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Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease with a complex clinical course characterized by inflammation, demyelination, and axonal degeneration. Diagnosis of MS most commonly includes finding lesions in at least two separate areas of the central nervous system (CNS), including the brain, spinal cord, and optic nerves. In recent years, there has been a remarkable increase in the number of available treatments for MS. An optimal treatment is usually based on a personalized approach determined by an individual patient's prognosis and treatment risks. Biomarkers that can predict disability progression, monitor ongoing disease activity, and assess treatment response are integral in making important decisions regarding MS treatment. This review describes MS biomarkers that are currently being used in clinical practice; it also reviews and consolidates published findings from clinically relevant potential MS biomarkers in recent years. The work also discusses the challenges of validating and application of biomarkers in MS clinical practice.
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Affiliation(s)
- Anu Paul
- Department of Neurology, Ann Romney Center for Neurological Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | - Manuel Comabella
- Department of Neurology, MS Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Roopali Gandhi
- Department of Neurology, Ann Romney Center for Neurological Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115
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102
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Zhang Y, Salter A, Wallström E, Cutter G, Stüve O. Evolution of clinical trials in multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419826547. [PMID: 30833985 PMCID: PMC6391540 DOI: 10.1177/1756286419826547] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/17/2018] [Indexed: 01/08/2023] Open
Abstract
Clinical trials have advanced the treatment of multiple sclerosis (MS) by demonstrating the safety and efficacy of disease-modifying therapies (DMTs). This review discusses major changes to MS clinical trials in the era of DMTs. As treatment options for MS continue to increase, patients in modern MS trials present earlier and with milder disease compared with historic MS populations. While placebo-controlled trials for some questions may still be relevant, DMT trials in relapsing–remitting MS (RRMS) are no longer ethical. The replacement of the placebo arm by an active comparator arm in trials have raised the cost of trials by requiring larger sample sizes to detect on-study changes in treatment effects. Efforts to improve trial efficiency in RRMS have focused on exploring adaptive designs and relying on sensitive magnetic resonance imaging measures of disease activity. In trials for progressive forms of MS (PMS), the lack of sensitive outcome measures that can be used in shorter-term trials have delayed the development of effective treatments. Recent shifting of the focus to advancing trials in PMS has identified paraclinical outcome measurements with improved potential, and the testing of agents for neuroprotection and remyelination is in progress.
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Affiliation(s)
- Yinan Zhang
- Department of Neurology and Neurotherapeutics, the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Erik Wallström
- Sanofi Genzyme, Neuro and Gene Therapy, Cambridge, MA, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olaf Stüve
- Neurology Section, VA North Texas Health Care System, Medical Service, 4500 South Lancaster Rd., Dallas, TX 75216, USADepartment of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
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103
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Magro-Checa C, Steup-Beekman GM, Huizinga TW, van Buchem MA, Ronen I. Laboratory and Neuroimaging Biomarkers in Neuropsychiatric Systemic Lupus Erythematosus: Where Do We Stand, Where To Go? Front Med (Lausanne) 2018; 5:340. [PMID: 30564579 PMCID: PMC6288259 DOI: 10.3389/fmed.2018.00340] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 01/18/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-systemic involvement. Nervous system involvement in SLE leads to a series of uncommon and heterogeneous neuropsychiatric (NP) manifestations. Current knowledge on the underlying pathogenic processes and their subsequent pathophysiological changes leading to NP-SLE manifestations is incomplete. Several putative laboratory biomarkers have been proposed as contributors to the genesis of SLE-related nervous system damage. Alongside the laboratory biomarkers, several neuroimaging tools have shown to reflect the nature of tissue microstructural damage associated with SLE, and thus were suggested to contribute to the understanding of the pathophysiological changes and subsequently help in clinical decision making. However, the number of useful biomarkers in NP-SLE in clinical practice is disconcertingly modest. In some cases it is not clear whether the biomarker is truly involved in pathogenesis, or the result of non-specific pathophysiological changes in the nervous system (e.g., neuroinflammation) or whether it is the consequence of a concomitant underlying abnormality related to SLE activity. In order to improve the diagnosis of NP-SLE and provide a better targeted care to these patients, there is still a need to develop and validate a range of biomarkers that reliably capture the different aspects of disease heterogeneity. This article critically reviews the current state of knowledge on laboratory and neuroimaging biomarkers in NP-SLE, discusses the factors that need to be addressed to make these biomarkers suitable for clinical application, and suggests potential future research paths to address important unmet needs in the NP-SLE field.
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Affiliation(s)
- César Magro-Checa
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Tom W Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
| | - Itamar Ronen
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
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104
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Quirant‐Sánchez B, Hervás‐García JV, Teniente‐Serra A, Brieva L, Moral‐Torres E, Cano A, Munteis E, Mansilla MJ, Presas‐Rodriguez S, Navarro‐Barriuso J, Ramo‐Tello C, Martínez‐Cáceres EM. Predicting therapeutic response to fingolimod treatment in multiple sclerosis patients. CNS Neurosci Ther 2018; 24:1175-1184. [PMID: 29656444 PMCID: PMC6489963 DOI: 10.1111/cns.12851] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Fingolimod, an orally active immunomodulatory drug for relapsing-remitting multiple sclerosis (RRMS), sequesters T cells in lymph nodes through functional antagonism of the sphingosine-1-phosphate receptor, reducing the number of potential autoreactive cells that migrate to the central nervous system. However, not all RRMS patients respond to this therapy. Our aim was to test the hypothesis that by immune-monitoring RRMS patient's leukocyte subpopulations it is possible to find biomarkers associated with clinical response to fingolimod. METHODS Prospective study. Analysis of peripheral blood mononuclear cell subpopulations by multiparametric flow cytometry, at baseline and +1, +3, +6, +12 months of follow-up in 40 RRMS patients starting fingolimod therapy. RESULTS Fingolimod treatment induced a severe lymphopenia affecting mainly T and B cells. A relative increase in Treg (memory Treg : 3.8 ± 1.0% baseline vs 8.8 ± 4.4% month +1; activated Treg : 1.5 ± 0.7% baseline vs 3.7 ± 2.1% month +1, P < 0.001) as well as transitional B cells (10.5 ± 12.3% baseline vs 18.7 ± 14.6% month +1, P < 0.001) was observed. Interestingly, lymphocyte subpopulations were already at baseline significantly different in responder patients. The percentage of recent thymic emigrants (RTE) used to stratify fingolimod responder, and no responder patients was the best biomarker (4.0 ± 1.4% vs 7.4 ± 1.9%, respectively [P < 0.001]). CONCLUSION The results support that immune-monitoring of lymphocyte subpopulations in peripheral blood is a promising tool to select RRMS candidate for fingolimod treatment.
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Affiliation(s)
- Bibiana Quirant‐Sánchez
- Immunology DivisionGermans Trias i Pujol University Hospital and Research InstituteBarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - José V. Hervás‐García
- Multiple Sclerosis UnitDepartment of NeurosciencesGermans Trias i Pujol University HospitalBarcelonaSpain
| | - Aina Teniente‐Serra
- Immunology DivisionGermans Trias i Pujol University Hospital and Research InstituteBarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Luis Brieva
- Neurology Department of Hospital Arnau VilanovaLeridaSpain
| | - Ester Moral‐Torres
- Neurology Department of Hospital San Joan Despi Moises BroggiBarcelonaSpain
| | - Antonio Cano
- Neurology Department of Hospital de MataróBarcelonaSpain
| | | | - María J. Mansilla
- Immunology DivisionGermans Trias i Pujol University Hospital and Research InstituteBarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Silvia Presas‐Rodriguez
- Multiple Sclerosis UnitDepartment of NeurosciencesGermans Trias i Pujol University HospitalBarcelonaSpain
| | - Juan Navarro‐Barriuso
- Immunology DivisionGermans Trias i Pujol University Hospital and Research InstituteBarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Cristina Ramo‐Tello
- Multiple Sclerosis UnitDepartment of NeurosciencesGermans Trias i Pujol University HospitalBarcelonaSpain
| | - Eva M. Martínez‐Cáceres
- Immunology DivisionGermans Trias i Pujol University Hospital and Research InstituteBarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBarcelonaSpain
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105
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Malmegrim KCR, Lima-Júnior JR, Arruda LCM, de Azevedo JTC, de Oliveira GLV, Oliveira MC. Autologous Hematopoietic Stem Cell Transplantation for Autoimmune Diseases: From Mechanistic Insights to Biomarkers. Front Immunol 2018; 9:2602. [PMID: 30505303 PMCID: PMC6250746 DOI: 10.3389/fimmu.2018.02602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022] Open
Abstract
Phase I/II clinical trials of autologous hematopoietic stem cell transplantation (AHSCT) have led to increased safety and efficacy of this therapy for severe and refractory autoimmune diseases (AD). Recent phase III randomized studies have demonstrated that AHSCT induces long-term disease remission in most patients without any further immunosuppression, with superior efficacy when compared to conventional treatments. Immune monitoring studies have revealed the regeneration of a self-tolerant T and B cell repertoire, enhancement of immune regulatory mechanisms, and changes toward an anti-inflammatory milieu in patients that are responsive to AHSCT. However, some patients reactivate the disease after transplantation due to reasons not yet completely understood. This scenario emphasizes that additional specific immunological interventions are still required to improve or sustain therapeutic efficacy of AHSCT in patients with AD. Here, we critically review the current knowledge about the operating immune mechanisms or established mechanistic biomarkers of AHSCT for AD. In addition, we suggest recommendations for future immune monitoring studies and biobanking to allow discovery and development of biomarkers. In our view, AHSCT for AD has entered a new era and researchers of this field should work to identify robust predictive, prognostic, treatment-response biomarkers and to establish new guidelines for immune monitoring studies and combined therapeutic interventions to further improve the AHSCT protocols and their therapeutic efficacy.
