neurofilament light chain ,chitinase-3 like-1 proteins and plasmacytoid dendritic cells in multiple sclerosis

Conditions: Multiple Sclerosis

Summary: multiple sclerosis (ms) is an autoimmune neurodegenerative disease characterized by demyelination and neurodegeneration of the central nervous system (cns) . current diagnostic criteria and management depend on mri, clinical status, and oligoclonal immunoglobulin g bands . these markers often fail to predict relapse, progression and therapy response .there is an increased need to identify biomarkers for clinical endpoints . one of the hallmark features of ms is axonal damage which associated with brain and cervical atrophy.nf levels indicate the extent of axonal damage. neurofilaments are composed of four subunits: neurofilament light polypeptides (nfl) is the most abundant and soluble and it is highly sensitive to neurodegenerative processes . chitinase 3-like 1 (chi3l1) is expressed in astrocytes in the brain tissue of ms patients . chi3l1 plays a role as prognostic biomarker in patients with ms. chi3l1 cerebrospinal fluid levels were associated correlated with disease activity and neurological disability. dendritic cells (dcs) are highly specialized antigen-presenting cells with a key role in activating and preventing cns immune-mediated damage in ms . dendritic cells express human leukocyte antigen-antigen d related (hla-dr) . plasmacytoid dendritic cells characterized by the expression of blood dendritic cells antigen-2 (bdca-2) .plasmacytoid dendritic cells are present in the cerebrospinal fluid (csf), leptomeninges and demyelinating lesions of patients with ms . plasmacytoid dendritic cells also exhibit up-regulation of chemokine (ccr7c) expression. it was demonstrated increased amounts of chemokine ccr7 in the csf from ms patients during relapses .ccr7 controls migration and functional activity of regulatory t cells and plays an important role in the establishment of tolerance . tolerogenic dcs (toldcs) present an intermediate phenotype between immature dendritic cells (idcs) and mature dendritic cells (mdcs) regarding costimulatory molecules, a pronounced shift toward anti-inflammatory . toldcs exhibit tolerogenic molecules such as hla-g and cd274 \[programmed death-ligand 1 (pd-l1)\] either in peripheral blood or in csf. these characteristics lead to t cell clonal anergy and t cell unresponsiveness due to ag presentation in the presence of low co-stimulation .we aim to investigate the role of nfl,(chi3l1) and markers of plasmacytoid dendritic cells in ms.


Eligibility criteria:
inclusion criteria: 1-ms patients diagnosis 2017 mcdonald criteria. 2-patients age 20-60 years 3-all males and female patients. 3-willingness and ability to comply with the protocol. 4-written informed consent given by the patient before the beginning of any study-related procedure, 5-non-ms control matched age and sex persons exclusion criteria:1-patients with intracranial space-occupying lesion. 2-abnormal intracranial pressure due to increased csf pressure or arnold-chiari malformation. 3-anticoagulant medication, coagulopathies and uncorrected bleeding diathesis. 4-congenital spine abnormalities. 5-local skin infection at the puncture site. 6-not fulfill macdonald criteria.