Has myelin basic protein received a fair trial in the treatment of multiple sclerosis?

Approaches to the treatment of central nervous system autoimmune disease using specific neuroantigen

The ultimate aim in the treatment of autoimmune disease is to restore self-tolerance to the autoantigen(s) in question. In lieu of this ideal result, the conversion of a destructive or pathogenic autoimmune response into one of benign autoimmunity would also be highly desirable. In either case the use of the antigenic epitope, which is the target of the destructive immune response, would ideally be employed so as to give specificity to the protection without the need for long-term immunosuppression. This review describes a number of different approaches using various forms, doses, and routes of injection of specific neuroantigen to inhibit the different clinical varieties of autoimmune encephalomyelitis in a number of animal models; all done with the view to translating the findings into the clinic for the treatment of multiple sclerosis. We conclude that any treatment strategy for multiple sclerosis (MS) must have a number of features: it must be clinically acceptable, specific, long-lasting, require only short-term treatment, able to shunt off ongoing disease, and have the potential to prevent or deal with epitope spreading. Few of the approaches we describe fulfill all of these criteria. We suggest that investigations of new adjunctive agents to be used with a specific antigen be pursued, and that currently the use of chimeric proteins or DNA vaccination with or without the new adjunctives may hold the most hope for the future.

Protection against generalized autoimmunity of the nervous system (GANS), a novel animal model with combined features of EAE, EAN and EAU by a recombinant HIV-1 Tat37-72 peptide-based multiple T cell epitope vaccine

A new model of multi-compartment auto-immune disease has been established to analyze the effects of polyvalent recombinant peptide vaccines. A synthetic gene encoding major pathogenic determinants for Lewis rats of guinea pig myelin basic protein (MBP68-84), bovine interphotoreceptor retinoid binding protein (IRBP1169-1191), and bovine P2 protein (P2,53-78) was used to induce Generalized Autoimmunity of the Nervous System (GANS), which is characterized by development of auto-immune infiltration of the brain and spinal cord, the eyes, the pineal organ and the peripheral nerves. Thus, this model integrates the prominent features of three auto-immune diseases: experimental autoimmune encephalomyelitis (EAE), neuritis (EAN) and uveitis (EAU). In this study, GANS was used to study the effect of HIV-1 Tat37-72 targeting peptide on vaccination by recombinant polyvalent T cell auto-antigen vaccine. Depending on the route of administration, the recombinant vaccine effectively protects against the development of auto-immune nervous system inflammation.

Intravenous antigen administration as a therapy for autoimmune demyelinating disease

Experimental allergic encephalomyelitis is a prototypic autoimmune disease characterized by central nervous system inflammation and demyelination. Previously, we demonstrated that intravenous administration of high doses of myelin basic protein abrogated the clinical and pathological signs of experimental allergic encephalomyelitis by causing the deletion of encephalitogenic, CD4+, myelin basic protein-specific T cells through antigen-induced programmed cell death. In the present study, we further characterized the ability of intravenous antigen administration to attenuate an immune response by myelin basic protein-reactive encephalitogenic T cells. We demonstrated that multiple injections of myelin basic protein are required to achieve a therapeutic response, and that this form of therapy is effective even after prolonged chronic disease. These studies showed that although interleukin-2-stimulated cell cycling is an important factor leading to T-cell death, the administration of exogenous interleukin-2 with antigen can result in the aggravation of clinical disease compared to administration of antigen alone. More importantly, administration of myelin basic protein alone without interleukin-2 was sufficient to reduce autoreactive T cells and clinical disease in experimental autoimmune encephalomyelitis. Our experiments support the rationale for antigen-specific therapy aimed at inducing the programmed death of autoreactive T cells in autoimmune diseases, potentially including the human demyelinating disease multiple sclerosis.

[Acute polyradiculoneuritis and acquired immunodeficiency virus]

A 50-year-old man with positive test for human immunodeficiency virus (HIV) by enzyme-linked-immunoassy and Western-blot, without clinical manifestations of acquired immunodeficiency syndrome (AIDS), developed acute polyradiculoneuritis and was treated by plasmapheresis with improvement. We believe that chemical homologies of antigenic determinants between HIV and P2 protein of peripheral nervous system and myelin basic protein may induce crossed-reaction, thus developing acute polyradiculoneuritis and central nervous system involvement, respectively. The nervous system involvement hy HIV also occur in the HI-viremy, seric conversion alone, and AIDS with or without oportunistic infections.

