Antibodies against different viral antigens in cerebrospinal fluid of patients with multiple sclerosis and other neurological diseases

Clinically observed chickenpox and the risk of childhood-onset multiple sclerosis

The authors conducted a population-based case-control study to investigate whether clinically observed chickenpox, linked with a level of intensity for clinical expression, increases the risk of multiple sclerosis (MS) in childhood. The cases were MS patients whose disease onset occurred between 1994 and 2003, before age 16 years, in France. Each case was matched for age, sex, and geographic origin with as many as 12 controls randomly selected from the general population. Information about clinically observed chickenpox in cases and controls before the index date regarding onset of MS was collected with a standardized questionnaire and was checked against health certificates. Conditional logistic regression was used to estimate the odds ratio for an association between MS and chickenpox. The 137 MS cases were matched with 1,061 controls. Clinically observed chickenpox had occurred in 76.6% of the cases and 84.9% of their matched controls. The adjusted odds ratio of MS onset associated with chickenpox occurrence was 0.58 (95% confidence interval: 0.36, 0.92). The authors concluded that clinically observed chickenpox was associated with a lower risk of childhood-onset MS in a French population.

Mitogen and antigen stimulation of multiple sclerosis cerebrospinal fluid lymphocytes in vitro

Responses of cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocytes from 20 MS patients to phytohemagglutinin (PHA), measles, rubella, mumps and herpes simplex virus antigens were followed during periods of from 6 to 13 months. Up to 6 examinations, each with 1-5 stimulants, were performed with a lymphocyte blast transformation test. Most of the patients responded with their CSF cells to PHA (14/19) and at least to some of the viral antigens tested (15/20) during the follow-up. Although the maximal responses of CSF and PB cells to PHA and measles virus antigen were of the same magnitude, non-reactive or weakly responding lymphocytes were more common in CSF than in PB. In 7 of 15 patients having viral antigen responsive CSF cells simultaneous reactivity to several antigens could be shown. The stimulation results of CSF lymphocytes did not correlate with the numbers of CSF leukocytes or the intrathecal IgG synthesis. A negative correlation was observed between the strength of the CSF cellular response to PHA or measles virus antigen and the rate of intrathecal antibody synthesis to measles virus antigen, suggesting that the stimulated cells may at least partially represent suppressor cells.

Intrathecal synthesis of virus antibodies in multiple sclerosis patients

A follow-up study on the intrathecal synthesis of viral antibodies in multiple sclerosis patients was made on 28 patients over a period of about 2 years. Serial serum and cerebrospinal fluid specimens were assayed for antibodies against measles, rubella, parainfluenza type 2, respiratory syncytial, mumps, influenza A, influenza B, adeno, and herpes simplex viruses by employing a solid-phase enzyme immunoassay technique. All patients had local antibody synthesis against one or more of the antigens studied. Rubella and measles virus antibodies were found with the highest frequency and were synthesized at the highest rate. Simultaneous intrathecal antibody synthesis against the greater number of the viruses studied was associated with higher local immunoglobulin G synthesis. A good overall correspondence in the fluctuations of the different viral antibodies synthesized intrathecally was usually found. Sometimes the changes in intrathecal antibody levels correlated well with the changes in immunoglobulin G index and sometimes not. These fluctuations could not be correlated with the clinical course of the disease. The results of this study suggest that the viral antibodies studied are not relevant to the etiology or the pathogenesis of multiple sclerosis.

Myelin basic protein antibodies in the serum and CSF of multiple sclerosis and subacute sclerosing panencephalitis patients

A solid-phase radioimmunoassay was developed for the detection of myelin basic protein antibodies of immunoglobulin G (IgG) class. Purified basic protein of myelin (MBP) was adsorbed onto polystyrene beads, followed by incubation in dilutions of serum or cerebrospinal fluid (CSF). 125I-labelled anti-human IgG was used to quantify antibodies bound to the solid-phase. The assay was optimized in tests with rabbit antibodies to MBP and with 125I-labelled anti-rabbit IgG. Serum and CSF specimens from 41 multiple sclerosis (MS), 16 subacute sclerosing panencephalitis (SSPE) and 58 control patients were tested for MBP antibodies. No statistically significant differences were found between MS and control patient groups, but the subgroup of acute MS patients had slightly elevated (P 0.02) antibody levels in their CSF specimens. The SSPE patients had markedly elevated levels (P 0.001) of antibodies to MBP in their CSF specimens.

The significance of abnormal immune responses in patients with multiple sclerosis

Early diagnosis of multiple sclerosis (MS) may be assisted by tests for the abnormal immune responses of the central nervous system (CNS) including oligoclonal IgG bands in the cerebrospinal fluid (CSF), increased CNS IgG synthesis, increased CNS antibody synthesis against multiple viruses and increased numbers of enlarged lymphoid cells in the CSF. Alterations in immunological responses are important in the pathogenesis of MS. Further studies are needed, however, to identify the antigen(s) and/or antibodies responsible for oligoclonal IgG in the CSF of MS patients. Also, the cause(s) for the other immunological abnormalities with diagnostic importance need to be identified. The increased synthesis of antibodies against multiple unrelated viruses suggests generalized alteration in the immune regulatory system. The etiology of MS might be multifactorial involving abnormal immunological responses, possibly precipitated by infectious agents acquired during childhood by genetically susceptible individuals. The immunological responses including alterations in myelin basic protein concentration, antimyelin antibody and immune complex activities in CSF, and in vitro stimulation, suppression and migration inhibition of blood lymphocytes appear to correlate with stage of MS and severity of CNS damage. Some of the tests may become useful in estimating the prognosis of the disease. Longitudinal studies are needed to clarify the sensitivity of the diagnostic and prognostic immunological tests and etiological significance of these abnormalities in MS.

