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Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing demyelinating neurological condition that requires prompt diagnosis and treatment to prevent the accrual of significant disability, such as blindness and immobility. It is caused by antibodies to the aquaporin-4 water channel, which can be detected within the serum of patients and are therefore a highly specific biomarker for the condition. However NMOSD can have overlapping clinical features with the more prevalent demyelinating disease relapsing remitting multiple sclerosis (RRMS). Thus in the situation of a negative aquaporin-4 antibody assay result diagnostic distinction can be difficult to achieve. This in turn leads to a treatment dilemma as NMOSD requires long term immunosuppression, and disease modifying therapies used in RRMS can worsen disease activity in NMOSD. The work presented in this thesis aimed to find further biomarkers of NMOSD, focusing on conventional and quantitative magnetic resonance imaging, and markers of neurodegeneration. The principle findings are: <ul><li>Lesion probability mapping analysis revealed that T2 lesion distribution and morphology can distinguish RRMS from NMO with a 92% sensitivity and 96% specificity. Radiological criteria to aid diagnosis have been proposed.</li><li>Quantitative imaging methods that provide complementary micro-structural measures within CNS tissue have shown that RRMS is associated with widespread neurodegenerative changes in the normal appearing tissue, where as NMO is lesion focused.</li><li>NMO is not associated with diffuse global neurodegeneration in the non-lesioned CNS tissue over a one-year period as determined by serial MRI.</li><li>Normalised thalamic and whole brain volume can be used in a function to help discriminate NMOSD and RRMS</li></ul> This thesis therefore contributes the knowledge that conventional and quantitative imaging can distinguish NMOSD and RRMS, and provides practical methods in which to apply this to patient management. It is the first longitudinal quantitative imaging study of NMOSD and lends further proof that global or diffuse neurodegeneration of the normal appearing brain or spinal cord tissue is not a feature of this condition.

Biomedical research have been revolutionized by recent technological advances, both in the fields of molecular biology and computer science, turning the biomolecular and genetic research into “big data science”. One of the main objectives have been to improve our understanding of complex human diseases. Among those diseases, multiple sclerosis (MS) is considered as one of the most common. MS is a chronic autoimmune disease that cause inflammation and damage to the central nervous system. In this study, a set of bioinformatics analyses have been conducted on SNP data, as an initial step to gain more information prior to an upcoming genotyping project. The results showed extensive regulatory properties for the 761 selected SNPs, which is consistent with current scientific knowledge, and also identified another 332 SNPs in linkage to these. However, during the study some issues have also been identified, which need to be addressed going forward.

Thesis (MMedSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The aetiology of multiple sclerosis (MS) remains largely unknown due to the multifactorial nature of disease susceptibility determined by both environmental and genetic factors. Progress has been made in identifying the genetic component of MS , as well as the possible interactions with the environment. In this study single nucleotide polymorphisms (SNPs) in the FTO (rs9939609, Intron 1 T>A), MTR (rs1805087, 2756 A>G), MTRR (rs1801394, 66 A>G), MTHFR (rs1801133, 677 C>T and rs1801131, 1298 A>C) and COMT (rs4680, 472 G>A) genes involved in the methylation metabolic pathway were studied in the context of MS. The overall objective of this study was to elucidate the mechanism underlying raised homocysteine levels in MS patients. The specific aims were 1) to