Saturday, 22 September 2012

Research: inflammation is not good for you

Epub: Kooi et al. Heterogeneity of cortical lesions in multiple sclerosis: Clinical and pathologic implications.Neurology. 2012 Sep 12.

OBJECTIVE: Autopsy cases show that cortical lesions (CLs) in multiple sclerosis (MS) lack lymphocyte/macrophage influx, blood-brain barrier breakdown, and complement activation. However, some CLs were demonstrated to harbor activated microglia. Here, we assessed the clinical significance of microglia activation in CLs in a large autopsy sample, and we investigated possible interrelationships with other pathologic characteristics.

METHODS: We cross-sectionally investigated the clinicopathologic characteristics of 22 patients with MS with extensive subpial demyelination (CL group) and 19 patients with MS with only little demyelination of the cerebral cortex (non-CL group).

RESULTS: A subset of the patients in the CL group (12 patients) showed rims of activated microglia (RAM) at the border of the CLs (RAM-CL group), whereas the other 10 patients in this group did not show microglia activation (non-RAM-CL group). A subsequent comparison between groups showed that patients with MS harboring RAM-CLs were significantly younger at the time of their death (53.5 years) than patients harboring mainly non-RAM-CLs (68.7 years; p < 0.05) or patients without extensive numbers of CLs (66.9 years; p < 0.01). In addition, a significantly shorter disease duration was found for the RAM-CL group (mean 20.9 years) than for the non-CL group (mean 34.5 years; p < 0.05). We also found that the presence of RAM-CLs is associated with a higher number of chronic active white matter (WM) lesions (Spearman ρ = 0.74; p < 0.0001).

CONCLUSIONS: RAM-CLs were found in a subset of patients with MS who also have more active WM inflammation and a less favorable disease course.

This study looked at grey matter lesions and found that those with an active immune system had a worse prognosis and also had more active white matter disease. Some may say that they are there to clear up the damage, others probably the majority will suggest that having activated microglia in your brain is not a good thing.

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