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Sciara AN, Beasley B, Crawford JD, Anderson EP, Carrasco T, Zheng S, Ordway GA, Chandley MJ. Neuroinflammatory Gene Expression Alterations in Anterior Cingulate Cortical White and Gray Matter of Males With Autism Spectrum Disorder. Autism Res 2020; 13:870-884. [PMID: 32129578 PMCID: PMC7540672 DOI: 10.1002/aur.2284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/26/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023]
Abstract
Evidence for putative pathophysiological mechanisms of autism spectrum disorder (ASD), including peripheral inflammation, blood-brain barrier disruption, white matter alterations, and abnormal synaptic overgrowth, indicate a possible involvement of neuroinflammation in the disorder. Neuroinflammation plays a role in the development and maintenance of the dendritic spines involved in glutamatergic and GABAergic neurotransmission, and also influences blood-brain permeability. Cytokines released from microglia can impact the length, location or organization of dendritic spines on excitatory and inhibitory cells as well as recruit and impact glial cell function around the neurons. In this study, gene expression levels of anti- and pro-inflammatory signaling molecules, as well as oligodendrocyte and astrocyte marker proteins, were measured in both gray and white matter tissue in the anterior cingulate cortex from ASD and age-matched typically developing (TD) control brain donors, ranging from ages 4 to 37 years. Expression levels of the pro-inflammatory gene, HLA-DR, were significantly reduced in gray matter and expression levels of the anti-inflammatory gene MRC1 were significantly elevated in white matter from ASD donors as compared to TD donors, but neither retained statistical significance after correction for multiple comparisons. Modest trends toward differences in expression levels were also observed for the pro-inflammatory (CD68, IL1β) and anti-inflammatory genes (IGF1, IGF1R) comparing ASD donors to TD donors. The direction of gene expression changes comparing ASD to TD donors did not reveal consistent findings implicating an elevated pro- or anti-inflammatory state in ASD. However, altered expression of pro- and anti-inflammatory gene expression indicates some involvement of neuroinflammation in ASD. Autism Res 2020, 13: 870-884. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The anterior cingulate cortex is an integral brain region in modulating social behaviors including nonverbal communication. The study found that inflammatory gene expression levels were altered in this brain region. We hypothesize that the inflammatory changes in this area could impact neuronal function. The finding has future implications in using these molecular markers to identify potential environmental exposures and distinct cell differences in autism.
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Affiliation(s)
- Aubrey N. Sciara
- Department of Biological SciencesEast Tennessee State UniversityJohnson CityTennessee
| | - Brooke Beasley
- Department of Health SciencesEast Tennessee State UniversityJohnson CityTN
| | - Jessica D. Crawford
- Department of Biomedical SciencesEast Tennessee State UniversityJohnson CityTN
| | - Emma P. Anderson
- Department of Health SciencesEast Tennessee State UniversityJohnson CityTN
| | - Tiffani Carrasco
- Department of Health SciencesEast Tennessee State UniversityJohnson CityTN
| | - Shimin Zheng
- Department of Biostatistics and EpidemiologyEast Tennessee State UniversityJohnson CityTN
| | - Gregory A. Ordway
- Department of Biomedical SciencesEast Tennessee State UniversityJohnson CityTN
- Department of Psychiatry and Behavioral SciencesEast Tennessee State University, Johnson CityJohnson CityTN
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Fahim M, Rafiee Zadeh A, Shoureshi P, Ghadimi K, Cheshmavar M, Sheikhinia N, Afzali M. Alcohol and multiple sclerosis: an immune system-based review. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2020; 12:58-69. [PMID: 32419901 PMCID: PMC7218739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 06/11/2023]
Abstract
Multiple sclerosis is a chronic inflammatory disease of the central nervous system (CNS). Although the exact etiology of multiple sclerosis is unknown, researchers suggest that genetic, environmental, and microbial factors play a central role in causing multiple sclerosis. Pathology of multiple sclerosis is based on inflammation as T cells enter the brain via disruptions in the blood-brain barrier, recognizing myelin as foreign antigen; and as a result, the T cells attack myelin and start the inflammatory processes, enhancing inflammatory cytokines and antibodies. Since previous studies show ethanol can suppress the immune system such as innate, humoral, and cellular immunity and increases the production of anti-inflammatory cytokines, we hypothesized maybe ethanol also have ameliorating effects on multiple sclerosis symptoms. Although alcohol induces apoptosis in oligodendrocytes and neurons, causing demyelination and affects CNS directly, in this study we will investigate ethanol's effects on some aspects of the immune system in multiple sclerosis.
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Affiliation(s)
- Maryam Fahim
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | | | - Pouria Shoureshi
- Department of Internal Medicine, Orange Park Medical CenterFlorida, USA
| | - Keyvan Ghadimi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoumeh Cheshmavar
- Department of Neurology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Neda Sheikhinia
- Department of Neurology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mahdieh Afzali
- Department of Neurology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Buckle G, Bandari D, Greenstein J, Gudesblatt M, Khatri B, Kita M, Repovic P, Riser E, Weinstock-Guttman B, Thrower B, Loring S, Riester K, Everage N, Prada C, Koulinska I, Mann M. Effect of dimethyl fumarate on lymphocyte subsets in patients with relapsing multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320918619. [PMID: 32440353 PMCID: PMC7227148 DOI: 10.1177/2055217320918619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients treated with dimethyl fumarate, absolute lymphocyte count decline typically occurs during the first year and then plateaus; early drops have been associated with the development of severe prolonged lymphopenia. OBJECTIVE We investigated the effect of dimethyl fumarate on absolute lymphocyte counts and CD4+/CD8+ T cells in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate in routine practice. METHODS Lymphocyte data were collected via medical chart abstraction. Primary endpoint: change from baseline in absolute lymphocyte count and CD4+/CD8+ counts at 6-month intervals following dimethyl fumarate initiation. RESULTS Charts of 483 patients were abstracted and 476 patients included in the analysis. Mean baseline absolute lymphocyte count (2.23 × 109/l) decreased by ∼39% (95% confidence interval: -41.1 to -37.2) by month 6 and 44% (95% confidence interval: -46.6 to -42.1) by month 12. CD4+ and CD8+ T-cell subsets strongly correlated with absolute lymphocyte count, with greater decreases from baseline to 6 months vs 6-12 months, and in CD8+ vs CD4+ T cells. Prior natalizumab was not a risk factor for lymphopenia. CONCLUSION Dimethyl fumarate-associated decline in absolute lymphocyte count in the first 12 months correlated with decline in CD4+ and CD8+ T cells and was independent of prior natalizumab. Absolute lymphocyte count monitoring continues to be an effective strategy to identify patients at risk of prolonged lymphopenia.
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Affiliation(s)
- Guy Buckle
- Multiple Sclerosis Institute at Shepherd Center, Inc., USA
| | | | | | | | - Bhupendra Khatri
- Center for Neurological Disorders, Wheaton Franciscan Healthcare, USA
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Najjar E, Staun-Ram E, Volkowich A, Miller A. Dimethyl fumarate promotes B cell-mediated anti-inflammatory cytokine profile in B and T cells, and inhibits immune cell migration in patients with MS. J Neuroimmunol 2020; 343:577230. [PMID: 32247228 DOI: 10.1016/j.jneuroim.2020.577230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/23/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023]
Abstract
Dimethyl Fumarate (DMF), known for its mechanism of action targeting Nrf2 and related redox homeostasis, is an approved immunotherapy for patients with Multiple Sclerosis (PwMS) in the relapsing form. We assessed how DMF modulates immune cell functions, namely the cytokine profile of co-cultured B and T cells, and the chemokine-mediated migration of immune cells. Following DMF therapy, LTα+, TNFα+ and IFNγ+ B cells were reduced while TGFβ and IL10 expression elevated. B cells from DMF-treated patients increased TGFβ and LTα expression on T cells, while DMF directly reduced TNFα+ and IFNγ+ T cells. CXCL12/CXCL13-mediated migration of B cells, Monocytes, CD4 and CD8 T cells was reduced, with altered CXCR5 and CXCR4 expression. Induction of regulatory B and T cells and reduced migration of immune cells may be part of the beneficial mechanism of DMF in PwMS.
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Affiliation(s)
- Eiman Najjar
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elsebeth Staun-Ram
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Anat Volkowich
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel.
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Cellerino M, Ivaldi F, Pardini M, Rotta G, Vila G, Bäcker-Koduah P, Berge T, Laroni A, Lapucci C, Novi G, Boffa G, Sbragia E, Palmeri S, Asseyer S, Høgestøl E, Campi C, Piana M, Inglese M, Paul F, Harbo HF, Villoslada P, Kerlero de Rosbo N, Uccelli A. Impact of treatment on cellular immunophenotype in MS: A cross-sectional study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e693. [PMID: 32139439 PMCID: PMC7136062 DOI: 10.1212/nxi.0000000000000693] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022]
Abstract
Objective To establish cytometry profiles associated with disease stages and immunotherapy in MS. Methods Demographic/clinical data and peripheral blood samples were collected from 227 patients with MS and 82 sex- and age-matched healthy controls (HCs) enrolled in a cross-sectional study at 4 European MS centers (Spain, Italy, Germany, and Norway). Flow cytometry of isolated peripheral blood mononuclear cells was performed in each center using specifically prepared antibody-cocktail Lyotubes; data analysis was centralized at the Genoa center. Differences in immune cell subsets were assessed between groups of untreated patients with relapsing-remitting or progressive MS (RRMS or PMS) and HCs and between groups of patients with RRMS taking 6 commonly used disease-modifying drugs. Results In untreated patients with MS, significantly higher frequencies of Th17 cells in the RRMS population compared with HC and lower frequencies of B-memory/B-regulatory cells as well as higher percentages of B-mature cells in patients with PMS compared with HCs emerged. Overall, the greatest deviation in immunophenotype in MS was observed by treatment rather than disease course, with the strongest impact found in fingolimod-treated patients. Fingolimod induced a decrease in total CD4+ T cells and in B-mature and B-memory cells and increases in CD4+ and CD8+ T-regulatory and B-regulatory cells. Conclusions Our highly standardized, multisite cytomics data provide further understanding of treatment impact on MS immunophenotype and could pave the way toward monitoring immune cells to help clinical management of MS individuals.
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Affiliation(s)
- Maria Cellerino
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Federico Ivaldi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Matteo Pardini
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Gianluca Rotta
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Gemma Vila
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Priscilla Bäcker-Koduah
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Tone Berge
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Alice Laroni
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Caterina Lapucci
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Giovanni Novi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Giacomo Boffa
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Serena Palmeri
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Susanna Asseyer
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Einar Høgestøl
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Cristina Campi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Michele Piana
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Friedemann Paul
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Hanne F Harbo
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Pablo Villoslada
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Nicole Kerlero de Rosbo
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Antonio Uccelli
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy.
