Aleksandra Podlecka-Piętowska

Sex hormone patterns in women with multiple sclerosis as related to disease activity — a pilot study

BACKGROUND AND PURPOSE The influence of sex hormones on immune system activity in multiple sclerosis (MS) has been suggested by clinical evidence. The aim of the study was to ana-lyse the pattern of sex hormones in MS women and to correlate the hormone pattern abnormalities to the disease course as well as to the magnetic resonance imaging (MRI) results. MATERIAL AND METHODS We studied the serum level of the progesterone, β-oestradiol and prolactin in 46 women with clinical definite MS aged from 19 to 65; mean disease duration was 11.80 ± 9.86 years. The evaluation of the intensity of hormonal changes was done using a scoring system (0-3). On the brain MRI, the presence of brain atrophy, of hypothalamic demyelination as well as demyelination intensity (or degree) were analysed. The evaluation of the degree of demyelination and brain atrophy was done using a scoring system (0-4). RESULTS The main hormonal abnormalities consisted of decreased progesterone level, increased oestradiol level or both. The sex hormone pattern was abnormal in 56% of patients. Hypothalamic lesions were found on MRI in 53% of cases. The abnormal hormonal pattern correlated with intensity of MR changes (p < 0.05, Fishers exact test), but neither with presence of hypothalamic changes nor with disease parameters (Expanded Disability Status Scale, relapse rate, disease duration). CONCLUSIONS It is important to check the hormonal pattern in MS women because according to our results it may be related to the disease activity and probably affects the type of therapeutic intervention. This pilot study will be extended in a larger population.

The N-terminal pro-brain natriuretic peptide as a marker of mitoxantrone-induced cardiotoxicity in multiple sclerosis patients.

BACKGROUND AND PURPOSE Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients. MATERIALS AND METHODS We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group. RESULTS The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated. CONCLUSIONS The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.

Metagenomic Analysis of Cerebrospinal Fluid from Patients with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of central nervous system of unknown etiology. However, some infectious agents have been suggested to play a significant role in its pathogenesis. Next-generation sequencing (NGS) and metagenomics can be employed to characterize microbiome of MS patients and to identify potential causative pathogens. In this study, 12 patients with idiopathic inflammatory demyelinating disorders (IIDD) of the central nervous system were studied: one patient had clinically isolated syndrome, one patient had recurrent optic neuritis, and ten patients had multiple sclerosis (MS). In addition, there was one patient with other non-inflammatory neurological disease. Cerebrospinal fluid (CSF) was sampled from all patients. RNA was extracted from CSF and subjected to a single-primer isothermal amplification followed by NGS and comprehensive data analysis. Altogether 441,608,474 reads were obtained and mapped using blastn. In a CSF sample from the patient with clinically isolated syndrome, 11 varicella-zoster virus reads were found. Other than that similar bacterial, fungal, parasitic, and protozoan reads were identified in all samples, indicating a common presence of contamination in metagenomics. In conclusion, we identified varicella zoster virus sequences in one out of the 12 patients with IIDD, which suggests that this virus could be occasionally related to the MS pathogenesis. A widespread bacterial contamination seems inherent to NGS and complicates the interpretation of results.

Sexual dysfunction in female patients with relapsing-remitting multiple sclerosis

Sexual dysfunction (SD) is one of the common symptoms of multiple sclerosis (MS) and is often underdiagnosed, especially in women. Relapsing‐remitting multiple sclerosis (RRMS) is the most widespread form of the disease, but the data on SD occurrence in this particular group of patients is limited. The aim of the study was to analyze the associations between demographic factors, symptoms and signs of MS, psychiatric comorbidities and SD in female patients with RRMS.

“Cure” for multiple sclerosis (MS)—Evolving views of therapy goals in patients on different stages of the disease: A pilot study in a cohort of Polish MS patients

New aggressive treatments promise improvement of results in the treatment of multiple sclerosis (MS), however, with high risk of serious complications. In this study, we analyzed patients’ acceptance for risks connected with the MS treatment.

Assessment of Serum Uric Acid Levels in Multiple Sclerosis during Disease-Modifying Treatment

Objective: Uric acid is a potent endogenous antioxidant and scavenger of peroxynitrite (PN), which hypothesized to be involved in the pathogenesis of multiple sclerosis (MS). Some studies reported lower levels of UA in MS patients compared with controls, whereas other studies found no difference. The main purpose of this analysis was to verify the hypothesis on lower serum levels of UA in MS patients compared with controls.Materials and methods: We examined 80 patients with clinically defined MS, according to the McDonald’s criteria and 53 patients of controls group (non-inflammatory neurological diseases, excluding vascular disorders). Uric acid concentration was determined by using a commercially available enzymatic colorimetric assay according to the manufacturer’s instructions.Results: Serum UA levels of MS patients were significantly lower (4.2 ± 1.1 mg/dl) when compared with control group (4.9 ± 1.4 mg/dl, P=0.0092). Correlation between MS duration and serum UA concentration did not reach statistical significance, however the tendency showing that patients who are suffering from this disorder for a longer time have lower serum UA concentration was observed. Moreover, we found a statistically significant correlation between disease duration and UA concentration in a subgroup of patient who did not have a history of mitoxantrone intake (P<0.0321).Conclusion: Although we do not know exactly whether and how uric acid is involved in MS pathogenesis, data suggest that UA concentration is lower in MS patients than in control group. It seems that low uric acid levels indicate patients with a higher risk of disease progression. Whether or not UA concentration can be useful as a biomarker in MS requires further study.

Evaluation of reproductive health in female patients with multiple sclerosis in Polish population

Multiple sclerosis (MS) is a chronic disease, which affects mostly women and has an early onset. Due to progress in treatment patients maintain a high quality of life for a long period and participate in all of its fields. One of them is reproductive health with all of its aspects. The aim of the study was to evaluate the reproductive health of female MS patients with regard to various features of MS. It was a cross-sectional study. The data was collected via anonymous survey distributed among patients with MS hospitalized at the Department of Neurology, Medical University of Warsaw and online. The study group consisted of 218 women diagnosed with MS. The survey consisted of demographic questions, questions assessing features of MS, reproductive health, sexual performance and psychological comorbidities, including depression and fatigue. 53.01% of MS patients declared interest in maternity. Patients interested in pregnancy were significantly younger (p < .01), often nulliparous (p < .001), had lower EDSS score (p < .006) and lower motor deficit (p < .001). History of at least one labour (p < .02) had a negative impact on the frequency of gynaecologic admissions. More advanced age (p < .003), unemployment (p < .01), at least one labour (p < .043), stronger balance problems (p < .003) and more intense motor deficit (p < .002) were related to less frequent Pap smears. Reproductive health of women with MS is similar to that of background population. Therefore, the general gynaecological care in those women should not be neglected.