Antibodies and disease activity

Epub ahead of printDurante et al. Intrathecal synthesis of IgM measured after a first demyelinating event suggestive of multiple sclerosis is associated with subsequent MRI brain lesion accrual. Mult Scler. 2011 Sep 30.


Background: Previous studies have demonstrated that production of a type of antibody called IgM within the brain and spinal cord is observed in MS'ers and correlates with a worse disease course.

"Antibodies are specialised proteins produced by our immune system to fight infections; IgM is a very large protein and is usually the first antibody produced in response  to an infection or vaccine."

There is also basic research that  suggest that IgM participates in the formation of MS lesions.

Objective: The aim of the present study was to assess the potential association between the level of spinal fluid IgM measured after a clinically isolated syndrome (CIS or first presentation of MS) and the subsequent formation of brain lesions. 

Methods: 57 MS'ers with a CIS and a high risk developing MS were enrolled in a longitudinal study. Examination of cerebrospinal fluid was performed after the CIS. MS'ers were assessed with MRI at baseline and after an average follow-up period of 49 months (range 36-60). 

Results: The level of IgM in the spinal fluid was correlated with the number of active or enhancing lesions at baseline and with accrual of brain lesions during the follow-up period. Interestingly, the level of IgG (a smaller antibody that is produced later during an immune response) did not correlate with MRI activity.

Conclusion: The present study demonstrates that the level of IgM synthesis within the brain and spinal cord measured after a CIS is associated with subsequent lesion accrual during the first years of MS. This result emphasizes the involvement of IgM in plaque formation.

"This study emphasises the need to provide some teaching posts on the immune system to make sure you are all up to speed on terms related immunology or the immune system."

"This study supports previous studies that have shown that antibody production within the brain and spinal cord plays a role in the pathology of MS and drives disease activity. Other studies have linked this phenomenon to progressive disease and cortical or gray matter pathology. This is why it is important to develop drugs that target the cells in the brain that produce these antibodies. Unfortunately, to date none of the drugs we use in MS or ones in development have been shown to reduce the antibody production within the brain and spinal cord. This is why I have a nagging suspicion that the emerging drugs, including the more effective ones, may not necessarily prevent the development of progressive disease, but may slow it down. Let's hope I am wrong."


"This post tells us how little we really know about the mechanisms of disease progression. We have hypotheses or theories, but don't know if they are correct. By doing clinical trials we will find the answers to these questions."

Labels: , , , ,