Chlamydia pneumoniae bactrium - one possible cause of Multiple Sclerosis? 20 November 2008
Recently, the most convincing data ever presented relating infection
with a specific organism to multiple sclerosis has been reported
from the Department of Neurology and Pathology, Vanderbilt School
of Medicine, Nashville, Tennessee. Dr. Subramaniam Sriram and coworkers, publishing their results in the Annals of Neurology, have demonstrated the presence of a specific type of bacteria in 100% of the 37 multiple sclerosis patients they studied.
As the authors reported, “The evidence of Chlamydia pneumoniae
in both progressive MS and relapsing-remitting patients suggests
that the infection of the central nervous system with Chlamydia
pneumoniae occurs early and persists perhaps throughout the course
of the disease and does not differentiate between different clinical
subtypes of the disease.”
This purported relationship between risk for multiple sclerosis and infection with Chlamydia pneumoniae was recently substantiated in a study appearing in the March 2003 issue of Epidemiology. In this report, Harvard researcher Kassandra Munger found a 70% increased incidence of multiple sclerosis in women seropositive for the presence of Chlamydia pneumoniae antibodies.
This organism is a fairly recent addition to the list of bacteria known
to affect humans. It is now recognized as a cause of pneumonia,
pharyngitis, bronchitis, and several chronic diseases. More
importantly, Chlamydia pneumoniae has now been recognized as
playing at least some causative role in reactive arthritis and coronary
artery disease – medical conditions which, like MS, are characterized
by ongoing inflammation.
The idea that multiple sclerosis may be caused by some form of
infectious agent is supported by several interesting observations.
On the Faroe Islands prior to 1920, MS was essentially unknown.
Subsequent to the invasion of British troops, the incidence of MS
increased dramatically. This would support the contention that MS,
at least on the Faroe Islands, was caused by some infectious agent to
which the native population had not been previously exposed.
In addition, the cerebrospinal fluid (CSF) in patients with documented
multiple sclerosis, is typically found to contain high amounts of specific
proteins known to be elevated in other nervous system disorders in
which infectious causes have been clearly identified.
If there is such a strong relationship between the presence of Chlamydia
pneumoniae and multiple sclerosis, how could its presence have been
missed by researchers for so many years? The answer lies in the fact
that the discovery of Chlamydia in the spinal fluid of MS patients
required the development of a very sophisticated test to detect a unique
protein found on the cell wall of the Chlamydia pneumoniae organism
itself. Indeed, this is not the first example of a profound delay in the
identification of an elusive bacterium as the cause of a specific illness. It
has been only in the past few years that the bacteria Helicobactor pylori
has been demonstrated to be the causative agent in most cases of gastric
ulcers. Incredibly, Helicobactor pylori has been identified in the stomachs
of humans since the early 1900s, but medical researchers couldn’t bring
themselves to admit the possibility that a disease like gastric ulcers could
be caused by a simple bacterium.
Another observation supporting the relationship between Chlamydia
pneumoniae and multiple sclerosis is based on the discovery that two
commonly used medications for multiple sclerosis, interferon-beta
and methotrexate, profoundly inhibit the growth of the Chlamydia
bacterium. This is interesting and provocative information as we
don’t yet fully understand why these drugs are sometimes effective
in MS treatment.
Over the past several years, the medical literature has published various
articles describing specific viruses thought to be the causative agent for
multiple sclerosis, only to have these reports subsequently refuted. But
this new research describing the possible relationship between Chlamydia
pneumoniae and multiple sclerosis is most compelling. And the good
news is that unlike viruses, specific antimicrobial medicines are available
to treat Chlamydia pneumoniae.
Based upon this research, it is not unreasonable for patients with
multiple sclerosis to consider an empiric treatment for Chlamydia
pneumoniae. As this discovery is relatively new, no specific treatment
protocols have as yet been created. And it will likely be several
years until clinical trials have been designed, approved, funded,
completed, and ultimately published, until we know for sure that
MS patients should be treated. But in light of the present evidence,
empirically treating MS patients for Chlamydia pneumoniae seems
reasonable. Obviously this decision should be discussed with the
treating physician. Antibiotics generally quite effective in treating
Chlamydia pneumoniae infections include minocycline and tetracycline.
Minocycline may be the more effective treatment since it is more
able to penetrate the blood-brain barrier to enter the brain.
The Perlmutter Health Center protocol for the empiric treatment of Chlamydia pneumoniae in our MS patients is: Minocycline 100 mg twice a day for 21 days.
Again, the decision to engage in this empiric treatment should be
made after patient and physician consider the literature linking
Chlamydia pneumoniae to multiple sclerosis, as well as the potential
risks of taking a course of minocycline or other antibiotic. It is always
important when taking any antibiotic to also use a probiotic. These
are nutritional supplements designed to reestablish appropriate levels
of the “friendly bacteria” in the gut like Lactobacillus acidophilus and
others which aid in the absorption of nutrients, help maintain the
integrity of the gut lining, and assist in detoxification.
Source: Renegade Neurologist - A Blog by David Perlmutter, MD, FACN