Long-term Antibiotic Treatment with Roxithromycin in Patients with Multiple Sclerosis

Abstract

Our study shows that the patients with MS do not profit from a long-term antibiotic treatment with roxithromycin compared to placebo treatment. A causative connection between bacterial infections with C. pneumonia and MS therefore does seem very unlikely.

Under the Microscope: Focus on Chlamydia pneumoniae Infection and Multiple Sclerosis

“…In the first study, anti-chlamydial treatment reduced brain atrophy, but did not show any beneficial influence on the number of MRI Gd enhancing lesions in four newly diagnosed RR MS patients (Sriram et al, 2005a). In a subsequent report, no substantial changes on relapse rate and severity of the disease were found in 9 RR, 5 SP and 1 PP patients after Chlamydia-specific antibiotic therapy (Woessner et al, 2006).…”

“…Some of these findings suggest that C. pneumoniae may represent an innocent bystander epiphenomenon due to ongoing MS inflammation which favours a selective infiltration of infectedmononuclear cells within the CNS since: there is no strong evidence for an association between a recent C. pneumoniae infection and the risk of MS (Munger et al, 2004); culture demonstration of C. pneumoniae is low in CSF and brain tissue of patients with MS (Swanborg et al, 2003); molecular evidence of C. pneumoniae in CSF and intrathecal synthesis of anti-C. pneumoniae IgG are inconstant in MS patients and, when present, are not selectively associated with MS, but are shared by several inflammatory neurological conditions (Gieffers et al, 2001;Fainardi et al, 2004); local production of anti-C. pneumoniae IgG within the CNS can be considered as a part of polyspecific intrathecal immune response sustained by MS chronic inflammation (Derfuss et al, 2001); anti-chlamydial antibiotic treatment is inconsistent in MS (Woessner et al, 2006). However, other results also indicate that, in a subset of MS patients, C. pneumoniae could act as a cofactor in initiation and maintenance of the disease by enhancing a pre-existing autoimmune response because: a possible influence of previous C. pneumoniae infection on the risk of developing MS can not be completely excluded because, in some individuals, serum levels of anti-C. pneumoniae antibodies are not always increased during C. pneumoniae infection or may gradually decrease and become undetectable within a few years (Grayston et al, 1990); C. pneumoniae seems to be more metabolically active in CSF of MS patients compared to other neurological disorders (Dong-Si et al, 2004); molecular evidence of C. pneumoniae in CSF seems to be more frequent in a subgroup of RR MS patients with clinical and MRI disease activity who experience the early inflammatory phase representing the development of the disease ; intrathecal synthesis of anti-C. pneumoniae high-affinity IgG seems to be predominant in a subgroup of patients with MS progressive forms (SP and PP MS) who experience the late degenerative phase reflecting the progression of the disease ; C. pneumoniae can disseminate from the systemic into the intrathecal compartments and can amplify an autoimmune process in animal models (hit-hit hypothesis) (Du et al, 2002); in MS patients, C. pneumoniae can be recognized within circumventricular organs which are lacking in a patent BBB and could represent the route of entry for C. pneumoniae infected-mononuclear cells into the CNS (Sriram et al, 2005b).…”

Missed epidemics and missing links: international birth cohort trends in multiple sclerosis

“…Whilst the former are in parallel with the increasing birth cohort trends, the latter might account for the decreasing trends in more recent cohorts. A protective effect with respect to MS has been shown for penicillin but not for other antibiotics [35,36]. 4 Smoking increases the risk of MS by a factor of 2 [37].…”

Chronic Inflammatory Diseases at Secondary Sites Ensuing Urogenital or Pulmonary Chlamydia Infections

“…This peptide is able to induce T helper 1 (T H 1) response in experimental autoimmune encephalomyelitis within infected Lewis rats, which closely resemble the pathology of MS [41]. Despite these reports, long term antibiotic treatment with roxithromycin on MS patients has failed to observe any significant benefits, suggesting that the pathology of the disease is probably more complex than originally thought [99,100].…”