Related Experiment Video
Updated: Sep 4, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Peripheral Hemolysis in Relation to Iron Rim Presence and Brain Volume in Multiple Sclerosis
Nik Krajnc1,2, Gabriel Bsteh1, Gregor Kasprian3
1Medical University of Vienna, Department of Neurology, Vienna, Austria.
Background:
Iron rim lesions (IRLs) represent chronic lesion activity and are associated with a more severe disease course in multiple sclerosis (MS). How the iron rims around the lesions arise in patients with MS (pwMS), and whether peripheral hemolysis may be a source of iron in rim associated macrophages, is unclear.
Objective:
To determine a potential correlation between peripheral hemolysis parameters and IRL presence in pwMS.
Methods:
This retrospective study included pwMS, who underwent a 3T brain MRI between 2015 and 2020 and had a blood sample drawn at ± 2 weeks. Patients with vertigo served as a control group.
Results:
We analyzed 75 pwMS (mean age 37.0 years [SD 9.0], 53.3% female) and 43 controls (mean age 38.3 years [SD 9.8], 51.2% female). Median number of IRLs was 1 (IQR 4), 28 (37.3%) pwMS had no IRLs. IRL patients showed significantly higher Expanded Disability Status Scale (EDSS) compared to non-IRL patients (median EDSS 2.3 [IQR 2.9] vs. 1.3 [IQR 2.9], p = 0.017). Number of IRLs correlated significantly with disease duration (r s = 0.239, p = 0.039), EDSS (r s = 0.387, p < 0.001) and Multiple Sclerosis Severity Scale (MSSS) (r s = 0.289, p = 0.014). There was no significant difference in hemolysis parameters between non-IRL, IRL patients (regardless of gender and/or disease type) and controls, nor between hemolysis parameters and the number of IRLs. Total brain volume was associated with fibrinogen (β= -0.34, 95% CI -1.32 to -0.145, p = 0.016), and absolute cortical and total gray matter volumes were associated with hemoglobin (β = 0.34, 95% CI 3.39-24.68, p = 0.011; β = 0.33, 95% CI 3.29-28.95, p = 0.015; respectively).
Conclusion:
Our data do not suggest an association between hemolysis parameters and IRL presence despite a significant association between these parameters and markers for neurodegeneration.
Insights
This study found no link between red blood cell breakdown (hemolysis) and iron rim lesions (IRLs) in multiple sclerosis (MS). Hemolysis markers did not correlate with IRL presence or number in patients with MS.
Area of Science:
- Neuroimmunology
- Neurodegeneration
- Multiple Sclerosis Pathophysiology
Background:
- Iron rim lesions (IRLs) indicate chronic activity and more severe disease in multiple sclerosis (MS).
- The origin of iron in IRLs and the potential role of peripheral hemolysis remain unclear in MS patients (pwMS).
Purpose of the Study:
- To investigate the correlation between peripheral hemolysis parameters and the presence of IRLs in pwMS.
- To explore the relationship between hemolysis and neurodegenerative markers in MS.
Main Methods:
- Retrospective analysis of 75 pwMS and 43 controls with 3T brain MRI and blood samples.
- Comparison of hemolysis parameters between IRL and non-IRL groups, and correlation with clinical/imaging data.
Main Results:
- IRL presence was associated with higher disability (EDSS) and disease severity (MSSS) in pwMS.
- No significant differences in hemolysis parameters were found between IRL, non-IRL patients, and controls.
- Hemolysis parameters showed associations with brain volume and hemoglobin levels, but not IRL presence.
Conclusions:
- Peripheral hemolysis is unlikely to be a direct source of iron for IRLs in MS.
- While hemolysis markers correlate with neurodegeneration markers, they are not associated with IRL presence.
