HIGHLIGHTS RESEARCH GAPS. 2019 6 4721 33 NONCODING RNAS IN MULTIPLE SCLEROSIS. MULTIPLE SCLEROSIS (MS), A CHRONIC INFLAMMATORY DEMYELINATING DISEASE OF THE CENTRAL NERVOUS SYSTEM, IS CHARACTERIZED BY AXONAL DEGENERATION AND GLIOSIS. ALTHOUGH THE CAUSES OF MS REMAIN UNKNOWN, GENE DYSREGULATION IN THE CENTRAL NERVOUS SYSTEM HAS BEEN ASSOCIATED WITH THE DISEASE PATHOGENESIS. AS SUCH, THE VARIOUS REGULATORS OF GENE EXPRESSION MAY BE CONTRIBUTING FACTORS. THE NONCODING (NC) RNAS HAVE PIQUED THE INTEREST OF MS RESEARCHERS DUE TO THEIR KNOWN FUNCTIONS IN HUMAN PHYSIOLOGY AND VARIOUS PATHOLOGICAL PROCESSES, DESPITE BEING GENERALLY CHARACTERIZED AS TRANSCRIPTS WITHOUT APPARENT PROTEIN-CODING CAPACITY. ACCUMULATING EVIDENCE HAS INDICATED THAT NCRNAS PARTICIPATE IN THE REGULATION OF MS BY ACTING AS EPIGENETIC FACTORS, ESPECIALLY THE LONG (L) NCRNAS AND THE MICRO (MI) RNAS, AND THEY ARE NOW RECOGNIZED AS KEY REGULATORY MOLECULES IN MS. IN THIS REVIEW, WE SUMMARIZE THE MOST CURRENT STUDIES ON THE CONTRIBUTION OF NCRNAS IN MS PATHOGENIC PROCESSES AND DISCUSS THEIR POTENTIAL APPLICATIONS IN THE DIAGNOSIS AND TREATMENT OF MS. 2018 7 6734 34 WHAT DO WE KNOW ABOUT THE ROLE OF LNCRNAS IN MULTIPLE SCLEROSIS? MULTIPLE SCLEROSIS IS A CHRONIC, INFLAMMATORY AND DEGENERATIVE DISEASE OF THE CENTRAL NERVOUS SYSTEM OF UNKNOWN AETIOLOGY ALTHOUGH WELL-DEFINED EVIDENCE SUPPORTS AN AUTOIMMUNE PATHOGENESIS. SO FAR, THE EXACT MECHANISMS LEADING TO AUTOIMMUNE DISEASES ARE STILL ONLY PARTIALLY UNDERSTOOD. WE KNOW THAT GENETIC, EPIGENETIC, MOLECULAR, AND CELLULAR FACTORS RESULTING IN PATHOGENIC INFLAMMATORY RESPONSES ARE CERTAINLY INVOLVED. LONG NON-CODING RNAS (LNCRNAS) ARE NON-PROTEIN CODING TRANSCRIPTS LONGER THAN 200 NUCLEOTIDES THAT PLAY AN IMPORTANT ROLE IN BOTH INNATE AND ACQUIRED IMMUNITY, SO THERE IS GREAT INTEREST IN LNCRNAS INVOLVED IN AUTOIMMUNE DISEASES. THE RESEARCH ON MULTIPLE SCLEROSIS HAS BEEN ENRICHED WITH MANY STUDIES ON THE MOLECULAR ROLE OF LNCRNAS IN THE PATHOGENESIS OF THE DISEASE AND THEIR POTENTIAL APPLICATION AS DIAGNOSTIC AND PROGNOSTIC BIOMARKERS. IN PARTICULAR, MANY MULTIPLE SCLEROSIS FIELDS OF RESEARCH ARE BASED ON THE IDENTIFICATION OF LNCRNAS AS POSSIBLE BIOMARKERS ABLE TO PREDICT THE ONSET OF THE DISEASE, ITS ACTIVITY DEGREE, ITS PROGRESSION PHASE AND THE RESPONSE TO DISEASE-MODIFYING DRUGS. LAST BUT NOT LEAST, STUDIES ON LNCRNAS CAN PROVIDE A NEW MOLECULAR TARGET FOR NEW THERAPIES, MISSING, SO FAR, A CURE FOR MULTIPLE SCLEROSIS. WHILE OUR KNOWLEDGE ON THE ROLE OF LNCRNA IN MULTIPLE SCLEROSIS HAS RECENTLY IMPROVED, FURTHER STUDIES ARE REQUIRED TO BETTER UNDERSTAND THE SPECIFIC ROLE OF LNCRNAS IN THIS NEUROLOGICAL DISEASE. IN THIS REVIEW, WE PRESENT THE MOST RECENT STUDIES ON MOLECULAR CHARACTERIZATION OF LNCRNAS IN MULTIPLE SCLEROSIS DISORDER DISCUSSING THEIR CLINICAL RELEVANCE AS BIOMARKERS FOR DIAGNOSIS AND TREATMENTS. 