Domenico Fiore, M.D. - Indipendent Professional - Piove di Sacco (PD) - Italia

Objective: Etiopathogenesis - Treatment

Subjects - Methods - Results. Having found a toxi-infection by Bordetella Pertussis in 250 patients affected by multiple sclerosis, I searched in the serum for anti-pertussis antibodies in 75 neurologic patients in whom the nuclear magnetic resonance had excluded the presence of patches (Amyotrophic Lateral Sclerosis, ALS - non-patched neuropathies, NPNs): in all these cases there was a infection from Bordetella Pertussis [in E.L.I.S.A. the research of anti-Bordetella Pertussis antibodies (total IgG and IgM; anti H.A. Filamentous and anti-Pertussis Toxin IgA and IgG) was positive].

Discussion - Conclusions. The experimental allergic encephalitis, in a determinate animal Species, may be induced only in subjects with astrocytes which produce II class-HLA-Antigens (anti II class-HLA Antigens antibodies inhibit its onset); soluble Adhesion Molecules are present in multiple sclerosis, they are not present in non-inflammatory neuropathies.
In ALS (in non-patched neuropathies):

• astrocytes are non-producers of II class-HLA antigens: it is not possible to get to a "strong adhesion" between lymphocytes and microvasale endotheliums of the Central Nervous Sistem (CNS);
• The immune-complexes, constituted by pertussis toxines and specific antibodies (ICC, which form in all cases), do not precipitate, so that they progressively increase and, at high levels, inhibit the antibodies production;
• during the stage of inhibition by ICC (relative lack of antibodies) the toxins which go into blood fix themselves directly on neuroepitheliums; the pathogenic power of pertussis toxins and the role of astrocytes in the physiology of the CNS perfectly explains the neuroepithelial damages characteristic of ALS and of NPNs.

Teatment.: reclamation of mucosae and a long-term prophylaxis of re-infections with Ethylsuccinate of Erythromycin; plasmapheresis (6-8 sittings) during the first 20 days of antibiotic treatment (to avoid a dangerous Jarisch-Herxheimer's reaction).

References: Fiore Domenico:

• Amyotrophic Lateral Sclerosis. In: www.domenicofiore.it
• Neuropathies from Bordetella Pertussis … XXXIII Congress of the Italian Neurological Society. Neurological Sciences - Supplement - Volume 23 - September 2002.
• Diagnosis and Treatment of Multiple Sclerosis and Amyotrophic Lateral Sclerosis: Neuropathies from Bordetella Pertussis. American Journal of Therapeutics, September/October 2003; 10(5): 377-379.