Chernenko M. State of the Brain-Blood Barrier in Patients with Multiple Sclerosis

The thesis investigates the state of the brain-blood barrier in 135 patients with different types of multiple sclerosis at different stages of the pathological process using clinical and neurological, biochemical, MR-imaging, mathematical, and statistical methods. Based on the comparison of clinical data and BBB functional state, patients with RRMS demonstrated direct highly reliable correlations between BBB perme-ability markers and EDSS disability index. No such correlations were established in progredient types of MS. It indicates that inflammatory processes are crucial for the formation of neurological deficit in RRMS, while neurodegenerative processes are crucial in progredient types of MS. This data is confirmed by MRI tests. Pre-dictors of unfavorable progredient disease course are МRI criteria, such as marked atrophic brain changes at early disease stages with a tendency to their rapid growth with formation of "black holes". Permeability of the brain-blood barrier is influenced by the content of matrix metalloproteinase. Matrix metalloproteinase level in patients with multiple sclero-sis depends on the disease type and the pathological process activity stage. Be-sides, matrix metalloproteinase level definitely depends on the patient's age (the older the patient the lower the MMP level) and disease duration (the longer the disease duration the lower the MMP level). Presence of the infection factor causes T-cell stimulation and an increase in MMP-9 blood level, thus increasing the BBB permeability. Ongoing pathogenetic therapy may be corrected in a timely manner based on the complex assessment of the brain-blood barrier functioning.