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Ludwig MD, Zagon IS, McLaughlin PJ. Featured Article: Serum [Met 5]-enkephalin levels are reduced in multiple sclerosis and restored by low-dose naltrexone. Exp Biol Med (Maywood) 2017; 242:1524-1533. [PMID: 28766982 PMCID: PMC5648293 DOI: 10.1177/1535370217724791] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022] Open
Abstract
Low-dose naltrexone is a widely used off-label therapeutic prescribed for a variety of immune-related disorders. The mechanism underlying low-dose naltrexone's efficacy for fatigue, Crohn's disease, fibromyalgia, and multiple sclerosis is, in part, intermittent blockade of opioid receptors followed by upregulation of endogenous opioids. Short, intermittent blockade by naltrexone specifically blocks the opioid growth factor receptor resulting in biofeedback events that increase production of the endogenous opioid growth factor (OGF) (chemically termed [Met5]-enkephalin) facilitating interactions between opioid growth factor and opioid growth factor receptor that ultimately, result in inhibited cell proliferation. Preclinical studies have reported that enkephalin levels are deficient in animal models of experimental autoimmune encephalomyelitis, a mouse model of multiple sclerosis. Our hypothesis is that serum enkephalin levels are diminished in humans with multiple sclerosis and experimental autoimmune encephalomyelitis mice, and that change in serum opioid growth factor levels may serve as a reasonable candidate biomarker for the onset of experimental autoimmune encephalomyelitis and response to therapy. To address this, we designed a two-part study to measure endogenous opioids in multiple sclerosis patients, and to investigate the temporal pattern of decline in serum enkephalin concentrations in mice with chronic progressive experimental autoimmune encephalomyelitis and treated with low-dose naltrexone. For comparison, we investigated whether low-dose naltrexone exposure in normal mice also resulted in altered enkephalin levels. In both animal models, we monitored tactile and heat sensitivity, as well as differential white blood cell counts as indicators of inflammation. Serum [Met5]-enkephalin levels were lower in humans with multiple sclerosis relative to non-multiple sclerosis patients, and low-dose naltrexone restored their levels. In experimental autoimmune encephalomyelitis mice, [Met5]-enkephalin levels were depressed prior to the appearance of clinical disease, and were restored with low-dose naltrexone treatment. Low-dose naltrexone therapy had no effect on serum [Met5]-enkephalin or β-endorphin in normal mice. Thus, [Met5]-enkephalin (i.e. opioid growth factor) may be a reasonable candidate biomarker for multiple sclerosis, and may signal new pathways for treatment of autoimmune disorders. Impact statement This report presents human and animal data identifying a novel biomarker for the onset and progression of multiple sclerosis (MS). Humans diagnosed with MS have reduced serum levels of OGF (i.e. [Met5]-enkephalin) relative to non-MS neurologic patients, and low-dose naltrexone (LDN) therapy restored their enkephalin levels. Serum OGF levels were reduced in mice immunized with MOG35-55 prior to any clinical behavioral sign of experimental autoimmune encephalomyelitis, and LDN therapy restored their serum OGF levels. β-endorphin concentrations were not altered by LDN in humans or mice. Thus, blood levels of OGF may serve as a new, selective biomarker for the progression of MS, as well as response to therapy.
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Affiliation(s)
- Michael D Ludwig
- Department of Neural & Behavioral Sciences, College of Medicine, Pennsylvania State University, PA 17033, USA
| | - Ian S Zagon
- Department of Neural & Behavioral Sciences, College of Medicine, Pennsylvania State University, PA 17033, USA
| | - Patricia J McLaughlin
- Department of Neural & Behavioral Sciences, College of Medicine, Pennsylvania State University, PA 17033, USA
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2252
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Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study. Mult Scler Int 2017; 2017:2826532. [PMID: 28900546 PMCID: PMC5576429 DOI: 10.1155/2017/2826532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/07/2017] [Accepted: 07/16/2017] [Indexed: 11/21/2022] Open
Abstract
Background. Although people with Multiple Sclerosis (pwMS) benefit from physical exercise, they still show reduced physical activity and exercise behaviour. This study aimed to investigate short- and long-term effects of an exercise-based patient education programme (ePEP) that focuses on empowering pwMS to a sustainable and self-regulated exercise training management. Methods. Fourteen pwMS were randomly assigned to immediate experimental group (EG-I: n = 8) and waitlist-control group (EG-W: n = 6) and attended biweekly in a six-week ePEP. All participants were measured for walking ability, quality of life, fatigue, and self-efficacy towards physical exercise before and after the ePEP, after 12 weeks, and one year after baseline. Short-term effects were analysed in a randomised control trial and long-term effects of all ePEP participants (EG-I + EG-W = EG-all) in a quasi-experimental design. Results. Only functional gait significantly improved in EG-I compared to EG-W (p = 0.008, r = −0.67). Moderate to large effects were found in EG-all for walking ability. Not significant, however, relevant changes were detected for quality of life and fatigue. Self-efficacy showed no changes. Conclusion. The ePEP seems to be a feasible option to empower pwMS to a self-regulated and sustainable exercise training management shown in long-term walking improvements.
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2253
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Bradshaw MJ, Farrow S, Motl RW, Chitnis T. Wearable biosensors to monitor disability in multiple sclerosis. Neurol Clin Pract 2017; 7:354-362. [PMID: 29185551 DOI: 10.1212/cpj.0000000000000382] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Abstract
Purpose of review Biosensors capable of measuring physiologic and kinetic parameters associated with disability are being applied to the study of people with multiple sclerosis (MS). We review the use of biosensors in people with MS with an emphasis on measuring/monitoring disability and understanding knowledge gaps between biosensor data and clinical care. Recent findings Accelerometers are available to the public and may be able to help the clinician understand a patient's degree of disability. Further studies with wearable biosensors capable of measuring other physiologic features, such as vital signs, are needed and are likely to contribute to our understanding of MS. Summary Wearable biosensors can improve our understanding of disability, response to treatment, and natural history of MS.
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Affiliation(s)
- Michael J Bradshaw
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Samantha Farrow
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert W Motl
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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2254
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't Hart BA, Dunham J, Faber BW, Laman JD, van Horssen J, Bauer J, Kap YS. A B Cell-Driven Autoimmune Pathway Leading to Pathological Hallmarks of Progressive Multiple Sclerosis in the Marmoset Experimental Autoimmune Encephalomyelitis Model. Front Immunol 2017; 8:804. [PMID: 28744286 PMCID: PMC5504154 DOI: 10.3389/fimmu.2017.00804] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/26/2017] [Indexed: 12/20/2022] Open
Abstract
The absence of pathological hallmarks of progressive multiple sclerosis (MS) in commonly used rodent models of experimental autoimmune encephalomyelitis (EAE) hinders the development of adequate treatments for progressive disease. Work reviewed here shows that such hallmarks are present in the EAE model in marmoset monkeys (Callithrix jacchus). The minimal requirement for induction of progressive MS pathology is immunization with a synthetic peptide representing residues 34–56 from human myelin oligodendrocyte glycoprotein (MOG) formulated with a mineral oil [incomplete Freund’s adjuvant (IFA)]. Pathological aspects include demyelination of cortical gray matter with microglia activation, oxidative stress, and redistribution of iron. When the peptide is formulated in complete Freund’s adjuvant, which contains mycobacteria that relay strong activation signals to myeloid cells, oxidative damage pathways are strongly boosted leading to more intensive pathology. The proven absence of immune potentiating danger signals in the MOG34–56/IFA formulation implies that a narrow population of antigen-experienced T cells present in the monkey’s immune repertoire is activated. This novel pathway involves the interplay of lymphocryptovirus-infected B cells with MHC class Ib/Caja-E restricted CD8+ CD56+ cytotoxic T lymphocytes.