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56
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Kornberg MD. The immunologic Warburg effect: Evidence and therapeutic opportunities in autoimmunity. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2020; 12:e1486. [PMID: 32105390 PMCID: PMC7507184 DOI: 10.1002/wsbm.1486] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022]
Abstract
Pro‐inflammatory signals induce metabolic reprogramming in innate and adaptive immune cells of both myeloid and lymphoid lineage, characterized by a shift to aerobic glycolysis akin to the Warburg effect first described in cancer. Blocking the switch to aerobic glycolysis impairs the survival, differentiation, and effector functions of pro‐inflammatory cell types while favoring anti‐inflammatory and regulatory phenotypes. Glycolytic reprogramming may therefore represent a selective vulnerability of inflammatory immune cells, providing an opportunity to modulate immune responses in autoimmune disease without broad toxicity in other tissues of the body. The mechanisms by which aerobic glycolysis and the balance between glycolysis and oxidative phosphorylation regulate immune responses have only begun to be understood, with many additional insights expected in the years to come. Immunometabolic therapies targeting aerobic glycolysis include both pharmacologic inhibitors of key enzymes and glucose‐restricted diets, such as the ketogenic diet. Animal studies support a role for these pharmacologic and dietary therapies for the treatment of autoimmune diseases, and in a few cases proof of concept has been demonstrated in human disease. Nonetheless, much more work is needed to establish the clinical safety and efficacy of these treatments. This article is categorized under:Biological Mechanisms > Metabolism Translational, Genomic, and Systems Medicine > Translational Medicine Biological Mechanisms > Cell Signaling
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Affiliation(s)
- Michael D Kornberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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57
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Goldman MD, Dwyer L, Coleman R, Sohn MW, Stuve O. Patient-specific factors modulate leukocyte response in dimethyl fumarate treated MS patients. PLoS One 2020; 15:e0228617. [PMID: 32045436 PMCID: PMC7012426 DOI: 10.1371/journal.pone.0228617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Determine if patient-specific factors modulate absolute lymphocyte count (ALC), neutrophil count (ANC), and/or Neutrophile-lymphocyte ratio (NLR) in Dimethyl Fumarate (DMF) treated patients. METHODS A retrospective study of patients who initiated DMF between 2013-2018. A multicenter study of two MS clinics: Charlottesville, VA (UVA) and Dallas, TX (DaVA). RESULTS 103 patients (67-UVA, 36-DaVA) met eligibility. At baseline, the DaVa population was younger (mean±sd: 38.6±9.0 vs 42.2±12.5, p 0.152) and had a higher proportion of males (61% vs. 35%), consistent with a veteran cohort. Pre-treatment, all other laboratory parameters were similar between the two groups. On treatment there was a 30% lowering of mean ALC, with 3% having grade-3 lymphopenia (ALC < 500). Sustained neutropenia occurred in 3.9% of patients and was more common in males. Over 50% of patients had a high NLR at baseline, with a further 44% increase in NLR on-treatment. Age was significantly predictive of lymphopenia, with grade-3 lymphopenia found in 33% of patients ≥ 55 years. Neutropenia was more common in males. Serum BG (sBG) has modest correlation to leukocyte parameters. BMI was not correlated with any leukocyte-related outcomes. CONCLUSIONS Patient-specific factors, specifically-age, sex, and serum blood glucose, modulate leukocyte response and ratios in DMF treated MS patients. Age appears to be a relevant predictor of lymphopenia and should be a factor in treatment decision making. Neutropenia, independent of lymphopenia, can occur and males may be at increased risk. High sBG may impact leukocyte count and ratios in MS patients and merits further study, particularly in patients with diabetes. NLR is abnormal in MS and increased with DMF-treatment, the clinical implications of this will require further study.
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Affiliation(s)
- Myla D. Goldman
- Virginia Commonwealth University School of Medicine, Department of Neurology, Richmond, Virginia, United States of America
- * E-mail:
| | - Lauren Dwyer
- Hendrix College, Conway, Arkansas, United States of America
| | - Rachael Coleman
- Virginia Commonwealth University School of Medicine, Department of Neurology, Richmond, Virginia, United States of America
| | - Min-Woong Sohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Olaf Stuve
- University of Texas Southwestern Medical Center at Dallas, Department of Neurology and Neurotherapeutics, Dallas, Texas, United States of America
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58
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Paolicelli D, Manni A, Iaffaldano A, Trojano M. Efficacy and Safety of Oral Therapies for Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2020; 34:65-92. [PMID: 31898276 DOI: 10.1007/s40263-019-00691-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Disease-modifying therapies have now become standard treatment for multiple sclerosis. These include five oral therapies for relapsing-remitting multiple sclerosis, namely fingolimod, dimethyl fumarate, teriflunomide, cladribine, and siponimod, although there is some discrepancy on the relative efficacy and safety of these agents. To gain further insight on these oral agents in relapsing-remitting multiple sclerosis, we performed a narrative review of fingolimod, dimethyl fumarate, teriflunomide, cladribine, and siponimod. We limited the analysis to randomized clinical studies in which a comparator was used (i.e., placebo or other disease-modifying therapy). As relapsing-remitting multiple sclerosis is a chronic disease and treatment is lifelong, long-term outcomes were an additional focus. A total of 37 studies met inclusion criteria: 15 for fingolimod, 8 for dimethyl fumarate, 7 for teriflunomide, 4 for cladribine, and 3 for siponimod. All drugs showed some functional and magnetic resonance imaging benefit in nearly all clinical studies. The reduction in annual relapse rate was similar for fingolimod, dimethyl fumarate, and cladribine, and somewhat greater than for teriflunomide; there is limited information on the annual relapse rate for siponimod. For all drugs, the benefits reported at short follow-up times are broadly consistent with those seen at longer follow-up times. For fingolimod and dimethyl fumarate, there was a definite trend towards a progressively lower annual relapse rate with continuing treatment. The safety profile of all five drugs was considered to be acceptable, even after extended treatment. While these results should be treated with caution, they highlight that future head-to-head studies are needed to better understand the long-term benefits of disease-modifying therapies. Such information will be of value when considering the risk-benefit profile of these oral therapies.
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Affiliation(s)
- Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Alessia Manni
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
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59
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Gross RH, Corboy JR. Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies. Continuum (Minneap Minn) 2019; 25:715-735. [PMID: 31162313 DOI: 10.1212/con.0000000000000738] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This article reviews appropriate monitoring of the various multiple sclerosis (MS) disease-modifying therapies, summarizes the reasons patients switch or stop treatment, and provides a framework for making these management decisions. RECENT FINDINGS With the increasing number of highly effective immunotherapies available for MS, the possibility of better control of the disease has increased, but with it, the potential for side effects has rendered treatment decisions more complicated. Starting treatment early with more effective and better-tolerated disease-modifying therapies reduces the likelihood of switching because of breakthrough disease or lack of compliance. Clinical and radiographic surveillance, and often blood and other paraclinical tests, should be performed periodically, depending on the disease-modifying therapy. Helping patients navigate the uncertainty around switching or stopping treatment, either temporarily or permanently, is one of the most important things we do as providers of MS care. SUMMARY Ongoing monitoring of drug therapy is a crucial component of long-term MS care. Switching treatments may be necessary for a variety of reasons. Permanent discontinuation of treatment may be appropriate for some patients with MS, although more study is needed in this area.
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60
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Lückel C, Picard F, Raifer H, Campos Carrascosa L, Guralnik A, Zhang Y, Klein M, Bittner S, Steffen F, Moos S, Marini F, Gloury R, Kurschus FC, Chao YY, Bertrams W, Sexl V, Schmeck B, Bonetti L, Grusdat M, Lohoff M, Zielinski CE, Zipp F, Kallies A, Brenner D, Berger M, Bopp T, Tackenberg B, Huber M. IL-17 + CD8 + T cell suppression by dimethyl fumarate associates with clinical response in multiple sclerosis. Nat Commun 2019; 10:5722. [PMID: 31844089 PMCID: PMC6915776 DOI: 10.1038/s41467-019-13731-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/21/2019] [Indexed: 12/20/2022] Open
Abstract
IL-17-producing CD8+ (Tc17) cells are enriched in active lesions of patients with multiple sclerosis (MS), suggesting a role in the pathogenesis of autoimmunity. Here we show that amelioration of MS by dimethyl fumarate (DMF), a mechanistically elusive drug, associates with suppression of Tc17 cells. DMF treatment results in reduced frequency of Tc17, contrary to Th17 cells, and in a decreased ratio of the regulators RORC-to-TBX21, along with a shift towards cytotoxic T lymphocyte gene expression signature in CD8+ T cells from MS patients. Mechanistically, DMF potentiates the PI3K-AKT-FOXO1-T-BET pathway, thereby limiting IL-17 and RORγt expression as well as STAT5-signaling in a glutathione-dependent manner. This results in chromatin remodeling at the Il17 locus. Consequently, T-BET-deficiency in mice or inhibition of PI3K-AKT, STAT5 or reactive oxygen species prevents DMF-mediated Tc17 suppression. Overall, our data disclose a DMF-AKT-T-BET driven immune modulation and suggest putative therapy targets in MS and beyond. Dimethyl fumarate (DMF) is a therapy for multiple sclerosis (MS) with undetermined mechanism of action. Here the authors find that clinical response to DMF associates with decrease in IL-17-producing CD8+ T cells (Tc17), delineate molecular pathways involved, and show that DMF suppresses Tc17 pathogenicity in a mouse model of MS.
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Affiliation(s)
- Christina Lückel
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany.,Institute for Immunology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Felix Picard
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany
| | - Hartmann Raifer
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany.,Core-Facility Flow Cytometry, University of Marburg, 35043, Marburg, Germany
| | - Lucia Campos Carrascosa
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany.,Laboratory of Gastroentrology and Hepatology, Erasmus MC University Medical Center, 3015 CE, Rotterdam, Netherlands
| | - Anna Guralnik
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany
| | - Yajuan Zhang
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany
| | - Matthias Klein
- Institute for Immunology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology at the University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Falk Steffen
- Department of Neurology at the University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Sonja Moos
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Renee Gloury
- The Peter Doherty Institute for Infection and Immunity, Dept. of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, 3000, Australia.,The Walter and Eliza Hall Institute of Medical Research, 1 G Royal Parade, Parkville, VIC, 3052, Australia
| | - Florian C Kurschus
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.,Department of Dermatology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ying-Yin Chao
- Center for Translational Cancer Research TranslaTUM, Technical University of Munich, 81675, Munich, Germany.,German Center for Infection Research (DZIF), Munich, Germany
| | - Wilhelm Bertrams
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), 35043, Marburg, Germany
| | - Veronika Sexl
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, 1210, Vienna, Austria
| | - Bernd Schmeck
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), 35043, Marburg, Germany.,Dept. of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), 35043, Marburg, Germany
| | - Lynn Bonetti
- Dept. of Infection and Immunity, Experimental and Molecular Immunology, Luxembourg Institute of Health, Esch-sur-Alzette, L-4354, Luxembourg
| | - Melanie Grusdat
- Dept. of Infection and Immunity, Experimental and Molecular Immunology, Luxembourg Institute of Health, Esch-sur-Alzette, L-4354, Luxembourg
| | - Michael Lohoff
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany
| | - Christina E Zielinski
- Center for Translational Cancer Research TranslaTUM, Technical University of Munich, 81675, Munich, Germany.,German Center for Infection Research (DZIF), Munich, Germany
| | - Frauke Zipp
- Department of Neurology at the University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Axel Kallies
- The Peter Doherty Institute for Infection and Immunity, Dept. of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, 3000, Australia.,The Walter and Eliza Hall Institute of Medical Research, 1 G Royal Parade, Parkville, VIC, 3052, Australia
| | - Dirk Brenner
- Dept. of Infection and Immunity, Experimental and Molecular Immunology, Luxembourg Institute of Health, Esch-sur-Alzette, L-4354, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg.,Odense Research Center for Anaphylaxis, Dept. of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, DK-5000, Denmark
| | - Michael Berger
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University, Jerusalem, 9112001, Israel
| | - Tobias Bopp
- Institute for Immunology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.,Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Björn Tackenberg
- Center of Neuroimmunology, Dept. of Neurology, University of Marburg, 35043, Marburg, Germany
| | - Magdalena Huber
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, 35043, Marburg, Germany.
