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Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

Published on: September 12, 2016

CNS immune reconstitution inflammatory syndrome.

Lauren Bowen¹, Avindra Nath¹, Bryan Smith¹

¹Section of Infections of the Nervous System, National Institute for Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.

Handbook of Clinical Neurology

|April 2, 2018

Summary

Immune reconstitution inflammatory syndrome (IRIS) is an aberrant immune response often seen with HIV. This chapter details central nervous system IRIS, its mechanisms, and management strategies for opportunistic infections.

Keywords:

CNS immune reconstitution inflammatory syndrome (CNS IRIS)Cryptococcus neoformans HIV encephalitis Toxoplasma gondii progressive multifocal leukoencephalopathy (PML)

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Area of Science:

Immunology
Infectious Diseases
Neurology

Background:

Immune reconstitution inflammatory syndrome (IRIS) is characterized by dysregulated immune responses during immune restoration, frequently observed in HIV-infected individuals.
IRIS involves an overactive immune response to opportunistic pathogens after CD4+ T-cell count normalization.
Central nervous system IRIS (CNS IRIS) presents unique challenges due to the complex interplay between host, pathogen, and immune system within the central nervous system.

Purpose of the Study:

To elucidate the unique characteristics of CNS IRIS.
To explore proposed mechanisms and historical context of IRIS.
To review common CNS pathogens implicated in IRIS and discuss current management strategies.

Main Methods:

Literature review and synthesis of existing research on IRIS and CNS IRIS.
Analysis of proposed immunological mechanisms and animal models of IRIS.
Compilation of data on pathogens associated with CNS IRIS and their clinical impact.

Main Results:

CNS IRIS involves a complex immune dysregulation specific to the central nervous system environment.
Multiple theories exist regarding the precise immunological mechanisms driving IRIS pathology.
Various opportunistic pathogens commonly cause CNS IRIS, each with distinct influences.

Conclusions:

Understanding CNS IRIS requires considering the specific host-pathogen interactions and immune system dynamics.
Further research into IRIS mechanisms is needed to clarify its pathology.
Effective management of CNS IRIS relies on identifying causative pathogens and implementing targeted strategies.