Bernhard HJ. Juurlink MD, Giovanni Battista Agus MD, Dario Alpini MD, Maria Amitrano MD, Giampiero Avruscio MD, Pietro Maria Bavera MD, Aldo Bruno MD, Pietro Cecconi MD, Elcio da Silveira Machado MD, Miro Denislic MD, Massimiliano Farina MD, Hector Ferral MD, Claude Franceschi MD, Massimo Lanza MD, Marcello Mancini MD, Donato Oreste MD, Raffaello Pagani MD, Fabio Pozzi Mucelli MD, Franz Schelling MD, Salvatore JA Sclafani MD, Adnan Siddiqui MD, PierluigI Stimamiglio MD, Gianfranco Vettorello MD, Ivan Zuran MD and Pierfrancesco Veroux MD

We read with interest the study titled "Free serum haemoglobin is associated with brain atrophy in secondary progressive multiple sclerosis" (1). Dr. Zamboni first outlined the similarities between impaired venous drainage in the lower extremities and MS in 2006 in his "Big Idea" paper (2). Chronic venous insufficiency can cause a breakdown of red blood cells, leading to increased levels of free hemoglobin. Exactly what the London researchers saw 11 years later.

References: 1) Lewin, Alex, et al. "Free serum haemoglobin is associated with brain atrophy in secondary progressive multiple sclerosis" Wellcome open research 1-10 (2016). 2) Zamboni, Paolo. "The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis" Journal of the Royal Society of Medicine 99.11 (2006): 589-593.
https://www.ncbi.nlm.nih.gov/pubmed/27996064#cm27996064_37477