Invited Presentations Invited Abstracts

TC16.02 - Presentation 02 (ID 636)

Speakers
  • J. Correale
Authors
  • J. Correale
Presentation Number
TC16.02
Presentation Topic
Invited Presentations

Abstract

Abstract

Multiple Sclerosis (MS) is a chronic inflammatory disease of the Central Nervous System (CNS) that affects young people leading to demyelination and neurodegeneration. Although its etiology is not clear it is known that autoimmunity plays a major role in disease pathogenesis influenced by environmental and genetic factors. The disease is clearly more common among women and its incidence in females has been rising causing an increase in sex bias Clinic and epidemiological data shows clear differences among sexes: women experience more frequent relapses, have more inflammatory lesions on MRI and earlier onset of MS compared to men. Male sex, on the other hand, is associated with faster progression and worse outcome with more cerebellar involvement, worse cognition, more gray matter atrophy and more T1 lesions. There are also important changes related to female reproductive cycle with a 3-fold increase in MS prevalence after menarche, a decrease of approximately 70% in relapse rates in the third trimester of pregnancy and an increase in relapse rate in 3-6 months after delivery to nearly three times higher than pre-pregnancy levels. During menopause recent evidence suggest worsening of MS symptoms and probably an increase in disease progression.

Hormonal factors and/or sex chromosomes are thus assumed to be involved in regulating the course of the disease and due to the presence of receptors on immune cells, sex hormones (estrogens, progesterone, prolactin and testosterone) can influence different aspects of immune system function and potentially affect the risk, activity and progression of MS. Sex hormones have different effects depending not only on the concentration but also on the type of target cell and the receptor subtype expressed on a given cell type. Thus, understanding how gender impacts MS requires the elucidation of complex interactions among sex hormones, sex chromosomes, immune response genes, and resident cells of the CNS. We will discuss clinical evidence that shows the impact of hormonal factors in MS. Then, we will try to elucidate the complex hormonal and immunological mechanisms potentially underlying these changes, as well as the current knowledge and new insights into the relationship of sex hormones and resident CNS cells in the context of MS. Understanding those molecular mechanisms may help to provide ways to develop novel and safer treatments for both men and women.

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