Pearls: multiple sclerosis

Inducible expression of antigens in plants: a study focused on peptides related to multiple sclerosis immunotherapy

Multiple sclerosis (MS) affects 2.3 million patients worldwide with no effective treatments available thus far. Depletion of autoreactive T-cells is considered the basis for immunotherapeutic approaches. For this purpose the peptides BV5S2, BV6S5, and BV13S1 have been identified as candidates for the development of a MS vaccine. Herein, the plant-based simultaneous production of these peptides is described as an effort to generate a new model of MS immunotherapy. A polyprotein comprising the sequence of the target peptides was designed having the picornaviral 2A sequence in between to mediate the release of the individual peptides upon translation. A codon optimized gene was cloned in vectors mediating constitutive (CaMV35S promoter) or inducible (AlcA promoter) expression. No transgenic tobacco plants were recovered from the constitutive vector suggesting toxicity of the target peptides. In contrast, several transformed lines were obtained with the inducible vector. The individual BV5S2, BV6S5, and BV13S1 peptides were detected in transformed lines upon ethanol-mediated induction and a quantitative analysis based on a OVA conjugate carrying the three peptides revealed accumulation levels up to 0.5 μg g-1 FW leaves. The plant-made peptides were able to induce humoral responses in orally immunized mice. This platform will be useful in the development of alternative immunotherapies against MS having low cost and safety as main attributes. Moreover the platform represents an attractive alternative for the expression of antigens having detrimental effects in plants.

Summary of eye examinations of 284 patients with multiple sclerosis

The aim of this article is to report the findings of ocular examinations in a group of patients diagnosed with multiple sclerosis who were referred to the eye department of the Nationaal Multiple Sclerosis Centrum of Melsbroek, Belgium, from 2007 to 2010. Patients were evaluated by a single examiner, who noted visual acuity for distance, the state of the optic disks, oculomotor balance, and the presence of nystagmus, uveitis, trigeminal neuralgia, and facial palsy. The sample consisted of 284 adults born between 1920 and 1989: 111 males and 173 females. There were 51 patients with a corrected visual acuity in the better-seeing eye of less than 6/20. The optic nerve head was found to be normal in 245 eyes. Nystagmus was noted in 104 patients. Diplopia at distance was found to be present in 20 males, of whom 12 also had nystagmus, and in 31 females, of whom 13 also had nystagmus. Oscillopsia was present in 6 males and 11 females. In summary, most of the patients evaluated had sufficient visual function to allow performance of activities of daily living without help. A small number of patients had visual failure due to dysfunction of the visual sensory pathway and/or disturbances of oculomotor balance, often of a supranuclear origin, resulting in considerable disability.

Multiple sclerosis: managing patients in primary care

In this era of the Patient Centered Medical Home model of care, chronic diseases such as multiple sclerosis (MS) are managed in partnership with specialty care practices. For the patient and family living with MS, assuring that patients get proper care when and where they need it requires that nurse practitioners understand their role in assessing and managing complex chronic diseases.