Medullasin activity in granulocytes of patients with multiple sclerosis

Neutrophil-to-Lymphocyte Ratio, ESR, and CRP Have No Roles as Markers for Disease Severity and Prognosis in Patients with RRMS

BACKGROUND

Up to now, there is no definitive prognostic factor for patients with multiple sclerosis.

OBJECTIVE

This study aimed to evaluate the neutrophil-to-lymphocyte ratio (N/L ratio) as a cheap, available, and noninvasive marker for disease activity and prognosis.

MATERIAL AND METHODS

A total of 112 patients, who were diagnosed with relapsing-remitting multiple sclerosis (RRMS), and 61 healthy controls were considered. We evaluated N/L ratio, ESR, CRP in the control, and patients in the first attack of the onset of the disease, 1 month and 6 months later during remission. All patients received interferon or Glatiramer acetate as disease-modifying therapies. The correlation of parameters with Expanded Disability Scale Score (EDSS) and Functional System (FS) involvement was evaluated.

RESULTS

The N/L ratio was increased significantly in patients with MS in the relapse phase (mean: 2.44 ± 0.68) compared to the healthy controls (mean: 1.84 ± 0.67) (P = 0.04). Also, we found a significant increase in CRP among the aforementioned groups (P = 0.028). A significant correlation was not found between NLR, ESR, or CRP and patient's EDSS during 6 months of follow-up. For ESR and the type of functional system, a significant difference was found between favorable and unfavorable categories, while the median (IQR) of ESR in the favorable group was 7.7 (4-12) and among unfavorable ones was 13.8 (6-17.75) (P = 0.008).

CONCLUSIONS

The results showed the effect of the innate immune system and inflammation during MS attacks. We considered that neutrophils, ESR, and CRP cannot predict disease severity or prognosis at least without a combination of other biomarkers.

Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are associated with a 2-year relapse in patients with multiple sclerosis

BACKGROUND

The association between increased neutrophil-to-lymphocyte ratio (NLR) and multiple sclerosis has been demonstrated in several studies. The monocyte-to-lymphocyte ratio (MLR) is an emerging biomarker for disease monitoring. Moreover, there has not been a published Taiwanese study to date.

AIM

To investigate the correlation of NLR, MLR and white blood cell (WBC) count as possible biomarkers for predicting a 2-year relapse in patients with multiple sclerosis (MS).

MATERIALS AND METHODS

A total of 641 Taiwanese patients with MS were enrolled in the present study between January 1, 2001, and December 31, 2018. We collected data on NLR, MLR, WBC count, disease-modifying therapy (DMT) use, and the time between first diagnosis and first relapse in all patients within a 2-year duration.

RESULTS

In the relapse group, there were significantly more patients with NLR >median or MLR >median (p = 0.006 and p = 0.020, respectively). There were also more patients with WBC count >median, although the difference was not statically significant (p = 0.069). The adjusted hazard ratio for relapse and NLR >median was 1.61(p = 0.008). The adjusted hazard ratio for relapse and MLR >median was 1.43 (p = 0.044). Patients with NLR >median or MLR >median had a significantly (p = 0.008 and p = 0.039, respectively) increased risk of MS relapse in the 2 years, compared with those who had NLR <median or MLR <median.

CONCLUSION

NLR and MLR are widely available, fast and measurable inflammatory markers for predicting the relapse risk of MS patients.

Neutrophil-lymphocyte ratio as a marker for disability and activity in multiple sclerosis

BACKGROUND

There is limited data regarding the association of Neutrophil-lymphocyte ratio (NLR) inflammatory marker with multiple sclerosis (MS) disability and activity.

OBJECTIVE

The aim of the present study was to evaluate validity of NLR as an inflammatory marker for MS disability and activity.

METHODS

A case-control study including 140 MS patients and 140 age, sex and body mass index matched healthy controls was performed. All participants were subjected to detailed history taking, complete general and neurological examination, laboratory and radiological investigations. Assessment of disease disability was performed using Expanded Disability Status Scale.

