21 patients with MS and 21 patients with NMO were imaged. There was one important difference between the two groups. Only the patients with MS showed signs of "iron laden lesions" which contained a central vein. None of the people with NMO showed this.
NMO is a truly autoimmune disease, in which immune cells attack the optic nerve and spine. In contrast to MS, NMO has a known antigen, called Aquaporin 4. In NMO, the immune cells attack this antigen and cause demyelination. However, there has never been a specific antigen discovered for MS. In fact, MS lesions are very different from NMO lesions, as high powered MRI is showing us that inside MS lesions, there is a central vein which is allowing blood products, like iron, into brain tissue.
Here is how the researchers describe the difference:
Distinguishing MS from NMO lesions.
Axial T2-weighted image from a representative patient with MS demonstrating a hyperintense lesion (black arrow) traversed by an ill-defined central venule adjacent to the inferior horn of the lateral ventricles. The lesion appears hypointense on a corresponding T1-weighted MPRAGE image. The lesion shows a hypointense peripheral rim and an iso- to hypointense central core traversed by a well-defined venule on GRE-T2*-weighted image. This lesion is hyperintense on QSM. Hypointense signal intensity within the lesion on GRE-T2*-weighted image and hyperintensity on QSM suggest iron accumulation (upper row). An axial T2-weighted image from a representative NMO lesion reveals 2 round hyperintense lesions (white arrows) in the subcortical WM region. The lesions appear hypointense on T1-weighted and hyperintense on GRE-T2*-weighted images. However, these lesions are isointense and therefore inconspicuous on QSM (lower row). The scale bar is for the QSM image with units of parts per billion.
Looking at the images, we can see the arrows pointing to the MS and NMO lesions. All the images (on the top for MS and bottom for NMO) are of the same area of brain tissue. It is the GRE-T2 image which clearly shows the MS lesion has a very small, yet well-defined vein (venule) going through the center. The NMO lesion does not. The QSM image shows that around this vein, in the MS patient, there is iron. The researchers do not say that this is from blood leaking into tissue. But this is the very obvious inference. Blood, or heme, contains iron. Microbleeds into brain tissue have been documented in MS. link And here, once again, we have more proof.
For those of us who know our history, we remember that Rindfleisch saw the EXACT SAME THING through his microscope in 1863.
If one looks carefully at freshly altered parts of the white matter ...one perceives already with the naked eye a red point or line in the middle of each individual focus,.. the lumen of a small vessel engorged with blood...All this leads us to search for the primary cause of the disease in an alteration of individual vessels and their ramifications; All vessels running inside the foci, but also those which traverse the immediately surrounding but still intact parenchyma are in a state characteristic of chronic inflammation.
Rindfleisch E. - "Histologisches detail zu der grauen degeneration von gehirn und ruckenmark". Archives of Pathological Anatomy and Physiology. 1863;26:474–483.
Yet, even after all the historical evidence, when Dr. Zamboni published on the link between venous disease, iron deposition into tissue, inflammation and MS lesions in his "Big Idea" paper in 2008---he was resoundingly ignored (or worse, mocked) by MS researchers. Here's the history of this research into the central vein sign, iron deposition and MS lesions-- link
At a certain point, you simply have to say---
WAKE UP!
My family reached that point almost a decade ago, and because of this, my husband remains healthy. The evidence continues. There is a vascular connection to MS.
Whether or not MS specialists and immunologists will ever acknowledge this fact and help patients is moot. It is up to all of us to educate, inform, encourage, and move the research forward.
Be well,
Joan