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Affiliation(s)
- Kelen Cristina Ribeiro Malmegrim
- Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Hemotherapy Center of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Rodrigues Lima-Júnior
- Center for Cell-based Therapy, Regional Hemotherapy Center of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Biosciences Applied to Pharmacy Program, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Coelho Marlière Arruda
- Division of Rheumatology, Allergy, Immunology and Immunotherapy, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Júlia Teixeira Cottas de Azevedo
- Division of Rheumatology, Allergy, Immunology and Immunotherapy, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Basic and Applied Immunology Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gislane Lelis Vilela de Oliveira
- São Paulo State University (UNESP), Institute of Biosciences, Humanities and Exact Sciences (IBILCE), São Jose do Rio Preto, São Paulo, Brazil
| | - Maria Carolina Oliveira
- Center for Cell-based Therapy, Regional Hemotherapy Center of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Division of Rheumatology, Allergy, Immunology and Immunotherapy, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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106
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Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing-remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Fondation Eugène Devic EDMUS Contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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107
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Relevance of KFLC quantification to differentiate clinically isolated syndrome from multiple sclerosis at clinical onset. Clin Neurol Neurosurg 2018; 174:220-229. [DOI: 10.1016/j.clineuro.2018.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/13/2018] [Accepted: 09/22/2018] [Indexed: 11/22/2022]
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108
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Peeters LM, van Munster CE, Van Wijmeersch B, Bruyndonckx R, Lamers I, Hellings N, Popescu V, Thalheim C, Feys P. Multidisciplinary data infrastructures in multiple sclerosis: Why they are needed and can be done! Mult Scler 2018; 25:500-509. [PMID: 30381984 DOI: 10.1177/1352458518807076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Personalized treatment is highly desirable in multiple sclerosis (MS). We believe that multidisciplinary measurements including clinical, functional and patient-reported outcome measures in combination with extensive patient profiling can enhance personalized treatment and rehabilitation strategies. We elaborate on four reasons behind this statement: (1) MS disease activity and progression are complex and multidimensional concepts in nature and thereby defy a one-size-fits-all description, (2) functioning, progression, treatment, and rehabilitation effects are interdependent and should be investigated together, (3) personalized healthcare is based on the dynamics of system biology and on technology that confirms a patient's fundamental biology and (4) inclusion of patient-reported outcome measures can facilitate patient-relevant healthcare. We discuss currently available multidisciplinary MS data initiatives and introduce joint actions to further increase the overall success. With this topical review, we hope to drive the MS community to invest in expanding towards more multidisciplinary and longitudinal data collection.
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Affiliation(s)
| | | | - Bart Van Wijmeersch
- Department of Neurology, Biomedical Research Institute, Hasselt University, Hasselt, Belgium/Rehabilitation & MS Center, Overpelt, Belgium
| | - Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium/Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Ilse Lamers
- Department of Neurology, Biomedical Research Institute, Hasselt University, Hasselt, Belgium/Rehabilitation & MS Center, Overpelt, Belgium
| | - Niels Hellings
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Veronica Popescu
- Department of Neurology, Biomedical Research Institute, Hasselt University, Hasselt, Belgium/Rehabilitation & MS Center, Overpelt, Belgium
| | - Christoph Thalheim
- External Affairs, European Multiple Sclerosis Platform, Brussels, Belgium
| | - Peter Feys
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
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109
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Tahedl M, Levine SM, Greenlee MW, Weissert R, Schwarzbach JV. Functional Connectivity in Multiple Sclerosis: Recent Findings and Future Directions. Front Neurol 2018; 9:828. [PMID: 30364281 PMCID: PMC6193088 DOI: 10.3389/fneur.2018.00828] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023] Open
Abstract
Multiple sclerosis is a debilitating disorder resulting from scattered lesions in the central nervous system. Because of the high variability of the lesion patterns between patients, it is difficult to relate existing biomarkers to symptoms and their progression. The scattered nature of lesions in multiple sclerosis offers itself to be studied through the lens of network analyses. Recent research into multiple sclerosis has taken such a network approach by making use of functional connectivity. In this review, we briefly introduce measures of functional connectivity and how to compute them. We then identify several common observations resulting from this approach: (a) high likelihood of altered connectivity in deep-gray matter regions, (b) decrease of brain modularity, (c) hemispheric asymmetries in connectivity alterations, and (d) correspondence of behavioral symptoms with task-related and task-unrelated networks. We propose incorporating such connectivity analyses into longitudinal studies in order to improve our understanding of the underlying mechanisms affected by multiple sclerosis, which can consequently offer a promising route to individualizing imaging-related biomarkers for multiple sclerosis.
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Affiliation(s)
- Marlene Tahedl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Seth M. Levine
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Mark W. Greenlee
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jens V. Schwarzbach
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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110
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Hussein AA, Forouzanfar T, Bloemena E, de Visscher J, Brakenhoff RH, Leemans CR, Helder MN. A review of the most promising biomarkers for early diagnosis and prognosis prediction of tongue squamous cell carcinoma. Br J Cancer 2018; 119:724-736. [PMID: 30131545 PMCID: PMC6173763 DOI: 10.1038/s41416-018-0233-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is a great interest in developing biomarkers to enhance early detection and clinical management of tongue squamous cell carcinoma (TSCC). However, the developmental path towards a clinically valid biomarker remains extremely challenging. Ideally, the initial key step in moving a newly discovered biomarker towards clinical implementation is independent replication. Therefore, the focus of this review is on biomarkers that consistently showed clinical relevance in two or more publications. METHODS We searched PubMed database for relevant papers across different TSCC sample sources, i.e., body fluids (saliva, serum/plasma) and tissues. No restriction regarding the date of publication was applied except for immunohistochemistry (IHC); only studies published between 2010 and June 2017 were included. RESULTS The search strategy identified 1429 abstracts, of which 96 papers, examining 150 biomarkers, were eventually included. Of these papers, 66% were exploratory studies evaluating single or a panel of biomarkers in one publication. Ultimately, based on studies that had undergone validation for their clinical relevance in at least two independent studies, we identified 10 promising candidates, consisting of different types of molecules (IL-6, IL-8, and Prolactin in liquid samples; HIF-1α, SOX2, E-cadherin, vimentin, MALAT1, TP53, and NOTCH1 in tissue biopsies) CONCLUSIONS: Although more exploratory research is needed with newer methods to identify biomarkers for TSCC, rigorous validation of biomarkers that have already shown unbiased assessment in at least two publications should be considered a high priority. Further research on these promising biomarkers or their combination in multi-institutional studies, could provide new possibilities to develop a specific panel for early diagnosis, prognosis, and individualized treatments.
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Affiliation(s)
- Aisha A Hussein
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Jgam de Visscher
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry, VU University Medical Center, Amsterdam, The Netherlands.
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111
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Vistbakka J, Sumelahti ML, Lehtimäki T, Elovaara I, Hagman S. Evaluation of serum miR-191-5p, miR-24-3p, miR-128-3p, and miR-376c-3 in multiple sclerosis patients. Acta Neurol Scand 2018. [PMID: 29527713 DOI: 10.1111/ane.12921] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biomarkers that could be used in early diagnosis of multiple sclerosis (MS), segregation of disease subtypes, and discrimination of the aggressive disease course from the benign one are urgently needed. OBJECTIVE The aim of this study was to investigate the specificity of circulating microRNAs: miR-191-5p, miR-128-3p, miR-24-3p, and miR-376c-3p in MS and evaluate their association with disease activity and disability progression. METHODS The expressions of circulating miRNAs were studied in serum of 100 subjects (53 relapsing-remitting (RRMS), 20 primary progressive (PPMS), and 27 controls), using miScript serum miRNA RT-PCR assay techniques. RESULTS In comparison with controls, miR-191-5p and miR-24-3p were overexpressed in RRMS and PPMS, with no differences between the subtypes. miR-24-3p correlated positively with the disability progression index in the combined group of all patients with MS. miR-128-3p showed tendency toward the predominant expression in PPMS and correlated positively with the annual relapse rate in RRMS. miR-376c-3p expression levels did not differ between the groups, and no associations were found to clinical parameters. CONCLUSION This study highlighted the connection of circulating miRNAs to MS. miR-24-3p and miR-128-3p showed a tendency of association with disability accumulation and disease activity, respectively. Further studies should evaluate their suitability for clinical use.
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Affiliation(s)
- J. Vistbakka
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
| | - M.-L. Sumelahti
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
- Department of Neurology; Tampere University Hospital; Tampere Finland
| | - T. Lehtimäki
- Department of Clinical Chemistry; Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere; Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - I. Elovaara
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
| | - S. Hagman
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
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112
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Begcevic I, Brinc D, Dukic L, Simundic AM, Zavoreo I, Basic Kes V, Martinez-Morillo E, Batruch I, Drabovich AP, Diamandis EP. Targeted Mass Spectrometry-Based Assays for Relative Quantification of 30 Brain-Related Proteins and Their Clinical Applications. J Proteome Res 2018; 17:2282-2292. [PMID: 29708756 DOI: 10.1021/acs.jproteome.7b00768] [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] [Indexed: 12/22/2022]
Abstract
Cerebrospinal fluid (CSF) is a promising clinical sample for identification of novel biomarkers for various neurological disorders. Considering its direct contact with brain tissue, CSF represents a valuable source of brain-related and brain-specific proteins. Multiple sclerosis is an inflammatory, demyelinating neurological disease affecting the central nervous system, and so far there are no diagnostic or prognostic disease specific biomarkers available in the clinic. The primary aim of the present study was to develop a targeted mass spectrometry assay for simultaneous quantification of 30 brain-related proteins in CSF and subsequently to demonstrate assay feasibility in neurological samples derived from multiple sclerosis patients. Our multiplex selected reaction monitoring assay had wide dynamic range (median fold range across peptides = 8.16 × 103) and high assay reproducibility (median across peptides CV = 4%). Candidate biomarkers were quantified in CSF samples from neurologically healthy individuals (n = 9) and patients diagnosed with clinically isolated syndrome (n = 29) or early multiple sclerosis (n = 15).
