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2 Types of MS, Study Reveals

Blood Test Would Predict Success of Multiple Sclerosis Treatment
By
WebMD Health News
Reviewed by Laura J. Martin, MD

March 29, 2010 - New study findings may soon revolutionize multiple sclerosis (MS) treatment and diagnosis.

The study strongly suggests that there are two major types of MS and that a simple blood test can tell one from the other. By itself, that would be a major finding. But that's not all.

One type of MS responds to beta interferon, generally considered the best treatment. The other type does not -- and beta interferon treatment may even make it worse, find Stanford University researcher Lawrence Steinman, MD, and colleagues.

"I'm very excited about some of the implications of this," Steinman tells WebMD. "The most important implication is that a simple blood test could tell us who does and does not respond to beta interferon. It could be that about 25% of patients are in the 'do not benefit' group."

For patients who do respond to beta interferon, the study raises hopes that the drug may work better than previously thought. That's because the clinical trials that proved beta interferon to be effective likely enrolled both types of MS patients, watering down the drug's average efficacy in beta interferon responders.

In coming months, Steinman said, he hopes to show that the two kinds of MS respond differently to other MS drugs, too.

Patricia O'Looney, PhD, vice president for biomedical research at the National MS Society, said the study will help researchers solve some of the mysteries surrounding MS.

"No two people with MS are exactly alike in disease course and in response to therapy. Why is this?" O'Looney tells WebMD. "We don't understand why about 50% of people who take beta interferon don't respond well."

Two Routes to MS

Multiple sclerosis is an autoimmune disease caused by haywire immune responses that attack the myelin sheath protecting nerve fibers in the central nervous system.  The culprits are lymphocytes called CD4 T helper cells, sometimes called the quarterbacks of the immune system.

In MS, a subset of CD4 cells called Th1 cells direct an inflammatory immune response against myelin. Beta interferon dampens this signal, so it's a great help to people with MS -- at least, to those who respond to treatment.

Why doesn't beta interferon always work for MS patients? A clue comes from a little known but equally devastating disease called neuromyelitis optica (NMO). In NMO, the immune system attacks nerve fibers, but it targets a protein different from myelin, says NMO researcher Michael R. Yeaman, PhD, vice chair of medical sciences at Harbor-UCLA Medical Center.

NMO researchers have shown that the CD4 cells behind NMO aren't Th1 cells, but another type called Th17. Might Th17 cells cause some cases of MS?

Yes, Steinman and colleagues found. First the researchers induced an MS like disease in mice using either autoimmune Th17 or autoimmune Th1 cells. Then they showed that beta interferon improved MS-like symptoms in mice with Th1-induced disease, but that the drug worsened MS symptoms in mice with Th17-induced disease.

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