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PubMed2004

A second-generation genomic screen for multiple sclerosis.

Multiple sclerosis (MS) is a debilitating neuroimmunological and neurodegenerative disorder. Despite substantial evidence for polygenic inheritance of the disease, the major histocompatibility complex is the only region that clearly and consistently demonstrates linkage and association in MS studies. The goal of this study was to identify additional chromosomal regions that harbor susceptibility genes for MS. With a panel of 390 microsatellite markers genotyped in 245 U.S. and French multiplex families (456 affected relative pairs), this is the largest genomic screen for MS conducted to date. Four regions met both of our primary criteria for further interest (heterogeneity LOD [HLOD] and Z scores >2.0): 1q (HLOD=2.17; Z=3.38), 6p (HLOD=4.21; Z=2.26), 9q (HLOD; Z=2.71), and 16p (HLOD=2.64; Z=2.05). Two additional regions met only the Z score criterion: 3q (Z=2.39) and 5q (Z=2.17). Further examination of the data by country (United States vs. France) identified one additional region demonstrating suggestive linkage in the U.S. subset (18p [HLOD=2.39]) and two additional regions generating suggestive linkage in the French subset (1p [HLOD=2.08] and 22q [HLOD=2.06]). Examination of the data by human leukocyte antigen (HLA)-DR2 stratification identified four additional regions demonstrating suggestive linkage: 2q (HLOD=3.09 in the U.S. DR2- families), 6q (HLOD=3.10 in the French DR2- families), 13q (HLOD=2.32 in all DR2+ families and HLOD=2.17 in the U.S. DR2+ families), and 16q (HLOD=2.32 in all DR2+ families and HLOD=2.13 in the U.S. DR2+ families). These data suggest several regions that warrant further investigation in the search for MS susceptibility genes.

Chromosome Mapping↗
PubMed2004

Lessons from the neuropathology of atypical forms of multiple sclerosis.

Multiple sclerosis (MS) is characterized by multiple demyelinated inflammatory lesions disseminated in the central nervous system (CNS). Additional features of MS pathology include axonal loss and gliosis. Remyelination may take place predominantly in the early stages of lesion formation. Pathologically, important inter-individual differences have been observed with respect to oligodendrocyte preservation. Furthermore, different mechanisms of demyelination, such as T-cell/macrophage-mediated demyelination, antibody/complement-mediated demyelination, and primary damage of the oligodendrocyte have been observed in individual MS patients. Atypical MS forms, such as Marburg's acute MS, Devic's neuromyelits optica, Balò's concentric sclerosis, and Schilder's diffuse sclerosis share key aspects of MS pathology, however, each of them harbors characteristic discriminative features. Devic's neuromyelitis optica may represent the prototypical disease with antibody/complement-mediated demyelination, whereas cases with Balò's concentric sclerosis show oligodendrocyte dystrophy. Acute disseminated encephalomyelitis (ADEM) may be regarded as a related condition lacking extensive demyelination. Thus, atypical MS forms may help to elucidate pathogenic mechanisms in MS.

Demyelinating Diseases↗
PubMed1997

Vestibular evaluation in patients with early multiple sclerosis.

Multiple sclerosis (MS) is a chronic, debilitating disease characterized by multiple areas of focal demyelination that develop throughout the white matter of the central nervous system at varying times. Most patients report disequilibrium at some point in the course of their disease. When balance disturbance occurs early in the course of the disease prior to diagnosis, the patient may present to the otolaryngologist for evaluation. Are there any patterns of balance dysfunction that might suggest the diagnosis to the evaluating physician? An evaluation of ten patients with known early MS suggests that platform posturography and ENG is the test most likely to provide useful diagnostic information in patients with early MS.

Adult↗
PubMed2001

Multiple sclerosis and multiple sclerosis-associated retrovirus in Sardinia.

The island of Sardinia has a high and increasing incidence of multiple sclerosis (MS). In a search for environmental factors that may account for this anomalously high incidence, we looked for evidence of multiple sclerosis-associated retrovirus (MSRV) that has previously been found in the plasma and cerebrospinal fluid of MS patients. We studied 25 MS patients and 25 matched healthy controls of ascertained Sardinian lineage. Blood samples were processed for extracellular RNA extraction. RNAs underwent reverse transcription/nested polymerase chain reaction (RT-PCR) with primers specific for MRSV-pol gene. We found a striking correlation between MSRV positivity and MS disease, but the virus was found also only in controls (100% and 12% respectively; Fisher's exact test, p<0.00001). It is unclear whether MSRV exerts any pathogenic role in MS. It is possible that this is simply an epiphenomenon, but even then, it may constitute a diagnostic marker.

Female↗
PubMed2001

[Recent therapeutic strategy for multiple sclerosis].

