The evaluation of the relationship between cytokines and hypothalamo-pituitary-adrenal axis, cortisol, acth and other melanocortines in multiple sclerosis patients with fatigue symptoms

Multiple Sclerosis (MS), is a chronic inflammatory demyelinating disorder affecting the white matter in the central nervous system (CNS), seen usually among young adults (20-40). Fatigue is an important symptom that affects a wide patient population. The reason for fatigue seen in MS patients is still not well-known. In this stduy, we aim to detect fatigue analysis in MS patients by using the Fatigue Severity Scale (FSS) and the Neurological Fatigue Index-Multiple Sclerosis (NFI-MS) and also to evaluate the relationship between serum cytokines and hypothalamo-pituitary-adrenal axis, cortisol, ACTH and other melanocortines in MS patients where we divided the patients into 2 groups (fatigue or non-fatigue) using FSS scale. 54 (29 women, 25 men) relapsing remiting multiple sclerosis patients diagnosed and followed by department of Neurology at Gaziantep University Faculty of Medicine and 26 (13 women, 13 men) healty people are involved in the study. 26 (48,1%) of the patients had fatigue symtoms and 28 (51,9 %) of Multiple Sclerosis (MS), is a chronic inflammatory demyelinating disorder affecting the white matter in the central nervous system (CNS), seen usually among young adults (20-40). Fatigue is an important symptom that affects a wide patient population. The reason for fatigue seen in MS patients is still not well-known. In this stduy, we aim to detect fatigue analysis in MS patients by using the Fatigue Severity Scale (FSS) and the Neurological Fatigue Index-Multiple Sclerosis (NFI-MS) and also to evaluate the relationship between serum cytokines and hypothalamo-pituitary-adrenal axis, cortisol, ACTH and other melanocortines in MS patients where we divided the patients into 2 groups (fatigue or non-fatigue) using FSS scale. 54 (29 women, 25 men) relapsing remiting multiple sclerosis patients diagnosed and followed by department of Neurology at Gaziantep University Faculty of Medicine and 26 (13 women, 13 men) healty people are involved in the study. 26 (48,1%) of the patients had fatigue symtoms and 28 (51,9 %) of them didn't have any fatigue symptom. The results of the study showed that there is a positive correlation between FSS and NFI-MS summary, NFI-MS 1, NFI-MS2, NFI-MS 3, NFI-MS4 (p value < 0.01 for both groups). There weren't any difference in the IL-1β and TNF-α (proinflammatory cytokines) levels both in the patient and control groups (p=0.09, p=0.70). As an antiinflammatory cytokine, IL-35 level were significantly higher in MS patients (p<0.01). But IL-35 levels were not different concerning to fatigue and non-fatigue groups (p=0.46). ACTH, cortisol, α-MSH were significantly higher in MS group compared to control group (respectfully p=0.02, p<0.01, p<0.01) but a relationship with fatigue couldn't be found. Corticotropin-like intermediate lobe peptide (CLIP) levels in MS were evaluated for the first time in our study and significantly lower in patients compared to control group (p<0.01). When investigating the relationship between HPA axis hormones and cytokine levels; a positive correlation was observed only between TNF- α and γ-MSH (p<0.01) and IL-1β and β-MSH. , In conclusion, NFI-MS summary is as sensitive as FSS when evaluating fatigue in MS patients. HPA axis is hyperactive in MS patients but a relationship between fatigue and cytokine levels couldn't be established. The fact that the higher evaluation of IL-35 in MS patients could be an important sign in the disease patophysiology and could be taken account while concerning new therapies. Key words: Multiple Sclerosis, Fatigue, Hypotalamo-Pituiary-Adrenal Axis them didn't have any fatigue symptom. The results of the study showed that there is a positive correlation between FSS and NFI-MS summary, NFI-MS 1, NFI-MS2, NFI-MS 3, NFI-MS4 (p value < 0.01 for both groups). There weren't any difference in the IL-1β and TNF-α (proinflammatory cytokines) levels both in the patient and control groups (p=0.09, p=0.70). As an antiinflammatory cytokine, IL-35 level were significantly higher in MS patients (p<0.01). But IL-35 levels were not different concerning to fatigue and non-fatigue groups (p=0.46). ACTH, cortisol, α-MSH were significantly higher in MS group compared to control group (respectfully p=0.02, p<0.01, p<0.01) but a relationship with fatigue couldn't be found. Corticotropin-like intermediate lobe peptide (CLIP) levels in MS were evaluated for the first time in our study and significantly lower in patients compared to control group (p<0.01). When investigating the relationship between HPA axis hormones and cytokine levels; a positive correlation was observed only between TNF- α and γ-MSH (p<0.01) and IL-1β and β-MSH. In conclusion, NFI-MS summary is as sensitive as FSS when evaluating fatigue in MS patients. HPA axis is hyperactive in MS patients but a relationship between fatigue and cytokine levels couldn't be established. The fact that the higher evaluation of IL-35 in MS patients could be an important sign in the disease patophysiology and could be taken account while concerning new therapies. Key words: Multiple Sclerosis, Fatigue, Hypotalamo-Pituiary-Adrenal Axis