T-CELL SUBSETS IN THE CEREBROSPINAL-FLUID AND PERIPHERAL-BLOOD OF MULTIPLE-SCLEROSIS PATIENTS TREATED WITH HIGH-DOSE INTRAVENOUS METHYLPREDNISOLONE

To determine the effects of high-dose intravenous methylprednisolone ( MP) on lymphocytes and lymphocyte subpopulations in the cerebrospinal fluid (CSF) and peripheral blood (PB) in multiple sclerosis (MS) patie nts, we studied 67 patients with definite MS treated with MP. They wer e classified according to the disease course: 32 chronic progressive ( CP) patients, 25 relapsing-remitting (RR) patients, and 10 patients wi th a chronic progressive disease course accompanied by relapses and re missions (CP + RR). MS patients were treated with 1000 mgr intravenous MP daily for 10 consecutive days. Before and after MP treatment we si multaneously studied CSF and PB CD3+, CD4+, CD8+, CD20+, and Ia1+ cell subsets. Kurtzke's Expanded Disability Status Scale (EDSS) was used f or clinical evaluation. Progression rate was defined as the ratio of E DSS to disease duration. Thirteen patients with lumbar disk herniation were investigated as controls. Before MP, we found in MS patients, es pecially in the CP group, significantly lower CD4+ T-cell percentages in the PB with respect to controls (p < 0.05). The percentage of CD4T-cells in the CSF of MS patients was significantly higher compared wi th PB (p = 0.0001), and tended to be higher than in controls (p = 0.07 2). The CSF mononuclear cell counts were significantly correlated with higher percentages of CSF CD3+ (r = 0.40) and CD4+ (r = 0.47) T-cells and lower CSF CD8+ (r = -0.33) T-cell percentages. B-cell percentages in the CSF were significantly elevated compared with controls for all MS groups. No relation could be obtained between T- or B-cell subsets and EDSS or progression rate. After MP, a significant decrease in PB CD8+ T-cell percentage and simultaneously an increase of the percentag e CD8+ T-cells in CSF was noted in the entire MS group and in the CP a nd RR MS patients. Except for the CP + RR MS patients, CD4+ T-cell per centages in the PB or CSF showed insignificant changes. Our findings s upport the view that in MS MP might affect the inflammatory process of demyelination by a selective and dissociative effect on T-suppressor/ cytotoxic cells in the PB and CSF.