Lymphocyte blast transformation responses and viral antibodies in relation to HLA antigens in multiple sclerosis

Fifty four clinically stable multiple sclerosis (MS) patients and 54 age- and sex-matched control subjects were HLA-typed, and their responses to herpes simplex, measles, mumps and rubella antigens were examined by the lymphocyte blast transformation test and by serum antibody titrations. Blast transformation response to purified tuberculin (PPD), mitogen phytohaemagglutinin (PHA), pokeweed mitogen (PWN) and concanavalin A (Con A) and spontaneous proliferation of lymphocytes were also studied. MS patients differed from controls by higher antibody levels to measles and rubella viruses and by lower specific blast transformation responses to rubella and measles antigens. When the relative strength of transformation responses was measured, mumps and herpes simplex responses were also lower in MS patients than in controls. In addition, spontaneous lymphocyte proliferation of MS patients in 6-day cultures was lower than that of control lymphocytes. In mitogen stimulations there were no differences between whole groups, but the oldest patients had lower responses to PHA and Con A than their matched controls. The frequency of HLA-Dw2 was 56.6% in MS patients and 32.1% in controls. The patients with and without Dw2 differed from each other only by a lower specific response to PPD in the Dw2-positive group. The immunological response of Dw2-positive controls resembled that of MS patients: low transformation response to viral antigens, low spontaneous proliferation and elevated measles antibodies. This finding supports the function of a genetically determined type of immune responsiveness with low cell-mediated immunity and high levels of certain viral antibodies as one susceptibility factor in multiple sclerosis.

Cerebrospinal fluid and serum immunoglobulins and antibody titers in mumps meningitis and aseptic meningitis of other etiology

Cerebrospinal fluid (CSF) and serum from 19 patients with mumps meningitis and 19 patients with meningitis of other etiology were investigated on two or more occasions for at least 1 month after onset. Intrathecal synthesis of immunoglobulin (Ig) G was found in 55%, of IgA in 26%, and of IgM in 24% of the patients. Oligoclonal Ig was demonstrable by agarose gel electrophoresis in 37% of the patients, mostly already during the first week after onset, and could persist for years. Mumps virus antibody synthesis within the central nervous system occurred in 37% of the mumps meningitis patients. The inflammatory reaction within the central nervous system as reflected by mononuclear pleocytosis, Ig synthesis, and oligoclonal Ig was not correlated to the clinical course. The blood-brain barrier was evaluated by determination of the CSF total protein, CSF/serum albumin ratio, and CSF/serum alpha2-macroglobulin ratio. A significant correlation was found among these three parameters. Persistence of the elevated CSF/serum albumin ratio seems to influence prognosis, and this parameter is recommended for evaluation of the blood-brain barrier function.

Multiple sclerosis: local synthesis of electrophoretically restricted measles, rubella, mumps and herpes simplex virus antibodies in the central nervous system

An imprint electroimmunofixation (IEIF) technique was used to study measles, rubella, mumps and herpes simplex virus antibodies in serum and concentrated cerebrospinal fluid (CSF) from ten patients with multiple sclerosis (MS). Electrophoretically restricted virus-specific antibodies were detected in sera or CSF from nine of the ten patients. Comparison of the antibody patterns in matching serum and CSF samples indicated that electrophoretically restricted populations of antibody against one or more of the four viruses were produced locally in the central nervous system of nine patients. No association between the locally produced antibody populations the oligoclonal IgG of the CSF could be demonstrated. The virus-specific antibodies studied thus seem to constitute only a minor fraction of the total IgG of the CSF from MS patients.

Tetanus antibody production in serum and cerebrospinal fluid in the rabbit and correlated histopathological features of the central nervous system

The histopathological features in the central nervous system (CNS) developing during the active phase of tetanus antibody formation in the cerebrospinal fluid (CSF) as induced in 15 rabbits were studied. The measurement of antibody titres in serum and CSF by electroimmunodiffusion and histological examination were done sequentially at the 1st, 3rd, 5th, 7th and 9th days after cisternal secondary inoculation with fluid tetanus toxoid. Tetanus antibodies appeared in serum after the 1st and in CSF after the 5th day. Decreasing values of CSF total protein were found. The meaning of an elevated Q ratio as observed in this situation of strong antibody formation in the CSF was enhanced. The histopathological features in the central nervous system consisted of perivascular inflammatory infiltration, at first polymorphic and then composed almost exclusively of mononuclear cells with a predominantly leptomeningeal and subpial localization, which might represent the origin of CSF tetanus antibodies. The localization was related to the contact zone between the antigen- and antibody-containing compartments, respectively the subarachnoid space and vascularized structures of the brain and spinal cord. Four control rabbits presented neither tetanus antibodies in the CSF nor perivascular inflammatory infiltration in the CNS. Similarity between the present experimental results and the immunopathological features of the primary demyelinating diseases provides some useful information about the immunological inflammatory events in these diseases.

