Quantitative T2' imaging in patients with clinically isolated syndrome

OBJECTIVE

The T2' imaging has been shown to be sensitive to oxygen saturation changes in normal appearing white and grey matter (NAWM, NAGM) in patients with relapsing-remitting multiple sclerosis (RRMS). We aimed to explore the presence and extent of T2' changes in patients with a clinically isolated syndrome (CIS) and a possible association of T2' with conventional magnetic resonance imaging and clinical outcomes.

MATERIAL AND METHODS

Quantitative T2- and T2*-weighted images were acquired in 32 treatment-naive patients with a CIS within 3 months of presentation and 15 age-matched healthy controls (HC). Quantitative T2' values were determined in six regions of interest (ROIs).

RESULTS

The T2' values in CIS did not differ significantly from those in HC. Among patients, T2' values correlated positively with the T2 lesion volume (T2LV, r = 0.34, P < 0.05). T2' values of the frontal NAWM correlated with the T2LV (r = 0.35, P < 0.05) and T2 lesion count (r = 0.4, P = 0.02).

CONCLUSION

As opposed to RRMS, patients with CIS did not show T2' alterations compared to HC. However, the association between the T2LV and higher T2' values suggests that T2' reflects disease evolution. In CIS metabolic changes might be masked by compensatory mechanisms and become overt when disease progresses as has been shown for RRMS patients.

Modelling the transfer of 14C from the atmosphere to grass: a case study in a grass field near AREVA-NC La Hague

Radioactive (14)C is formed as a by-product of nuclear power generation and from operation of nuclear fuel reprocessing plants like AREVA-NC La Hague (North France), which releases about 15 TBq per year of (14)C into the atmosphere. Since the autumn of 2006, (14)C activity concentrations in samples from the terrestrial environment (air, grass and soil) have been monitored monthly on grassland 2 km downwind of the reprocessing plant. The monitoring data provides an opportunity to validate radioecology models used to assess (14)C transfer to grassland ecosystems. This article compares and discusses the ability of two different models to reproduce the observed temporal variability in grass (14)C activity in the vicinity of AREVA-NC La Hague. These two models are the TOCATTA model which is specifically designed for modelling transfer of (14)C and tritium in the terrestrial environment, and PaSim, a pasture model for simulating grassland carbon and nitrogen cycling. Both TOCATTA and PaSim tend to under-estimate the magnitude of observed peaks in grass (14)C activity, although they reproduce the general trends. PaSim simulates (14)C activities in substrate and structural pools of the plant. We define a mean turn-over time for (14)C within the plant, which is based on both experimental data and the frequency of cuts. An adapted PaSim result is presented using the 15 and 20 day moving average results for the (14)C activity in the substrate pool, which shows a good match to the observations. This model reduces the Root Mean Square Error (RMSE) by nearly 40% in comparison to TOCATTA.

Treatment of steroid-unresponsive optic neuritis with plasma exchange

OBJECTIVES

Until now, the significance of plasma exchange (PE) as a treatment for steroid-unresponsive optic neuritis (ON) is still unclear because placebo-controlled and larger studies are missing. We report our experience with 23 patients treated by PE due to steroid-unresponsive ON.

MATERIALS AND METHODS

Patients were admitted to the University Medical Center Hamburg-Eppendorf between 2006 and 2010 with a visual acuity of <50% on the affected eye following steroid treatment. Ten patients suffered from RR-MS, one from neuromyelitis optica, and 12 patients developed ON as a clinically isolated syndrome. Routinely, they were treated with five cycles of PE. Visual acuity was measured before and directly after PE and during follow-up (first follow-up after 50 days, second follow-up after 174 days).

RESULTS

Altogether, 70% of our patients improved after PE, 69% of them showed a good or very good response to therapy. Patients who improved well after PE (n = 11) showed a mean visual acuity of 16% before PE compared to 45% immediately after PE and 60% at the first follow-up. No serious adverse events occurred.

CONCLUSIONS

To our knowledge, our study is the largest case series of patients with steroid-unresponsive ON treated with PE. Based on our experience, we conclude that PE is an important treatment option for patients with steroid-unresponsive ON although placebo-controlled studies are missing until now.

Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European Group for Blood and Marrow Transplantation

In 1997, the first consensus guidelines for haematopoietic SCT (HSCT) in autoimmune diseases (ADs) were published, while an international coordinated clinical programme was launched. These guidelines provided broad principles for the field over the following decade and were accompanied by comprehensive data collection in the European Group for Blood and Marrow Transplantation (EBMT) AD Registry. Subsequently, retrospective analyses and prospective phase I/II studies generated evidence to support the feasibility, safety and efficacy of HSCT in several types of severe, treatment-resistant ADs, which became the basis for larger-scale phase II and III studies. In parallel, there has also been an era of immense progress in biological therapy in ADs. The aim of this document is to provide revised and updated guidelines for both the current application and future development of HSCT in ADs in relation to the benefits, risks and health economic considerations of other modern treatments. Patient safety considerations are central to guidance on patient selection and HSCT procedural aspects within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and EBMT accredited centres. A need for prospective interventional and non-interventional studies, where feasible, along with systematic data reporting, in accordance with EBMT policies and procedures, is emphasized.

Anti-CD47 antibodies promote phagocytosis and inhibit the growth of human myeloma cells

Multiple myeloma is a plasma cell neoplasm residing in bone marrow. Despite advances in myeloma therapies, novel therapies are required to improve patient outcomes. CD47 is highly expressed on myeloma cells and a potential therapeutic candidate for myeloma therapies. Flow cytometric analysis of patient bone marrow cells revealed that myeloma cells overexpress CD47 when compared with non-myeloma cells in 73% of patients (27/37). CD47 expression protects cells from phagocytosis by transmitting an inhibitory signal to macrophages. Here we show that blocking CD47 with an anti-CD47 monoclonal antibody increased phagocytosis of myeloma cells in vitro. In xenotransplantation models, anti-CD47 antibodies inhibited the growth of RPMI 8226 myeloma cells and led to tumor regression (42/57 mice), implicating the eradication of myeloma-initiating cells. Moreover, anti-CD47 antibodies retarded the growth of patient myeloma cells and alleviated bone resorption in human bone-bearing mice. Irradiation of mice before myeloma cell xenotransplantation abolished the therapeutic efficacy of anti-CD47 antibodies delivered 2 weeks after radiation, and coincided with a reduction of myelomonocytic cells in spleen, bone marrow and liver. These results are consistent with the hypothesis that anti-CD47 blocking antibodies inhibit myeloma growth, in part, by increasing phagocytosis of myeloma cells.

A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper

Background:

Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage.

Objectives:

An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments.

Conclusions:

Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.

Results of screening for intracranial aneurysms in patients with coarctation of the aorta

BACKGROUND AND PURPOSE

IAs are found in 2.3% of adults; the mean age at detection is 52 years. Prevalence is <0.5% in young adults. Early studies suggest that 10%-50% of patients with aortic coarctation have IAs. Screening recommendations are variable. We sought to examine the prevalence of IAs through screening with MRA.

MATERIALS AND METHODS

Consecutive patients older than 16 years of age with coarctation undergoing brain MRA between May 1999 and October 2007 were included. MRA was performed by using a 1.5T scanner with a 3D time-of-flight protocol; simultaneous MR imaging was performed of the heart and aorta. Cerebral MRAs were double-reported by a neuroradiologist. Statistics are described as mean ± SD and median ± range. Continuous variables were compared by using Student t tests and Mann-Whitney U tests (categoric variables, by using the Fisher exact test).

RESULTS

One hundred seventeen MRAs were double-reported. The median age was 29 ± 11 years (range, 16-59 years). IAs were found in 12 patients (10.3%). The mean diameter of IAs was 3.9 mm (range, 2.0-8.0 mm). Patients with aneurysms were older (median, 37 years; range, 16-50 years) than those without (median, 23 years; range, 16-59 years; Z = -2.01, P = .04). Hypertension was more common in those with IAs (IA 83% versus no IA 43%, P = .01). There was no association between ascending aortopathy, bicuspid aortic valves, and IAs.

CONCLUSIONS

Patients with coarctation have a higher prevalence of IAs, occurring at an earlier age than in population studies. Whether routine screening is appropriate for this group of patients is unclear. Hypertension is likely to be an important pathophysiologic factor.