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Ozel O, Vaughn CB, Eckert SP, Jakimovski D, Lizarraga AA, Weinstock-Guttman B. Dimethyl Fumarate in the Treatment of Relapsing-Remitting Multiple Sclerosis: Patient Reported Outcomes and Perspectives. Patient Relat Outcome Meas 2019; 10:373-384. [PMID: 31849554 PMCID: PMC6911812 DOI: 10.2147/prom.s168095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022] Open
Abstract
Dimethyl fumarate (DMF) is a commonly prescribed oral medication for the treatment of relapsing forms of multiple sclerosis (MS) with a wide range of hypothesized downstream mechanisms of action. Randomized clinical trials have established its clinical efficacy by using standard objective clinical measures. However, MS is a chronic disease that, apart from physical ailments, can affect an individual's mood, psychosocial status, and quality of life which cannot be captured by using only objective assessment tools. Given the challenge of determining the efficacy of the treatment in a real-world clinical setting, the use of patient-reported outcomes (PROs) may help us to better address these aspects of patient care and establish a more patient-centered approach to MS care. To date, a review of PubMed identified six studies which reported on PROs in patients who are taking DMF. In total, twelve different kinds of PRO measures were utilized and 6359 patients provided at least one form of PRO in these studies. Upon review of these studies, we were able to conclude that people with MS had decreased quality of life compared to the healthy population in the US. MS patients on DMF, however, had better health-related quality of life assessment scores compared to those using a placebo. Previous studies also suggested that DMF decreased work productivity impairment scores after one year of use compared to baseline. DMF was associated with less impairment in fatigue and depression scales along with improved treatment quality assessment and adherence scores. This review will present a brief synopsis of the published literature and will provide indications for future directions with respect to PROs and DMF in people with MS.
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Affiliation(s)
- Osman Ozel
- Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Caila B Vaughn
- Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Svetlana P Eckert
- Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Alexis A Lizarraga
- Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Morales FS, Koralnik IJ, Gautam S, Samaan S, Sloane JA. Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate. J Neurol 2019. [PMID: 31583427 DOI: 10.1007/s00415‐019‐09557‐w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To identify risk factors for DMF-induced lymphopenia and characterize its impact on T lymphocyte subsets in MS patients. METHODS We performed a retrospective analysis of 194 RRMS patients treated with DMF at the Beth Israel Deaconess Medical Center (BIDMC) over a median of 17 months. We reviewed demographics, ethnic background, prior medication history, complete blood counts and T lymphocyte subsets. Possible lymphopenia risk factors examined included age, prior natalizumab exposure, vitamin D levels, and concomitant exposure to carbamazepine, opiates, tobacco, or steroids. Lymphopenia was defined as grade 1: absolute lymphocytes count (ALC) 800-999/μl; grade 2: ALC 500-799/μl; grade 3: ALC 200-499/μl; and grade 4: ALC < 200/μl. RESULTS Of 194 DMF-treated patients, 73 (38%) developed lymphopenia and reached an ALC nadir after a median of 504 days (range 82-932). Risk of developing DMF-induced lymphopenia increased with BMI 25-30, older age, white ethnicity, non-smoking status, and lowest quartile baseline ALC. Prior exposure to natalizumab or concomitant steroid, opiates or carbamazepine/oxcarbamazepine use was not associated with lymphopenia. Compared to baseline levels, CD8 T cells were significantly more reduced than CD4 cells. CD8 counts were more commonly reduced with age or white ethnicity. Subjects with BMI 25-30 was associated with a higher risk of abnormal CD4 cell count reductions. In contrast, non-smokers were more likely to experience reductions in both CD4 and CD8 counts while on DMF. CONCLUSIONS Patients with low baseline lymphocyte counts, with intermediate BMI, with white ethnicity, with advanced age, or with no tobacco use, had a significantly higher incidence of lymphopenia on DMF. Intermediate BMI or lowest quartile baseline ALC predicted low CD4 levels, while advanced age or white ethnicity predicted low CD8 levels from DMF exposure.
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Affiliation(s)
- Fabian Sierra Morales
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Igor J Koralnik
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shiva Gautam
- Division of Biostatistics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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63
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Morales FS, Koralnik IJ, Gautam S, Samaan S, Sloane JA. Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate. J Neurol 2019; 267:125-131. [PMID: 31583427 DOI: 10.1007/s00415-019-09557-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To identify risk factors for DMF-induced lymphopenia and characterize its impact on T lymphocyte subsets in MS patients. METHODS We performed a retrospective analysis of 194 RRMS patients treated with DMF at the Beth Israel Deaconess Medical Center (BIDMC) over a median of 17 months. We reviewed demographics, ethnic background, prior medication history, complete blood counts and T lymphocyte subsets. Possible lymphopenia risk factors examined included age, prior natalizumab exposure, vitamin D levels, and concomitant exposure to carbamazepine, opiates, tobacco, or steroids. Lymphopenia was defined as grade 1: absolute lymphocytes count (ALC) 800-999/μl; grade 2: ALC 500-799/μl; grade 3: ALC 200-499/μl; and grade 4: ALC < 200/μl. RESULTS Of 194 DMF-treated patients, 73 (38%) developed lymphopenia and reached an ALC nadir after a median of 504 days (range 82-932). Risk of developing DMF-induced lymphopenia increased with BMI 25-30, older age, white ethnicity, non-smoking status, and lowest quartile baseline ALC. Prior exposure to natalizumab or concomitant steroid, opiates or carbamazepine/oxcarbamazepine use was not associated with lymphopenia. Compared to baseline levels, CD8 T cells were significantly more reduced than CD4 cells. CD8 counts were more commonly reduced with age or white ethnicity. Subjects with BMI 25-30 was associated with a higher risk of abnormal CD4 cell count reductions. In contrast, non-smokers were more likely to experience reductions in both CD4 and CD8 counts while on DMF. CONCLUSIONS Patients with low baseline lymphocyte counts, with intermediate BMI, with white ethnicity, with advanced age, or with no tobacco use, had a significantly higher incidence of lymphopenia on DMF. Intermediate BMI or lowest quartile baseline ALC predicted low CD4 levels, while advanced age or white ethnicity predicted low CD8 levels from DMF exposure.
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Affiliation(s)
- Fabian Sierra Morales
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.,Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Igor J Koralnik
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.,Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shiva Gautam
- Division of Biostatistics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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Pars K, Gingele M, Kronenberg J, Prajeeth CK, Skripuletz T, Pul R, Jacobs R, Gudi V, Stangel M. Fumaric Acids Do Not Directly Influence Gene Expression of Neuroprotective Factors in Highly Purified Rodent Astrocytes. Brain Sci 2019; 9:brainsci9090241. [PMID: 31546798 PMCID: PMC6769695 DOI: 10.3390/brainsci9090241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Dimethylfumarate (DMF) has been approved for the treatment of relapsing remitting multiple sclerosis. However, the mode of action of DMF and its assumed active primary metabolite monomethylfumarate (MMF) is still not fully understood. Former reports suggest a neuroprotective effect of DMF mediated via astrocytes by reducing pro-inflammatory activation of these glial cells. We investigated potential direct effects of DMF and MMF on neuroprotective factors like neurotrophic factors and growth factors in astrocytes to elucidate further possible mechanisms of the mode of action of fumaric acids; (2) Methods: highly purified cultures of primary rat astrocytes were pre-treated in vitro with DMF or MMF and incubated with lipopolysaccharides (LPS) or a mixture of interferon gamma (IFN-γ) plus interleukin 1 beta (IL-1β) in order to simulate an inflammatory environment. The gene expression of neuroprotective factors such as neurotrophic factors (nuclear factor E2-related factor 2 (NGF), brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF)) and growth factors (fibroblast growth factor 2 (FGF2), platelet-derived growth factor subunit A (PDGFa), ciliary neurotrophic factor (CNTF)) as well as cytokines (tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), IL-1β, inducible nitric oxide synthase (iNOS)) was examined by determining the transcription level with real-time quantitative polymerase chain reaction (qPCR); (3) Results: The stimulation of highly purified astrocytes with either LPS or cytokines changed the expression profile of growth factors and pro- inflammatory factors. However, the expression was not altered by either DMF nor MMF in unstimulated or stimulated astrocytes; (4) Conclusions: There was no direct influence of fumaric acids on neuroprotective factors in highly purified primary rat astrocytes. This suggests that the proposed potential neuroprotective effect of fumaric acid is not mediated by direct stimulation of neurotrophic factors in astrocytes but is rather mediated by other pathways or indirect mechanisms via other glial cells like microglia as previously demonstrated.
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Affiliation(s)
- Kaweh Pars
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
- Department of Neurology, European Medical School, University Oldenburg, 26129 Oldenburg, Germany.
| | - Marina Gingele
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
| | - Jessica Kronenberg
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
- Center for Systems Neuroscience, University of Veterinary Medicine, 30559 Hannover, Germany.
| | - Chittappen K Prajeeth
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
| | - Thomas Skripuletz
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
| | - Refik Pul
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
- Department of Neurology, University Clinic Essen, 45147 Essen, Germany.
| | - Roland Jacobs
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30559 Hannover, Germany.
| | - Viktoria Gudi
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover, Medical School, 30559 Hannover, Germany.
- Center for Systems Neuroscience, University of Veterinary Medicine, 30559 Hannover, Germany.
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Ciolac D, Luessi F, Gonzalez-Escamilla G, Koirala N, Riedel C, Fleischer V, Bittner S, Krämer J, Meuth SG, Muthuraman M, Groppa S. Selective Brain Network and Cellular Responses Upon Dimethyl Fumarate Immunomodulation in Multiple Sclerosis. Front Immunol 2019; 10:1779. [PMID: 31417557 PMCID: PMC6682686 DOI: 10.3389/fimmu.2019.01779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Efficient personalized therapy paradigms are needed to modify the disease course and halt gray (GM) and white matter (WM) damage in patients with multiple sclerosis (MS). Presently, promising disease-modifying drugs show impressive efficiency, however, tailored markers of therapy responses are required. Here, we aimed to detect in a real-world setting patients with a more favorable brain network response and immune cell dynamics upon dimethyl fumarate (DMF) treatment. Methods: In a cohort of 78 MS patients we identified two thoroughly matched groups, based on age, disease duration, disability status and lesion volume, receiving DMF (n = 42) and NAT (n = 36) and followed them over 16 months. The rate of cortical atrophy and deep GM volumes were quantified. GM and WM network responses were characterized by brain modularization as a marker of regional and global structural alterations. In the DMF group, lymphocyte subsets were analyzed by flow cytometry and related to clinical and MRI parameters. Results: Sixty percent (25 patients) of the DMF and 36% (13 patients) of the NAT group had disease activity during the study period. The rate of cortical atrophy was higher in the DMF group (-2.4%) compared to NAT (-2.1%, p < 0.05) group. GM and WM network dynamics presented increased modularization in both groups. When dividing the DMF-treated cohort into patients free of disease activity (n = 17, DMFR) and patients with disease activity (n = 25, DMFNR) these groups differed significantly in CD8+ cell depletion counts (DMFR: 197.7 ± 97.1/μl; DMFNR: 298.4 ± 190.6/μl, p = 0.03) and also in cortical atrophy (DMFR: -1.7%; DMFNR: -3.2%, p = 0.01). DMFR presented reduced longitudinal GM and WM modularization and less atrophy as markers of preserved structural global network integrity in comparison to DMFNR and even NAT patients. Conclusions: NAT treatment contributes to a reduced rate of cortical atrophy compared to DMF therapy. However, patients under DMF treatment with a stronger CD8+ T cell depletion present a more favorable response in terms of cortical integrity and GM and WM network responses. Our findings may serve as basis for the development of personalized treatment paradigms.
