It presents with varying symptoms such as muscle fatigue, paralysis, loss of sensation/numbness, and pain, as well as emotional impairments such as depression and other mood disorders

It presents with varying symptoms such as muscle fatigue, paralysis, loss of sensation/numbness, and pain, as well as emotional impairments such as depression and other mood disorders. in the world.1 NAD 299 hydrochloride (Robalzotan) This demyelinating autoimmune disease usually presents in the prime of life and is associated with marked physical and cognitive disabilities and a shortened life span.2 Classically described as a neuroinflammatory autoimmune disease that targets the myelin in the brain and spinal cord, this complicated disease has NAD 299 hydrochloride (Robalzotan) an unknown etiology and no known cure. It presents with varying symptoms such as muscle fatigue, paralysis, loss of sensation/numbness, and pain, as well as emotional impairments such as depression and other mood disorders. The disease has diverse phenotypes.3 The majority of MS patients initially present with subacute attacks, with symptoms and signs referable to the NAD 299 hydrochloride (Robalzotan) central nervous system (CNS) C defined as a clinically isolated syndrome (CIS).4 When the attack is followed by a complete or partial remission which is then followed by another attack(s), often focused in a different location in the CNS and possibly of higher intensity, the disease course is defined as relapsing and remitting MS (RRMS).4 Patients who present with a gradually progressive course without a well-defined initial attack are presenting with primary progressive MS (PPMS).4 Secondary progressive MS (SPMS) is characterized by CIS or RRMS followed by progressive clinical worsening over time, generally 3 years or more after the onset of disease.4 The pathology of MS includes penetration of leukocytes across the bloodCbrain barrier (BBB), intrathecal production of antibodies, and neuroinflammation, which leads to demyelination and astrocytic and/or neuronal/axonal injury.2,5 In a recent study, Lucchinetti et al used immunohistochemistry to characterize demyelinating activity, inflammatory infiltrates, and the presence of meningeal inflammation in cortical lesions from a cohort of patients with early-stage MS.6 They observed that cortical demyelination was common in the early stages of MS, that the majority of cortical lesions studied were positive for CD3+ T cells, and that a subset were positive for CD20+ B cells. Further, there was a strong topographic association between cortical demyelination and meningeal inflammation suggesting a direct relationship between inflammation and demyelination. The authors speculate that the reason why inflammatory cortical demyelination is not typically observed in chronic, progressive MS may relate to efficient clearance of cortical inflammation over time and thus does not preclude the possibility that inflammation may contribute to demyelination at its onset.6C11 Recent work highlighting how B cells contribute to inflammation and pathogenesis of certain MS disease subtypes are explored in this review.12,13 Evidence that intrathecal B cells contribute to MS pathogenesis In the majority of MS patients, B cell numbers are elevated in the CNS.14 In an extensive histopathological study on actively demyelinating lesions obtained from MS patient biopsies and autopsies, four distinct lesion patterns were observed.15 Pattern II lesions, but not lesions following pattern I, II, or IV, were positive for B cells and they had prominent antibody deposition and complement components at sites of active myelin destruction.15 In other studies, immunohistochemical analysis of brain and spinal cord sections revealed lymphoid follicle-like structures containing T cells, B cells, and plasma cells in the cerebral meninges in patients with SPMS, but not in patients with RRMS or PPMS.16C18 These results suggest de novo formation and maintenance of ectopic lymphoid structures that contribute to increased B cell production in patients with active SPMS.16C18 Meningeal B cell follicles were found in close proximity to large subpial gray matter lesions and diffuse meningeal inflammation, which suggests that the lymphoid-like follicles or products produced by them negatively impacted the integrity of the cortical structures and contributed to gray matter cortical demyelination.18,19 In a recent study, Lee-Chang et al determined that patients with CIS and RRMS had reduced transitional B cell numbers in the peripheral blood compared to control patients, but of the transitional B cells present, these cells had upregulated surface expression of integrins (4 and 1).20 Further, transitional B cells were present in the cerebral spinal fluid (CSF) obtained from the NAD 299 hydrochloride (Robalzotan) CIS and RRMS patients but they were absent from the CSF of individuals with other inflammatory neurological disease.20 Upregulated integrins (4 and 1) likely assist these cells to cross the bloodCCSF barrier. Overall, these studies suggest that MS patients have increased intrathecal B cells which may Rab21 contribute to MS pathogenesis through antibody-dependent or antibody-independent mechanisms. Antigen-independent mechanisms through which B cells may contribute to MS pathogenesis Treatment with rituximab (anti-CD20 antibody, Rituxan?) C a humanized mouse anti-CD20 antibody which depletes CD20+ cells (ie, pre-B cells, immature B cells, mature B cells,.

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