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Affiliation(s)
- Ilijana Begcevic
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
| | - Lora Dukic
- Department of Medical Laboratory Diagnostics , University Hospital "Sveti Duh" , 10000 Zagreb , Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital "Sveti Duh" , 10000 Zagreb , Croatia
| | - Iris Zavoreo
- University Department of Neurology , Medical School University Hospital "Sestre milosrdnice" , 10000 Zagreb , Croatia
| | - Vanja Basic Kes
- University Department of Neurology , Medical School University Hospital "Sestre milosrdnice" , 10000 Zagreb , Croatia
| | - Eduardo Martinez-Morillo
- Laboratory of Medicine, Department of Clinical Biochemistry , Hospital Universitario Central de Asturias , 33011 Oviedo , Spain
| | - Ihor Batruch
- Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada
| | - Andrei P Drabovich
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
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DellaValle B, Manresa-Arraut A, Hasseldam H, Stensballe A, Rungby J, Larsen A, Hempel C. Detection of Glycan Shedding in the Blood: New Class of Multiple Sclerosis Biomarkers? Front Immunol 2018; 9:1254. [PMID: 29915593 PMCID: PMC5994890 DOI: 10.3389/fimmu.2018.01254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is a devastating autoimmune disease, afflicting people in the prime of their lives. Presently, after initial clinical presentation, there are no reliable markers for whether a patient will develop MS, or whether their prognosis will be aggressive or relapsing–remitting. Furthermore, many MS patients do not respond to treatment. Thus, markers for diagnosis, prognosis, and treatment-responsiveness are lacking for a disease, where a precision medicine approach would be valuable. The glycocalyx (GLX) is the carbohydrate-rich outer surface of the blood vessel wall and is the first interaction between the blood and the vessel. We hypothesized that cleavage of the GLX may be an early stage predictor of immune attack, blood–brain barrier (BBB) breakdown, and disease severity in MS. Methods Two experimental models of MS, experimental autoimmune encephalitis (EAE), were included in this study. EAE was induced in C57BL/6J mice and Lewis rats, which were monitored for weight loss and clinical presentation in comparison to healthy controls. Plasma samples were obtained longitudinally from mice until peak disease severity and at peak disease severity in rats. Soluble GLX-associated glycosaminoglycans (GAG) and proteoglycans (PG) were detected in plasma samples. Results All animals receiving EAE emulsion developed fulminant EAE (100% penetrance). Increased plasma levels of chondroitin sulfate were detected before the onset of clinical symptoms and remained elevated at peak disease severity. Hyaluronic acid was increased at the height of the disease, whereas heparan sulfate was transiently increased during early stages only. By contrast, syndecans 1, 3, and 4 were detected in EAE samples as well as healthy controls, with no significant differences between the two groups. Discussion In this study, we present data supporting the shedding of the GLX as a new class of biomarker for MS. In particular, soluble, sugar-based GLX components are associated with disease severity in two models of MS, molecules that would not be detected in proteomics-based screens of MS patient samples. Patient studies are presently underway.
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Affiliation(s)
- Brian DellaValle
- Department of Biomedicine/Pharmacology, Aarhus University, Aarhus, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alba Manresa-Arraut
- Department of Biomedical Sciences, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hasseldam
- Department of Biomedical Sciences, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen Rungby
- Department of Biomedicine/Pharmacology, Aarhus University, Aarhus, Denmark.,Department of Endocrinology, Bispebjerg Hospital Copenhagen, Copenhagen, Denmark
| | - Agnete Larsen
- Department of Biomedicine/Pharmacology, Aarhus University, Aarhus, Denmark
| | - Casper Hempel
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Micro- and Nanotechnology, Technical University of Denmark, Kongens Lyngby, Denmark
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114
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Hegen H, Bsteh G, Berger T. 'No evidence of disease activity' - is it an appropriate surrogate in multiple sclerosis? Eur J Neurol 2018; 25:1107-e101. [PMID: 29687559 PMCID: PMC6099351 DOI: 10.1111/ene.13669] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
The increasing number of disease‐modifying treatments available for multiple sclerosis has broadened treatment options for patients, but also challenges clinicians to select the best therapy for each individual at the appropriate stage of the disease. Early prediction of treatment response still remains one of the main difficulties in the management of multiple sclerosis patients. The concept of ‘no evidence of disease activity’ (NEDA) has been proposed as a surrogate for treatment response based on the absence of relapses, disability progression and radiological activity. Although there are several apparently logical arguments for the NEDA approach, there are also some major concerns that have to be considered and that are not sufficiently addressed yet. Amongst others, each parameter's limitations are not eliminated solely by its use within a composite score, and the contribution of each parameter to NEDA is not well balanced, as the detection of, for example, a single new magnetic resonance imaging lesion is considered as significant as the occurrence of a severely disabling relapse. NEDA in its current form also neglects underlying pathophysiology of the disease, has not been shown to fulfil formal criteria of a surrogate marker and its prognostic value has not been sufficiently evidenced yet. From a clinical point of view, ‘evidence of disease activity’ seems the more relevant surrogate; however, its implications are even less clear than those of NEDA. Here, existing literature on NEDA is critically reviewed and improvements are discussed that value its potential use in clinical trials and, even more importantly, treatment decision making in daily routine.
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Affiliation(s)
- H Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - G Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - T Berger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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115
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Enhanced release of acid sphingomyelinase-enriched exosomes generates a lipidomics signature in CSF of Multiple Sclerosis patients. Sci Rep 2018; 8:3071. [PMID: 29449691 PMCID: PMC5814401 DOI: 10.1038/s41598-018-21497-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/01/2018] [Indexed: 01/09/2023] Open
Abstract
Multiple Sclerosis (MuS) is a complex multifactorial neuropathology, resulting in heterogeneous clinical presentation. A very active MuS research field concerns the discovery of biomarkers helpful to make an early and definite diagnosis. The sphingomyelin pathway has emerged as a molecular mechanism involved in MuS, since high levels of ceramides in cerebrospinal fluid (CSF) were related to axonal damage and neuronal dysfunction. Ceramides are the hydrolysis products of sphingomyelins through a reaction catalyzed by a family of enzymes named sphingomyelinases, which were recently related to myelin repair in MuS. Here, using a lipidomic approach, we observed low levels of several sphingomyelins in CSF of MuS patients compared to other inflammatory and non-inflammatory, central or peripheral neurological diseases. Starting by this result, we investigated the sphingomyelinase activity in CSF, showing a significantly higher enzyme activity in MuS. In support of these results we found high number of total exosomes in CSF of MuS patients and a high number of acid sphingomyelinase-enriched exosomes correlated to enzymatic activity and to disease severity. These data are of diagnostic relevance and show, for the first time, high number of acid sphingomyelinase-enriched exosomes in MuS, opening a new window for therapeutic approaches/targets in the treatment of MuS.
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116
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Baecher-Allan C, Kaskow BJ, Weiner HL. Multiple Sclerosis: Mechanisms and Immunotherapy. Neuron 2018; 97:742-768. [DOI: 10.1016/j.neuron.2018.01.021] [Citation(s) in RCA: 432] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/25/2017] [Accepted: 01/09/2018] [Indexed: 12/17/2022]
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117
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Vermersch P, Berger T, Gold R, Lukas C, Rovira A, Meesen B, Chard D, Comabella M, Palace J, Trojano M. The clinical perspective: How to personalise treatment in MS and how may biomarkers including imaging contribute to this? Mult Scler 2018; 22:18-33. [PMID: 27465613 DOI: 10.1177/1352458516650739] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a highly heterogeneous disease, both in its course and in its response to treatments. Effective biomarkers may help predict disability progression and monitor patients' treatment responses. OBJECTIVE The aim of this review was to focus on how biomarkers may contribute to treatment individualisation in MS patients. METHODS This review reflects the content of presentations, polling results and discussions on the clinical perspective of MS during the first and second Pan-European MS Multi-stakeholder Colloquia in Brussels in May 2014 and 2015. RESULTS In clinical practice, magnetic resonance imaging (MRI) measures play a significant role in the diagnosis and follow-up of MS patients. Together with clinical markers, the rate of MRI-visible lesion accrual once a patient has started treatment may also help to predict subsequent treatment responsiveness. In addition, several molecular (immunological, genetic) biomarkers have been established that may play a role in predictive models of MS relapses and progression. To reach personalised treatment decisions, estimates of disability progression and likely treatment response should be carefully considered alongside the risk of serious adverse events, together with the patient's treatment expectations. CONCLUSION Although biomarkers may be very useful for individualised decision making in MS, many are still research tools and need to be validated before implementation in clinical practice.
