Multiple Sclerosis Flashcards
true or false: MS is an autoimmune disease
true
- myelin coating inside the ventricles of the brain is attacked
- leads to pre-ventricular lesions around the ventricles of the brain
- brain shrinks like a raisin
- then slowly disintegrates the entire body
Is there a geographical influence on the diagnosis of MS?
- odds to getting MS is 1:500 to 1:1000
- yet Canada has the highest geographical prevalence of MS worldwide
- Winnipeg and Brandon have the highest rates of prevalence within Canada
Contributing factors to MS
- race (caucasian)
- age (25 and 38)
- sex: m vs f (female more likely, but if male gets it is much more debilitating-> put in wheelchair faster)
- infection (epstein-barr, HHV6, Clamydia pneuoniae, ect)
- injury
- genetics
- geography (less 15 yrs of age acquires susceptibility of the new region but over 15 will not affect-> i.e. if you come into canada before the age of 15 you take on the incidence of an average caucasian woman within Canada but after you have the inherent risk of the nationality from which you immigrated)
- diet/sunshine (Vitamin D is an inherant deficiency in MS pts)
Susceptibility to MS:
sex, age, ethnicity
- 3F:1M
- age of onset= 30-40
- high risk= N. european, US caucasians, Canadians
- middle= australia, S. African whites, S. Europeans
- low: african blacks, orientals
Genetic factors
- in a 1st degree family relative of a patient with MS, absolute risk of MS is: under 5% which equals 20-40x greater risk
- in monozygotic twins: concordance rate for MS is 31%, and in dizygotic 5% (proof genetics alone is not solely responsible for disease)
- presence of HLA-DR2 allele increases the risk of MS
- MS is not a hereditary disease BUT patients may have a genetic predisposition
why is MS not hereditary?
-b/c we have not characterized the exact gene responsible for passing MS through the generation
Theories of MS
1) infectious theory
- measles, mumps, rubella, EBV, HHV-6
2) molecular mimicry
- shed a protein that looks similar to the myelin in the CNS
- phagocytic cells can’t tell the difference between the foreign Ag in the body and the myelin covering the nerves, so the phagocytes attack the myelin
3) autoimmune disease
- the sequence of aa’s produced by these might look similar to the AA that covers nerves
- the body might have trouble differentiating between the myelin and the foreign proteins coming in
MS as an Autoimmune disease
- injuries or tissue damage- protein from an injury could be a trigger
- macrophages, monocytes and dendritic cells- Ag presenting cells that are filters of the blood from foreign proteins
- the foreign proteins flow through the blood; the Ag-presenting cells act like the filter in your blood and anything not supposed to be there will get picked up
- they then stick this forgein protein to a naive T cell (aka non-activated T-helper cell)
- activates T cell to turn into a Th1 inflammatory cell that drives the autoimmune inflammatory responses of MS
- CD28 CD80 = B7.1
MS and the imbalance of the immune system
- there is an overactive proliferation of inflammatory Th1 cells (Pro-inflamm»anti-inflamm)
- we need Th0 cells to have a balance and equally proliferate into both Th1 and Th2
Do MS patients ever recover from the imbalance of Th1 and Th2 cells?
no- there are always more Th1
T-Cell Balance
- there is a large immune deviation favouring the inflammatory Th1 cells over the protective Th2 (Th3) therefore they cannot suppress the inflammatory Th1 effects
- they keep producing more and more mediators of inflammation, which induces the positive feedback of proliferation to make more Th1 cells, all turning on the same mediators
What are the predominate activated mediators of inflammation that Th1 turns on?
IL-12
IFN-gamma
TNF-alpha
(others: IL-2, IL-6)
What are the mediators activated by Th2 cells (and are therefore lacking)
IL-4
IL-10
TGF-beta
Generic overview steps of MS Immunology
1) activation
2) adhesion
3) invasion
4) reactivation
- > -> tissue damage in the CNS
How does the familiarization of that foreign protein cause myelin to be attacked?
- mediators of inflammation induce and feedback of proliferation to make more Th1 cells for that specific protein
- Th1 cells now recognize that one foreign protein that is similar to the myelin -> myelin is attacked
where does up-regulation of adhesion molecules occur?
- in molecules on the endothelial surface of the blood brain barrier
- this is caused by the mediators of inflammation
- the blood brain barrier then becomes sticky like velcro to the Th1 cells
- the Th1 cells keep sticking to the BBB and keep churning more inflammatory and adhesion mediators
What other up-regulation occurs at the BBB?
- up-regulation of the metaloproteases
- they loosen the integrity of the BBB of the endothelial cells that allows the T cells to pass through the BBB and into the CNS and therefore also into the cerebral spinal fluid
- this generates the white spots of damage that we see in an MRI
Do Th1 cells cause direct myelin damage?
no- because they are an immune cell
How do the Th1 cells end up causing their damage to the myelin?
- Th1 cells start becoming reactivated ALL over again INSIDE THE BBB on the CNS side
- inflammatory mediators of the reactivated Th1 cells activates the productions of the ABs and the other phagocytic cells (i.e. macrophages, plasma cells, etc)
true or false: the mediators of inflammation released by the Th1 cells are only released in the CNS
true- since they are only within the CNS they start to eat away at the myelin that coats the brain
What mediators are re-activated within the CNS?
cytotoxic t-cells, macrophages, large granular lymphocytes neutrophils, b-lymphocytes (which release antibodies)
(the macrophages themselves can also proliferate into large granular lymphocytes and neutrophils)
What are the antigen-presenting cells?
macrophages, monocytes, dendritic cells
how do the macrophages contribute to MS?
- they eat up the myelin
- also activate the B lymphocytes that turn into inflammatory antibodies
How do B-lymphocytes contribute to MS?
- produce AB’s
- phagocytic function
true or false: here are normally antibodies in the CSF
false- normally none, but an MS patient would show ABs
What is a consequence of having ABs in the CNS?
-means they have a full blown immune response to myelin
What makes the myelin in the CNS?
-oligodendrocytes
true or false: can the oligodendrocytes regenerate
false
- in the PNS the Schwann cells produce the myelin and they can regenerate
- but the oligodendrocytes CANNOT regenerate
What are the ABs that are found in the CNS in MS?
IgG
true or false: MS is a white matter disease
true