Primary source back in March: "Neurology" Brain iron serves as marker for MS - facebook prikbord

If this study was in "Neurology" back in March it makes me wonder why Neurologist are against getting rid of the iron buildup in the brain. Oh yes that's right they don't want to because they don't know how or refuse to believe it, or their willing to be ignorant, guess I'm a cynic. Give this article to the negative neuro's and ask; well how do I get rid of the excess iron?

Brain iron serves as marker for MS

Brain Iron Deposits Iron accumulation in the basal ganglia was found in patients with advanced multiple sclerosis (MS), but not in patients with a clinically isolated syndrome (CIS) that is suggestive of MS, Austrian researchers reported.

In this quantitative study, 113 MS and CIS patients, as well as 35 healthy controls, underwent 3T MRI imaging, which showed increased levels of brain iron in MS patients compared with CIS patients (P<0.001) and healthy controls (P<0.005), wrote Franz Fazekas, MD, of the Medical University of Graz, and colleagues in Neurology.

MRI-based iron mapping has been proposed as a marker of neurodegeneration in various neurologic disorders, including MS, explained Alex Rovira, MD, from the Hospital Vall d'Hebron in Barcelona, in an accompanying editorial. "Iron is an essential trace element with a vital role in normal brain metabolism, oxygen transport, myelin production, and neurotransmitter synthesis, and in reactions critical to oxidative stress," he wrote.

Abnormal iron accumulation has been identified pathologically in MS, but few studies have investigated brain iron levels in patients with CIS, the investigators stated. Recently R2* relaxometry has been validated for measuring brain iron.

Of the 113 consecutive patients, 78 had MS and 35 had CIS. Along with the MR studies, the participants underwent clinical and neuropsychological examination. Iron deposition in subcortical gray matter was assessed by automated, regional calculation of R2* rates.

In addition to significantly increased R2* levels in the basal ganglia of MS patients, the authors found that the levels correlated with age (r=0.5, P<0.001), disease duration (r=0.5, P<0.001), the Expanded Disability Status Scale (r=0.3, P<0.005), and the z values of mental processing speed (r=-0.3, P< 0.01).

The regional brain R2* relaxation rates were as follows in CIS, MS, and controls, respectively:

Basal ganglia: 25 (CI 23.7 to 26.7) versus 27.9 (CI 25.8 to 29.4) versus 25.6 (CI 24.6 to 28.5)
Putamen: 22.6 (CI 21.8 to 24) versus 25.3 (CI 23.3 to 27.8) versus 23.7 (CI 22.2 to 26.1)
Pallidum: 31.7 (CI 29.8 to 33.8) versus 35.3 (CI 33.3 to 27.4) versus 33 (CI 20.9 to 35.2)
Caudate: 20.1 (CI 19.1 to 21.4) versus 22.4 (CI 10.7 to 24) versus 21.1 (CI 20 to 22.9)

The difference between basal ganglia R2* relaxation rates in MS and CIS was statistically significant (P<0.001) as was the difference between MS and healthy controls (P<0.005), the authors stated. Also, the difference between CIS and controls was significant at P<0.05.

Stepwise linear regression analysis revealed gray matter atrophy as the strongest independent predictor of basal ganglia R2* levels (P<0.001), followed by age (P< 0.001), and T2-lesion load (P<0.005).

Basal ganglia iron accumulation in MS occurs with advancing disease and is related to the extent of morphologic brain damage, the researchers said. These study results argue for iron deposition as an epiphenomenon, and the absence of increased iron levels in patients with CIS indicates that iron accumulation does not precede the development of MS, they explained.

Once iron accumulates within the brain, subsequent oxidative stress-induced tissue damage may enhance the extent of axonal damage and of neurodegeneration, Fazekas said. However, given the limitations of this study, he added that the present findings do not support a strong role of such a mechanism. It would be important to examine more advanced stages of MS and to obtain longitudinal data, he concluded.

Rovira, along with co-editorialist Xavier Montalban, MD, PhD, said this study should be looked at as a "first step ... the second step will require reproducing these preliminary results in an MS cohort with a wide range of physical disability." The study only included patients with mild physical disability, which is not representative of the full spectrum of the disease, he added.

Subsequent studies will have to determine whether the MR technique is sensitive to iron content changes in deep gray matter structures, visible MS lesions, and in normal-appearing brain tissue, "as this would provide better assessment of the diffuse pattern characterizing MS,"Rovira said.

Fazekas serves on scientific advisory boards for a variety of drug companies including Bayer, Schering Pharma, Biogen, Merck Serono, Novartis, D-pharma, and Teva Pharmaceutical Industries. Other authors reported research support from the Austrian Fund and various drug companies.

Rovira serves on scientific advisory boards for NeuroTEC, Bayer Schering Pharma, and BTG International. He has received speaker honoraria from Bayer Schering Pharma, sanofi-aventis, Bracco, Merck Serono, Teva Pharmaceutical Industries, and Biogen Idec. He receives research support from Bayer Schering Pharma.

Montalban has received research support for clinical trials from Genentech, Genzyme, and Wyeth. He receives research support from the Fundacio Esclerosi Multiple (FEM, Multiple Sclerosis Foundation).

Primary source: Neurology
Source reference:
Kahil M, et al "Determinants of brain iron in multiple sclerosis: A quantitative 3T MRI study" Neurology 2011; 77: 1691–1697.

Additional source: Neurology
Source reference:
Rovira A, et al "MR brain iron mapping in MS -- A potential neurodegenerative marker or just another technique?" Neurology 2011; 77: 1660–1661.