Chronic Progressive Form Of Multiple Sclerosis Research Articles

Therapeutic Plasmapheresis with Albumin Replacement in Alzheimer's Disease and Chronic Progressive Multiple Sclerosis: A Review.

Background: Reducing the burden of beta-amyloid accumulation and toxic autoimmunity-related proteins, one of the recognized pathophysiological markers of chronic and common neurological disorders such as Alzheimer’s disease (AD) and multiple sclerosis (MS), may be a valid alternative therapy to reduce their accumulation in the brain and thus reduce the progression of these disorders. The objective of this review was to evaluate the efficacy of plasmapheresis (PP) in AD and chronic progressive MS patients (in terms of improving clinical symptoms) and to analyze its safety and protocols. Methods: Articles related to this topic and published without time limitations in the Medline, and Cochrane databases were reviewed. Results: In AD patients, PP reduced amyloid beta (Aβ) levels in the brain, accompanied by a tendency towards cognitive stabilization, and improved language and verbal fluency. In regards to structural and functional brain changes, PP reduced brain volume and favored the stabilization, or absence, of the progression of perfusion. In chronic progressive form of MS patients, PP improved neurological deficits in 20–70% of patients with a chronic progressive form of MS, and restored interferon (IFN) responsiveness, which was not accompanied by any image change in brain plaques. Conclusions: Therapeutic plasmapheresis with albumin replacement is a promising strategy for reducing Aβ mediated toxicity and slowing the progression of the disorder. Some patients with chronic progressive forms of MS show improvement in neurological deficits. The features of AD and MS patients who benefit most from this approach need further research.

The role of gut microbiota in shaping the relapse-remitting and chronic-progressive forms of multiple sclerosis in mouse models

Using a mouse model of multiple sclerosis (MS), experimental autoimmune encephalitis (EAE), we evaluated the role of gut microbiota in modulating chronic-progressive (CP) versus relapse-remitting (RR) forms of the disease. We hypothesized that clinical courses of EAE may be shaped by differential gut microbiota. Metagenomic sequencing of prokaryotic 16S rRNA present in feces from naïve mice and those exhibiting CP-EAE or RR-EAE revealed significantly diverse microbial populations. Microbiota composition was considerably different between naïve strains of mice, suggesting microbial components present in homeostatic conditions may prime mice for divergent courses of disease. Additionally, there were differentially abundant bacteria in CP and RR forms of EAE, indicating a potential role for gut microbiota in shaping tolerant or remittance-favoring, and pathogenic or pro-inflammatory-promoting conditions. Furthermore, immunization to induce EAE led to significant alterations in gut microbiota, some were shared between disease courses and others were course-specific, supporting a role for gut microbial composition in EAE pathogenesis. Moreover, using Linear Discriminant Analysis (LDA) coupled with effect size measurement (LEfSe) to analyze microbial content, biomarkers of each naïve and disease states were identified. Our findings demonstrate for the first time that gut microbiota may determine the susceptibility to CP or RR forms of EAE.

Herpes Zoster and Multiple Sclerosis

Multiple sclerosis (MS), a demyelinating disease of the central nervous system, has been considered multifactorial, and viruses may have a role in disease pathogenesis. Evidence suggests that certain viruses may trigger autoimmune neurological processes that lead to MS in genetically susceptible individuals [1, 2]. In this issue of the Journal, Kang et al analyze a database of 349,477 patients who had herpes zoster (experimental group) as a risk factor for MS (study outcome variable) in a region of the world historically considered low risk for MS. The authors compare their data with a randomly selected control group, more than 3 times as large as the initial sample (n 5 1,262,200), of participants who did not have herpes zoster. Their results show that the herpes zoster group had a 3.96 times greater risk of developing MS than did the control group (95% confidence interval [CI], 2.22–7.07, P % .001). This Kang et al study provides clear epidemiological observations suggesting a role for herpes zoster in the development of MS [3]. Previous studies noted that certain herpes viruses may trigger proinflammatory and autoimmune cascades through particles such as the toll-like receptor 4 (TLR-4) [3, 4], and that infectious environmental factors associated with MS may also belong to the herpesviridae family [4, 5]. This study highlights the time elapsed from the event of shingles until the occurrence of MS (approximately 100 d). In addition, evidence suggests that up to 30% of relapses among MS patients are associated with an infectious process [6, 7]. A possible explanation is the reactivation of latent herpes viruses by other infectious agents, and crossrecognition of common viral antigens with antigens found in the myelin sheath, which thereby induces molecular mimicry or superantigens [8–10]. The time lag for the occurrence of MS could be explained by a series of processes required by the immune systems of genetically susceptible individuals to reach a ‘‘threshold’’ and start the disease process. The threshold may also explain, in part, the observation that some patients have higher recurrence rates of MS around certain months of the year [11]. Some viruses of the herpesviridae family cause B cells to express alpha and beta crystal, a small stress protein that is normally absent from lymphoid tissues and has been considered an immunodominant antigen in the central nervous systems of MS patients [12]. Other studies have suggested a role of varicella zoster virus in the genesis of relapse and progression of some patients with chronic-progressive forms of MS [13, 14]. The evidence provided in this study by Kang et al allows us to better understand the role of these viral factors as an MS risk among certain genetically susceptible individuals. These epidemiological findings should be corroborated in other parts of the world to further clarify the role of varicella zoster virus and other herpes viruses in the pathogenesis of multiple sclerosis.