RESULTS

The NLR levels was significantly higher in MS patients compared to the controls and in patients with relapse compared to remission. Logistic regression analyses showed that NLR was significantly associated with disease disability (odds ratio (OR): 2.568; confidence interval (CI): 1.377 - 4.788; P: 0.003) and activity (OR: 3.603; CI: 2.086 - 6.226; P: 0.02). The cutoff value for the NLR to predict MS disability and activity was 3.12.

CONCLUSION

NLR was significantly increased in MS patients compared to controls. The significant association of NLR with MS disability and activity suggest that it could be utilized as a simple, rapid and inexpensive inflammatory marker.

The Emerging Role of Neutrophil Granulocytes in Multiple Sclerosis

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system with a strong autoimmune, neurodegenerative, and neuroinflammatory component. Most of the common disease modifying treatments (DMTs) for MS modulate the immune response targeting disease associated T and B cells and while none directly target neutrophils, several DMTs do impact their abundance or function. The role of neutrophils in MS remains unknown and research is ongoing to better understand the phenotype, function, and contribution of neutrophils to both disease onset and stage of disease. Here we summarize the current state of knowledge of neutrophils and their function in MS, including in the rodent based MS model, and we discuss the potential effects of current treatments on these functions. We propose that neutrophils are likely to participate in MS pathogenesis and their abundance and function warrant monitoring in MS.

Relationship between Neutrophil-to-Lymphocyte Ratio and Stress in Multiple Sclerosis Patients

INTRODUCTION

Multiple Sclerosis (MS), a disease of autoimmunity and inflammation, is characterized by deterioration of the myelin sheath that protects the nerve fibers. The high levels of neutrophils in serum may be related to the chronic inflammation and caused by other triggers such as infections that have been associated with relapses in MS.

AIM

To investigate the value of Neutrophil/Lymphocyte Ratio (NLR) as a possible marker and relationship with Depression, Anxiety and Stress (DAS) score in MS patients.

MATERIALS AND METHODS

A total of 60 MS patients and 60 age and sex matched healthy controls were recruited for the present study. We measured DAS score, NLR, calcium, phosphate, magnesium, chloride, alkaline phosphatase, albumin in serum levels in MS patients and in healthy controls.

RESULTS

The mean age was not significantly different in both case and control groups. The case and control groups were similar in terms of sex; however, the majority of the MS group was female. The NLR values of MS patients were significantly higher than those of the healthy controls (p=<0.001). The NLR values were also significantly (p<0.001) correlated with stress score.

CONCLUSION

NLR could be considered as a quick, cheap, easily measurable and inflammatory marker for assessment of inflammation in MS patients. The role of NLR in MS must be explored further.

The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis

Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the central nervous system that causes functional disability in young people. The aim of this study was to investigate the neutrophil-to-lymphocyte ratio (NLR) in patients with MS and the relationship between the NLR and the severity of the disease. One hundred and two MS patients (31 patients were in relapse; 71 patients were in remission) and 56 healthy controls were included. Complete blood counts as well as demographic and clinical data from MS patients were evaluated retrospectively. The NLRs were calculated for all participants and were compared; the cut-off value was also determined for the NLR and Expanded Disability Status Scale (EDSS). MS patients had a significantly higher NLR (p < 0.001) than the control group. The NLR levels were significantly higher in patients who were in relapse than patients in remission (p = 0.039). The cut-off value for the NLR to predict an MS diagnosis and activity were determined to be 2.04 and 3.90, respectively. The NLRs were directly correlated with erythrocyte sedimentation rate levels (r = 0.795, p < 0.001). Logistic regression analysis with dichotomous EDSS score showed that a high NLR was an independent predictor of the progression of disability. The NLR may be a biomarker that has simple, quick, inexpensive and reproducible properties in MS to predict patient's prognosis.

Neutrophil-related factors as biomarkers in EAE and MS

Using a mouse model of multiple sclerosis (MS), the authors show that neutrophils expand in the bone marrow and accumulate in the circulation before clinical onset of disease. Early in disease development, neutrophils infiltrate the CNS, which is suppressed by G-CSF receptor deficiency and blockade of CXCL1 to ameliorate disease. In patients with MS, systemic expression of neutrophil-related mediators correlates with new lesion formation, lesion burden, and clinical disability.

