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Increase in multiple sclerosis activity after assisted reproduction technology.

Jorge Correale1, Mauricio F Farez, María C Ysrraelit

  • 1Department of Neurology, Institute for Neurological Research Dr Raúl Carrea, Foundation Against Neurological Disease in childhood (FLENI), Buenos Aires, Argentina. jcorreale@fleni.org.ar

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Summary
This summary is machine-generated.

Assisted reproduction technology (ART) significantly increases multiple sclerosis (MS) exacerbation risk by 7-fold. Reproductive hormones during ART may drive this increased immune activity and disease worsening in MS patients.

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Area of Science:

  • Neuroimmunology
  • Reproductive Endocrinology

Background:

  • Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
  • Assisted reproduction technology (ART) involves hormonal stimulation that may impact immune function.
  • The risk of MS exacerbations during ART treatment is not well-established.

Purpose of the Study:

  • To evaluate the risk of MS exacerbations in patients undergoing ART.
  • To investigate the immunological changes associated with ART in MS patients.

Main Methods:

  • Prospective study of 16 relapsing-remitting MS patients undergoing 26 ART cycles using GnRH agonists and recombinant FSH.
  • Monitoring included neurological exams, MRI, and immunological assays (cytokines, antibodies, VEGF) every 3 months.
  • Assessed T-cell and peripheral blood mononuclear cell (PBMC) responses, and in vitro blood-brain barrier transmigration.

Main Results:

  • ART was associated with a 7-fold increase in MS exacerbation risk and a 9-fold increase in MRI-detected disease activity.
  • Increased pro-inflammatory markers (IL-8, IL-12, IFN-γ, VEGF, CXCL-12) and GnRH-mediated effects were observed.
  • Elevated 17-β estradiol correlated with increased anti-MOG antibodies and B-cell activation factors (BAFF, Bcl-2).
  • ART promoted PBMC transmigration across an in vitro blood-brain barrier, mediated by IL-8, VEGF, and CXCL-12.

Conclusions:

  • ART significantly increases MS disease activity, a risk neurologists must consider.
  • Reproductive hormones play a crucial role in modulating immune responses in autoimmune diseases like MS.