Citation

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disorder of the central nervous system (CNS) and the most frequent cause of early disabilities in young adults. Multifocal CNS lesions are typical for the disease and characterized by inflammation, demyelination and axonal pathology that lead to multiple neurological deficits. Currently disease modifying therapies (DMTs) make it possible to reduce the immune response and to delay the progression of the disease, but there is still no cure for MS. However, it is not fully understood whether these new treatment options provide long-lasting protection against neurodegeneration beyond immune modulation/-suppression. Based on promising data from clinical studies of the anti-CD52 antibody alemtuzumab for the treatment of relapsing-remitting MS that leads to depletion of CD52-expressing lymphocytes, investigations on this question were performed in animal models for MS. Since studies of the underlying pathomechanisms and effector functions are difficult to carry out in humans, MS research is still dependent on animal models to gain deeper understanding. Experimental autoimmune encephalomyelitis (EAE) is the most widely distributed model for MS, for which the C57BL/6 (B6) mouse strain is commonly used, since most gene-modified mice are bred on this background. The animal experiments that applied a murine anti-CD52 antibody at early disease stage of EAE (first appearance of paralytic symptoms) indicated a neuroprotective and apparent regenerative effect of the antibody. Indeed, little is known about a neuroprotective effect of alemtuzumab when given at the chronic progressive phase of MS which is still difficult to treat. The present study is the first detailed investigation on the impact of the murine anti-CD52 antibody on demyelination, axonal damage and brain atrophy in MP4-induced EAE in B6 mice during the chronic stage of the disease (starting at stable plateau of clinical symptoms). MP4 is a myelin fusion protein of MBP (myelin basic protein) and PLP (proteolipid protein) that induces chronic EAE in B6 mice via active immunization. MP4-induced EAE is one of the few models that reflects the B cell component in addition to the T cell-mediated features of MS. Its chronic stage is characterized by severe spinal cord and cerebellar pathology with B cell aggregation especially in the cerebellum. After MP4-induced mice were treated at the chronic stage of EAE either with 10 mg/kg body weight murine anti-CD52 specific IgG2a isotype antibody or murine unspecific IgG2a isotype control antibody for five consecutive days, flow cytometric analysis of lymphocyte depletion was performed on peripheral blood and its effect on MP4-specific antibodies was determined by indirect enzyme-linked immunosorbent assay (ELISA). The level of released phosphorylated neurofilament-heavy (pNF-H) in the serum as a marker for axonal damage was measured by indirect Sandwich-ELISA. Change of myelination (by using the g-ratio: axon diameter divided by nerve fiber diameter) and axonal pathology (decreased nearest neighbour neurofilament distance, axolytic axons, axonal loss) was evaluated in spinal cord and cerebellum by electron microscopy. Brain atrophy was measured based on MRI and clinical course was daily evaluated. The treatment with the anti-CD52 antibody drastically reduced the number of T cells and B cells, while the titers of MP4-specific antibodies remained unaffected. There was no effect on de- and remyelination. Furthermore, brain volume and clinical disease severity remained unaltered. While there was no difference in pNF-H concentration, on the ultrastructural level the number of damaged axons was decreased. In sum, these data reveal that the anti-CD52 antibody has a low impact on neurodegenerative processes and none on regeneration in the chronic stage of EAE/MS. This is probably due to the impermeability of the blood-brain barrier for antibodies and the limited understanding of the effects of antibody treatment in the CNS. Thus, this study points towards the need for effective antibody treatment in the CNS as well as for more selective neuroprotective and remyelination promoting therapeutic strategies that could complement the existing DMTs.