Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Cognitive impairment is common in multiple sclerosis (MS), with as many as 70% of patients with MS affected. Individuals with MS who experience cognitive deficits are less likely to be employed, and may have more difficulty performing independent activities of daily living. Most commonly, deficits are observed in processing speed, complex attention, and memory. Because lesion location varies widely among individuals, no clear pattern of cognitive dysfunction in MS has emerged. However, a number of risk and protective factors may influence the likelihood of individuals to develop and/or express dysfunction, though the contribution of each to specific domains of cognition has not been fully explored. Recently, support for the cognitive reserve hypothesis (i.e., enriching life experiences protect against cognitive decline despite disease burden) has emerged in the MS literature. The current study investigated the contributions of cognitive reserve to learning and memory functioning in MS and the interaction of cognitive reserve variables and risk factors known to impact cognitive functioning in individuals with MS. Finding revealed cognitive reserve protects against decline in the domains of processing speed and complex attention. Furthermore, indirect protective effects of cognitive reserve through these domains were observed for verbal learning and memory. Finally, in line with previous literature, cognitive dysfunction predicted employment status of the current sample. Clinical implications and future directions for intervention efforts are discussed.

Alemtuzumab exerts its clinical efficacy by its specific pattern of depletion and repopulation of different immune cell subsets. Recently, single cases of multiple sclerosis patients who developed severe exacerbation after the first alemtuzumab application, accompanied by re-appearance of peripheral B cells, were reported. Here we present a case with underlying B cell-driven multiple sclerosis that impressively improves after alemtuzumab, although peripheral B cell repopulation took place. Our detailed clinical, histopathological, imaging and immunological data suggest that alemtuzumab can act as an effective rescue treatment in highly active B cell-driven and antibody/complement-mediated multiple sclerosis type II patients.

The Major Histocompatibility Complex (MHC) is a genomic region in chromosome 6 which has been consistently found to be associated with the risk of developing virtually all common autoimmune diseases. Although its importance in disease pathogenesis has been known for decades, efforts to disentangle the roles of the classical human leukocyte antigens (HLA) and other variants responsible for the susceptibility to disease have often met with limited success, owing to the complex structure and extreme heterogeneity of the region. In this thesis, I interrogate the MHC for association with three common autoimmune diseases, ankylosing spondylitis, psoriasis and multiple sclerosis, with the aim of confirming the previously-reported associations and of identifying novel ones. To do so, I employ a systematic, joint analysis of single nucleotide polymorphism (SNP) and HLA allele data, in a logistic regression framework, using a recently developed algorithm to predict the HLA alleles for samples where such information is unavailable. To ensure the reliability of the analysis, I apply stringent quality control procedures and integrate over the uncertainty of the HLA allele predictions. Moreover, I resolve the haplotype phase of individuals from the HapMap project to create reliable reference panels, used in both HLA prediction and in quality control procedures. By directly testing HLA subtypes for association with the disease, the power to detect such associations is increased. I present the results of the analysis on the three disease phenotypes and discuss the evidence for important novel findings amongst both SNPs and HLA alleles in two of the diseases. In the final part of this thesis, I introduce a novel, model-based approach to detect inconsistencies in the data and show how it can be used to flag problematic SNPs which conventional quality control procedures may fail to identify.

Endogenous retroviruses (of the HERV-W family) represent about 8% (1%) of our genome. Their endogenous and exogenous forms (MSRV, Multiple Sclerosis-associated RetroVirus) can alter the regulation of the immune system and be involved in inam- matory and autoimmune pathologies (Multiple Sclerosis). The MSRV envelope protein (ENV) stimulates T lymphocytes by acting as a superantigen. It also interacts with mono- cytes and dendritic cells via membrane receptors, thereby provoking inammatory cytokine production. Our studies are based on the characterisation of the immunological cascade leading from the interaction of the viral envelope with its receptor to the pathological inammatory reaction. The work presented in this thesis combines an in vitro cellular and molecular approach with an in vivo validation using an animal model (mouse). The chosen animal model is Experimental Autoimmune Encephalomyelitis (EAE) in which the complete Freund's adjuvant can be replaced by ENV. Its effects on the murine organism are evaluated on several levels: analysis of behaviour (clinical score) and brain (IRM), cellular and molecular analysis of the immune system. Furthermore, we want to generate a transgenic mouse model expressing different ENVs (MSRV/HERV) under the control of different promoters since MSRV/HERV are found only in great apes. This model, of which the rst steps of elaboration are part of this work, will allow us to study the behaviour of the ENV over-expressing animals as well as their brain and the effects on the immune system.

No description available.

