Increase in multiple sclerosis activity after assisted reproduction technology
Abstract
OBJECTIVE: Our objective was to evaluate risk of exacerbations in multiple sclerosis (MS) patients undergoing assisted reproduction technology (ART) infertility treatment. METHODS: Sixteen patients with relapsing-remitting MS subjected to 26 ART treatment cycles receiving gonadotropin-releasing hormone (GnRH) agonists and recombinant follicle-stimulating hormone were studied prospectively. The baseline study period encompassed 12 months prior to the first cycle and 9 months after final ART cycle. Neurological examinations, brain magnetic resonance imaging (MRI), and immunology testing were conducted every 3 months. Anti-myelin-oligodendrocyte glycoprotein (MOG) antibody production, interleukin (IL)-4, IL-8, IL-10, IL-12, IL-17, interferon (IFN)-γ, and transforming growth factor (TGF)-β secretion by myelin basic protein- and MOG-peptide-specific T cells, as well as ex vivo isolated peripheral blood mononuclear cells (PBMCs), were studied using enzyme-linked immunospot. vascular endothelial growth factor (VEGF) production by PBMCs was assessed using enzyme-linked immunosorbent assay. RESULTS: ART was associated with a 7-fold increase in risk of MS exacerbation, and a 9-fold increase in risk of enhanced disease activity on MRI. Worsening was associated with higher number of cells producing IL-8, IL-12, IFN-γ, and TGF-β, as well as increased VEGF production by CD4(+) T cells and CXCL-12 plasma levels, all GnRH-mediated effects. A rise in 17-β estradiol production associated with ART increased anti-MOG antibody titers, as well as B-cell survival factor BAFF (B-cell activating factor) and antiapoptotic molecule Bcl-2 levels from purified CD19(+) B cells. Finally, ART facilitated PBMC transmigration across an in vitro blood-brain barrier model, an effect mediated by IL-8, VEGF, and CXCL-12. INTERPRETATION: Results indicate a significant increase in MS disease activity in patients receiving ART, a risk that neurologists should be aware of. Reproductive hormones appear to exert an important role in regulating immune responses during the course of autoimmune diseases.
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CXCL8 and IL-23 are associated with pathological neuroinflammation.
“both of these cytokines are associated with pathological neuroinflammation58–60”
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- Authors
- Correale, J., Farez, M. F., & Ysrraelit, M. C.
- Affiliations
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (AR)
- Corresponding author
- Correale, Jorge
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2012-10-03
- Volume
- 72
- Issue
- 5
- Pages
- 682-694
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- OpenAlex
- W2084790948
- Cited by
- 134
- References
- 54
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 5 · 2023: 10 · 2022: 11 · 2021: 11 · 2020: 13 · 2019: 14 · 2018: 10 · 2017: 6 · 2016: 9 · 2015: 11 · 2014: 9 · 2013: 8 · 2012: 3
- FWCI
- 7.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Keywords
- multiple sclerosis, assisted reproduction, relapsing-remitting multiple sclerosis, disease exacerbation, GnRH agonist, follicle-stimulating hormone, anti-MOG antibodies, cytokines, interferon-gamma, TGF-beta, vascular endothelial growth factor, CXCL12, estradiol, B cell activation, BAFF, Bcl-2, blood-brain barrier permeability, reproductive hormones, autoimmune disease
- MeSH terms
- Adult, Antibodies, Brain, Cell Movement, Disability Evaluation, Myelin Basic Protein, Enzyme-Linked Immunosorbent Assay, Female, Follicle Stimulating Hormone, Humans, Immunosuppressive Agents, Infertility, Gonadotropin-Releasing Hormone, Magnetic Resonance Imaging, Multiple Sclerosis, Recurrence, Retrospective Studies, T-Lymphocytes, Time Factors, Transfection, Case-Control Studies, Cytokines, Proto-Oncogene Proteins c-bcl-2, Reproductive Techniques, Assisted, RNA, Small Interfering, Vascular Endothelial Growth Factor A, B-Cell Activating Factor
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