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Affiliation(s)
- Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nabin Koirala
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Krämer
- Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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66
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Sinnecker T, Hadisurya J, Schneider-Hohendorf T, Schwab N, Wrede K, Gembruch O, Gold R, Hellwig K, Pilgram-Pastor S, Adams O, Albrecht P, Hartung HP, Aktas O, Kraemer M. Extensive immune reconstitution inflammatory syndrome in Fingolimod-associated PML: a case report with 7 Tesla MRI data. BMC Neurol 2019; 19:190. [PMID: 31399069 PMCID: PMC6688281 DOI: 10.1186/s12883-019-1407-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) is a rare complication of patients treated with fingolimod. Case presentation Routine MRI eventually led to diagnosis of asymptomatic early PML that remained stable after discontinuation of fingolimod. As blood lymphocyte counts normalized, signs of immune reconstitution inflammatory syndrome (IRIS) and renewed MS activity developed. Both, advanced laboratory and ultrahigh field MRI findings elucidated differences between PML and MS. Conclusions In our case, early discontinuation of fingolimod yielded a good outcome, lymphocyte counts reflected immune system activity, and paraclinical findings helped to differentiate between PML-IRIS and MS.
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Affiliation(s)
- Tim Sinnecker
- Department of Neurology, Universitätsspital, Basel, Switzerland.,Medical Image Analysis Center Basel, Basel, Switzerland
| | - Jeffrie Hadisurya
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany
| | - Tilman Schneider-Hohendorf
- Clinic of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nicholas Schwab
- Clinic of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Ortwin Adams
- Institute of Virology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany. .,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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67
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Galli E, Hartmann FJ, Schreiner B, Ingelfinger F, Arvaniti E, Diebold M, Mrdjen D, van der Meer F, Krieg C, Nimer FA, Sanderson N, Stadelmann C, Khademi M, Piehl F, Claassen M, Derfuss T, Olsson T, Becher B. GM-CSF and CXCR4 define a T helper cell signature in multiple sclerosis. Nat Med 2019; 25:1290-1300. [PMID: 31332391 PMCID: PMC6689469 DOI: 10.1038/s41591-019-0521-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
Cytokine dysregulation is a central driver of chronic inflammatory diseases such as multiple sclerosis (MS). Here we sought to determine the characteristic cellular and cytokine polarization profile in patients with relapsing-remitting multiple sclerosis (RRMS) by high-dimensional single-cell mass cytometry (CyTOF). Using a combination of neural network-based representation learning algorithms, we identified an expanded T helper cell subset in MS patients, characterized by the expression of GM-CSF and the C-X-C chemokine receptor type 4. This cellular signature, which includes expression of very late antigen 4 (VLA4) in peripheral blood, was also enriched in the central nervous system of RRMS patients. In independent validation cohorts, we confirmed that this cell population is increased in MS patients compared to other inflammatory and non-inflammatory conditions. Lastly, we also found the population to be reduced under effective disease-modifying therapy, suggesting that the identified T cell profile represents a specific therapeutic target in MS.
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Affiliation(s)
- Edoardo Galli
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Felix J Hartmann
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Bettina Schreiner
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Ingelfinger
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Eirini Arvaniti
- Institute for Molecular Systems Biology, Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Martin Diebold
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Dunja Mrdjen
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Franziska van der Meer
- Institut für Neuropathologie, Klinik für Neurologie, Universitätsmedizin Göttingen, Gottingen, Germany
| | - Carsten Krieg
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.,Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Faiez Al Nimer
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nicholas Sanderson
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Christine Stadelmann
- Institut für Neuropathologie, Klinik für Neurologie, Universitätsmedizin Göttingen, Gottingen, Germany
| | - Mohsen Khademi
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Manfred Claassen
- Institute for Molecular Systems Biology, Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Tobias Derfuss
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Tomas Olsson
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.
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68
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Marastoni D, Buriani A, Pisani AI, Crescenzo F, Zuco C, Fortinguerra S, Sorrenti V, Marenda B, Romualdi C, Magliozzi R, Monaco S, Calabrese M. Increased NK Cell Count in Multiple Sclerosis Patients Treated With Dimethyl Fumarate: A 2-Year Longitudinal Study. Front Immunol 2019; 10:1666. [PMID: 31379857 PMCID: PMC6658905 DOI: 10.3389/fimmu.2019.01666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Dimethyl fumarate (DMF) is a disease-modifying drug for relapsing-remitting multiple sclerosis. Among others, DMF impedes immune activation by shifting the balance between inflammatory and regulatory cell types and by inducing apoptosis-triggered lymphopenia. Although the decrease in lymphocyte count is an early effect of the drug in several patients, the long-term impact on lymphocyte subsets is largely unknown. Methods: We performed a 2-years observational study on total lymphocyte count and subsets thereof by flow cytometry of peripheral blood of 38 multiple sclerosis patients in treatment with DMF. Data were collected at the beginning and after 3, 6, 12, and 24 months of therapy. Results: Total lymphocyte count decreased in relation to time of exposure to DMF. Mean absolute B cell count decreased by 34.1% (p < 0.001) within the first 3 months of therapy and then remained stable over time. Mean absolute CD3+ T cells count decrement reached 47.5% after 12 months of treatment (p < 0.001). NK cells count showed a heterogeneous trend, increasing by 85.9% (p < 0.001) after 2 years of treatment. CD4+ T cells and CD8+ T cells substantially decreased, with a significant increase of CD4+/CD8+ ratio during the first year of therapy. Conclusions: NK cells showed a heterogeneous behavior during DMF treatment with a significant increase over time. Since NK cells may also have a regulatory effect on immune system modulation, their increase during DMF treatment might play a role in the efficacy and safety of the drug.
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Affiliation(s)
- Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Buriani
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Anna Isabella Pisani
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Crescenzo
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carmela Zuco
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Fortinguerra
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Vincenzo Sorrenti
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Bruno Marenda
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | | | - Roberta Magliozzi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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69
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Carlström KE, Ewing E, Granqvist M, Gyllenberg A, Aeinehband S, Enoksson SL, Checa A, Badam TVS, Huang J, Gomez-Cabrero D, Gustafsson M, Al Nimer F, Wheelock CE, Kockum I, Olsson T, Jagodic M, Piehl F. Therapeutic efficacy of dimethyl fumarate in relapsing-remitting multiple sclerosis associates with ROS pathway in monocytes. Nat Commun 2019; 10:3081. [PMID: 31300673 PMCID: PMC6626021 DOI: 10.1038/s41467-019-11139-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/25/2019] [Indexed: 12/15/2022] Open
Abstract
Dimethyl fumarate (DMF) is a first-line-treatment for relapsing-remitting multiple sclerosis (RRMS). The redox master regulator Nrf2, essential for redox balance, is a target of DMF, but its precise therapeutic mechanisms of action remain elusive. Here we show impact of DMF on circulating monocytes and T cells in a prospective longitudinal RRMS patient cohort. DMF increases the level of oxidized isoprostanes in peripheral blood. Other observed changes, including methylome and transcriptome profiles, occur in monocytes prior to T cells. Importantly, monocyte counts and monocytic ROS increase following DMF and distinguish patients with beneficial treatment-response from non-responders. A single nucleotide polymorphism in the ROS-generating NOX3 gene is associated with beneficial DMF treatment-response. Our data implicate monocyte-derived oxidative processes in autoimmune diseases and their treatment, and identify NOX3 genetic variant, monocyte counts and redox state as parameters potentially useful to inform clinical decisions on DMF therapy of RRMS.
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Affiliation(s)
- Karl E Carlström
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden.
| | - Ewoud Ewing
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Granqvist
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Gyllenberg
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Shahin Aeinehband
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Sara Lind Enoksson
- Department of Clinical Immunology Karolinska University Hospital, Stockholm, Sweden
| | - Antonio Checa
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Tejaswi V S Badam
- Department of Bioinformatics, School of Bioscience, University of Skövde, Skövde, Sweden.,Department of Physics, Chemistry & Biology (IFM), Bioinformatics, Linköping University, Linköping, Sweden
| | - Jesse Huang
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - David Gomez-Cabrero
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Publica de Nevarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mika Gustafsson
- Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Faiez Al Nimer
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Craig E Wheelock
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Maja Jagodic
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neurosciences, Section of Neurology, Karolinska Institutet, Stockholm, Sweden
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70
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Braley TJ, Huber AK, Segal BM, Kaplish N, Saban R, Washnock-Schmid JM, Chervin RD. A randomized, subject and rater-blinded, placebo-controlled trial of dimethyl fumarate for obstructive sleep apnea. Sleep 2019; 41:5003425. [PMID: 29800466 DOI: 10.1093/sleep/zsy109] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Indexed: 01/03/2023] Open
Abstract
Study Objectives To investigate the therapeutic effect of dimethyl fumarate (DMF, an immunomodulatory agent) on obstructive sleep apnea (OSA), and potential influence of any such effect by selected proinflammatory molecules. Methods Patients with OSA who deferred positive airway pressure therapy were randomized (2:1) to receive DMF or placebo for 4 months. Participants underwent polysomnography before randomization and at 4 months. Blood was collected monthly. The primary outcome was the mean group change in respiratory disturbance index (δ-RDI). Secondary analyses focused on the association between treatment effect of DMF (on RDI) and expression of plasma cytokines and chemokines, or nuclear factor κ-B (NFκB) signaling molecules in peripheral blood mononuclear cells. Results N = 65 participants were randomized. N = 50 participants (DMF = 35, placebo = 15) had complete data for final analyses. The mean difference in δ-RDI between groups was 13.3 respiratory events/hour of sleep: -3.1+/-12.9 vs. 10.2+/-13.1 in DMF and placebo groups, respectively (mixed-effects model treatment effect: β = -0.14, SE = 0.062, p = 0.033). Plasma levels of TNF-α showed only nonsignificant decreases, and IL-10 and IL-13 only nonsignificant increases, in DMF-treated participants compared with placebo. No significant interaction or main effect on RDI for selected cytokines and chemokines was found. Participants with a therapeutic response to DMF did experience significant reductions in intracellular NFκB signaling molecules at 4 months. Overall, DMF was well-tolerated. Conclusions The immunomodulatory drug DMF partially ameliorates OSA severity. Suppression of systemic inflammation through reduction of NFκB signaling may mediate this effect. Clinical Trials ClinicalTrials.gov, NCT02438137, https://clinicaltrials.gov/ct2/show/NCT02438137?term=NCT02438137&rank=1.
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Affiliation(s)
- Tiffany J Braley
- Department of Neurology, Multiple Sclerosis and Sleep Disorders Centers, University of Michigan, Ann Arbor, MI
| | - Amanda K Huber
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology, University of Michigan, Ann Arbor, MI
| | - Benjamin M Segal
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology, University of Michigan, Ann Arbor, MI
| | - Neeraj Kaplish
- Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Rachel Saban
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Jesse M Washnock-Schmid
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology, University of Michigan, Ann Arbor, MI
| | - Ronald D Chervin
- Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI
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71
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Mansilla MJ, Navarro-Barriuso J, Presas-Rodríguez S, Teniente-Serra A, Quirant-Sánchez B, Ramo-Tello C, Martínez-Cáceres EM. Optimal response to dimethyl fumarate is mediated by a reduction of Th1-like Th17 cells after 3 months of treatment. CNS Neurosci Ther 2019; 25:995-1005. [PMID: 31066225 PMCID: PMC6698982 DOI: 10.1111/cns.13142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 01/08/2023] Open
Abstract
Aim Dimethyl fumarate (DMF) is one of the most promising therapies for relapsing‐remitting multiple sclerosis (RRMS) patients since it has shown immunomodulatory and neuroprotective effects. However, a percentage of RRMS patients do not exhibit an optimal response to DMF. The objective of this study was to identify early biomarkers of treatment response by analyzing changes in peripheral leukocyte subpopulations directly in whole blood samples. Methods A longitudinal and prospective study analyzing peripheral blood leukocyte subpopulations in 22 RRMS patients before initiating DMF treatment (baseline) and at 1, 3, 6, and 12 months of follow‐up was performed. Differences between no evidence of disease activity (NEDA) and ongoing disease activity (ODA) patients were analyzed. Results The beneficial effect of DMF was associated with a specific depletion of memory CD4+ and CD8+ T lymphocytes and B cells. Importantly, only NEDA patients showed (a) a shift from a pro‐ to an antiinflammatory profile, with an increase of Th2 cells and a decrease of Th1‐like Th17 lymphocytes; and (b) an increase of regulatory CD56bright NK cells. Conclusion The optimal response to DMF is mediated by a shift to antiinflammatory and immunoregulatory profile, which puts forward Th1‐like Th17 lymphocytes as a potential early biomarker of treatment response.