analytically validate high throughput real-time polymerase chain reaction (RT-PCR) genotyping assays for the 6 selected SNPs against direct sequencing as the gold standard for 2) possible integration into a pathology-supported genetic testing strategy aimed at improved clinical management of MS. The study population included a total of 114 unrelated Caucasian MS patients (98 females and 16 males) and 195 unrelated Caucasian control individuals without a diagnosis of neurological disease (128 females and 67 males). A novel finding of this study was that the risk-associated FTO rs9939609 A-allele was associated with raised homocysteine levels (p=0.003) in patients diagnosed with MS, but not in controls. Furthermore, homocysteine levels correlated significantly with bo dy mass index (BMI) (p=0.046) and total cholesterol levels (p=0.048). Both homocysteine (p=0.011) and BMI (p=0.017) were significantly reduced with increasing intake of folate in the diet, while high saturated/trans fat intake correlated significantly with increased BMI (p<0.001). High physical activity correlated with reduced BMI (p<0.006) in the study population, adjusted for age, gender and disease status. Daily intake of at least five fruit and vegetable portions and the COMT rs4680 (472 G>A) AA genotype had a favourable lowering effect on MS disability as assessed by the expanded disability status scale (EDSS) (p=0.035), while smoking increased MS disability significantly (p<0.001). All SNPs studied were found to be in Hardy-Weinberg equilibrium (HWE), with no significant differences detected between patients and control individuals in genotype distribution or allele frequencies. This study has shown for the first time that the underlying disease process of MS moderates the effect of the FTO rs9939609 polymorphism on homocysteine levels , which is consistent with the role of FTO in demethylation and epigenetic changes. Identification of FTO rs9939609 reinforces the importance of adequate folate intake in the diet that can be assessed accurately with use of the Medical History and Lifestyle Questionnaire applied in this study. Finally, the finding that raised homocysteine levels and BMI are significantly influenced by lifestyle factors such as diet and physical activity in our study cohort , offers a solution to counteract the detrimental effects of genetic risk factors contributing to the development of these established vascular risk factors for MS. Combining this information with FTO rs9939609 and COMT rs4680 genotyping may in future translate into a comprehensive pathology supported genetic testing strategy aimed at improved risk management and quality of life in MS patients. / AFRIKAANSE OPSOMMING: Die etiologie van meervoudige sklerose (MS) is grootliks onbekend as gevolg van die multifaktoriale aard van siekte vatbaarheid wat bepaal word deur beide genetiese en omgewingsfaktore. Vordering is reeds gemaak in die identifisering van die genetiese component van MS, asook moontlike interaksie met die omgewing. In hierdie studie is enkel nukleotied polimorfismes (SNPs) in die FTO (rs9939609, Intron 1 T > A), MTR (rs1805087, 2756 A> G), MTRR (rs1801394, 66 A> G), MTHFR (rs1801133, 677 C > T en rs1801131, 1298 A> C) en COMT (rs4680, 472 G > A) gene, wat betrokke is in die metilering metaboliese padweg, in die konteks van MS bestudeer. Die oorhoofse doel van hierdie studie was om die onderliggende meganisme betrokke by verhoogde homosisteïen vlakke in MS pasiënte uit te lig. Die spesifieke doelwitte was 1) om die analitiese geldigheid van die hoë deurvoer riëeltyd polymerase kettingreaksie (RT-PCR) genotipering metode soos toegepas vir die 6 geselekteerde SNPs te bevestig teen direkte DNA volgorde bepaling as die goue standaard, vir 2) moontlike integrasie in 'n patologie-gesteunde genetiese toetsing (PSGT) stategie wat gemik is op verbeterde kliniese hantering van MS. Die studiepopulasie bestaan uit 'n totaal van 114 nie-verwante Kaukasiese MS pasiënte (98 vroue en 16 mans) en 195 nie-verwante Kaukasiese kontroles sonder ‘n diagnose van neurologiese siektes (128 vroue en 67 mans). 