The conundrum of iron in multiple sclerosis – time for an individualised approach
Date
2012-03
Authors
Janse Van Rensburg, Susan
Kotze, Maritha J.
Van Toorn, Ronald
Journal Title
Journal ISSN
Volume Title
Publisher
Springer US
Abstract
Although the involvement of immune mechanisms
in multiple sclerosis (MS) is undisputed, some argue
that there is insufficient evidence to support the hypothesis
that MS is an autoimmune disease, and that the difference
between immune- and autoimmune disease mechanisms has
yet to be clearly delineated. Uncertainties surrounding MS
disease pathogenesis and the modest efficacy of currently
used disease modifying treatments (DMTs) in the prevention
of disability, warrant the need to explore other possibilities.
It is evident from the literature that people diagnosed with
MS differ widely in symptoms and clinical outcome - some
patients have a benign disease course over many years
without requiring any DMTs. Attempting to include all
patients into a single entity is an oversimplification and
may obscure important observations with therapeutic consequences.
In this review we advocate an individualised
approach named Pathology Supported Genetic Testing
(PSGT), in which genetic tests are combined with biochemical
measurements in order to identify subgroups of patients
requiring different treatments. Iron dysregulation in MS is
used as an example of how this approach may benefit patients. The theory that iron deposition in the brain contributes
to MS pathogenesis has caused uncertainty among
patients as to whether they should avoid iron. However, the
fact that a subgroup of people diagnosed with MS show
clinical improvement when they are on iron supplementation
emphasises the importance of individualised therapy,
based on genetic and biochemical determinations.
Description
The original publication is available at http://rd.springer.com/article/10.1007/s11011-012-9290-1
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Multiple sclerosis -- Alternative treatment, Autoimmunity, Biochemistry, Genetics, Autoimmune diseases -- Personalised medicine, Multiple sclerosis -- Research, Myelin
Citation
Janse Van Rensbrug, S., Kotze, M. J. & Van Toorn, R. 2012. The conundrum of iron in multiple sclerosis – time for an individualised approach. Metabolic Brain Disease, 27(3), 239-253, doi:10.1007/s11011-012-9290-1.