0-TESTO COMPLETO.pdf - Fondazione Santa Lucia

Sezione III: Attività per progetti
EXTERNAL COLLABORATIONS
– Fondazione Santa Lucia, Roma, Unità di Neuroimmunologia – Luca
Battistini
– Università di Chieti e Pescara, Centro regionale dell’Abruzzo per la
Sclerosi Multipla, Chieti – Alessandra Lugaresi
– Università di Roma Tor Vergata, Centro Sclerosi Multipla Policlinico di
Tor Vergata – Diego Centonze
– Università di Careggi, Firenze, Dipartimento di Scienze Neurologiche e
Psichiatriche e Azienda Ospdaliera – Francesco Lolli
RELEVANCE FOR MULTIPLE SCLEROSIS
No markers of inflammatory activity in peripheral blood have been so far
unequivocally associated with the disease. The identification of these markers
might be important as further diagnostic tools and, more importantly, to
define precociously in MS patients the course of the disease, which is now
classified as relapsing, remitting, or progressive only based on clinical evidence.
BACKGROUND, STATE OF THE ART
Multiple Sclerosis (MS) neurodegeneration is primarily caused by autoreactive
lymphocytes invading the brain from the periphery. MS diagnosis can be
difficult, and it is currently based on the combination of clinical, neuroimaging,
neurophysiological and cerebrospinal fluid alterations. No markers of inflammatory
activity in peripheral blood have been so far unequivocally associated
with the disease. The identification of these markers might be important as further
diagnostic tools and, more importantly, to define precociously in MS
patients the course of the disease, which is now classified as relapsing, remitting,
or progressive only based on clinical evidence. The sensitivity of clinical
data to define MS course, however, is very low and accordingly only a minority
of the new active CNS lesions gives rise to new neurological symptoms or signs,
especially in the early phases of MS [Cotton et al. 2003]. Furthermore, at least
6-12 months of clinical observation are necessary to identify a shift towards the
secondary progressive phase of the disease in patients with a previous relapsing-remitting
form of MS. An anticipated identification of the inflammatory or
neurodegenerative condition of MS patients could be very helpful for therapeutic
purposes, since it is increasingly evident that the efficacy of the currently
available immunomodulatory agents substantially decreases when the disease
progresses in terms of lesion load and brain atrophy even in the absence of clinical
deterioration [Kappos et al. 2007]. The analyses of CSF can be highly diagnostic
of MS, revealing increased levels of gamma globulin and oligoclonal
bands. However in the early stages of MS these findings might not be clearly
present and they are not prognostic of the disease course.
Autoreactive T lymphocytes have a predominant role in lesion development,
this is supported by several lines of evidence: firstly, in the murine
622 2009