Incidence and prevalence of epilepsy among older U.S. Medicare beneficiaries

OBJECTIVE

To determine the prevalence and incidence of epilepsy among U.S. Medicare beneficiaries aged 65 years old and over, and to compare rates across demographic groups.

METHODS

We performed a retrospective analysis of Medicare administrative claims for 2001-2005, defining prevalent cases as persons with ≥1 claim with diagnosis code 345.xx (epilepsy) or 2 or more with diagnosis code 780.3x (convulsion) ≥1 month apart, and incident cases as prevalent cases with 2 years immediately before diagnosis without such claims. Prevalence and incidence rates were calculated for the years 2003-2005 using denominators estimated from a 5% random sample of Medicare beneficiaries. Results were correlated with gender, age, and race.

RESULTS

We identified 282,661 per year on average during 2001-2005 (a total of 704,243 unique cases overall), and 62,182 incident cases per year on average during 2003-2005. Average annual prevalence and incidence rates were 10.8/1,000 and 2.4/1,000. Overall, rates were higher for black beneficiaries (prevalence 18.7/1,000, incidence 4.1/1,000), and lower for Asians (5.5/1,000, 1.6/1,000) and Native Americans (7.7/1,000, 1.1/1,000) than for white beneficiaries (10.2/1,000, 2.3/1,000). Incidence rates were slightly higher for women than for men, and increased with age for all gender and race groups.

CONCLUSIONS

Epilepsy is a significant public health problem among Medicare beneficiaries. Efforts are necessary to target groups at higher risk, such as minorities or the very old, and to provide the care necessary to reduce the negative effects of epilepsy on quality of life.

No proinflammatory signature in CD34+ hematopoietic progenitor cells in multiple sclerosis patients

Autologous hematopoietic stem cell transplantation (aHSCT) has been used as a therapeutic approach in multiple sclerosis (MS). However, it is still unclear if the immune system that emerges from autologous CD34+ hematopoietic progenitor cells (HPC) of MS patients is pre-conditioned to re-develop the proinflammatory phenotype. The objective of this article is to compare the whole genome gene and microRNA expression signature in CD34+ HPC of MS patients and healthy donors (HD). CD34+ HPC were isolated from peripheral blood of eight MS patients and five HD and analyzed by whole genome gene expression and microRNA expression microarray. Among the differentially expressed genes (DEGs) only TNNT1 reached statistical significance (logFC=3.1, p<0.01). The microRNA expression was not significantly different between MS patients and HD. We did not find significant alterations of gene expression or microRNA profiles in CD34+ HPCs of MS patients. Our results support the use of aHSCT for treatment of MS.

[Relationships between different parameters for the evaluation of the energy balance and the differential cell count in milk from cows with healthy udders]

OBJECTIVE

The aim of the study was to investigate possible associations between the energy balance of dairy cows and the differential cell count in milk. Such associations could be used for the assessment of the mastitis risk due to metabolic stress.

MATERIAL AND METHODS

In 15 red Holstein cows, samples were collected in the 2nd, 6th and 12th week post partum. To reflect the energy balance of the cows, the following parameters were evaluated: β-hydroxybutyric acid (BHB) in serum, fat-protein-ratio (FEQ) in milk at times of examination and difference of the body condition score (DBCS) between times of examination. The overall somatic cell count (SCC) and the differential cell count were determined. Measuring the differential cell count, comprising fractions of lymphocytes (LYM), macrophages (MAK), polymorphonuclear leucocytes (PMN) and epithelial cells (EPI), was carried out using indirect immune fluorescent staining in combination with propidium iodide staining. The interrelationships between parameters of energy status and milk cells were statistically assessed using correlation analysis. Data which were not normally distributed were transformed using logarithms (log). A mixed model was used to test the associations between milk cell parameters and the parameters of energy balance, using the animal as a random effect.

RESULTS

There was a significant correlation between FEQ and SCClog as well as between DBCS and SCClog (FEQ: r=0.459, p<0.01; DBCS: r=-0.301, p<0.05). Similarly directed correlations were found between both parameters of energy balance and LYMlog (FEQ: r=0.530, p<0.01; DBCS: r=-0.318, p<0.05) and MAKlog (FEQ: r=0.520, p<0.01; DBCS: r=-0.299, p<0.05). Univariate analysis provided the highest correlations between LYMlog and FEQ and between MAKlog and FEQ (LYMlog: F=17.36, p<0.01; MAKlog: F=14.46, p<0.01).

