MS and the IMMune system
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Introduction
MS is an autoimmune disease, it’s not a disease that you catch, it occurs when the body’s immune system attacks its own tissues in the mistaken belief that it’s a foreign object. In MS the immune system targets a material called myelin. Myelin is a protective protein that surrounds the nerves in the central nervous system (CNS). The CNS is the collective term used for the brain and spinal cord. When the myelin is damaged it affects the ability of nerves to transmit messages, this can mean that they are less reliable or that the messages do not get through at all, which causes the symptoms of MS. Symptoms can include muscle weakness, pain, loss or disordered sensory perception, and sometimes problems with memory and cognitive functions.
Why is it called multiple sclerosis?
Sclerosis comes from the Greek work ‘skleros’ meaning hard. In MS, hard areas called plaques or lesions develop around the damaged nerves. The multiple refers to the fact that many different areas of the CNS will have damaged myelin and therefore lesions. These lesions can be seen in an MRI scan of the brain. This is one of the tests that doctors use when diagnosing MS. |
As mentioned above MS is a disease of the CNS involving the immune system. The CNS is an immunoprivileged site and normally there are few immune cells present. In MS, this privilege is lost and immune cells enter the brain triggered by an, as yet unknown event. This leads to inflammation and activation of microglia, which destroy the myelin around the nerves in the region. Other immune cells, known as lymphocytes enter the area and antibody-producing B cells also arrive leading to further damage. The damage to myelin is known as demyelination and if prolonged this can lead to the axons of the nerves being damaged resulting in the loss of neurons. If however, the damage and inflammation is short-lived the myelin can be repaired by oligodendrocytes (a type of brain cell that produces myelin).
How does this tie into out talk?Professor Sandra Amor studies the pathological process of MS. She is interested in what triggers the immune system to attack the CNS and what are the mechanisms underlying demyelination and neurodegenerative in MS.
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What are we knitting?
We're going to knit a section of brain showing what changes occur during MS. There will be normal tissue, an area of inflammation and demyelination, and the scar that is left once all the myelin is removed.
Patterns
For each pattern in addition to wool, you will need a small amount of stuffing and a darning needle.
Myelin/Damaged myelinOligodendrocyteMicrogliaFoamy MacrophagesAstrocytesA key to the abbreviations used in the patterns can be found
here.
Click
here to download a pdf document containing all the patterns.
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Myelin/Damaged myelin
Myelin is a protective sheet that is wrapped around the axons of nerves to insulate them. It is produced by oligodendrocytes and it is made up of fats and proteins. It is the proteins within myelin that are targeted by the immune system in MS.
Like in the brain we’re going to be wrapping myelin sheets around our neurons, so we need lots of these little rectangles. We're going to be knitting them in blue.
Myelin
Cast on 25 stitches
R1: k1, p1 repeat to end of row
R2: p1, k1 repeat to end of row
Repeat R1 and 2 until you have a rectangle between 15 and 20 cm
Cast off
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Damaged Myelin
This is made using a square lace pattern
Cast on 17 stitches
R1: Knit
R2: Knit
R3: k1,* ssk, yo 2 times, dbl dec, yo 2 times, k2tog, k1; rep from * to end of row
R4: k1 *(k2, p1) twice, K4; repeat from * to last 6 sts, (p1, k2) twice
R5: Knit
R6: Knit
Repeat R3-6 until to have a rectangle between 15 and 20 cm
Cast off
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Oligodendrocyte
Oligodendrocytes are specialised cells that make myelin. Processes from the oligodendrocyte extend to many neurons wrapping a layer of myelin around them.
Our knitted oligodendrocytes will only be wrapped around two neurons for simplicity. It consist of two sheets of myelin attached to a cell body. You will need one colour of wool to knit these cells. As these cells produce the myelin we're going to be knitting them in blue like the myelin sheets.
Cast on 35 stitches
R1: k1, p1 repeat to end of row
R2: p1, k1 repeat to end of row
Repeat R1 and 2 until you have a rectangle between 6-10 cm
Cast off 16 stitches, knit to end of row
Cast off stitches until you are left with 3 stitches on your needle.
Either swop to double pointed needles or using the single needle method, knit 2 cm of i-cord.
We’re now going to knit the body of the cell.
If using
double pointed needles split the 3 stitches between needles and join in round, before knitting the follow pattern in round. Stuff the resulting ball as you knit, at the end place all 3 stitches on 1 needle to knit i-cord.
R1: 3 x M1 (6 stitches)
R2 and all subsequent even rows: knit
R3: 3 x [k1, M1] (9 stitches)
R5: 3 x [k2, M1] (12 stitches)
R7: 3 x [k3, M1] (15 stitches)
R9: 3 x [k4, M1] (18 stitches)
R11: 3 x [k5, M1] (21 stitches)
R12-14: knit row
R15:3 x [k5, k2tog] (18 stitches)
R17: 3 x [k4, k2tog] (15 stitches)
R19: 3 x [k3, k2tog] (12 stitches)
R21: 3 x [k2, k2 tog] (9 stitches)
R23: 3 x [k1, k2tog] (6 stitches)
R25: 3 x k2tog (3 stitches)
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R27 onwards Knit 2 cm of i-cord either on single or double pointed needles.
