Neuromuscular rate of force development discriminates fallers in ambulatory persons with multiple sclerosis - an exploratory study

BACKGROUND

Falls as well as fall-related injuries (e.g., bone fractures) are common in persons with multiple sclerosis (pwMS). Whilst some studies have identified lower extremity maximal muscle strength (Fmax) as one among several risk factors, no previous studies have investigated the association between rate of force development (RFD; ability to generate a rapid rise in muscle force) and falls in pwMS. Not only is RFD substantially compromised (and more so than Fmax) in pwMS, studies involving other neurodegenerative populations have shown that RFD - to a greater extent than Fmax - is crucial for counteracting unexpected perturbations and avoiding falling.

OBJECTIVE

To explore whether knee extensor RFD (and Fmax) can discriminate fallers from non-fallers in pwMS.

METHODS

Knee extensor neuromuscular function (comprising RFD_50ms and RFD_200ms (force developed in the interval 0-50 ms and 0-200 ms, respectively) as well as Fmax) of the weaker leg was assessed by isokinetic dynamometry. Falls were determined by 1-year patient recall, with pwMS subsequently being classified as non-fallers (0 falls), fallers (1-2 falls), or recurrent fallers (≥3 falls).

RESULTS

A total of n=53 pwMS were enrolled in the study, with n=24 classified as non-fallers (63% females, 48 years, EDSS 2.2), n=16 as fallers (88% females, 57 years, EDSS 3.3), and n=13 as recurrent fallers (46% females, 60 years, EDSS 4.2). Compared with non-fallers, neuromuscular function was reduced in both fallers (RFD₅₀ -4.42 [-7.47;-1.37] Nm^.s^-1.kg^-1, -48%; RFD₂₀₀ -1.45 [-2.98;0.07] Nm^.s^-1.kg^-1, -24%; Fmax -0.42 [-0.81;-0.03] Nm^.kg^-1, -21%) and recurrent fallers (RFD₅₀ -5.69 [-8.94;-2.43] Nm^.s^-1.kg^-1, -62%; RFD₂₀₀ -2.26 [-3.89;-0.63] Nm^.s^-1.kg^-1, -38%; Fmax -0.38 [-0.80;0.03] Nm^.kg^-1, -19%). Across all participants, associations were observed between RFD_50ms and falls (r_s = -0.46 [-0.67;-0.24], between RFD_200ms and falls (r_s = -0.34 [-0.59;-0.09]), and between Fmax and falls (r_s = -0.24 [-0.48;0.01]).

CONCLUSION

In this exploratory study, knee extensor neuromuscular function was able to discriminate fallers from non-fallers in pwMS, with RFD being superior to Fmax. Routine assessment of lower extremity neuromuscular function (RFD_50ms in particular) may be a helpful tool in identifying pwMS at future risk of falling.

An epitope delivery system for use with recombinant mycobacteria

We have developed a novel epitope delivery system based on the insertion of peptides within a permissive loop of a bacterial superoxide dismutase molecule. This system allowed high-level expression of heterologous peptides in two mycobacterial vaccine strains, Mycobacterium bovis bacille Calmette-Guérin (BCG) and Mycobacterium vaccae. The broader application of the system was analyzed by preparation of constructs containing peptide epitopes from a range of infectious agents and allergens. We report detailed characterization of the immunogenicity of one such construct, in which an epitope from the Der p1 house dust mite allergen was expressed in M. vaccae. The construct was able to stimulate T-cell hybridomas specific for Der p1, and it induced peptide-specific gamma interferon responses when used to immunize naive mice. This novel expression system demonstrates new possibilities for the use of mycobacteria as vaccine delivery vehicles.

Induction of T cell responses to the invariant chain derived peptide CLIP in mice immunized with the group 1 allergen of house dust mite

In this study we demonstrate that immunization of H-2(b) mice with the allergen Der p 1 induces MHC class II restricted T cells that proliferate to residues 15-29 of Der p 1 (p15-29) and to the murine MHC class II-associated invariant chain derived peptide (CLIP). T cells from naive H-2(b) mice and those immunized with murine CLIP fail to respond to either CLIP or p15-29. T cell lines and clones reactive with p15-29 strongly proliferate in response to splenic antigen-presenting cells (APC) from normal H-2(b) mice but show reduced proliferation to APC from invariant chain deficient mice. Furthermore, T cells isolated from Der p 1 primed mice and expanded on H-2(b) spleen cells in the absence of the p15-29 epitope retained specificity for both p15-29 and CLIP, suggesting that naturally presented self components can act as mimetic peptides and may maintain T cell memory to foreign antigens.

Peptide modulation of allergen-specific immune responses

In vitro peptide stimulation of allergen-reactive T-helper type 1 and type 0 cells, in the absence of costimulatory signals, induces anergy that is accompanied by the modulation of cell surface phenotype and changes in cytokine production. In experimental animal models, the administration of allergen-derived peptides may result in the downregulation of cytokine and antibody production, which is preceded by transient activation of CD4+ T cells, without the induction of effector immunity. Preliminary results of clinical trials using allergen-derived peptides for desensitization are becoming available and should provide some insight into the efficacy of peptide therapy in man.