Risk of Relapse in Pregnancy


I first came across Activin A when it was first mentioned in relation to remyelination and the the activity of macrophages. Whilst I have heard that this was all an artifact of mouse and didn’t really happen in humans, here we have if as an indicator of relapse during pregnancy and you appear to be thirteen times more likely to have a relapse if you are low for this molecule. I wonder what NDG will make of this. Will they test this? If they do would they do anything about it? As for the rest of the correlations they are relatively meaning less r= 0.5 means un interesting to the individual, shame we let the imagers claim this was an interesting level of correlation as it has created bad habits for our clinical chums to pretend the data is somehow interesting, when it is rather uninterpretable.

Cytokine profile during pregnancy predicts relapses during pregnancy and postpartum in multiple sclerosis. Cuello JP, Martínez Ginés ML, Tejeda-Velarde A, Medina Heras S, García Domínguez JM, Fernández Velasco JI, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon Larroca S, De León-Luis J, de Andrés C, Álvarez Lafuente R, Villar LM.

J Neurol Sci. 2020 Mar 30;414:116811. doi: 10.1016/j.jns.2020.116811. [Epub ahead of print]

To explore the serum cytokine profile associated with disease activity during pregnancy and postpartum in MS, and to assess any potential biomarkers predicting the occurrence of relapses during this period.

METHODS:We included 53 MS pregnant women recruited between 2007 and 2018. Interferon-gamma, Tumor necrosis factor-alpha, interleukin-17, granulocyte/macrophage-colony stimulating factor, Activin-A, interleukin-10, and programmed-death-ligand-1 (PD-L1) were measured quarterly in serum by ELISA.

RESULTS:Seventeen patients (32%) experienced relapses during pregnancy or puerperium and 37(68%) did not. We did not found differences in clinical characteristics or treatment status between the two groups. However, relapsing patients showed at the first trimester of pregnancy considerably lower levels of serum Activin-A (336.4 pg/dl [289.6-491.7], median [IQR] vs. 760.0 pg/dl [493.2-1108.0],p = .003), which correlated positively with serum PD-L1 (r = 0.53,p = .0005) and IL-10 (r = 0.43,p = .004) values. Activin-A levels lower than 515 pg/ml at the first trimester identified patients with high probability of relapsing during pregnancy and postpartum (OR = 13.75, CI: 2.5-76.8, p = .001).

CONCLUSIONS:MS patients with no relapses during pregnancy and puerperium showed an early triggering of a tolerogenic innate immune response evidenced by high serum Activin-A concentrations during the first trimester of pregnancy. Thus, serum Activin-A can be a useful biomarker to predict clinical activity during this period.

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  • “which correlated positively with serum PD-L1”

    This is t cell biology (mafia????)

    You only focus on the Activin A 🙂

    Programmed death-ligand 1 (PD-L1) is a 40kDa type 1 transmembrane protein that has been speculated to play a major role in suppressing the adaptive arm of immune system during particular events such as pregnancy, tissue allografts, autoimmune disease and other disease states such as hepatitis. Normally the adaptive immune system reacts to antigens that are associated with immune system activation by exogenous or endogenous danger signals. In turn, clonal expansion of antigen-specific CD8+ T cells and/or CD4+ helper cells is propagated. The binding of PD-L1 to the inhibitory checkpoint molecule PD-1 transmits an inhibitory signal based on interaction with phosphatases (SHP-1 or SHP-2) via Immunoreceptor Tyrosine-Based Switch Motif (ITSM).[6] This reduces the proliferation of antigen-specific T-cells in lymph nodes, while simultaneously reducing apoptosis in regulatory T cells (anti-inflammatory, suppressive T cells) – further mediated by a lower regulation of the gene Bcl-2.[citation needed]


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