Dramtic decrease in EDSS with Liver Transplant ? Why ?

[sandonpoint]

Was reading a couple of articles ( see below ) and I just cant get my head around these things

Just wondering if anybody else has an opinion on why a liver transplant can result in Huge decrease in EDSS and solid disease stablization ?

The articles don't really even speculate why ?

see these two articles

Abstract:

The Canadian Journal of Neurological Sciences
Issue: Volume 31, Number 4 / November 2004
Pages: 539 - 541

Background: The effect of liver transplantation on pre-existing multiple sclerosis (MS) has never been reported. We report the three year post-transplant neurological outcome of a patient with MS. Case report: A Caucasian woman with MS received an urgent liver transplant for fulminant liver failure at the age of 59. Her Extended Disability Scale Score (EDSS) pretransplant was 5.0 and clinically she had cerebellar and brainstem dysfunction. Post-transplant immunosuppression consisted of tacrolimus, mycophenolate mofetil and tapering corticosteroids that were discontinued after 1.5 years. Post-transplant her EDSS decreased to 2.0 and after three years she is clinically asymptomatic with only very mild dysarthria on neurologic examination. Long-term maintenance immunosuppression consists of low dose tacrolimus.

Conclusions: Combination immunosuppression with tacrolimus may have a beneficial effect on MS although an effect of donor allograft itself can not be excluded.


also see article

Transplant International
Volume 20 Issue 12, Pages 1077 - 1079

Improvement of multiple sclerosis on tacrolimus plus mycophenolate mofetil after liver transplantation
Clinical improvement of multiple sclerosis in a patient requiring liver transplantation for acute liver failure following interferon-β therapy

Wish I knew the answer - ;(
Sandon

[TwistedHelix]

Well, this is fascinating and unexpected. My immediate thought was that it has something to do with the immunosuppressive drugs – as they hinted – and if it's not that, then it might be something to do with the liver itself.
The liver performs so many functions that it can never be completely discounted, (at least, not until we have proof positive), and it would come as an earth-shattering shock to find that MS originates there. However, a lot of us feel that research has been looking in the wrong places for decades and that the true answers will come from somewhere really surprising… and this certainly qualifies!
Interesting find, Sandon

[sandonpoint]

Yes it is very interesting, I would love to see if there is any data on disease ameriolatrion in PPMS, then that would be very unexpected.

There seems there is only a handful of cases of liver transplant in MS and every case that I have read has had marked improvement ?

Go Figure

[cheerleader]

Welcome, Sandon. Neat find.
Just one of the many things that makes us all go, hmmm.
Dom is right, it could be from transplantation interferon treatment or the liver itself.

My husband presented with high liver enzymes at his first flare. His neuro said his liver and MS were not connected, but I was unconvinced. We did a liver cleanse with milk thistle and continue to do monthly liver cleanses. He remains stable, as do his liver enzymes.

I've also read about a liver transplant receiver taking on the donor's immune system and changing blood types:
http://www.scienceagogo.com/news/200800 ... _sys.shtml

There's more to the liver and the immune system to be discovered,
AC

[sandonpoint]

I had read about that girl from Australia before and call me a fool, my gut feeling that along these lines ie "immune system transplant" is where there will be massive inroads made into MS treatments.

Peace

Sandon

[gwa]

One thing about liver transplants is that just a small piece of someone's liver will grow into a complete liver when transplanted into another person.

At least livers don't have to be taken out of a dead donor's body. This sounds fascinating, especially since most of us will have relatives willing to give us a chunk of their liver if it helped us.

The article posted is from 2004, so it would be worth a hunt around the medical journals to see if anything newer has been reported on the topic.


gwa

[viper498]

This is VERY interesting...

The reason it perks my interest even more is because even before I was diagnosed with MS, my Liver enzymes would come back elavated. This fluctuates quite a bit. Some times they are, some times they aren't. I wonder if they would correlate with a relapse if I have another one?

VERY interesting article, thank you! This NEEDS and DESERVES much more research.

Brock

[lyndacarol]

Sandon has put forth an intriguing idea and papers with it! Since I am the one with the insulin angle here and I do NOT subscribe to the autoimmune hypothesis, this is my two cents' worth: I understand that the Insulin- Degrading Enzyme (IDE) is mostly made in the liver. Could it be that the pancreas synthesizes too much insulin and/or the liver produces too little IDE? The result is that my body has hyperinsulinemia.

Dom's suggested possibility,

it might be something to do with the liver itself.

would seem to open the door to this line of thinking.

Hmmm....

[sandonpoint]

What really surprised me about these articles, is that the article stresses that the clinical improvement was stable and immediate post transplant.

You would think such a intensive operation would make the condition worse.

...Anyway it is widely understood that the liver is responsible for over 100 processes in the human body ( and remember its a system ).

Could it be that the reason people improved so dramatically that the liver is sub-clinically damaged in MS patients ( ie on a cellular level ? )

Is this why there is improvement with swank diet and statins , because that helps the liver ?

I dont subscribe to the thory that MS is a total autoimmune disease , ie like Myasthenia Gravis, Aplastic Anemina etc....

White coats would have already found what the target is in MS if it were a total autoimmune disease.

Furhermore lesions that are hours old ( pineas and barnett ) show cell death of myelin making cells is the first noticable change in a MS lesion.

I personally believe that scientists need to start looking at obscure things because the immune system is only half the answer !

Peace Out - Sandon

[whyRwehere]

I followed a link from the second article and found another interesting one...not about the liver, sorry, but about the immune system, double sorry, but it was still interesting: http://www.scienceagogo.com/news/200507 ... _sys.shtml

[Terry]

In the 30's, Edgar Cayce blamed the liver, gall ducts(?) and gold deficiency for MS. (Cayce- non-scientific, I know.)

Long-term maintenance immunosuppression consists of low dose tacrolimus.

Looks like another name for this is FK 506, and it has been discussed here a couple of times before.

[Frank]

Hi all,

the two drugs given for immunesuppression are/have been also investigated in MS.
Tacrolimus seems to be a more potent version of Cyclosporin.
Mycophenolate mofetil is in phase-III for MS under the name CellCept.

Its not uncommon to see lasting improvements under serious immonsuppression (see HDC or ASCT, daclizumab).

Still it would be interesting to see how MS patients are doing that received an other organ transplant under the same immunsuppression regime to dertermin if the liver plays a particular role.

--Frank

[TwistedHelix]

Excellent suggestion Frank! Comparing patients post transplant, who have received the same immunosuppressive drugs, is the perfect way to find out whether it is the drugs or the transplanted organ which is having an effect,

[Wonderfulworld]

This is really fascinating.

Obviously the effect of the immunosupressive drugs have to be ruled out, but it really makes me go "hmmm"?

At age 18 I developed glandular fever (epstein-barr/mono) and it actually infected my liver and caused jaundice, which caused much confusion to the medics for about a fortnight until they finally realised it was glandular fever. 6 months later I had a recognisable MS-relapse, but not diagnosed for another 7 years after that.

Very very interesting, I'd be most curious to see more about any possible liver/MS connections, if there are any.
Thanks for posting this.

[viper498]

Likewise. If the source of that aticle is correct then there is definitely something to this. I will be looking for more information with regards to this subject!

Can anyone get the full study on this?

Brock