Multiple sclerosis: the proinflammatory cytokines lymphotoxin-alpha and tumour necrosis factor-alpha are upregulated in cerebrospinal fluid mononuclear cells.

Lymphotoxin-alpha (LT-alpha) and tumour necrosis factor-alpha (TNF-alpha) promote inflammation in autoimmune diseases and have been detected in the multiple sclerosis (MS) brain lesions and blood, suggesting these cytokines are also present in the cerebrospinal fluid (CSF). To study this, mononuclear cells (MNC) were examined for transcripts of LT-alpha and TNF-alpha, using in situ hybridization (ISH) with synthetic oligonucleotide probes. Most patients with MS had LT-alpha and TNF-alpha mRNA-expressing MNC in their CSF at mean frequencies of about 1/2800 cells for both cytokines. Numbers were dramatically higher than in the paired blood specimens. Control patients with other inflammatory neurological diseases (OIND) also had LT-alpha and TNF-alpha mRNA-expressing cells in CSF but at mean frequencies of only 1/36,000 and 1/18,000 cells, respectively. In blood, levels were similar in OIND and MS. To elucidate the influence of myelin antigen stimulation on LT-alpha and TNF-alpha expression, MNC were cultivated with or without myelin basic protein. Strongly elevated levels of MBP-reactive TNF-alpha mRNA-expressing cells were detected in the MS patients' CSF, in particular when examined during clinical exacerbations, as well as MBP-reactive LT-alpha mRNA-expressing MNC. No such patterns were observed in the OIND controls. The strong accumulation of LT-alpha- and TNF-alpha-producing cells and of MBP-reactive LT-alpha and TNF-alpha mRNA-positive cells in the immediate vicinity of the demyelinating process in MS patients implicates a role of these cytokines in the development of MS.