Cytokine Gene Expression and Treatment Impact on MRI Outcomes in Jordanian Patients with Multiple Sclerosis

Abstract

Background: Central nervous system autoimmune disorders, like multiple sclerosis (MS), are chronic conditions where cytokines contribute significantly to the regulation of inflammation. The diagnosis, progression, and treatment effectiveness of MS are assessed through laboratory tests and clinical evaluation, as well as imaging.

Method: This study included 40 healthy individuals as a control group and 75 MS patients, divided into two groups: 45 MS patients receiving fingolimod treatment (MSW) and 30 patients taking other medications (MSOs). Blood samples (3 mL) were collected from all participants, and the mRNA relative expression of cytokine genes (IL-1β, TNF-α, IL-6, and INF-γ) was measured. Additionally, MRI images of MS patients undergoing fingolimod or other treatments were analyzed.

Results: The MSO patient group displayed higher mRNA expressions of IL-1β, TNF-α, IL-6, and INF-γ compared to the control group. Furthermore, TNF-α, IL-6, and INF-γ expressions were elevated in the MSO group compared to the MSW group. MRI scans showed significant improvement in MS patients taking fingolimod compared to those receiving other medications.

Conclusions: Fingolimod demonstrated greater effectiveness in improving MS patients' conditions, possibly due to its impact on cytokine expression.

Keywords: Jordanians; MRI; cytokines; fingolimod; multiple sclerosis; relative gene expression.

Figure 1

Relative mRNA expression of (A) IL-1β, (B) TNF-α, (C) IL-6, and (D) INF-γ in control, MSW, and MSO groups. Results are expressed as the mean ± SD (n = 40 for control; 30 for MSW and 45 for MSO). (ns: no significance; * p < 0.05; *** p < 0.001; ****: p < 0.0001). Significant differences were based on one-way ANOVA followed by Tukey’s multiple comparisons. The MSO group showed higher mRNA expressions for all measured cytokines compared to the control group, while the MSO group showed higher mRNA expressions for TNF-α, IL-6, and INF-γ compared to the MSW group.

Figure 2

MRI examination of an MSW patient taking fingolimod. (A). The number of lesions before treatment = 13, with an average lesion size (cm) of 0.36 ± 0.21, (B). The number of lesions after treatment = 6, with an average lesion size (cm) of 0.17 ± 0.24. The number and extent of the lesions were reduced after one year of fingolimod treatment.

Figure 3

MRI examination of a second MSW patient taking fingolimod. (A). The number of lesions before treatment = 13, with an average lesion size (cm) of 0.48 ± 0.24, (B). The number of lesions after treatment = 10, with an average lesion size (cm) of 0.37 ± 0.20. The number and extent of lesions were similar after one year of fingolimod treatment (stable). Arrows refer to lesions.

Figure 4

MRI examination of an MSO patient taking another medication (not fingolimod). (A). The number of lesions before treatment = 14, with an average lesion size (cm) of 0.35 ± 0.17, (B). The number of lesions after treatment = 18, with an average lesion size (cm) of 0.40 ± 0.19. The progression of the disease worsened after one year of treatment. Arrows refer to new lesions formed.

Figure 5

MRI examination of an MSO patient taking another medication (not fingolimod). (A). The number of lesions before treatment = 17, with an average lesion size (cm) of 0.45 ± 0.23, (B). The number of lesions after treatment = 21, with an average lesion size (cm) of 0.44 ± 0.15. The progression of the disease worsened after one year of treatment. Arrows refer to new lesions formed.