2004 International Rare Neuroimmunologic Disorders Symposium – a SUCCESS!
Chitra Krishnan, M.H.S.

The goal of the 2004 Rare Neuroimmunologic Disorders Symposium held at the Baltimore Hyatt from August 19th – 22nd was to bring together basic and clinical scientists to focus on molecular and neurobiological aspects of immune-mediated neurologic disorders. Associated with this scientific symposium was a parallel clinical symposium that involved patients, clinicians and other health care providers and focused on clinical aspects of patients with rare neuroimmunologic disorders. 

The rationale for the symposium was that various neuroimmunologic disorders share common pathologic processes and studying them as a group, rather than as individual disease entities, will lead to further understanding of the shared immunopathogenic processes and to the development of new therapies.  There are a variety of rare neuroimmunologic disorders that include the following: transverse myelitis (TM), neuromyelitis optica (NMO), stiff person syndrome (SPS), acute disseminated encephalomyelitis (ADEM), myasthenia gravis (MG), Rasmussen’s Syndrome (RS), paraneoplastic neurologic disorders (PND), poststreptococcal neurologic disorders, Guillain–Barre´ syndrome (GBS), Miller–Fisher Syndrome (MFS), tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM), polymyositis (PM), and inclusion body myositis (IBM). In each of these disorders, there is an acquired alteration in the innate or acquired immune system, resulting in dysfunction and/or cellular injury to cells within the nervous system. Although not a complete list, recent advances in each of these disorders make them instructive in understanding fundamental immunopathogenesis of the others.

The symposium was attended by over 300 scientists, clinicians, researchers, patients and their families! Scientists participating in this symposium are widely regarded as leaders in the field of neuroimmunology and a manuscript on the scientific symposium proceedings was published in The Journal of Neuroimmunology!

The Science Symposium was organized into five sessions:

(1) What are the trigger mechanisms for immune-mediated neural injury (molecular mimicry, superantigen (SA) stimulation, loss of regulatory immune cell function)?
(2) What are the T lymphocyte immune-effector mechanisms (deficient function of T-regulatory cells, dysfunction of cytotoxic T cells, and development of antigen-specific T cells)?

(3) What are the B lymphocyte immune effector mechanisms (autoantibody generation, function of B lymphocytes as antigen presenting cells, cytokine elaboration)?

(4) What are the mechanisms by which immune cells traffic into the central nervous system (CNS; matrix metalloproteinases, chemokine signaling, integrins)?

(5) What are the mechanisms of neural injury (apoptosis, excitotoxicity, cytokine-mediated neural injury, microglial activation, free-radical injury, immune complex deposition)?

What came from this discussion was an appreciation of shared pathophysiology involving different arms of the immune system and “cross-pollination” by researchers studying distinct neuroimmunologic disorders. We developed an understanding of shared and unique features in the pathogenesis of neuroimmunologic disorders. We identified common and unique targets for immunotherapy of related disorders based on similar pathophysiology of selected neuroimmunologic disorders. It also became clear that, in many of these neuroimmune disorders, multiple arms of the immune response are implicated (CD4, CD8, NK T cells, B cells, antibodies, complement, cytokines, macrophages, and microglia), and each may have differential effects depending on the locally affected tissue response to injury, as well as the heterogeneous subtypes and stages of the diseases. The development of more specific diagnostic tests and biomarkers of disease should allow better-targeted therapeutic interventions. Finally, we established collaborative research efforts as groups became aware of expertise, reagents, and protocols present in other research groups that will enhance our understanding of these rare but collectively not uncommon neuroimmunological diseases.

The clinical sessions were video taped and are available at The Transverse Myelitis Association website: http://www.myelitis.org/rnds2004/index.htm.  The clinical presentations may be watched as streaming video or you can order the DVDs using a form located on this web page.  These presentations represent one of the most comprehensive and thorough sources of information about the neuroimmunologic disorders, including extensive information about treatment strategies for all of the symptoms from these disorders.

Finally, and most importantly, a big THANK YOU to all of you who made this symposium a success! We are grateful for the support of Johns Hopkins University Department of Neurology, The Transverse Myelitis Association, the National Institutes of Neurological Disorders and Stroke (NINDS) and the Office of Rare Diseases (ORD) through an R13 mechanism, and the Christopher Reeve Paralysis Foundation.  Other sponsorship was provided (in alphabetical order) by the following: Barr Laboratories, Biogen Idec, Cody Unser First Step Foundation, Genentech, International Disabilities Coalition, Merck Research Laboratories, Novartis, Pfizer Inc, Serono, Teva Neuroscience and the World Health and Education Foundation.