IMMUNOLOGY

JAN KOCHANOWSKI UNIVERSITY

MULTIPLE SCLEROSIS
Paola Viñé Ortega
WHAT IS MULTIPLE SCLEROSIS?
 MS is a disease that ``short circuits´´ nerves
 MS is though to be an autoinmune disease that affects the Central Nervous System (brain,
spinal cord and optic nerves)
 Nerve damage is caused by the immune system attacking the nervous system
 Its name is derived from the scarring caused by these attacks at multiple sites in the CNS
WHO GETS MS?
 1,000,000 in US
 Over 2,000,000
worldwide
 Starts in early adult
life
 More common in
Caucasians/Northern
European ancestry
 MS is the second most
common cause of
neurologic disability
in Young adults.
 WHAT CAUSES MS?

Genetic Environmental
Predisposition Trigger

Autoimmunity

Loss of myelin &

nerve fiber
 IMMUNE STEPS LEADING TO
NEUROLOGICAL DEFICITS
``Activated´´ immune cells…

…cross the blood-brain

barrier…

…launch attacks on myelin &

nerve fibers…

…nerve do not function

normally.

Myelinated nerve fiber Myelinated nerve fiber

WHAT HAPPENS IN MS?

 Misguided immune cells enter central nervous

system by getting through the blood-brain
barrier
 Immune cells attack myelin surrounding the
nerve fibers
 Nerve fibers are also damaged
 Damaged nerve fibers cannot send appropiate
electrical and chemical signals, and this causes
symptoms
NERVE DAMAGE IN MULTIPLE SCLEROSIS

The myelin sheath covering the nerves fibers of the brain and spinal cord is composed of several layers of a
fatty substance known as lipoprotein. In addition to acting as a protective covering for the nerves, the
myelin sheath also allows rapid conduction of electrical impulses along the nerve fibers. When the myelin
sheath is damaged, there may be a slow down of electrical impulses traveling along the nerves. The
condition may be further exacerbated when the nerve fibers are also damaged.
DAMAGE IN MULTIPLE SCLEROSIS

Destruction of the myelin sheath is known as demyelination.

Although the myelin sheath may be able to repair and regenerate
itself in some cases, severe damage to it may cause the
enclosednerve to die.
Since regeneration of nerve fibers in the brain and spinal cord is
rarely possible,
the nerve damage is usually permanent.
Some disorders may affect the nerves of the central nervous
system (brain and spinal cord) while others may affect the
nerves in other parts of the body.
TYPES OF MS

 Clinically isolated syndrome (CIS): This is a single, first episode, with symptoms lasting
at least 24 hours. If another episode occurs at a later date, a doctor will diagnose relapse-
remitting MS.

 Relapse-remitting MS (RRMS): This is the most common form, affecting around 85% of
people with MS. RRMS involves episodes of new or increasing symptoms, followed by
periods of remission, during which symptoms go away partially or totally.
TYPES OF MS

 Primary progressive MS (PPMS): Symptoms worsen progressively, without early

relapses or remissions. Some people may experience times of stability and periods when
symptoms worsen and then get better. Around 15% of people with MS have PPMS.

 Secondary progressive MS (SPMS): At first, people will experience episodes of relapse

and remission, but then the disease will start to progress steadily.
WHAT ARE POSSIBLE SYMPTOMS?
 Fatigue (most common)
 Vision problems
 Muscle stiffness (spasticity)
 Muscle weakness
 Bladder/bowel problems
 Sexual problems
 Sensory problems (numbness, tingling, pain)
 Emotional changes
 Walking difficulties (weakness, imbalance, incoordination)
 Cognitive changes (attention, memory, processing)
 Speech/swallowing difficulties
RISK FACTORS

