Abstract
Multiple sclerosis is the principal demyelinating disease of the central nervous system. Although the prevalence of the disease is moderately low, averaging about 40 cases per 100,000 people in high risk areas, it is a particularly devastating disease. It primarily affects young adults, is chronic, and has an unpredictable course. Most discouraging, the cause of the disease is not known and an effective treatment has not been identified. Recently, however, research has yielded some important findings concerning the etiology of MS. Much evidence now points to an immunological process as one of the major elements in the disease. It is also likely that an environmental influence, possibly an infectious process, may contribute to the disease. Finally, it is now certain that genetic makeup influences susceptibility to the disease. At present, the strongest evidence is for a polygenic effect, not the effect of a single gene or gene locus. This review will examine some of the possible immunologically mediated disease processes that could be involved in MS, especially those that could account for a role for infectious and genetic factors in the disease.
Footnotes
Presented as part of a symposium entiled “Immunoregulation in Clinical Disease,” May 26–27, 1988, Palazzo dei Congressi, Florence, Italy.
References
- 1.Reder A.T., Arnason B.G.W. Immunology of multiple sclerosis. In: Vinken P.J., Bruyn G.W., Klawans H.C., editors. Vol. 47. Elsevier; Amsterdam: 1985. pp. 337–396. (Handbook of Clinical Neurology). [Google Scholar]
- 2.McFarlin D.E., Pierce M.L., Goodman A., Mingioli E.S., McFarland H.F. Cellular and humoral components of cerebrospinal fluid. In: Lowenthal A., Raus J., editors. Multiple Sclerosis. Plenum; New York/London: 1987. pp. 1–9. [Google Scholar]
- 3.Tourtellotte W.W., Walsh M.J., Baumhefner R.W. Ann. N.Y. Acad. Sci. 1984;436:52–67. doi: 10.1111/j.1749-6632.1984.tb14775.x. [DOI] [PubMed] [Google Scholar]
- 4.Ebers C.G. Ann. N.Y. Acad. Sci. 1984;436:206–212. doi: 10.1111/j.1749-6632.1984.tb14791.x. [DOI] [PubMed] [Google Scholar]
- 5.Goswami A.A., Randall R.E., Lange L.S., Russell W.C. Nature (London) 1987;324:244–247. doi: 10.1038/327244a0. [DOI] [PubMed] [Google Scholar]
- 6.Lisak R.P., Zweiman B., Burns J.B. Ann. N.Y. Acad. Sci. 1984;436:221–230. doi: 10.1111/j.1749-6632.1984.tb14793.x. [DOI] [PubMed] [Google Scholar]
- 7.Albrecht P., Tourtellotte W.W., Hick J.T. Neurology. 1983;33:45–50. doi: 10.1212/wnl.33.1.45. [DOI] [PubMed] [Google Scholar]
- 8.Hasse A.T., Ventura P., Gibbs C.J., Tourtellotte W.W. Science. 1981;212:672–675. doi: 10.1126/science.7221554. [DOI] [PubMed] [Google Scholar]
- 9.Raine C.S., Mohktarian F., McFarlin D.E. Lab. Invest. 1984;51:534–546. [PubMed] [Google Scholar]
- 10.Prineas J.W., Kwon E.E., Cho E., Sharer L.R. Ann. N.Y. Acad. Sci. 1984;436:11–32. doi: 10.1111/j.1749-6632.1984.tb14773.x. [DOI] [PubMed] [Google Scholar]
- 11.Raine C.S., Traugott U., Mohktarian F. Lab. Invest. 1981;45:174–182. [PubMed] [Google Scholar]
- 12.Schluesener H.J., Sobel R.A., Linngton C., Weiner H.L. J. Immunol. 1987;139:4016–4021. [PubMed] [Google Scholar]
- 13.Adams D.O., Hamilton T.A. Annu. Rev. Immunol. 1984;2:283–318. doi: 10.1146/annurev.iy.02.040184.001435. [DOI] [PubMed] [Google Scholar]
- 14.Haase A.T. Nature (London) 1986;322:130–136. doi: 10.1038/322130a0. [DOI] [PubMed] [Google Scholar]
- 15.Navia B.A., Cho E., Petito C.K., Price R.W. Ann. Neurol. 1986;19:525–535. doi: 10.1002/ana.410190603. [DOI] [PubMed] [Google Scholar]
- 16.Mattson D.H., McFarlin D.E., Maora E. Lancet. 1987;2:49. doi: 10.1016/s0140-6736(87)93091-1. [DOI] [PubMed] [Google Scholar]