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Affiliation(s)
- Bert A 't Hart
- Department of Immunobiology, Biomedical Primate Research Center, Rijswijk, Netherlands.,Department of Neuroscience, University of Groningen, University Medical Center, Groningen, Netherlands
| | - Jordon Dunham
- Department of Immunobiology, Biomedical Primate Research Center, Rijswijk, Netherlands.,Department of Neuroscience, University of Groningen, University Medical Center, Groningen, Netherlands
| | - Bart W Faber
- Department of Parasitology, Biomedical Primate Research Center, Rijswijk, Netherlands
| | - Jon D Laman
- Department of Neuroscience, University of Groningen, University Medical Center, Groningen, Netherlands.,MS Center Noord-Nederland, Groningen, Netherlands
| | - Jack van Horssen
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Bauer
- Department of Neuroimmunology, Brain Research Institute, Medical University Vienna, Vienna, Austria
| | - Yolanda S Kap
- Department of Immunobiology, Biomedical Primate Research Center, Rijswijk, Netherlands
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2255
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Kumar N, Chugh H, Tomar R, Tomar V, Singh VK, Chandra R. Exploring the interplay between autoimmunity and cancer to find the target therapeutic hotspots. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 46:658-668. [PMID: 28687059 DOI: 10.1080/21691401.2017.1350188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autoimmunity arises when highly active immune responses are developed against the tissues or substances of one's own body. It is one of the most prevalent disorders among the old-age population with prospects increasing with age. The major cause of autoimmunity and associated diseases is the dysregulation of host immune surveillance. Impaired repairment of immune system and apoptosis regulation can be seen as major landmarks in autoimmune disorders such as the mutation of p53 gene which results in rheumatoid arthritis, bowel disease which consequently lead to tissue destruction, inflammation and dysfunctioning of body organs. Cytokines mediated apoptosis and proliferation of cells plays a regulatory role in cell cycle and further in cancer development. Anti-TNF therapy, Treg therapy and stem cell therapy have been used for autoimmune diseases, however, with the increase in the use of immunomodulatory therapies and their development for autoimmune diseases and cancer, the understanding of human immune system tends to become an increasing requirement. Hence, the findings associated with the relationship between autoimmune diseases and cancer may prove to be beneficial for the improvement in the health of suffering patients. Here in, we are eliciting the underlying mechanisms which result in autoimmune disorders causing the onset of cancer, exploration of interactome to find the pathways which are mutual to both, and recognition of hotspots which might play important role in autoimmunity mediated therapeutics with different therapies such as anti-TNF therapy, Treg therapy and stem cell therapy.
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Affiliation(s)
- Neeraj Kumar
- a Department of Chemistry, Drug Discovery and Development Laboratory , University of Delhi , Delhi , India.,b Department of Biotechnology, Stem Cell Research Laboratory , Delhi Technological University , Delhi , India
| | - Heerak Chugh
- a Department of Chemistry, Drug Discovery and Development Laboratory , University of Delhi , Delhi , India
| | - Ravi Tomar
- a Department of Chemistry, Drug Discovery and Development Laboratory , University of Delhi , Delhi , India
| | - Vartika Tomar
- a Department of Chemistry, Drug Discovery and Development Laboratory , University of Delhi , Delhi , India
| | - Vimal Kishor Singh
- b Department of Biotechnology, Stem Cell Research Laboratory , Delhi Technological University , Delhi , India
| | - Ramesh Chandra
- a Department of Chemistry, Drug Discovery and Development Laboratory , University of Delhi , Delhi , India.,c Dr. B. R. Ambedkar Center for Biomedical Research , University of Delhi , Delhi , India
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2256
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Adami A, Rossiter HB. Principles, insights, and potential pitfalls of the noninvasive determination of muscle oxidative capacity by near-infrared spectroscopy. J Appl Physiol (1985) 2017; 124:245-248. [PMID: 28684592 DOI: 10.1152/japplphysiol.00445.2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alessandra Adami
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
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2257
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Skromne-Eisenberg E. Disease-modifying therapies in multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317723369. [PMID: 28979794 PMCID: PMC5617092 DOI: 10.1177/2055217317723369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
The treatment of multiple sclerosis (MS) has become increasingly complex during the last 10 years, mainly because of the advent of new and more potent disease-modifying therapies (DMTs). In Latin America, the therapeutic repertoire available for MS treatment is similar to the one in the rest of the world, but the high costs of these drugs, in conjunction with the limited resources of the social security health systems, makes the treatment of MS more difficult. For neurologists in Latin America, providing personalized MS treatment has become a challenge. We present a review of the status of the DMT in Central and South America, benefits as well as limitations for providing full access to these medications in Latin America.
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2258
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Singer BA. The role of natalizumab in the treatment of multiple sclerosis: benefits and risks. Ther Adv Neurol Disord 2017; 10:327-336. [PMID: 28861122 PMCID: PMC5557182 DOI: 10.1177/1756285617716002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/23/2017] [Indexed: 02/04/2023] Open
Abstract
Natalizumab, a monoclonal antibody that blocks lymphocyte infiltration in the central nervous system, is a valuable tool in the treatment of relapsing forms of multiple sclerosis (MS). In a phase III clinical trial comparing natalizumab with placebo over 2 years, natalizumab reduced annualized relapse rate by 68%, 12-week confirmed disability progression by 42%, and reduced contrast-enhancing lesions by 92%. In post hoc analyses, natalizumab treatment was associated with 37% of patients achieving no evidence of disease activity (versus 7% on placebo) and 30% achieving sustained disability improvement (versus 19% on placebo). Natalizumab did not achieve a statistically significant primary composite disability outcome in a trial of 887 patients with secondary progressive MS, but it did demonstrate a benefit on a prespecified component of the 9-Hole Peg Test. The greatest risk of natalizumab treatment is progressive multifocal leukoencephalopathy (PML), with a 23% mortality rate. Risk stratification on the basis of immunosuppressant exposure, natalizumab treatment duration and anti-John Cunningham virus (JCV) antibody status and index has greatly improved clinical decision making. Other potential serious natalizumab-associated risks reported in clinical trials and postmarketing settings include infusion reactions, hepatotoxicity and rare, serious opportunistic infections. With more than a decade of continuous postmarketing experience, natalizumab remains a very effective option for patients with relapsing forms of MS. To optimize appropriate selection of natalizumab for patients with relapsing MS, however, a thorough understanding of individual patient risk factors for PML or other adverse events is also required.