 Scientists do not really know what causes MS, but risk factors include:
 Age: Most people receive a diagnosis between the ages of 20 and 40 years.
 Sex: Most forms of MS are twice as likely to affect women than men.
 Genetic factors: Susceptibility may pass down in the genes, but scientists believe an
environmental trigger is also necessary for MS to develop, even in people with specific
genetic features.
 Smoking: People who smoke appear to be more likely to develop MS. They tend to have
more lesions and brain shrinkage than non-smokers.
RISK FACTORS

 Infections: Exposure to viruses, such as Epstein-Barr virus (EBV), or

mononucleosis, may increase a person’s risk of developing MS, but research has not
shown a definite link. Other viruses that may play a role include human herpes virus
type 6 (HHV6) and mycoplasma pneumonia.

 Vitamin D deficiency: MS is more common among people who have less exposure

to bright sunlight, which is necessary for the body to create vitamin D. Some experts
think that low levels of vitamin D may affect the way the immune system works.

 Vitamin B12 deficiency: The body uses vitamin B when it produces myelin. A lack

of this vitamin may increase the risk of neurological diseases, such as MS.
HOW IS MS DIFFERENT FROM OTHER
NEUROLOGIC CONDITIONS?

ALS (Amyotrophic Lateral Sclerosis

"Lou Gehrig's disease") Muscular Dystrophy
Progressive loss of the motor neurons
that carry impulses from the brain to the Damaje occurs in muscles rather
spinal cord and the spinal cord to than nerves
muscles

Stroke
Parkinson's Stroke
Injury to neurons due to lack of
Progressive loss of neurons that
blood supply or bleeding in the
contain chemical neurotransmitter
brain UCLA Health than the
dopamine which controls
symptoms of multiple sclerosis
movements
muscular
HOW IS MD DIAGNOSED?

 Patient history of symptoms

 Patient neurologic examination
 MRI
 Spinnal tap
 Electrical test
 Tests to rule out other diseases that may mimic MS
Other autoinmune/inflammatory
Infectious
Metabolic
HOW IS MS TREATED?

 MS can be managed by two categories of treatment

•1. Disease Modifying Therapies

These medications reduce new nerve damage and decrease clinical attacks

•2. Symptom management

These strategies, which include medicine and non- medication strategies, help people feel and
function better
PATHOPHYSIOLOGY

 Autoimmune response results in damage and lost fibers.

 Nerve can regain myelin, but process is not fast enough to avoid the deterioration that
occurs

 Astrocytes form scars where myelin formerly existed

 Inflammation, loss of myelin, and nerve fibers, and the scarring that follows results in
reduced transmission of nerve signals within the CNS.

 Types of symptoms and severity vary widely due to the location of the scar tissue and
extent of demyelination
TREATMENT OF SYMPTOMS

 Medication

 Rehabilitation

 Lifestyle
DISEASE MODIFYING THERAPIES

 Interfere with the immune system´s ability to attack the nerves

 Reduce attacks, and new áreas of nerve damage

 May reduce future disability

 Do not reverse damage

 Do not treat symptoms

DISEASE MODIFYING THERAPIES
INJECTABLE ORAL INTRAVENOUS
BETASERON GILENYA TYSABRI
EXTAVIA (Fingolimod) (Natalizumab)
(beta interferon)
AVONEX AUBAGIO LEMTRADA
(B IFN) (Teriflunomide) (Alemtuzumab)
REBIF TECFIDERA RITUXAN
(B IFN) (Dimethyl fumarate) (Rituximab)
(OFF LABEL)
PLEGRIDY OCREVUS
(B IFN) (Ocrelizumab)
COPAXONE NOVANTRONE
GLATOPA (Mitoxantrone)
MYLAN
(Glatiramer Acetate)
LIFESTYLE
Diet, exercise and healthy habits are
very important in helping people with
MS feel and function at their best
Healthier diets associated with less disability
Smoking increases progression & disability
Physicial exercise is beneficial improves:
Fatigue
Strength
Endurance
Cognition
Healthier gut bacteria