title: Immune Parameters That Distinguish Multiple Sclerosis Patients from Patients with Other Neurological Disorders at Presentation.
abstract: OBJECTIVE
  Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system. Effector T helper cells, mainly Th1 and Th17, cytotoxic T-cells, B-cells, macrophages, microglia, and the cytokines they secrete, are implicated in the initiation and maintenance of a deregulated immune response to myelin antigens and the ensuing immune-mediated demyelination. In this study, we investigated whether signature cytokines exist in MS patients at presentation to gain an insight into the underlying immunopathogenic processes at the early stage of the disease.
  
  
  METHODS
  We collected serum and cerebrospinal fluid (CSF) samples from 123 patients at presentation, eventually diagnosed with MS or non-inflammatory (NIND) or inflammatory neurological diseases (IND) or symptomatic controls (SC). The levels of cytokines IFN-γ, TNF-α, TGF-β1, IL-2, IL-4, IL-6, IL-10 and IL-17 were measured, and cytokine ratios, such as Th1/Th2, Th1/Th17, and Type-1/Type-2, were calculated. All parameters were tested for their correlations with the intrathecal IgG synthesis.
  
  
  RESULTS
  Cytokine levels in CSF were lower than in serum in all the patients, with the exception of IL-6. Serum or CSF cytokine levels of MS patients did not differ significantly from NIND or SC, with the exception of serum IFN-γ and TNF-α that were significantly higher in NIND. IND patients presented with the highest levels of all cytokines in serum and CSF, with the exception of serum IL-10 and CSF IL-17. MS patients had a significantly lower serum Th1/Th2 ratio compared to the NIND and IND groups, and significantly lower serum Type-1/Type-2, IFN-γ/IL-10 and CSF Th1/Th17 ratios compared to IND patients. MS patients had a significantly higher CSF IL-17/IL-10 ratio compared to IND patients. The IgG index was higher in MS patients compared to the control groups; the differences reached statistical significance between the MS and the NIND and SC groups. Reiber-Felgenhauer analysis of the QIgG and QAlb indices revealed higher intrathecal IgG synthesis in MS patients, and higher blood-CSF barrier dysfunction in IND patients. The IgG index correlated with CSF IL-4 in MS patients only.
  
  
  CONCLUSIONS
  We found no signature cytokines or profiles thereof in MS patients at presentation. Only IND patients presented with a clear Th1 cytokine polarization in serum and CSF. The parameters that distinguished MS patients from patients with other neurological disorders were IgG intrathecal synthesis, the IgG index and its correlation with CSF IL-4 levels.
authors: Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
authors: Athanasia
authors: A
authors: Mouzaki
authors: Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
authors: Maria
authors: M
authors: Rodi
authors: Department of Neurology, Patras University Hospital, Patras, Greece.
authors: Nikolaos
authors: N
authors: Dimisianos
authors: Laboratory of Hematology, Patras University Hospital, Patras, Greece.
authors: Andreas
authors: A
authors: Emmanuil
authors: Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
authors: Dimitra
authors: D
authors: Kalavrizioti
authors: Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece.
authors: Rosa
authors: R
authors: Lagoudaki
authors: Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece.
authors: Nikolaos C
authors: NC
authors: Grigoriadis
authors: Department of Neurology, Patras University Hospital, Patras, Greece.
authors: Panagiotis
authors: P
authors: Papathanasopoulos
mesh_terms: D000328:Adult; D015415:Biomarkers; D016207:Cytokines / Q000097:blood / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology*; D009422:Nervous System Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines; D007074:Immunoglobulin G