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Affiliation(s)
- Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, 3009 North Ballas Road, Suite 207B, St Louis, MO 63131, USA
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2259
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Kowalec K, Kingwell E, Carruthers R, Marrie RA, Bernatsky S, Traboulsee A, Ross CJD, Carleton B, Tremlett H. Application of pharmacogenomics to investigate adverse drug reactions to the disease-modifying treatments for multiple sclerosis: a case-control study protocol for dimethyl fumarate-induced lymphopenia. BMJ Open 2017; 7:e016276. [PMID: 28576902 PMCID: PMC5623385 DOI: 10.1136/bmjopen-2017-016276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are a global public health issue. The potential for pharmacogenomic biomarkers has been demonstrated in several therapeutical areas, including HIV infection and oncology. Dimethyl fumarate (DMF) is a licensed disease-modifying therapy for the treatment of multiple sclerosis (MS). The use of DMF in MS has been associated with a severe reduction in lymphocyte counts and reports of progressive multifocal leukoencephalopathy. Here, we outline the protocol for a case-control study designed to discover genomic variants associated with DMF-induced lymphopenia. The ultimate goal is to replicate these findings and create an efficient and adaptable approach towards the identification of genomic markers that could assist in mitigating adverse drug reactions in MS. METHODS AND ANALYSIS The population sample will comprise DMF-exposed patients with MS, with cases representing those who developed lymphopenia and controls who did not. DNA genotyping will take place using a high-throughput genome-wide array. Fine mapping and imputation will be performed to focus in on the potentially causal variants associated with lymphopenia. Multivariable logistic regression will be used to compare genotype and allele frequencies between the cases and the controls, with consideration of potential confounders. The association threshold will be set at p<1.0×10-5 for the discovery of genomic association analyses to select variants for replication. ETHICS AND DISSEMINATION Ethics approval has been obtained from the respective research ethics board, which includes written informed consent. Findings will be disseminated widely, including at scientific conferences, via podcasts (targeted at both healthcare professionals as well as patients and the wider community), through patient engagement and other outreach community events, written lay summaries for all participants and formal publication in peer-reviewed scientific journals.
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Affiliation(s)
- Kaarina Kowalec
- Faculty of Medicine, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancover, British Columbia, Canada
| | - Elaine Kingwell
- Faculty of Medicine, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancover, British Columbia, Canada
| | - Robert Carruthers
- Faculty of Medicine, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancover, British Columbia, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University, Montreal, Quebec, Canada
| | - Anthony Traboulsee
- Faculty of Medicine, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancover, British Columbia, Canada
| | - Colin J D Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancover, British Columbia, Canada
- B.C. Childrens Hospital Research Institute, Vancouver, Canada
| | - Bruce Carleton
- B.C. Childrens Hospital Research Institute, Vancouver, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Helen Tremlett
- Faculty of Medicine, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancover, British Columbia, Canada
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2260
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Gieselbach RJ, Muller-Hansma AH, Wijburg MT, de Bruin-Weller MS, van Oosten BW, Nieuwkamp DJ, Coenjaerts FE, Wattjes MP, Murk JL. Progressive multifocal leukoencephalopathy in patients treated with fumaric acid esters: a review of 19 cases. J Neurol 2017; 264:1155-1164. [PMID: 28536921 DOI: 10.1007/s00415-017-8509-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare and potentially fatal condition caused by a brain infection with JC polyomavirus (JCV). PML develops almost exclusively in immunocompromised patients and has recently been associated with use of fumaric acid esters (FAEs), or fumarates. We reviewed the literature and the Dutch and European pharmacovigilance databases in order to identify all available FAE-associated PML cases and distinguish possible common features among these patients. A total of 19 PML cases associated with FAE use were identified. Five cases were associated with FAE use for multiple sclerosis and 14 for psoriasis. Ten patients were male and nine were female. The median age at PML diagnosis was 59 years. The median duration of FAE therapy to PML symptom onset or appearance of first PML lesion on brain imaging was 31 months (range 6-110). In all cases a certain degree of lymphocytopenia was reported. The median duration of lymphocytopenia to PML symptom onset was 23 months (range 6-72). The median lymphocyte count at PML diagnosis was 414 cells/µL. CD4 and CD8 counts were reported in ten cases, with median cell count of 137 and 39 cells/µL, respectively. Three patients died (16% mortality). The association between occurrence of PML in patients with low CD4 and CD8 counts is reminiscent of PML cases in the HIV population and suggests that loss of T cells is the most important risk factor.
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Affiliation(s)
- Robbert-Jan Gieselbach
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn T Wijburg
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bob W van Oosten
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Dennis J Nieuwkamp
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Frank E Coenjaerts
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jean-Luc Murk
- Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands.
- Laboratory of Medical Microbiology and Immunology, St. Elisabeth TweeSteden ziekenhuis (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
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2261
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Bollaert RE, Marsh AP, Cutter GR, Motl RW. The Virtual Short Physical Performance Battery: Psychometric Properties and Validation in Older Adults With Multiple Sclerosis. J Appl Gerontol 2017; 38:1492-1505. [PMID: 28506093 DOI: 10.1177/0733464817709532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There are increasing numbers of older adults with multiple sclerosis (MS) who undergo declines in physical function that require attention of clinicians and researchers. Objective and perceived measures of disablement feasible for clinical and residential settings, such as the Short Physical Performance Battery and its virtual counterpart (vSPPB), are critical for defining the degree of disablement. Objective: We evaluated the psychometric properties and validity of the vSPPB as a measure of perceived lower extremity physical function in older adults with MS (age ≥60 years). Method: The sample included 35 older adults with MS and 35 age- and sex-matched healthy controls (age ≥60 years) who completed a battery of assessments, including the vSPPB. Results: The vSPPB performed satisfactorily in older adults with MS regarding data quality, scaling assumptions, and acceptability (i.e., psychometrics). The vSPPB further demonstrated criterion, known-groups, convergent, and discriminant construct validity. Conclusion: This report provides evidence for the validity of vSPPB scores as a measure of perceived lower extremity physical function in older adults with MS.