Multiple Sclerosis (MS) is an inflammatory demyelinating disease in the central nervous system (CNS), and it is clinically characterized by multiplicity in time (relapse and remission) and space (multiple lesions in CNS). In Asian countries including Japan, it has been pointed out that the prevalence rate of MS patients is extremely low and the frequency of the optic-spinal form of MS is high, compared with Western countries. Although the etiology remains unknown, it has been postulated that the pathogenesis of MS may involve immune mechanisms, virus-like infectious agents or genetic factors. MS should be attacked on two fronts: treatment to suppress the disease itself and alter its natural history, and treatment to improve the symptoms of MS and mask the deficits it causes. Although steroid therapy probably improves MS attacks by inhibiting the immune system and reducing inflammation, they seem ineffective in changing the natural history of the disease or preventing ultimate disability. Interferon beta has been approved as an effective drug for reducing the rate of MS attacks and the volume of MRI lesions and altering its natural history, based on positive results from large controlled trials in western countries as well as in Japan. Other immunomodulating treatments, such as glatiramer acetate, intravenous immunoglobulin, and mitoxantorone have been also approved as effective drugs for MS.

Adjuvants, Immunologic↗
PubMed1995

The pathology of multiple sclerosis.

Multiple sclerosis (MS) is a chronic neurologic disease characterized in early phases by a cellular immune response and later by multiple areas of demyelination or plaques in the central nervous system (CNS) white matter. The clinical manifestations of the disease are highly variable, but probably are related to the extent of breakdown of the blood-brain barrier associated with inflammation in the acute phase, and with the extent of demyelination in the chronic phase. The initiating events of MS are not known, but current hypotheses include immune responses to an initiating viral infection and autoimmune responses to CNS myelin antigens. Both inflammatory and CNS resident cells contribute to the immunopathology of the disease. Chronic lesions are characterized by glial scarring and depletion of both oligodendrocytes and axons.

Blood Cells↗
PubMed1993

[Association of amyotrophic lateral sclerosis and multiple sclerosis].

A twenty-five year old woman developed a progressive right hemiparesis which remitted within three months, without treatment. The diagnosis was a first relapse of multiple sclerosis. After a 10 year fully asymptomatic period, the patient developed weakness of the legs with falls and swallowing difficulties. Fasciculations and amyotrophy were present in the limbs and the tongue. There were no sensory abnormalities. The electromyogram confirmed the peripheral neurogenic degeneration with signs of anterior horn involvement. Motor and sensory nerve conductions were normal. Muscle weakness and atrophy increased in the limbs and the bulbar territory and the patient died nine months later. The autopsy showed characteristic "old" plaques of multiple sclerosis in the cerebrum with anterior horn cell and pyramidal tracts degeneration, typical of amyotrophic lateral sclerosis, in the spinal cord. Although exceptional, this association of amyotrophic lateral sclerosis and multiple sclerosis leads to the discussion of an etiological immunological dysregulation common to these two diseases.

Adult↗
PubMed2006

[Borderlines types of multiple sclerosis].

Multiple sclerosis (MS) has been described for more than a century, but its cause remains unknown. Numerous reports have been written concerning borderline types of the disease. In the present paper we present the pseudo-tumoral variants of MS (so called Balo's, Marburg's and Schilder's forms), demographic variants (young and elderly onset of MS), related disorders (neuromyelitis optica and acute demyelinating encephalomyelitis). We also discuss the differential diagnosis with other auto-immune diseases.

Acute Disease↗
PubMed2006

[Interferon -beta therapy in multiple sclerosis].

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) white matter mediated by an autoimmune process, whose development is triggered by a complex interplay of multiple genetic and environmental factors. Interferon-beta (IFNbeta) substantially reduces clinical exacerbation and MRI disease activity in MS, possibly by inhibiting the antigen-presenting capacity, by reversing a Th1 shift of the immune response, and by suppressing the transmigration of autoreactive T cells into the CNS. However, it has become evident that a significant number of MS patients do not well respond to IFNbeta and experience adverse effects. Using a DNA microarray, we have recently identified a battery of IFN-responsive genes (IRG) in peripheral blood lymphocytes, which play a key role in biological effects of IFNbeta in MS. They include IRF-7, a positive feedback regulator of IFNbeta production, IFI30 and TAP1, a key component of the antigen-presentation machinery, and TNFAIP6, a secreted protein with antiinflammatory activities. Furthermore, IFNbeta promptly induces proinflammatory chemokines and cytokines responsible for adverse effects in MS. Hierarchical clustering analysis of T cell gene expression profile discriminates four molecularly distinct subgroups of MS, associated with differential disease activity and therapeutic response to IFNbeta. A panel of IRG are upregulated persistently in IFNbeta responders but not in nonresponders after treatment. These observations suggest that DNA microarray analysis is valuable for designing and optimizing personalized treatment of MS.