'n Nuwe bevinding van hierdie studie was dat die risiko-verwante FTO rs9939609 A- alleel geassosieer was met verhoogde homosisteïen vlakke (p = 0,003) in pasiënte gediagnoseer met MS, maar nie in kontroles nie. Homosisteïen vlakke was verder beduidend geassosieer met liggaamsmassa-indeks (BMI) (p=0,046) en totale cholesterol vlakke (p=0.048). Beide homosisteïen (p=0,011) en BMI (p=0,017) het aansienlik verminder met 'n hoër inname van folaat in die dieet, terwyl 'n hoë versadigde/trans vet en koolhidrate inname beduidend gekorreleer het met 'n verhoogde BMI (p <0.001). Hoë fisiese aktiwiteit was gekorreleer met 'n verminderde BMI (p< 0.006) in die gekombineerde groep, aangepas vir die ouderdom, geslag en MS diagnose. Daaglikse inname van ten minste vyf vrugte en groente porsies en die COMT rs4680 (472 G>A) AA genotipe het 'n gunstige uitwerking op vermindering van gestremdheid gehad, soos bepaal deur die uitgebreide gestremdheid status skaal (EDSS) (p=0,035), terwyl rook MS gestremdheid beduidend verhoog het (p <0.001). Alle SNPs bestudeer was in Hardy-Weinberg ewewig (HWE), met geen beduidende verskille waargeneem in genotipe verspreiding of alleelfrekwensies tussen pasiënte en kontroles nie. Hierdie studie het vir die eeste keer aangetoon dat ‘n diagnose van MS die effek van die FTO rs9939609 polimorfisme op homosisteïen vlakke modereer, wat ooreenstem met die rol van FTO in demetilering en epigenetiese veranderinge. Identifikasie van FTO rs9939609 versterk die belangrikheid van genoegsame folaat inname in die dieet wat akkuraat gemeet kon word deur gebruik te maak van die Mediese Geskiedenis en Leefstyl Vraelys soos toegepas in hierdie studie. Ten slotte, die bevinding dat verhoogde homosisteïen vlakke en BMI statisties betekenisvol beïnvloed word deur leefstylfaktore soos dieet en fisiese aktiwiteit in ons studie populasie, verskaf 'n oplossing om die genetiese bydrae tot hierdie gevestigde vaskulêre risikofaktore vir MS teen te werk. Kombinasie van hierdie inligting met FTO rs9939609 en COMT rs4680 genotipering kan moontlik in die toekoms benut word as deel van 'n omvattende patologie- gesteunende genetiese toetsing strategie wat daarop gemik is om die risikobestuur en kwaliteit van lewe te verbeter in MS pasiënte.

Background: Multiple sclerosis (MS) is a chronic neurological autoimmune disease. The disease affects most young people between 20-40 years of age, mainly women. There are about 2.5 million people worldwide are affected by MS. The most common symptoms that a patient with MS suffers from are the fatigue (tiredness), pain, depression, sleep disturbance, balance disorder, dizziness, palsies (paralysis) and heat intolerance. There are also other physical and mental dysfunctions. Aim: The purpose of this study was to describe patients' experiences of MS disease symptoms and the nurse's possible role in disease progression. Method: A literature study based on nine scientific articles. Articles were searched in the databases CINAHL and PubMed in the fall 2015th.   Results: This study showed how the experiences of the symptoms for patients with MS affected their health, social life and quality of life in a negative way. The study also showed that nurses have an important informative, supportive and integrated role for the patient and family, during the course of the disease. Conclusions: MS disease affects the sufferer's life in a negative way, both physically and mentally. The disease usually means that the patient is facing uncertain and unpredictable future, and suffers unpleasant symptoms. These experiences involve not only a part of the body but the whole person. The assistance of the care and especially the nurse is of great importance to facilitate the patient's situation and help the patient to preserve their quality of life as good as possible. The nurses’ informative and caring role is a great support to patients with MS. Better understanding of patients' experience can be valuable for a better communication and care.

