Cholesterol-lowering statins possess anti-inflammatory activity that might be useful for treatment of MS

SS Zamvil, L Steinman - Neurology, 2002 - AAN Enterprises
Neurology, 2002AAN Enterprises
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins)
reduce atherogenesis and cardiovascular morbidity. These effects are attributed to alteration
in cholesterol metabolism and reduction in low-density lipoprotein (LDL) formation. Now
there is evidence that statins have immunomodulatory activities that could be beneficial in
treatment of various inflammatory conditions. In 1995, pravastatin was reported to reduce
hemodynamically significant rejection episodes and increase survival in cardiac transplant …
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) reduce atherogenesis and cardiovascular morbidity. These effects are attributed to alteration in cholesterol metabolism and reduction in low-density lipoprotein (LDL) formation. Now there is evidence that statins have immunomodulatory activities that could be beneficial in treatment of various inflammatory conditions. In 1995, pravastatin was reported to reduce hemodynamically significant rejection episodes and increase survival in cardiac transplant recipients, independent of its cholesterollowering effects. 1 This observation prompted subsequent in vitro studies that demonstrated that statins interfered with production of several important proinflammatory mediators. 2, 3 Of relevance to treatment of CNS inflammatory conditions such as MS, lovastatin suppressed production of inducible nitric oxide synthase (iNOS) and secretion of tumor necrosis factor-α (TNFα) by interferon-γ (IFNγ)-activated astrocytes and microglia. 2 iNOS and TNFα may play important roles in the inflammatory process of MS. 4 Lovastatin partially suppressed acute experimental autoimmune encephalomyelitis (EAE) in rats. 5 Central in importance to activation of proinflammatory CD4 T cells, statins inhibited IFNγ-inducible major histocompatibility complex (MHC) class II upregulation on certain antigenpresenting cells via inhibition of IFNγ-inducible transcription of the MHC class II transactivator (CIITA), 6 a protein that directs MHC class II expression. MHC class II genes are associated with susceptibility to MS, and induction of MHC class II in the CNS during the pathogenesis of MS is at the center of a destructive cascade of inflammatory events targeting the white matter and the underlying axon in this disease.
American Academy of Neurology