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2262
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Charvet LE, Yang J, Shaw MT, Sherman K, Haider L, Xu J, Krupp LB. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial. PLoS One 2017; 12:e0177177. [PMID: 28493924 PMCID: PMC5426671 DOI: 10.1371/journal.pone.0177177] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022] Open
Abstract
Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS). We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74) vs. active control (n = 61) training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02–0·30), despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006). This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction. Trial Registration: Clinicaltrials.gov NCT02141386
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Affiliation(s)
- Leigh E. Charvet
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jie Yang
- Department of Family, Population, and Preventive Medicine, Stony Brook Medicine, New York, New York, United States of America
| | - Michael T. Shaw
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Kathleen Sherman
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Lamia Haider
- Taub Institute, Columbia University Medical Center, New York, New York, United States of America
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook Medicine, Stony Brook, New York, United States of America
| | - Lauren B. Krupp
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
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2263
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Fleischer V, Friedrich M, Rezk A, Bühler U, Witsch E, Uphaus T, Bittner S, Groppa S, Tackenberg B, Bar-Or A, Zipp F, Luessi F. Treatment response to dimethyl fumarate is characterized by disproportionate CD8+ T cell reduction in MS. Mult Scler 2017; 24:632-641. [PMID: 28436295 DOI: 10.1177/1352458517703799] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effect of dimethyl fumarate (DMF) on circulating lymphocyte subsets and their contribution as predictors of clinical efficacy have not yet been investigated in multiple sclerosis (MS). OBJECTIVE To evaluate lymphocytes and lymphocyte subsets (analyzed 6 months after DMF start) in MS patients with and without disease activity after 1 year of treatment in a retrospective study. METHODS Peripheral blood lymphocyte subsets were analyzed by flow cytometry. Untreated MS patients ( n = 40) were compared to those 6 months after onset of DMF treatment ( n = 51). Clinical and magnetic resonance imaging (MRI) disease activity of DMF-treated patients were assessed in the first year under treatment. RESULTS Stable patients showed significantly lower lymphocytes, CD4+ and CD8+ T cells as well as CD19+ B cells compared to active patients under DMF treatment. Furthermore, an increased CD4/CD8 ratio ( p < 0.025) in stable patients indicated a disproportionate reduction of CD8+ T cells relative to CD4+ T cells. Reduced lymphocytes, CD8+ T cells, and CD19+ B cells 6 months after DMF start allowed prediction of the treatment response in the first year. CONCLUSION DMF treatment response is reflected by lower circulating lymphocytes and specific lymphocyte subsets. Changes in the cellular immune profiles under DMF treatment are clinically relevant and might serve as a surrogate marker of treatment response.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michaela Friedrich
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ayman Rezk
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ulrike Bühler
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Esther Witsch
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Björn Tackenberg
- Clinical Neuroimmunology Group, Department of Neurology, Philipps University, Marburg, Germany
| | - Amit Bar-Or
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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2264
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Chaves C, Ganguly R, Ceresia C, Camac A. Lymphocyte subtypes in relapsing-remitting multiple sclerosis patients treated with dimethyl fumarate. Mult Scler J Exp Transl Clin 2017; 3:2055217317702933. [PMID: 28607757 PMCID: PMC5408504 DOI: 10.1177/2055217317702933] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/12/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent data suggest that lymphopenia is more prevalent than reported in relapsing-remitting multiple sclerosis (RRMS) patients taking dimethyl fumarate (DMF). OBJECTIVE The objective of this study was to investigate the effect of DMF on lymphocyte subtypes in RRMS patients with and without lymphopenia. METHOD A retrospective study compared lymphocyte subtypes in DMF-treated RRMS patients with low (G1, n = 35) and normal lymphocyte counts (G2, n = 24). RESULTS Fifty-nine patients were identified, with mean age 49, 71.2% females, and average DMF duration 20 months. Age, sex, baseline white blood count, disease and treatment durations were similar between groups. Prior interferon therapy and baseline lower normal lymphocyte counts were more frequent in G1. Mean lymphocyte counts were 0.8 ± 0.2 × 109/L in G1 and 1.6 ± 0.3 × 109/L in G2. CD3+, CD4+, and CD8+ T cell mean counts were lower (p < 0.0001), while CD4/CD8 ratio higher (p = 0.03) in G1 than G2. Mean CD19 + B cell counts were normal; however, values were lower in G1 (p = 0.04). After adjusting for confounders, significantly positive correlations were noted between lymphocyte counts and CD3 + , CD4+, CD8+ T, and B cell counts. Negative correlation was observed between lymphocyte counts and CD4/CD8 ratio driven by low CD8+ T cell counts. CONCLUSION DMF treatment predominantly impacts T cells, in particular CD8+ subtype. This finding may have implications in this population's immunocompetence.
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Affiliation(s)
| | | | | | - A Camac
- Neurology Department, Lahey Clinic, Lexington, MA, USA
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2265
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Zareie P, Connor B, La Flamme AC. Amelioration of experimental autoimmune encephalomyelitis by clozapine is not associated with defective CD4 T cell responses. J Neuroinflammation 2017; 14:68. [PMID: 28356108 PMCID: PMC5372297 DOI: 10.1186/s12974-017-0842-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/16/2017] [Indexed: 02/10/2023] Open
Abstract
Atypical antipsychotic agents, such as clozapine, are used for treating psychosis and depression and have recently been found to modulate neuroinflammation. We have shown previously that treatment of mice with the atypical antipsychotic agents, clozapine or risperidone, attenuates disease severity in experimental autoimmune encephalomyelitis (EAE); however, the mechanism by which they are protective is unknown. In this study, we investigated the effects of clozapine on CD4+ T cell responses and found that clozapine did not significantly affect the expansion of myelin-specific T cells, their differentiation into pathogenic subsets, or their encephalitogenic capacity to induce EAE. Interestingly, although clozapine enhanced differentiation of regulatory T (Treg) cells, in vivo neutralization of Tregs indicated that Tregs were not responsible for the protective effects of clozapine during the induction and effector phase of EAE. Taken together, our studies indicate that clozapine does not mediate its protective effects by directly altering CD4 T cells.
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Affiliation(s)
- Pirooz Zareie
- Centre for Biodiscovery, School of Biological Sciences, Victoria University of Wellington, P.O. Box 600, Wellington, 6140, New Zealand
| | - Bronwen Connor
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Anne Camille La Flamme
- Centre for Biodiscovery, School of Biological Sciences, Victoria University of Wellington, P.O. Box 600, Wellington, 6140, New Zealand. .,The Malaghan Institute of Medical Research, Wellington, New Zealand.
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2266
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Wu Q, Wang Q, Mao G, Dowling CA, Lundy SK, Mao-Draayer Y. Dimethyl Fumarate Selectively Reduces Memory T Cells and Shifts the Balance between Th1/Th17 and Th2 in Multiple Sclerosis Patients. THE JOURNAL OF IMMUNOLOGY 2017; 198:3069-3080. [PMID: 28258191 DOI: 10.4049/jimmunol.1601532] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/08/2017] [Indexed: 01/20/2023]
Abstract
Dimethyl fumarate (DMF; trade name Tecfidera) is an oral formulation of the fumaric acid ester that is Food and Drug Administration approved for treatment of relapsing-remitting multiple sclerosis. To better understand the therapeutic effects of Tecfidera and its rare side effect of progressive multifocal leukoencephalopathy, we conducted cross-sectional and longitudinal studies by immunophenotyping cells from peripheral blood (particularly T lymphocytes) derived from untreated and 4-6 and 18-26 mo Tecfidera-treated stable relapsing-remitting multiple sclerosis patients using multiparametric flow cytometry. The absolute numbers of CD4 and CD8 T cells were significantly decreased and the CD4/CD8 ratio was increased with DMF treatment. The proportions of both effector memory T cells and central memory T cells were reduced, whereas naive T cells increased in treated patients. T cell activation was reduced with DMF treatment, especially among effector memory T cells and effector memory RA T cells. Th subsets Th1 (CXCR3+), Th17 (CCR6+), and particularly those expressing both CXCR3 and CD161 were reduced most significantly, whereas the anti-inflammatory Th2 subset (CCR3+) was increased after DMF treatment. A corresponding increase in IL-4 and decrease in IFN-γ and IL-17-expressing CD4+ T cells were observed in DMF-treated patients. DMF in vitro treatment also led to increased T cell apoptosis and decreased activation, proliferation, reactive oxygen species, and CCR7 expression. Our results suggest that DMF acts on specific memory and effector T cell subsets by limiting their survival, proliferation, activation, and cytokine production. Monitoring these subsets could help to evaluate the efficacy and safety of DMF treatment.
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Affiliation(s)
- Qi Wu
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Qin Wang
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Guangmei Mao
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Catherine A Dowling
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Steven K Lundy
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109; and.,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109; .,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI 48109
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2267
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Alifirova VM, Boiko AN, Vlasov YV, Davydovskaya MV, Zakharova MN, Malkova NA, Popova EV, Sivertseva SA, Spirin NN, Khachanova NV, Shmidt ТЕ. [Clinical guidelines for the use of dimethyl fumarate in relapsing-remitting multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:97-102. [PMID: 28252608 DOI: 10.17116/jnevro20171171197-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiple sclerosis is a chronic demyelinating and neurodegenerative disease of the central nervous system, in which autoimmune inflammation and oxidative stress play essential pathogenetic roles. Activation and infiltration of immune cells in brain tissues, lipid peroxidation products, mitochondrial dysfunction, defective antioxidant protection, and many other pathological factors result in demyelination, axonal injury and death, and apoptosis of oligodendrocytes and neurons, all of which causes constant progression of the disease. The new oral agent for the treatment of relapsing-remitting multiple sclerosis (RRMS), dimethyl fumarate (DMF), helps change the pathogenetic mechanisms of the disease, thus decreasing the rate of exacerbations, slowing down disease progression, and reducing the risk of radiological progression of the disease.