Multiple sclerosis is a complex disease and one for which the aetiology remains largely unanswered. Anti-dsDNA antibodies have been found intrathecally and bordering lesions in multiple sclerosis patients and in view of their known pathogenity in lupus nephritis the aim of this project was to further investigate their role in multiple sclerosis. Using the acute experimental allergic encephalomyelitis (EAE) model in the Lewis rat, the inflammatory phase of disease was profiled using immunohistological and ELISA methods and was related to clinical sign severity. The parameters of interest were central nervous system deposits of IgM, IgG, B cells and C3 and anti-DNA antibodies in sera, cerebrospinal fluid and in situ. In situ evaluation of anti-dsDNA antibodies was also performed in tissue taken from Biozzi (AH) mice (relapsing/remitting EAE model) and from a multiple sclerosis patient. Inflammatory deposits specifically at sites of perivascular cuffing were found to increase with increasing clinical sign severity. At the time clinical signs had plateaued in the Lewis rat, intrathecal anti-dsDNA antibodies were at their highest level and anti-ssDNA antibodies at their lowest. The latter possibly due to their involvement in the 'clearing-up' process following tissue damage. Using novel DNA probes fluorescence suggestive of the presence of anti-dsDNA iii antibodies was seen in both animal and human tissue. Within human tissue the antibodies appeared to accumulate around active lesions and within vessels, raising the question of these antibodies having differing location dependent functions. EAE models have the potential to investigate these findings further and to evaluate new therapies.

Background: Multiple Sclerosis (MS) is a chronic, degenerative, neurological condition affecting approximately 85,000 people in the UK. The impact of MS on physical abilities is well‐known and there is increasing recognition of the impact of MS on mood and cognitive function. Recently MS has been linked to impaired emotion recognition and impaired Theory of Mind (ToM –the ability to attribute mental states, e.g. beliefs to oneself and others). Methods: This study measured executive function, ToM, empathy and quality of life in an MS sample (n=42). A correlational analysis was then conducted to determine whether executive function was associated with the other variables. Results: Two executive function measures (Mental Flexibility and Response to Feedback) were significantly associated with two ToM tasks (Revised Eyes and Stories). Mental Flexibility and the Revised Eyes ToM task were significantly associated with measures of empathy, but this effect was not present in the other executive function or ToM tasks. Neither executive functioning nor ToM measures were significantly associated with reported quality of life. Conclusion: Overall, the MS sample demonstrated specific ToM impairment, no significant empathy impairment and widespread executive impairment relative to normative data. Low rates of depression (10%) and higher levels of anxiety (29%) were found. MS participants rated the psychological impact of MS as equivalent to the physical impact, highlighting the importance of addressing psychological aspects of MS.

The Ytterby mine is located on Resarö island in the Stockholm archipelago. Mainly feldspars but also quartz were historically quarried in the mine, which is also the place of discovery of seven rare earth elements (REE). During the cold war era, the mine shaft was used as a diesel and jet fuel deposit for the Swedish Armed Forces. Recently, a spatial coupling between multiple sclerosis (MS), a chronic neurodegenerative disease in the central nervous system, prevalence and the quarry has been suggested. Previous studies show that adverse neurological health effects are associated with oral intake of REEs and there is support for a coupling between ionizing radiation and MS. The extent and character of health effects as a result of exposure to petroleum products are still debated. However, a substantial number of scientific reports support a coupling between neurodegenerative health effects and toxic constituents of jet fuels such as benzene, toluene, and n-hexane. My data show that a possible overrepresentation of MS patients within the Ytterby postal code area could be an indication of a spatial coupling between the mine and MS. Such a possible coupling could be associated with the REEs present in the local rocks, with the previous storage of diesel or jet fuel MC-77 in the mine and/or with zones of high natural radioactivity in the area. Water samples collected in 15 wells in the Ytterby village show traces of five REEs, i.e. scandium (Sc), yttrium (Y), lanthanum (La), neodymium (Nd) and samarium (Sm) and the majority of sample locations at low ground elevation show contamination of diesel which is the most recent fuel stored in the mine. Moreover, results from an analysis of a black substance leaking out of cracks in the mine corridors confirm that REEs are present in substantial concentrations in the local rocks and also appear to be mobile. This should be taken into account when considering a potential contamination of the local water supply. Measurements of natural radioactivity have also been made around the contours of the quarry and zones of high ionizing radiation have been identified. By using these zones of high ionizing radiation as a proxy for rare minerals containing rare earth elements, I further suggest that the REE occurrences are highly localized around the quarry and could be associated with, or remobilized by, younger faults.  My data show that a full investigation is warranted of a possible spatial coupling between neurological health issues, MS being one of them, and the mine.