2021 8 3602 32 IMPRINTED GENES AND MULTIPLE SCLEROSIS: WHAT DO WE KNOW? MULTIPLE SCLEROSIS (MS) IS A CHRONIC AUTOIMMUNE NEURODEGENERATIVE DISEASE OF THE CENTRAL NERVOUS SYSTEM THAT ARISES FROM INTERPLAY BETWEEN NON-GENETIC AND GENETIC RISK FACTORS. THE EPIGENETICS FUNCTIONS AS A LINK BETWEEN THESE FACTORS, AFFECTING GENE EXPRESSION IN RESPONSE TO EXTERNAL INFLUENCE, AND THEREFORE SHOULD BE EXTENSIVELY STUDIED TO IMPROVE THE KNOWLEDGE OF MS MOLECULAR MECHANISMS. AMONG OTHERS, THE EPIGENETIC MECHANISMS UNDERLIE THE ESTABLISHMENT OF PARENT-OF-ORIGIN EFFECTS THAT APPEAR AS PHENOTYPIC DIFFERENCES DEPENDING ON WHETHER THE ALLELE WAS INHERITED FROM THE MOTHER OR FATHER. THE MOST WELL DESCRIBED MANIFESTATION OF PARENT-OF-ORIGIN EFFECTS IS GENOMIC IMPRINTING THAT CAUSES MONOALLELIC GENE EXPRESSION. IT BECOMES MORE OBVIOUS THAT DISTURBANCES IN IMPRINTED GENES AT THE LEAST AFFECTING THEIR EXPRESSION DO OCCUR IN MS AND MAY BE INVOLVED IN ITS PATHOGENESIS. IN THIS REVIEW WE WILL FOCUS ON THE POTENTIAL ROLE OF IMPRINTED GENES IN MS PATHOGENESIS. 2021 9 2662 35 EPSTEIN-BARR VIRUS AND MULTIPLE SCLEROSIS: A CONVOLUTED INTERACTION AND THE OPPORTUNITY TO UNRAVEL PREDICTIVE BIOMARKERS. SINCE THE EARLY 1980S, EPSTEIN-BARR VIRUS (EBV) INFECTION HAS BEEN DESCRIBED AS ONE OF THE MAIN RISK FACTORS FOR DEVELOPING MULTIPLE SCLEROSIS (MS), AND RECENTLY, NEW EPIDEMIOLOGICAL EVIDENCE HAS REINFORCED THIS PREMISE. EBV SEROCONVERSION PRECEDES ALMOST 99% OF THE NEW CASES OF MS AND LIKELY PREDATES THE FIRST CLINICAL SYMPTOMS. THE MOLECULAR MECHANISMS OF THIS ASSOCIATION ARE COMPLEX AND MAY INVOLVE DIFFERENT IMMUNOLOGICAL ROUTES, PERHAPS ALL RUNNING IN PARALLEL (I.E., MOLECULAR MIMICRY, THE BYSTANDER DAMAGE THEORY, ABNORMAL CYTOKINE NETWORKS, AND COINFECTION OF EBV WITH RETROVIRUSES, AMONG OTHERS). HOWEVER, DESPITE THE LARGE AMOUNT OF EVIDENCE AVAILABLE ON THESE TOPICS, THE ULTIMATE ROLE OF EBV IN THE PATHOGENESIS OF MS IS NOT FULLY UNDERSTOOD. FOR INSTANCE, IT IS UNCLEAR WHY AFTER EBV INFECTION SOME INDIVIDUALS DEVELOP MS WHILE OTHERS EVOLVE TO LYMPHOPROLIFERATIVE DISORDERS OR SYSTEMIC AUTOIMMUNE DISEASES. IN THIS REGARD, RECENT STUDIES SUGGEST THAT THE VIRUS MAY EXERT EPIGENETIC CONTROL OVER MS SUSCEPTIBILITY GENES BY MEANS OF SPECIFIC VIRULENCE FACTORS. SUCH GENETIC MANIPULATION HAS BEEN DESCRIBED IN VIRALLY-INFECTED MEMORY B CELLS FROM PATIENTS WITH MS AND ARE THOUGHT TO BE THE MAIN SOURCE OF AUTOREACTIVE IMMUNE RESPONSES. YET, THE ROLE OF EBV INFECTION IN THE NATURAL HISTORY OF MS AND IN THE INITIATION OF NEURODEGENERATION IS EVEN LESS CLEAR. IN THIS NARRATIVE REVIEW, WE WILL DISCUSS THE AVAILABLE EVIDENCE ON THESE TOPICS AND THE POSSIBILITY OF HARNESSING SUCH IMMUNOLOGICAL ALTERATIONS TO UNCOVER PREDICTIVE BIOMARKERS FOR THE ONSET OF MS AND PERHAPS FACILITATE PROGNOSTICATION OF THE CLINICAL COURSE. 