Multiple Sclerosis: Brain Atrophy Linked to Leaked Hemoglobin Interview with:

Charles Bangham PhD ScD Division of Infectious Diseases, Department of Medicine Imperial College London London, UK

Dr. Charles Bangham

Charles Bangham PhD ScD
Division of Infectious Diseases, Department of Medicine
Imperial College London
London, UK What is the background for this study?

Response: Multiple sclerosis (MS) is a neurological disease of the brain and spinal cord, often beginning in the 20s and 30s which can cause both attacks (relapses) and disability over time. Most people with the condition have intermittent episodes of illness at first, but about two-thirds go on to develop a progressive form, known as secondary progressive MS. In this form, there is a gradual loss of nerve cells in the brain, resulting in shrinkage of the brain and progressive disability.

Neither the initiating cause of  Multiple sclerosis nor the reasons for this brain shrinkage are known, and existing treatments for the early phase of the condition are unsatisfactory. What are the main findings?

Response: We studied a well-characterized group of 140 patients with secondary progressive  Multiple sclerosis , who had serial MRI scans over 2 years to measure brain volume. What we found was that the brain shrinkage was associated with a leak of a protein, haemoglobin, out of red blood cells and into the serum. Haemoglobin’s normal function is to transport oxygen around the body, and it is normally contained within red blood cells. The presence of free haemoglobin in the serum, outside the red cells, suggests that some red blood cells are being destroyed in the circulation, a process called intravascular haemolysis.

This finding was a real surprise to us. But having identified the protein as haemoglobin, we realised that it could explain some long-standing observations that have been mysterious. Specifically, it could explain why active lesions in the brain in multiple sclerosis often have an abnormal amount of iron deposited around the blood vessels: haemoglobin contains iron. Also, it was found as long ago as the 1960s that red blood cells in patients with MS are abnormally fragile. We do not yet know the cause of this red cell fragility, or what leads to the destruction of red cells. What should readers take away from your report?

Response: These are early findings, and they need to be reproduced by other people. If others make the same findings, it may be possible to try new types of therapy, using agents that mop up excess haemoglobin in the blood.

In the meantime, it is important to emphasize that, although it is believed that iron deposition plays a role in the brain shrinkage in progressive multiple sclerosis, the amount deposited in the brain will not be affected by the amount that you eat. Therefore, it is important that patients with MS do not change their diet in any way. What recommendations do you have for future research as a result of this study?

1) Study the concentration of free serum haemoglobin in other cohorts of MS patients, especially those with secondary progressive multiple sclerosis,, and – where possible – measure brain volume in a longitudinal study.

2) Study potential causes of red blood cell fragility in multiple sclerosis,.

3) If other results agree, it may be indicated to test the impact of chelators of free haemoglobin in clinical trials. Thank you for your contribution to the community.


Alex Lewin, Shea Hamilton, Aviva Witkover, Paul Langford, Richard Nicholas, Jeremy Chataway, Charles R.M. Bangham. Free serum haemoglobin is associated with brain atrophy in secondary progressive multiple sclerosis. Wellcome Open Research, 2016; 1: 10 DOI: 10.12688/wellcomeopenres.9967.1

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on December 19, 2016 by Marie Benz MD FAAD