Psycho-neuro-endocrino-immunologic issues in multiple sclerosis: a critical review of clinical and therapeutic implications

Anagnostouli, Maria; Markoglou, Nikolaos; Chrousos, George P.

doi:10.1007/s42000-020-00197-8

Cited by 16 publications

(13 citation statements)

References 73 publications

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“…Perinatal depression is linked to dysregulation of the maternal hypothalamic-pituitary-adrenal (HPA) axis. 30 , 31 The HPA axis is also involved in the mechanisms of MS. 32 The knowledge of having a severe and potentially progressive disease may cause psychological distress. Uncertainty and lack of hope are shown to be independent predictors for depression in MS, regardless of disability status.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Depression and Anxiety in Women With Multiple Sclerosis

et al. 2021

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ObjectiveTo assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS).Methods114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study 1999–2008. We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into 1) MS diagnosed before pregnancy (n = 140), MS diagnosed after pregnancy with 2) symptom onset before pregnancy (n = 98) and 3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS.ResultsWomen with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval 1.2–3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors, history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.ConclusionWomen diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Perinatal Depression and Anxiety in Women With Multiple Sclerosis

et al. 2021

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“…Also, the effects of acute and chronic stress on the immune system are different. The hormonal response to acute stress is mainly mediated by the HPA axis through the release of both neurotransmitter and endocrine mediators, which are peripheral but central actions (35).…”

Section: Discussionmentioning

confidence: 99%

“…Chronic and autoimmune disorders such as MS can cause disturbance in this fine-tuned circuit. Peripheral inflammation cytokines can induce HPA axis activation, and in turn, cortisol can suppress inflammation (35). It has been proposed that elevated cortisol levels in MS patients are a compensatory mechanism against inflammation by the inhabitation of NF-κB, AP1, several signal transducers and activators of transcription (STATs), and proinflammatory cytokines such as TNF-α, IL-1, IL-2, IL-6, IL-12, and IFN-γ (36,37).…”

Section: Discussionmentioning

confidence: 99%

Acute Response of Stress System in Multiple Sclerosis

et al. 2021

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Background: It has long been suspected that exposure to stress is a major factor that can increase the risk of Multiple Sclerosis (MS) and exacerbate it, as a stress-related disorder. Therefore, we conducted this study to investigate the response of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullar (SAM) system to acute social stress. Methods: A total of 46 MS patients and 23 age-sex-matched healthy controls were recruited in the study. The Trier Social Stress Test (TSST) was used to induce acute psychosocial stress. We measured salivary cortisol (SC) to evaluate the HPA axis. In addition, electrocardiography (ECG) was recorded to evaluate the SAM system based on the linear and non-linear features of Heart Rate Variation (HRV). Then, SC and HRV were measured before and after the stress exposure. We also used the Depression Anxiety Stress Scale (DASS) and Emotional Visual Analog Scale (EVAS) to conduct the psychometric assessment and evaluate the perceived stress level, respectively. Results: The mean age of the MS group was 35.38 ± 15 years, with a mean disease duration of 7.4 ± 60. Besides, the HC group's mean age was 35.8 ± 9 years. There were no significant differences in demographic features and DASS scores between the two groups. In response to TSST, both MS and healthy individuals showed a significant increase in the SC levels and EVAS scores, as well as changes in the HRV indices. Notably, significant differences were also found between the two groups regarding the basic and post-stress SC levels, EVAS score, and HRV indices. Unlike the HC group, the SC level returned to its baseline after recovery in the MS group, and the sympathetic tone was more sensitive. Conclusions: Our results indicated that both MS and healthy individuals respond to acute stress regarding neuroendocrine assessment; however, patients with multiple sclerosis show some impairments in this response.

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“…DMTs are distinguished in two main categories, first-line DMTs (moderate effective; Oral administration or injection) (IFN-β, Glatiramer Acetate, Teriflunomide and Dimethyl fumarate) and second-line DMTs (high effective; Infusible or oral therapies) (Natalizumab, Fingolimod, Alemtuzumab, Cladribine and anti-CD20 treatment, Rituximab, Ocrelizumab, and Ofatumubab), as escalation therapy [ 39 ]. First-line therapies are moderately effective, but not immunosuppressive, and have excellent long-term safety profiles [ 40 ], while second-line therapies show greater efficacy, but cause immunosuppression and/or immunomodulation [ 41 ].…”

Section: Interaction Covid-19 and Multiple Sclerosismentioning

confidence: 99%

“…Regarding the first-line DMTs, Glatiramer Acetate [ 3 ] causes blockage of MHC-II in immunological synapsis and shift from Th1 to Th2 immune responses [ 39 ]. This has been associated with a lower risk of SARS-CoV-2 infection in pwMS, like IFN-β, which has powerful antiviral effects in vivo [ 42 ] and reduces antigen presentation and Th1 expression [ 39 ].…”

Section: Interaction Covid-19 and Multiple Sclerosismentioning

confidence: 99%

SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19

et al. 2022

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The SARS-CoV-2 pandemic has raised particular concern for people with Multiple Sclerosis, as these people are believed to be at increased risk of infection, especially those being treated with disease-modifying therapies. Therefore, the objective of this review was to describe how COVID-19 affects people who suffer from Multiple Sclerosis, evaluating the risk they have of suffering an infection by this virus, according to the therapy to which they are subjected as well as the immune response of these patients both to infection and vaccines and the neurological consequences that the virus can have in the long term. The results regarding the increased risk of infection due to treatment are contradictory. B-cell depletion therapies may cause patients to have a lower probability of generating a detectable neutralizing antibody titer. However, more studies are needed to help understand how this virus works, paying special attention to long COVID and the neurological symptoms that it causes.

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Psycho-neuro-endocrino-immunologic issues in multiple sclerosis: a critical review of clinical and therapeutic implications

Cited by 16 publications

References 73 publications

Perinatal Depression and Anxiety in Women With Multiple Sclerosis

Perinatal Depression and Anxiety in Women With Multiple Sclerosis

Acute Response of Stress System in Multiple Sclerosis

SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19

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