Multiple Sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The etiology of MS is unknown but many researchers believe that it is autoimmune mediated. This study investigated naive CD4+ and naive CD8+ T-cell homeostasis in patients with Primary Progressive Multiple Sclerosis and Relapsing Remitting Multiple Sclerosis. The naive T-cell compartment involves a balance between thymic production of naive T-cells, homeostatic proliferation and the delivery of death and survival signals. Naive T-cell production was quantified by measuring signal joint T-cell receptor excision circles (sj-TRECs); episomal byproducts formed during V(D)J T-cell receptor rearrangement. / Homeostatic proliferation was quantified by flow cytometry analysis of % expression of CD31 and Ki-67. CD31 is a marker found on CD4+ recent thymic emigrants (RTE) but not on naive T-cells that have undergone homeostatic proliferation. CD31 can be used as a marker of the proliferation history of naive CD4+ T-cells. Ki-67 is a nuclear and nucleolar antigen found in actively cycling cells. It can be used as a marker of cell proliferation at the moment of isolation. Cell survival was measured by quantifying plasma IL-7 levels and by measuring Bcl-2 expressions. IL-7 plays an important role in maintaining and restoring peripheral naive T-cell homeostasis. It stimulates naive T-cell proliferation and prevents the reduction of Bcl-2, an antiapoptotic protein. / In this study, PPMS patients had significantly reduced naive CD4 + T-cell sj-TRECs compared to healthy controls (p = 0.0007) and compared to RRMS patients (p = 0.0010). RRMS patients had fewer sj-TRECs than healthy controls but this difference was not significant (p = 0.4652). Similarly, in PPMS, naive CD4+ T-cells had significantly lower CD31 expression than healthy controls (p = 0.0017) and RRMS patients (p = 0.0032). This finding indicates increased homeostatic proliferation in naive CD4 + T-cells in PPMS, most probably a response to decreased thymic export as marked by the decreased naive CD4+ T-cell sj-TRECs. % CD31 expression in naive CD4+ T-cells did not differ significantly in RRMS compared to healthy controls (p = 0.7455) which is consistent with their naive CD4+ sj-TREC levels. / Naive CD8+ T-cell sj-TRECs were significantly reduced in PPMS patients compared to healthy controls (p = 0.0212) but not compared to RRMS patients (p = 0.2379). RRMS patients had fewer naive CD8 + T-cell sj-TRECs compared to healthy controls but this difference was not significant (p = 0.1517). PPMS patients expressed increased Bcl-2 levels in their naive CD8+ T-cells. This finding indicates upregulation of survival signals, most probably a consequence of reduced thymic export of naive CD8+ T-cells. / The data from this study indicate that PPMS is different from RRMS in their naive CD4+ T-cell sj-TRECs and naive CD4 + T-cell % CD31 expression but is similar to RRMS in their naive CD8+ T-cell sj-TRECs. This study concludes, therefore, that both PPMS and RRMS patients have altered naive T-cell homeostasis.

Many phenomena in the BAEP are difficult to explain on the basis of the accepted hypothesis of its origin (after Jewett, 1970). The alternative mechanism of origin to which these phenomena point is summation of oscillations. Therefore, simulation of the BAEP by a mathematical model consisting of the addition of four sine waves was tested. The model did simulate a normal BAEP as well variations in the waveform produced by reversing click polarity. This simulation gives further clues to the origin of the BAEP. The four sine waves begin simultaneously; corresponding BAEP oscillations must, therefore, originate from a single structure. These oscillations begin in less than half a millisecond after the click. This suggests that the structure from which they arise is outside the brainstem. This alternative mechanism indicates that wave latencies do not reflect nervous conduction between discrete nuclei, and interpretation of BAEP abnormality need to be reconsidered. It also implies that mathematical frequency analysis is more appropriate, but this could be applied only when these methods have been perfected. Meanwhile, through visual analysis and recognition of oscillations, abnormality can be detected and described in terms that may have physiological significance.

Medical computer vision is a novel research discipline based on the application of computer vision methods to data sets acquired via medical imaging techniques. This work focuses on magnetic resonance imaging (MRI) data sets, particularly in studies of schizophrenia and multiple sclerosis. Research on these diseases is challenged by the lack of appropriate morphometric tools to accurately quantify lesion growth, assess the effectiveness of a drug treatment, or investigate anatomical information believed to be evidence of schizophrenia. Thus, most hypotheses involving these conditions remain unproven. This thesis contributes towards the development of such morphometric techniques. A framework combining several tools is established, allowing for compensation of bias fields, boundary detection by modelling partial volume effects (PVE), and a combined statistical and geometrical segmentation method. Most importantly, it also allows for the computation of confidence bounds in the location of the object being segmented by bounding PVE voxels. Bounds obtained in such fashion encompass a significant percentage of the volume of the object (typically 20-60%). A statistical model of the intensities contained in PVE voxels is used to provide insight into the contents of PVE voxels and further narrow confidence bounds. This not only permits a reduction by an order of magnitude in the width of the confidence intervals, but also establishes a statistical mechanism to obtain probability distributions on shape descriptors (e.g. volume), instead of just a raw magnitude or a set of confidence bounds. A challenging clinical study is performed using these tools: to investigate differences in asymmetry of the temporal horns in schizophrenia. This study is of high clinical relevance. The results show that our tools are sufficiently accurate for studies of this kind, thus providing clinicians, for the first time, with the means to corroborate unproven hypotheses or reliably assess patient evolution.