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April 2005

Evaluating the Evidence for Multiple Sclerosis as an Autoimmune Disease

Arch Neurol. 2005;62(4):688. doi:10.1001/archneur.62.4.688-a

I read with great interest the recent piece in the ARCHIVES by Chaudhuri and Behan1 “Multiple Sclerosis Is Not an Autoimmune Disease” and the accompanying counterargument by Weiner.2

While appreciating that the intention is to be provocative and stimulate debate, one is concerned that by quoting rather selectively from the immunology literature, Behan and Chaudhuri may have created a misleading impression that is not fully addressed by Weiner's piece. Space limitations preclude a detailed response to all the specific points in the case made by Chaudhuri and Behan. To take one example, they mention that epidemiological studies cast doubt on the role of inflammation, yet the article they cite by Bell and Lapthrop3 is a commentary on the initial genome scanning studies from which the overwhelming conclusion was that the strongest contribution to genetic susceptibility in multiple sclerosis (MS) comes from the immune response genes in the HLA region. With respect to T-cell responses to myelin epitopes, of course these are not exclusive to patients with MS, although changes in the specific pattern of response to myelin have been correlated with relapse.4

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