CONCLUSION

The results of the study indicate associations between energy balance and the differential cell count in milk.

Zusammenhänge zwischen verschiedenen Parametern zur Beurteilung der Energiebilanz und Zellsubpopulationen in der Milch eutergesunder Kühe

Ziel der Arbeit war festzustellen, ob bei eutergesunden Kühen Zusammenhänge zwischen verschiedenen Parametern zur Beurteilung der Energiebilanz der Tiere und dem Differenzialzellbild in der Milch bestehen. Diese Zusammenhänge könnten nach weiteren Untersuchungen zur Beurteilung des stoffwechselbedingten Mastitisrisikos dienen.Material und Methoden: Bei 15 Red-Holstein-Kühen wurden in der 2., 6. und 12. Woche post partum die β-Hydroxy-Buttersäure-(BHBA-)Konzentration im Blutserum, der Fett-Eiweiß-Quotient (FEQ) in der Milch sowie die Körperkonditionsveränderungen (DBCS) im Zeitraum zwischen Kalbung und erster Probenentnahme bzw. zwischen den weiteren Probenentnahmezeitpunkten bestimmt. Ferner erfolgte mittels indirekter Immunfluoreszenzfärbung in Kombination mit einer Propidiumjodidfärbung eine Messung des Differenzialzellbildes der Milch (Lymphozyten [LYM], Makrophagen [MAK], polymorphkernige Granulozyten [PMN] und Epithelzellen [EPI]). Zur statistischen Analyse wurden Korrelationen zwischen allen Zellparametern und den Parametern zur Beurteilung der Energiebilanz berechnet. Lag keine Normalverteilung der Daten vor, erfolgte eine Logarithmierung (log). Zur weiteren Bearbeitung wurde in einem Mixed Model die Abhängigkeit der Zellparameter von den Parametern zur Beurteilung der Energiebilanz geprüft, wobei der Parameter Tier als zufälliger Effekt fungierte. Ergebnisse: Es bestanden signifikante Korrelationen zwischen FEQ und SCClog sowie zwischen DBCS und SCClog (FEQ: r = 0,459, p < 0,01; DBCS: r = –0,301, p < 0,05). Gleichgerichtete Korrelationen ergaben sich für die beiden Parameter zur Beurteilung der Energiebilanz und LYMlog (FEQ: r = 0,530, p < 0,01; DBCS: r = –0,318, p < 0,05) sowie MAKlog (FEQ: r = 0,520, p < 0,01; DBCS: r = –0,299, p < 0,05). LYMlog und MAKlog wiesen im Mixed Model univariat die höchste Abhängigkeit vom FEQ auf (LYMlog: F = 17,36, p < 0,01; MAKlog: F = 14,46, p < 0,01). Schlussfolgerung: Die Ergebnisse weisen auf Zusammenhänge zwischen Energiebilanz und dem Differenzialzellbild der Milch hin.

[Effects of dry period length on milk production, health, fertility, and quality of colostrum in dairy cows. Invited review]

In terms of milk production, the dry period (DP) is a non-productive time. In addition, the risk of mastitis increases when cows with daily milk yield >12.5kg are dried off, which is often the case when the DP is set to 55-60 days. References on the positive effects of a shortened DP on the metabolic health at the start of lactation and the subsequent reproductive performance were the motive of this review. Completely foregoing or shortening the DP produces a decrease in milk yield during the following lactation. This decrease is particularly pronounced for cows at the beginning of the second lactation. It is thought that this may be due in part to different involution and proliferation processes of the mammary glands in primiparous and multiparous animals. The majority of the scientific papers suggest that shortening the DP has a positive rather than a negative effect on udder health. The quality of the colostrum is also unaffected; but if there is no drying off, the colostrum will be diluted. When considered overall, the literature, with support from metabolic profile studies, appears to favour a reduced impact on energy metabolism in early lactation in circumstances when the DP is shortened or waived. Clear positive effects on parameters relevant to energy metabolism however only apply to multiparous animals, and other factors, such as milking frequency before and after calving, exert an influence. Positive effects of shortening the DP on the reproductive performance were shown in several studies. Time from calving to first ovulation as well as indicators for assessing the success of artificial insemination and reproductive performance showed better results in animals with no or shortened drying off periods. Again, this only applied to multiparous animals. Overall, there is no single clear answer to the question of an optimal length of the DP, but conversely it is abundantly clear that a dry period of 55-60 days is not necessary in all cases and does not make sense under certain circumstances. Based on the study findings from recent years, the determination of dry periods should be used as a farm-specific and needs-oriented applied management decision.