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Affiliation(s)
- María José Mansilla
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Juan Navarro-Barriuso
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Silvia Presas-Rodríguez
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Aina Teniente-Serra
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Bibiana Quirant-Sánchez
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Cristina Ramo-Tello
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Eva María Martínez-Cáceres
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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72
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Dickel H, Bruckner T, Höxtermann S, Dickel B, Trinder E, Altmeyer P. Fumaric acid ester-induced T-cell lymphopenia in the real-life treatment of psoriasis. J Eur Acad Dermatol Venereol 2019; 33:893-905. [PMID: 30680823 PMCID: PMC6593701 DOI: 10.1111/jdv.15448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fumaric acid esters (FAEs) are used to treat psoriasis and are known to cause lymphopenia in roughly 60% of the patients. Much remains to be elucidated about the biological effects of FAEs on lymphocytes. OBJECTIVE To evaluate the influence of long-term FAE (Fumaderm® ) treatment on peripheral blood CD4+ and CD8+ T cells, CD19+ B cells and CD56+ natural killer (NK) cells in psoriasis. METHODS In this single-centre retrospective observational subcohort study, we obtained leucocyte and lymphocyte subset counts before initiating FAE therapy in 371 psoriasis patients (mean age, 47.8 years; 63.3% males) and monitored them during treatment (mean treatment duration, 2.9 years). Multiparametric flow cytometry was used for immunophenotyping. RESULTS FAEs significantly reduced the numbers of CD4+ T, CD8+ T, CD19+ B and CD56+ NK cells. Among lymphocyte subsets, the mean percentage reduction from baseline was always highest for CD8+ T cells, with a peak of 55.7% after 2 years of therapy. The risk of T-cell lymphopenia increased significantly with the age of the psoriasis patients at the time that FAE therapy was initiated. It was significantly decreased for the combination therapy with methotrexate and folic acid (vitamin B9) supplementation. Supporting evidence was found suggesting that T-cell lymphopenia enhances the effectiveness of FAE therapy. CONCLUSIONS Monitoring distinct T-cell subsets rather than just absolute lymphocyte counts may provide more meaningful insights into both the FAE treatment safety and efficacy. We therefore suggest optimizing pharmacovigilance by additionally monitoring CD4+ and CD8+ T-cell counts at regular intervals, especially in patients of middle to older age. Thus, further prospective studies are needed to establish evidence-based recommendations to guide dermatologists in the management of psoriasis patients who are taking FAEs and who develop low absolute T-cell counts.
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Affiliation(s)
- H. Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - T. Bruckner
- Institute of Medical Biometry and Informatics (IMBI)University Hospital HeidelbergHeidelbergGermany
| | - S. Höxtermann
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - B. Dickel
- Dermatology Practice Peter WenzelMDHattingenGermany
| | - E. Trinder
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - P. Altmeyer
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
- Dermatology Practice at City ParkBochumGermany
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73
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Mehta D, Miller C, Arnold DL, Bame E, Bar-Or A, Gold R, Hanna J, Kappos L, Liu S, Matta A, Phillips JT, Robertson D, von Hehn CA, Campbell J, Spach K, Yang L, Fox RJ. Effect of dimethyl fumarate on lymphocytes in RRMS: Implications for clinical practice. Neurology 2019; 92:e1724-e1738. [PMID: 30918100 PMCID: PMC6511089 DOI: 10.1212/wnl.0000000000007262] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/04/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess functional changes in lymphocyte repertoire and subsequent clinical implications during delayed-release dimethyl fumarate (DMF) treatment in patients with multiple sclerosis. METHODS Using peripheral blood from several clinical trials of DMF, immune cell subsets were quantified using flow cytometry. For some patients, lymphocyte counts were assessed after DMF discontinuation. Incidence of adverse events, including serious and opportunistic infections, was assessed. RESULTS In DMF-treated patients, absolute lymphocyte counts (ALCs) demonstrated a pattern of decline followed by stabilization, which also was reflected in the global reduction in numbers of circulating functional lymphocyte subsets. The relative frequencies of circulating memory T- and B-cell populations declined and naive cells increased. No increased incidence of serious infection or malignancy was observed for patients treated with DMF, even when stratified by ALC or T-cell subset frequencies. For patients who discontinued DMF due to lymphopenia, ALCs increased after DMF discontinuation; recovery time varied by ALC level at discontinuation. T-cell subsets closely correlated with ALCs in both longitudinal and cross-sectional analyses. CONCLUSIONS DMF shifted the immunophenotype of circulating lymphocyte subsets. ALCs were closely correlated with CD4+ and CD8+ T-cell counts, indicating that lymphocyte subset monitoring is not required for safety vigilance. No increased risk of serious infection was observed in patients with low T-cell subset counts. Monitoring ALC remains the most effective way of identifying patients at risk of subsequently developing prolonged moderate to severe lymphopenia, a risk factor for progressive multifocal leukoencephalopathy in DMF-treated patients. TRIAL REGISTRATION NUMBERS EUDRA CT 2015-001973-42, NCT00168701, NCT00420212, NCT00451451, and NCT00835770.
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Affiliation(s)
- Devangi Mehta
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT.
| | - Catherine Miller
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT.
| | - Douglas L Arnold
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Eris Bame
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Amit Bar-Or
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Ralf Gold
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Jerome Hanna
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Ludwig Kappos
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Shifang Liu
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - André Matta
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - J Theodore Phillips
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Derrick Robertson
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Christian A von Hehn
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Jordana Campbell
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Karen Spach
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Lili Yang
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Robert J Fox
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
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74
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Traub J, Traffehn S, Ochs J, Häusser-Kinzel S, Stephan S, Scannevin R, Brück W, Metz I, Weber MS. Dimethyl fumarate impairs differentiated B cells and fosters central nervous system integrity in treatment of multiple sclerosis. Brain Pathol 2019; 29:640-657. [PMID: 30706542 PMCID: PMC6849574 DOI: 10.1111/bpa.12711] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
In multiple sclerosis (MS), the effect of dimethyl fumarate (DMF) treatment is primarily attributed to its capacity to dampen pathogenic T cells. Here, we tested whether DMF also modulates B cells, which are newly recognized key players in MS, and to which extent DMF restricts ongoing loss of oligodendrocytes and axons in the central nervous system (CNS). Therefore, blood samples and brain tissue from DMF-treated MS patients were analyzed by flow cytometry or histopathological examination, respectively. Complementary mechanistic studies were conducted in inflammatory as well as non-inflammatory CNS demyelinating mouse models. In this study, DMF reduced the frequency of antigen-experienced and memory B cells and rendered remaining B cells less prone to activation and production of pro-inflammatory cytokines. Dissecting the functional consequences of these alterations, we found that DMF ameliorated a B cell-accentuated experimental autoimmune encephalomyelitis model by diminishing the capacity of B cells to act as antigen-presenting cells for T cells. In a non-inflammatory model of toxic demyelination, DMF limited oligodendrocyte apoptosis, promoted maturation of oligodendrocyte precursors and reduced axonal damage. In a CNS biopsy of a DMF-treated MS patient, we equivalently observed higher numbers of mature oligodendrocytes as well as a reduced extent of axonal damage when compared to a cohort of treatment-naïve patients. In conclusion, we showed that besides suppressing T cells, DMF dampens pathogenic B cell functions, which probably contributes to its clinical effectiveness in relapsing MS. DMF treatment may furthermore limit chronically ongoing CNS tissue damage, which may reduce long-term disability in MS apart from its relapse-reducing capacity.
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Affiliation(s)
- Jan Traub
- Institute of Neuropathology, University Medical Center, Göttingen, Germany.,Department of Neurology, University Medical Center, Göttingen, Germany
| | - Sarah Traffehn
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Jasmin Ochs
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | | | - Schirin Stephan
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | | | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Imke Metz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Martin S Weber
- Institute of Neuropathology, University Medical Center, Göttingen, Germany.,Department of Neurology, University Medical Center, Göttingen, Germany
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75
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Sainz de la Maza S, Medina S, Villarrubia N, Costa-Frossard L, Monreal E, Tejeda-Velarde A, Rodríguez-Martín E, Roldán E, Álvarez-Cermeño JC, Villar LM. Factors associated with dimethyl fumarate-induced lymphopenia. J Neurol Sci 2019; 398:4-8. [DOI: 10.1016/j.jns.2019.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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76
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Yadav SK, Soin D, Ito K, Dhib-Jalbut S. Insight into the mechanism of action of dimethyl fumarate in multiple sclerosis. J Mol Med (Berl) 2019; 97:463-472. [PMID: 30820593 DOI: 10.1007/s00109-019-01761-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/26/2022]
Abstract
Dimethyl fumarate (DMF) is an oral, disease-modifying agent for the treatment of relapsing-remitting multiple sclerosis (RRMS). However, details regarding its mode of action are still emerging. It is believed that the mode of action of DMF involves both nuclear factor erythroid-derived 2-related factor (Nrf2)-dependent and independent pathways, which lead to an anti-inflammatory immune response due to type II myeloid cell and Th2 cell differentiation and neuroprotection. In this review, we will focus on the molecular and signaling effects of DMF that lead to changes in peripheral immune cell composition and function, alteration in CNS cell-specific functions, and effect on the blood-brain barrier.
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Affiliation(s)
- Sudhir Kumar Yadav
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, 08854, USA
| | - Devika Soin
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, 08854, USA
| | - Kouichi Ito
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, 08854, USA
| | - Suhayl Dhib-Jalbut
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, 08854, USA.
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77
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Abstract
B cells play a vital function in multiple sclerosis (MS) pathogenesis through an array of effector functions. All currently approved MS disease-modifying therapies alter the frequency, phenotype, or homing of B cells in one way or another. The importance of this mechanism of action has been reinforced with the successful development and clinical testing of B-cell-depleting monoclonal antibodies that target the CD20 surface antigen. Ocrelizumab, a humanized anti-CD20 monoclonal antibody, was approved by the Food and Drug Administration (FDA) in March 2017 after pivotal trials showed dramatic reductions in inflammatory disease activity in relapsing MS as well as lessening of disability progression in primary progressive MS. These and other clinical studies place B cells at the center of the inflammatory cascade in MS and provide a launching point for development of therapies that target selective pathogenic B-cell populations.
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Affiliation(s)
- Joseph J Sabatino
- Multiple Sclerosis Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Scott S Zamvil
- Multiple Sclerosis Center, Department of Neurology, University of California, San Francisco, California 94158
| | - Stephen L Hauser
- Multiple Sclerosis Center, Department of Neurology, University of California, San Francisco, California 94158
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78
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Fox EJ, Buckle GJ, Singer B, Singh V, Boster A. Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist. Neurol Clin Pract 2019; 9:53-63. [PMID: 30859008 PMCID: PMC6382377 DOI: 10.1212/cpj.0000000000000567] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of review To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. Recent findings DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs. Summary DMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune surveillance. Serial monitoring of total leukocytes and absolute lymphocyte counts (ALCs) is advisable in patients receiving DMTs. ALCs should be interpreted regarding expected immunologic changes and individual patient characteristics. Any decision to switch DMTs should consider these factors, along with drug efficacy, safety, and effect on quality of life.