- 17.Gartner S., Markovits P., Markovitz D.M. JAMA. 1986;256:2365–2371. [PubMed] [Google Scholar]
- 18.Narayan O. J. Gen. Virol. 1982;59:245–256. doi: 10.1099/0022-1317-59-2-345. [DOI] [PubMed] [Google Scholar]
- 19.Jacobson S., Raine C.S., Mingioli E.S., McFarlin D.E. Nature (London) 1988;331:540–543. doi: 10.1038/331540a0. [DOI] [PubMed] [Google Scholar]
- 20.Zamvil S.S., Nelson P.A., Mitchell D.J. J. Exp. Med. 1985;162:2107–2124. doi: 10.1084/jem.162.6.2107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Johnson D., Hafler D.A., Fallis R.J. J. Neuroimmunol. 1986;13:99–108. doi: 10.1016/0165-5728(86)90053-6. [DOI] [PubMed] [Google Scholar]
- 22.Hafler D.A., Benjamin D.S., Burks J., Weiner H.L. J. Immunol. 1987;139:68–72. [PubMed] [Google Scholar]
- 23.Kurtzke J.F., Hyllested K. Ann. Neurol. 1979;5:6–21. doi: 10.1002/ana.410050104. [DOI] [PubMed] [Google Scholar]
- 24.Clatch R.J., Lipton H.L., Miller S.D. J. Immunol. 1986;136:920–927. [PubMed] [Google Scholar]
- 25.Melvold R.W., Jokinen D.M., Knobler R., Lipton H.L. J. Immunol. 1987;138:1429–1436. [PubMed] [Google Scholar]
- 26.Jacobson S.J., Flerlage M.L., McFarland H.F. J. Exp. Med. 1985;162:839–850. doi: 10.1084/jem.162.3.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.McFarland, H. F., Goodman, A., and Jacobson, S. J., Ann. N.Y. Acad. Sci., in press. [DOI] [PubMed]
- 28.Watanabe R., Wage H., ter Meulen V. Nature (London) 1983;305:150–152. doi: 10.1038/305150a0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Leibert U.G., Linington C., ter Meulen V. J. Neuroimmunol. 1988;17:103. doi: 10.1016/0165-5728(88)90018-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Johnson R.T., Griffin D.E., Hirsch R.L. N. Engl. J. Med. 1984;310:137–141. doi: 10.1056/NEJM198401193100301. [DOI] [PubMed] [Google Scholar]
- 31.Jahnke U., Fisher E.H., Alvord E.C. Science. 1985;229:282–284. doi: 10.1126/science.2409602. [DOI] [PubMed] [Google Scholar]
- 32.McCarron R.M., Spatz M., Kempski O. J. Immunol. 1986;137:3428–3435. [PubMed] [Google Scholar]
- 33.Fontana A., Fienz W., Wekerle H. Nature (London) 1984;307:273–276. doi: 10.1038/307273a0. [DOI] [PubMed] [Google Scholar]
- 34.Massa P.T., ter Meulen V., Fontana A. Vol. 84. 1987. pp. 4219–4223. (Proc. Natl. Acad. Sci. USA). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Massa P.T., Dorries R., ter Meulen V. Nature (London) 1986;320:543–544. doi: 10.1038/320543a0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Antel J.P., Bania M.B., Reyda A., Cashman N. J. Immunol. 1986;137:137–141. [PubMed] [Google Scholar]
- 37.Antel J.P., Nickolas M.K., Bania M.B. J. Neuroimmunol. 1986;12:215–224. doi: 10.1016/s0165-5728(86)80005-4. [DOI] [PubMed] [Google Scholar]
- 38.Morimoto C., Hafler D.A., Weiner H.L. N. Engl. J. Med. 1987;316:67–72. doi: 10.1056/NEJM198701083160202. [DOI] [PubMed] [Google Scholar]
- 39.Brinbaum G., Kotilinek L. Ann. Neurol. 1981;9:439–446. doi: 10.1002/ana.410090505. [DOI] [PubMed] [Google Scholar]
- 40.Crisp D.T., Greenstein J.I., Kleiner J.E. Ann. Neurol. 1985;18(1):129. [Google Scholar]
- 41.Hafler D.A., Buchsbaum M., Weiner H.L. J. Neuroimmunol. 1985;9:339–347. doi: 10.1016/s0165-5728(85)80034-5. [DOI] [PubMed] [Google Scholar]
- 42.Nathanson N., Panitch H., Palsson P.A., Georgsson G. Lab. Invest. 1976;35:444–451. [PubMed] [Google Scholar]
- 43.Lehmann-Grube F. Ann. N.Y. Acad. Sci. 1988 (in press) [Google Scholar]
- 44.Norrby E. Prog. Med. Virol. 1978;24:1–39. [PubMed] [Google Scholar]
- 45.Greenstein J.I., McFarland H.F. Clin. Immunol. Allergy. 1982;2:371–383. [Google Scholar]
- 46.Hickey W.F., Kimura H. Science. 1988;239:290–292. doi: 10.1126/science.3276004. [DOI] [PubMed] [Google Scholar]