Inflammation on the surface of brain drives grey matter disease in MS

Epub ahead of printHowell et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain. 2011 Aug 11. 

Background: Inflammation of the coverings layers of the brain and spinal cord, in the form of lymph node like structures, has been suggested to play an important role in the development of grey matter pathology in MS. The gray matter is where the neurons live and is found on the surface of the brain.

Aim: This study analysed the incidence and distribution of these lymph-node-like structures in MS'ers who had unfortunately died with secondary progressive MS (SPMS). 

Results: 123 MS'ers with SPMS were studied. Ectopic lymph-node-like structures were found 40% of MS'ers and were distributed throughout the brain. 

Cortical (surface of brain) grey matter demyelinated lesions were located both adjacent to, and some distance from lymph-node-like structures. 

The presence of lymph-node-like structures was associated with an increase in diffuse inflammation of the covering of the brain and correlated with the degree of activation of immune cells and grey matter cortical demyelination. 

The average age of disease onset, time to disease progression, time to wheelchair dependence and age at death all differed significantly in these cases when compared with those without these lymph-node-like structures. 

Conclusions: These findings suggest that meningeal inflammation may play a contributory role in the underlying grey matter pathology and accelerated clinical course in MS.

"This study supports previous work in this area demonstrating that inflammation on the surface of the brain may be responsible for gray matter pathology in MS. Another reason to target these structures as part of an MS therapy. Pity Biogen-Idec aborted their trial of baminercept (see link below)."

07 Jun 2011
We were very excited when Biogen-Idec annoucned they were going to do a trial in SPMS with an inhibitor of lymphotoxin called Baminercept. This drug is very clever indeed; it is a soluble form of the lymphotoxin receptor ...