Direct leukocyte migration inhibition in multiple sclerosis--a possible assessment of activity

Twenty-four patients with multiple sclerosis were evaluated and classified according to their clinical state. Specific migration inhibition studies were carried out on blood samples from each using myelin basic protein, an acid soluble protein fraction isolated from normal human CNS white matter, and multiple sclerosis myelin basic protein isolated from patients who had the disease, as the antigenic material. This test system employed selected media. Results were compared with those of normal controls and patients with other neurological disease states. Antigen concentration of 500 mu g/ml in serum free medium combined to produce the greatest inhibiting effect on leukocytes in patients with apparent multiple sclerosis and differentiated these patients from those in the other groups tested. Leukocytes in patients who had probable multiple sclerosis with partial impairment, signifying possible current activity of the disease, were especially inhibited as compared to the leukocytes from other groups tested against myelin antigen. Cerebrospinal fluid from affected patients when used as a media enhanced the test. This study suggests that migration inhibition of peripheral leukocytes using myelin protein may be useful in the diagnosis of patients with multiple sclerosis. There is additional evidence that the degree of leukocyte migration inhibition may reflect activity of the disease with its consequent implications on treatment and prognosis.

Virus antibody levels in the cerebrospinal fluid from patients with optic neuritis

Virus antibody levels were studied in the cerebrospinal fluid (CSF) of 58 patients with optic neuritis and 58 control patients with no indication of multiple sclerosis (MS) or infectious disorders of the central nervous system (CNS). The specimens were tested against three different structural components of measles virus with measles hemagglutination inhibition (HI), measles hemolysis inhibition (HLI) and gel precipitation (GP) tests. Measles antibodies occurred in 62 per cent of CSF specimens from patients with optic neuritis, and 21 per cent of the controls. In the specimens from patients with optic neuritis, the positive rate figures were: for rubella HI test 35, parainfluenza-1 HI 16, and Epstein-Barr virus immunofuorescence (IF) 53 per cent. The frequencies in the control group were 10, 10 and 26 per cent, respectively. Serum/CSF antibody ratios below 80 occurred in measles tests in 45 per cent of patients with optic neuritis and 16 per cent of the control group. Some patients with optic neuritis (but none from the control group) had a reduced serum/CSF antibody ratio in more than one measles antibody test, The patients with optic neuritis had a higher frequency of low serum/CSF albumin ratios indicating blood brain barrier damage, There were, however, several patients with a normal serum/CSF albumin ratio but low serum/CSF immunoglobulin G and measles antibody ratios. This supports the hypothesis that local production of measles antibodies takes place in CNS in some patients with optic neuritis as well as in MS patients. The CSF specimens were further tested against 12 other viruses and mycoplasma pneumoniae complement fixation, but there were no positive specimens. New CSF specimens were taken from five patients during optic neuritis, and from seven patients later on during the follow-up because of the appearance of new neurological symptoms. There were no changes in virus antibody levels, except for two patients with an increase of measles virus antibody titres.

Virus antibody levels in serum specimens from patients with optic neuritis and from matched controls;

Virus antibody levels in serum specimens taken in acute and convalescent phases from 77 patients with optic neuritits were tested by measles hamagglutination inhibition (HI), measles hemolysis inhibition (HLI), rubella HI, parainfluenza-1 HI, Epstein-Barr immunofluorescence (IF), and against 11 other viruses and mycoplasma pneumoniae with the complement fixation (CF) technique. The virus antibody levels were indicated to be usually very stable, and a fourfold change in virus antibody levels was demonstrated in only eight patients. The virus antibody levels were compared with specimens from two carefully selected control groups. The first control group consisted of 71 healthy persons matched in age, sex and place of residence with the patients with optic neuritis. The other control group consisted of 58 patients with various neurological diseases other than multiple sclerosis (MS) or infectious diseases of the central nervous system. The patients with optic neuritis had significantly higher measles antibody titres than the two control groups in both measles HI and measles HLI tests. Also in 33 patients with optic neuritis of unknown cause, the measles antibody levels were higher than in the control groups. On the other hand, various other antibody tests showed no statistically significant differences between patients with optic neuritis and the control group.

Measles virus-specific IgG in cerebrospinal fluid in multiple sclerosis

The prevalence of measles virus-specific IgG in cerebrospinal fluid (C.S.F.) of patients with multiple sclerosis (M.S.) has been compared with that in fluids from patients with other neurological diseases and from normal control subjects. The prevalence in the three groups was 58.1%, 24.1%, and 0% respectively. Fivefold concentration of the specimens increased the prevalence in the first two groups to 80.6% and 34.5% respectively, while measles IgG was not detected in any fluids of the normal control group, even after concentration.