Amyotrophic Lateral Sclerosis Progression Associated With Changes in Immune Status

Macrophage illustration
Macrophage illustration
The findings suggest that changes in immune status may be a consequence of ALS.

Changes in the number of neutrophils and CD4 T cells are associated with progression of amyotrophic lateral sclerosis (ALS), according to results of a longitudinal cohort study published in JAMA Neurology.

In this study, researchers sought to identify immune system changes by evaluating peripheral inflammatory markers in patients with ALS (n=119) and healthy controls (n=35). Additionally, the researchers wished to identify whether or not these changes correlated with progression of ALS.

Investigators found that people with ALS had numerically higher average counts of total leukocytes (× 106/mL) compared with healthy controls (5.53 [0.16; 95% CI, 5.21-5.84] vs 4.57 [0.29; 95% CI, 3.94-5.11], respectively). Additionally, patients with ALS also had a greater number of neutrophils compared with controls (3.80 [0.12; 95% CI, 3.56-4.04] vs 2.87 [0.23; 95% CI, 2.40-3.35], respectively). CD16+ and CD16- monocytes were also higher among patients with ALS.

Change in the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) was also observed, demonstrating a significant association with immune system changes and ALS progression. These changes were most noticeable with CD4 T cells (-30.47 [95% CI, -46.02 to -14.94] per -3.72 × 104/mL [SD, 26.21 × 104/mL] per year) and neutrophils (-4.37 [95% CI, -6.60 to -2.14] per 11.47 × 104/mL [SD, 58.04 × 104/mL] per year).

This study examined correlations only and failed to establish a causative component related to immune system changes and ALS disease progression. The researchers suggested that “changes in peripheral immunity may be a consequence rather than a cause of disease.”

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Murdock BJ, Zhou T, Kashlan SR, Little RJ, Goutman SA, Feldman EL. Correlation of peripheral immunity with rapid amyotrophic lateral sclerosis progression [published online September 25, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.225