2023 10 2546 49 EPIGENETICS IN MULTIPLE SCLEROSIS: MOLECULAR MECHANISMS AND DIETARY INTERVENTION. INTRODUCTION: MULTIPLE SCLEROSIS (MS) IS A CHRONIC, INFLAMMATORY, NEURODEGENERATIVE DEMYELINATING DISEASE OF THE CENTRAL NERVOUS SYSTEM (CNS). UNFORTUNATELY, MS CAUSES IMPORTANT DISABILITY IN YOUNG ADULTS AND ITS PREVALENCE IS INCREASING. WHILE THE ETIOLOGY OF MS ETIOLOGY IS NOT COMPLETELY UNDERSTOOD, IT SEEMS TO BE A MULTIFACTORIAL ENTITY THAT IS INFLUENCED BY BOTH GENETIC AND EPIGENETIC MODIFICATIONS. EPIGENETIC MECHANISMS ADD OR REMOVE DIFFERENT CHEMICAL GROUPS FOR THE ACTIVATION OR INHIBITION OF GENE EXPRESSION TO BLOCK THE PRODUCTION OF PROINFLAMMATORY PROTEINS. IT IS TRULY IMPORTANT TO IDENTIFY THE FACTORS THAT CAN TRIGGER EPIGENETIC CHANGES IN MS TO COMPLEMENT THE THERAPEUTIC APPROACH, PREVENT DISABILITY AND IMPROVE PATIENTS QUALITY OF LIFE. HERE, WE HAVE CONDUCTED A REVIEW OF EXTERNAL FACTORS THAT INFLUENCE IN MS AND THEIR EPIGENETIC MECHANISMS. FOR EXAMPLE, HYPOMETHYLATION CAN PROMOTE CHANGES IN THE MYELIN AND SUBSEQUENT AUTOIMMUNE REACTIONS. THERAPEUTIC TOOLS CAN BE USED, INCLUDING THE HISTONE DEACETYLASE INHIBITOR TRICHOSTATIN A, WHICH AMELIORATES DEMYELINATING DISEASES IN RODENTS. HOWEVER, DRUGS ARE NOT ONLY THE THERAPEUTIC OPTION: RECENT STUDIES HAVE ALSO EVALUATED THE THERAPEUTIC POTENTIAL OF SEVERAL BIOACTIVE DIETARY COMPONENTS IN NEURODEGENERATION AND AXONAL DYSFUNCTION. NUMEROUS FOOD-DERIVED MOLECULES EXERT IMPORTANT METABOLIC ACTIONS. THESE MOLECULES INCLUDE PLANT POLYPHENOLS SUCH AS CATECHINS AND ISOFLAVONES, OMEGA-3 AND OMEGA-6 POLYUNSATURATED FATTY ACIDS, SHORT-CHAIN FATTY ACIDS, SULFUR-CONTAINING COMPOUNDS SUCH AS DALLY SULFIDE AND OTHER COMPOUNDS. ANTIOXIDANT AND ANTI-INFLAMMATORY COMPONENTS IN THE DIET INVOLVE TRANSCRIPTION FACTORS AS WELL. HOWEVER, MANY EXTERNAL FACTORS HAVE SHOWN TO INFLUENCE MS, ALTHOUGH NO SPECIFIC EPIGENETIC MECHANISMS ARE KNOWN. CONCLUSION: IN THIS REVIEW, WE GATHER BOTH ESTABLISHED AND NEW EVIDENCES ABOUT THE GENETIC, EPIGENETIC AND ENVIRONMENTAL FACTORS INFLUENCING MS AND THE DIETARY COMPONENTS THAT COULD MODULATE MS RELAPSE AND PROGRESSION. 2018 11 6738 32 WHAT'S YOUR CUP OF TEA? THE ROLE OF HERBAL COMPOUNDS IN THE MANAGEMENT OF MULTIPLE SCLEROSIS. MULTIPLE SCLEROSIS (MS) IS A CHRONIC, INFLAMMATORY, NEURODEGENERATIVE DISEASE THAT IS CHARACTERIZED BY A COMPLEX ETIOLOGY. EFFORTS TOWARDS THE MANAGEMENT OF MS HAVE LONG BEEN DIRECTED TOWARDS SYMPTOMATIC RELIEF, AS WELL AS THE USE OF IMMUNE-MODULATORY, DISEASE MODIFYING THERAPIES; HOWEVER, INCONSISTENT TREATMENT RESPONSES STILL PREVAIL, INCREASING THE RISK FOR DISEASE PROGRESSION. WHILE A GREAT DEAL OF RESEARCH ATTEMPTED TO UNRAVEL THE COMPLEXITY OF TREATMENT RESPONSES IN LIGHT OF EPIGENETIC VARIABILITY, PARALLEL EFFORTS IN THE DIRECTION OF ALTERNATIVE MEDICINE MAY BE AS PARAMOUNT. HERBAL COMPOUNDS HAVE LONG BEEN REGARDED AS SAFE AND VERSATILE OPTIONS FOR AIDING IN VARIOUS DISORDERS, INCLUDING NEURODEGENERATIVE CONDITIONS LIKE MS. NUMEROUS STUDIES HAVE TAKEN INTEREST IN A MYRIAD OF HERBAL PLANTS FOR THEIR POTENTIAL BENEFIT IN ALLEVIATING SOME OF THE MOST COMMON MS SYMPTOMS SUCH AS SPASTICITY AND FATIGUE, DELAYING THE PROGRESSION OF THE DISEASE, AS WELL AS INFLUENCING THE OVERALL QUALITY OF LIFE FOR MS PATIENTS. THIS REVIEW AIMS TO PROVIDE A COMPREHENSIVE OVERVIEW OF RECENT CLINICAL STUDIES EXAMINING THE EFFECTS OF VARIOUS HERBAL PLANTS ON DIFFERENT ASPECTS OF MS, IN AN ATTEMPT TO SHED LIGHT ON AN IMPORTANT TOOL FOR AIDING IN THE MANAGEMENT OF THIS COMPLEX AND MULTIFACTORIAL DISEASE. 