Transient Peripheral Immune Response and Central Nervous System Leaky Compartmentalization in a Viral Model for Multiple Sclerosis

Theiler's virus-induced demyelination represents an important animal model to study the chronic-progressive form of multiple sclerosis (MS). The aim of the present study was to identify specific genes and pathways in the deep cervical lymph node (cLN) and spleen of experimentally infected SJL-mice, using DNA microarrays. Analyses identified 387 genes in the deep cLN and only 6 genes in the spleen of infected animals. The lymph node presented 27.4% of genes with fold changes +/-1.5 at 14 days post infection (dpi) and a reduced transcription at later time points. K-means clustering analyses resulted in five clusters. Accordingly, functional annotation revealed that the B-cell immune response pathway was the most up-regulated cluster at the early phase. Additionally, an increase of CD68- and lysozyme-positive cells in the deep cLN was observed by immunohistochemistry. Polioencephalitis was most intense at 14 dpi, and the spinal cord demyelinating leukomyelitis started at 42 dpi. In summary, early gene expression is indicative of virus-trigged immune responses in the central nervous system (CNS)-draining lymph node. The decreased gene transcription in the deep cLN during the chronic phase and the low number of spleen genes supports the hypothesis of a compartmentalized inflammation within the CNS, as described in progressive MS.

Multiple sclerosis--more than one disease?

We have previously found an increase in prevalence and incidence of multiple sclerosis (MS) in the county of Hordaland, Western Norway. This study shows that the increase in incidence over a 30-year period is due to an increase of remittent and remittent/progressive MS. The incidence of the chronic progressive form of MS has remained stable during the same period. The two subgroups of MS also vary in symptomatology and age at onset. This suggests that MS has two different forms which behave differently when considered epidemiologically and clinically. The remitting and progressive forms may therefore each have a different etiology.

Efficient technique for immortalization of murine microglial cells relevant for studies in murine models of multiple sclerosis

Microglia are macrophage-like cells that populate the central nervous system (CNS) and become activated upon injury or infection. Microglia have been implicated as playing critical roles in various CNS diseases including multiple sclerosis (MS), a human autoimmune demyelinating disease, as well as in other neurodegenerative diseases. Two well-characterized models of MS, relapsing experimental autoimmune encephalomyelitis (R-EAE) and Theiler's murine encephalomyelitis virus (TMEV)-induced demyelinating disease, are inducible in SJL mice and model the relapsing–remitting and chronic-progressive forms of MS, respectively. These models are useful for the study of the mechanisms of initiation, progression, and therapy of the disease. Currently, a major limitation to studying the functions of microglia in these murine models of MS is the restricted number of cells capable of being isolated from the CNS of neonatal mice and propagated in culture. The current studies describe the preparation of SV-40 large T antigen-immortalized mouse microglia lines, M4T.4 and M4T.6, from the SJL/J mice. The immortalization technique was very efficient requiring only 6 weeks to develop long-term, highly replicating cell lines. The resulting microglia cell lines remain quiescent, but are induced to express various immune cytokines and to function as efficient antigen presenting cells upon activation with IFN-γ or infection with TMEV. Thus, the SV-40 large T antigen immortalized microglia lines react to innate and infectious stimuli similar to primary microglia isolated from neonatal mice, but are more easily maintained in culture. This technique should allow for the efficient cultivation of large numbers of microglial cells from a variety of disease-relevant mouse strains, including knock-out and transgenic mice.

Extracorporeal photochemotherapy for secondary chronic progressive multiple sclerosis: a pilot study.

