Multiple sclerosis patients who become pregnant experience a significant decrease in relapses that may be mediated by a shift in immune responses from T helper 1 to T helper 2. Animal models of
multiple sclerosis have shown that the pregnancy
hormone,
estriol, can ameliorate disease and can cause an immune shift. We treated nonpregnant female
multiple sclerosis patients with the pregnancy
hormone estriol in an attempt to recapitulate the beneficial effect of pregnancy. As compared with pretreatment baseline, relapsing remitting patients treated with oral
estriol (8 mg/day) demonstrated significant decreases in delayed type
hypersensitivity responses to
tetanus,
interferon-gamma levels in peripheral blood mononuclear cells, and
gadolinium enhancing lesion numbers and volumes on monthly cerebral magnetic resonance images. When
estriol treatment was stopped, enhancing lesions increased to pretreatment levels. When
estriol treatment was reinstituted, enhancing lesions again were significantly decreased. Based on these results, a larger, placebo-controlled trial of
estriol is warranted in women with
relapsing remitting multiple sclerosis. This novel treatment strategy of using pregnancy doses of
estriol in
multiple sclerosis has relevance to other
autoimmune diseases that also improve during pregnancy.