151
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Efstathopoulos P, Kourgiantaki A, Karali K, Sidiropoulou K, Margioris AN, Gravanis A, Charalampopoulos I. Fingolimod induces neurogenesis in adult mouse hippocampus and improves contextual fear memory. Transl Psychiatry 2015; 5:e685. [PMID: 26795749 PMCID: PMC5545691 DOI: 10.1038/tp.2015.179] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 12/15/2022] Open
Abstract
Fingolimod (FTY720) was the first per os administered disease-modifying agent approved for the treatment of relapsing-remitting multiple sclerosis. It is thought that fingolimod modulates the immune response by activating sphingosine-1 phosphate receptor type 1 (S1P1) on lymphocytes following its in vivo phosphorylation. In addition to its immune-related effects, there is evidence that fingolimod exerts several other effects in the central nervous system, including regulation of the proliferation, survival and differentiation of various cell types and their precursors. In the present study, we have investigated the effect of fingolimod on the production of new neurons in the adult mouse hippocampus and the association of this effect with the ability for pattern separation, an established adult neurogenesis-dependent memory function. Immunofluorescence analysis after chronic administration of a physiologic dose of fingolimod (0.3 mg kg(-1)) revealed a significant increase in both the proliferation and the survival of neural progenitors in the area of dentate gyrus of hippocampus, compared with control animals. These effects were replicated in vitro, in cultures of murine hippocampal neural stem/precursor cells that express S1P1 receptor, suggesting cell-autonomous actions. The effects of fingolimod on neurogenesis were correlated to enhanced ability for context discrimination after fear conditioning. Since impairment of adult hippocampal neurogenesis and memory is a common feature of many neuropsychiatric conditions, fingolimod treatment may be beneficial in therapeutic armamentarium of these disorders.
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Affiliation(s)
- P Efstathopoulos
- Department of Pharmacology, School of Medicine, University of Crete, Heraklion, Greece,Institute of Molecular Biology & Biotechnology, Foundation of Research & Technology-Hellas (IMBB-FORTH), Heraklion, Greece
| | - A Kourgiantaki
- Department of Pharmacology, School of Medicine, University of Crete, Heraklion, Greece,Institute of Molecular Biology & Biotechnology, Foundation of Research & Technology-Hellas (IMBB-FORTH), Heraklion, Greece
| | - K Karali
- Department of Pharmacology, School of Medicine, University of Crete, Heraklion, Greece,Institute of Molecular Biology & Biotechnology, Foundation of Research & Technology-Hellas (IMBB-FORTH), Heraklion, Greece
| | - K Sidiropoulou
- Department of Biology, University of Crete, Heraklion, Greece
| | - A N Margioris
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Greece
| | - A Gravanis
- Department of Pharmacology, School of Medicine, University of Crete, Heraklion, Greece,Institute of Molecular Biology & Biotechnology, Foundation of Research & Technology-Hellas (IMBB-FORTH), Heraklion, Greece
| | - I Charalampopoulos
- Department of Pharmacology, School of Medicine, University of Crete, Heraklion, Greece,Department of Pharmacology, School of Medicine, University of Crete, Stavrakia Voutes, Heraklion, Crete, GR-71003, Greece. E-mail:
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152
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Azin M, Mirnajafi-Zadeh J, Javan M. Fibroblast Growth Factor-2 Enhanced The Recruitment of Progenitor Cells and Myelin Repair in Experimental Demyelination of Rat Hippocampal Formations. CELL JOURNAL 2015; 17:540-456. [PMID: 26464826 PMCID: PMC4601875 DOI: 10.22074/cellj.2015.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/20/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Hippocampal insults have been observed in multiple sclerosis (MS) patients. Fibroblast growth factor-2 (FGF2) induces neurogenesis in the hippocampus and en- hances the proliferation, migration and differentiation of oligodendrocyte progenitor cells (OPCs). In the current study, we have investigated the effect of FGF2 on the processes of gliotoxin induced demyelination and subsequent remyelination in the hippocampus. MATERIALS AND METHODS In this experimental study adult male Sprague-Dawley rats re- ceived either saline or lysolecithin (LPC) injections to the right hippocampi. Animals re- ceived intraperitoneal (i.p.) injections of FGF2 (5 ng/g) on days 0, 5, 12 and 26 post-LPC. Expressions of myelin basic protein (Mbp) as a marker of myelination, Olig2 as a marker of OPC proliferation, Nestin as a marker of neural progenitor cells, and glial fibrillary acidic protein (Gfap) as a marker of reactive astrocytes were investigated in the right hippocampi by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS There was reduced Mbp expression at seven days after LPC injection, in- creased expressions of Olig2 and Nestin, and the level of Gfap did not change. FGF2 treatment reversed the expression level of Mbp to the control, significantly enhanced the levels of Olig2 and Nestin, but did not change the level of Gfap. At day-28 post- LPC, the expression level of Mbp was higher than the control in LPC-treated animals that received FGF2. The levels of Olig2, Nestin and Gfap were at the control level in the non-treated LPC group but significantly higher in the FGF2-treated LPC group. CONCLUSION FGF2 enhanced hippocampal myelination and potentiated the recruitment of OPCs and neural stem cells (NSCs) to the lesion area. Long-term application of FGF2 might also enhance astrogliosis in the lesion site.
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Affiliation(s)
- Mahdieh Azin
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Javad Mirnajafi-Zadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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153
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Rocca MA, Pravatà E, Valsasina P, Radaelli M, Colombo B, Vacchi L, Gobbi C, Comi G, Falini A, Filippi M. Hippocampal-DMN disconnectivity in MS is related to WM lesions and depression. Hum Brain Mapp 2015; 36:5051-63. [PMID: 26366641 DOI: 10.1002/hbm.22992] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/12/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
The hippocampus is part of the default-mode network (DMN) and is functionally hit early in multiple sclerosis (MS). Hippocampal and DMN dysfunctions have been associated with depression, both in patients with MS and in major depressive disorders. We hypothesized that white matter lesions may contribute, through a disconnection mechanism, to hippocampal dysfunction. To test this, we assessed the relationship between hippocampal resting-state (RS) functional connectivity (FC) abnormalities with brain T2 lesion volumes and the presence and severity of depression. Structural and RS fMRI images were acquired from 69 patients with cognitively intact MS and 42 matched healthy controls (HC). Depression was quantified using the Montgomery-Asberg Depression Rating Scale. Seed-voxel hippocampal RS FC was assessed. SPM8 was used for between-group comparisons and correlation analysis between RS FC abnormalities with clinical and structural MRI variables. Compared to HC, patients with MS showed a significant atrophy of the whole brain and left hippocampus (P < 0.001), and a distributed pattern of decreased RS FC between the hippocampi and several cortical-subcortical regions, which were mostly located within the DMN. Reduced hippocampal RS FC with regions of the DMN was strongly correlated with higher T2 lesion volume, longer disease duration, and the severity of depression and disability. In patients with cognitively preserved MS, brain focal WM lesions are related to the functional integration of the hippocampus to other brain regions of the DMN, suggesting a disconnection syndrome. Such a disruption of hippocampal RS FC is likely to contribute to the occurrence of depression and to clinical disability.
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Affiliation(s)
- 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, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Pravatà
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neuroradiology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Radaelli
- Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Vacchi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Giancarlo Comi
- Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - 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, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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154
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Marasescu R, Cerezo Garcia M, Aladro Benito Y. Impairment of visuospatial/visuoconstructional skills in multiple sclerosis patients: the correlation with regional lesion load and subcortical atrophy. Neurologia 2015; 31:169-75. [PMID: 26342250 DOI: 10.1016/j.nrl.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/29/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION About 20% to 26% of patients with multiple sclerosis (MS) show alterations in visuospatial/visuoconstructive (VS-VC) skills even though temporo-parieto-occipital impairment is a frequent finding in magnetic resonance imaging. No studies have specifically analysed the relationship between these functions and lesion volume (LV) in these specific brain areas. OBJECTIVE To evaluate the relationship between VS-VC impairment and magnetic resonance imaging temporo-parieto-occipital LV with subcortical atrophy in patients with MS. METHODOLOGY Of 100 MS patients undergoing a routine neuropsychological evaluation, 21 were selected because they displayed VS-VC impairments in the following tests: Incomplete picture, Block design (WAIS-III), and Rey-Osterrieth complex figure test. We also selected 13 MS patients without cognitive impairment (control group). Regional LV was measured in FLAIR and T1-weighted images using a semiautomated method; subcortical atrophy was measured by bicaudate ratio and third ventricle width. Partial correlations (controlling for age and years of school) and linear regression analysis were employed to analyse correlations between magnetic resonance imaging parameters and cognitive performance. RESULTS All measures of LV and brain atrophy were significantly higher in patients with cognitive impairment. Regional LV, bicaudate ratio, and third ventricle width are significantly and inversely correlated with cognitive performance; the strongest correlation was between third ventricle width and VC performance (Block design: P=.001; Rey-Osterrieth complex figure: P<.000). In the multivariate analysis, third ventricle width only had a significant effect on performance of VC tasks (Block design: P=.000; Rey-Osterrieth complex figure: P=.000), and regional FLAIR VL was linked to the VS task (Incomplete picture; P=.002). CONCLUSIONS Measures of subcortical atrophy explain the variations in performance on visuocostructive tasks, and regional FLAIR VL measures are linked to VS tasks.
