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Corneal Immune Cells Are Increased in Patients With Multiple Sclerosis
Adnan Khan1, Yi Li2, Georgios Ponirakis1
1Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar.
Insights
Corneal confocal microscopy revealed increased immature immune cells in multiple sclerosis (MS) patients. This technique may serve as a biomarker for MS neuroimmune changes.
Area of Science:
- Ophthalmology
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease.
- Corneal confocal microscopy (CCM) detects immune cells in the cornea.
- Previous studies linked increased corneal immune cells (IC) to peripheral neuropathies.
Purpose of the Study:
- To compare corneal immune cell density and nerve distance in MS subtypes versus controls.
- To investigate CCM's potential as a biomarker for MS.
Main Methods:
- A cross-sectional study involving patients with clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and controls.
- Corneal confocal microscopy (CCM) was used to quantify total, mature, and immature corneal IC density and nearest nerve distance.
- Data analysis compared these metrics between patient groups and controls.
Main Results:
- Total IC density was higher in MS, RRMS, and SPMS patients compared to controls.
- Immature IC density was elevated in MS and RRMS patients.
- Immature IC near-nerve distance was significantly greater in all MS subtypes compared to controls.
- Immature IC density correlated with cognitive function (Symbol Digit Modalities Test).
- Near-nerve distance correlated with disability (Expanded Disability Status Scale).
Conclusions:
- In vivo CCM shows increased immature IC density and near-nerve distance in MS patients.
- These findings suggest CCM may be a useful tool for assessing neuroimmune alterations in MS.
- Further research is warranted to validate CCM as an imaging biomarker for MS disease status.
Purpose:
Corneal confocal microscopy (CCM) is an ophthalmic imaging technique that has been used to identify increased corneal immune cells in patients with immune-mediated peripheral neuropathy. Given that multiple sclerosis has an immune-mediated etiology, we have compared corneal immune cell (IC) density and near-nerve distance in different subtypes of patients with multiple sclerosis (MS) to controls.
Methods:
This is a blinded, cross-sectional study conducted at a tertiary hospital. Patients with clinically isolated syndrome (CIS) (n = 9), relapsing-remitting multiple sclerosis (RRMS) (n = 43), secondary progressive multiple sclerosis (SPMS) (n = 22), and control subjects (n = 20) underwent CCM. The total, mature, and immature corneal IC density and their nearest nerve distance were quantified.
Results:
The total IC density was higher in patients with MS (P = 0.02), RRMS (P = 0.01), and SPMS (P = 0.04) but not CIS (P = 0.99) compared to controls. Immature IC density was higher in patients with MS (P = 0.03) and RRMS (P = 0.02) but not SPMS (P = 0.10) or CIS (P = 0.99) compared to controls. Mature IC density (P = 0.15) did not differ between patients with MS and controls. The immature IC near-nerve distance was significantly greater in patients with MS (P = 0.001), RRMS (P = 0.007), and SPMS (P = 0.002) compared to controls. Immature IC density correlated with the Symbol Digit Modalities Test (r = -0.281, P = 0.02) and near-nerve distance correlated with the Expanded Disability Status Scale (r = 0.289, P = 0.005).
Conclusions:
In vivo CCM demonstrates an increase in immature IC density and the near-nerve distance in patients with MS. These observations merit further studies to assess the utility of CCM in assessing neuroimmune alterations in MS.
Translational Relevance:
Multiple sclerosis is an immune-mediated neurodegenerative disease. Dendritic cells mediate communication between the innate and adaptive immune systems. We have used in vivo CCM to show increased corneal ICs and suggest it may act as an imaging biomarker for disease status in patients with MS.
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