2023 12 4796 38 NUTRITIONAL INTERVENTION AS AN ESSENTIAL PART OF MULTIPLE SCLEROSIS TREATMENT? MULTIPLE SCLEROSIS (MS) IS A CHRONIC INFLAMMATORY AND DEMYELINATING DISEASE OF THE CENTRAL NERVOUS SYSTEM. IN ADDITION TO THE GENETIC, EPIGENETIC AND IMMUNOLOGICAL COMPONENTS, VARIOUS OTHER FACTORS, E.G. UNHEALTHY DIETARY HABITS, PLAY A ROLE IN THE MS PATHOGENESIS. DIETARY INTERVENTION IS A HIGHLY APPEALING APPROACH, AS IT PRESENTS A SIMPLE AND RELATIVELY LOW RISK METHOD TO POTENTIALLY IMPROVE OUTCOMES IN PATIENTS WITH BRAIN DISORDERS IN ORDER TO ACHIEVE REMISSION AND IMPROVEMENT OF CLINICAL STATUS, WELL-BEING AND LIFE EXPECTANCY OF PATIENTS WITH MS. THE IMPORTANCE OF SATURATED FAT INTAKE RESTRICTION FOR THE CLINICAL STATUS IMPROVEMENT OF MS PATIENTS WAS POINTED FOR THE FIRST TIME IN 1950S. RECENTLY, DECREASED RISK OF FIRST CLINICAL DIAGNOSIS OF CNS DEMYELINATION ASSOCIATED WITH HIGHER INTAKE OF OMEGA-3 POLYUNSATURATED FATTY ACIDS PARTICULARLY ORIGINATING FROM FISH WAS REPORTED. ONLY FEW CLINICAL TRIALS HAVE BEEN PERFORMED TO ADDRESS THE QUESTION OF THE ROLE OF DIETARY INTERVENTION, SUCH IS E.G. LOW SATURATED FAT DIET IN MS TREATMENT. THIS REVIEW SUMMARIZES CURRENT KNOWLEDGE ABOUT THE EFFECT OF DIFFERENT DIETARY APPROACHES (DIETS LOW IN SATURATED FAT AND DIETARY SUPPLEMENTS SUCH AS FISH OIL, LIPOIC ACID, OMEGA-3 POLYUNSATURATED FATTY ACIDS, SEEDS OILS, HIGH FIBER DIET, VITAMIN D, ETC.) ON NEUROLOGICAL SIGNS, PATIENT'S WELL-BEING, PHYSICAL AND INFLAMMATORY STATUS. SO FAR THE RESULTS ARE NOT CONCLUSIVE, THEREFORE MUCH MORE RESEARCH IS NEEDED TO CONFIRM AND TO UNDERSTAND THE EFFECTIVENESS OF THESE DIETARY INTERVENTIONS IN THE LONG TERM AND WELL DEFINED STUDIES. 2018 13 5280 27 PROMOTING SYMPATHOVAGAL BALANCE IN MULTIPLE SCLEROSIS; PHARMACOLOGICAL, NON-PHARMACOLOGICAL, AND SURGICAL STRATEGIES. ACCUMULATED EVIDENCE SUGGESTS THAT CARDIOVASCULAR AUTONOMIC NERVOUS SYSTEM (ANS) DYSFUNCTION MAY BE THE UNDERLYING CAUSE OF MANY MS CLINICAL PRESENTATIONS, INCLUDING NEURODEGENERATION AND REDUCED RESPONSE TO IMMUNOMODULATORY THERAPIES, DEPRESSION, FATIGUE AND SLEEP DISORDERS, MIGRAINE, OSTEOPOROSIS, AND CHRONIC CEREBROSPINAL VENOUS INSUFFICIENCY, THE NEWER MS VASCULAR ETIOLOGY. WE HAVE RECENTLY DESCRIBED THE GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS WITH THE POTENTIAL INFLUENCING ANS ACTIVITY, AND THE INTERACTIONS AMONG THESE FACTORS. THIS REVIEW EXPANDS UPON PREVIOUS ONES, DESCRIBING THE PHARMACOLOGICAL, NON-PHARMACOLOGICAL, AND SURGICAL STRATEGIES THAT COULD BE ADOPTED TO PREVENT AND MINIMIZE THE DETERIORATION IN ANS FUNCTION, PROMOTING A STATE OF SYMPATHOVAGAL