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Affiliation(s)
- Patrick Vermersch
- University of Lille, CHRU de Lille, Lille International Research Inflammation Center (LIRIC), INSRRM U995, FHU Imminent, Lille, France
| | - Thomas Berger
- Neuroimmunology and Multiple Sclerosis Clinic, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Department of Diagnostic and Interventional Radiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alex Rovira
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Bianca Meesen
- Managing Director at Ismar Healthcare, Lier, Belgium
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK/Biomedical Research Centre, University College London Hospitals (UCLH), National Institute for Health Research (NIHR), London, UK
| | - Manuel Comabella
- Department of Clinical Neuroimmunology, Multiple Sclerosis Center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jacqueline Palace
- Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Osteopontin (OPN) as a CSF and blood biomarker for multiple sclerosis: A systematic review and meta-analysis. PLoS One 2018; 13:e0190252. [PMID: 29346446 PMCID: PMC5773083 DOI: 10.1371/journal.pone.0190252] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 12/02/2022] Open
Abstract
Identifying a reliable biomarker may accelerate diagnosis of multiple sclerosis (MS) and lead to early management of the disease. Accumulating evidence suggest that cerebrospinal fluid (CSF) and peripheral blood concentration of osteopontin (OPN) may have diagnostic and prognostic value in MS. We conducted a systematic review and meta-analysis of studies that measured peripheral blood and CSF levels of OPN in MS patients and controls to evaluate the diagnostic potential of this biomarker better. We searched PubMed, Web of Science and Scopus databases to find articles that measured OPN concentration in peripheral blood and CSF samples from MS patients up to October 19, 2016. Q statistic tests and the I2 index were applied for heterogeneity assessment. If the I2 index was less than 40%, the fixed-effects model was used for meta-analysis. Random-effects meta-analysis was chosen if the I2 value was greater than 40%. After removal of duplicates, 918 articles were identified, and 27 of them fulfilled the inclusion criteria. We included 22 eligible studies in the final meta-analysis. MS patients, in general, had considerably higher levels of OPN in their CSF and blood when compared to all types of controls (p<0.05). When the comparisons were made between different subtypes of MS patients and controls, the results pointed to significantly higher levels of OPN in CSF of MS subgroups (p<0.05). All subtypes of MS patients, except CIS patients, had increased blood levels of OPN compared to controls (p<0.05). In the second set of meta-analyses, we compared the peripheral blood and CSF concentrations of OPN between MS patient subtypes. CIS patients had significantly lower levels of OPN both in their peripheral blood and CSF compared to patients with progressive subtypes of MS (p<0.05). CSF concentration of OPN was significantly higher among RRMS patients compared to the CIS patients and SPMS patients (P<0.05). Finally, patients with active MS had significantly higher OPN levels in their CSF compared to patients with stable disease (P = 0.007). The result of this study confirms that increased levels of OPN exist in CSF and peripheral blood of MS patients and strengthens the evidence regarding the clinical utility of OPN as a promising and validated biomarker for MS.
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119
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Iparraguirre L, Muñoz-Culla M, Prada-Luengo I, Castillo-Triviño T, Olascoaga J, Otaegui D. Circular RNA profiling reveals that circular RNAs from ANXA2 can be used as new biomarkers for multiple sclerosis. Hum Mol Genet 2018. [PMID: 28651352 DOI: 10.1093/hmg/ddx243] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Multiple sclerosis is an autoimmune disease, with higher prevalence in women, in whom the immune system is dysregulated. This dysregulation has been shown to correlate with changes in transcriptome expression as well as in gene-expression regulators, such as non-coding RNAs (e.g. microRNAs). Indeed, some of these have been suggested as biomarkers for multiple sclerosis even though few biomarkers have reached the clinical practice. Recently, a novel family of non-coding RNAs, circular RNAs, has emerged as a new player in the complex network of gene-expression regulation. MicroRNA regulation function through a 'sponge system' and a RNA splicing regulation function have been proposed for the circular RNAs. This regulating role together with their high stability in biofluids makes them seemingly good candidates as biomarkers. Given the dysregulation of both protein-coding and non-coding transcriptome that have been reported in multiple sclerosis patients, we hypothesised that circular RNA expression may also be altered. Therefore, we carried out expression profiling of 13.617 circular RNAs in peripheral blood leucocytes from multiple sclerosis patients and healthy controls finding 406 differentially expressed (P-value < 0.05, Fold change > 1.5) and demonstrate after validation that, circ_0005402 and circ_0035560 are underexpressed in multiple sclerosis patients and could be used as biomarkers of the disease.
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Affiliation(s)
- Leire Iparraguirre
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain
| | - Maider Muñoz-Culla
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain.,Spanish Network of Multiple Sclerosis, 08028, Barcelona, Spain
| | - Iñigo Prada-Luengo
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain
| | - Tamara Castillo-Triviño
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain.,Spanish Network of Multiple Sclerosis, 08028, Barcelona, Spain.,Neurology Department, Donostia University Hospital, 20014, San Sebastián, Spain
| | - Javier Olascoaga
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain.,Spanish Network of Multiple Sclerosis, 08028, Barcelona, Spain.,Neurology Department, Donostia University Hospital, 20014, San Sebastián, Spain
| | - David Otaegui
- Multiple Sclerosis Unit, Neurosciences Area, Biodonostia Health Research Institute, 20014, San Sebastián, Spain.,Spanish Network of Multiple Sclerosis, 08028, Barcelona, Spain
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120
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Repetitive Transcranial Magnetic Stimulation, Cognition, and Multiple Sclerosis: An Overview. Behav Neurol 2018; 2018:8584653. [PMID: 29568339 PMCID: PMC5822759 DOI: 10.1155/2018/8584653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022] Open
Abstract
Multiple sclerosis (MS) affects cognition in the majority of patients. A major aspect of the disease is brain volume loss (BVL), present in all phases and types (relapsing and progressive) of the disease and linked to both motor and cognitive disabilities. Due to the lack of effective pharmacological treatments for cognition, cognitive rehabilitation and other nonpharmacological interventions such as repetitive transcranial magnetic stimulation (rTMS) have recently emerged and their potential role in functional connectivity is studied. With recently developed advanced neuroimaging and neurophysiological techniques, changes related to alterations of the brain's functional connectivity can be detected. In this overview, we focus on the brain's functional reorganization in MS, theoretical and practical aspects of rTMS utilization in humans, and its potential therapeutic role in treating cognitively impaired MS patients.
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121
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122
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Cross-reactivity of antibodies against interferon beta in multiple sclerosis patients and interference of the JAK-STAT signaling pathway. Sci Rep 2017; 7:16585. [PMID: 29185487 PMCID: PMC5707350 DOI: 10.1038/s41598-017-16828-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/17/2017] [Indexed: 02/08/2023] Open
Abstract
Interferon beta (IFNβ) therapy has immunogenic properties and induces the development of neutralizing antibodies (NAbs). From the extensive literature focused in the development of NAbs in multiple sclerosis (MS) patients, their ability to cross-react has been deficiently evaluated, despite having important consequences in the clinical practice. Here, the relation between the cross-reactivity and the NAbs titers has been evaluated in MS patients, by inhibition of the antiviral activity of IFNβ by bioassay and through the interference with the activation of the IFNß pathway (JAK-STAT), by phosphoflow. Thus, patients with intermediate-high titers of NAbs, determined by bioassay, had a 79-fold increased risk of cross-reactivity compared to patients with low titers. The cross-reactivity is also demonstrated because NAbs positive sera were able to decrease significantly the activation of pSTAT1 achieved by other different IFNβ molecules in the cells patients. Besides, a linear relationship between the STAT1 phosphorylation and NAbs titers was found. The study demonstrates that cross-reactivity increases with the titer of antibodies, which has important implications in clinical practice when switching the treatment. The direct relationship between the NAbs titer and the activation of STAT1 suggest that its determination could be an indirect method to identify the presence of NAbs.
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Puz P, Steposz A, Lasek-Bal A, Bartoszek K, Radecka P, Karuga-Pierścieńska A. Diagnostic methods used in searching for markers of atrophy in patients with multiple sclerosis. Neurol Res 2017; 40:110-116. [DOI: 10.1080/01616412.2017.1403729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Przemyslaw Puz
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Arkadiusz Steposz
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Karina Bartoszek
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Patrycja Radecka
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Aleksandra Karuga-Pierścieńska
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
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124
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Vitamin D and Neurological Diseases: An Endocrine View. Int J Mol Sci 2017; 18:ijms18112482. [PMID: 29160835 PMCID: PMC5713448 DOI: 10.3390/ijms18112482] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023] Open
Abstract
Vitamin D system comprises hormone precursors, active metabolites, carriers, enzymes, and receptors involved in genomic and non-genomic effects. In addition to classical bone-related effects, this system has also been shown to activate multiple molecular mediators and elicit many physiological functions. In vitro and in vivo studies have, in fact, increasingly focused on the "non-calcemic" actions of vitamin D, which are associated with the maintenance of glucose homeostasis, cardiovascular morbidity, autoimmunity, inflammation, and cancer. In parallel, growing evidence has recognized that a multimodal association links vitamin D system to brain development, functions and diseases. With vitamin D deficiency reaching epidemic proportions worldwide, there is now concern that optimal levels of vitamin D in the bloodstream are also necessary to preserve the neurological development and protect the adult brain. The aim of this review is to highlight the relationship between vitamin D and neurological diseases.
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125
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Hellberg S, Eklund D, Gawel DR, Köpsén M, Zhang H, Nestor CE, Kockum I, Olsson T, Skogh T, Kastbom A, Sjöwall C, Vrethem M, Håkansson I, Benson M, Jenmalm MC, Gustafsson M, Ernerudh J. Dynamic Response Genes in CD4+ T Cells Reveal a Network of Interactive Proteins that Classifies Disease Activity in Multiple Sclerosis. Cell Rep 2017; 16:2928-2939. [PMID: 27626663 DOI: 10.1016/j.celrep.2016.08.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/01/2016] [Accepted: 08/11/2016] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the CNS and has a varying disease course as well as variable response to treatment. Biomarkers may therefore aid personalized treatment. We tested whether in vitro activation of MS patient-derived CD4+ T cells could reveal potential biomarkers. The dynamic gene expression response to activation was dysregulated in patient-derived CD4+ T cells. By integrating our findings with genome-wide association studies, we constructed a highly connected MS gene module, disclosing cell activation and chemotaxis as central components. Changes in several module genes were associated with differences in protein levels, which were measurable in cerebrospinal fluid and were used to classify patients from control individuals. In addition, these measurements could predict disease activity after 2 years and distinguish low and high responders to treatment in two additional, independent cohorts. While further validation is needed in larger cohorts prior to clinical implementation, we have uncovered a set of potentially promising biomarkers.
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Affiliation(s)
- Sandra Hellberg
- Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Daniel Eklund
- Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden.
| | - Danuta R Gawel
- The Centre for Individualised Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Mattias Köpsén
- The Centre for Individualised Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden; Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden
| | - Huan Zhang
- The Centre for Individualised Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Colm E Nestor
- The Centre for Individualised Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Ingrid Kockum
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 77 Linköping, Sweden
| | - Tomas Olsson
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 77 Linköping, Sweden
| | - Thomas Skogh
- Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Alf Kastbom
- Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Christopher Sjöwall
- Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Magnus Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Irene Håkansson
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Mikael Benson
- The Centre for Individualised Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Maria C Jenmalm
- Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Mika Gustafsson
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden.
