Thesis (Ph.D)--University of Tennessee Health Science Center, 2007. / Title from title page screen (viewed on July 22, 2008). Research advisor: Terrence L. Geiger, MD, Ph.D. Document formatted into pages (xiv, 149 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 140-149).

Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that is characterized by widespread focal areas of inflammation and demyelination. Although the exact cause of the disease is still not known, myelin-reactive T cells that enter the CNS trigger the disease and lead to the recruitment and activation of macrophages and other immune cells. One set of candidates that could serve to mediate these CNS changes is the family of phospholipase A2 (PLA2) enzymes, which consist of secreted (sPLA2) and cytosolic (cPLA2) forms. These enzymes hydrolyze membrane phospholipids to release free fatty acids (arachidonic acid) that can stimulate complex inflammatory cascades, and lysophospholipids that can induce myelin breakdown and demyelination, the two pathological hallmarks of MS. / For my Ph.D. research I studied the expression and role of different members of the PLA2 family in 'experimental autoimmune encephalomyelitis' (EAE), a widely used animal model of MS. I first generated a relapsing-remitting form of EAE in the C57BL/6 mouse strain that lacks a major form of sPLA2. I showed that cPLA2 is expressed by immune cells in the EAE lesions in the CNS. Furthermore blocking the activity of cPLA2 with a broad-spectrum chemical inhibitor starting at the time of EAE induction reduced the incidence and severity of disease, reduced lesion burden as well as reduced the expression of a number of chemokines and cytokines. Treating mice in the remission phase also prevented further clinical episodes. This showed that some or all members of the cPLA2 family play an important role in the onset and progression of EAE in a strain of mice lacking sPLA2. / I next carried out studies to assess the expression of all 14 members of the sPLA2 and cPLA2 families at the onset, peak and remission stages of EAE in the SJL/J mouse strain that expresses all forms of PLA2. The mRNA expression of only 4 of these PLA2s was increased. These include sPLA2 (groups IIA and V) and cPLA 2 (groups IVA and VIA). The expression of these PLA2s in the CNS was also characterized by double-immunofluorescence. The role of these PLA2s was assessed using selective inhibitors and analysed by monitoring the clinical disability scores, chemokine/cytokine protein arrays, lipomics lipid profiling, and histological analysis. Surprisingly, the sPLA2 inhibitor prevented disease remission and worsened the clinical outcome. This was accompanied by an increase in several pro-inflammatory chemokines. Selective inhibitors of cPLA2 group IVA and the calcium independent foam group VIA (iPLA2) reduced severity of EAE when given starting before onset of disease. The cPLA2 inhibitor treatment was effective only while administered, while iPLA2 inhibitor treatment was effective even after treatment was stopped. Furthermore, only delayed treatment with the iPLA2 inhibitor was effective, suggesting that cPLA2 group IVA only plays a role in the initiation of disease, while iPLA 2 plays a role in both disease onset and progression. These effects were also associated with concomitant reduction in chemokine/cytokine expression, reduction of inflammatory lipid mediators, and increase in protective lipids e.g., omega 3 fatty acids. / This work has allowed us to dissect out the expression and role of different members of the PLA2 family and has revealed the importance of selectively inhibiting some but not others in EAE. These findings may therefore have important implications for the treatment of MS.

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This thesis presents methods for quantitative MRI analysis of brain injury, repair and degeneration in multiple sclerosis (MS) that provide new insights into disease pathogenesis and evolution. / Demyelinated and inflammatory white-matter lesions are hallmark features of MS. A methodology is described to detect regions of acute white-matter lesions that undergo myelin destruction and repair based on analysis of magnetization transfer ratio (MTR) images. Validation is performed based on histopathology and error is assessed based on same-day scans. To quantify the spatial extent and temporal evolution of myelin destruction and repair, data from a 3-year clinical trial is analyzed using this method. Approximately 20% of acute lesion voxels show some repair over the initial 7 months. In subsequent months, there is little further repair, but some increases in the lesion volume undergoing demyelination. / Although less conspicuous on conventional MRI, there is considerable MS pathology in the brain tissue outside of white-matter lesions. An image-processing methodology was developed to obtain accurate metrics that quantify change over time in whole-brain MTR (associated with changes in myelin-density) and in T2 relaxation time (associated with changes in inflammatory edema). These metrics, in addition to metrics of brain atrophy and axonal integrity, were used to quantify brain injury and degeneration following immunoablation and autologous hematopoietic stem cell transplantation therapy for MS. Pronounced brain volume loss was detected immediately following therapy, associated with decreased myelin density and not resolution of edema. / Post-mortem histopathology has revealed abnormalities in the cortical grey-matter of MS patients that appear to be independent of white-matter lesions. A methodology to quantify neocortical injury and degeneration that yields cross-sectional and longitudinal metrics of cortical thickness and grey-matter/white-matter interface integrity both globally and regionally is presented and validated. MS patients with progressive disability showed greater decreases in cortical metrics compared to MS patients with stable disability. / The quantitative MRI analysis methods presented in this thesis are applicable to MRI data obtained in clinical trials of therapies for MS, have the necessary sensitivity and specificity to assess therapeutic efficacy, and provide new insights into disease pathogenesis and evolution.

Brain atrophy has been used as a marker for disease progression in Multiple Sclerosis (MS). SIENA, an automated tool for measuring brain volume change, was tested to see whether MRI slice thickness and gap presence affect longitudinal atrophy measures. Isotropic global scan-rescan images were used to simulate 3 mm and 5 mm axial slice thicknesses with 1 and 2mm gaps, respectively. SIENA remained accurate and precise with increasing slice thickness and gap presence. Furthermore, symmetric pre-registration was crucial for scans with larger slice-thickness and gaps. / SIENA was used to observe atrophy in children who have experienced a Clinically Isolated Syndrome (CIS) of the type leading to MS (CIS-MS). Brain atrophy was present within the first three months after a CIS event, and then subsided over the rest of the year. If the first acute episode was excluded, there was no significant difference in atrophy rates between the CIS-MS group and the CIS group, and no significant difference between those with T2-weighted brain lesions versus those who had none.

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