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Affiliation(s)
- Edward J Fox
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Guy J Buckle
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Barry Singer
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Vibhuti Singh
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Aaron Boster
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
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79
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Hosseini A, Masjedi A, Baradaran B, Hojjat‐Farsangi M, Ghalamfarsa G, Anvari E, Jadidi‐Niaragh F. Dimethyl fumarate: Regulatory effects on the immune system in the treatment of multiple sclerosis. J Cell Physiol 2018; 234:9943-9955. [DOI: 10.1002/jcp.27930] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/24/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Arezoo Hosseini
- Drug Applied Research Center, Tabriz University of Medical Sciences Tabriz Iran
- Immunology Research Center, Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Faculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
| | - Ali Masjedi
- Immunology Research Center, Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Faculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Faculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
| | - Mohammad Hojjat‐Farsangi
- Immune and Gene therapy Lab Department of Oncology‐Pathology Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute Stockholm Sweden
- Department of Immunology School of Medicine, Bushehr University of Medical Sciences Bushehr Iran
| | - Ghasem Ghalamfarsa
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences Yasuj Iran
| | - Enayat Anvari
- Department of Physiology Faculty of Medicine, Ilam University of Medical Sciences Ilam Iran
| | - Farhad Jadidi‐Niaragh
- Immunology Research Center, Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Faculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
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80
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Montes Diaz G, Hupperts R, Fraussen J, Somers V. Dimethyl fumarate treatment in multiple sclerosis: Recent advances in clinical and immunological studies. Autoimmun Rev 2018; 17:1240-1250. [DOI: 10.1016/j.autrev.2018.07.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 12/30/2022]
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81
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Bhargava P, Fitzgerald KC, Venkata SLV, Smith MD, Kornberg MD, Mowry EM, Haughey NJ, Calabresi PA. Dimethyl fumarate treatment induces lipid metabolism alterations that are linked to immunological changes. Ann Clin Transl Neurol 2018; 6:33-45. [PMID: 30656182 PMCID: PMC6331509 DOI: 10.1002/acn3.676] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 12/22/2022] Open
Abstract
Objective Identify metabolic changes produced by dimethyl fumarate (DMF) treatment and link them to immunological effects. Methods We enrolled 18 MS patients and obtained blood prior to DMF and 6 months postinitiation. We also enrolled 18 healthy controls for comparison. We performed global metabolomics on plasma and used weighted correlation network analysis (WGCNA) to identify modules of correlated metabolites. We identified modules that changed with treatment, followed by targeted metabolomics to corroborate changes identified in global analyses. We correlated changes in metabolite modules and individual metabolites with changes in immunological parameters. Results We identified alterations in lipid metabolism after DMF treatment – increases in two modules (phospholipids, lysophospholipids and plasmalogens) and reduction in one module (saturated and poly‐unsaturated fatty acids) eigen‐metabolite values (all P < 0.05). Change in the fatty acid module was greater in participants who developed lymphopenia and was strongly associated with both reduction in absolute lymphocyte counts (r = 0.65; P = 0.005) and change in CD8+ T cell subsets. We also noted significant correlation of change in lymphocyte counts with multiple fatty acid levels (measured by targeted or untargeted methods). Interpretation This study demonstrates that DMF treatment alters lipid metabolism and that changes in fatty acid levels are related to DMF‐induced immunological changes.
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Affiliation(s)
- Pavan Bhargava
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Kathryn C Fitzgerald
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Swarajya L V Venkata
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Matthew D Smith
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Michael D Kornberg
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Ellen M Mowry
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Norman J Haughey
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
| | - Peter A Calabresi
- Department of Neurology Johns Hopkins University School of Medicine Baltimore Maryland
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82
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Staun-Ram E, Najjar E, Volkowich A, Miller A. Dimethyl fumarate as a first- vs second-line therapy in MS: Focus on B cells. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e508. [PMID: 30345334 PMCID: PMC6192691 DOI: 10.1212/nxi.0000000000000508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
Objective To elucidate the immunomodulatory effects of dimethyl fumarate (DMF) on B cells in patients with relapsing MS receiving DMF as a "1st-line" vs "2nd-line" therapy. Methods B cells were isolated from 43 patients with MS at baseline and after 15-week DMF therapy. Phenotype and functional markers and cytokine profile were assessed by flow cytometry. Analysis included clinical and MRI parameters recorded during a 1-year follow-up. Results 1st-line and 2nd-line patients presented several differences in their baseline immune profile, which corresponded with differences in their immunologic response to DMF treatment. DMF reduced the proportions of B cells and CD8 T cells whereas increased monocytes. DMF reduced memory B cells, including plasma cells in 2nd-line patients only, whereas strongly increased transitional B cells. Several IL10+ B-cell subsets and TGFβ+ B cells were increased. Proinflammatory LTα+ and TNFα+ B cells were reduced, while IL4+ B cells elevated, whereas IFNγ+ B cells showed opposite effects in 1st-line and 2nd-line patients. HLA and ICAM-1 expression was increased, but % CD86+ B cells reduced. The expression of B-cell activating factor receptor and the proportion of activated CD69 B cells were increased. Conclusions DMF is associated with increased transitional and IL10+ and TGFβ+ regulatory B cells and a shift toward a more anti-inflammatory immune profile. Cell activation with reduced costimulatory capacity may induce immune hyporesponsiveness. Carryover effects of preceding therapies in 2nd-line patients and the stage of disease influence the immune profile of the patients and the immunomodulatory effects of DMF.
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Affiliation(s)
- Elsebeth Staun-Ram
- Rappaport Faculty of Medicine (E.S.-R., E.N., A.M.), Technion-Israel Institute of Technology; and the Department of Neurology (A.V., A.M.), Neuroimmunology Unit & Multiple Sclerosis Center, Carmel Medical Center, Haifa, Israel
| | - Eiman Najjar
- Rappaport Faculty of Medicine (E.S.-R., E.N., A.M.), Technion-Israel Institute of Technology; and the Department of Neurology (A.V., A.M.), Neuroimmunology Unit & Multiple Sclerosis Center, Carmel Medical Center, Haifa, Israel
| | - Anat Volkowich
- Rappaport Faculty of Medicine (E.S.-R., E.N., A.M.), Technion-Israel Institute of Technology; and the Department of Neurology (A.V., A.M.), Neuroimmunology Unit & Multiple Sclerosis Center, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Rappaport Faculty of Medicine (E.S.-R., E.N., A.M.), Technion-Israel Institute of Technology; and the Department of Neurology (A.V., A.M.), Neuroimmunology Unit & Multiple Sclerosis Center, Carmel Medical Center, Haifa, Israel
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83
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Perini P, Rinaldi F, Puthenparampil M, Marcon M, Perini F, Gallo P. Herpes simplex virus encephalitis temporally associated with dimethyl fumarate-induced lymphopenia in a multiple sclerosis patient. Mult Scler Relat Disord 2018; 26:68-70. [PMID: 30227312 DOI: 10.1016/j.msard.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) is approved as first line therapy for relapsing-remitting multiple sclerosis (RRMS). In some (3%) patients, DMF induces a marked lymphopenia. Herpes simplex encephalitis (HSE) may occur in lymphopenic subjects under treatment with immune-suppressive drugs. CASE PRESENTATION We report a case of a 39-year-old female patient with RRMS that developed HSE temporally associated with a marked and sudden drop in lymphocyte count, from 1200/µl to 600/µl, in the peripheral blood. HSE DNA was demonstrated in the cerebrospinal fluid. HSE had the features that characterize HSE occurring in immunosuppressed subjects, i.e. less prominent CSF pleocytosis, bilateral and mainly cortical involvement and less extensive tissue necrosis. Antiviral therapy determined a progressive, although incomplete, improvement. Three months later the patient presented only a mild short-term memory deficit and sporadic episodes of inappropriate emotionality. Lymphocyte count returned to normal values (1120/µl) after DMF discontinuation. CONCLUSION Our case of HSE in a lymphopenic DMF-treated RRMS patient, points out the necessity of further studies on DMF-related lymphopenia, especially whether it implies an impaired immunity against viruses.
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Affiliation(s)
- Paola Perini
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy.
| | | | | | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy.
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84
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Li R, Patterson KR, Bar-Or A. Reassessing B cell contributions in multiple sclerosis. Nat Immunol 2018; 19:696-707. [PMID: 29925992 DOI: 10.1038/s41590-018-0135-x] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023]
Abstract
There is growing recognition that B cell contributions to normal immune responses extend well beyond their potential to become antibody-producing cells, including roles at the innate-adaptive interface and their potential to modulate the responses of other immune cells such as T cells and myeloid cells. These B cell functions can have both pathogenic and protective effects in the context of central nervous system (CNS) inflammation. Here, we review recent advances in the field of multiple sclerosis (MS), which has traditionally been viewed as primarily a T cell-mediated disease, and we consider antibody-dependent and, particularly, emerging antibody-independent functions of B cells that may be relevant in both the peripheral and CNS disease compartments.
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Affiliation(s)
- Rui Li
- Center for Neuroinflammation and Experimental Therapeutics (CNET) and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristina R Patterson
- Center for Neuroinflammation and Experimental Therapeutics (CNET) and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics (CNET) and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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85
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Cunill V, Massot M, Clemente A, Calles C, Andreu V, Núñez V, López-Gómez A, Díaz RM, Jiménez MDLR, Pons J, Vives-Bauzà C, Ferrer JM. Relapsing-Remitting Multiple Sclerosis Is Characterized by a T Follicular Cell Pro-Inflammatory Shift, Reverted by Dimethyl Fumarate Treatment. Front Immunol 2018; 9:1097. [PMID: 29896193 PMCID: PMC5986897 DOI: 10.3389/fimmu.2018.01097] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/02/2018] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is considered a T cell-mediated autoimmune disease, although several evidences also demonstrate a B cell involvement in its etiology. Follicular T helper (Tfh) cells, a CXCR5-expressing CD4+ T cell subpopulation, are essential in the regulation of B cell differentiation and maintenance of humoral immunity. Alterations in circulating (c)Tfh distribution and/or function have been associated with autoimmune diseases including MS. Dimethyl fumarate (DMF) is a recently approved first-line treatment for relapsing-remitting MS (RRMS) patients whose mechanism of action is not completely understood. The aim of our study was to compare cTfh subpopulations between RRMS patients and healthy subjects and evaluate the impact of DMF treatment on these subpopulations, relating them to changes in B cells and humoral response. We analyzed, by flow cytometry, the distribution of cTfh1 (CXCR3+CCR6-), cTfh2 (CXCR3-CCR6-), cTfh17 (CXCR3-CCR6+), and the recently described cTfh17.1 (CXCR3+CCR6+) subpopulations of CD4+ Tfh (CD45RA-CXCR5+) cells in a cohort of 29 untreated RRMS compared to healthy subjects. CD4+ non-follicular T helper (Th) cells (CD45RA-CXCR5-) were also studied. We also evaluated the effect of DMF treatment on these subpopulations after 6 and 12 months treatment. Untreated RRMS patients presented higher percentages of cTfh17.1 cells and lower percentages of cTfh2 cells consistent with a pro-inflammatory bias compared to healthy subjects. DMF treatment induced a progressive increase in cTfh2 cells, accompanied by a decrease in cTfh1 and the pathogenic cTfh17.1 cells. A similar decrease of non-follicular Th1 and Th17.1 cells in addition to an increase in the anti-inflammatory Th2 subpopulation were also detected upon DMF treatment, accompanied by an increase in naïve B cells and a decrease in switched memory B cells and serum levels of IgA, IgG2, and IgG3. Interestingly, this effect was not observed in three patients in whom DMF had to be discontinued due to an absence of clinical response. Our results demonstrate a possibly pathogenic cTfh pro-inflammatory profile in RRMS patients, defined by high cTfh17.1 and low cTfh2 subpopulations that is reverted by DMF treatment. Monitoring cTfh subsets during treatment may become a biological marker of DMF effectiveness.