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Affiliation(s)
| | - A N Boiko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya V Vlasov
- Samara State Medical University, Samara, Russia
| | - M V Davydovskaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - N A Malkova
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - E V Popova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Sivertseva
- Tyumen Regional Center of Multiple Sclerosis, Tyumen, Russia
| | - N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - N V Khachanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Т Е Shmidt
- Sechenov First Moscow State Medical University, Moscow, Russia
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2268
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Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system most often characterized by clinical relapses and periods of remission. RECENT FINDINGS The past decade has seen a dramatic increase in disease-modifying therapies for MS. Fourteen FDA-approved immunomodulatory drugs are currently available, and more medications are in development. A growing number of reported opportunistic infections, including progressive multifocal leukoencephalopathy (PML), highlight the serious complications of these new drugs and the need for specific screening guidelines. Using data from Phase II and III randomized controlled trials, case reports, drug manufacturing data, and clinical experience, we outline the most common and serious infections associated with novel MS therapies.
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2269
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Charvet L, Shaw M, Dobbs B, Frontario A, Sherman K, Bikson M, Datta A, Krupp L, Zeinapour E, Kasschau M. Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis. Neuromodulation 2017; 21:383-389. [PMID: 28225155 DOI: 10.1111/ner.12583] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the efficacy of remotely-supervised transcranial direct current stimulation (RS-tDCS) paired with cognitive training (CT) exercise in participants with multiple sclerosis (MS). METHODS In a feasibility study of RS-tDCS in MS, participants completed ten sessions of tDCS paired with CT (1.5 mA × 20 min, dorsolateral prefrontal cortex montage). RS-tDCS participants were compared to a control group of adults with MS who underwent ten 20-min CT sessions through the same remotely supervised procedures. Cognitive outcomes were tested by composite scores measuring change in performance on standard tests (Brief International Cognitive Assessment in MS or BICAMS), basic attention (ANT-I Orienting and Attention Networks, Cogstate Detection), complex attention (ANT-I Executive Network, Cogstate Identification and One-Back), and intra-individual response variability (ANT-I and Cogstate identification; sensitive markers of disease status). RESULTS After ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99). CONCLUSIONS These initial findings indicate benefit for RS-tDCS paired with CT in MS. Exploratory analyses indicate that the earliest tDCS cognitive benefit is seen in complex attention and response variability. Telerehabilitation using RS-tDCS combined with CT may lead to improved outcomes in MS.
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Michael Shaw
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Kathleen Sherman
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Engineering Department, City College of New York, New York, NY, USA
| | | | - Lauren Krupp
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Esmail Zeinapour
- Engineering Department, City College of New York, New York, NY, USA
| | - Margaret Kasschau
- School of Health Technology and Management, Stony Brook Medicine, Stony Brook, NY, USA
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2270
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Fritz NE, Keller J, Calabresi PA, Zackowski KM. Quantitative measures of walking and strength provide insight into brain corticospinal tract pathology in multiple sclerosis. Neuroimage Clin 2017; 14:490-498. [PMID: 28289599 PMCID: PMC5338912 DOI: 10.1016/j.nicl.2017.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 01/21/2023]
Abstract
At least 85% of individuals with multiple sclerosis report walking dysfunction as their primary complaint. Walking and strength measures are common clinical measures to mark increasing disability or improvement with rehabilitation. Previous studies have shown an association between strength or walking ability and spinal cord MRI measures, and strength measures with brainstem corticospinal tract magnetization transfer ratio. However, the relationship between walking performance and brain corticospinal tract magnetization transfer imaging measures and the contribution of clinical measurements of walking and strength to the underlying integrity of the corticospinal tract has not been explored in multiple sclerosis. The objectives of this study were explore the relationship of quantitative measures of walking and strength to whole-brain corticospinal tract-specific MRI measures and to determine the contribution of quantitative measures of function in addition to basic clinical measures (age, gender, symptom duration and Expanded Disability Status Scale) to structural imaging measures of the corticospinal tract. We hypothesized that quantitative walking and strength measures would be related to brain corticospinal tract-specific measures, and would provide insight into the heterogeneity of brain pathology. Twenty-nine individuals with relapsing-remitting multiple sclerosis (mean(SD) age 48.7 (11.5) years; symptom duration 11.9(8.7); 17 females; median[range] Expanded Disability Status Scale 4.0 [1.0-6.5]) and 29 age and gender-matched healthy controls (age 50.8(11.6) years; 20 females) participated in clinical tests of strength and walking (Timed Up and Go, Timed 25 Foot Walk, Two Minute Walk Test ) as well as 3 T imaging including diffusion tensor imaging and magnetization transfer imaging. Individuals with multiple sclerosis were weaker (p = 0.0024) and walked slower (p = 0.0013) compared to controls. Quantitative measures of walking and strength were significantly related to corticospinal tract fractional anisotropy (r > 0.26; p < 0.04) and magnetization transfer ratio (r > 0.29; p < 0.03) measures. Although the Expanded Disability Status Scale was highly correlated with walking measures, it was not significantly related to either corticospinal tract fractional anisotropy or magnetization transfer ratio (p > 0.05). Walk velocity was a significant contributor to magnetization transfer ratio (p = 0.006) and fractional anisotropy (p = 0.011) in regression modeling that included both quantitative measures of function and basic clinical information. Quantitative measures of strength and walking are associated with brain corticospinal tract pathology. The addition of these quantitative measures to basic clinical information explains more of the variance in corticospinal tract fractional anisotropy and magnetization transfer ratio than the basic clinical information alone. Outcome measurement for multiple sclerosis clinical trials has been notoriously challenging; the use of quantitative measures of strength and walking along with tract-specific imaging methods may improve our ability to monitor disease change over time, with intervention, and provide needed guidelines for developing more effective targeted rehabilitation strategies.
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Affiliation(s)
- Nora E Fritz
- Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, USA
- Wayne State University, Program in Physical Therapy, Department of Neurology, Detroit, MI, USA
| | - Jennifer Keller
- Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter A Calabresi
- Johns Hopkins School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Kathleen M Zackowski
- Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Department of Neurology, Baltimore, MD, USA
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2271
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Moon Y, McGinnis RS, Seagers K, Motl RW, Sheth N, Wright JA, Ghaffari R, Sosnoff JJ. Monitoring gait in multiple sclerosis with novel wearable motion sensors. PLoS One 2017; 12:e0171346. [PMID: 28178288 PMCID: PMC5298289 DOI: 10.1371/journal.pone.0171346] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/19/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mobility impairment is common in people with multiple sclerosis (PwMS) and there is a need to assess mobility in remote settings. Here, we apply a novel wireless, skin-mounted, and conformal inertial sensor (BioStampRC, MC10 Inc.) to examine gait characteristics of PwMS under controlled conditions. We determine the accuracy and precision of BioStampRC in measuring gait kinematics by comparing to contemporary research-grade measurement devices. METHODS A total of 45 PwMS, who presented with diverse walking impairment (Mild MS = 15, Moderate MS = 15, Severe MS = 15), and 15 healthy control subjects participated in the study. Participants completed a series of clinical walking tests. During the tests participants were instrumented with BioStampRC and MTx (Xsens, Inc.) sensors on their shanks, as well as an activity monitor GT3X (Actigraph, Inc.) on their non-dominant hip. Shank angular velocity was simultaneously measured with the inertial sensors. Step number and temporal gait parameters were calculated from the data recorded by each sensor. Visual inspection and the MTx served as the reference standards for computing the step number and temporal parameters, respectively. Accuracy (error) and precision (variance of error) was assessed based on absolute and relative metrics. Temporal parameters were compared across groups using ANOVA. RESULTS Mean accuracy±precision for the BioStampRC was 2±2 steps error for step number, 6±9ms error for stride time and 6±7ms error for step time (0.6-2.6% relative error). Swing time had the least accuracy±precision (25±19ms error, 5±4% relative error) among the parameters. GT3X had the least accuracy±precision (8±14% relative error) in step number estimate among the devices. Both MTx and BioStampRC detected significantly distinct gait characteristics between PwMS with different disability levels (p<0.01). CONCLUSION BioStampRC sensors accurately and precisely measure gait parameters in PwMS across diverse walking impairment levels and detected differences in gait characteristics by disability level in PwMS. This technology has the potential to provide granular monitoring of gait both inside and outside the clinic.
