The T-cell pool is anergized in patients with multiple sclerosis in remission


M. Fransson, Clinical Immunology Division/Uppsala University, Rudbeck Laboratory C11, Dag Hammarskjoldsv 20, 751 85 Uppsala, Sweden. Email:
Senior author: Angelica Loskog,


Relapsing–remitting multiple sclerosis (RRMS) is a complex autoimmune disease of the central nervous system with oscillating phases of relapse and remission. RRMS has been considered to be driven by T helper type 1 (Th1) lymphocytes but new data indicate the involvement of Th17 responses. In the present study, blood samples from patients (= 48) and healthy individuals (= 44) were evaluated for their immunological status. T cells from patients with RRMS expressed high levels of the activation marker CD28 (< 0·05) and secreted both interferon-γ (CD8: < 0·05) and interleukin-17 upon polyclonal mitogen or myelin oligodendrocyte glycoprotein antigen stimulation. However, T cells from patients with RRMS in remission, in contrast to relapse, had poor proliferative capacity (< 0·05) suggesting that they are controlled and kept in anergy. This anergy could be broken with CD28 stimulation that restored the T-cell replication. Furthermore, the patients with RRMS had normal levels of CD4+ Foxp3+ T regulatory cells but the frequency of Foxp3+ cells lacking CD127 (interleukin-7 receptor) was lower in patients with MS (mean 12%) compared to healthy controls (mean 29%). Still, regulatory cells (CD25+ sorted cells) from patients with RRMS displayed no difference in suppressive capacity. In conclusion, patients in relapse/remission demonstrate in vitro T-cell responses that are both Th1 and Th17 that, while in remission, appear to be controlled by tolerogenic mechanisms yet to be investigated.