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Affiliation(s)
- Vanesa Cunill
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Margarita Massot
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Antonio Clemente
- Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain.,Clinical Trials and Methodology Support Platform, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Carmen Calles
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Valero Andreu
- Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Vanessa Núñez
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Antonio López-Gómez
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Rosa María Díaz
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - María de Los Reyes Jiménez
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Jaime Pons
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Cristòfol Vives-Bauzà
- Research Unit, Institut d'Investigació Sanitària de les Illes Balears and Hospital Universitari Son Espases, Palma, Spain
| | - Joana Maria Ferrer
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
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Dimethyl fumarate induces a persistent change in the composition of the innate and adaptive immune system in multiple sclerosis patients. Sci Rep 2018; 8:8194. [PMID: 29844361 PMCID: PMC5974280 DOI: 10.1038/s41598-018-26519-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
The effects of dimethyl fumarate (DMF) on the immune system in multiple sclerosis (MS) are not completely elucidated. In this study, an extensive immunophenotypic analysis of innate and adaptive immune cells of DMF-treated MS patients was performed. Peripheral blood immune cell phenotypes were determined using flow cytometry in a follow-up study of 12 MS patients before, after 3 and 12 months of DMF treatment and a cross-sectional study of 25 untreated and 64 DMF-treated MS patients. Direct effects of DMF on B cells were analyzed in vitro. After 12 months of DMF treatment, percentages of monocytes, natural killer cells, naive T and B cells and transitional B cells increased. Percentages of (effector) memory T cells, (non) class-switched memory B cells and double negative B cells decreased together with CD4+ T cells expressing interferon-γ (IFN-γ), granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-17 (IL-17). DMF treatment was fully effective as of 6 months and directly induced apoptosis and decreased expression of costimulatory CD40, antigen presentation molecule MHCII and B cell activating factor receptor (BAFFR) on B cells. DMF induced a persistent change of the immune system of MS patients, directly induced apoptosis and reduced expression of functional markers on B cells.
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87
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Dimethyl fumarate downregulates the immune response through the HCA 2/GPR109A pathway: Implications for the treatment of multiple sclerosis. Mult Scler Relat Disord 2018; 23:46-50. [PMID: 29763776 DOI: 10.1016/j.msard.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/02/2018] [Accepted: 04/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms of action of dimethyl fumarate (DMF), and its metabolite, monomethyl fumarate (MMF), for the treatment of multiple sclerosis are not completely elucidated. OBJECTIVES To discuss the role of DMF/MMF-induced hydroxycarboxylic acid receptor 2 (HCA2/GPR109A) pathway activation in the immune response and treatment of MS. METHODS A narrative (traditional) review of the current literature. RESULTS Studies have shown that binding of DMF/MMF to HCA2 on dendritic cells inhibits the production of pro-inflammatory cytokines in vitro and in MS murine models. Evidence suggests that activation of HCA2 expressed in immune cells and gut epithelial cells by DMF/MMF, may induce anti-inflammatory responses in the intestinal mucosa. CONCLUSION Although the DMF/MMF mechanism of action remains unclear, evidence suggests that the activation of HCA2/GPR109A pathway downregulates the immune response and may activate anti-inflammatory response in the intestinal mucosa, possibly leading to reduction in CNS tissue damage in MS patients.
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88
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Brück J, Dringen R, Amasuno A, Pau-Charles I, Ghoreschi K. A review of the mechanisms of action of dimethylfumarate in the treatment of psoriasis. Exp Dermatol 2018; 27:611-624. [DOI: 10.1111/exd.13548] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jürgen Brück
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - Ralf Dringen
- Faculty 2 (Biology/Chemistry); Center for Biomolecular Interactions Bremen; University of Bremen; Bremen Germany
- Center for Environmental Research and Sustainable Technology; University of Bremen; Bremen Germany
| | | | | | - Kamran Ghoreschi
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
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89
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Hammer A, Waschbisch A, Kuhbandner K, Bayas A, Lee DH, Duscha A, Haghikia A, Gold R, Linker RA. The NRF2 pathway as potential biomarker for dimethyl fumarate treatment in multiple sclerosis. Ann Clin Transl Neurol 2018; 5:668-676. [PMID: 29928650 PMCID: PMC5989754 DOI: 10.1002/acn3.553] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/29/2018] [Accepted: 02/17/2018] [Indexed: 12/11/2022] Open
Abstract
Objective Immunological studies have demonstrated a plethora of beneficial effects of dimethyl fumarate (DMF) on various cell types. However, the cellular and molecular targets are incompletely understood and response markers are scarce. Here, we focus on the relation between nuclear factor (erythroid‐derived 2)‐like 2 (NRF2) pathway induction under DMF therapy and the composition of the blood immune cell compartment and clinical efficacy in relapsing‐remitting multiple sclerosis (MS) patients. Methods We explored effects of DMF on peripheral immune cell subsets by flow cytometric and transcriptional analysis of serial blood samples obtained from 43 MS patients during the first year of therapy. Results Gene expression analysis proved activation of NRF2 signaling under DMF therapy that was paralleled by a temporal expansion of FoxP3+ regulatory T cells, CD56bright natural killer cells, plasmacytoid dendritic cells, and a decrease in CD8+ T cells, B cells, and type 1 myeloid dendritic cells. In a subgroup of 28 patients with completely available clinical data, individuals with higher levels of the NRF2 target gene NAD(P)H quinone dehydrogenase 1 (NQO1) 4–6 weeks after DMF therapy initiation were more likely to achieve no evidence of disease activity status 1 year later. The degree of NQO1 induction further correlated with patient age. Interpretation We demonstrate that positive effects of DMF on the clinical outcome are paralleled by induction of the antioxidant NRF2 transcriptional pathway and a shift toward regulatory immune cell subsets in the periphery. Our data identify a role of the NRF2 pathway as potential biomarker for DMF treatment in MS.
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Affiliation(s)
- Anna Hammer
- Department of Neurology University Hospital Erlangen Friedrich-Alexander-University Erlangen-Nürnberg Erlangen 91054 Germany
| | - Anne Waschbisch
- Department of Neurology University Hospital Erlangen Friedrich-Alexander-University Erlangen-Nürnberg Erlangen 91054 Germany.,Present address: Department of Neurology University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Aachen 52074 Germany
| | - Kristina Kuhbandner
- Department of Neurology University Hospital Erlangen Friedrich-Alexander-University Erlangen-Nürnberg Erlangen 91054 Germany
| | - Antonios Bayas
- Department of Neurology Hospital Augsburg Augsburg 86156 Germany
| | - De-Hyung Lee
- Department of Neurology University Hospital Erlangen Friedrich-Alexander-University Erlangen-Nürnberg Erlangen 91054 Germany
| | - Alexander Duscha
- Department of Neurology Ruhr-University Bochum Bochum 44791 Germany
| | - Aiden Haghikia
- Department of Neurology Ruhr-University Bochum Bochum 44791 Germany
| | - Ralf Gold
- Department of Neurology Ruhr-University Bochum Bochum 44791 Germany
| | - Ralf A Linker
- Department of Neurology University Hospital Erlangen Friedrich-Alexander-University Erlangen-Nürnberg Erlangen 91054 Germany
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90
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Kornberg MD, Bhargava P, Kim PM, Putluri V, Snowman AM, Putluri N, Calabresi PA, Snyder SH. Dimethyl fumarate targets GAPDH and aerobic glycolysis to modulate immunity. Science 2018; 360:449-453. [PMID: 29599194 DOI: 10.1126/science.aan4665] [Citation(s) in RCA: 434] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 01/29/2018] [Accepted: 03/15/2018] [Indexed: 12/27/2022]
Abstract
Activated immune cells undergo a metabolic switch to aerobic glycolysis akin to the Warburg effect, thereby presenting a potential therapeutic target in autoimmune disease. Dimethyl fumarate (DMF), a derivative of the Krebs cycle intermediate fumarate, is an immunomodulatory drug used to treat multiple sclerosis and psoriasis. Although its therapeutic mechanism remains uncertain, DMF covalently modifies cysteine residues in a process termed succination. We found that DMF succinates and inactivates the catalytic cysteine of the glycolytic enzyme glyceraldehyde 3-phosphate dehydrogenase (GAPDH) in mice and humans, both in vitro and in vivo. It thereby down-regulates aerobic glycolysis in activated myeloid and lymphoid cells, which mediates its anti-inflammatory effects. Our results provide mechanistic insight into immune modulation by DMF and represent a proof of concept that aerobic glycolysis is a therapeutic target in autoimmunity.
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Affiliation(s)
- Michael D Kornberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Pavan Bhargava
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Paul M Kim
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Vasanta Putluri
- Advanced Technology Core, Baylor College of Medicine, Houston, TX 77030, USA
| | - Adele M Snowman
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nagireddy Putluri
- Advanced Technology Core, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Solomon H Snyder
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. .,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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91
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Grebenciucova E, Berger JR. Immunosenescence: the Role of Aging in the Predisposition to Neuro-Infectious Complications Arising from the Treatment of Multiple Sclerosis. Curr Neurol Neurosci Rep 2018; 17:61. [PMID: 28669032 DOI: 10.1007/s11910-017-0771-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This review highlights some of the important changes in the immune system that occur in the process of normal aging. Immunosenescence as a concept is directly relevant to the world of neuro-inflammation, as it may be a contributing factor to the risks associated with some of the current immunosuppressive and immunomodulatory therapies used in treating multiple sclerosis (MS) and other inflammatory disorders. RECENT FINDINGS Profound qualitative and quantitative changes occur in the adaptive and innate immunity compartments during aging. These changes may explain why patients of older age are at an increased risk of infections and infection-associated mortality. Immunosenescence-associated changes may be additive or synergistic with the effects produced by immunomodulatory and immunosuppressive medications. Clinicians should exercise a high level of vigilance in monitoring the risk of infections in older patients on these treatments.
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Affiliation(s)
- Elena Grebenciucova
- Multiple Sclerosis Division, The Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, 3400 Convention Avenue, Philadelphia, PA, 19104, USA.
| | - Joseph R Berger
- Multiple Sclerosis Division, The Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, 3400 Convention Avenue, Philadelphia, PA, 19104, USA
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92
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Zivadinov R, Hagemeier J, Bergsland N, Tavazzi E, Weinstock‐Guttman B. Effect of dimethyl fumarate on gray and white matter pathology in subjects with relapsing multiple sclerosis: a longitudinal study. Eur J Neurol 2018; 25:584-e36. [DOI: 10.1111/ene.13562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- R. Zivadinov
- Department of Neurology Buffalo Neuroimaging Analysis Center Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
- Translational Imaging Center at Clinical and Translational Science Institute Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
| | - J. Hagemeier
- Department of Neurology Buffalo Neuroimaging Analysis Center Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
| | - N. Bergsland
- Department of Neurology Buffalo Neuroimaging Analysis Center Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
| | - E. Tavazzi
- Department of Neurology Buffalo Neuroimaging Analysis Center Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
| | - B. Weinstock‐Guttman
- Department of Neurology Jacobs Comprehensive MS Treatment and Research Center Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NY USA
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93
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Mills EA, Mao-Draayer Y. Understanding Progressive Multifocal Leukoencephalopathy Risk in Multiple Sclerosis Patients Treated with Immunomodulatory Therapies: A Bird's Eye View. Front Immunol 2018; 9:138. [PMID: 29456537 PMCID: PMC5801425 DOI: 10.3389/fimmu.2018.00138] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
The increased use of newer potent immunomodulatory therapies for multiple sclerosis (MS), including natalizumab, fingolimod, and dimethyl fumarate, has expanded the patient population at risk for developing progressive multifocal leukoencephalopathy (PML). These MS therapies shift the profile of lymphocytes within the central nervous system (CNS) leading to increased anti-inflammatory subsets and decreased immunosurveillance. Similar to MS, PML is a demyelinating disease of the CNS, but it is caused by the JC virus. The manifestation of PML requires the presence of an active, genetically rearranged form of the JC virus within CNS glial cells, coupled with the loss of appropriate JC virus-specific immune responses. The reliability of metrics used to predict risk for PML could be improved if all three components, i.e., viral genetic strain, localization, and host immune function, were taken into account. Advances in our understanding of the critical lymphocyte subpopulation changes induced by these MS therapies and ability to detect viral mutation and reactivation will facilitate efforts to develop these metrics.
