Eduardo Lima*, Joana Guimarães††, Ana Pereira*, Abília Bodas*, Luís Delgado*‡, Maria José Sá*
*Laboratório de Imunologia, Hospital de São João, Porto; † †Serviço de Neurologia, Hospital de São João, Porto; ‡ Serviço de Imunologia, Faculdade de Medicina, Universidade do Porto
Introdução: A Esclerose Múltipla é uma doença desmielinizante primária de carácter autoimune, envolvendo diferentes mecanismos imunopatológicos. Pensa-se que anticorpos dirigidos contra antigénios da mielina podem estar associados aos danos na mielina ou surgirem devido a estes, pelo que, o seu doseamento poderá constituir um marcador de evolução da doença. No entanto, a positividade desta pesquisa pode levantar dúvidas em termos de valorização clínica dada a descrição destes auto-anticorpos também em indivíduos sem doença. O objectivo deste trabalho foi a avaliação da presença de auto-anticorpos para a mielina em pacientes com o diagnóstico de Esclerose Múltipla, comparativamente a amostras de controlo, avaliando a sua associação com sintomas clínicos em pacientes com diferentes formas clínicas da Esclerose Múltipla. Métodos: A pesquisa de anticorpos para a mielina foi realizada por uma técnica de imunofluorescência indirecta usando como substrato, nervo periférico de primata (EUROIMMUN®). Foram estudados 34 doentes (14M/11H), observados no serviço de Neurologia do Hospital de São João: 8 com forma monosintomática em surto, 11 com forma Surto/Remissão (SR) em remissão, 11 com forma SR em surto e 4 com forma Primária Progressiva (PP) em remissão. A população de controlo foi constituída por 25 amostras de indivíduos saudáveis (26M/8H). Resultados: Encontraram-se diferenças significativas nas duas populações em relação à presença de anticorpos para a mielina (p<0,001). A análise dos diferentes tipos clínicos demonstrou uma prevalência de 87,5% nos casos com SCI, 77,3% na forma SR e 75,0% na forma PP. Em relação à situação clínica, 94,7% dos doentes em surto possuíam anticorpos anti-mielina enquanto que nos doentes em remissão 60,0% foram positivos. No grupo sem patologia, 32,0% apresentou positividade para os anticorpos anti-mielina. Conclusões: Apesar deste teste não ser específico na Esclerose Múltipla, na população de doentes estudada verificou-se uma maior prevalência dos anticorpos anti-mielina por imunofluorescência indirecta nos pacientes em surto. Até que novos e melhores marcadores serológicos estejam disponíveis, este teste poderá ser útil para monitorizar pacientes com diagnóstico definitivo ou possível de Esclerose Múltipla, na qual a presença destes auto anticorpos poderá indicar um possível surto.
Palavras-chave: esclerose múltipla; auto-anticorpos; mielina; imunofluorescência indirecta.
Anti-Myelin Autoantibodies in Multiple Sclerosis
Introduction: Multiple Sclerosis (MS) is a primary demyelinating disease of autoimmune ethiology with different immunopathologic mechanisms. Anti-myelin autoantibodies may be associated with myelin damage and a possible marker of the disease evolution. However, the clinical usefulness of these autoantibodies is questionable as they may be present in healthy individuals. The aim of this work was the evaluation of autoantibodies against myelin in patients with MS comparatively with control samples, and their association with differents clinical types. Methology: For the search of anti-myelin antibodies we used indirect immunofluorescence in primate peripheral nerves (EUROIMMUN®). Thirty four patients (14 female/11 male) followed in the Neurology department were studied: 8 with the Clinically Isolated Syndrome (CIS) with relapse, 11 with Relapsing/Remitting (RR) in remission, 11 with RR with relapse and 4 with Primary Progressive (PP); 25 samples of healthy individuals (26 female/8 male) were studied as controls. Results: The presence of autoantibodies to myelin was signifiantly different in the two studied populations (p<0.001). Within the different clinical types we found a prevalence of 87.5% in CIS, 77.3% in RR and 75.0% in the patients with PP. Most patients (94.7%) in relapse had antibodies against myelin versus 60.0% of those in remision. In the control group, 32.0% presented anti-myelin antibodies. Conclusions: Although this test was not specific for MS, in the patient population studied the presence of anti-myelin antibodies by indirect immunofluorescence was higher in those in relapse. Until new and better serologic markers are available, this test may be useful to monitor patients with possible or definitive diagnosis of MS, in witch the presence of anti-myelin antibodies may support a possible relapse.
]]> Key-words: multiple sclerosis; auto-antibody; myelin; indirect immunofluorescence.
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Correspondência:
Dr. Eduardo Lima
Laboratório de Imunologia
Hospital de São João
Alameda Prof. Hernâni Monteiro
]]> 4200-319 Portoe-mail: edlima1982@hotmail.com
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