MULTIPLE-SCLEROSIS - PROSPECTIVE ANALYSIS OF TNF-ALPHA AND 55 KDA TNFRECEPTOR IN CSF AND SERUM IN CORRELATION WITH CLINICAL AND MRI ACTIVITY

The possibility of antagonizing tumor necrosis factor-alpha (TNF-alpha ) in vivo with antibodies or soluble TNF receptor has focused much int erest on the role of this cytokine in the natural course of MS. We stu died nine patients prospectively and serially for one year (14 time po ints, 131 observations). TNF-alpha and the 55 kDa soluble TNF receptor were measured every 4 weeks in the serum and at defined time points i n the CSF, Each value was correlated to clinical symptoms and to MRI m easurements obtained on the same day. All patients with relapsing-remi tting disease showed periodic increases of TNF concentrations, Overall , the association between serum TNF-alpha levels and bursts of Gd-DTPA enhancement on cranial MRI was not sufficiently tight to reach statis tical significance. However, serum TNF levels > 50 pg/ml and measurabl e CSF levels were always associated with Gd-DTPA enhancing MRI lesions . Isolated high serum TNF peaks were noted during episodes of infectio n, hay fever or psychic stress. After treatment with glucocorticoids, TNF levels were suppressed for several months, whereas new Gd-DTPA enh ancing lesions continued to appear. The concentrations of the soluble 55 kDa TNF receptor did not show marked fluctuations, These results ar e consistent with an active role of TNF-alpha in MS during periods of disease activity and provide further support for the clinical evaluati on of anti-TNF therapies.