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Affiliation(s)
- Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States.,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
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94
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Smith MD, Calabresi PA, Bhargava P. Dimethyl fumarate treatment alters NK cell function in multiple sclerosis. Eur J Immunol 2018; 48:380-383. [PMID: 29108094 PMCID: PMC7577262 DOI: 10.1002/eji.201747277] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/10/2017] [Accepted: 11/02/2017] [Indexed: 01/08/2023]
Abstract
Dimethyl fumarate (DMF) treatment in multiple sclerosis (MS) increased the proportion of immunoregulatory CD56bright NK cells and this change was proportional to reductions in CD8+ memory T cells. DMF and monomethyl fumarate (MMF) treatment in vitro had directs effects on NK cells and promoted degranulation and cytotoxicity.
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Affiliation(s)
- Matthew D Smith
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MD, USA
| | - Pavan Bhargava
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MD, USA
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95
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Mills EA, Ogrodnik MA, Plave A, Mao-Draayer Y. Emerging Understanding of the Mechanism of Action for Dimethyl Fumarate in the Treatment of Multiple Sclerosis. Front Neurol 2018; 9:5. [PMID: 29410647 PMCID: PMC5787128 DOI: 10.3389/fneur.2018.00005] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023] Open
Abstract
Dimethyl fumarate (DMF) is an effective treatment option for relapsing-remitting multiple sclerosis (MS), but its therapeutic mechanism of action has not been fully elucidated. A better understanding of its mechanism will allow for the development of assays to monitor its clinical efficacy and safety in patients, as well as guide the development of the next generation of therapies for MS. In order to build the foundation for determining its mechanism, we reviewed the manner in which DMF alters lymphocyte subsets in MS patients, its impact on clinical efficacy and safety, as well as its molecular effects in cellular and animal models. DMF decreases absolute lymphocyte counts, but does not affect all subsets uniformly. CD8+ T-cells are the most profoundly affected, but reduction also occurs in the CD4+ population, particularly within the pro-inflammatory T-helper Th1 and Th17 subsets, creating a bias toward more anti-inflammatory Th2 and regulatory subsets. Similarly, B-lymphocyte, myeloid, and natural killer populations are also shifted toward a more anti-inflammatory state. In vitro and animal models demonstrate a role for DMF within the central nervous system (CNS) in promoting neuronal survival in an Nrf2 pathway-dependent manner. However, the impact of DMF directly within the CNS of MS patients remains largely unknown.
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Affiliation(s)
- Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Magdalena A Ogrodnik
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Andrew Plave
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States.,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
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96
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Mrowietz U, Morrison PJ, Suhrkamp I, Kumanova M, Clement B. The Pharmacokinetics of Fumaric Acid Esters Reveal Their In Vivo Effects. Trends Pharmacol Sci 2018; 39:1-12. [DOI: 10.1016/j.tips.2017.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022]
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97
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The influence and impact of ageing and immunosenescence (ISC) on adaptive immunity during multiple sclerosis (MS) and the animal counterpart experimental autoimmune encephalomyelitis (EAE). Ageing Res Rev 2018; 41:64-81. [PMID: 29101043 DOI: 10.1016/j.arr.2017.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022]
Abstract
The human ageing process encompasses mechanisms that effect a decline in homeostasis with increased susceptibility to disease and the development of chronic life-threatening illness. Increasing age affects the immune system which undergoes a progressive loss of efficiency, termed immunosenescence (ISC), to impact on quantitative and functional aspects of innate and adaptive immunity. The human demyelinating disease multiple sclerosis (MS) and the corresponding animal model experimental autoimmune encephalomyelitis (EAE) are strongly governed by immunological events that primarily involve the adaptive arm of the immune response. MS and EAE are frequently characterised by a chronic pathology and a protracted disease course which thereby creates the potential for exposure to the inherent, on-going effects and consequences of ISC. Collective evidence is presented to confirm the occurrence of established and unendorsed biological markers of ISC during the development of both diseases. Moreover, results are discussed from studies during the course of MS and EAE that reveal a premature upregulation of ISC-related biomarkers which indicates untimely alterations to the adaptive immune system. The effects of ISC and a prematurely aged immune system on autoimmune-associated neurodegenerative conditions such as MS and EAE are largely unknown but current evaluation of data justifies and encourages further investigation.
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98
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Nakhaei-Nejad M, Barilla D, Lee CH, Blevins G, Giuliani F. Characterization of lymphopenia in patients with MS treated with dimethyl fumarate and fingolimod. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e432. [PMID: 29296636 PMCID: PMC5746425 DOI: 10.1212/nxi.0000000000000432] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/03/2017] [Indexed: 01/08/2023]
Abstract
Objective: Lymphopenia is a common occurrence of disease-modifying therapies (DMTs) for relapsing-remitting MS (RRMS). The aim of this study was to dissect the prevalence of various lymphocyte subsets in patients with RRMS treated with 2 DMTs commonly associated with lymphopenia, dimethyl fumarate (DMF), and fingolimod (FTY). Methods: Multicolor flow cytometry and multiplex assays were used to identify up to 50 lymphocyte subpopulations and to examine the expression of multiple cytokines in selected patients. We compared patients untreated (NT) or treated with FTY or DMF who did (DMF-L) or did not (DMF-N) develop lymphopenia. Results: All FTY patients developed lymphopenia in both T-cell and B-cell compartments. CD41 T cells were more affected by this treatment than CD81 cells. In the B-cell compartment, the CD271IgD2 subpopulation was reduced. T cells but not B cells were significantly reduced in DMF-L. However, within the B cells, CD271 cells were significantly lower. Both CD41 and CD81 subpopulations were reduced in DMF-L. Within the remaining CD41 and CD81 compartments, there was an expansion of the naive subpopulation and a reduction of the effector memory subpopulation. Unactivated lymphocyte from DMF-L patients had significantly higher levels of interferon-γ, interleukin (IL)-12, IL-2, IL-4, IL-6, and IL-1β compared with DMF-N. In plasma, TNFβ was significantly higher in DMF-N and DMF-L compared with NT, whereas CCL17 was significantly higher in DMF-L compared with NT and DMF-N. Conclusions: This study shows that different treatments can target different lymphocyte compartments and suggests that lymphopenia can induce compensatory mechanisms to maintain immune homeostasis.
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Affiliation(s)
- Maryam Nakhaei-Nejad
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - David Barilla
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chieh-Hsin Lee
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gregg Blevins
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Fabrizio Giuliani
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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99
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Baharnoori M, Gonzalez CT, Chua A, Diaz-Cruz C, Healy BC, Stankiewicz J, Weiner HL, Chitnis T. Predictors of hematological abnormalities in multiple sclerosis patients treated with fingolimod and dimethyl fumarate and impact of treatment switch on lymphocyte and leukocyte count. Mult Scler Relat Disord 2017; 20:51-57. [PMID: 29304497 DOI: 10.1016/j.msard.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/04/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is limited data regarding the predictors of hematological abnormalities in multiple sclerosis (MS) patients treated with dimethyl fumarate (DMF) or fingolimod (FNG), and the impact of treatment switch on lymphocyte and leukocyte count METHODS: We identified 405 patients on DMF and 300 patients on FNG (treatment duration: at least 12 month) within a large prospective study of MS patients conducted at the Partners MS Center, Brigham and Women's Hospital (CLIMB study) between Jan 2011 to Feb 2016. Patients had complete blood counts with differentials at baseline and every 6 months while on treatment. Most participants had a clinical visit with complete neurologic examinations every 6 months and brain MRI scan every 12 months. T cell subset profile was available for subgroup of patients (n = 116). RESULTS In the FNG group, the risk of developing lymphopenia grade 4 (< 200) was higher in female patients (p = 0.0117) and those who were previously treated with natalizumab (p = 0.0116), while the risk of lymphopenia grade 3b+4 (< 350) was higher in female patients (p = 0.0009). DMF treated patients with lower baseline lymphocyte count had a higher chance of developing lymphopenia grade 2 (< 800) (p < 0.0001) or 2+3 (< 500) (p < 0.0001). We examined the effect of treatment switch between DMF and FNG. No significant recovery in lymphocyte and leukocyte count was observed after treatment switches. Reduced dosing of FNG in patients with lymphopenia led to increase in lymphocyte count but also increased disease activity in 25% of patients. CONCLUSION Female sex and prior exposure to natalizumab increased the probability of lymphopenia on FNG, while low absolute lymphocyte count was associated with increased risk of lymphopenia on DMF. Parallel switch did not lead to recovery from hematological abnormalities. Long-term studies with larger number of patients are required to confirm our findings and to establish guidelines for prediction and management of hematological abnormalities.
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Affiliation(s)
- M Baharnoori
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - C T Gonzalez
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - A Chua
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - C Diaz-Cruz
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - B C Healy
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - J Stankiewicz
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - H L Weiner
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States
| | - T Chitnis
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Brookline, Boston, MA United States.
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100
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Calabrese M, Pitteri M, Farina G, Bajrami A, Castellaro M, Magliozzi R, Monaco S. Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events. J Neurol Neurosurg Psychiatry 2017; 88:1073-1078. [PMID: 28844068 DOI: 10.1136/jnnp-2017-316236] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/08/2017] [Accepted: 08/06/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Among disease-modifying treatments for multiple sclerosis, natalizumab (NTZ) is highly effective, well tolerated and generally safe. Major concerns regard the risk of developing progressive multifocal leukoencephalopathy (PML), and the occurrence of rebounds or disease activity after its discontinuation. The aim of this study was to explore the efficacy of dimethyl fumarate (DMF) in preventing disease reactivation after NTZ discontinuation. METHODS Thirty-nine patients with relapsing remitting multiple sclerosis, at high risk of PML, were switched from NTZ to DMF and underwent neurological and 3T MRI monitoring for 2 years. Clinical and MRI data regarding the 2-year period preceding NTZ treatment, the 2 years of NTZ treatment and the 2 years of DMF were collected. RESULTS During the DMF phase, among the 39 patients, one or more relapses occurred in five patients (12.8%), increased disability progression in 4 (10.3%) and MRI activity in 8 (20.5%). Post-NTZ rebound effect was observed only in one patient. Overall, only two dropouts (one rebound activity and one gastrointestinal side effect) were registered and almost 80% of the patients have still no evidence of disease activity at the end of DMF treatment. The multiple linear regression model revealed that the number of relapses and MRI parameters before DMF treatment were good predictors of disease activity during treatment with DMF. DISCUSSION DMF appeared generally safe and no carryover PML among investigated cases was observed. Although DMF did not eliminate the possibility of disease reactivation, it seems anyway a promising drug for those patients who shall discontinue NTZ. The clinical and radiological activity preceding the DMF treatment might be used as a prognostic marker of therapy response.
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Affiliation(s)
- Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Marco Pitteri
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Gabriele Farina
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Albulena Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Roberta Magliozzi
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy.,Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Salvatore Monaco
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
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