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Affiliation(s)
- R Marasescu
- Servicio de Neurología, Hospital Universitario de Getafe, Getafe, España.
| | - M Cerezo Garcia
- Servicio de Neurología, Hospital Universitario de Getafe, Getafe, España
| | - Y Aladro Benito
- Servicio de Neurología, Hospital Universitario de Getafe, Getafe, España
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155
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van Munster CE, Jonkman LE, Weinstein HC, Uitdehaag BM, Geurts JJ. Gray matter damage in multiple sclerosis: Impact on clinical symptoms. Neuroscience 2015; 303:446-61. [DOI: 10.1016/j.neuroscience.2015.07.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 01/12/2023]
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156
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Atteinte de la mémoire épisodique verbale dans la sclérose en plaques : revue critique des processus cognitifs concernés et de leur exploration. Rev Neurol (Paris) 2015; 171:624-45. [DOI: 10.1016/j.neurol.2015.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/01/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
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157
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Rocca MA, Longoni G, Pagani E, Boffa G, Colombo B, Rodegher M, Martino G, Falini A, Comi G, Filippi M. In vivo evidence of hippocampal dentate gyrus expansion in multiple sclerosis. Hum Brain Mapp 2015; 36:4702-13. [PMID: 26287572 DOI: 10.1002/hbm.22946] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/30/2015] [Accepted: 08/10/2015] [Indexed: 02/02/2023] Open
Abstract
Using MR-based radial mapping, we assessed morphological alterations of the hippocampal dentate gyrus (DG) in patients with relapse-onset multiple sclerosis (MS). We analyzed different stages of the disease and the association of DG alterations with hippocampal-related cognitive functions. Using high-resolution morphological imaging, hippocampal radial mapping analysis was performed in 28 relapsing-remitting (RR), 34 secondary progressive, and 26 benign MS patients and 28 healthy controls (HC). Between-groups differences of DG radial distance (from surface points to the central core of the hippocampus) and correlations with clinical, neuropsychological, and radiological measures were evaluated using surface-based mesh modeling. Compared with HC, all MS clinical phenotypes revealed a larger radial distance of the DG, which was more marked on the left side. Radial distance enlargement was more pronounced in RRMS patients compared with the other disease clinical phenotypes and was inversely correlated to disease duration. Radial distance enlargement was correlated with higher T2 lesion volume and a better cognitive performance in RRMS and with a poor cognitive performance in secondary progressive and benign MS patients. Surface expansion of the DG might represent an inflammation-induced neurogenic (reactive) process of the subgranular zone of the hippocampus primarily aimed at rescuing the functional competence of hippocampal circuitry.
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Affiliation(s)
- 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, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Longoni
- 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, San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Boffa
- 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, San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Mariaemma Rodegher
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - 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, San Raffaele Scientific Institute, Milan, Italy
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158
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Rocca MA, Morelli ME, Amato MP, Moiola L, Ghezzi A, Veggiotti P, Capra R, Pagani E, Portaccio E, Fiorino A, Pippolo L, Pera MC, Comi G, Falini A, Filippi M. Regional hippocampal involvement and cognitive impairment in pediatric multiple sclerosis. Mult Scler 2015; 22:628-40. [DOI: 10.1177/1352458515598569] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022]
Abstract
Objectives: We assessed global and regional hippocampal volume abnormalities in pediatric multiple sclerosis (MS) patients and their correlations with clinical, neuropsychological and magnetic resonance imaging metrics. Methods: From 53 pediatric MS patients and 18 healthy controls, global hippocampal volume was computed using a manual tracing procedure. Regional hippocampal volume modifications were assessed using a radial mapping analysis. MS patients with abnormal performance in three or more tests of a neuropsychological battery for children were classified as cognitively impaired. Results: Global hippocampal volume was reduced in MS patients compared with controls, but did not correlate with clinical, neuropsychological and magnetic resonance imaging measures. Compared to controls, MS patients experienced bilateral radial atrophy of the cornu ammonis, subiculum and dentate gyrus subfields as well as radial hypertrophy of the dentate gyrus subfield. Regional hippocampal volume modifications correlated with brain T2 lesion volume as well as attention and language abilities. Global hippocampal volume did not differ between cognitively impaired ( n=12) and cognitively preserved MS patients. Compared to cognitively preserved, cognitively impaired MS patients had atrophy of the subiculum and dentate gyrus subfields of the right hippocampus. Conclusions: Hippocampal subregions have different vulnerability to damage in pediatric MS. Regional rather than global hippocampal involvement contributes to global cognitive impairment as well as to deficits of selected cognitive tests.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Maria E Morelli
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Maria P Amato
- Department of Neurology, University of Florence, Italy
| | - Lucia Moiola
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Center, Ospedale di Gallarate, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry, C. Mondino National Neurological Institute, Pavia, Italy and Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | | | - Agnese Fiorino
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | | | - Maria C Pera
- Department of Child Neurology and Psychiatry, C. Mondino National Neurological Institute, Pavia, Italy and Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
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159
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Detection and quantification of regional cortical gray matter damage in multiple sclerosis utilizing gradient echo MRI. NEUROIMAGE-CLINICAL 2015; 9:164-75. [PMID: 27330979 PMCID: PMC4907986 DOI: 10.1016/j.nicl.2015.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/29/2022]
Abstract
Cortical gray matter (GM) damage is now widely recognized in multiple sclerosis (MS). The standard MRI does not reliably detect cortical GM lesions, although cortical volume loss can be measured. In this study, we demonstrate that the gradient echo MRI can reliably and quantitatively assess cortical GM damage in MS patients using standard clinical scanners. High resolution multi-gradient echo MRI was used for regional mapping of tissue-specific MRI signal transverse relaxation rate values (R2(*)) in 10 each relapsing-remitting, primary-progressive and secondary-progressive MS subjects. A voxel spread function method was used to correct artifacts induced by background field gradients. R2(*) values from healthy controls (HCs) of varying ages were obtained to establish baseline data and calculate ΔR2(*) values - age-adjusted differences between MS patients and HC. Thickness of cortical regions was also measured in all subjects. In cortical regions, ΔR2(*) values of MS patients were also adjusted for changes in cortical thickness. Symbol digit modalities (SDMT) and paced auditory serial addition (PASAT) neurocognitive tests, as well as Expanded Disability Status Score, 25-foot timed walk and nine-hole peg test results were also obtained on all MS subjects. We found that ΔR2(*) values were lower in multiple cortical GM and normal appearing white matter (NAWM) regions in MS compared with HC. ΔR2(*) values of global cortical GM and several specific cortical regions showed significant (p < 0.05) correlations with SDMT and PASAT scores, and showed better correlations than volumetric measures of the same regions. Neurological tests not focused on cognition (Expanded Disability Status Score, 25-foot timed walk and nine-hole peg tests) showed no correlation with cortical GM ΔR2(*) values. The technique presented here is robust and reproducible. It requires less than 10 min and can be implemented on any MRI scanner. Our results show that quantitative tissue-specific R2(*) values can serve as biomarkers of tissue injury due to MS in the brain, including the cerebral cortex, an area that has been difficult to evaluate using standard MRI.
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Key Words
- 25FTW, 25-foot timed walk
- 9HPT, Nine-hole peg test
- Cognitive disability
- Cortical gray matter
- EDSS, expanded disability status scale
- GEPCI, gradient echo plural contrast imaging
- GM, gray matter
- HC, healthy control
- MPRAGE, magnetization prepared rapid gradient echo
- MS, multiple sclerosis
- Multiple sclerosis
- NAWM, normal appearing white matter
- NCGMV, normalized cortical gray matter volume
- PASAT, paced auditory serial addition test
- PPMS, primary-progressive multiple sclerosis
- Quantitative
- R2*
- ROI, region of interest
- RRMS, relapsing–remitting multiple sclerosis
- SDMT, symbol digit modalities test
- SPMS, secondary-progressive multiple sclerosis
- WM, white matter
- WMLL, white matter lesion load
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160
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Abstract
The hippocampus has a pivotal role in learning and in the formation and consolidation of memory and is critically involved in the regulation of emotion, fear, anxiety, and stress. Studies of the hippocampus have been central to the study of memory in humans and in recent years, the regional specialization and organization of hippocampal functions have been elucidated in experimental models and in human neurological and psychiatric diseases. The hippocampus has long been considered a classic model for the study of neuroplasticity as many examples of synaptic plasticity such as long-term potentiation and -depression have been identified and demonstrated in hippocampal circuits. Neuroplasticity is the ability to adapt and reorganize the structure or function to internal or external stimuli and occurs at the cellular, population, network or behavioral level and is reflected in the cytological and network architecture as well as in intrinsic properties of hippocampal neurons and circuits. The high degree of hippocampal neuroplasticity might, however, be also negatively reflected in the pronounced vulnerability of the hippocampus to deleterious conditions such as ischemia, epilepsy, chronic stress, neurodegeneration and aging targeting hippocampal structure and function and leading to cognitive deficits. Considering this framework of plasticity and vulnerability, we here review basic principles of hippocampal anatomy and neuroplasticity on various levels as well as recent findings regarding the functional organization of the hippocampus in light of the regional vulnerability in Alzheimer's disease, ischemia, epilepsy, neuroinflammation and aging.
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Affiliation(s)
- T Bartsch
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - P Wulff
- Institute of Physiology, Neurophysiology, University of Kiel, Olshausenstrasse 40, 24098 Kiel, Germany.
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161
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Powell DJH, Moss-Morris R, Liossi C, Schlotz W. Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis. Psychoneuroendocrinology 2015; 56:120-31. [PMID: 25817406 DOI: 10.1016/j.psyneuen.2015.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Abstract
Cortisol is a key regulator of the immune system, energy metabolism, and stress, yet its relevance to fatigue experienced by people with relapsing-remitting multiple sclerosis (RRMS) remains uncertain. We examined cortisol secretory activity in RRMS and its association with fatigue severity between-individuals and within-individuals (day-to-day) using a case-control ecological momentary assessment design. While undergoing usual daily routines, 38 people with RRMS and 38 healthy control participants provided saliva samples at strategic time-points over 4 consecutive weekdays to measure the cortisol awakening response (CAR; 0, 30, and 45 min after awakening) and the diurnal cortisol slope (DCS; 6 quasi-random samples provided between 1000 h and 2000 h). Recalled fatigue was measured at baseline, and daily fatigue was measured as the mean average of momentary fatigue ratings provided alongside each DCS sample. Multilevel modeling found CAR output was greater in RRMS than controls, and recalled fatigue in RRMS was associated with both lower waking cortisol level and larger awakening response. Day-to-day, the CAR was not associated with same-day fatigue levels in RRMS. Cortisol appears to have a role in fatigue experienced in RRMS, but whether it is a causal factor remains unclear.