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Affiliation(s)
- Yaejin Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Ryan S. McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
| | - Kirsten Seagers
- MC10 Inc., Lexington, Massachusetts, United States of America
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nirav Sheth
- MC10 Inc., Lexington, Massachusetts, United States of America
| | - John A. Wright
- MC10 Inc., Lexington, Massachusetts, United States of America
| | | | - Jacob J. Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
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2272
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Popova EV, Boyko AN, Orlova EV. [Dimethylfumarate in the treatment of relapsing-remitting multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:68-72. [PMID: 28139614 DOI: 10.17116/jnevro201611610268-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review includes results of experimental and clinical studies of dimethyl fumarate, a new oral drug for pathogenetic treatment of multiple sclerosis (MS). The mechanism of action, data from clinical trials, including MRI-results related to tolerability and safety of the drug are reviewed. The risk management plan for possible adverse events and a place of dimethyl fumarate in the current pathogenetic treatment of MS are discussed.
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Affiliation(s)
- E V Popova
- City Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Resaerch Medical University, Moscow, Russia
| | - A N Boyko
- City Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Resaerch Medical University, Moscow, Russia
| | - E V Orlova
- 'Jonson& ,Jonson Ltd', Moscow, Russia
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2273
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Hughes AJ, Parmenter BA, Haselkorn JK, Lovera JF, Bourdette D, Boudreau E, Cameron MH, Turner AP. Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis. J Sleep Res 2017; 26:428-435. [DOI: 10.1111/jsr.12490] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 11/20/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Abbey J. Hughes
- Multiple Sclerosis Center of Excellence - West; VA Puget Sound Health Care System; Seattle WA USA
- Department of Physical Medicine and Rehabilitation; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Brett A. Parmenter
- Mental Health Service; VA Puget Sound Health Care System; Tacoma WA USA
- Department of Psychiatry and Behavioral Sciences; University of Washington; Seattle WA USA
| | - Jodie K. Haselkorn
- Multiple Sclerosis Center of Excellence - West; VA Puget Sound Health Care System; Seattle WA USA
- Rehabilitation Care Service; VA Puget Sound Health Care System; Seattle WA USA
- Department of Rehabilitation Medicine; University of Washington; Seattle WA USA
- Department of Epidemiology; University of Washington; Seattle WA USA
| | - Jesus F. Lovera
- Department of Neurology; Louisiana State University Health Science Center; New Orleans LA USA
| | - Dennis Bourdette
- Multiple Sclerosis Center of Excellence - West; VA Portland Health Care System; Portland OR USA
- Department of Neurology; Oregon Health & Science University; Portland OR USA
| | - Eilis Boudreau
- Department of Neurology; Oregon Health & Science University; Portland OR USA
- Neurology Service; VA Portland Health Care System; Portland OR USA
| | - Michelle H. Cameron
- Multiple Sclerosis Center of Excellence - West; VA Portland Health Care System; Portland OR USA
- Department of Neurology; Oregon Health & Science University; Portland OR USA
| | - Aaron P. Turner
- Multiple Sclerosis Center of Excellence - West; VA Puget Sound Health Care System; Seattle WA USA
- Rehabilitation Care Service; VA Puget Sound Health Care System; Seattle WA USA
- Department of Rehabilitation Medicine; University of Washington; Seattle WA USA
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2274
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Pandit L, Nakashima I, Mustafa S, Takahashi T, Kaneko K. Anti Myelin Oligodendrocyte Glycoprotein associated Immunoglobulin G (AntiMOG-IgG)-associated Neuromyelitis Optica Spectrum Disorder with Persistent Disease Activity and Residual Cognitive Impairment. Ann Indian Acad Neurol 2017; 20:411-413. [PMID: 29184347 PMCID: PMC5682748 DOI: 10.4103/aian.aian_250_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Antibodies targeting myelin oligodendrocyte glycoprotein (MOG) have been recently reported in association with idiopathic inflammatory central nervous system disorders. Initially believed to be a benign disorder, anti MOG-IgG was noted to cause steroid responsive recurrent optic neuritis and isolated longitudinally extensive myelitis. However, there is growing evidence that the disease may be predominantly relapsing, often producing severe visual loss and involving regions other than the spinal cord and optic nerve. We report an adolescent male with an aggressive disease course previously undescribed in anti MOG-IgG-associated disease that left him with residual cognitive dysfunction.
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Affiliation(s)
- Lekha Pandit
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Ichiro Nakashima
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Sharik Mustafa
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimhiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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2275
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't Hart BA, Kap YS. An essential role of virus-infected B cells in the marmoset experimental autoimmune encephalomyelitis model. Mult Scler J Exp Transl Clin 2017; 3:2055217317690184. [PMID: 28607749 PMCID: PMC5466146 DOI: 10.1177/2055217317690184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
Abstract
Infection with Epstein–Barr virus (EBV) has been associated with an enhanced risk of genetically susceptible individuals to develop multiple sclerosis (MS). However, an explanation for the contrast between the high EBV infection prevalence (60–90%) and the low MS prevalence (0.1%) eludes us. Here we propose a new concept for the EBV–MS association developed in the experimental autoimmune encephalomyelitis model in marmoset monkeys, which are naturally infected with the EBV-related γ1-herpesvirus CalHV3. The data indicate that the infection of B cells with a γ1-herpesvirus endows them with the capacity to activate auto-aggressive CD8+ T cells specific for myelin oligodendrocyte glycoprotein.
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Affiliation(s)
- Bert A 't Hart
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Yolanda S Kap
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
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2276
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Abstract
Brain atrophy occurs at a faster rate in patients with multiple sclerosis (MS) than in healthy individuals. In three randomized, controlled, phase III trials, fingolimod reduced the annual rate of brain volume loss (BVL) in patients with relapsing MS (RMS) by approximately one-third relative to that in individuals receiving placebo or intramuscular interferon beta-1a. Analysis of brain volume changes during study extensions has shown that this reduced rate of BVL is sustained in patients with RMS receiving fingolimod continuously. Subgroup analyses of the core phase III and extension studies have shown that reductions in the rate of BVL are observed irrespective of levels of inflammatory lesion activity seen by magnetic resonance imaging at baseline and on study; levels of disability at baseline; and treatment history. The rate of BVL in these studies was predicted independently by T2 lesion and gadolinium-enhancing lesion burdens at baseline, and correlations observed between BVL and increasing levels of disability strengthened over time. In another phase III trial in patients with primary progressive MS (PPMS), fingolimod did not reduce BVL overall relative to placebo; however, consistent with findings in RMS, there was a treatment effect on BVL in patients with PPMS with gadolinium-enhancing lesion activity at baseline. The association between treatment effects on BVL and future accumulation of disability argues in favor of measuring BVL on a more routine basis and with a more structured approach than is generally the case in clinical practice. Despite several practical obstacles, progress is being made in achieving this goal.
