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Summary of lectures Clinical immunology (AM_470655)

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Course
Clinical immunology (AM_470655)

Institution
Vrije Universiteit Amsterdam (VU)

Summary of lectures Clinical immunology (AM_470655) of the master Biomedical Sciences. The summary consist of notets from lectures and also helpful images from the powerpoints for supporting information

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Uploaded on September 4, 2024
Number of pages 84
Written in 2023/2024
Type Class notes
Professor(s) Dr. gijs kooij
Contains All classes

clinical immunology
immunology
biomedical sciences
am470655
master biomedical sciences

Institution
Vrije Universiteit Amsterdam (VU)
Education
Biomedical Sciences
Course
Clinical immunology (AM_470655)

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Clinical immunology

Lecture 1: Multiple sclerosis- clinic & treatment
1. Background

Definition: multiple scars in the central nervous system
Multifocal inflammation in the brain and spinal cord.
- White matter
- Gray matter
MS facts
- Prevalence 1:1000 in the NL
- Starts between 20-40 years
- More women are affected than man
- Almost normal life expectancy
- Prevalence increases with higher latitude → less sun → less Vit D
Contributing factors
- Vitamin D levels
- Diet
- Smoking
- Epstein-barr virus/mononucleosis infectiosa
- Ethnicity and genes
Anatomy
- Gray matter → cell bodies of the axons are located here
- White matter → axons surrounded by myelin
- Myelin → improves the conduction → action potential is disrupted because of the
lesions in the brains
- The myelin is build up by oligodendrocytes and are covered by myelin sheets
Pathological hallmarks: chronic inflammatory demyelinating disease of the CNS
→ inflammation, demyelination, remyelination, gliosis (scarring)

Inflammation and demyelination of the CNS
- The blood brain barrier (BBB) is infiltrated by immune cells, the immune cells cause a
immune response in the brain → the immune cells attack the myelin resulting in
lesions in the brain
- The immune cells in in the blood vessels in the white matter → later scaring is
Induced by the immune cells
Remyelination and scarring
- Remyelination: the myelin recovers fully or partially
- Gliosis is the scarring of the brain → the scar formation is formed after the damage of
the demyelination
- The cycle repeats itself

, 2. Clinical symptoms

Clinical features
- Symptoms in MS vary widely, it has different locations and severity
- New neurological symptoms, relapses → slowly progressive symptoms
Symptoms in MS
- Symptoms vary widely → different location and different severity

3. Diagnosis MS

Diagnosis
- Clinical features are checked if it is linked to MS
- Radiological characteristics
- Abnormalities in cerebrospinal fluid
- Diagnosis based on
o Dissemination of time (DIT) → new attacks or relapses
o Dissemination of space (DIS) → different places in your brain or spinal cord
that have been damaged
Symptoms
- Visual problems
o Pain behind the eye, decreased colour vision decreased, diplopia (double
vision)
- Pyramidal symptoms
o Paresis
o Spasticity
o Abnormal reflexes
- Sensory symptoms
o Tingling, Numbness
o Symptom of Lhermite

, - Bladder-/bowel/sexual problems
o Incontinence: urine and faeces
o Urine retention, frequent urinary tract infections, sexual problems
- Coordination problems
o Ataxia
o Tremor
o Balance
- Coordination problems
o Memory, concentration, attentions, difficulties organizing
- Fatique
o High prevalence and there is no good treatment for this
o Unknown cause of the fatique and its less visible
- Less visible
o Depression, suicide, relationship, walking gets difficult after a while
Clinical DIS/DIT
- The first phase the optic neuritis starts. In the second relapse gait problems strt, so a
wheelchair is needed. In the thirs relapse diplopia starts
MRI in MS
- With the MRI the lesions in the brain and in the spinal cor scan be visualized. The
number size and distribution vary widely
- Typical brain lesions are ovoid shaped and are close to the bloodvessels, because this
is the location where the immune cells infiltrate the brain → perivascular orientation
Different types of MRIs for different lesions
- T2 lesions → disease burden
- T1 lesions → black holes, irreversible damage
- T1 contrast → enhancing lesions, active lesions
Specific MS localization
- Specific locations for the lesions
o periventricular: close to the ventricles in the brain
o Juxtacortical: close to the cortex
o Infratentorial: above the cerebellum
o Spinal cord
- Dissemination in SPACE → lesions in 2 of 4 locations
- MRI show dissemination in time → make different MRIs
at different time points
o Combination of different type of lesions
o Combination of T2 lesions and contrast enhancing
lesions
o New T2 lesions over time
MRI in MS - degeneration
- Atrophy: widening of ventricles that happens in a later disease stage in both brain
and spinal cord
- Partially independent from white matter lesion load
- Exclusions of differential diagnosis
- Monitor the disease activity → to determine the efficacy of the treatment and
pharmacovigilance → medicine

, Cerebrospinal fluid (CSF)
- Used to determine the dissemination in time for MS patients
- Oligoclonal bands → extra clue for correct diagnosis of MS
o In MS patients there are a lot of thick IgG oligoclonal bands
o Done by a lumbar puncture
McDonald criteria
- For Dissemination in time and space for diagnosing the patient

Clinically isolated syndrome (CIS)
- Pre-symptoms of MS
- Monosymptomatic clinical presentation demyelination
- Could evolve to MS later
→ do a follow up to determine whether it evolves to MS

4. Disease course and subtypes

Different MS subtypes
- Relapsing-remitting (RRMS)
- Secondary progressive (SPMS)
- Primary progressive (PPS) → progressive
relapsing (PRMS)
Disease progression of MS
- Radiological isolated syndrome (RIS) > CIS
and MS
- Clinically isolated syndrome (CIS) → RRMs
and SPMS
Most common presenting symptoms
- Relapsing-remitting MS: optic
neuritis, sensory symptoms
- Primary progressive MS: motor
symptoms, progressive walking
disabilities

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