Early life: gut microbiota and immune development in infancy

The immune system of infants is actively downregulated during pregnancy and therefore the first months of life represent a period of heightened susceptibility to infection. After birth, there is an age-dependent maturation of the immune system. Exposure to environmental microbial components is suggested to play an important role in the maturation process. The gastrointestinal tract is the major site of interaction between the host immune system and microorganisms, both commensal as well as potentially pathogenic. It is well established that the mammalian immune system is designed to help protect the host from invading microorganisms and other danger signals. However, recent research is emerging in the field of host-microbe interactions showing that commensal microorganisms (microbiota) are most likely one of the drivers of immune development and, in turn the immune system shapes the composition of the microbiota. Specific early microbial exposure of the gut is thought to dramatically reduce the incidence of inflammatory, autoimmune and atopic diseases further fuelling the scientific view that microbial colonisation plays an important role in regulating and fine-tuning the immune system throughout life. Therefore, the use of pre-, pro- and synbiotics may result in a beneficial microbiota composition that might have a pivotal role on the prevention of several important diseases that develop in early life such as necrotizing enterocolitis and atopic eczema.

Intrathecal effects of daclizumab treatment of multiple sclerosis

OBJECTIVES

We previously reported that daclizumab, a humanized monoclonal antibody against CD25, reduced contrast-enhancing lesions (CEL) in patients with multiple sclerosis (MS) who were suboptimal responders to interferon-β and that this response correlated with expansion of CD56(bright) NK cells. These data have been reproduced in a placebo-controlled multicenter trial (CHOICE study). The current study investigates whether daclizumab monotherapy reduces CEL in untreated patients with relapsing-remitting MS (RRMS) and the effects of daclizumab on the intrathecal immune system.

METHODS

Sixteen patients with RRMS with high inflammatory activity were enrolled in an open-label, baseline-vs-treatment, phase II trial of daclizumab monotherapy for 54 weeks and followed by serial clinical and MRI examinations and immunologic biomarkers measured in the whole blood and CSF.

RESULTS

The trial achieved predefined outcomes. There was an 87.7% reduction in brain CEL (primary) and improvements in Multiple Sclerosis Functional Composite (secondary), Scripps Neurologic Rating Scale, and Expanded Disability Status Scale (tertiary) outcomes. There was significant expansion of CD56(bright) NK cells in peripheral blood and CSF, with resultant decrease in T cells/NK cells and B cells/NK cells ratios and IL-12p40 in the CSF. Surprisingly, CD25 Tac epitope was equally blocked on the immune cells in the CSF and in peripheral blood.

CONCLUSIONS

Daclizumab monotherapy inhibits formation of MS plaques in patients with RRMS and immunoregulatory NK cells may suppress activation of pathogenic immune responses directly in the CNS compartment.

CLASSIFICATION OF EVIDENCE

The study provides Class III evidence that daclizumab reduces the number of contrast-enhancing lesions in treatment-naive patients with RRMS over a 54-week period.

Sensitivity analysis for models of greenhouse gas emissions at farm level. Case study of N(2)O emissions simulated by the CERES-EGC model

Modelling complex systems such as farms often requires quantification of a large number of input factors. Sensitivity analyses are useful to reduce the number of input factors that are required to be measured or estimated accurately. Three methods of sensitivity analysis (the Morris method, the rank regression and correlation method and the Extended Fourier Amplitude Sensitivity Test method) were compared in the case of the CERES-EGC model applied to crops of a dairy farm. The qualitative Morris method provided a screening of the input factors. The two other quantitative methods were used to investigate more thoroughly the effects of input factors on output variables. Despite differences in terms of concepts and assumptions, the three methods provided similar results. Among the 44 factors under study, N(2)O emissions were mainly sensitive to the fraction of N(2)O emitted during denitrification, the maximum rate of nitrification, the soil bulk density and the cropland area.