Measles virus antibody in cerebrospinal fluids from patients with multiple sclerosis

The initiation and prevention of multiple sclerosis

Although strong genetic determinants of multiple sclerosis (MS) exist, the findings of migration studies support a role for environmental factors in this disease. Through rigorous epidemiological investigation, Epstein-Barr virus infection, vitamin D nutrition and cigarette smoking have been identified as likely causal factors in MS. In this Review, the strength of this evidence is discussed, as well as the potential biological mechanisms underlying the associations between MS and environmental, lifestyle and dietary factors. Both vitamin D nutrition and cigarette smoking are modifiable; as such, increasing vitamin D levels and smoking avoidance have the potential to substantially reduce MS risk and influence disease progression. Improving our understanding of the environmental factors involved in MS will lead to new and more-effective approaches to prevent this disease.

Viral triggers of multiple sclerosis

Genetic and environmental factors jointly determine the susceptibility to develop Multiple Sclerosis (MS). Collaborative efforts during the past years achieved substantial progress in defining the genetic architecture, underlying susceptibility to MS. Similar to other autoimmune diseases, HLA-DR and HLA-DQ alleles within the HLA class II region on chromosome 6p21 are the highest-risk-conferring genes. Less-robust susceptibility effects have been identified for MHC class I alleles and for non-MHC regions. The role of environmental risk factors and their interaction with genetic susceptibility alleles are much less well defined, despite the fact that infections have long been associated with MS development. Current data suggest that infectious triggers are most likely ubiquitous, i.e., highly prevalent in the general population, and that they require a permissive genetic trait which predisposes for MS development. In this review article, we illustrate mechanisms of infection-induced immunopathologies in experimental animal models of autoimmune CNS inflammation, discuss challenges for the translation of these experimental data into human immunology research, and provide future perspectives on how novel model systems could be utilized to better define the role of viral pathogens in MS.

MS and clinically isolated syndromes: shared specificity but diverging clonal patterns of virus-specific IgG antibodies produced in vivo and by CSF B cells in vitro

BACKGROUND

Intrathecal synthesis of oligoclonal IgG antibodies against measles virus (MeV), varicella zoster virus (VZV) and herpes simplex virus type-1 (HSV-1) is a characteristic feature multiple sclerosis (MS).

METHODS

We have used isoelectric focusing-immunoblot to define the clonal patterns of IgG and of IgG antibodies to MeV, VZV and HSV-1 in supernatants of in vitro cultures of peripheral blood lymphocytes (PBL) and cerebrospinal fluid (CSF) cells and in sera and CSF from three patients with MS and three patients with clinically isolated syndromes (CIS) suspective of demyelinating disease.

RESULTS

In vitro synthesis of IgG by PBL was not detected in any patient. In contrast, in vitro synthesis by CSF cells of oligoclonal IgG and oligoclonal IgG antibodies to one or two of the three viruses tested was observed in all six patients. The clonal patterns of the in vitro synthesized IgG and virus specific IgG differed to varying extent from those synthesized intrathecally in vivo. However, in each patient, the in vitro and in vivo intrathecally produced antibodies displayed specificity for the same viruses. The addition of B cell activating factor (BAFF) had no effect on the amounts or clonal patterns of either total IgG or virus-specific IgG produced by CSF cells in vitro.

CONCLUSION

Virus specific B cells capable of spontaneous IgG synthesis are clonally expanded in the CSF of patients with MS. The B-cell repertoire in CSF samples is only partially representative of the intrathecal B-cell repertoire.

EBV in MS: guilty by association?

Epstein-Barr Virus (EBV) is one of the most successful human viruses, infecting more than 90% of the adult population worldwide and persisting for the lifetime of the host. Individuals with a history of symptomatic primary EBV infection, called infectious mononucleosis, carry a moderately higher risk of developing multiple sclerosis (MS). In addition, EBV-specific immune responses, which crucially regulate the host-virus balance in healthy virus carriers, are altered in patients with MS. Although no data so far unequivocally support a direct etiologic role of the virus, recent studies allow for the development of testable hypotheses as to how EBV infection potentially promotes autoimmunity and central nervous system (CNS) tissue damage in MS.

Induction of tolerance in autoimmune diseases by hematopoietic stem cell transplantation: getting closer to a cure?