Autoimmunity↗
PubMed2006

Follow-up investigation of 12 proposed linkage regions in multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune disease with overwhelming evidence for genetic determination, and for which a maternal parent-of-origin effect has been reported. As with many complex diseases, multiple suggestive linkage signals have been observed. However, the only unambiguous association and linkage identified to date is with alleles of the human lymphocyte antigen (HLA) class II region. We have now carried out high-density microsatellite genotyping for 12 of the most promising regions (1p, 1q, 2q, 4q, 5p, 9q, 10p, 11p, 12q, 17q, 18p, 19p) from a whole-genome scan in 552 affected sibling pairs. This has been carried out in 194 families containing avuncular pairs. These permit examination of parent-of-origin effects in non-colineal pairs when divided into likely maternal and paternal trait transmission. The results do not confirm any non-major histocompatibility complex linkage in the overall subset nor in the maternal, paternal or HLA-DRB1*1501 subsets. We were able to establish exclusion for a locus with lambda(AV) > or = 1.3 for all the previously suggested regions. These results again raise the possibility that the paradigm of multiple genes of small individual effect used to justify genome searches in MS is incorrect.

Alleles↗
PubMed2004

The nature of multiple sclerosis.

Multiple sclerosis (MS) has recently been classified according to its clinical course. Despite relapses and remissions, its course is invariably progressive, and the observed progression from the remitting-relapsing to the secondary progressive form represents the accumulation of permanent damage to the nervous system. Discussions of the nomenclatural position of Schilder's, Marburg's, and Baló's diseases, ignore the fact that the unique, pathognomonic, sharp-edged plaque of MS, is also the pathologic end-result in the three variants. Devic's disease or neuromyelitis optica (NMO) is quite different and with some exceptions, is a particular form of disseminated encephalomyelitis (DEM). There is no evidence that the 'oriental form of MS' is anything but NMO. The suggestion that MS and DEM are variants of the same condition is contradicted by the fact that the pathological characteristics of the two are quite different. While it is probable that the two share aspects of pathogenesis, the patients differ because of their genetic endowment. This was dramatically demonstrated in a group of Japanese patients who died after anti-rabies vaccination and were found to have the typical sharp-edged lesions of MS. The genetic determinant was also crucial in the marmoset in which EAE uniquely resulted in a chronic relapsing-remitting (RR) disease characterized by the classic sharp-edged lesions of MS. The question 'ADEM: distinct disease or part of the MS spectrum?' can be answered with a resounding no. A new classification is proposed separating the different forms of MS from the various types of DEM.

Brain↗
PubMed2006

[Risk factors of osteoporosis in women with multiple sclerosis].

Multiple sclerosis (MS) is a progressive disease that leads to early disability of young adults at a reproductive age. Motor disturbances caused by progressive pyramidal deficit and cerebellar dysfunction, accompanied by ataxia with frequent falls, and early decrease of physical activity are risk factors of osteoporosis in MS patients. A relapsing-remitting course of the disease with frequent attacks demands multiple courses of steroid therapy. Long-term steroid treatment causes bone loss and development of secondary osteoporosis. We have shown that reduced bone mineral density (BMD) in lumbar spine and femoral neck is associated with high level of EDSS score caused by the combination of moderate pyramidal and cerebellar dysfunction. An additional risk factor of osteoporosis in MS patients is low body weight. The glucocorticoid therapy does not exert a negative impact on BMD in lumbar spine and femoral neck in patients with MS.

Adult↗
PubMed1989

Weakness, numbness, tingling and multiple sclerosis.

Multiple sclerosis is the most common serious neurological disease in young patients but it is not the only cause of paraesthesiae. Such sensory symptoms occur frequently and reflect a variety of underlying conditions.

Adolescent↗
PubMed2006

Lower urinary tract dysfunction due to multiple sclerosis.

Multiple sclerosis (MS) is a chronic neurological disease that commonly affects lower urinary tract function. In fact, change in bladder function may be the presenting complaint in as many as 10% of patients suffering from this condition and eventually up to 80% of patients with MS will suffer bladder symptoms.

Humans↗
PubMed1998

Immunologic aspects of multiple sclerosis.

Multiple sclerosis (MS) is the most common autoimmune disease involving the central nervous system. Knowledge of the basic autoimmunologic properties related to MS is critical to formulating a logical treatment approach to the patient. A review of immunologic systems and their specific applicability to MS is included in this article.

Autoimmune Diseases↗
PubMed2003

Multiple paths towards repair in multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS, affecting approximately 1/1000 individuals in the Western world. Available treatments limit CNS inflammation and strategies to repair damage in the CNS offer the potential of recovery of both tissue and function. With further fundamental knowledge developing, this area is ripe for 'translation' to clinical application.

Humans↗