BALANCE. HOWEVER, THESE STRATEGIES SHOULD NOT BE APPLIED AS "ONE SIZE FITS ALL", BUT SHOULD TAKE INTO ACCOUNT THE NATURE AND THE DEGREE OF ANS DYSFUNCTION. THESE STRATEGIES WOULD BE EFFECTIVE IN IMPROVING ANS FUNCTION NOT ONLY IN MS, BUT ALSO IN OTHER AUTOIMMUNE AND NEURODEGENERATIVE DISEASES, WHERE THE DYSFUNCTION OF THIS SYSTEM PLAYS A ROLE. 2016 14 3549 40 IMMUNOSENESCENCE AND MULTIPLE SCLEROSIS. CHANGES IN THE IMMUNE SYSTEM ASSOCIATED WITH AGEING ARE KNOWN AS IMMUNOSENESCENCE. THIS IS CHARACTERISED BY A DECLINE IN IMMUNE RESPONSE, CHRONIC INFLAMMATION AND AN INCREASED RISK OF AUTOIMMUNE DISEASES. A CHRONIC INFLAMMATORY PROCESS WITH PERSISTENT PRODUCTION OF PROINFLAMMATORY MEDIATORS INCREASES THE RISK FOR MORBIDITY AND MORTALITY RELATED TO AGE, AND HAS BEEN DUBBED 'INFLAMM-AGEING'. IMMUNOSENESCENCE IS ASSOCIATED WITH A DECREASE IN THE NUMBER OF NAIVE T AND B CELLS, NK CELLS AND DISRUPTION OF THE PRO- AND ANTI-INFLAMMATORY BALANCE BY CHANGES IN THE PRODUCTION OF CYTOKINES. IN FACT, AGEING OF THE IMMUNE SYSTEM HAS A COMPLEX NETWORK OF UNDERLYING CAUSES WHICH INCLUDE NOT ONLY NATURAL MECHANISMS OF SENESCENCE BUT ALSO CHRONIC DISORDERS, LIFESTYLE, ENVIRONMENTAL AND EPIGENETIC FACTORS, AND INFECTIONS. MOREOVER, IMMUNOSENESCENCE HAS AN INFLUENCE ON THE COURSE OF CHRONIC DISEASES WHICH HAVE AN ONSET IN YOUNG ADULTS, SUCH AS MULTIPLE SCLEROSIS (MS). CURRENT DISEASE MODIFYING THERAPIES (DMTS) IN MS AIM TO REDUCE THE FREQUENCY OF RELAPSES AND TO SLOW DISEASE PROGRESSION, BUT THEY DO NOT NECESSARILY STOP THE ACCUMULATION OF DISABILITY RELATED TO DISEASE PROGRESSION. SOME FEATURES OF IMMUNOSENESCENCE FOUND IN AGED HEALTHY CONTROLS ARE ALREADY OBSERVED IN MS PATIENTS AT A YOUNGER AGE. THE OLDER POPULATION IS CHARACTERISED BY AN INCREASED SUSCEPTIBILITY TO INFECTIONS, A POOR RESPONSE TO VACCINATIONS, AND A HIGHER RISK OF DEVELOPING CANCER, VASCULAR DISEASES AND NEURODEGENERATION. IMMUNOSENESCENCE IS AN IMPORTANT FACTOR INFLUENCING THE COURSE OF MS, AND THE SAFETY AND EFFECTIVENESS OF DMTS. THE RELATIONSHIP BETWEEN THE PATHOGENIC PROCESS UNDERLYING THE DEVELOPMENT OF MS AND IMMUNOSENESCENCE REQUIRES FURTHER INVESTIGATION. 2022 15 4439 34 MOLECULAR GENETIC AND EPIGENETIC BASIS OF MULTIPLE SCLEROSIS. MULTIPLE SCLEROSIS (MS) IS A CHRONIC IMMUNE-MEDIATED DISEASE OF SPINAL CORD AND BRAIN. THE INITIAL EVENT IN MS OCCURS WHEN ACTIVATED CD4(+) T CELLS IN PERIPHERY EXACERBATES IMMUNE RESPONSES BY STIMULATING IMMUNE CELLS SUCH AS B CELLS, CD8(+) CELLS, MAST CELLS, GRANULOCYTES AND MONOCYTES. THESE PROINFLAMMATORY CELLS PASS BLOOD BRAIN BARRIER BY SECRETING PROINFLAMMATORY CYTOKINES INCLUDING TNF-ALPHA AND INF-(GAMMA) WHICH ACTIVATE ADHESION FACTORS. APCS (ANTIGEN-PRESENTING CELLS) REACTIVATE CD4(+) T CELLS AFTER INFILTRATING THE CNS AND CD4(+) T CELLS PRODUCE CYTOKINES AND CHEMOKINES. THESE PROINFLAMMATORY CYTOKINES AGGRAVATE INFLAMMATION BY INDUCING MYELIN PHAGOCYTOSIS THROUGH MICROGLIA AND ASTROCYTES ACTIVATION. MS IS BELIEVED TO HAVE