Multiple sclerosis is a neurodegenerative disorder affecting the central nervous system (CNS). Currently, the disease is incurable and immunomodulating drugs are the only option to control the disease. CD49d is an adhesion receptor expressed on most immune cells. Antibodies that bind to CD49d and block immune cells from trafficking toward the CNS are being pursued as one class of therapeutics. In this work, by combining recombinant antibody and phage display technologies we isolated 10 anti-CD49d single domain antibodies from a synthetic antibody light chain variable domain (VL) phage display library. Isolated VLs (~ 12 kDa) were expressed in Escherichia coli, purified and analysed for biophysical characteristics. The majority were expressed in good yields and were non-aggregating. All 10 VLs bound recombinant CD49d by ELISA, and 7 bound to CD49d-expressing cells in flow cytometry experiments. To empower the VLs for better therapeutic efficacy (thru increasing avidity and half-life), three of the lead VLs were re-engineered as fusions to fragment crystallisable (Fc) of human immunoglobulin gamma (IgG). The engineered hFc-VL fragments (~ 70 – 90 kDa) retained their specificity for CD49d by flow cytometry. With (i) being less immunogenic due to their human nature, (ii) their efficient access to cryptic epitopes (iii) having half-lives comparable to IgGs’ and (iv) being more cost effective compared to IgGs, these novel antibody fragments (monovalent VLs and bivalent hFc-VLs) provide a promising therapeutic platform against multiple sclerosis.

The subventricular zone (SVZ) is an adult neurogenic niche that contains multipotent stem/progenitor cells that may be a viable target for remyelination in Multiple Sclerosis. In response to demyelination, SVZ progenitors are recruited into myelin lesions. Currently, the effect of inflammation on the endogenous brain stem cell compartment remains poorly characterised. Theiler's murine encephalomyelitis virus (TMEV) induces a demyelinating disease in susceptible SJL/J mice, due to persistence of the virus, which models the chronic progressive form of multiple sclerosis. In contrast, virus is rapidly cleared in TMEV resistant C57BL/6 mice. This viral clearance is critically dependent on infiltration of CD4⁺ and CD8⁺ T cells during the first 3-14 days after infection, through the blood vessels and meninges. This project aimed to characterise the impact of TMEV induced inflammation on SVZ homeostasis. In both strains of mice the most pronounced and consistent inflammation in the CNS was observed in periventricular regions and in particular, the SVZ, which showed targeted infection by the TMEV virus. However, the time course and kinetics for infiltration at 3,7 and 14 days post infection have very different profiles between resistant C57BL/6 and susceptible SJL mice. Using RT-PCR arrays and ELISA I have shown that these differences in T cell infiltration to the SVZ may be due to much higher chemokine and cytokine expression levels in B6 mice. TMEV infection decreases SVZ cell proliferation and results in a loss of neuroblast numbers. Galectin-3 (Gal-3) is a &beta;-galactoside binding protein that is constitutively expressed specifically in the SVZ. Following TMEV infection Gal-3 levels are significantly upregulated in the SVZ, with higher expression in B6 mice compared to SJL mice. Primary SVZ astrocytes secrete extracellular Galectin-3 at much higher levels than cortical astrocytes. Galectin-3 is a pro-inflammatory mediator which upon secretion is able to activate immune and inflammatory signaling events and amplify pro-inflammatory cytokine production. Both SJL and B6 Gal-3^-/- KO mice have decreased expression of CCL2, CCL5 CXCL10 and CCL8 chemokines in the SVZ after TMEV infection. Deletion of Gal-3 prevents the loss of SVZ proliferation and in B6 mice decreases hematopoietic cell infiltration and enhances ectopic neuroblast emigration. These data implicate Galectin- 3 as a novel regulator of the SVZ inflammatory response and may provide a new target for regulating T cell CNS immigration in autoimmune disease.