WINETECH Technical Yearbook 2019

currently available are not licensed to prevent disability. They are nevertheless licensed to reduce relapses and give a better outcome as far as the increase in the number of lesions is concerned (Tremlett et al ., 2012). To take the load shedding analogy further, one should pay careful attention to the damage in mye l in. Mye l in (or whi te matter) is produced by specialised cells (oligodendrocytes) that are situated all along the axons, and surround the axons with myelin. However, myelin is far more than an isolation material such as the plastic covering of electrical wires. It is involved in electrical conduction through increasing the signal transduction of the axons (Bartzokis, 2011). Myelin forms the basis of the “bandwidth” of the brain’s “computer capacity”. The difference between the human brain and that of a chimpanzee is the fact that humans have 20% more white matter relative to grey matter. The myelin is therefore involved in cognitive capacity, as well as physical abilities (Bartzokis, 2011). If the signals have to increase, such as for example when one learns to play the piano, then the structure of the myelin improves to comply with the demand for increased conductivity (Herbert et al ., 2018). The oligodendrocytes can therefore be considered to be “power stat ions” that prov ide the e l ect r i ca l capacity required by the body. The energy is generated by mitochondria that occur within the oligodendrocytes.

Just like the power stations in Eskom’s electricity network have to be maintained, the oligodendrocytes require ongoing maintenance. The generation of power requires oxygen, iron, vitamin B12 and folic acid, as well as antioxidants, which have to constantly counter oxidation (“rust”). Vitamin D is required for many reactions, such as controlling inflammation. Furthermore copper, zinc and magnesium also form part of the power generation mechanism of the mitochondria. Essential fatty acids and lecithin form part of the structure of the oligodendrocytes. The uptake of nutrients from food is genetically controlled and the provision of nutrients to brain cells occurs through the blood vessels (Hohlfeld, 2010). The ethically approved MS project of Stellenbosch University, which is supported by Winetech, has the following objectives: • To conduct research to determine whe t he r gene t i c abe r ra t i on s o r environmental factors may impact on the availability of nutrients to the oligodendrocytes, and • To empower patients with knowledge a bou t t a k i n g r e s pon s i b i l i t y f o r t he i r hea l t h by ma i nta i n i ng t he o l i godend roc y te s and p ro tec t i ng them against toxic substances, such as inhalation of cigarette smoke (active or passive smoking).

The results obtained so far are very encouraging. The project has been running for about 20 years. We have found that people with an MS diagnosis who ensure that they ingest sufficient amounts of iron (but not too much) to keep their iron levels within normal parameters (Van Rensburg et al ., 2006), who regularly supplement their vitamin B12, vitamin D and essential fatty acids, and who include sufficient amounts of folic acid and antioxidants (fruit and vegetables) in their diet on a daily basis, are protected against disability and have a normal neurological outcome (Davis et al ., 2014). For such people it is therefore not true that their MS diagnosis condemns them to experience disability. Neurological disability in MS is measured by means of the Expanded Disability Status Scale (EDSS) (Kurtzke, 1983). Dr Clint Johannes, an MMed student on the project, conducts the EDSS tests. It comprises an objective measurement that has to be done by a doctor. On a scale of 0 to 10, a lower figure indicates reduced disability. Our research shows that the same factors which cause heart disease are also involved in disability in MS. Moderate alcohol intake, such as red wine as part of a Mediterranean diet, results in reduced EDSS (Van Rensburg et al ., 2016). Increased physical exercise is also very beneficial. A few patients participating in our project regularly run athletic races, for

example Karen Nortje, who was diagnosed with MS in 2006. She completed the most recent Two Oceans Ultramarathon of 56 km (see photo). Such unexpected outcomes for patients d i agnosed wi th MS years ago cause confusion in medical circles. Recently studies were published showing that approximately one in five MS patients were incorrectly diagnosed with MS (Kaisey et al ., 2019). Our research project, “The role of moderate alcohol consumption in promoting improved disease outcome in multiple sclerosis (MS); an investigation involving transformation t ra i n i ng to persons f rom prev i ous l y disadvantaged groups in South Africa”, aims to carefully analyse the diagnosis of 22 MS patients to examine their initial diagnoses. Clear guidelines exist in the literature according to which people are diagnosed with MS (Polman et al ., 2010). Dr Coenie Hattingh, a post-doctoral fellow, and Mariaan Jaftha, a prospective MSc student, will do the MRI analyses. Merlisa Kemp is currently doing her PhD on the health of the vascular system in these patients using ultrasound examination of the neck vessels. In her MSc study Merlisa showed that the thickness of the intima media of the carotid artery walls correlate significantly with the EDSS, in other words that the health of the arteries impacts disability outcomes (Nelson et al ., 2014). We hope to confirm this finding in the PhD study.