Immunological effects of oral high-dose methylprednisolone in acute optic neuritis and multiple sclerosis

The immunological effects of high-dose methylprednisolone in attacks of mul tiple sclerosis and acute optic neuritis have only been examined in a few r andomized, controlled trials. We studied immunological changes in 50 patien ts with optic neuritis or multiple sclerosis who underwent lumbar puncture before and 1 week after completing a 15-day course of oral high-dose methyl prednisolone treatment. Treatment resulted in a decrease in the concentrati on of myelin basic protein, a decrease in the serum concentration of immuno globulin G (IgG) and intrathecal IgG synthesis, an increase in the cerebros pinal fluid concentration of transforming growth factor-beta 1, and changes in the expression of CD25, CD26, and human leukocyte antigen-DR (HLA-DR) o n CD4 T-cells. No effect was seen on the cerebrospinal fluid leucocyte coun t or the cerebrospinal fluid activity of matrix metalloproteinase-9 (MMP-9) . The lack of a persistent effect on cerebrospinal fluid leucocyte recruitm ent and MMP-9 activity, despite changes in IgG synthesis, T-cell activation , and cytokine production, suggests that modulation of the function of infl ammatory cells may contribute to the clinical efficacy of oral high-dose me thylprednisolone treatment in optic neuritis and multiple sclerosis.