Suppression of the immune reaction in multiple sclerosis might be achieved by intravenous injections of myelin basic protein, concomitant with the administration of an immunosuppressant and a corticosteroid

The author presents evidence from published papers of research done by numerous investigators that Multiple Sclerosis (MS) is an autoimmune disease, that the target tissue is the myelin sheath which covers the nerve fibers in the brain and spinal cord, that Myelin Basic Protein (MBP) is the antigen or one of the antigens involved, that the autoimmune reaction is effected by sensitized lymphocytes together with a specific antibody, that Experimental Allergic Encephalomyelitis (EAE) produced in animals can be used as a model for MS, and that the autoimmune reaction in MS can possibly be suppressed by the use of MBP given by an intravenous procedure together with an immunosuppressive drug and a corticosteroid.

Suppression of the immune reaction in multiple sclerosis might be achieved by intravenous injections of myelin basic protein, concomitant with the administration of an immunosuppressant and a corticosteroid

The author presents evidence from published papers of research done by numerous investigators that Multiple, Sclerosis (MS) is an autoimmune disease, that the target tissue is the myelin sheath which covers the nerve fibers in the brain and spinal cord, that Myelin Basic Protein (MBP) is the antigen or one of the antigens involved, that the autoimmune reaction is effected by sensitized lymphocytes together with a specific antibody, that Experimental Allergic Encephalomyelitis (EAE) produced in animals can be used as a model for MS, and that the autoimmune reaction in MS can possibly be suppressed by the use of MBP given by an intravenous procedure together with an immunosuppressive drug and a corticosteroid.

Treatment of experimental allergic encephalomyelitis with myelin basic protein: which route is best?

When myelin basic protein (BP) has been used for the treatment of multiple sclerosis (MS), it has been injected intramuscularly (IM) or subcutaneously (SC). Experimental allergic encephalomyelitis (EAE) is widely used as a model for MS, and the use of BP for MS is based on its efficacy in EAE. The present work shows that BP is more effective in EAE when administered by intravenous (IV) route than by IM or SC routes. These observations may be pertinent to therapeutic trials in MS.

Immunological treatment of multiple sclerosis

Immunosuppressive treatment of multiple sclerosis (MS) is based on the autoimmune hypothesis for which the main evidence is the close histological similarity between the human disease and chronic relapsing EAE. Although controlled trials indicate that ACTH is effective in accelerating recovery from relapses, long term ACTH or oral steroids are ineffective. Two controlled trials have suggested a beneficial effect of azathioprine, but neither was conducted "blind" and neither was sufficiently convincing to cause the widespread adoption of azathioprine by neurologists. One controlled trial, also not blind, reported a beneficial effect of an intensive course of cyclophosphamide, but this hazardous treatment will not be widely adopted unless other trials confirm this result. The converse hypothesis that MS is due to a deficient immune response to a virus has led to trials of immunostimulation. Interferon and levamisole have proven ineffective so far, but transfer factor slowed disease progression in one well conducted trial.

Administration of myelin basic protein-coupled spleen cells prevents experimental allergic encephalitis

Intravenous administration of mouse myelin basic protein covalently coupled with chromic chloride to syngeneic spleen cells (MBP-SC) prevents the subsequent induction of experimental allergic encephalitis (EAE). Whereas 1 in 28 mice receiving MBP-SC developed EAE after immunization with mouse spinal cord homogenate (MSCH) and adjuvants, 16 out of 25 mice receiving ovalbumin-coupled spleen cells (OA-SC) had EAE following encephalitogenic challenge. The effect of administration of antigen-coupled spleen cells on in vitro proliferation responses is shown.

Myelin basic protein treatment of experimental allergic encephalomyelitis in monkeys

Treatment of experimental allergic encephalomyelitis (EAE) in two strains of monkeys with large amounts of myelin basic basic protein (BP) fails unless an adjunct is also used. In both strains the adjunct by itself is more effective than BP by itself, but in the one strain which could be investigated sufficiently, the combination can be made almost totally effective in reversing EAE. The adjunct varies with the strain of monkey, an antibiotic in Macaca mulatta and a steroid in Macaca fascicularis. Similar adjunctive treatments should be considered in the management of multiple sclerosis, for EAE remains one of the best studied models.