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
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Lycke J, Zetterberg H. The role of blood and CSF biomarkers in the evaluation of new treatments against multiple sclerosis. Expert Rev Clin Immunol 2017; 13:1143-1153. [PMID: 29090607 DOI: 10.1080/1744666x.2017.1400380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated chronic neurodegenerative disease of the central nervous system (CNS). Therapeutic interventions with immunomodulatory agents reduce disease activity and disability development, which are monitored clinically and by magnetic resonance imaging (MRI). However, these measures largely lack information on the impact from these therapies on inflammation, demyelination and axonal injury, the essential pathophysiological features of MS. Several biomarkers for inflammation and neurodegeneration have been detected in cerebrospinal fluid (CSF). In MS, some of these biomarkers seem to reflect disease activity, disability progression, and therapeutic response. Areas covered: In this review, we describe the most promising CSF biomarkers of inflammation and degeneration for monitoring therapeutic interventions in MS. We also describe the evolution of highly sensitive immunoassays that enable determination of neuron-specific biomarkers in blood. Expert commentary: Together with clinical and MRI measures, CSF biomarkers may improve the assessment of therapeutic efficacy and make personalized treatment possible. One disadvantage has been the need of repetitive lumbar punctures to obtain CSF. However, the technical development of highly sensitive immunoassays allows determination of extremely low quantities of neuron-specific proteins in blood. This will potentially open a new era for monitoring disease activity and treatment response in MS.
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Affiliation(s)
- Jan Lycke
- a Department of Clinical Neuroscience, Institute of Neuroscience and Physiology , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Henrik Zetterberg
- b Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology at Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.,c Clinical Neurochemistry Laboratory , Sahlgrenska University Hospital , Mölndal , Sweden.,d Department of Molecular Neuroscience , UCL Institute of Neurology , London , UK.,e UK Dementia Research Institute , London , UK
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Successful combined targeting of B- and plasma cells in treatment refractory anti-NMDAR encephalitis. J Neuroimmunol 2017; 312:15-18. [DOI: 10.1016/j.jneuroim.2017.08.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/18/2022]
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128
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Abstract
Nonimaging biomarkers can be applied in differential diagnosis, evaluation of disease progression and therapy monitoring of multiple sclerosis (MS). Presence of oligoclonal IgG bands in cerebrospinal fluid is a diagnostic element and a negative predictor of MS evolution. AQP4 antibodies are pathogenic and diagnostic for neuromyelitis optica spectrum disorder. Antibodies to myelin oligodendrocyte glycoprotein develop in about 50% of predominantly pediatric patients with acute disseminated encephalomyelitis, but their possible role in pathogenesis is unknown. Currently, there are no individualized biomarkers suitable to track disease progression. Neutralizing antibodies against IFN-β, natalizumab and daclizumab arise with variable frequency and reduce treatment efficacy. The anti-John Cunningham virus antibody index has potential as a biomarker for risk of progressive multifocal leukoencephalopathy.
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Affiliation(s)
- Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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129
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Pulido-Valdeolivas I, Zubizarreta I, Martinez-Lapiscina EH, Villoslada P. Precision medicine for multiple sclerosis: an update of the available biomarkers and their use in therapeutic decision making. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1393315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Irene Pulido-Valdeolivas
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
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130
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Barro C, Leocani L, Leppert D, Comi G, Kappos L, Kuhle J. Fluid biomarker and electrophysiological outcome measures for progressive MS trials. Mult Scler 2017; 23:1600-1613. [DOI: 10.1177/1352458517732844] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Progressive multiple sclerosis (MS) is characterized by insidious clinical worsening that is difficult to accurately quantify and predict. Biofluid markers and electrophysiological measures are potential candidate outcome measures in clinical trials, allowing the quantification of nervous damage occurring in the disease. Neurofilaments are highly specific neuronal proteins. They may have come closest to such applications by their higher concentrations repeatedly demonstrated in cerebrospinal fluid (CSF) in all stages of MS, during relapses, their responsiveness to disease-modifying treatments in relapsing and progressive MS and their associations with measures of inflammatory and degenerative magnetic resonance imaging (MRI) outcomes. Digital single-molecule array (Simoa) technology improves accuracy of bioassays in the quantification of neurofilament light chain (NfL) in serum and plasma. NfL seems to mark a common final path of neuroaxonal injury independent of specific causal pathways. CSF and blood levels of NfL are highly correlated across various diseases including MS, suggesting that blood measurements may be useful in assessing response to treatment and predicting future disease activity. Other biomarkers like matrix metalloproteinases, chemokines, or neurotrophic factors have not been studied to a similar extent. Such measures, especially in blood, need further validation to enter the trial arena or clinical practice. The broadening armamentarium of highly sensitive assay technologies in the future may shed even more light on patient heterogeneity and mechanisms leading to disability in MS. Evoked potentials (EPs) are used in clinical practice to measure central conduction of central sensorimotor pathways. They correlate with and predict the severity of clinical involvement of their corresponding function. Their validation for use in multicenter studies is still lacking, with the exception of visual EPs. If further validated, EPs and fluid biomarkers would represent useful outcome measures for clinical trials, being related to specific mechanisms of the ongoing pathologic changes.
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Affiliation(s)
- Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Letizia Leocani
- Department of Neurology and Institute of Experimental Neurology (INSPE), San Raffaele Hospital, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland/Novartis Pharma AG, Basel, Switzerland
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology (INSPE), San Raffaele Hospital, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
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131
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D'Hooghe T, Kyriakidi K, Karassa FB, Politis D, Skamnelos A, Christodoulou DK, Katsanos KH. Biomarker Development in Chronic Inflammatory Diseases. BIOMARKERS FOR ENDOMETRIOSIS 2017. [PMCID: PMC7122305 DOI: 10.1007/978-3-319-59856-7_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic inflammatory diseases, such as inflammatory bowel disease—namely, Crohn’s disease and ulcerative colitis—psoriasis, multiple sclerosis, rheumatoid arthritis, and many others affect millions of people worldwide, causing a high burden of disease, socioeconomic impact, and healthcare cost. These diseases have common features including autoimmune pathogenesis and frequent co morbidity. The treatment of these chronic inflammatory diseases usually requires long-term immunosuppressive therapies with undesirable side effects. The future of chronic inflammatory disease prevention, detection, and treatment will be greatly influenced by the use of more effective biomarkers with enhanced performance. Given the practical issues of collecting tissue samples in inflammatory diseases, biomarkers derived from body fluids have great potential for optimized patient management through the circumvention of the abovementioned limitations. In this chapter, peripheral blood, urine, and cerebrospinal fluid biomarkers used in chronic inflammatory conditions are reviewed. In detail, this chapter reviews biomarkers to fore used or emerging to be used in patients with chronic inflammatory conditions. Those include inflammatory bowel diseases, chronic inflammatory conditions of the liver, biliary tract, pancreas, psoriasis, atopic disease, inflammatory skin diseases, rheumatic diseases, demyelination, and also the chronic inflammatory component of various other diseases in general medicine—including diabetes, cardiovascular disease, renal disease, and chronic obstructive pulmonary disease. Development of personalized medicine is closely linked to biomarkers, which may serve as the basis for diagnosis, drug discovery, and monitoring of diseases.
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Affiliation(s)
- Thomas D'Hooghe
- 0000 0001 0668 7884grid.5596.fDepartment of Development and Regeneration Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
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132
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Yokote H, Kamata T, Toru S, Sanjo N, Yokota T. Serum retinol levels are associated with brain volume loss in patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 3:2055217317729688. [PMID: 28932409 PMCID: PMC5598802 DOI: 10.1177/2055217317729688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/13/2017] [Indexed: 11/24/2022] Open
Abstract
Background Although predicting future brain volume loss (BVL) in patients with multiple sclerosis (MS) is important, studies have shown only a few biomarkers that can predict BVL. Objectives The aim of this study is to elucidate the association between longitudinal BVL and serum biomarker candidates. Methods This single-center, retrospective, observational study intended to cover MS patients during January 2008 to March 2016. Patients who underwent brain MRI two times at intervals of >24 months and had a blood test to measure biomarker candidates at the time or within three months of the MRI scan were included. Evaluation of brain volume was performed by using SIENAX and SIENA in the FMRIB software library. Results Twenty-three patients with MS were included in this study. We found that serum retinol binding protein (RBP) levels were significantly correlated with percentage brain volume change (PBVC) (p = 0.0079). Furthermore, best subset selection of multiple linear regression models identified baseline normalized brain volume and serum RBP as the best predictors of PBVC. Conclusions Our study shows that lower serum retinol levels are associated with greater longitudinal BVL and that serum RBP and can be a predictor of BVL.