A MULTIFACTORIAL ORIGIN THAT INCLUDES A COMBINATION OF MULTIPLE GENETIC, ENVIRONMENTAL AND STOCHASTIC FACTORS. ALTHOUGH THE EXACT COMPONENT OF MS RISKS THAT CAN BE EXPLAINED BY THESE FACTORS IS DIFFICULT TO DETERMINE, ESTIMATES BASED ON GENETIC AND EPIDEMIOLOGICAL STUDIES SUGGEST THAT UP TO 60-70 % OF THE TOTAL RISK OF MS MAY BE CONTRIBUTE TO GENETIC FACTORS. IN CONTINUE, FIRSTLY WE PROVIDE AN OVERVIEW OF THE CURRENT UNDERSTANDING OF EPIGENETIC MECHANISMS, AND SO PRESENT EVIDENCE OF HOW THE EPIGENETIC MODIFICATIONS CONTRIBUTE TO INCREASED SUSCEPTIBILITY OF MS. WE ALSO EXPLAIN HOW SPECIFIED EPIGENETIC MODIFICATIONS MAY INFLUENCE THE PATHOPHYSIOLOGY AND KEY ASPECTS OF DISEASE IN MS (DEMYELINATION, REMYELINATION, INFLAMMATION, AND NEURODEGENERATION). FINALLY, WE TEND TO DISCUSS HOW ENVIRONMENTAL FACTORS AND EPIGENETIC MECHANISMS MAY INTERACT TO HAVE AN EFFECT ON MS RISK AND CLINICAL OUTCOME AND RECOMMEND NEW THERAPEUTIC INTERVENTIONS THAT MIGHT MODULATE PATIENTS' EPIGENETIC PROFILES. 2017 16 2139 41 EPIGENETIC INSIGHTS INTO MULTIPLE SCLEROSIS DISEASE PROGRESSION. MULTIPLE SCLEROSIS (MS), A CHRONIC INFLAMMATORY DEMYELINATING AND NEURODEGENERATIVE DISEASE OF THE CENTRAL NERVOUS SYSTEM, IS TODAY A LEADING CAUSE OF UNPREDICTABLE LIFELONG DISABILITY IN YOUNG ADULTS. THE TREATMENT OF PATIENTS IN PROGRESSIVE STAGES REMAINS HIGHLY CHALLENGING, ALLUDING TO OUR LIMITED UNDERSTANDING OF THE UNDERLYING PATHOLOGICAL PROCESSES. IN THIS REVIEW, WE PROVIDE INSIGHTS INTO THE MECHANISMS UNDERPINNING MS PROGRESSION FROM A PERSPECTIVE OF EPIGENETICS, THAT REFERS TO STABLE AND MITOTICALLY HERITABLE, YET REVERSIBLE, CHANGES IN THE GENOME ACTIVITY AND GENE EXPRESSION. WE FIRST RECAPITULATE FINDINGS FROM EPIGENETIC STUDIES EXAMINING THE BRAIN TISSUE OF PROGRESSIVE MS PATIENTS, WHICH SUPPORT A CONTRIBUTION OF DNA AND HISTONE MODIFICATIONS IN IMPAIRED OLIGODENDROCYTE DIFFERENTIATION, DEFECTIVE MYELINATION/REMYELINATION AND SUSTAINED NEURO-AXONAL VULNERABILITY. WE NEXT EXPLORE POSSIBILITIES FOR IDENTIFYING FACTORS AFFECTING PROGRESSION USING EASILY ACCESSIBLE TISSUES SUCH AS BLOOD BY COMPARING EPIGENETIC SIGNATURES IN PERIPHERAL IMMUNE CELLS AND BRAIN TISSUE. DESPITE MINOR OVERLAP AT INDIVIDUAL METHYLATION SITES, NEARLY 30% OF ALTERED GENES REPORTED IN PERIPHERAL IMMUNE CELLS OF PROGRESSIVE MS PATIENTS WERE FOUND IN BRAIN TISSUE, JOINTLY CONVERGING ON ALTERATIONS OF NEURONAL FUNCTIONS. WE FURTHER SPECULATE ABOUT THE MECHANISMS UNDERLYING SHARED EPIGENETIC PATTERNS BETWEEN BLOOD AND BRAIN, WHICH LIKELY IMPLY THE INFLUENCE OF INTERNAL (GENETIC CONTROL) AND/OR EXTERNAL (E.G. SMOKING AND AGEING) FACTORS IMPRINTING A COMMON SIGNATURE IN BOTH COMPARTMENTS. OVERALL, WE PROPOSE THAT EPIGENETICS MIGHT SHED LIGHT ON CLINICALLY RELEVANT MECHANISMS INVOLVED IN DISEASE PROGRESSION AND OPEN NEW AVENUES FOR THE TREATMENT OF PROGRESSIVE MS PATIENTS IN THE FUTURE. 