A major function of T helper (Th) 17 cells is to induce the production of factors that activate and mobilize neutrophils. Although Th17 cells have been implicated in the pathogenesis of multiple sclerosis (MS) and the animal model experimental autoimmune encephalomyelitis (EAE), little attention has been focused on the role of granulocytes in those disorders. We show that neutrophils, as well as monocytes, expand in the bone marrow and accumulate in the circulation before the clinical onset of EAE, in response to systemic up-regulation of granulocyte colony-stimulating factor (G-CSF) and the ELR⁺ CXC chemokine CXCL1. Neutrophils comprised a relatively high percentage of leukocytes infiltrating the central nervous system (CNS) early in disease development. G-CSF receptor deficiency and CXCL1 blockade suppressed myeloid cell accumulation in the blood and ameliorated the clinical course of mice that were injected with myelin-reactive Th17 cells. In relapsing MS patients, plasma levels of CXCL5, another ELR⁺ CXC chemokine, were elevated during acute lesion formation. Systemic expression of CXCL1, CXCL5, and neutrophil elastase correlated with measures of MS lesion burden and clinical disability. Based on these results, we advocate that neutrophil-related molecules be further investigated as novel biomarkers and therapeutic targets in MS.

Neutrophils in multiple sclerosis are characterized by a primed phenotype

Neutrophils are armed with proteases with indiscriminate histotoxic potential, and to minimize tissue injury, their activation involves priming with inflammatory mediators before cells are fully activated in a second step. Here, we show that neutrophils in multiple sclerosis patients are more numerous and exhibit a primed state based on reduced apoptosis, higher expression of TLR-2, fMLP receptor, IL-8 receptor and CD43, enhanced degranulation and oxidative burst as well as higher levels of neutrophil extracellular traps in serum. The chronic inflammatory environment in multiple sclerosis probably underlies this inappropriate neutrophil priming, which may result in enhanced neutrophil activation during infection.

Azurocidin induces elastinolytic activity of medullasin

Addition of azurocidin, a protein in granulocytes similar to serine proteases but has no protease activity because of replacement of the active serine residue by glycine, to the incubation mixture containing medullasin induced elastinolytic activity of medullasin. Both medullasin and human leukocyte elastase were already shown to have negligible elastinolytic activity (Aoki, Y. et al. J. Biochem. 114, 122, 1993). Elastinolytic activity of medullasin was induced dose-dependently by the addition of azurocidin. Medullasin activity determined by using apo-ornithine transaminase or casein as substrates or that by N-methoxy-succinyl-(Ala)2-Pro-Val-p-nitroanilide as substrate remained unchanged when azurocidin was added to the tube containing medullasin. Therefore, azurocidin is considered to cause an appearance of elastinolytic activity of medullasin without affecting the protease activity of it.

The immunoregulatory abilities of polymorphonuclear neutrophils in the course of multiple sclerosis

The polymorphonuclear neutrophils (PMN) possess sufficient potential to affect both immune response and inflammation, however it has not been yet described in the course of multiple sclerosis (MS). We have studied binding of fluorescein isothiocyanate (FITC)- stained TNF-alpha by PMN, the expression of CD11a, CD11b, and CD18 molecules of beta2-integrines and the expression of CD10 (neutral endopeptidase-NEP) and of CD13 (aminopeptidase N; APN) antigens on PMN in three different groups of MS patients. The control group included neurological patients (OND) with noninflammatory diseases. The obtained results have proved that during MS exacerbation and in the course of chronic progressive MS, PMN reveal several forms of preactivation, including significantly higher stained-TNF-alpha binding, higher expression of CD11b and CD18, as well as CD10 and CD13 antigens, in comparison with MS remission or OND. We suggest that the increased expression of these molecules on PMN of MS patients in exacerbation of the disease and to a lower degree in the course of CP-MS is a result of PMN priming, and directly prove the PMN involvement in the disease pathogenesis.