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Affiliation(s)
- H Yokote
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan
| | - T Kamata
- Department of Neurology, Musashino Red Cross Hospital, Japan
| | - S Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan
| | - N Sanjo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Japan
| | - T Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Japan
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133
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134
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Disanto G, Barro C, Benkert P, Naegelin Y, Schädelin S, Giardiello A, Zecca C, Blennow K, Zetterberg H, Leppert D, Kappos L, Gobbi C, Kuhle J. Serum Neurofilament light: A biomarker of neuronal damage in multiple sclerosis. Ann Neurol 2017; 81:857-870. [PMID: 28512753 PMCID: PMC5519945 DOI: 10.1002/ana.24954] [Citation(s) in RCA: 730] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 12/12/2022]
Abstract
Objective Neurofilament light chains (NfL) are unique to neuronal cells, are shed to the cerebrospinal fluid (CSF), and are detectable at low concentrations in peripheral blood. Various diseases causing neuronal damage have resulted in elevated CSF concentrations. We explored the value of an ultrasensitive single‐molecule array (Simoa) serum NfL (sNfL) assay in multiple sclerosis (MS). Methods sNfL levels were measured in healthy controls (HC, n = 254) and two independent MS cohorts: (1) cross‐sectional with paired serum and CSF samples (n = 142), and (2) longitudinal with repeated serum sampling (n = 246, median follow‐up = 3.1 years, interquartile range [IQR] = 2.0–4.0). We assessed their relation to concurrent clinical, imaging, and treatment parameters and to future clinical outcomes. Results sNfL levels were higher in both MS cohorts than in HC (p < 0.001). We found a strong association between CSF NfL and sNfL (β = 0.589, p < 0.001). Patients with either brain or spinal (43.4pg/ml, IQR = 25.2–65.3) or both brain and spinal gadolinium‐enhancing lesions (62.5pg/ml, IQR = 42.7–71.4) had higher sNfL than those without (29.6pg/ml, IQR = 20.9–41.8; β = 1.461, p = 0.005 and β = 1.902, p = 0.002, respectively). sNfL was independently associated with Expanded Disability Status Scale (EDSS) assessments (β = 1.105, p < 0.001) and presence of relapses (β = 1.430, p < 0.001). sNfL levels were lower under disease‐modifying treatment (β = 0.818, p = 0.003). Patients with sNfL levels above the 80th, 90th, 95th, 97.5th, and 99th HC‐based percentiles had higher risk of relapses (97.5th percentile: incidence rate ratio = 1.94, 95% confidence interval [CI] = 1.21–3.10, p = 0.006) and EDSS worsening (97.5th percentile: OR = 2.41, 95% CI = 1.07–5.42, p = 0.034). Interpretation These results support the value of sNfL as a sensitive and clinically meaningful blood biomarker to monitor tissue damage and the effects of therapies in MS. Ann Neurol 2017;81:857–870
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Affiliation(s)
- Giulio Disanto
- Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sabine Schädelin
- Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Chiara Zecca
- Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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135
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Londoño AC, Mora CA. Evidence of disease control: a realistic concept beyond NEDA in the treatment of multiple sclerosis. F1000Res 2017; 6:566. [PMID: 28588765 PMCID: PMC5446020 DOI: 10.12688/f1000research.11349.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
Although no evidence of disease activity (NEDA) permits evaluation of response to treatment in the systematic follow-up of patients with multiple sclerosis (MS), its ability to accomplish detection of surreptitious activity of disease is limited, thus being unable to prevent patients from falling into a non-reversible progressive phase of disease. A protocol of evaluation based on the use of validated biomarkers that is conducted at an early stage of disease would permit the capture of abnormal neuroimmunological phenomena and lead towards intervention with modifying therapy before tissue damage has been reached.
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Affiliation(s)
- Ana C Londoño
- Instituto Neurológico de Colombia (INDEC), Medellín, Colombia
| | - Carlos A Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
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136
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Arellano G, Acuña E, Reyes LI, Ottum PA, De Sarno P, Villarroel L, Ciampi E, Uribe-San Martín R, Cárcamo C, Naves R. Th1 and Th17 Cells and Associated Cytokines Discriminate among Clinically Isolated Syndrome and Multiple Sclerosis Phenotypes. Front Immunol 2017; 8:753. [PMID: 28713377 PMCID: PMC5491887 DOI: 10.3389/fimmu.2017.00753] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/13/2017] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. It is a heterogeneous pathology that can follow different clinical courses, and the mechanisms that underlie the progression of the immune response across MS subtypes remain incompletely understood. Here, we aimed to determine differences in the immunological status among different MS clinical subtypes. Blood samples from untreated patients diagnosed with clinically isolated syndrome (CIS) (n = 21), different clinical forms of MS (n = 62) [relapsing–remitting (RRMS), secondary progressive, and primary progressive], and healthy controls (HCs) (n = 17) were tested for plasma levels of interferon (IFN)-γ, IL-10, TGF-β, IL-17A, and IL-17F by immunoanalysis. Th1 and Th17 lymphocyte frequencies were determined by flow cytometry. Our results showed that IFN-γ levels and the IFN-γ/IL-10 ratio were higher in CIS patients than in RRMS patients and HC. Th1 cell frequencies were higher in CIS and RRMS than in progressive MS, and RRMS had a higher Th17 frequency than CIS. The Th1/Th17 cell ratio was skewed toward Th1 in CIS compared to MS phenotypes and HC. Receiver operating characteristic statistical analysis determined that IFN-γ, the IFN-γ/IL-10 ratio, Th1 cell frequency, and the Th1/Th17 cell ratio discriminated among CIS and MS subtypes. A subanalysis among patients expressing high IL-17F levels showed that IL-17F and the IFN-γ/IL-17F ratio discriminated between disease subtypes. Overall, our data showed that CIS and MS phenotypes displayed distinct Th1- and Th17-related cytokines and cell profiles and that these immune parameters discriminated between clinical forms. Upon validation, these parameters might be useful as biomarkers to predict disease progression.
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Affiliation(s)
- Gabriel Arellano
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Eric Acuña
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Lilian I Reyes
- Faculty of Science, Universidad San Sebastián, Santiago, Chile
| | - Payton A Ottum
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Patrizia De Sarno
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luis Villarroel
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Neurology Service, Hospital Sotero del Río, Santiago, Chile
| | - Reinaldo Uribe-San Martín
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Neurology Service, Hospital Sotero del Río, Santiago, Chile
| | - Claudia Cárcamo
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Naves
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
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137
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Piehl F, Kockum I, Khademi M, Blennow K, Lycke J, Zetterberg H, Olsson T. Plasma neurofilament light chain levels in patients with MS switching from injectable therapies to fingolimod. Mult Scler 2017. [DOI: 10.1177/1352458517715132] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Neurofilament light chain (NFL) is a cerebrospinal fluid (CSF) marker of neuroaxonal damage in multiple sclerosis (MS). Objective: To determine the correlation of NFL in CSF and serum/plasma, and in plasma after switching from injectable MS therapies to fingolimod. Methods: A first cohort consisted of MS patients ( n = 39) and neurological disease controls ( n = 27) where CSF and plasma/serum had been collected for diagnostic purposes. A second cohort ( n = 243) consisted of patients from a post-marketing study of fingolimod. NFL was determined with Single Molecule Array (Simoa™) technology (detection threshold 1.95 pg/mL). Results: Mean NFL pg/mL (standard deviation ( SD)) was 341 (267) and 1475 (2358) in CSF and 8.2 (3.58) and 17.0 (16.94) in serum from controls and MS, respectively. CSF/serum and plasma/serum levels were highly correlated ( n = 66, rho = 0.672, p < 0.0001 and n = 16, rho = 0.684, p = 0.009, respectively). In patients starting fingolimod ( n = 243), mean NFL pg/mL ( SD) in plasma was reduced between baseline (20.4 (10.7)) and at 12 months (13.5 (7.3), p < 3 × 10−6), and levels remained stable at 24 months (13.2 (6.2)). Conclusion: NFL in serum and CSF are highly correlated and plasma NFL levels decrease after switching to highly effective MS therapy. Blood NFL measurement can be considered as a biomarker for MS therapy response.
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Affiliation(s)
- Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Mohsen Khademi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden/Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden/Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden/Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
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138
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Londoño AC, Mora CA. Evidence of disease control: a realistic concept beyond NEDA in the treatment of multiple sclerosis. F1000Res 2017; 6:566. [PMID: 28588765 PMCID: PMC5446020 DOI: 10.12688/f1000research.11349.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 10/13/2023] Open
Abstract
Although no evidence of disease activity (NEDA) permits evaluation of response to treatment in the systematic follow-up of patients with multiple sclerosis (MS), its ability to accomplish detection of surreptitious activity of disease is limited, thus being unable to prevent patients from falling into a non-reversible progressive phase of disease. A protocol of evaluation based on the use of validated biomarkers that is conducted at an early stage of disease would permit the capture of abnormal neuroimmunological phenomena and lead towards intervention with modifying therapy before tissue damage has been reached.
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Affiliation(s)
- Ana C. Londoño
- Instituto Neurológico de Colombia (INDEC), Medellín, Colombia
| | - Carlos A. Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
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139
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Casserly CS, Nantes JC, Whittaker Hawkins RF, Vallières L. Neutrophil perversion in demyelinating autoimmune diseases: Mechanisms to medicine. Autoimmun Rev 2017; 16:294-307. [DOI: 10.1016/j.autrev.2017.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
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140
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Rajda C, Pukoli D, Bende Z, Majláth Z, Vécsei L. Excitotoxins, Mitochondrial and Redox Disturbances in Multiple Sclerosis. Int J Mol Sci 2017; 18:ijms18020353. [PMID: 28208701 PMCID: PMC5343888 DOI: 10.3390/ijms18020353] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 01/03/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). There is increasing evidence that MS is not only characterized by immune mediated inflammatory reactions, but also by neurodegenerative processes. There is cumulating evidence that neurodegenerative processes, for example mitochondrial dysfunction, oxidative stress, and glutamate (Glu) excitotoxicity, seem to play an important role in the pathogenesis of MS. The alteration of mitochondrial homeostasis leads to the formation of excitotoxins and redox disturbances. Mitochondrial dysfunction (energy disposal failure, apoptosis, etc.), redox disturbances (oxidative stress and enhanced reactive oxygen and nitrogen species production), and excitotoxicity (Glu mediated toxicity) may play an important role in the progression of the disease, causing axonal and neuronal damage. This review focuses on the mechanisms of mitochondrial dysfunction (including mitochondrial DNA (mtDNA) defects and mitochondrial structural/functional changes), oxidative stress (including reactive oxygen and nitric species), and excitotoxicity that are involved in MS and also discusses the potential targets and tools for therapeutic approaches in the future.
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Affiliation(s)
- Cecilia Rajda
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary.
| | - Dániel Pukoli
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary.
- Department of Neurology, Vaszary Kolos Hospital, 2500 Esztergom, Hungary.
| | - Zsuzsanna Bende
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary.
| | - Zsófia Majláth
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary.
| | - László Vécsei
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary.