Hematopoietic stem cells (HSCs) are the earliest cells of the immune system, giving rise to B and T lymphocytes, monocytes, tissue macrophages, and dendritic cells. In animal models, adoptive transfer of HSCs, depending on circumstances, may cause, prevent, or cure autoimmune diseases. Clinical trials have reported early remission of otherwise refractory autoimmune disorders after either autologous or allogeneic hematopoietic stem cell transplantation (HSCT). By percentage of transplantations performed, autoimmune diseases are the most rapidly expanding indication for stem cell transplantation. Although numerous editorials or commentaries have been previously published, no prior review has focused on the immunology of transplantation tolerance or development of phase 3 autoimmune HSCT trials. Results from current trials suggest that mobilization of HSCs, conditioning regimen, eligibility and exclusion criteria, toxicity, outcome, source of stem cells, and posttransplantation follow-up need to be disease specific. HSCT-induced remission of an autoimmune disease allows for a prospective analysis of events involved in immune tolerance not available in cross-sectional studies.

Viruses, virulence and pathogenicity

Pathogenicity is a complex process with stringent requirements of both the host cell and the infecting virion. Among these requirements are a port of entry into host cells, a means of replication for the virus, and a means by which infection damages host cells. Damage to the host can result from multiple mechanisms including transformation, suppression of cellular metabolism, apoptosis, autoimmune responses directed against infected or uninfected tissues, or by molecular mimicry. In the attempt to identify new associations between viral infection and disease, investigators should be mindful that variable host factors as well as viral infection may be required for pathogenesis. Efforts to associate specific viral infections with specific diseases may be obscured by final common pathways through which multiple agents damage host cells in similar ways.

Mitogen and antigen stimulation of multiple sclerosis cerebrospinal fluid lymphocytes in vitro

Responses of cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocytes from 20 MS patients to phytohemagglutinin (PHA), measles, rubella, mumps and herpes simplex virus antigens were followed during periods of from 6 to 13 months. Up to 6 examinations, each with 1-5 stimulants, were performed with a lymphocyte blast transformation test. Most of the patients responded with their CSF cells to PHA (14/19) and at least to some of the viral antigens tested (15/20) during the follow-up. Although the maximal responses of CSF and PB cells to PHA and measles virus antigen were of the same magnitude, non-reactive or weakly responding lymphocytes were more common in CSF than in PB. In 7 of 15 patients having viral antigen responsive CSF cells simultaneous reactivity to several antigens could be shown. The stimulation results of CSF lymphocytes did not correlate with the numbers of CSF leukocytes or the intrathecal IgG synthesis. A negative correlation was observed between the strength of the CSF cellular response to PHA or measles virus antigen and the rate of intrathecal antibody synthesis to measles virus antigen, suggesting that the stimulated cells may at least partially represent suppressor cells.

Measles antibodies and kappa-lambda light chain distribution in immunoglobulins of patients affected with multiple sclerosis

The presence of measles antibodies in serum immunoglobulin G fractions from seven patients affected with multiple sclerosis was investigated with HI technic. The kappa-lambda light chain ratios of all samples under investigation were evaluated. Three multiple sclerosis patients, who displayed either fractionation or a tendency towards fractionation in their serum, had slightly elevated measles antibody titers associated to increased kappa/lambda ratios.

Measles virus and its associated diseases

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Viral antibody in the cerebrospinal fluid of patients with acute central nervous system infections

Cerebrospinal fluid (CSF) and sera from 129 patients of a study population of 139 were tested for antibody to herpes simplex, measles,and mumps viruses. Herpes simplex virus antibody was found in three of five patients with laboratory-confirmed herpes simplex infection and in eight patients without serological or virological evidence of current infection with this or other common neurotropic visuses. Eleven of the 139 patients were studied for antibody to lymphocytic choriomeningitis (LCM) virus. Eight of these had laboratory-confirmed LCM infection, and antibody was detected in the CSF of five of them. In one of these five, complement-fixing antibody appeared earlier in the CSF than in the blood. Assay of LCM virus antibody in the CSF may thus indicate infection with LCM virus more rapidly than serological and virological studies. The diagnostic and the possible prognostic significance of herpes simplex visus antibody in CSF remains to be ascertained.

Monozygous twins discordant for multiple sclerosis. Report of one pair and discussion of possible causes of multiple sclerosis

One pair of male monozygous twins was examined: only 1 twin had multiple sclerosis. Differences in the life histories of the twins were identified. Haematological, biochemical and microbiological studies were performed. It is possible in theory to determine which environmental factors may have been responsible for the development of multiple sclerosis in 1 twin. Several differences in life history were found in this study.