The primary structure and elastinolytic activity of medullasin (a serine protease of bone marrow)

The amino acid sequence around the carboxyl terminal of medullasin was determined by digesting the protease with carboxypeptidase Y and measuring the rate of release of amino acids from the carboxyl terminal. By considering the structure of the protease's cDNA, we concluded that His-238 is the C-terminal residue of medullasin. Therefore, medullasin is composed of 238 amino acid residues with Ile as the amino terminal and His as the carboxyl terminal. Medullasin is essentially devoid of elastinolytic activity, because it failed to digest orcein-elastin.

Granulocyte medullasin levels in gingival crevicular fluid from chronic adult periodontitis patients and experimental gingivitis subjects

The concentration of medullasin, an elastase-like serine proteinase, in gingival crevicular fluid (GCF) from chronic adult periodontitis patients and experimental gingivitis subjects was determined by the highly sensitive immunoassay method. In periodontitis patients, the medullasin content increased with increase of the GCF volume and then attained a maximum value at a relatively mildly inflamed stage. The value was maintained through more serious stages of disease activity. However, the medullasin content was independent of the probing depth. The medullasin content of the patients was markedly decreased after periodontal treatment, indicating that the enzyme participates in the development of the chronic periodontitis. Large amounts of medullasin were also detected in GCF from experimental gingivitis subjects, although it was not detected by the activity measurements. There was a rapid increase in the medullasin content during the 4-day period after abstention from oral hygiene measures, which corresponded to those of severely inflamed periodontitis patients. The peak value decreased up to the 7th-d followed by a gradual increase during the 21-d experimental period. The increased medullasin level rapidly decreased following resumption of oral hygiene measures. The results suggest that medullasin plays important roles both in the defence mechanism against the gingival inflammation and in the development of the acute inflammation.

Low molecular weight peptide inhibitors of medullasin: purification and structure

Two low molecular weight peptide inhibitors of medullasin were isolated from human bone marrow cells. Determination of their amino acid composition and amino acid sequence revealed that one inhibitor was composed of 36 amino acid residues and the other 34 amino acid residues which are identical with the C-terminal portions (Formula; see text) of the beta-chain of human hemoglobin. These two peptides when synthesized also showed the same degree of inhibitory effect on medullasin activity as the natural products. Neither the N-terminal portion of the inhibitor, composed of 21 amino residues, nor the C-terminal peptide, composed of 20 amino acids, inhibited medullasin activity. Medullasin was inhibited reversibly and non-competitively against by these inhibitors and was the most effectively inhibited serine protease among several tested.

Enzyme immunoassay of medullasin in peripheral blood

An enzyme immunoassay method for the determination of the amount of medullasin, a serine protease in granulocytes, was developed. Beads coated with IgG obtained from immunized rabbits were incubated with medullasin, Fab'-peroxidase conjugate was added, and peroxidase activity bound to beads was measured by a fluorophotometer. The amount of medullasin determined by this method correlated well with the value calculated from the protease activity measured by the conventional method. The minimum detectable amount of medullasin was 300 pg. Granulocytes obtained from patients with multiple sclerosis in active phase and those from patients with Behçet's disease in relapse showed elevated levels of medullasin as compared with normal controls. However, the amount of medullasin in granulocytes obtained from patients in remission revealed normal values. These results indicate that elevated levels of medullasin activity in granulocytes of these diseases in relapse is due to an increased amount of medullasin in granulocytes and that the normalization of medullasin activity in remission is the result of the decrease of the amount of medullasin in granulocytes.

