PubMed Health⌕ Search

PubMed · 14722821

Practical consultations: multiple sclerosis.

Abstract

People with multiple sclerosis (MS) are increasingly referred for specialty care to tertiary centers, particularly for advice regarding initiation and monitoring of immunomodulatory therapies. However, the generalist must still be able to apply appropriate skills and technology to diagnose the disease and its complications, provide basic counseling of patients, and be aware of potential treatment options at the time of diagnosis and when therapeutic regimens fail. A general approach, supported by evidence where possible, to common and contemporary clinical issues in MS care is provided in a case-based narrative.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Dean M Wingerchuk, Jonathan L Carter. 2003. Practical consultations: multiple sclerosis.. https://doi.org/10.1055/s-2003-814737

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Combining several ordinal measures in clinical studies.

In medical research, it is rare that a single variable is sufficient to represent all relevant aspects of epidemiological risk, genomic activity, adverse events, or clinical response. Since biological systems tend to be neither linear, nor hierarchical in nature, the assumptions of traditional multivariate statistical methods based on the linear model can often not be justified on theoretical grounds. Establishing concept validity through empirical validation is not only problematic, but also time consuming. This paper proposes the use of u-statistics for scoring multivariate ordinal data and a family of simple non-parametric tests for analysis. The scoring method is demonstrated to be applicable to scoring clinical response profiles in the treatment of psoriasis and then to identifying genomic pathways that best correlate with these profiles.

Adjuvants, Immunologic↗

Cutting edge: the natural ligand for glucocorticoid-induced TNF receptor-related protein abrogates regulatory T cell suppression.

CD4(+)25(+) regulatory T (Treg) cells maintain immunological self-tolerance through mechanisms that are only in part understood. Previous studies suggest that the glucocorticoid-induced TNFR-related protein (GITR), which is preferentially expressed on the surface of Treg cells, potentially provides a signal that abrogates Treg suppression. In this study, we show that a soluble form of mouse GITR ligand (sGITR-L) induces GITR-dependent NF-kappaB activation and blocks in vitro suppression mediated by both resting and preactivated polyclonal and Ag-specific Treg cells. Since sGITR-L along with rIL-2 induces proliferation of CD4(+)25(+) cells, it appears that sGITR-L can break the anergic state of Treg cells. Because sGITR-L also up-regulates IL-2 secretion by activated CD4(+)25 (-)T cells, these two sGITR-L induced signals synergize to interfere with suppressor activity by CD4(+)25(+) Treg cells.

Adjuvants, Immunologic↗

Cutting edge: C3d functions as a molecular adjuvant in the absence of CD21/35 expression.

Complement component C3 covalently attaches to Ags following activation, where the C3d cleavage fragment can function as a molecular adjuvant to augment humoral immune responses. C3d is proposed to exert its adjuvant-like activities by targeting Ags to the C3d receptor (CD21/35) expressed by B cells and follicular dendritic cells. To directly assess the importance of CD21/35 in mediating the immunostimulatory effects of C3d, CD21/35-deficient (CD21/35(-/-)) mice were immunized with streptavidin (SA), SA-C3dg tetramers, recombinant HIV gp120 (gp120), or gp120 fused with linear multimers of C3d. Remarkably, SA- and gp120-specific Ab responses were significantly augmented in CD21/35(-/-) mice when these Ags were complexed with C3d in comparison to Ag alone. In fact, primary and secondary Ab responses and Ab-forming cell responses of CD21/35(-/-) mice approached those of wild-type mice immunized with SA-C3dg and gp120-C3d. Thus, C3d can function as a molecular adjuvant in the absence of CD21/35 expression.

Adjuvants, Immunologic↗