Subclinical atherosclerosis in patients with relapsing-remitting multiple sclerosis

Carotid intima-media thickness and risk of atherosclerosis in multiple sclerosis: A cross-sectional study

BACKGROUND

Multiple sclerosis (MS) is characterized by inflammation and demyelination in the central nervous system. Recent studies have suggested a potential association between MS and an increased risk of atherosclerosis, a systemic vascular disease involving arterial wall thickening. Understanding this relationship is crucial, given the heightened cardiovascular risk observed in MS patients.

OBJECTIVE

To investigate factors influencing the development of atherosclerosis in patients with multiple sclerosis (pwMS), focusing on carotid intima-media thickness (CIMT) as a marker.

METHODS

114 pwMS (82 females and 32 males) and 127 control subjects (57 females and 70 males) were included. The mean CIMT between the two groups was compared. Additionally, the effects of annual relapse rate, EDSS (Expanded Disability Status Scale), MS duration, treatment duration, and type of Disease-modifying treatment (DMT) on CIMT were evaluated.

RESULTS

This study included 241 participants with a mean (SD) age of 41.13 years (10.93). CIMT was significantly higher in pwMS compared to controls (p < 0.001). Even after adjusting for age, sex, and BMI (Body Mass Index), CIMT remained significantly higher in the pwMS group (p < 0.001). Spearman's correlation analysis revealed significant associations between CIMT and age, BMI, EDSS score, and disease duration (all p < 0.05). Additionally, the SPMS (Secondary Progressive Multiple Sclerosis) disease course was significantly associated with higher CIMT (p < 0.001). Linear regression analysis identified age as the most significant predictor of increased CIMT in pwMS (p < 0.001), followed by BMI (p = 0.054).

CONCLUSION

This study demonstrates a significant association between MS and increased CIMT. Additionally, age emerged as the most prominent predictor of high CIMT in pwMS, followed by BMI. These findings suggest a potential link between MS and increased cardiovascular risk. Further research is warranted to explore the underlying mechanisms and investigate the long-term cardiovascular outcomes in this population.

Vascular function in multiple sclerosis: Systematic review with meta-analysis

BACKGROUND

Vascular comorbidities are prevalent in persons with multiple sclerosis (MS), yet less is known about underlying vascular function (VF). We performed a systematic review with meta-analysis of studies that compared VF in persons with MS and healthy controls and examined factors that may moderate the difference in vascular outcomes between groups.

METHODS

We conducted a systematic search using PubMed/MEDLINE, CINAHL, and Embase from inception through March 2024. The search identified studies that included comparisons of VF between MS and controls on a range of function and structure outcomes (e.g., pulse wave velocity, augmentation index, arterial diameter, intima-media thickness, flow-mediated dilation). Effect sizes were calculated as standardized mean differences (SMD) using Hedge's g with a positive effect indicating worse VF in MS than controls. The meta-analysis involved a multilevel random effects model with follow-up moderator analyses.

RESULTS

Fourteen studies met the inclusion criteria and yielded 49 effect sizes for meta-analysis. The MS subjects (N = 614) were predominantly female (72.0 %), with mean ages ranging from 29.9 to 54.4 years. There was a moderate difference in VF between persons with MS and healthy controls (SMD [95 % CI] = 0.56 [0.08, 1.03]; p = 0.02), and the effects were heterogenous (Q48=634.5, p < 0.01; I2=94.39 %). There was a greater difference in arterial stiffness between MS and controls (0.78 [0.21, 1.36], p = 0.008), but not in other arterial structure or function outcomes (p > 0.05). No significant moderators were detected (p > 0.05).

CONCLUSIONS

The cumulative evidence supports that persons with MS have worse VF, notably greater arterial stiffness, than healthy controls. Such findings support future research on the cause, consequences, and management of arterial stiffness among persons with MS.

Interleukin-6 cytokine: An overview of the immune regulation, immune dysregulation, and therapeutic approach

Several studies have shown that interleukin 6 (IL-6) is a multifunctional cytokine with both pro-inflammatory and anti-inflammatory activity, depending on the immune response context. Macrophages are among several cells that secrete IL-6, which they express upon activation by antigens, subsequently inducing fever and production of acute-phase proteins from the liver. Moreover, IL-6 induces the final maturation of B cells into memory B cells and plasma cells as well as an adaptive role for short-term energy allocation. Activation of IL-6 receptors results in the intracellular activation of the JAK/STAT pathway with resultant production of inflammatory cytokines. Several mechanisms-controlled IL-6 expression, but aberrant production was shown to be crucial in the pathogenesis of many diseases, which include autoimmune and chronic inflammatory diseases. IL-6 in combination with transforming growth factor β (TGF-β) induced differentiation of naïve T cells to Th17 cells, which is the cornerstone in autoimmune diseases. Recently, IL-6 secretion was shown to form the backbone of hypercytokinemia seen in the Coronavirus disease 2019 (COVID-19)-associated hyperinflammation and multiorgan failure. There are two classes of approved IL-6 inhibitors: anti-IL-6 receptor monoclonal antibodies (e.g., tocilizumab) and anti-IL-6 monoclonal antibodies (i.e., siltuximab). These drugs have been evaluated in patients with rheumatoid arthritis, juvenile idiopathic arthritis, cytokine release syndrome, and COVID-19 who have systemic inflammation. JAK/STAT pathway blockers were also successfully used in dampening IL-6 signal transduction. A better understanding of different mechanisms that modulate IL-6 expression will provide the much-needed solution with excellent safety and efficacy profiles for the treatment of autoimmune and inflammatory diseases in which IL-6 derives their pathogenesis.

Carotid intima-media thickness measurements in patients with multiple sclerosis

Objectives

The goal of this study was to evaluate the mean carotid intima-media thickness (CIMT) in patients with Multiple Sclerosis (MS).

Methods

In this cross-sectional study, 100 patients with MS were enrolled. Carotid intima-media thickness was measured by Doppler Ultrasonography. The mean CIMT was then compared between different groups of sex, age, body mass index (BMI), medications, and site of the MS plaques in the brain and cervical MRI. In addition, disease duration, annual relapse rate, and Expanded Disability Status Scale (EDSS) were compared between high and normal CIMT groups.

Results

Among 100 patients, Sixty-two percent of the patients were female. The mean age was 35.95 ± 9.32 years. Mean CIMT was 0.38 ± 0.2 mm, and 22% of the patients had abnormal CIMT measures. CIMT was significantly associated with higher age (P = 0.01) and prolonged disease duration (P < 0.001). CIMT was not associated with other disease factors or types of the disease-modifying drug (P > 0.05).

Conclusion

Multiple Sclerosis might be associated with carotid atherosclerotic vascular disease.

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MS is a chronic inflammatory and immune-mediated disease.

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Atherosclerosis is a complex and chronic inflammatory disease, Which is a predictor of cardiovascular disease.

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Intima-media thickness as a marker of atherosclerotic vascular disease can be assessed in Multiple Sclerosis.