Autoimmune liver disease and multiple sclerosis: state of the art and future perspectives

Villani, Rosanna; Serviddio, Gaetano; Avolio, Carlo; Cassano, Tommaso; D’Amico, Emanuele

doi:10.1007/s10238-023-01128-8

Cited by 4 publications

(3 citation statements)

References 147 publications

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“…We found no differences regarding liver diseases between people with MS and controls from the general population. This aligns with the existing literature despite the potential liver-related side effects associated with all MS treatments and a suggested association between autoimmune liver diseases and MS ( 25 , 46 – 49 ). In terms of peptic ulcer, our results showed a slightly higher prevalence among people with MS, which is partly supported by the literature, despite high heterogeneity in results ( 25 , 46 , 47 ).…”

Section: Discussionsupporting

confidence: 90%

Comorbidity in the aging population with multiple sclerosis: a Danish nationwide study

Holm,

Wandall-Holm,

Sellebjerg

et al. 2023

Front. Neurol.

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IntroductionMultiple sclerosis (MS) is a neurodegenerative disease accumulating disabilities over time. However, the mean age of individuals with MS is increasing, consequently elevating their risk of developing comorbidities. Comorbidities' impact on MS is widely debated. Yet very few countries possess population-based registries, which provide unique opportunities for individual-level data linkage. This study aims to assess acute and chronic comorbidities among elderly patients with MS, comparing them to matched controls. Additionally, this study seeks to investigate the influence of chronic comorbidities on all-cause mortality.MethodsA nationwide register-based study using the Danish Multiple Sclerosis Registry to identify all living patients with MS older than 50 years at the reference date (January 1st, 2022). Patients were matched 1:10 with individuals from the general population. Comprehensive healthcare data within the Danish hospital system were obtained. Chronic comorbidities were classified according to the Charlson Comorbidity Index, while acute comorbidities were based on ICD-10 codes and an “acute” admission type. To investigate all-cause mortality, a Cox regression analysis was conducted.ResultsThe study encompassed a total of 8,688 individuals with MS, matched with 86,880 controls. The mean age was 63.5 years, with females constituting 68.3%. Individuals with MS exhibited a higher frequency of acute hospitalizations (OR: 2.1, 95% CI: 1.9–2.2), primarily due to various infectious diseases, along with longer median hospital stays (4 vs. 3 days, p < 0.001). When assessed using the Charlson Comorbidity Index, individuals with MS carried a significantly greater burden of chronic comorbidities (p < 0.001). The most prevalent chronic comorbidity among individuals with MS was “Uncomplicated Diabetes” (20.1%). Notably, while individuals with MS displayed an overall lower 5-year survival rate, this difference ceased to be statistically significant among those with a high Charlson Comorbidity Index score of ≥4 (p = 0.32).ConclusionThis study highlights a heightened prevalence of both acute and chronic comorbidities among individuals with MS, with chronic comorbidities significantly increasing the risk of mortality. These findings underscore the critical importance of factoring in comorbidities when devising treatment strategies for individuals living with MS.

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Section: Discussionsupporting

confidence: 90%

Comorbidity in the aging population with multiple sclerosis: a Danish nationwide study

Holm,

Wandall-Holm,

Sellebjerg

et al. 2023

Front. Neurol.

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“…AIH is a rare condition marked by high levels of transaminase, bilirubin, γ-globulin, and immunoglobulin G in the blood, along with the presence of anti-liver/kidney microsomal type 1 autoantibodies [157]. In order to stimulate macrophages and Kupffer cells to secrete IL-1β, IL-18, and TNF-α, Th cells generate and release IFN-γ and IL-2 during the progression of AIH [158,159].…”

Section: Inflammasome In Autoimmune Hepatitismentioning

confidence: 99%

Inflammasome Molecular Insights in Autoimmune Diseases

Neamțu,

Bild,

Vasincu

et al. 2024

CIMB

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Autoimmune diseases (AIDs) emerge due to an irregular immune response towards self- and non-self-antigens. Inflammation commonly accompanies these conditions, with inflammatory factors and inflammasomes playing pivotal roles in their progression. Key concepts in molecular biology, inflammation, and molecular mimicry are crucial to understanding AID development. Exposure to foreign antigens can cause inflammation, potentially leading to AIDs through molecular mimicry triggered by cross-reactive epitopes. Molecular mimicry emerges as a key mechanism by which infectious or chemical agents trigger autoimmunity. In certain susceptible individuals, autoreactive T or B cells may be activated by a foreign antigen due to resemblances between foreign and self-peptides. Chronic inflammation, typically driven by abnormal immune responses, is strongly associated with AID pathogenesis. Inflammasomes, which are vital cytosolic multiprotein complexes assembled in response to infections and stress, are crucial to activating inflammatory processes in macrophages. Chronic inflammation, characterized by prolonged tissue injury and repair cycles, can significantly damage tissues, thereby increasing the risk of AIDs. Inhibiting inflammasomes, particularly in autoinflammatory disorders, has garnered significant interest, with pharmaceutical advancements targeting cytokines and inflammasomes showing promise in AID management.

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“…Although many patients remain asymptomatic upon diagnosis, some may experience symptoms such as fatigue or itching. The association between MS and PBC is rare, with only a limited number of cases reported [ 8 ]. In this study, we review a case of new-onset PBC in an elderly woman with MS.…”

Section: Introductionmentioning

confidence: 99%

A Case of Primary Biliary Cholangitis in a Patient With Multiple Sclerosis

Kakhktsyan,

Aleksanyan,

Acob

et al. 2024

Cureus

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Multiple sclerosis (MS) is a chronic inflammatory disease that causes demyelination in the brain and spinal cord, leading to significant neurological disability in young adults. Patients with MS are predisposed to other autoimmune disorders, though the co-occurrence of MS and primary biliary cholangitis (PBC) is rare. PBC is an autoimmune liver disease that affects bile ducts, leading to cholestasis and liver cirrhosis, predominantly in women aged over 40 years. We report the case of an 81-year-old woman with a history of MS and hypertension, bedridden for 10 years, who was admitted with a severe sacral ulcer and bacteremia. During hospitalization, she developed persistent itching, and elevated liver enzymes were detected. Imaging ruled out cholecystitis but revealed a large gallstone and hepatomegaly. Elevated M2 antimitochondrial antibodies confirmed PBC. The patient was treated with ursodeoxycholic acid, leading to symptom improvement. This case highlights the necessity for a thorough evaluation of autoimmune comorbidities in patients with MS and suggests a potential genetic and environmental link between MS and PBC. Further research is needed to explore this association and improve treatment strategies.

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Autoimmune liver disease and multiple sclerosis: state of the art and future perspectives

Cited by 4 publications

References 147 publications

Comorbidity in the aging population with multiple sclerosis: a Danish nationwide study

Comorbidity in the aging population with multiple sclerosis: a Danish nationwide study

Inflammasome Molecular Insights in Autoimmune Diseases

A Case of Primary Biliary Cholangitis in a Patient With Multiple Sclerosis

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