Hychka K. Multiple sclerosis: the study of comorbid pathology and elaboration of diagnostic and prognostic criteria using glycan markers of immunoglobulins.

The thesis presents a conceptual synthesis and a new approach to improving the MS diagnosis and treatment by identifying new diagnostic and prognostic biomarkers in patients’ blood serum and cerebrospinal fluid samples. The structure of comorbid pathology in MS and the peculiarities of MS occurrence in temporal connection with the first showing of the disease were studied. Clinical and statistical analysis with the results of clinical and neurological, radiological (MRI scanning) and immunobiological testing of 141 MS patients of different age and gender was outlined. In 2016-2019, the patients received comprehensive outpatient or inpatient treatment on the clinical basis of the Department of Neurology of Danylo Halytsky Lviv National Medical University (Department of Neurology of CNE LRC Lviv Regional Clinical Hospital). Immunobiological studies of blood serum and cerebrospinal fluid (CSF) were carried out at the Department of Histology, Cytology and Embryology of Danylo Halytsky Lviv National Medical University. The thesis findings provided new data on the pathogenetic mechanisms of MS development, presented a new approach for improved diagnosis of multiple sclerosis including comorbid pathology in MS and identified new diagnostic and prognostic biomarkers of the disease by examining changes in immunoglobulin glycosyl determinants in blood serum samples. The comorbid pathology and MS development were associated. It was shown that not only MS affects the clinical course of coexisting diseases, but also coexisting diseases make the course of MS more severe. In the case of MS comorbidity with a number of diseases and conditions, the rates of its advance and severity increase. It was shown that changes in IgG glycosylation determine their pro- or anti-inflammatory effects. It was proved that the onset of IgG immunoglobulins with altered glycosylation spectrum and pathological pro-inflammatory properties is prevalent in MS. It was found that in MS there is an altered glycosylation of antibodies in patients’ CSF and blood serum. This rate is one of the key ones involved in the pathogenesis of MS, and is as a reliable biomarker of MS activity and advance, and therapeutic response of the pathosis, which helps to improve the diagnosis of the disease and to assess treatment efficacy.