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Affiliation(s)
- Daniel J H Powell
- Aberdeen Health Psychology Group, Institute of Applied Health Science, University of Aberdeen, AB25 2ZD, UK; Psychology, Faculty of Social and Human Sciences, University of Southampton, SO17 1BJ, UK.
| | - Rona Moss-Morris
- Psychology, Faculty of Social and Human Sciences, University of Southampton, SO17 1BJ, UK; Health Psychology Section, Institute of Psychiatry, King's College London, London SE1 9RT, UK
| | - Christina Liossi
- Psychology, Faculty of Social and Human Sciences, University of Southampton, SO17 1BJ, UK
| | - Wolff Schlotz
- Psychology, Faculty of Social and Human Sciences, University of Southampton, SO17 1BJ, UK; Max Planck Institute of Empirical Aesthetics, 60322 Frankfurt am Main, Germany
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162
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Leavitt VM, Wylie GR, Girgis PA, DeLuca J, Chiaravalloti ND. Increased functional connectivity within memory networks following memory rehabilitation in multiple sclerosis. Brain Imaging Behav 2015; 8:394-402. [PMID: 22706694 DOI: 10.1007/s11682-012-9183-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Identifying effective behavioral treatments to improve memory in persons with learning and memory impairment is a primary goal for neurorehabilitation researchers. Memory deficits are the most common cognitive symptom in multiple sclerosis (MS), and hold negative professional and personal consequences for people who are often in the prime of their lives when diagnosed. A 10-session behavioral treatment, the modified Story Memory Technique (mSMT), was studied in a randomized, placebo-controlled clinical trial. Behavioral improvements and increased fMRI activation were shown after treatment. Here, connectivity within the neural networks underlying memory function was examined with resting-state functional connectivity (RSFC) in a subset of participants from the clinical trial. We hypothesized that the treatment would result in increased integrity of connections within two primary memory networks of the brain, the hippocampal memory network, and the default network (DN). Seeds were placed in left and right hippocampus, and the posterior cingulate cortex. Increased connectivity was found between left hippocampus and cortical regions specifically involved in memory for visual imagery, as well as among critical hubs of the DN. These results represent the first evidence for efficacy of a behavioral intervention to impact the integrity of neural networks subserving memory functions in persons with MS.
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Affiliation(s)
- Victoria M Leavitt
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation Research Center, 300 Executive Drive, suite 70, West Orange, NJ, 07052, USA
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163
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Arginine-rich polyplexes for gene delivery to neuronal cells. Biomaterials 2015; 60:151-60. [PMID: 26000961 DOI: 10.1016/j.biomaterials.2015.04.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022]
Abstract
Neuronal gene therapy potentially offers an effective therapeutic intervention to cure or slow the progression of neurological diseases. However, neuronal cells are difficult to transfect with nonviral vectors, and in vivo their transport across the blood-brain barrier (BBB) is inefficient. We synthesized a series of arginine-rich oligopeptides, grafted with polyethyleneimine (PEI) and modified with a short-chain polyethylene glycol (PEG). We hypothesized that the arginine would enhance cellular uptake and transport of these polyplexes across the BBB, with PEG imparting biocompatibility and "stealth" properties and PEI facilitating DNA condensation and gene transfection. The optimized composition of the polyplexes demonstrated hemocompatibility with red blood cells, causing no lysis or aggregation, and showed significantly better cytocompatibility than PEI in vitro. Polyplexes formulated with luciferase-expressing plasmid DNA could transfect rat primary astrocytes and neurons in vitro. Confocal imaging data showed efficient cellular uptake of DNA and its sustained intracellular retention and nuclear localization with polyplexes. Intravenous administration of the optimized polyplexes in mice led to gene expression in the brain, which upon further immunohistochemical analysis demonstrated gene expression in neurons. In conclusion, we have successfully designed a nonviral vector for in vitro and in vivo neuronal gene delivery.
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164
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Distinct and common cerebral activation changes during mental time travel in relapsing-remitting multiple sclerosis patients. Brain Imaging Behav 2015; 10:296-313. [PMID: 25972116 DOI: 10.1007/s11682-015-9394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mental time travel (MTT) entails the ability to mentally travel into autobiographical memory (AM) and episodic future thinking (EFT). While AM and EFT share common phenomenological and cerebral functional properties, distinctive characteristics have been documented in healthy and clinical populations. No report, to our knowledge, has informed on the functional underpinnings of MTT impairment in multiple sclerosis (MS) patients, hence the aim of this work. We studied 22 relapsing-remitting MS patients and 22 matched controls. Participants underwent an AM/EFT assessment using the Autobiographical Interview (Levine et al. 2002), followed by a functional MRI session. The latter consisted in AM and EFT tasks, distinguishing the construction and elaboration phases of events. The results showed impaired performance for AM and EFT in patients, accompanied by increased cerebral activations mostly located in the frontal regions, which extended to the parietal, lateral temporal and posterior regions during AM/EFT tasks, relative to healthy controls. Enhanced brain activations in MS patients were particularly evident during the EFT task and involved the hippocampus, frontal, external temporal, and cingulate regions. The construction phase required greater fronto-parieto-temporal activations in MS patients relative to both healthy controls, and the elaboration phase. Taking together, our results suggested the occurrence of cerebral activation changes in the context of MTT in MS patients, expressed by distinct and common mechanisms for AM and EFT. This study may provide new insights in terms of cerebral activation changes in brain lesion and their application to clinical settings, considering AM/EFT's central role in everyday life.
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165
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Michailidou I, Willems JGP, Kooi EJ, van Eden C, Gold SM, Geurts JJG, Baas F, Huitinga I, Ramaglia V. Complement C1q-C3-associated synaptic changes in multiple sclerosis hippocampus. Ann Neurol 2015; 77:1007-26. [PMID: 25727254 DOI: 10.1002/ana.24398] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, leading to memory impairment in up to 65% of patients. Memory dysfunction in MS has been associated with loss of synapses in the hippocampus, but its molecular basis is unknown. Accumulating evidence suggests that components of the complement system, C1q and C3, can mediate elimination of synapses. METHODS To investigate the involvement of complement in synaptic changes in MS, gene and protein expression and localization of C1q and C3 were analyzed in relation to neuropathological changes in myelinated and demyelinated hippocampi from postmortem MS brains. Findings were compared to hippocampi of Alzheimer disease (AD) and non-neurological controls. RESULTS C1q expression and C3 activation were increased in myelinated and demyelinated MS hippocampi, mainly in the CA3/2 and CA1 subfields, which also showed a marked decrease in synaptic density and increased neuronal staining for the mitochondrial heat shock protein 70 (mtHSP70) stress marker. Neurons were the major source of C1q mRNA. C1q protein and activated C3 localized at synapses within human leukocyte antigen-positive cell processes and lysosomes, suggesting engulfment of complement-tagged synapses by microglia. A significant association (p < 0.0001) between the density of C1q and synaptophysin-positive synapses or mtHSP70 was seen in myelinated MS hippocampi, further pointing toward a link between the complement pathway and synaptic changes. In contrast to AD, MS hippocampi were consistently negative for the terminal complement activation complex C5b9. INTERPRETATION These data support a role for the C1q-C3 complement axis in synaptic alterations in the MS hippocampus.
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Affiliation(s)
- Iliana Michailidou
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
| | - Janske G P Willems
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands.,Department of Neuroimmunology, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Evert-Jan Kooi
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Corbert van Eden
- Department of Neuroimmunology, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Stefan M Gold
- Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Charité, Berlin, Germany
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Frank Baas
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
| | - Inge Huitinga
- Department of Neuroimmunology, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Valeria Ramaglia
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands.,Department of Neuroimmunology, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
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166
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Cognitive impairment and memory disorders in relapsing-remitting multiple sclerosis: the role of white matter, gray matter and hippocampus. J Neurol 2015; 262:1691-7. [PMID: 25957638 DOI: 10.1007/s00415-015-7763-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/21/2023]
Abstract
Cognitive disorders occur in up to 65 % of multiple sclerosis (MS) patients; they have been correlated with different MRI measures of brain tissue damage, whole and regional brain atrophy. The hippocampal involvement has been poorly investigated in cognitively impaired (CI) MS patients. The objective of this study is to analyze and compare brain tissue abnormalities, including hippocampal atrophy, in relapsing-remitting MS (RRMS) patients with and without cognitive deficits, and to investigate their role in determining cognitive impairment in MS. Forty-six RRMS patients [20 CI and 26 cognitively preserved (CP)] and 25 age, sex and education-matched healthy controls (HCs) underwent neuropsychological evaluation and 3-Tesla anatomical MRI. T2 lesion load (T2-LL) was computed with a semiautomatic method, gray matter volume and white matter volume were estimated using SIENAX. Hippocampal volume (HV) was obtained by manual segmentation. Brain tissues volumes were compared among groups and correlated with cognitive performances. Compared to HCs, RRMS patients had significant atrophy of WM, GM, left and right Hippocampus (p < 0.001). Compared to CP, CI RRMS patients showed higher T2-LL (p = 0.02) and WM atrophy (p = 0.01). In the whole RRMS group, several cognitive tests correlated with brain tissue abnormalities (T2-LL, WM and GM atrophy); only verbal memory performances correlated with left hippocampal atrophy. Our results emphasize the role of T2-LL and WM atrophy in determining clinically evident cognitive impairment in MS patients and provide evidence that GM and hippocampal atrophy occur in MS patients regardless of cognitive status.
