Hecker M, Fitzner B, Koczan D, Klehmet J, Grothe M, Schwab M, Winkelmann A, Meister S, Dudesek A, Ludwig-Portugall I, Eulitz K, and Zettl UK
Background: Despite remarkable advances in the therapy of multiple sclerosis (MS), patients with MS may still experience relapses. High-dose short-term methylprednisolone (MP) remains the standard treatment in the acute management of MS relapses due to its potent anti-inflammatory and immunosuppressive properties. However, there is a lack of studies on the cell type-specific transcriptome changes that are induced by this synthetic glucocorticoid (GC). Moreover, it is not well understood why some patients do not benefit adequately from MP therapy., Methods: We collected peripheral blood from MS patients in relapse immediately before and after ∼3-5 days of therapy with MP at 4 study centers. CD19 + B cells and CD4 + T cells were then isolated for profiling the transcriptome with high-density arrays. The patients' improvement of neurological symptoms was evaluated after ∼2 weeks by the treating physicians. We finally analyzed the data to identify genes that were differentially expressed in response to the therapy and whose expression differed between clinical responders and non-responders., Results: After MP treatment, a total of 33 genes in B cells and 55 genes in T helper cells were significantly up- or downregulated. The gene lists overlap in 10 genes and contain genes that have already been described as GC-responsive genes in the literature on other cell types and diseases. Their differential expression points to a rapid and coordinated modulation of multiple signaling pathways that influence transcription. Genes that were previously suggested as potential prognostic biomarkers of the clinical response to MP therapy could not be confirmed in our data. However, a greater increase in the expression of genes encoding proteins with antimicrobial activity was detected in CD4 + T cells from non-responders compared to responders., Conclusion: Our study delved into the cell type-specific effects of MP at the transcriptional level. The data suggest a therapy-induced ectopic expression of some genes (e.g., AZU1, ELANE and MPO), especially in non-responders. The biological consequences of this remain to be explored in greater depth. A better understanding of the molecular mechanisms underlying clinical recovery from relapses in patients with MS will help to optimize future treatment decisions., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MH received speaking fees and travel funds from Bayer HealthCare, Biogen, Merck Healthcare, Novartis and Teva. JK received personal compensation for consulting as well as speaker honoraria from Bayer, Biogen, Bristol Myers Squibb, Grifols, Janssen, Merck Serono, Novartis, Roche, Sanofi Genzyme, Takeda and Teva. MG received honoraria, speaking fees and research funding from Bayer, Biogen, Bristol Myers Squibb, Johnson & Johnson, Merck, Novartis, Roche, Sanofi and Teva as well as BMBF and DFG. AW received speaking fees and travel funds from Biogen, GlaxoSmithKline, Merck Serono, Novartis and Sanofi Genzyme. IL-P and KE are employees of Miltenyi Biotec, a biotechnology company that provides products and services for biomedical research as well as cell and gene therapy. UKZ received research support, speaking fees and travel funds from Alexion, Almirall, Bayer HealthCare, Biogen, Bristol Myers Squibb, Janssen, Merck Healthcare, Novartis, Roche, Sanofi Genzyme and Teva as well as the European Union, BMBF, BMWi and DFG. BF, DK, MS, SM and AD declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)