Virus antibodies in serum and synovial fluid of patients with rheumatoid arthritis and other connective tissue diseases

Rubella and influenza A (H3N2) haemagglutination inhibition (HI) antibody titres and measles complement-fixing (CF), haemagglutination inhibition (HI), haemolysis inhibition (HLI), and ribonucleoprotein gel precipitation (RNP-GP) antibody titres were studied in the serum and synovial fluid of twenty patients with rheumatoid arthritis (RA), two patients with ankylosing spondylitis, and two patients with Reiter's syndrome. Antibody titres were also studied in the serum and CSF of four patients with systemic lupus erythematosus (SLE), one patient with dermatomyositis, and in the synovial fluid only of five patients with osteoarthritic knee effusions. Antibodies were found with each serological technique used in the synovial fluid of RA patients and the antibody titres were usually at about the same level as in the serum. The mean measles (HI, HLI, and RNP-GP) antibody titres were 4 to 6 times higher in the synovial fluid of RA patients than in synovial fluid of patients with osteoarthritic knee effusions, but a corresponding difference was not found in rubella and influenza A antibody titres. The mean measles antibody titres (CF, HI, HKI, and RNP-GP) were consistently higher in the synovial fluid of RA patients without rheumatoid factor than in the synovial fluid of RA patients with rheumatoid factor. In serum this difference was observed only with measles CF titres. The mean measles, antibody titres were consistently lower in the serum and synovial fluid of the RA patients without the synovial fluid haemolytic complement than in the RA patients with this haemolytic complement. No similar differences were found in the rubella and influenza antibody titres. No significant measles antibody titres were found in the CSF of patients with SLE or dermatomyositis.

Myelin-specific autoantibodies associated with central nervous system demyelination in canine distemper virus infection

Sera from dogs with spontaneously occurring and experimentally produced canine distemper virus-associated demyelinating encephalitis were examined for antibodies to central nervous system myelin by the complement fixation and indirect immunofluorescent methods. Complement-fixing immunoglobulin M antibodies and non-complement-fixing immunoglobulin G antibodies were found in 97% of the spontaneous cases. In comparison, only 28% of control sera contained these antibodies; furthermore, mean antibody titers in the control groups were significantly lower (P < 0.005) when compared to the distemper group. Complement-fixing antimyelin antibodies were also demonstrated in gnotobiotic dogs with experimentally induced distemper virus-associated demyelination. The antibody response could be correlated with clinicopathological features of the disease produced. Results of this study indicate that demyelination in canine distemper may proceed by immune mechanisms.

Identification of different measles virus-specific antibodies in the serum and cerebrospinal fluid from patients with subacute sclerosing pancencephalitis and multiple sclerosis

Matched serum and cerebrospinal fluid (CSF) samples from eight cases of subacute sclerosing panencephalitis (SSPE) and 15 cases of multiple sclerosis (MS) were characterized in neutralization, hemolysis-inhibition (HLI), hemagglutination-inhibition (HI) with Tween 80-ether-treated antigen, complement-fixation (CF), and immunodiffusion tests. CF tests were carried out with crude virus material, purified nucleocapsids, and small particle hemagglutinin as antigens. A certain diversity in the relative content of antibodies against different virus products in various sera was found. There was a high degree of correlation between titers of neutralizing and HLI antibodies, but a less strict correlation between titers of HLI and HI antibodies. Serum samples from two cases of MS and one case of SSPE contained high titers of HLI and neutralizing antibodies in the presence of only low titers of HI antibodies demonstrable with Tween 80-ether-treated antigen. The major fraction of antibodies detected in CF and immunodiffusion tests reacted with nucleocapsids. There was a tendency of nucleocapsid CF antibody titers, as compared to neutralization and HLI antibody titers, to be higher in samples from patients with SSPE than from cases of MS. No significant differences were found between antibody titers recorded in neutralization, HLI, and HI tests carried out with two different measles virus strains, Edmonston and a strain (LEC) derived from a case of SSPE. Comparison of antibodies against measles virus products and, as a reference, against a group-specific vertex capsomer antigen of adenovirus in matched serum and CSF samples revealed a production of measles virus-specific antibodies within the central nervous system of all cases of SSPE and 8 out of 15 cases of MS.