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167
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Daulatzai MA. Olfactory dysfunction: its early temporal relationship and neural correlates in the pathogenesis of Alzheimer’s disease. J Neural Transm (Vienna) 2015; 122:1475-97. [DOI: 10.1007/s00702-015-1404-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/29/2015] [Indexed: 12/18/2022]
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168
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Romero K, Pavisian B, Staines WR, Feinstein A. Multiple sclerosis, cannabis, and cognition: A structural MRI study. NEUROIMAGE-CLINICAL 2015; 8:140-7. [PMID: 26106538 PMCID: PMC4473732 DOI: 10.1016/j.nicl.2015.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 02/09/2023]
Abstract
Objective A subset of patients with multiple sclerosis (MS) smoke cannabis to relieve symptoms including spasticity and pain. Recent evidence suggests that smoking cannabis further impairs cognition in people with MS and is linked to impaired functional brain changes. No such association, however, has been reported between cannabis use and structural brain changes, hence the focus of the present study. Methods Twenty patients with MS who smoke cannabis for symptom relief, and 19 matched non-cannabis-smoking MS patients were given the Brief Repeatable Neuropsychological Battery and structural MRI scans. Images were segmented into gray matter and white matter, and subsequently analysed with Partial Least Squares, a data-driven multivariate technique that explores brain–behaviour associations. Results In both groups, the Partial Least Squares analysis yielded significant correlations between cognitive scores and both gray matter (33% variance, p < .0001) and white matter (17% variance, p < .05) volume. Gray matter volume in the thalamus, basal ganglia, medial temporal, and medial prefrontal regions, and white matter volume in the fornix correlated with cognitive deficits. Crucially, the analysis indicated that brain volume reductions were associated with more extensive cognitive impairment in the cannabis versus the non-cannabis MS group. Interpretation These results suggest that cannabis use in MS results in more widespread cognitive deficits, which correlate with tissue volume in subcortical, medial temporal, and prefrontal regions. These are the first findings demonstrating an association between cannabis use, cognitive impairment and structural brain changes in MS patients. In MS, cannabis use moderates the association between cognition and brain integrity. Gray matter correlates with more widespread cognitive deficits in cannabis users. Hippocampal volume & white matter are correlated with memory only in cannabis users. Such differential patterns suggest that cannabis use has negative effects in MS patients.
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Affiliation(s)
- Kristoffer Romero
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bennis Pavisian
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - William R Staines
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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169
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Novkovic T, Shchyglo O, Gold R, Manahan-Vaughan D. Hippocampal function is compromised in an animal model of multiple sclerosis. Neuroscience 2015; 309:100-12. [PMID: 25795599 DOI: 10.1016/j.neuroscience.2015.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 11/30/2022]
Abstract
Multiple sclerosis (MS) is a progressive inflammatory autoimmune disease that is characterized by demyelination and axonal damage in the nervous system. One obvious consequence is a cumulative loss of muscle control. However, cognitive dysfunction affects roughly half of MS sufferers, sometimes already early in the disease course. Although long-term (remote) memory is typically unaffected, the ability to form new declarative memories becomes compromised. A major structure for the encoding of new declarative memories is the hippocampus. Encoding is believed to be mediated by synaptic plasticity in the form of long-term potentiation (LTP) and long-term depression (LTD) of synaptic strength. Here, in an animal model of MS we explored whether disease symptoms are accompanied by a loss of functional neuronal integrity, synaptic plasticity, or hippocampus-dependent learning ability. In mice that developed MOG35-55-induced experimental autoimmune encephalomyelitis (EAE), passive properties of CA1 pyramidal neurons were unaffected, although the ability to fire action potentials became reduced in the late phase of EAE. LTP remained normal in the early phase of MOG35-55-induced EAE. However, in the late phase, LTP was impaired and LTP-related spatial memory was impaired. In contrast, LTD and hippocampus-dependent object recognition memory were unaffected. These data suggest that in an animal model of MS hippocampal function becomes compromised as the disease progresses.
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Affiliation(s)
- T Novkovic
- Department of Neurophysiology, Medical Faculty, Ruhr University Bochum, Germany; International Graduate School of Neuroscience, Ruhr University Bochum, Germany
| | - O Shchyglo
- Department of Neurophysiology, Medical Faculty, Ruhr University Bochum, Germany; International Graduate School of Neuroscience, Ruhr University Bochum, Germany
| | - R Gold
- International Graduate School of Neuroscience, Ruhr University Bochum, Germany; Neurological University Clinic, St. Josef Hospital, Medical Faculty, Ruhr University Bochum, Germany
| | - D Manahan-Vaughan
- Department of Neurophysiology, Medical Faculty, Ruhr University Bochum, Germany; International Graduate School of Neuroscience, Ruhr University Bochum, Germany.
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170
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Cardiorespiratory fitness and its association with thalamic, hippocampal, and basal ganglia volumes in multiple sclerosis. NEUROIMAGE-CLINICAL 2015; 7:661-6. [PMID: 25844320 PMCID: PMC4375633 DOI: 10.1016/j.nicl.2015.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/14/2015] [Accepted: 02/23/2015] [Indexed: 11/22/2022]
Abstract
Background There is little known about cardiorespiratory fitness and its association with volumes of the thalamus, hippocampus, and basal ganglia in multiple sclerosis (MS). Such inquiry is important for identifying a possible behavioral approach (e.g., aerobic exercise training) that might change volumes of deep gray matter (DGM) structures associated with cognitive and motor functions in MS. Purpose This study examined the association between cardiorespiratory fitness and volumes of the thalamus, hippocampus, and basal ganglia in MS. Method We enrolled 35 persons with MS who underwent a maximal exercise test for measuring cardiorespiratory fitness as peak oxygen consumption (VO2peak) and brain MRI. Volumes of the thalamus, hippocampus, caudate, putamen, and pallidum were calculated from 3D T1-weighted structural brain images. We examined associations using partial (pr) correlations controlling for demographic and clinical variables. Results VO2peak was significantly associated with composite scaled volumes of the caudate(pr = .47, p < .01), putamen (pr = .44, p < .05), pallidum (pr = .40, p < .05), and hippocampus (pr = .42, p < .05), but not thalamus (pr = .31, p = .09), when controlling for sex, age, disability, and duration of MS. Conclusion Our results provide novel evidence that cardiorespiratory fitness is associated with volumes of DGM structures that are involved in motor and cognitive functions in MS. We examine the association between cardiorespiratory fitness and deep gray matter structures in multiple sclerosis. Cardiorespiratory fitness was positively associated with volumes of basal ganglia nuclei in multiple sclerosis. Researchers should examine aerobic exercise training for improving brain health in multiple sclerosis.
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171
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Muhlert N, Penner IK. Understanding intellectual enrichment: how cognitive reserve impacts on hippocampal volume in multiple sclerosis. Eur J Neurol 2015; 23:9-10. [PMID: 25683751 DOI: 10.1111/ene.12674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Muhlert
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK.
| | - I K Penner
- Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland
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172
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Hulst HE, Schoonheim MM, Van Geest Q, Uitdehaag BMJ, Barkhof F, Geurts JJG. Memory impairment in multiple sclerosis: Relevance of hippocampal activation and hippocampal connectivity. Mult Scler 2015; 21:1705-12. [DOI: 10.1177/1352458514567727] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
Background: Memory impairment is frequent in multiple sclerosis (MS), but it is unclear what functional brain changes underlie this cognitive deterioration. Objective: To investigate functional hippocampal activation and connectivity, in relation to memory performance in MS. Methods: Structural and functional magnetic resonance imaging data were acquired for 57 MS patients and 28 healthy controls (HCs), yielding hippocampal measures of volume, lesions, functional activation during a memory task and functional connectivity at rest. Memory function was based on two subtests of a larger neuropsychological test battery and related to hippocampal neuroimaging measures, using linear regression. Results: Hippocampal volume was lower in MS patients, as compared to HCs. In MS, hippocampal activation during the task was increased in cognitively preserved, but decreased in cognitively impaired, patients. Increased hippocampal connectivity was detected in MS patients, as compared to HCs, between the left hippocampus and the right posterior cingulate. Memory impairment in MS was explained (adjusted R2 = 0.27) by male gender, decreased hippocampal activation and increased hippocampal connectivity ( p = 0.001). Conclusions: Decreased activation of the hippocampus, increased connectivity and male gender were associated with worse memory performance in MS. These results indicate that increased activation and increased connectivity do not always coincide, and relate differently to cognitive dysfunction in MS.
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Affiliation(s)
- Hanneke E Hulst
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Quinten Van Geest
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen JG Geurts
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
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173
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Sumowski JF, Rocca MA, Leavitt VM, Riccitelli G, Sandry J, DeLuca J, Comi G, Filippi M. Searching for the neural basis of reserve against memory decline: intellectual enrichment linked to larger hippocampal volume in multiple sclerosis. Eur J Neurol 2015; 23:39-44. [PMID: 25648966 DOI: 10.1111/ene.12662] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Active engagement in intellectually enriching activities (e.g. reading, hobbies) builds 'reserve' against memory decline in elders and persons with multiple sclerosis (MS), but the neural basis for this protective influence of enrichment is unknown. Herein the neuroanatomical basis of reserve against memory decline in MS patients is investigated. METHODS Relapse-onset MS patients (N = 187) underwent 3.0 T magnetic resonance imaging of the brain to quantify T2 lesion volume (T2LV) and normalized volumes of total brain, total white, total grey (using SIENAX) and thalamus, caudate, putamen, pallidum, amygdala and hippocampus (using FIRST). Patients completed a survey quantifying their engagement in early life intellectual enrichment (i.e. reading, hobbies). Verbal and visuospatial episodic memory was assessed with neuropsychological tasks in a representative subsample (N = 97). RESULTS Controlling for demographics and T2LV, intellectual enrichment was specifically linked to larger normalized hippocampal volume (r(p) = 0.213, P = 0.004), with no link to other brain volumes/structures. Moreover, greater intellectual enrichment moderated/attenuated the negative relationship between normalized total brain volume (i.e. overall cerebral atrophy) and normalized hippocampal volume (i.e. hippocampal atrophy; P = 0.001) whereby patients who engaged in more early life intellectual enrichment better maintained hippocampal volume in the face of worse overall cerebral atrophy. Finally, the link between greater intellectual enrichment and better memory was partially mediated through larger hippocampal volume. CONCLUSIONS These findings support larger hippocampal volume as one key component of the neuroanatomical basis of reserve against memory decline in MS. These findings are consistent with previous literature on experience-dependent neuroplasticity within the hippocampus.
