DISEASE-ACTIVITY AND THE IMMUNE SET IN MULTIPLE-SCLEROSIS - BLOOD MARKERS FOR IMMUNOTHERAPY

There is no established immunological marker of multiple sclerosis act ivity, which reflects the poor understanding of the immunopathogenesis of multiple sclerosis. Passive measurement of the levels of soluble i nflammatory markers, whose half lives are usually measured in minutes and hours, can only indicate the extent of instantaneous inflammation, which is known to fluctuate in multiple sclerosis. We favour measurem ent of immune responses in vitro. As healthy individuals have T cell r eactivities to myelin proteins that ore postulated to be pathogenic in multiple sclerosis, (1,2) we Prefer non-antigen specific mitogen and recall antigen essays as immunological markers. We illustrate their us e in the treatment of 27 Patients with multiple sclerosis using a puls e of humanised anti-lymphocyte (CD52) antibody that caused prolonged T cell depletion. The mitogen-induced proliferation, and secretion of I FN-gamma, from peripheral blood mononuclear cells in vitro was signifi cantly reduced after treatment, suggesting that immune responses had b een modulated. Such observations will only gain credence as an outcome measure if they are shown to correlate with clinical or radiological measures of multiple sclerosis activity. Perhaps more importantly, asp ects of the pathogenesis of multiple sclerosis may be revealed by clos e immunological surveillance of patients undergoing experimental treat ments.