Significance of lymphocytes and blood vessel changes for edema formation in polyradiculoneuritis

Human sural nerve biopsies of eight cases with acute, subacute and chronic polyradiculoneuritis were studied by means of immunohistochemistry to characterize the inflammatory infiltrates. In addition, the structural changes of the endoneurial blood vessels were examined by electron microscopy, since both factors are likely to contribute to disturbances of the blood-nerve barrier. By use of six monoclonal antibodies, it was shown that the inflammatory infiltrates in cases with more acute polyradiculoneuritis are predominantly recruited by Leu 3a- and Leu 4-positive T lymphocytes. In more chronic polyradiculoneuritis beside of few Leu 3a-positive and Leu 4-positive T lymphocytes also B cells occurred. Leu M3-positive macrophages were detected in all cases with fluoride myelin degeneration. Since immunoreactivity for antigens of the HLA-D-locus (Leu-HLA-DR and Leu 10) were present on the infiltrating mononuclear cells, it can be postulated that they represent active and immunocompetent cells. Ultrastructurally, the amount of pinocytotic vesicles in the endothelial cells of the endoneurial blood vessels was increased. Moreover, a prominent folding of the luminal and abluminal surface of vascular endothelial cells and diminution of the intercellular tight junctions were observed. These findings appear suitable to explain the increased leakage of serum proteins across the blood-nerve barrier in polyradiculoneuritis sharing general features of cell-mediated immunity.

Neutral protease in cerebrospinal fluid from patients with multiple sclerosis and other neurological diseases

Neutral protease activity was significantly elevated in the cerebro-spinal fluid of patients with multiple sclerosis (MS) in exacerbation and in the acute phase of acute viral meningoencephalitis (AME) compared with that of MS in remission, amyotrophic lateral sclerosis or psychosomatic disease. Since in each relapse of MS, protease activity was higher in exacerbation than in remission, this activity may be one good marker of disease activity in MS. One hundred micro molar of FOY305, synthetic protease inhibitor, inhibited in vitro increased neutral protease activity in MS in exacerbation, which suggests the possibility of a clinical application of this protease inhibitor for MS.

The leakage of serum proteins across the blood-nerve barrier in hereditary and inflammatory neuropathies. An immunohistochemical and morphometric study

The leakage of eight different serum proteins and immunoglobulins across the blood-nerve barrier (BNB) was studied by means of the peroxidase-antiperoxidase method in hereditary and inflammatory neuropathies and graded semiquantitatively with respect to endoneurial staining intensity and distribution. These data were compared with the degree of alterations of the myelinated nerve fibre population evaluated by morphometric analysis. Our series of 18 human sural nerve biopsies included seven hereditary neuropathies (three HMSN I, two HMSN II, two tomaculous neuropathies), nine inflammatory neuropathies (seven polyneuritis, two hypertrophic neuritis) and two normal controls. In HMSN II and in tomaculous neuropathy there was no enhanced endoneurial staining for serum proteins despite of a severe nerve fibre loss, whereas in HMSN I a rise of serum proteins of small and moderate molecular size like albumin and IgG was demonstrated in the endoneurial space indicating an impaired BNB function. Qualitative changes of the BNB with leakage also of high molecular weight proteins were observed in polyneuritis and hypertrophic neuritis, irrespective of the degree of nerve fibre changes. Our results show that fibre loss and alteration of the BNB are not correlated. The unselective leakage of serum proteins through the BNB appears to be a characteristic change in inflammatory neuropathies leading to proteinous edema. With regard to the subperineurial accentuation of the endoneurial edema it will be discussed that the vascular diffusion barrier is more fragile than the perineurial diffusion barrier.

Polymorphonuclear neutral protease activity in multiple sclerosis and other diseases

Polymorphonuclear neutral protease activity (PMN-NPA) was examined in 87 patients with definite multiple sclerosis (MS) (48 active, 39 inactive), 49 patients with other neurological diseases (OND), 24 patients with immune-mediated non-neurological diseases (INND), and 32 normal subjects. PMN-NPA was found to be significantly increased in active MS compared with inactive MS and compared with each of the control groups. No differences were found between the group of normal subjects and the groups of patients with OND, INND, or inactive MS. Levels of PMN-NPA were significantly higher in the OND group than in inactive MS group. The differences for INND versus normal controls, neurological controls, and patients with inactive MS were not significant. No significant differences have been detected between active and inactive INND. These results suggest that PMN-NPA may be useful in the diagnosis and evaluation of MS.