Once you have 2 cm of i-cord you want to make the second panel of myelin.
Cast on 16 stitches at the end of your i-cord, turn
Knit row, cast on another 16 stitches at the end to give you 35 stitches in total.
R1: k1, p1 repeat to end of row
R2: p1, k1 repeat to end of row
Repeat R1 and 2 until you have a rectangle between 6-10 cm
Cast off.
If you used single pointed needles to make your oligodendrocyte you will need to sew up the central body of your cell and stuff it.
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Microglia
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Microglia are the macrophage of the brain. These special immune cells, unique to the brain, can detect damaged or unhealthy neurons as well as detecting foreign invades (bacteria and viruses). The microglia eat the foreign invaders and damaged neurons in a process known as phagocytosis. They can also display the chewed up parts on their cell surface to signal for help from other immune cells.
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For this pattern you'll need one colour of wool, we're using purple.
Cell Body
Cast on 6
R1: 6xM1 (12 stitches)
R2: Purl to end
R3: 12xM1 (24 stitches)
R4: P to end
R5-18: St st, starting on K row
R19: 6 x [K2 tog, K2] (18 stitches)
R20: P
R21: 6 x [K2 tog, K1] (12 stitches)
R22: P
R23: 6 x [K2 tog] (=6 st)
R24: P to end
Cast off: Cut wool with 15-20cm/6-8” length left. Use darning needle to bring wool through remaining 6st. Slide off needle.
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To assemble the body of your microglia, pull the loop of cast off stitches tight and stitch closed. Sew together the sides of the body, stuff and then stitch over the top.
To make the processes of a microglia cell cut 6 equal lengths of wool (about 10-15cm). With darning needle, pull strands through a few stitches on the cell body so that you have 12 free ends hanging out. Divide into 3x2 strands & start plaiting. Make the process branch by separating out & tying off strands at intervals, continuing to plait with remaining strands. Knot the end. Repeat many times all over the cell body.
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Foamy Macrophages
A foamy macrophage that has eaten lots of myelin by Zoe Jorro |
Foamy macrophages are microglia that have been activated and are full of lipids as result of all the myelin that they have eaten (phagocytosed). They are a sign of inflammation and demyelination.
For this pattern you'll need one colour of wool and then some embroidery thread or wool in a contrasting colour. We're making using pink/red wool for the cell body and base. We're using blue wool to create the lipid dots inside the cells. This is to show that the lipids inside them used to be myelin.
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Base
Cast on 7 stitches
R1: knit row
R2: knit row, M1 at the beginning and end of row (2 x M1) (9 stitches)
R3-5: knit row
R6: knit row, 6 x M1 (15 stitches)
R7-10: knit row
R11: knit row, 8 xM1 (23 stitches)
R12-15: knit row
R16: knit row, 7 x M1 (30 stitches)
R17-22: knit row
R23: 10 x [k2tog, k1] (20 stitches)
R24-31: knit row
R32: 6 x [k2tog, k1], k2tog (13 stitches)
R33-36: knit row
R37: k1, 6 x k2tog (7 stitches)
R38-42: knit row
Cast off
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Cell bodyCast on 18 stitches, leave long tail
R1-25: knit
Cast off, leave long tail
With the wrong side of your body facing upwards, thread your long cast on yarn tail on to your sewing needle, complete a running stitch gather all the way around the edge of your square, pull yarn gently to gather your body into a round shape, push some toy stuffing inside and shape before tying off your yarn.
To put your foamy macrophage sew the body of your macrophage onto the base. Using wool or a matching thread sew the base up around the body to create a ruffled effect.
Finally in a contrasting thread embroider circles all over the macrophage to create the vesicles of lipids that the macrophage is full of.
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Astrocytes
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Astrocytes are star-shaped brain cells that hold neurons in place, get nutrients to them, and like microglia digest parts of dead neurons. Astrocytes are the “housekeepers” of the brain. In MS they are responsible for forming the hard scars that form around the damaged neurons. More recent studies suggest that they may also have a role in the immune system’s attack on the myelin, as well as promoting oligodendrocytes to repair myelin.
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You will need one colour of wool to knit astrocytes, we're using yellow.
Cell body
Cast on 6
R1: 6xM1 (12 stitches)
R2: Purl to end
R3: 12xM1 (24 stitches)
R4: P to end
R5-18: St st, starting on K row
R19: 6 x [K2 tog, K2] (18 stitches)
R20: P
R21: 6 x [K2 tog, K1] (12 stitches)
R22: P
R23: 6 x [K2 tog] (=6 st)
R24: P to end
Cast off: Cut wool with 15-20cm/6-8” length left. Use darning needle to bring wool through
remaining 6st. Slide off needle.
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To assemble the body of your astrocyte, pull the loop of cast off stitches tight and stitch closed. Sew together the sides of the body, stuff and then stitch over the top.
To make the processes of the astrocyte knit a 6-10 cm 3 stitch i-cord in the same colour wool. With a darning needle, sew in place on to the body. Repeat many times all over the cell body to create a star shaped cell.
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