Dr. Guilio Gabbiani from the Centre Medical Universitaire in Geneve, Switzerland speaking on jugular wall changes in MS. His laboratory was interested in the fibrotic changes. He was interested in learning the importance of venous morphology, and is surprised so little is known.
Comparing arteries to veins: Arteries are thicker and there is more resistance.
Dr. Gabbiani took 5 specimens from IJV tissue removed by Dr. Zamboni from some of the patients he treated endovascularly. The tissue was from the area NOT damaged by angioplasty.
He compared it to healthy tissue from autopsy controls.
He looked at eosin, hematoxylin, Miller’s elastic stain and massons trichrome.
He found smooth muscle cells were numerous and increased in MS compared to controls. He then used isoelectric focusing to measure contractions in the smooth muscle cells via actin heterogeneity to ID the smooth muscle cells in the veins.
There is an increased expression of smooth muscle actin in MS, much more than controls.
By red staining for collagen and using unpolarized and polarized light, he saw that there is less collagen 1 type fibers in the MS jugular vein tissue, and more collagen III fibers in MS. This is the exact opposite of the controls.
Connective tissue in MS switches from collagen I to collagen III and this takes place in the IJVs. THis switch also happens in fibromatosis, colloids and hypertrophied scars, and this remodeling may play a role in CCSVI disturbances.
Dr. Lee makes a comment...
This collagen conversion from I to III happens in the arteries had no idea it could happen in the veins as well!
answer: Collagen III is stiffer, and fibrosis takes place for some reason. There was no inflammation on the tissue samples, but inflammation might have occurred before the the intervention and the fibrotic changes happened. All is still speculation, we do not know.
Dr. Zivadinov asks, so the testing was in the normal, non-stenosed part of the IJV?
Answer: Yes, we are trying to examine the normal part of the vein not affected by stenosis.
This collagen switch between type 1 and type 3 occurs in some genetic connective tissue disorders, and is present at birth. I keep wondering if there is a connection here (pun intended) between these other connective tissue disorders (which include RA, SLE, Raynaud's and others) and MS...and the area affected in MS is the veins. As Dr. Gabbiani noted, the venous system has not been studied as closely as the arteries. That is becoming more apparent everyday. We know Ehler-Danlos can affect arteries. And Dr. Dake's comment to Jeff sticks with me, "Your veins are sticky, the lining is like glue. Never seen anything like this." Or, it could just be the change occurs secondarily to inflammation. More research is needed, but it will be interesting to read the new genetic research coming out, and see if there are any shared loci between connective tissue disorders and MS.