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Affiliation(s)
- J F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ, USA.,Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - M A Rocca
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - V M Leavitt
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - G Riccitelli
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - J Sandry
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ, USA.,Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ, USA.,Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - G Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Filippi
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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174
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Rocca MA, Amato MP, De Stefano N, Enzinger C, Geurts JJ, Penner IK, Rovira A, Sumowski JF, Valsasina P, Filippi M. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 2015; 14:302-17. [PMID: 25662900 DOI: 10.1016/s1474-4422(14)70250-9] [Citation(s) in RCA: 368] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In patients with multiple sclerosis (MS), grey matter damage is widespread and might underlie many of the clinical symptoms, especially cognitive impairment. This relation between grey matter damage and cognitive impairment has been lent support by findings from clinical and MRI studies. However, many aspects of cognitive impairment in patients with MS still need to be characterised. Standardised neuropsychological tests that are easy to administer and sensitive to disease-related abnormalities are needed to gain a better understanding of the factors affecting cognitive performance in patients with MS than exists at present. Imaging measures of the grey matter are necessary, but not sufficient to fully characterise cognitive decline in MS. Imaging measures of both lesioned and normal-appearing white matter lend support to the hypothesis of the existence of an underlying disconnection syndrome that causes clinical symptoms to trigger. Findings on cortical reorganisation support the contribution of brain plasticity and cognitive reserve in limiting cognitive deficits. The development of clinical and imaging biomarkers that can monitor disease development and treatment response is crucial to allow early identification of patients with MS who are at risk of cognitive impairment.
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Affiliation(s)
- 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
| | - Maria P Amato
- Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Jeroen J Geurts
- Department of Anatomy and Neuroscience, Section of Clinical Neuroscience, VU University Medical Centre, VUmc Multiple Sclerosis Centre Amsterdam, Amsterdam, Netherlands
| | - Iris-K Penner
- University and University Children's Hospital Basel, Cognitive Psychology and Methodology and Division of Paediatric Neurology and Developmental Medicine, Basel, Switzerland
| | - Alex Rovira
- Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - James F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation Research Center, West Orange, NJ, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - 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.
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175
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Datta S, Staewen TD, Cofield SS, Cutter GR, Lublin FD, Wolinsky JS, Narayana PA. Regional gray matter atrophy in relapsing remitting multiple sclerosis: baseline analysis of multi-center data. Mult Scler Relat Disord 2015; 4:124-36. [PMID: 25787188 PMCID: PMC4366621 DOI: 10.1016/j.msard.2015.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/25/2014] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
Regional gray matter (GM) atrophy in multiple sclerosis (MS) at disease onset and its temporal variation can provide objective information regarding disease evolution. An automated pipeline for estimating atrophy of various GM structures was developed using tensor based morphometry (TBM) and implemented on a multi-center sub-cohort of 1008 relapsing remitting MS (RRMS) patients enrolled in a Phase 3 clinical trial. Four hundred age and gender matched healthy controls were used for comparison. Using the analysis of covariance, atrophy differences between MS patients and healthy controls were assessed on a voxel-by-voxel analysis. Regional GM atrophy was observed in a number of deep GM structures that included thalamus, caudate nucleus, putamen, and cortical GM regions. General linear regression analysis was performed to analyze the effects of age, gender, and scanner field strength, and imaging sequence on the regional atrophy. Correlations between regional GM volumes and expanded disability status scale (EDSS) scores, disease duration (DD), T2 lesion load (T2 LL), T1 lesion load (T1 LL), and normalized cerebrospinal fluid (nCSF) were analyzed using Pearson׳s correlation coefficient. Thalamic atrophy observed in MS patients compared to healthy controls remained consistent within subgroups based on gender and scanner field strength. Weak correlations between thalamic volume and EDSS (r=-0.133; p<0.001) and DD (r=-0.098; p=0.003) were observed. Of all the structures, thalamic volume moderately correlated with T2 LL (r=-0.492; P-value<0.001), T1 LL (r=-0.473; P-value<0.001) and nCSF (r=-0.367; P-value<0.001).
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Affiliation(s)
- Sushmita Datta
- Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, United States.
| | - Terrell D Staewen
- Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, United States
| | - Stacy S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Fred D Lublin
- The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Jerry S Wolinsky
- Department of Neurology University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, United States
| | - Ponnada A Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, United States
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Zhou F, Zhuang Y, Wang L, Zhang Y, Wu L, Zeng X, Gong H. Disconnection of the hippocampus and amygdala associated with lesion load in relapsing-remitting multiple sclerosis: a structural and functional connectivity study. Neuropsychiatr Dis Treat 2015; 11:1749-65. [PMID: 26229470 PMCID: PMC4514382 DOI: 10.2147/ndt.s84602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about the functional and structural connectivity (FC and SC) of the hippocampus and amygdala, which are two important structures involved in cognitive processes, or their involvement in relapsing-remitting multiple sclerosis (RRMS). In this study, we aimed to examine the connectivity of white-matter (WM) tracts and the synchrony of intrinsic neuronal activity in outer regions connected with the hippocampus or amygdala in RRMS patients. PATIENTS AND METHODS Twenty-three RRMS patients and 23 healthy subjects participated in this study. Diffusion tensor probabilistic tractography was used to examine the SC, the FC correlation coefficient (FC-CC) and combined FC strength (FCS), which was derived from the resting-state functional magnetic resonance imaging used to examine the FC, of the connection between the hippocampus or the amygdala and other regions, and the correlations of these connections with clinical markers. RESULTS Compared with healthy subjects, the RRMS patients showed significantly decreased SC and increased FCS of the bilateral hippocampus, and left amygdala. Their slightly increased FC-CC was positively correlated with WM tract damage in the right hippocampus (ρ=0.57, P=0.005); an increased FCS was also positively correlated with WM tract damage in the right amygdala. A relationship was observed between the WM lesion load and SC alterations, including the lg(N tracts) of the right hippocampus (ρ=-0.68, P<0.05), lg(N tracts) (ρ=-0.69, P<0.05), and fractional anisotropy (ρ=-0.68, P<0.05) and radial diffusivity of the left hippocampus (ρ=0.45, P<0.05). A relationship between WM lesion load and FCS of the left amygdale was also observed. CONCLUSION The concurrent increased functional connections and demyelination-related structural disconnectivity between the hippocampus or amygdala and other regions in RRMS suggest that the functional-structural relationships require further investigation.
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Affiliation(s)
- Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China ; Jiangxi Province Medical Imaging Research Institute, Jiangxi Province, People's Republic of China
| | - Ying Zhuang
- Department of Oncology, The Second Hospital of Nanchang, Nanchang, Jiangxi Province, People's Republic of China
| | - Lingling Wang
- Department of Geriatrics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People's Republic of China
| | - Yue Zhang
- Department of Radiology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China ; Jiangxi Province Medical Imaging Research Institute, Jiangxi Province, People's Republic of China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China ; Jiangxi Province Medical Imaging Research Institute, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China ; Jiangxi Province Medical Imaging Research Institute, Jiangxi Province, People's Republic of China
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DeLuca GC, Yates RL, Beale H, Morrow SA. Cognitive impairment in multiple sclerosis: clinical, radiologic and pathologic insights. Brain Pathol 2015; 25:79-98. [PMID: 25521179 PMCID: PMC8029470 DOI: 10.1111/bpa.12220] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 01/18/2023] Open
Abstract
Cognitive impairment is a common and debilitating feature of multiple sclerosis (MS) that has only recent gained considerable attention. Clinical neuropsychological studies have made apparent the multifaceted nature of cognitive troubles often encountered in MS and continue to broaden our understanding of its complexity. Radiographic studies have started to decipher the neuroanatomic substrate of MS-related cognitive impairment and have shed light onto its pathogenesis. Where radiographic studies have been limited by inadequate resolution or non-specificity, pathological studies have come to the fore. This review aims to provide an overview of the nature of cognitive impairment typically seen in MS and to explore the literature on imaging and pathological studies relevant to its evolution. In particular, the relative contributions of gray (i.e., cerebral cortex, hippocampus, thalamus and basal ganglia) and white matter to MS-related cognitive impairment will be discussed and the importance of interconnectivity between structures highlighted. The pressing need for longitudinal studies combining standardized neuropsychometric, paraclinical and radiographic outcomes obtained during life with post-mortem tissue analysis after death is presented.
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Affiliation(s)
- Gabriele C. DeLuca
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Richard L. Yates
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Harry Beale
- Oxford Medical SchoolUniversity of OxfordOxfordUK
| | - Sarah A. Morrow
- Department of Clinical Neurological SciencesThe University of Western OntarioLondonCanada
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Kern KC, Gold SM, Lee B, Montag M, Horsfall J, O'Connor MF, Sicotte NL. Thalamic-hippocampal-prefrontal disruption in relapsing-remitting multiple sclerosis. NEUROIMAGE-CLINICAL 2014; 8:440-7. [PMID: 26106524 PMCID: PMC4473119 DOI: 10.1016/j.nicl.2014.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/06/2014] [Accepted: 12/21/2014] [Indexed: 01/22/2023]
Abstract
Background Cortical, thalamic and hippocampal gray matter atrophy in relapsing–remitting MS (RRMS) is associated cognitive deficits. However, the role of interconnecting white matter pathways including the fornix, cingulum, and uncinate fasciculus (UF) is less well studied. Objective To assess MS damage to a hippocampal–thalamic–prefrontal network and the relative contributions of its components to specific cognitive domains. Methods We calculated diffusion tensor fractional anisotropy (FA) in the fornix, cingulum and UF as well as thalamic and hippocampal volumes in 27 RRMS patients and 20 healthy controls. A neuropsychological battery was administered and 4 core tests known to be sensitive to MS changes were used to assess cognitive impairment. To determine the relationships between structure and cognition, all tests were grouped into 4 domains: attention/executive function, processing speed, verbal memory, and spatial memory. Univariate correlations with structural measures and depressive symptoms identified potential contributors to cognitive performance and subsequent linear regression determined their relative effects on performance in each domain. For significant predictors, we also explored the effects of laterality and axial versus radial diffusivity. Results RRMS patients had worse performance on the Symbol Digit Modalities Test, but no significant impairment in the 4 cognitive domains. RRMS had reduced mean FA of all 3 pathways and reduced thalamic and hippocampal volumes compared to controls. In RRMS we found that thalamic volume and BDI predicted attention/executive function, UF FA predicted processing speed, thalamic volume predicted verbal memory, and UF FA and BDI predicted spatial memory. Conclusions Hippocampal–thalamic–prefrontal disruption affects cognitive performance in early RRMS with mild to minimal cognitive impairment, confirming both white and gray matter involvement in MS and demonstrating utility in assessing functional networks to monitor cognition. We detect limbic white matter and gray matter insult in early RRMS patients with mild to minimal cognitive impairment. Thalamic atrophy and uncinate fasciculus microstructural changes are associated with cognitive performance in early RRMS. Depressive symptomatology also independently predicts cognitive performance
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Key Words
- AD, axial diffusivity
- BDI, Beck Depression Inventory
- BSRT, Buschke Selective Reminding Test
- BVMT, Brief Visuospatial Memory Test
- BVRT, Benton Visual Retention Test
- CVLT-II, California Verbal Learning Test II
- Cognition
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- EDSS, Expanded Disability Status Scale
- FA, fractional anisotropy
- FAST, FMRIB's Automated Segmentation Tool
- FLAIR, Fluid Attenuated Inversion Recovery
- FOV, field of view
- FSL, Functional MRI of the Brain Software Library
- GM, gray matter
- Limbic system
- MPRAGE, Magnetization Prepared Rapid Acquisition Gradient Echo
- MRI
- MRI, magnetic resonance image
- Memory
- Multiple sclerosis
- NEX, number of excitations
- PASAT, Paced Auditory Serial Addition Test
- RAVLT, Rey Auditory Verbal Learning Test
- RD, radial diffusivity
- ROI, region of interest
- RRMS, relapsing remitting multiple sclerosis
- SDMT, Symbol Digit Modalities Test
- TBSS, Tract-based Spatial Statistics
- TE, echo time
- TI, inversion time
- TR, repetition time
- UF, uncinate fasciculus
- WAIS, Wechsler Adult Intelligence Scale
- WM, white matter.