2020 17 966 37 CHRONIC NEUROLOGICAL DISORDERS: GENETIC AND EPIGENETIC MARKERS FOR MONITORING OF PHARMACOTHERAPY. INTRODUCTION: CHRONIC NEUROLOGICAL DISEASES ARE A MAJOR CAUSE OF MORTALITY AND MORBIDITY IN THE WORLD. WITH INCREASING LIFE EXPECTANCY IN THE DEVELOPING WORLD, THE INCIDENCE AND PREVALENCE OF THESE DISEASES ARE PREDICTED TO RISE EVEN FURTHER. THIS HAS ALSO CONTRIBUTED TO AN INCREASE IN DISABILITY-ADJUSTED LIFE YEARS (DALYS) FOR NONCOMMUNICABLE DISEASES. TREATMENT FOR SUCH DISEASES ALSO POSES A CHALLENGE WITH MULTIPLE GENETIC AND EPIGENETIC FACTORS LEADING TO A VARIED OUTCOME. PERSONALIZATION OF TREATMENT IS ONE WAY THAT TREATMENT OUTCOME/PROGNOSIS OF DISEASE CAN BE IMPROVED, AND PHARMACOGENOMICS PLAYS A SIGNIFICANT ROLE IN THIS CONTEXT. METHODOLOGY: THIS ARTICLE REVIEWED THE EVIDENCE PERTAINING TO THE ASSOCIATION OF GENETIC AND EPIGENETIC MARKERS WITH MAJOR NEUROLOGICAL DISORDERS LIKE MULTIPLE SCLEROSIS (MS), ALZHEIMER'S DISEASE (AD), AND PARKINSON'S DISEASE (PD), WHICH ARE A MAJOR SOURCE OF BURDEN AMONG NEUROLOGICAL DISORDERS. TYPES OF STUDIES INCLUDED ARE PEER-REVIEWED ORIGINAL RESEARCH ARTICLES FROM THE PUBMED DATABASE (1999-2018). RESULTS: THIS STUDY COMPILED DATA REGARDING SPECIFIC GENETIC AND EPIGENETIC MARKERS WITH A SIGNIFICANT CORRELATION BETWEEN THE CLINICAL DIAGNOSIS OF THE DISEASE AND PROGNOSIS OF THERAPY FROM 65 STUDIES. IN A SINGLE PLATFORM, THIS REVIEW HIGHLIGHTS THE CLUES TO SOME VITAL QUESTIONS, SUCH AS WHY INTERFERON BETA (IFN-BETA) THERAPY FAILS TO IMPROVE SYMPTOMS IN ALL MS PATIENTS? WHY CHOLINESTERASE INHIBITORS FAIL TO IMPROVE COGNITIVE IMPAIRMENT IN A SUBSET OF PEOPLE SUFFERING FROM AD? OR WHY SOME INDIVIDUALS ON LEVODOPA (L-DOPA) FOR PD SUFFER FROM SIDE-EFFECTS RANGING FROM DYSKINESIA TO HALLUCINATION WHILE OTHERS DO NOT? CONCLUSION: THIS ARTICLE SUMMARIZES THE GENETIC AND EPIGENETIC FACTORS THAT MAY EITHER REQUIRE MONITORING OR HELP IN DECIDING FUTURE PHARMACOTHERAPY IN A PATIENT SUFFERING FROM MS, AD, AND PD. AS THE HEALTH CARE SYSTEM DEVELOPS AND REACHES NEWER HEIGHTS, WE EXPECT MORE AND MORE OF THESE BIOMARKERS TO BE USED AS PHARMACOTHERAPEUTIC OUTCOME INDICATORS. 2021 18 5138 33 POTENTIAL METABOLIC BIOMARKERS IN ADULT ASTHMATICS. ASTHMA IS THE MOST COMMON CHRONIC AIRWAY INFLAMMATION, WITH MULTIPLE PHENOTYPES CAUSED BY COMPLICATED INTERACTIONS OF GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS. TO DATE, VARIOUS DETERMINANTS HAVE BEEN SUGGESTED FOR ASTHMA PATHOGENESIS BY A NEW TECHNOLOGY TERMED OMICS, INCLUDING GENOMICS, TRANSCRIPTOMICS, PROTEOMICS, AND METABOLOMICS. IN PARTICULAR, THE SYSTEMATIC ANALYSIS OF ALL METABOLITES IN A BIOLOGICAL SYSTEM, SUCH AS CARBOHYDRATES, AMINO ACIDS, AND LIPIDS, HAS HELPED IDENTIFY A NOVEL PATHWAY RELATED TO COMPLEX DISEASES. THESE METABOLITES ARE INVOLVED IN THE REGULATION OF HYPERMETHYLATION, RESPONSE TO HYPOXIA, AND IMMUNE REACTIONS IN THE PATHOGENESIS OF ASTHMA. AMONG THEM, LIPID METABOLISM HAS BEEN SUGGESTED TO BE RELATED TO LUNG DYSFUNCTION IN MILD-TO-MODERATE ASTHMA. SPHINGOLIPID METABOLITES ARE AN IMPORTANT