Wednesday, 27 May 2015

Blood cells as a maker of inflammation

Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, YĆ¼rekli VA. The Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Multiple Sclerosis. Int J Neurosci. 2015 May 22:1-24. [Epub ahead of print]

Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the central nervous system that causes functional disability in young people. The aim of this study was to investigate the neutrophil-to-lymphocyte ratio (NLR) in patients with MS and the relationship between the NLR and the severity of the disease. One hundred two MS patients (31 patients were in relapse; 71 patients were in remission) and 56 healthy controls were included. Complete blood counts as well as demographic and clinical data from MS patients were evaluated retrospectively. The NLRs were calculated for all participants and were compared; the cut-off value was also determined for the NLR and Expanded Disability Status Scale (EDSS). MS patients had a significantly higher NLR (p < 0.001) than the control group. The NLR levels were significantly higher in patients that were in relapse than patients in remission (p = 0.039). The cut-off value for the NLR to predict a MS diagnosis and activity were determined to be 2.04 and 3.90 respectively. The NLRs were directly correlated with erythrocyte sedimentation rate (ESR) levels (r = 0.795, p < 0.001). Logistic regression analysis with dichotomous EDSS score showed that a high NLR was an independent predictor of the progression of disability. The NLR may be a biomarker that has simple, quick, inexpensive, and reproducible properties in MS to predict patient's prognosis.

Neutrophil granulocytes (also known as neutrophils) are the most abundant (40% to 75%) type of white blood cells in mammals and form an essential part of the innate immune system. They are short-lived and highly motile. The name neutrophil derives from staining characteristics on hematoxylin and eosin (H&E) histological or cytological preparations. Whereas basophilic white blood cells stain dark blue and eosinophilic white blood cells stain bright red, neutrophils stain a neutral pink. Normally, neutrophils contain a nucleus divided into 2–5 lobes.

Neutrophils are a type of phagocyte and are normally found in the bloodstream. During the beginning (acute) phase of inflammation, particularly as a result of bacterial infection, environmental exposure, and some cancers, neutrophils are one of the first-responders of inflammatory cells to migrate towards the site of inflammation. They migrate through the blood vessels, then through interstitial tissue, following chemical signals such as Interleukin-8 (IL-8), C5a, fMLP and Leukotriene B4 in a process called chemotaxis. They are the predominant cells in pus, accounting for its whitish/yellowish appearance.Neutrophils are recruited to the site of injury within minutes following trauma, and are the hallmark of acute inflammation.

MS is considered to be chronic inflammation and are rare in MSand are also a rare in EAE,that is unless its mouse EAE. I has been suggested that Th17 T cells can induce EAE has lots of neutrophils and if you look in some mouse strains, neutrophils can make up about 80% of the white cells. Neutrophils are common in mouse inflammatory skin lesions and are rare in rats lesions and guinea pig skin lesions. its a mouse thing. But because of neutrophils in mouse and so some people think that they are important in MS and maybe they are, but it is important that we look at MS,rather than make MS mouse EAE. Neutrophils are more common in neuromyelitis optica lesions

In this study they look at the neutrophil to lymphocyte ratio (NLR) and find that it is elevated in MS and active MS. However the NLR is used as a marker of subclinical inflammation and occurs in a number of conditionsBlood nu


  1. Mouse - so if I want to calculate the ratio what do I do:

    neutrophiles (56) divided by (28) equals 2.0? Is that correct?

    that would mean a grey territory between remission and relapse (<2.04) whereas last summer the ratio was 3.8 so definately a relapse (as felt by me as well).

  2. The neutrophil-to-lymphocite ratio is also dependent on the lymphocyte count, which is often decreased by DMTs (certainly fingolimod, often dimethyl fumarate, etc.). So, this ratio will vary for MS patients treated with different DMTs.

    1. Thank you your right - however, I wasn't on DMTs when my ratio was 2.0.


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