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2277
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Geographical Heterogeneity of Multiple Sclerosis Prevalence in France. PLoS One 2016; 11:e0167556. [PMID: 27936086 PMCID: PMC5147922 DOI: 10.1371/journal.pone.0167556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 11/16/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Geographical variation in the prevalence of multiple sclerosis (MS) is controversial. Heterogeneity is important to acknowledge to adapt the provision of care within the healthcare system. We aimed to investigate differences in prevalence of MS in departments in the French territory. Methods We estimated MS prevalence on October 31, 2004 in 21 administrative departments in France (22% of the metropolitan departments) by using multiple data sources: the main French health insurance systems, neurologist networks devoted to MS and the Technical Information Agency of Hospitalization. We used a spatial Bayesian approach based on estimating the number of MS cases from 2005 and 2008 capture–recapture studies to analyze differences in prevalence. Results The age- and sex-standardized prevalence of MS per 100,000 inhabitants ranged from 68.1 (95% credible interval 54.6, 84.4) in Hautes-Pyrénées (southwest France) to 296.5 (258.8, 338.9) in Moselle (northeast France). The greatest prevalence was in the northeast departments, and the other departments showed great variability. Discussion By combining multiple data sources into a spatial Bayesian model, we found heterogeneity in MS prevalence among the 21 departments of France, some with higher prevalence than anticipated from previous publications. No clear explanation related to health insurance coverage and hospital facilities can be advanced. Population migration, socioeconomic status of the population studied and environmental effects are suspected.
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2278
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Ventura RE, Antezana AO, Bacon T, Kister I. Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans. Mult Scler 2016; 23:1554-1557. [DOI: 10.1177/1352458516679894] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whether disease course in Hispanic Americans (HA) with multiple sclerosis (MS) is different from Caucasian Americans (CA) or African Americans (AA) is unknown. We compared MS severity in the three main ethnic populations in our tertiary MS clinics using disease duration–adjusted rank score of disability: Patient-Derived Multiple Sclerosis Severity Score (P-MSSS). The age- and gender-adjusted P-MSSS was significantly higher in HA (3.9 ± 2.6) and AA (4.5 ± 3.0) compared to CA (3.4 ± 2.6; p < 0.0001 for both). Adjusting for insurance did not change these results. These findings suggest that HA, as AA, have more rapid disability accumulation than CA.
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Affiliation(s)
- Rachel E Ventura
- Department of Neurology, School of Medicine, New York University, New York, NY, USA/Ambulatory Care Center, NYU Langone Medical Center, New York, NY, USA
| | | | - Tamar Bacon
- Department of Neurology, School of Medicine, New York University, New York, NY, USA
| | - Ilya Kister
- Department of Neurology, School of Medicine, New York University, New York, NY, USA/Barnabas Multiple Sclerosis Care Center, RWJBarnabas Health, Livingston, NJ, USA
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2279
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Block VJ, Lizée A, Crabtree-Hartman E, Bevan CJ, Graves JS, Bove R, Green AJ, Nourbakhsh B, Tremblay M, Gourraud PA, Ng MY, Pletcher MJ, Olgin JE, Marcus GM, Allen DD, Cree BAC, Gelfand JM. Continuous daily assessment of multiple sclerosis disability using remote step count monitoring. J Neurol 2016; 264:316-326. [PMID: 27896433 DOI: 10.1007/s00415-016-8334-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022]
Abstract
Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk ≥2-min were prospectively recruited. At 4 weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC = 0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p < 0.01). Lower average daily step count was associated with greater disability on the Expanded Disability Status Scale (EDSS) (p < 0.001). Within each EDSS category, substantial variability in step count was apparent (i.e., EDSS = 6.0 range 1097-7152). Step count demonstrated moderate-strong correlations with other walking measures. Lower average daily step count is associated with greater MS disability and captures important variability in real-world walking activity otherwise masked by standard disability scales, including the EDSS. These results support remote step count monitoring as an exploratory outcome in MS trials.
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Affiliation(s)
- V J Block
- Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA
| | - A Lizée
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - E Crabtree-Hartman
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - C J Bevan
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - J S Graves
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - R Bove
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - A J Green
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - B Nourbakhsh
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - M Tremblay
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - P-A Gourraud
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - M Y Ng
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - M J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - J E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - G M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - D D Allen
- Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA
| | - B A C Cree
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - J M Gelfand
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
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2280
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Gyllensten H, Wiberg M, Alexanderson K, Hillert J, Tinghög P. How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group. BMJ Open 2016; 6:e012731. [PMID: 27856477 PMCID: PMC5128990 DOI: 10.1136/bmjopen-2016-012731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography. DESIGN Population-based cohort study. SETTING The adult Swedish general population. PARTICIPANTS Residents aged 24-57 diagnosed with MS (n=3685) in 2003-2006 and 18 425 matched controls without MS. PRIMARY AND SECONDARY OUTCOME MEASURES Annual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T-5-T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability. RESULTS Work disability of patients with MS increased gradually between T-5 and T-1 (mean: 46-82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis. CONCLUSIONS Patients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.
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Affiliation(s)
- Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre for Person-centred Care (GPCC), and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Wiberg
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Analysis and Prognosis, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Public Health and Medicine, Red Cross University College, Stockholm, Sweden
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2281
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George MF, Holingue CB, Briggs FBS, Shao X, Bellesis KH, Whitmer RA, Schaefer C, Benedict RH, Barcellos LF. Feasibility study for remote assessment of cognitive function in multiple sclerosis. ACTA ACUST UNITED AC 2016; 1:10-18. [PMID: 28255581 DOI: 10.29245/2572.942x/2016/8.1084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published. OBJECTIVE To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals. METHODS The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized. RESULTS 11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (p<0.001). Cases who did complete testing did not differ in terms of perceived cognitive deficit compared to cases that did participate. More severe disease, smoking, and being male were associated with a lower TICS-M score among cases (p<0.001). The TICS-M score was significantly lower in cases compared to controls (p=0.007). CONCLUSIONS Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.
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Affiliation(s)
- Michaela F George
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Calliope B Holingue
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Farren B S Briggs
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaorong Shao
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | | | - Lisa F Barcellos
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA; Kaiser Permanente Division of Research, Oakland, CA, USA
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2282
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The role of sleep on cognition and functional connectivity in patients with multiple sclerosis. J Neurol 2016; 264:72-80. [PMID: 27778159 PMCID: PMC5225184 DOI: 10.1007/s00415-016-8318-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 11/23/2022]
Abstract
Sleep disturbances are common in multiple sclerosis (MS), but its impact on cognition and functional connectivity (FC) of the hippocampus and thalamus is unknown. Therefore, we investigated the relationship between sleep disturbances, cognitive functioning and resting-state (RS) FC of the hippocampus and thalamus in MS. 71 MS patients and 40 healthy controls underwent neuropsychological testing and filled out self-report questionnaires (anxiety, depression, fatigue, and subjective cognitive problems). Sleep disturbances were assed with the five-item version of the Athens Insomnia Scale. Hippocampal and thalamic volume and RS FC of these regions were determined. Twenty-three patients were categorized as sleep disturbed and 48 as normal sleeping. No differences were found between disturbed and normal sleeping patients concerning cognition and structural MRI. Sleep disturbed patients reported more subjective cognitive problems, and displayed decreased FC between the thalamus and middle and superior frontal gyrus, inferior frontal operculum, anterior cingulate cortex, inferior parietal gyrus, precuneus, and angular gyrus compared to normal sleeping patients. We conclude that sleep disturbances in MS are not (directly) related to objective cognitive functioning, but rather to subjective cognitive problems. In addition, sleep disturbances in MS seem to coincide with a specific pattern of decreased thalamic FC.