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Affiliation(s)
- Kyle C. Kern
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stefan M. Gold
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Brian Lee
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Montag
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jessica Horsfall
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Nancy L. Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Corresponding Author: Department of Neurology, Cedars-Sinai Medical Center, Rm 6414, 127 S. San Vicente Blvd., AHSP, Los Angeles, CA 90048, USA. Tel.:1-310 423 1320.
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179
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Dell'Oglio E, Ceccarelli A, Glanz BI, Healy BC, Tauhid S, Arora A, Saravanan N, Bruha MJ, Vartanian AV, Dupuy SL, Benedict RHB, Bakshi R, Neema M. Quantification of global cerebral atrophy in multiple sclerosis from 3T MRI using SPM: the role of misclassification errors. J Neuroimaging 2014; 25:191-199. [PMID: 25523616 PMCID: PMC4409073 DOI: 10.1111/jon.12194] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/30/2014] [Indexed: 12/31/2022] Open
Abstract
Purpose We tested the validity of a freely available segmentation pipeline to measure compartmental brain volumes from 3T MRI in patients with multiple sclerosis (MS). Our primary focus was methodological to explore the effect of segmentation corrections on the clinical relevance of the output metrics. Methods Three-dimensional T1-weighted images were acquired to compare 61 MS patients to 30 age- and gender-matched normal controls (NC). We also tested the within patient MRI relationship to disability (eg, expanded disability status scale [EDSS] score) and cognition. Statistical parametric mapping v. 8 (SPM8)-derived gray matter (GMF), white matter (WMF), and total brain parenchyma fractions (BPF) were derived before and after correcting errors from T1 hypointense MS lesions and/or ineffective deep GM contouring. Results MS patients had lower GMF and BPF as compared to NC (P<.05). Cognitively impaired patients had lower BPF than cognitively preserved patients (P<.05). BPF was related to EDSS; BPF and GMF were related to disease duration (all P<.05). Errors caused bias in GMFs and WMFs but had no discernable influence on BPFs or any MRI-clinical associations. Conclusions We report the validity of a segmentation pipeline for the detection of MS-related brain atrophy with 3T MRI. Longitudinal studies are warranted to extend these results.
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Affiliation(s)
- Elisa Dell'Oglio
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Antonia Ceccarelli
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Bonnie I Glanz
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Ashish Arora
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Nikila Saravanan
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Matthew J Bruha
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Alexander V Vartanian
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Sheena L Dupuy
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | | | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Mohit Neema
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
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Ernst A, Noblet V, Denkova E, Blanc F, de Seze J, Gounot D, Manning L. Functional cerebral changes in multiple sclerosis patients during an autobiographical memory test. Memory 2014; 23:1123-39. [DOI: 10.1080/09658211.2014.955805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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181
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Muhlert N, Atzori M, De Vita E, Thomas DL, Samson RS, Wheeler-Kingshott CAM, Geurts JJG, Miller DH, Thompson AJ, Ciccarelli O. Memory in multiple sclerosis is linked to glutamate concentration in grey matter regions. J Neurol Neurosurg Psychiatry 2014; 85:833-9. [PMID: 24431465 PMCID: PMC4112488 DOI: 10.1136/jnnp-2013-306662] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Glutamate is the principal excitatory neurotransmitter and is involved in normal brain function. Cognitive impairment is common in multiple sclerosis (MS), and understanding its mechanisms is crucial for developing effective treatments. We used structural and metabolic brain imaging to test two hypotheses: (i) glutamate levels in grey matter regions are abnormal in MS, and (ii) patients show a relationship between glutamate concentration and memory performance. METHODS Eighteen patients with relapsing-remitting MS and 17 healthy controls were cognitively assessed and underwent (1)H-magnetic resonance spectroscopy at 3 T to assess glutamate levels in the hippocampus, thalamus, cingulate and parietal cortices. Regression models investigated the association between glutamate concentration and memory performance independently of magnetisation transfer ratio values and grey matter lesions withint he same regions, and whole-brain grey matter volume. RESULTS Patients had worse visual and verbal memory than controls. A positive relationship between glutamate levels in the hippocampal, thalamic and cingulate regions and visuospatial memory was detected in patients, but not in healthy controls. CONCLUSIONS The relationship between memory and glutamate concentration, which is unique to MS patients, suggests the reliance of memory on glutamatergic systems in MS.
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Affiliation(s)
- Nils Muhlert
- Department of Neuroinflammation, NMR Research Unit, UCL Institute of Neurology, London, UK Cognitive Neuroscience, Department of Psychology, Cardiff University, Cardiff, UK
| | - Matteo Atzori
- Department of Brain Repair and Rehabilitation, NMR Research Unit, UCL Institute of Neurology, London, UK Department of Neurology, University of Padova, Padova, Italy
| | - Enrico De Vita
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Rebecca S Samson
- Department of Neuroinflammation, NMR Research Unit, UCL Institute of Neurology, London, UK
| | | | - Jeroen J G Geurts
- Department of Anatomy and Neuroscience, Section of Clinical Neuroscience, VU University Medical Center, VUmc MS Center Amsterdam, Amsterdam, The Netherlands
| | - David H Miller
- Department of Neuroinflammation, NMR Research Unit, UCL Institute of Neurology, London, UK National Institute for Health and Research (NIHR) University College London Hospital (UCLH) Biomedical Research Centre, London, UK
| | - Alan J Thompson
- Department of Brain Repair and Rehabilitation, NMR Research Unit, UCL Institute of Neurology, London, UK National Institute for Health and Research (NIHR) University College London Hospital (UCLH) Biomedical Research Centre, London, UK
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, NMR Research Unit, UCL Institute of Neurology, London, UK National Institute for Health and Research (NIHR) University College London Hospital (UCLH) Biomedical Research Centre, London, UK
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182
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Delineation of hippocampal subregions using T1-weighted magnetic resonance images at 3 Tesla. Brain Struct Funct 2014; 220:3259-72. [PMID: 25081550 DOI: 10.1007/s00429-014-0854-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 07/18/2014] [Indexed: 01/18/2023]
Abstract
Although several novel approaches for hippocampal subregion delineation have been developed, they need to be applied prospectively and may be limited by long scan times, the use of high field (>3T) imaging systems, and limited reliability metrics. Moreover, the majority of MR imaging data collected to date has employed a T1-weighted acquisition, creating a critical need for an approach that provides reliable hippocampal subregion segmentation using such a contrast. We present a highly reliable approach for the identification of six subregions comprising the hippocampal formation from MR images including the subiculum, dentate gyrus/cornu Ammonis 4 (DG/CA4), entorhinal cortex, fimbria, and anterior and posterior segments of cornu Ammonis 1-3 (CA1-3). MR images were obtained in the coronal plane using a standard 3D spoiled gradient sequence acquired on a GE 3T scanner through the whole head in approximately 10 min. The average ICC for inter-rater reliability across right and left volumetric regions-of-interest was 0.85 (range 0.71-0.98, median 0.86) and the average ICC for intra-rater reliability was 0.92 (range 0.66-0.99, median 0.97). The mean Dice index for inter-rater reliability across right and left hemisphere subregions was 0.75 (range 0.70-0.81, median 0.75) and the mean Dice index for intra-rater reliability was 0.85 (range 0.82-0.90, median 0.85). An investigation of hippocampal asymmetry revealed significantly greater right compared to left hemisphere volumes in the anterior segment of CA1-3 and in the subiculum.
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183
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Klawiter EC, Ceccarelli A, Arora A, Jackson J, Bakshi S, Kim G, Miller J, Tauhid S, von Gizycki C, Bakshi R, Neema M. Corpus callosum atrophy correlates with gray matter atrophy in patients with multiple sclerosis. J Neuroimaging 2014; 25:62-7. [PMID: 24816394 DOI: 10.1111/jon.12124] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/12/2014] [Accepted: 03/02/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Atrophy of the corpus callosum is a recognized characteristic of multiple sclerosis (MS). We describe a new reliable method for measuring corpus callosum atrophy and correlate this with global cerebral atrophy measures. METHODS Whole brain 3T MRI was performed in 38 relapsing-remitting MS subjects and 21 healthy controls (HC). Brain global gray and white matter volumes were segmented with SPM8. The contour of the corpus callosum was outlined on the midline of 3-D T1-weighted images by a semiautomated edge-detection technique to determine the corpus callosum area (CCA). Normalized CCA was correlated with other brain atrophy measures in MS subjects. RESULTS CCA was disproportionately lower in MS subjects vs. HC (20.1% mean decrease; P < .001), with a large effect size (d = .62) when compared with global atrophy measures. In MS subjects, CCA correlated with brain parenchymal fraction (r = .55; P < .001) and gray matter fraction (r = .45; P = .005) but not white matter fraction (r = .18; P = .29). An inverse correlation with FLAIR hyperintense lesion volume (r = -.40; P = .01) was detected for CCA. CONCLUSION Measurement of atrophy of the corpus callosum can have sensitivity as a useful imaging biomarker in patients with MS, even in patients with low disability levels. Both gray and white matter involvement in MS contribute to corpus callosum atrophy.
