Normal CSF ferritin levels in MS suggest against etiologic role of chronic venous insufficiency
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To the Editor: I read the article by Worthington et al.1 with interest. The authors assessed the etiologic role of chronic venous insufficiency and multiple sclerosis (MS).
Chronic cerebral venous insufficiency may result in an altered blood–brain barrier and subsequent exposure of brain constituents ordinarily isolated from the vascular immune system, resulting in autoimmunization to the brain. This autoimmunization to the brain could then result in development of secondary autoimmunity to the brain and development of MS.
While the blood–brain barrier will ordinarily prevent blood and vascular components from penetrating into the brain, a less-recognized role of the blood–brain barrier may be to isolate the brain from the immune system. If the blood–brain barrier fails, then autoimmunization to the brain and development of MS may occur.
Experimental spinal cord injury from spinal cord contusion triggers systemic immunity and development of oligoclonal immunoglobulin G (IgG) activity against multiple CNS proteins2 similar to the oligoclonal bands seen in MS. Sera from patients with MS have polyclonal IgGs which interact with myelin basic protein.3
The oligoclonal IgGs in serum may result from CNS exposure to the vascular system, due to blood–brain barrier breakdown from chronic venous insufficiency, causing autovaccination with CNS components and subsequent development of MS due to autoimmunity to the CNS.
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Disclosure: The author reports no disclosures.
To the Editor: In their recent report, Worthington et al.1 found increased CSF ferritin levels in some patients with MS. However, no information was provided by the authors regarding eventual medications prescribed at the time of ferritin analysis.
We recently reported that serum ferritin levels were significantly increased in patients with relapsing-remitting MS at 12 months after initiating interferon-β therapy.4 In this context, it is interesting that Worthington et al. found that an increase …
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