- MTA-SZTE Neuroscience Research Group, 6725 Szeged, Hungary.
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141
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Kizlaitienė R, Kaubrys G, Giedraitienė N, Ramanauskas N, Dementavičienė J. Composite Marker of Cognitive Dysfunction and Brain Atrophy is Highly Accurate in Discriminating Between Relapsing-Remitting and Secondary Progressive Multiple Sclerosis. Med Sci Monit 2017; 23:588-597. [PMID: 28145395 PMCID: PMC5301955 DOI: 10.12659/msm.903234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With the advent of numerous new-generation disease-modifying drugs for multiple sclerosis (MS), the discrimination between relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) has become a problem of high importance. The aim of our study was to find a simple way to accurately discriminate between RRMS and SPMS that is applicable in clinical practice as a composite marker, using the linear measures of magnetic resonance imaging (MRI) and the results of cognitive tests. Material/Methods We included 88 MS patients in the study: 43 participants had RRMS and 45 had SPMS. A battery consisting of 11 tests was used to evaluate cognitive function. We used 11 linear MRI measures and 7 indexes to assess brain atrophy. Results Four cognitive tests and 3 linear MRI measures were able to distinguish RRMS from SPMS with the AUC >0.8 based on ROC analysis. Multiple logistic regression models were constructed to identify the best set of cognitive and MRI markers. The model, using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Huckman Index, showed the highest predictive ability: AUC=0.921 (p<0.001). We constructed a simple remission-progression index from the same 3 variables, which discriminated well between RRMS and SPMS: AUC=0.920 (p<0.001), maximal Youden Index=0.702, cut-off=1.68, sensitivity=79.1%, and specificity=91.1%. Conclusions The composite remission-progression index, using the RAVLT test, DSST test, and MRI Huckman Index, is highly accurate in discriminating between RRMS and SPMS.
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Affiliation(s)
- Rasa Kizlaitienė
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | - Nataša Giedraitienė
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | | | - Jūratė Dementavičienė
- Department of Radiology, Nuclear Medicine and Physics of Medicine, Center of Radiology and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
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Bodini B, Calabresi PA. From neurofilament research to multiple sclerosis clinical practice: Where do we stand? Neurology 2017; 88:816-817. [PMID: 28148634 DOI: 10.1212/wnl.0000000000003676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benedetta Bodini
- From Sorbonne Universités (B.B.), UPMC Paris 06, Institut du Cerveau et de la Moelle Épinière, ICM, Pitié-Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France; and Department of Neurology (P.A.C.), Johns Hopkins Hospital, Baltimore, MD.
| | - Peter Arthur Calabresi
- From Sorbonne Universités (B.B.), UPMC Paris 06, Institut du Cerveau et de la Moelle Épinière, ICM, Pitié-Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France; and Department of Neurology (P.A.C.), Johns Hopkins Hospital, Baltimore, MD
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Villoslada P, Alonso C, Agirrezabal I, Kotelnikova E, Zubizarreta I, Pulido-Valdeolivas I, Saiz A, Comabella M, Montalban X, Villar L, Alvarez-Cermeño JC, Fernández O, Alvarez-Lafuente R, Arroyo R, Castro A. Metabolomic signatures associated with disease severity in multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e321. [PMID: 28180139 PMCID: PMC5278923 DOI: 10.1212/nxi.0000000000000321] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Abstract
Objective: To identify differences in the metabolomic profile in the serum of patients with multiple sclerosis (MS) compared to controls and to identify biomarkers of disease severity. Methods: We studied 2 cohorts of patients with MS: a retrospective longitudinal cohort of 238 patients and 74 controls and a prospective cohort of 61 patients and 41 controls with serial serum samples. Patients were stratified into active or stable disease based on 2 years of prospective assessment accounting for presence of clinical relapses or changes in disability measured with the Expanded Disability Status Scale (EDSS). Metabolomic profiling (lipids and amino acids) was performed by ultra-high-performance liquid chromatography coupled to mass spectrometry in serum samples. Data analysis was performed using parametric methods, principal component analysis, and partial least square discriminant analysis for assessing the differences between cases and controls and for subgroups based on disease severity. Results: We identified metabolomics signatures with high accuracy for classifying patients vs controls as well as for classifying patients with medium to high disability (EDSS >3.0). Among them, sphingomyelin and lysophosphatidylethanolamine were the metabolites that showed a more robust pattern in the time series analysis for discriminating between patients and controls. Moreover, levels of hydrocortisone, glutamic acid, tryptophan, eicosapentaenoic acid, 13S-hydroxyoctadecadienoic acid, lysophosphatidylcholines, and lysophosphatidylethanolamines were associated with more severe disease (non-relapse-free or increase in EDSS). Conclusions: We identified metabolomic signatures composed of hormones, lipids, and amino acids associated with MS and with a more severe course.
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Affiliation(s)
- Pablo Villoslada
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Cristina Alonso
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Ion Agirrezabal
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Ekaterina Kotelnikova
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Irati Zubizarreta
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Irene Pulido-Valdeolivas
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Albert Saiz
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Manuel Comabella
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Xavier Montalban
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Luisa Villar
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Jose Carlos Alvarez-Cermeño
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Oscar Fernández
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Rafael Arroyo
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
| | - Azucena Castro
- Center of Neuroimmunology (P.V., I.A., E.K., I.Z., I.P.-V., A.S.), Institute d'Investigaciones Biomediques August Pi Sunyer (IDIBAPS)-Hospital Clinic, Barcelona, Spain; University of California (P.V.), San Francisco; OWL (C.A., A.C.), Parque Tecnológico de Bizkaia, Derio; Cemcat (M.C., X.M.), Hospital Vall d'Hebron, Barcelona; Hospital Ramon y Cajal (L.V., J.C.A.-C.), Madrid; Hospital Universitario Regional (O.F.), Instituto de Investigación Biomédica (IBIMA), Malaga; and Hospital Clinico San Carlos (R.A.-L., R.A.), Madrid, Spain
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Activation of the JAK-STAT Signaling Pathway after In Vitro Stimulation with IFNß in Multiple Sclerosis Patients According to the Therapeutic Response to IFNß. PLoS One 2017; 12:e0170031. [PMID: 28103257 PMCID: PMC5245989 DOI: 10.1371/journal.pone.0170031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022] Open
Abstract
Interferon beta (IFNß) is a common treatment used for multiple sclerosis (MS) which acts through the activation of the JAK-STAT pathway. However, this therapy is not always effective and currently there are no reliable biomarkers to predict therapeutic response. We postulate that the heterogeneity in the response to IFNß therapy could be related to differential activation patterns of the JAK-STAT signaling pathway. Our aim was to evaluate the basal levels and the short term activation of this pathway after IFNß stimulation in untreated and IFNß treated patients, as well as according to therapeutic response. Therefore, cell surface levels of IFNAR subunits (IFNAR1 and IFNAR2) and the activated forms of STAT1 and STAT2 were assessed in peripheral blood mononuclear cells from MS patients by flow cytometry. Basal levels of each of the markers strongly correlated with the expression of the others in untreated patients, but many of these correlations lost significance in treated patients and after short term activation with IFNß. Patients who had undergone IFNß treatment showed higher basal levels of IFNAR1 and pSTAT1, but a reduced response to in vitro exposure to IFNß. Conversely, untreated patients, with lower basal levels, showed a greater ability of short term activation of this pathway. Monocytes from responder patients had lower IFNAR1 levels (p = 0.039) and higher IFNAR2 levels (p = 0.035) than non-responders just after IFNß stimulation. A cluster analysis showed that levels of IFNAR1, IFNAR2 and pSTAT1-2 in monocytes grouped 13 out of 19 responder patients with a similar expression pattern, showing an association of this pattern with the phenotype of good response to IFNß (p = 0.013). Our findings suggest that an activation pattern of the IFNß signaling pathway in monocytes could be associated with a clinical phenotype of good response to IFNß treatment and that a differential modulation of the IFNAR subunits in monocytes could be related with treatment effectiveness.
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145
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Opsahl JA, Vaudel M, Guldbrandsen A, Aasebø E, Van Pesch V, Franciotta D, Myhr KM, Barsnes H, Berle M, Torkildsen Ø, Kroksveen AC, Berven FS. Label-free analysis of human cerebrospinal fluid addressing various normalization strategies and revealing protein groups affected by multiple sclerosis. Proteomics 2016; 16:1154-65. [PMID: 26841090 DOI: 10.1002/pmic.201500284] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/08/2015] [Accepted: 01/28/2016] [Indexed: 11/05/2022]
Abstract
The aims of the study were to: (i) identify differentially regulated proteins in cerebrospinal fluid (CSF) between multiple sclerosis (MS) patients and non-MS controls; (ii) examine the effect of matching the CSF samples on either total protein amount or volume, and compare four protein normalization strategies for CSF protein quantification. CSF from MS patients (n = 37) and controls (n = 64), consisting of other noninflammatory neurological diseases (n = 50) and non neurological spinal anesthetic subjects (n = 14), were analyzed using label-free proteomics, quantifying almost 800 proteins. In total, 122 proteins were significantly regulated (p < 0.05), where 77 proteins had p-value <0.01 or AUC value >0.75. Hierarchical clustering indicated that there were two main groups of MS patients, those with increased levels of inflammatory response proteins and decreased levels of proteins involved in neuronal tissue development (n = 30), and those with normal protein levels for both of these protein groups (n = 7). The main subgroup of controls clustering with the MS patients showing increased inflammation and decreased neuronal tissue development were patients suffering from chronic fatigue. Our data indicate that the preferable way to quantify proteins in CSF is to first match the samples on total protein amount and then normalize the data based on the median intensities, preferably from the CNS-enriched proteins.