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Affiliation(s)
- Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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184
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Bove R, Musallam A, Healy BC, Raghavan K, Glanz BI, Bakshi R, Weiner H, De Jager PL, Miller KK, Chitnis T. Low testosterone is associated with disability in men with multiple sclerosis. Mult Scler 2014; 20:1584-92. [PMID: 24710799 DOI: 10.1177/1352458514527864] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gonadal steroids may modulate disease course in multiple sclerosis (MS). OBJECTIVE To assess the prevalence and clinical associations of hypogonadism in men with MS. METHODS Male patients, aged 18-65 years, with relapsing-remitting MS (RRMS) or clinically-isolated syndrome (CIS) and their first symptom < 10 years prior were selected from a longitudinal clinical study. We measured their hormones in stored morning blood samples, and collected their Expanded Disability Status Scale (EDSS) scores every 6 months and their Symbol Digit Modalities Test (SDMT) results annually. RESULTS Our analysis included 96 men with a mean age of 40 years, EDSS of 1.1 and disease duration of 4.6 years. Of these men, 39% were hypogonadal (total testosterone < 288 ng/dL); none showed compensatory elevations in luteinizing hormone. Their low testosterone levels and testosterone:estradiol ratios were negatively correlated with body mass index (BMI) and leptin, and showed no correlation with 25-hydroxy-vitamin D levels. In our primary cross-sectional analyses, there was a negative age-adjusted correlation between total testosterone and EDSS (p = 0.044). In the age-adjusted longitudinal analyses, higher baseline testosterone levels were associated with less decline in SDMT (p = 0.012). CONCLUSIONS Men with MS may experience hypogonadotropic hypogonadism. Low testosterone levels may be associated with worse clinical outcomes. A potential neuroprotective role for testosterone warrants further investigation.
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Affiliation(s)
- R Bove
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - A Musallam
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USA
| | - B C Healy
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USAMassachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | | | - B I Glanz
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USA
| | - R Bakshi
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USA
| | - H Weiner
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - P L De Jager
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - K K Miller
- Harvard Medical School, Boston, MA, USANeuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - T Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW This article summarizes the use of MRI in the diagnosis and treatment of multiple sclerosis (MS). Current and emerging imaging techniques are reviewed pertaining to their utility in MS. RECENT FINDINGS Conventional T1-weighted and T2-weighted sequences are used to identify and characterize disease pathology in MS. T2 lesion burden, postcontrast enhancement, T1 hypointensities, and regional and global atrophy are all informative and correlate to clinical measures, such as disease disability, to a variable extent. Newer techniques such as diffusion tensor imaging, magnetization transfer imaging, and MR spectroscopy are increasingly being incorporated into clinical trials and may provide improved specificity to the underlying pathology. Double inversion recovery and ultrahigh-field-strength MRI have direct application in MS for evaluating cortical pathology. Newer functional MRI techniques such as resting-state functional connectivity are increasingly being applied in MS. SUMMARY Conventional and emerging imaging techniques greatly inform our understanding of MS. These techniques are integral in diagnosis, in evaluating new treatments for MS, and for following patients in the clinical setting.
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186
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De Stefano N, Airas L, Grigoriadis N, Mattle HP, O'Riordan J, Oreja-Guevara C, Sellebjerg F, Stankoff B, Walczak A, Wiendl H, Kieseier BC. Clinical relevance of brain volume measures in multiple sclerosis. CNS Drugs 2014; 28:147-56. [PMID: 24446248 DOI: 10.1007/s40263-014-0140-z] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Multiple sclerosis (MS) is a chronic disease with an inflammatory and neurodegenerative pathology. Axonal loss and neurodegeneration occurs early in the disease course and may lead to irreversible neurological impairment. Changes in brain volume, observed from the earliest stage of MS and proceeding throughout the disease course, may be an accurate measure of neurodegeneration and tissue damage. There are a number of magnetic resonance imaging-based methods for determining global or regional brain volume, including cross-sectional (e.g. brain parenchymal fraction) and longitudinal techniques (e.g. SIENA [Structural Image Evaluation using Normalization of Atrophy]). Although these methods are sensitive and reproducible, caution must be exercised when interpreting brain volume data, as numerous factors (e.g. pseudoatrophy) may have a confounding effect on measurements, especially in a disease with complex pathological substrates such as MS. Brain volume loss has been correlated with disability progression and cognitive impairment in MS, with the loss of grey matter volume more closely correlated with clinical measures than loss of white matter volume. Preventing brain volume loss may therefore have important clinical implications affecting treatment decisions, with several clinical trials now demonstrating an effect of disease-modifying treatments (DMTs) on reducing brain volume loss. In clinical practice, it may therefore be important to consider the potential impact of a therapy on reducing the rate of brain volume loss. This article reviews the measurement of brain volume in clinical trials and practice, the effect of DMTs on brain volume change across trials and the clinical relevance of brain volume loss in MS.
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Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, Siena, 53100, Italy,
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Gray matters in multiple sclerosis: cognitive impairment and structural MRI. Mult Scler Int 2014; 2014:609694. [PMID: 24587905 PMCID: PMC3920616 DOI: 10.1155/2014/609694] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/30/2013] [Accepted: 10/29/2013] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disease affecting central nervous system (CNS). Although MS is classically considered a white matter (WM) disease, the involvement of gray matter (GM) in the pathogenic process has been confirmed by pathology studies and MRI studies. Impairment of cognitive domains such as memory, mental processing speed, attention, and executive function can occur from the early stage of the disease and tends to worsen over time, despite stable physical symptoms. WM demyelination is moderately correlated with CI, suggesting that probably WM abnormalities alone cannot fully explain the extent of clinical symptoms in MS, including CI. Several MRI techniques have shown the involvement of GM in MS and the association between GM damage, physical disability, and CI. The aim of this review is to provide an overview of CI and GM damage assessed by structural brain MRI.
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189
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Leavitt VM, Cirnigliaro C, Cohen A, Farag A, Brooks M, Wecht JM, Wylie GR, Chiaravalloti ND, DeLuca J, Sumowski JF. Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary findings. Neurocase 2014; 20:695-7. [PMID: 24090098 DOI: 10.1080/13554794.2013.841951] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Multiple sclerosis leads to prominent hippocampal atrophy, which is linked to memory deficits. Indeed, 50% of multiple sclerosis patients suffer memory impairment, with negative consequences for quality of life. There are currently no effective memory treatments for multiple sclerosis either pharmacological or behavioral. Aerobic exercise improves memory and promotes hippocampal neurogenesis in nonhuman animals. Here, we investigate the benefits of aerobic exercise in memory-impaired multiple sclerosis patients. Pilot data were collected from two ambulatory, memory-impaired multiple sclerosis participants randomized to non-aerobic (stretching) and aerobic (stationary cycling) conditions. The following baseline/follow-up measurements were taken: high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Intervention was 30-minute sessions 3 times per week for 3 months. Aerobic exercise resulted in 16.5% increase in hippocampal volume and 53.7% increase in memory, as well as increased hippocampal resting-state functional connectivity. Improvements were specific, with no comparable changes in overall cerebral gray matter (+2.4%), non-hippocampal deep gray matter structures (thalamus, caudate: -4.0%), or in non-memory cognitive functioning (executive functions, processing speed, working memory: changes ranged from -11% to +4%). Non-aerobic exercise resulted in relatively no change in hippocampal volume (2.8%) or memory (0.0%), and no changes in hippocampal functional connectivity. This is the first evidence for aerobic exercise to increase hippocampal volume and connectivity and improve memory in multiple sclerosis. Aerobic exercise represents a cost-effective, widely available, natural, and self-administered treatment with no adverse side effects that may be the first effective memory treatment for multiple sclerosis patients.
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Affiliation(s)
- V M Leavitt
- a Kessler Foundation Research Center , West Orange , NJ , USA
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190
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Filippi M, Charil A, Rovaris M, Absinta M, Rocca MA. Insights from magnetic resonance imaging. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:115-149. [PMID: 24507516 DOI: 10.1016/b978-0-444-52001-2.00006-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent years have witnessed impressive advancements in the use of magnetic resonance imaging (MRI) for the assessment of patients with multiple sclerosis (MS). Complementary to the clinical evaluation, conventional MRI (cMRI) provides crucial pieces of information for the diagnosis of MS, the understanding of its natural history, and monitoring the efficacy of experimental treatments. Measures derived from cMRI present clear advantages over the clinical assessment, including their more objective nature and an increased sensitivity to MS-related changes. However, the correlation between these measures and the clinical manifestations of the disease remains weak, and this can be explained, at least partially, by the limited ability of cMRI to characterize and quantify the heterogeneous features of MS pathology. Quantitative MR-based techniques have the potential to overcome the limitations of cMRI. Magnetization transfer MRI, diffusion-weighted and diffusion tensor MRI with fiber tractography, proton magnetic resonance spectroscopy, T1 and T2 relaxation time measurement, and functional MRI are contributing to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. All conventional and nonconventional MR techniques will benefit from the use of high-field MR systems (3.0T or more).
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Arnaud Charil
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Rovaris
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Absinta
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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191
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Koenig KA, Sakaie KE, Lowe MJ, Lin J, Stone L, Bermel RA, Beall EB, Rao SM, Trapp BD, Phillips MD. Hippocampal volume is related to cognitive decline and fornicial diffusion measures in multiple sclerosis. Magn Reson Imaging 2013; 32:354-8. [PMID: 24512796 DOI: 10.1016/j.mri.2013.12.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess for associations between hippocampal atrophy and measures of cognitive function, hippocampal magnetization transfer ratio (MTR), and diffusion measures of the fornix, the largest efferent white matter tract from the hippocampus, in patients with multiple sclerosis (MS) and controls. MATERIALS AND METHODS A total of 53 patients with MS and 20 age- and sex-matched healthy controls participated in cognitive testing and scanning including high spatial-resolution diffusion imaging and a T1-MPRAGE scan. Hippocampal volume and fornicial thickness measures were calculated and compared to mean values of fornicial transverse diffusivity, mean diffusivity, longitudinal diffusivity, fractional anisotropy, mean hippocampal MTR, and scores on measures of episodic memory, processing speed, and working memory tasks. RESULTS In patients with MS, hippocampal volume was significantly related to fornicial diffusion measures (P<7×10(-4)) and to measures of verbal (P=0.030) and visual spatial (P=0.004) episodic memory and a measure of information processing speed (P<0.037). DISCUSSION These results highlight the role of the hippocampus in cognitive dysfunction in patients with MS and suggest that measures of hippocampal atrophy could be used to capture aspects of disease progression.
