Tourtellotte W W, Walsh M J, Baumhefner R W, Staugaitis S M, Shapshak P
Ann N Y Acad Sci. 1984;436:52-67. doi: 10.1111/j.1749-6632.1984.tb14775.x.
The status of the central nervous system as an immunologic organ synthesizing IgG in several neurological diseases has been established convincingly in the past two decades. The measurement of intra-BBB IgG synthesis has been accomplished. It has been demonstrated that this synthesis is a potential marker for an abnormal immunologic process within the CNS which if manipulated may be a quantifiable aspect of disease modulation. Modulation of intra-BBB IgG synthesis is feasible, but there is no evidence yet that modulation of this synthesis is an index of effective disease control in MS. Only ACTH and corticosteroids lead to a significant and lasting depression of intra-BBB IgG synthesis, even though clonal eradication is not achieved. Based on our immunopharmacologic studies in MS we have proposed an immunokinetic model. The qualitative analysis of the specificity of IgG synthesized intra-BBB in MS has not led to the etiology of MS, but utilization of quantitative methods may. Questions raised by this review with suggested experiments to advance further our understanding of intra-BBB IgG synthesis as it relates to the etiopathogenesis of MS are included.
在过去二十年中，中枢神经系统作为在多种神经疾病中合成IgG的免疫器官这一地位已得到令人信服的确立。血脑屏障内IgG合成的测量已经完成。已经证明，这种合成是中枢神经系统内异常免疫过程的一个潜在标志物，如果对其进行调控，可能成为疾病调节的一个可量化方面。调节血脑屏障内IgG合成是可行的，但尚无证据表明这种合成的调节是多发性硬化症有效疾病控制的指标。即使未实现克隆清除，只有促肾上腺皮质激素和皮质类固醇会导致血脑屏障内IgG合成显著且持久的降低。基于我们对多发性硬化症的免疫药理学研究，我们提出了一个免疫动力学模型。对多发性硬化症血脑屏障内合成的IgG特异性的定性分析尚未得出多发性硬化症的病因，但定量方法的应用可能会得出病因。本综述提出的问题以及为进一步推进我们对血脑屏障内IgG合成与多发性硬化症病因发病机制关系的理解而建议的实验也包括在内。
