Inflammation as a predictor for depression in multiple sclerosis

由于其对患者生活质量的影响及其对各自经济负担的贡献，抑郁症是多发性硬化症（MS）最相关的合并症之一。确定抑郁症的预测因素将有助于尽早开始诊断和治疗步骤，并改善多发性硬化症的护理。重度抑郁障碍（MDD）的研究强调了炎症分子在抑郁症状发展中的相关性。因此，从科学和临床的角度来看，研究炎症过程及其与多发性硬化症抑郁症状的相关性（多发性硬化症本身是一种慢性炎症）是非常有趣的。我们的项目解决了炎症标志物预测新诊断的多发性硬化症患者抑郁症状发展的悬而未决的问题。我们的重点是研究在多发性硬化症和重度抑郁症患者中都可以确定的血清标志物。此外，它们可以很容易地通过微创手术获得，因此是后期临床常规中可能实施的潜在候选人。此外，我们还考虑了其他临床、人口学、实验室和影像学参数（特别是MS病变和病变位置）作为抑郁症的预测因素。该项目设计为一项前瞻性队列研究，有两个队列（60名新诊断的MS患者和60名MDD患者，过去12个月内没有抗抑郁药物史），并在基线和12个月后的随访中进行测量。血清炎症标志物（CRP、白蛋白、IL-1、sIL2R、IL-3、IL-6、IL-12、IL-17、IL-18、IL-38、TNF-α、Th1-/Th17-/ t调节淋巴细胞）以及临床（包括EDSS作为身体残疾的指标）和其他变量（MS患者：基线脑脊液、基线和随访的MRI参数）将被测试作为抑郁症状的预测因子。此外，MS和MDD患者之间的比较将有助于识别那些与抑郁症状发生有关的炎症标志物，特别是在MS中。疾病修饰治疗对抑郁症状和促炎分子的影响也将被研究。这项研究的见解将允许识别具有更高抑郁症状风险的多发性硬化症患者。可以对这些患者进行更密切的监测，并在必要时及时提供相应的治疗。因此，ms相关性抑郁症的疾病负担可以显著减轻。

Due to its effect on patients’ quality of life and its contribution to the respective economic burden, depression is one of the most relevant comorbidities of multiple sclerosis (MS). Identifying predictors of depression would allow initiating diagnostic and therapeutic steps as early as possible and improve MS care. Major depressive disorder (MDD) studies have highlighted the relevance of inflammatory molecules in the development of depressive symptoms. Thus, investigating inflammatory processes and their relevance for depressive symptoms in MS – which itself is a chronic inflammatory condition – is highly interesting from both scientific and clinical point of view. Our project addresses the unanswered question which inflammatory markers predict the development of depressive symptoms in newly diagnosed MS patients. We focus on studying serum markers which can be determined in both MS and MDD patients. Furthermore, they can be easily obtained with a minimally invasive procedure and are thus potential candidates for a possible implementation in the clinical routine at a later stage. Additionally, we consider also other clinical, demographic, laboratory and imaging parameters (especially MS lesions and the lesion location) as predictors of depression. The project is designed as a prospective cohort study with two cohorts (60 newly diagnosed MS patients and 60 patients with MDD and no history of antidepressant medication in the last 12 months) and measurements at baseline and at a follow-up 12 months later. Serum inflammatory markers (CRP, Albumin, IL-1, sIL2R, IL-3, IL-6, IL-12, IL-17, IL-18, IL-38, TNF-α, Th1-/Th17-/T-regulatory lymphocytes) as well as clinical (including EDSS as an indicator for physical disability) and other variables (for MS patients: cerebrospinal fluid at baseline and MRI parameters at baseline and follow up) will be tested as predictors for depressive symptoms. Furthermore, a comparison between MS and MDD patients will allow the identification of those inflammatory markers, which are relevant for the occurrence of depressive symptoms especially in MS. The effects of disease modifying therapy on depressive symptoms and proinflammatory molecules will be studied as well. The insights from this study would allow to identify MS patients with a higher risk for developing depressive symptoms. Those patients could be more closely monitored and a respective treatment could be provided timely, if necessary. Thus, the disease burden of MS-related depression can be significantly reduced.