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Affiliation(s)
- Jill A Opsahl
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Marc Vaudel
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Astrid Guldbrandsen
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Elise Aasebø
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Vincent Van Pesch
- Neurology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Kjell-Morten Myhr
- The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Harald Barsnes
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Magnus Berle
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,Surgical Clinic, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Ann C Kroksveen
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frode S Berven
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway.,The KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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146
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Guldbrandsen A, Farag Y, Kroksveen AC, Oveland E, Lereim RR, Opsahl JA, Myhr KM, Berven FS, Barsnes H. CSF-PR 2.0: An Interactive Literature Guide to Quantitative Cerebrospinal Fluid Mass Spectrometry Data from Neurodegenerative Disorders. Mol Cell Proteomics 2016; 16:300-309. [PMID: 27890865 DOI: 10.1074/mcp.o116.064477] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/18/2016] [Indexed: 01/23/2023] Open
Abstract
The rapidly growing number of biomedical studies supported by mass spectrometry based quantitative proteomics data has made it increasingly difficult to obtain an overview of the current status of the research field. A better way of organizing the biomedical proteomics information from these studies and making it available to the research community is therefore called for. In the presented work, we have investigated scientific publications describing the analysis of the cerebrospinal fluid proteome in relation to multiple sclerosis, Parkinson's disease and Alzheimer's disease. Based on a detailed set of filtering criteria we extracted 85 data sets containing quantitative information for close to 2000 proteins. This information was made available in CSF-PR 2.0 (http://probe.uib.no/csf-pr-2.0), which includes novel approaches for filtering, visualizing and comparing quantitative proteomics information in an interactive and user-friendly environment. CSF-PR 2.0 will be an invaluable resource for anyone interested in quantitative proteomics on cerebrospinal fluid.
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Affiliation(s)
- Astrid Guldbrandsen
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Yehia Farag
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Ann Cathrine Kroksveen
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Eystein Oveland
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Ragnhild R Lereim
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Jill A Opsahl
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Kjell-Morten Myhr
- §KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway.,¶Norwegian Multiple Sclerosis Registry and Biobank, Haukeland University Hospital, 5021 Bergen, Norway
| | - Frode S Berven
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway; .,§KG Jebsen Centre for Multiple Sclerosis Research, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway.,‖Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Harald Barsnes
- From the ‡Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, 5009 Bergen, Norway.,**Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.,‡‡Computational Biology Unit, Department of Informatics, University of Bergen, 5020 Bergen, Norway
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147
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Cordiglieri C, Baggi F, Bernasconi P, Kapetis D, Faggiani E, Consonni A, Andreetta F, Frangiamore R, Confalonieri P, Antozzi C, Mantegazza R. Identification of a gene expression signature in peripheral blood of multiple sclerosis patients treated with disease-modifying therapies. Clin Immunol 2016; 173:133-146. [PMID: 27720845 DOI: 10.1016/j.clim.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023]
Abstract
Multiple Sclerosis (MS) is an inflammatory disease with neurodegenerative alterations, ultimately progressing to neurological handicap. Therapies are effective in counteracting inflammation but not neurodegeneration. Biomarkers predicting disease course or treatment response are lacking. We investigated whether altered gene and protein expression profiles were detectable in the peripheral blood of 78 relapsing remitting MS (RR-MS) patients treated by disease-modifying therapies. A discovery/validation study on RR-MS responsive to glatiramer acetate identified 8 differentially expressed genes: ITGA2B, ITGB3, CD177, IGJ, IL5RA, MMP8, P2RY12, and S100β. A longitudinal study on glatiramer acetate, Interferon-β, or Fingolimod treated RR-MS patients confirmed that 7 out of 8 genes were downregulated with reference to the different therapies, whereas S100β was always upregulated. Thus, we identified a peripheral gene signature associated with positive response in RR-MS which may also explain drug immunomodulatory effects. The usefulness of this signature as a biomarker needs confirmation on larger series of patients.
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Affiliation(s)
- Chiara Cordiglieri
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Fulvio Baggi
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Pia Bernasconi
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Dimos Kapetis
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Elisa Faggiani
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Alessandra Consonni
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Francesca Andreetta
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Rita Frangiamore
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Paolo Confalonieri
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Carlo Antozzi
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy
| | - Renato Mantegazza
- Neurology IV - Neuroimmunology and Neuromuscular Diseases Unit, Neurological Institute "Carlo Besta", Milan, Italy.
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148
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Londoño AC, Mora CA. Autologous Bone Marrow Transplantation in Multiple Sclerosis: Biomarker Relevance for Patient Recruitment and Follow up. JOURNAL OF CLINICAL & CELLULAR IMMUNOLOGY 2016; 7:455. [PMID: 28090375 PMCID: PMC5226132 DOI: 10.4172/2155-9899.1000455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the current availability of disease modifying therapies for the treatment of multiple sclerosis, there are still patients who suffer from severe neurological dysfunction in the relapsing-remitting or early progressive forms of the disease. For these patients autologous hematopoietic stem cell transplant offers an important therapeutic solution to prevent progression to irreversible disability. In spite of multiple studies in the last two decades, patient inclusion criteria, protocols for peripheral blood stem cell mobilization and bone marrow cell conditioning and methodology of follow up for autologous hematopoietic stem cell transplant in multiple sclerosis have not been strictly unified. METHODS We reviewed five recent clinical studies that confirmed the positive outcome of transplant in spite of disclosing significant differences in methodology of enrollment including patient disease subtypes, disease duration range, disability, regimens of peripheral blood stem cell mobilization and bone marrow cell conditioning, scheduling of imaging studies after transplant, and absence of laboratory biomarkers consistently applied to these studies. RESULTS Therapy with autologous hematopoietic stem cell transplant has shown best results among young individuals with severe relapsing-remitting or early progressive disease through its ability to maintain no evidence of disease activity status in a significantly higher proportion of patients after transplant in comparison to patients treated with disease modifying therapies. Important cross-sectional differences in the reviewed studies were found. CONCLUSION A specific and careful selection of biomarkers, based on the current physiopathological mechanisms known to result in multiple sclerosis, will contribute to a better and earlier patient selection for autologous hematopoietic stem cell transplant and follow up process. An objective and measurable response could be obtained with the determination of biomarkers at the onset of treatment and after follow-up on reconstitution of the immune response. The application of such parameters could also help further our understanding of pathogenesis of the disease.
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Affiliation(s)
- Ana C. Londoño
- Instituto Neurológico de Colombia-INDEC (A.C.L.), Medellin, Colombia
| | - Carlos A. Mora
- Department of Neurology (C.A.M.), Georgetown Multiple Sclerosis Center, MedStar Georgetown University Hospital, Washington, DC, USA
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Arrambide G, Espejo C, Eixarch H, Villar LM, Alvarez-Cermeño JC, Picón C, Kuhle J, Disanto G, Kappos L, Sastre-Garriga J, Pareto D, Simon E, Comabella M, Río J, Nos C, Tur C, Castilló J, Vidal-Jordana A, Galán I, Arévalo MJ, Auger C, Rovira A, Montalban X, Tintore M. Neurofilament light chain level is a weak risk factor for the development of MS. Neurology 2016; 87:1076-84. [PMID: 27521440 PMCID: PMC5027802 DOI: 10.1212/wnl.0000000000003085] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine the prognostic value of selected biomarkers in clinically isolated syndromes (CIS) for conversion to multiple sclerosis (MS) and disability accrual. Methods: Data were acquired from 2 CIS cohorts. The screening phase evaluated patients developing clinically definite MS (CIS-CDMS) and patients who remained as CIS during a 2-year minimum follow-up (CIS-CIS). We determined levels of neurofascin, semaphorin 3A, fetuin A, glial fibrillary acidic protein, and neurofilament light (NfL) and heavy chains in CSF (estimated mean [95% confidence interval; CI]). We evaluated associations between biomarker levels, conversion, disability, and magnetic resonance parameters. In the replication phase, we determined NfL levels (n = 155) using a 900 ng/L cutoff. Primary endpoints in uni- and multivariate analyses were CDMS and 2010 McDonald MS. Results: The only biomarker showing significant differences in the screening was NfL (CIS-CDMS 1,553.1 [1,208.7–1,897.5] ng/L and CIS-CIS 499.0 [168.8–829.2] ng/L, p < 0.0001). The strongest associations were with brain parenchymal fraction change (rs = −0.892) and percentage brain volume change (rs = −0.842) at 5 years. NfL did not correlate with disability. In the replication phase, more NfL-positive patients, according to the cutoff, evolved to MS. Every 100-ng/L increase in NfL predicted CDMS (hazard ratio [HR] = 1.009, 95% CI 1.005–1.014) and McDonald MS (HR = 1.009, 95% CI 1.005–1.013), remaining significant for CDMS in the multivariate analysis (adjusted HR = 1.005, 95% CI 1.000–1.011). This risk was lower than the presence of oligoclonal bands or T2 lesions. Conclusions: NfL is a weak independent risk factor for MS. Its role as an axonal damage biomarker may be more relevant as suggested by its association with medium-term brain volume changes.
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Affiliation(s)
- Georgina Arrambide
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Espejo
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Herena Eixarch
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Luisa M Villar
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José C Alvarez-Cermeño
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Picón
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jens Kuhle
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Giulio Disanto
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ludwig Kappos
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Deborah Pareto
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eva Simon
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manuel Comabella
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Río
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Nos
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Tur
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joaquín Castilló
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Angela Vidal-Jordana
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ingrid Galán
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria J Arévalo
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Auger
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alex Rovira
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintore
- From Servei de Neurologia-Neuroimmunologia (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., M.J.A., X.M., M.T.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona; Universitat Autònoma de Barcelona (G.A., C.E., H.E., J.S.-G., E.S., M.C., J.R., C.N., C.T., J.C., A.V.-J., I.G., X.M., M.T.), Bellaterra; Departments of Neurology and Immunology (L.M.V., J.C.A.-C., C.P.), Multiple Sclerosis Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Department of Neurology (J.K., L.K.), University Hospital Basel; Neurocentre of Southern Switzerland (G.D.), Ospedale Civico, Lugano, Switzerland; and Magnetic Resonance Unit (IDI) (D.P., C.A., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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