Extracorporeal photochemotherapy (ECP) has been proposed for the treatment of various auto- and allo-immune reactions. However, a standard ECP regimen did not significantly alter the course of chronic progressive multiple sclerosis (MS). We tested whether an intensive ECP treatment can affect the course of secondary chronic progressive form of MS. Five patients free of immunosuppression were included. Soluble 8-MOP was added ex vivo to a mononuclear cell suspension obtained in a cell separator. This cellular suspension was then irradiated using an UVA irradiator and re-infused into the patient. ECP was performed once a week for 6 weeks and then, depending on clinical evaluation, for a maximum of 6 months, with 2-year follow-up after treatment discontinuation. Scoring was performed with the Kurzke scale and EDSS by a single independent neurologist. One patient was excluded because of recurrent attacks at the very beginning of treatment. Four patients completed the study: one exhibited clinical improvement and three remained stable during the first 6 months of treatment. However, all experienced relapse or worsening of the disease after discontinuation of ECP treatment. Our intensive ECP treatment only transiently alters the course of the severe secondary chronic progressive form of MS, with rebound after treatment discontinuation.

Menstrually related worsening of symptoms in multiple sclerosis

The objective of this study was to investigate whether the menstrual cycle influences multiple sclerosis (MS) symptoms. Seventy-two normally menstruating women (aged 20–50 years) with MS were interviewed. Of the 60 patients with a relapsing–remitting form of MS (RR-MS), 26 (43%) regularly experienced worsening of their MS symptoms in the period just before, or at the beginning of, the menstruation. Significantly more patients of the group reporting no influence of the premenstrual period on MS symptoms were using an oral contraceptive ( p=0.041), suggesting a protective effect. There were 12 patients with the primary chronic progressive form of MS (PCP-MS). None of them experienced an influence of the menstrual cycle on their symptoms. Our results suggest that hormonal changes preceding menstruation may worsen symptoms in a subgroup of women with RR-MS.

Urinary Free Kappa Light Chain Levels in Chronic Progressive Multiple Sclerosis

Previous studies have shown elevated levels of free kappa light chains (FKLC) in the urine of patients with relapsing-remitting multiple sclerosis (MS). The levels correlated well with clinical relapses, indicating that they could serve as useful markers of disease activity. In this study, we performed monthly measurements of urinary FKLC in patients with the chronic progressive form of MS, and correlated them with clinical indicators of disease activity, as expressed by Kurtzke's expanded disability status scale (EDSS) and brain magnetic resonance imaging (MRI). We noted wide fluctuations in the FKLC levels, which correlated poorly with EDSS scores or MRI changes. Longer follow-up periods may be needed before definite conclusions can be drawn.

Role of Predisposing and Protective HLA-DQA and HLA-DQB Alleles in Sardinian Multiple Sclerosis

To study the role of HLA genes in susceptibility and resistance to multiple sclerosis (MS) in Sardinian patients. To verify whether HLA-DQA and HLA-DQB genes differed between unrelated (MSU) and related (MSR) patients, and whether relapsing-remitting and chronic progressive forms of MS are immunogenetically distinct entities. Case-control study of HLA-DQA and HLA-DQB gene frequency. All patients investigated were followed up by our MS referral centers. The study involved 116 MSU patients, 67 of whom had a relapsing-remitting form (MSr), 28 of whom had a chronic progressive from-the-onset form (MSc), and 21 of whom had a benign form (MSb), 32 patients with MSR, 19 parents and 27 healthy siblings of patients with MSR, and 86 controls. Selection of patients was random, while control subjects came from families without known immunologic diseases. All patients had definite MS. Statistical analysis of gene frequencies was conducted with the chi 2 test with correction (Pc) for the alleles investigated, as was decided before the study began. The DQA1*0301 allele was found to be increased in patients (MSU vs controls, Pc = .008; patients with MSc vs controls, Pc = .001; patients with MSR vs controls, Pc = .02; and parents vs controls, Pc = .04), while the DQA1*0102 allele was found to be diminished in patients with MSr vs controls (Pc = .001). Among the DQB genes, the DQB1*0502 allele was diminished in patients with MSr vs controls (Pc = .04), while the sum of DQB1*0201 and *0302 alleles was significantly increased in patients with MSR vs controls (Pc = .003). Both HLA-DQA and HLA-DQB genes influence genetic susceptibility and resistance to MS. The roles of these genes differ in the various forms of MS. Patients with MSU and MSR both share HLA-DQA susceptibility genes.