{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T07:36:02Z","timestamp":1781249762443,"version":"3.54.1"},"reference-count":30,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2011,9,9]],"date-time":"2011-09-09T00:00:00Z","timestamp":1315526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2012,3]]},"abstract":"<jats:p>Background: Long-term therapy with natalizumab increases the risk of progressive multifocal leukoencephalopathy (PML).<\/jats:p>\n                  <jats:p>Objectives: We present a patient study through therapy, the diagnosis of PML (after 29 infusions), plasma exchange (PE) and development of immune reconstitution inflammatory syndrome (IRIS).<\/jats:p>\n                  <jats:p>Methods: Routine diagnostics, magnetic resonance imaging (MRI), immunological status (flow cytometry, T-cell migration assays and T-cell repertoire analysis), and brain biopsy with immunohistological analysis.<\/jats:p>\n                  <jats:p>Results: CD49d decreased after 12 months of treatment. At PML diagnosis, CD49d expression and migratory capacity of T cells was low and peripheral T-cell receptor (TCR) complexity showed severe perturbations. The distribution of peripheral monocytes changed from CCR5+ to CCR7+. After PE some changes reverted: CD49d increased and overshot earliest levels, migratory capacities of T cells recovered and peripheral TCR complexity increased. With no clinical, routine laboratory or cerebrospinal fluid (CSF) changes, MRI 2 months after PE demonstrated progressive lesion development. Brain histopathology confirmed the presence of infiltrates indicative of IRIS without clinical signs, immunologically accompanied by CCR7\/CCR5 recovery of peripheral monocytes.<\/jats:p>\n                  <jats:p>Conclusion: Natalizumab-associated immunological changes accompanying PML were reversible after PE; IRIS can occur very late, remain asymptomatic and be elusive to CSF analysis. Our study may provide insights into the changes under treatment with natalizumab associated with JC virus control.<\/jats:p>","DOI":"10.1177\/1352458511421919","type":"journal-article","created":{"date-parts":[[2011,9,9]],"date-time":"2011-09-09T23:11:17Z","timestamp":1315609877000},"page":"335-344","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["Immunological and clinical consequences of treating a patient with natalizumab"],"prefix":"10.1177","volume":"18","author":[{"given":"Nicholas","family":"Schwab","sequence":"first","affiliation":[{"name":"Department of Neurology - Inflammatory Disorders of the Nervous System and Neurooncology, University of M\u00fcnster, M\u00fcnster, Germany"},{"name":"Department of Neurology, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin 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