MEDIATOR CONTRIBUTING TO AIRWAY INFLAMMATION IN OBESE ASTHMA AND ASPIRIN-EXACERBATED RESPIRATORY DISEASE. ALTHOUGH HOW THESE MOLECULAR VARIANTS IMPACT THE DISEASE HAS NOT BEEN COMPLETELY DETERMINED, IDENTIFICATION OF NEW CAUSATIVE FACTORS MAY POSSIBLY LEAD TO MORE-PERSONALIZED AND PRECISE PATHWAY-SPECIFIC APPROACHES FOR BETTER DIAGNOSIS AND TREATMENT OF ASTHMA. IN THIS REVIEW, PERSPECTIVES OF METABOLITES RELATED TO ASTHMA AND CLINICAL IMPLICATIONS HAVE BEEN HIGHLIGHTED ACCORDING TO VARIOUS PHENOTYPES. 2021 19 6907 26 [THE ROLE OF THE CIRCULAR RNAS IN MULTIPLE SCLEROSIS AND OTHER NEUROIMMUNE DISORDERS]. IN RECENT YEARS NON-CODING RNAS HAVE RECEIVED INCREASING ATTENTION AS AN IMPORTANT EPIGENETIC MECHANISM, WITH PARTICULAR ROLE OF MICRO RNAS. AS THE REGULATION OF MIRNA EXPRESSION IS HIGHLY DYNAMIC AND COMPLEX, GROWING EVIDENCE SUGGESTS THE EXISTENCE OF ANOTHER HIGHER LEVEL OF REGULATORY MECHANISM INVOLVED IN MIRNA ACTIVITY - CIRCULAR RNAS (CIRCRNAS). CIRCRNAS REPRESENT NOVEL, UNIQUE CLASS OF ENDOGENOUS NCRNAS CONTROLLING THE EXPRESSION AND FUNCTION OF MIRNA. THEY ARE CALLED NATURAL MIRNA "SPONGES". ACCUMULATING EVIDENCE REVEALS CIRCRNAS ROLE IN PHYSIOLOGICAL AND PATHOLOGICAL PROCESSES INCLUDING CNS AND IMMUNE REGULATION. PREVIOUS STUDIES IMPLICATED MIRNAS IN REGULATION OF AUTOIMMUNE DEMYELINATION IN MS. MULTIPLE SCLEROSIS IS A CHRONIC NEUROLOGICAL INFLAMMATORY DEMYELINATING DISORDER OF THE CENTRAL NERVOUS SYSTEM. WHILE THE ETIOLOGY OF MS IS STILL NOT FULLY UNDERSTOOD, ACCUMULATING EVIDENCE SUGGESTS THAT IT IS A MULTIFACTORIAL ENTITY WITH SIGNIFICANT INVOLVEMENT OF AUTOIMMUNE PROCESSES. 2022 20 2192 31 EPIGENETIC METHODS AND TWIN STUDIES. GENOMIC PREDISPOSITION FAILS TO FULLY EXPLAIN THE ONSET OF COMPLEX DISEASES, WHICH IS WELL ILLUSTRATED BY THE LARGELY INCOMPLETE CONCORDANCE AMONG MONOZYGOTIC TWINS. EPIGENETIC MECHANISMS, INCLUDING DNA METHYLATION, CHROMATIN REMODELING, AND NON-CODING RNA, ARE THE LINK BETWEEN ENVIRONMENTAL STIMULI AND DISEASE ONSET ON A PERMISSIVE GENETIC BACKGROUND IN AUTOIMMUNE AND CHRONIC INFLAMMATORY DISEASES. AUTOIMMUNE DISEASES NOW INCLUDE ALMOST 100 CONDITIONS AND ARE ESTIMATED TO CUMULATIVELY AFFECT UP TO 5% OF THE WORLD POPULATION WITH A HEALTHCARE EXPENDITURE SUPERIOR TO CANCER WORLDWIDE. MANY ADVANCES IN MEDICINE HAVE BEEN MADE TO TREAT THESE CONDITIONS BUT THERE ARE STILL GAPS, AND AN INNOVATIVE AND EFFICIENT THERAPY IS NEEDED. SYSTEMIC AUTOIMMUNE DISEASES INCLUDE RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS, SYSTEMIC SCLEROSIS, SJOGREN SYNDROME, POLYMYOSITIS, AND DERMATOMYOSITIS. MONOZYGOTIC TWINS DISCORDANT FOR ANY DISEASE OFFER AN IDEAL STUDY DESIGN AS THEY ARE MATCHED FOR MANY FACTORS, INCLUDING GENETIC VARIATION AND THIS IS A REAL ADVANTAGE FOR EPIGENETICS STUDY. WE WILL HEREIN DISCUSS THE AVAILABLE DATA IN THE EPIGENETIC DIFFERENCES LEADING TO DISEASE DISCORDANCE IN MZ TWINS FOR SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS, AND SYSTEMIC SCLEROSIS. 2020