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Affiliation(s)
| | - Ken E Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark J Lowe
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jian Lin
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lael Stone
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert A Bermel
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erik B Beall
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen M Rao
- Schey Center for Cognitive Neuroimaging, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce D Trapp
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Papadaki EZ, Simos PG, Panou T, Mastorodemos VC, Maris TG, Karantanas AH, Plaitakis A. Hemodynamic evidence linking cognitive deficits in clinically isolated syndrome to regional brain inflammation. Eur J Neurol 2013; 21:499-505. [PMID: 24373026 DOI: 10.1111/ene.12338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 11/18/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE To investigate the relation between hemodynamic measurements and memory function in patients with clinically isolated syndrome (CIS). METHODS Forty CIS patients were administered tests of verbal short-term/working memory and passage learning. Using dynamic susceptibility contrast MRI cerebral blood volume (CBV), cerebral blood flow and mean transit time values were estimated in 20 cerebral regions of interest, placed in normal appearing white matter (NAWM) and normal appearing deep gray matter structures, bilaterally. RESULTS CIS patients showed significantly impaired scores on working memory and secondary verbal memory that correlated inversely with elevated CBV values in the left frontal and periventricular NAWM, thalamus, right caudate and corpus callosum. CONCLUSIONS Verbal memory in CIS correlates inversely with elevated CBV values of brain structures involved in memory. As these hemodynamic changes, detected in CIS, are indicative of inflammation, the observed cognitive disturbances may relate to widespread brain inflammatory processes that prevail in early multiple sclerosis.
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Affiliation(s)
- E Z Papadaki
- Department of Radiology, University of Crete, Heraklion, Crete, Greece
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193
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Pardini M, Bergamino M, Bommarito G, Bonzano L, Luigi Mancardi G, Roccatagliata L. Structural correlates of subjective and objective memory performance in multiple sclerosis. Hippocampus 2013; 24:436-45. [PMID: 24375730 DOI: 10.1002/hipo.22237] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 12/18/2022]
Abstract
Subjective and objective memory deficits represent a frequent and ill-understood aspect of multiple sclerosis (MS), and a significant cause of disability and quality of life reduction. The aim of the study is to verify the role of hippocampal and temporal associative fibers' damage in MS-related memory complaints. To reach this aim, 25 patients with low disability relapsing-remitting MS and 19 healthy controls were included in the study. All subjects underwent 3D T1 structural imaging and Diffusion Tensor Imaging. Additionally, MS patients underwent neuropsychological evaluation of objective (Selective Reminding Test and Spatial Recall Test) and of subjective (Perceived Deficit Questionnaire, Retrospective and Prospective Memory Subscales) memory deficits. Normalized hippocampal volume (NHV) and mean Fractional Anisotropy (FA) for the uncinate fasciculus (UF) and for the ventral division of the cingulum bundle (VCB) were calculated for all subjects. We showed that, compared to controls, MS subjects presented with reduced right NHV and with reduced mean FA bilaterally in the UF and the VCB. In the MS group, verbal memory scores correlated with left NHV, spatial memory scores correlated with right NHV, while perceived retrospective and prospective memory deficits correlated with left VCB and left UF mean FA respectively. Our data confirm an early involvement of memory-related brain structures in MS patients. Our data suggest that verbal and nonverbal memory as well as perceived retrospective and prospective memory deficits are related to alterations of discrete anatomical structures in the low-disability phase of MS.
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Affiliation(s)
- Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
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Nisticò R, Mori F, Feligioni M, Nicoletti F, Centonze D. Synaptic plasticity in multiple sclerosis and in experimental autoimmune encephalomyelitis. Philos Trans R Soc Lond B Biol Sci 2013; 369:20130162. [PMID: 24298163 DOI: 10.1098/rstb.2013.0162] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Approximately half of all patients with multiple sclerosis (MS) experience cognitive dysfunction, including learning and memory impairment. Recent studies suggest that hippocampal pathology is involved, although the mechanisms underlying these deficits remain poorly understood. Evidence obtained from a mouse model of MS, the experimental autoimmune encephalomyelitis (EAE), suggests that in the hippocampus of EAE mice long-term potentiation (LTP) is favoured over long-term depression in response to repetitive synaptic activation, through a mechanism dependent on enhanced IL-1β released from infiltrating lymphocytes or activated microglia. Facilitated LTP during an immune-mediated attack might underlie functional recovery, but also cognitive deficits and excitotoxic neurodegeneration. Having identified that pro-inflammatory cytokines such as IL-1β can influence synaptic function and integrity in early MS, it is hoped that new treatments targeted towards preventing synaptic pathology can be developed.
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Affiliation(s)
- Robert Nisticò
- Department of Physiology and Pharmacology, Sapienza University of Rome, , 00185 Rome, Italy
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195
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Ožura A, Šega S. Profile of depression, experienced distress and capacity for coping with stress in multiple sclerosis patients—A different perspective. Clin Neurol Neurosurg 2013; 115 Suppl 1:S12-6. [DOI: 10.1016/j.clineuro.2013.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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196
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Clinical, MRI, and CSF markers of disability progression in multiple sclerosis. DISEASE MARKERS 2013; 35:687-99. [PMID: 24324285 PMCID: PMC3842089 DOI: 10.1155/2013/484959] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/12/2013] [Accepted: 10/09/2013] [Indexed: 11/17/2022]
Abstract
Multiple sclerosis (MS) is a chronic disorder of the central nervous system (CNS) in which the complex interplay between inflammation and neurodegeneration determines varying degrees of neurological disability. For this reason, it is very difficult to express an accurate prognosis based on purely clinical information in the individual patient at an early disease stage. Magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarkers are promising sources of prognostic information with a good potential of quantitative measure, sensitivity, and reliability. However, a comprehensive MS outcome prediction model combining multiple parameters is still lacking. Current relevant literature addressing the topic of clinical, MRI, and CSF markers as predictors of MS disability progression is reviewed here.
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197
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Longoni G, Rocca MA, Pagani E, Riccitelli GC, Colombo B, Rodegher M, Falini A, Comi G, Filippi M. Deficits in memory and visuospatial learning correlate with regional hippocampal atrophy in MS. Brain Struct Funct 2013; 220:435-44. [DOI: 10.1007/s00429-013-0665-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/19/2013] [Indexed: 01/18/2023]
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198
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The nature of verbal memory impairment in multiple sclerosis: a list-learning and meta-analytic study. J Int Neuropsychol Soc 2013; 19:995-1008. [PMID: 24059259 DOI: 10.1017/s1355617713000957] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary purpose of this study was to test the hypothesis that multiple sclerosis (MS) patients have impaired acquisition rather than a retrieval deficit. Verbal memory impairment in MS was examined in 53 relapsing-remitting MS patients and 31 healthy controls (HC), and in a meta-analysis of studies that examined memory functioning in MS with list-learning tasks. The MS group demonstrated significantly lower acquisition and delayed recall performance than the HC group, and the meta-analysis revealed that the largest effect sizes were obtained for acquisition measures relative to delayed recall and recognition. Our data argue against a retrieval deficit as the sole explanation for verbal memory impairment in MS, and make a consistent case for the position that deficient acquisition contributes to the memory dysfunction of MS patients. Deficient acquisition may result from demyelination in relevant white matter tracts that reduces encoding efficiency as a result of impaired speed of information processing.
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199
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Dutra RC, Moreira ELG, Alberti TB, Marcon R, Prediger RD, Calixto JB. Spatial reference memory deficits precede motor dysfunction in an experimental autoimmune encephalomyelitis model: the role of kallikrein-kinin system. Brain Behav Immun 2013; 33:90-101. [PMID: 23777652 DOI: 10.1016/j.bbi.2013.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/21/2013] [Accepted: 06/07/2013] [Indexed: 12/28/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive T cell-mediated autoimmune demyelinating inflammatory disease of the central nervous system (CNS). Although it is recognized that cognitive deficits represent a manifestation of the disease, the underlying pathogenic mechanisms remain unknown. Here we provide evidence of spatial reference memory impairments during the pre-motor phase of experimental autoimmune encephalomyelitis (EAE) in mice. Specifically, these cognitive deficits were accompanied by down-regulation of choline acetyltransferase (ChAT) mRNA expression on day 5 and 11 post-immunization, and up-regulation of inflammatory cytokines in the hippocampus and prefrontal cortex. Moreover, a marked increase in B1R mRNA expression occurred selectively in the hippocampus, whereas protein level was up-regulated in both brain areas. Genetic deletion of kinin B1R attenuated cognitive deficits and cholinergic dysfunction, and blocked mRNA expression of both IL-17 and IFN-γ in the prefrontal cortex, lymph node and spleen of mice subjected to EAE. The discovery of kinin receptors, mainly B1R, as a target for controlling neuroinflammatory response, as well as the cognitive deficits induced by EAE may foster the therapeutic exploitation of the kallikrein-kinin system (KKS), in particular for the treatment of autoimmune disorders, such as MS, mainly during pre-symptomatic phase.
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Affiliation(s)
- Rafael C Dutra
- Laboratory of Autoimmunity and Immunopharmacology, Campus Araranguá, Universidade Federal de Santa Catarina, 88900-000 Araranguá, SC, Brazil; Department of Pharmacology, Centre of Biological Sciences, Universidade Federal de Santa Catarina, 88049-900 Florianópolis, SC, Brazil.
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200
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Future MRI tools in multiple sclerosis. J Neurol Sci 2013; 331:14-8. [DOI: 10.1016/j.jns.2013.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 11/20/2022]
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