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2283
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Coclitu C, Constantinescu CS, Tanasescu R. The future of multiple sclerosis treatments. Expert Rev Neurother 2016; 16:1341-1356. [DOI: 10.1080/14737175.2016.1243056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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2284
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Wickström A, Fagerström M, Wickström L, Granåsen G, Dahle C, Vrethem M, Sundström P. The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis. Mult Scler 2016; 23:1137-1147. [DOI: 10.1177/1352458516671818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability. Objectives: To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations. Methods: Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years. Results: The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population ( p < 0.001). The employees in the northern population had significantly lower requirements, greater adapted work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population ( p = 0.042). Conclusion: Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.
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Affiliation(s)
- Anne Wickström
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Maria Fagerström
- Department of Rehabilitation and Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lucas Wickström
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Charlotte Dahle
- Department of Neurology, Linköping University, Linköping, Sweden/Department of Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden/Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Vrethem
- Department of Neurology, Linköping University, Linköping, Sweden/Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden/Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Peter Sundström
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
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2285
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2286
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Sater RA, Gudesblatt M, Kresa-Reahl K, Brandes DW, Sater P. NAPS-MS: Natalizumab Effects on Parameters of Sleep in Patients with Multiple Sclerosis. Int J MS Care 2016; 18:177-82. [PMID: 27551242 DOI: 10.7224/1537-2073.2015-033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) have higher rates of fatigue, mood disturbance, and cognitive impairments than healthy populations. Disease-modifying agents may affect sleep. Although patients taking natalizumab often show improvement in fatigue during the first year of therapy, the mechanism behind this effect is unknown. The aim of the NAPS-MS study was to investigate whether natalizumab affected objective measures of sleep as determined by polysomnography (PSG) and multiple sleep latency testing (MSLT) in patients with MS with fatigue or sleepiness initiating therapy. Additional goals were to evaluate changes in measures of fatigue, mood, and cognition and to correlate these measures with objective sleep measures. METHODS Patients underwent PSG and MSLT before their first natalizumab infusion and after their seventh. Patients completed the Modified Fatigue Impact Scale, Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and visual analogue scale for fatigue (VAS-F) at their first, fourth, and seventh natalizumab infusions. NeuroTrax cognitive tests and the Hospital Anxiety and Depression Scale (HADS) were performed at the first and seventh natalizumab infusions. RESULTS Changes in sleep efficiency, wakefulness after sleep onset, and multiple sleep latency from baseline to 6 months of therapy did not reach significance. The FSS, VAS-F, ESS, and HADS scores were significantly improved after 6 months of therapy; cognitive scores were not significantly improved. CONCLUSIONS Although treatment with natalizumab was associated with improvements in fatigue, sleepiness, and mood, changes in objective measures of sleep were not significant.
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2287
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Lim ZW, Elwood E, Naveed H, Galea I. Lymphopenia in treatment-naive relapsing multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e275. [PMID: 27559542 PMCID: PMC4982853 DOI: 10.1212/nxi.0000000000000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 07/11/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Zhi Wei Lim
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Elliot Elwood
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Hammad Naveed
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, UK
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2288
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Hutchinson M. Integrated multidisciplinary clinics should be the gold standard in managing progressive MS – Commentary. Mult Scler 2016; 22:1130-1. [DOI: 10.1177/1352458516650527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Hutchinson
- St Vincent’s University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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2289
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Seebacher B, Kuisma R, Glynn A, Berger T. The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial. Mult Scler 2016; 23:286-296. [PMID: 27055804 DOI: 10.1177/1352458516644058] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motor imagery and rhythmic auditory stimulation are physiotherapy strategies for walking rehabilitation. OBJECTIVES To investigate the effect of motor imagery combined with rhythmic cueing on walking, fatigue and quality of life (QoL) in people with multiple sclerosis (MS). METHODS Individuals with MS and Expanded Disability Status Scale scores of 1.5-4.5 were randomised into one of three groups: 17 minutes of motor imagery, six times per week, for 4 weeks, with music (A) or metronome cues (B), both with verbal cueing, and (C) controls. Primary outcomes were walking speed (Timed 25-Foot Walk) and distance (6-Minute Walk Test). Secondary outcomes were walking perception (Multiple Sclerosis Walking Scale-12), fatigue (Modified Fatigue Impact Scale) and QoL (Short Form-36 Health Survey, Multiple Sclerosis Impact Scale-29, Euroquol-5D-3L Questionnaire). RESULTS Of the 112 participants randomised, 101 completed the study. Compared to controls, both interventions significantly improved walking speed, distance and perception. Significant improvements in cognitive but not psychosocial fatigue were seen in the intervention groups, and physical fatigue improved only in the music-based group. Both interventions improved QoL; however, music-cued motor imagery was superior at improving health-related QoL. CONCLUSION Rhythmic-cued motor imagery improves walking, fatigue and QoL in people with MS, with music-cued motor imagery being more effective.
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Affiliation(s)
| | - Raija Kuisma
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Angela Glynn
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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2290
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Linker RA, Haghikia A. Dimethyl fumarate in multiple sclerosis: latest developments, evidence and place in therapy. Ther Adv Chronic Dis 2016; 7:198-207. [PMID: 27433310 DOI: 10.1177/2040622316653307] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dimethyl fumarate (DMF) is one of the newer additions to the armamentarium of potent immunomodulators for the treatment of relapsing-remitting multiple sclerosis (RRMS). After more than 2 years of real-world experience and more than 190,000 patients currently treated with DMF worldwide, it is a good timepoint to review the experience gathered so far and to re-evaluate the potential of this first-line oral multiple sclerosis (MS) drug. Post-hoc analyses of clinical and magnetic resonance imaging (MRI) data, some comprising more than 6 years of drug exposure including patients from the clinical trials, and the overall notion in clinical practice widely confirm the good efficacy of DMF in RRMS. Despite an overall good safety profile, it became also clear that the necessary clinical vigilance while using DMF may not be neglected. So far, four reported cases of progressive multifocal leukoencephalopathy (PML), a towering shadow over many MS therapies, warrant proper attention in newly-updated risk management plans. This review recapitulates efficacy and safety aspects of DMF therapy in relation to reported data from the pivotal clinical trials. In addition, we summarize recent insights into DMF mechanisms of action drawn from the field of basic research which may have important implications for clinical practice.
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Affiliation(s)
- Ralf A Linker
- Department of Neurology, Friedrich-Alexander-University Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Aiden Haghikia
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, Germany
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2291
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Klaren RE, Sebastiao E, Chiu CY, Kinnett-Hopkins D, McAuley E, Motl RW. Levels and Rates of Physical Activity in Older Adults with Multiple Sclerosis. Aging Dis 2016; 7:278-84. [PMID: 27330842 PMCID: PMC4898924 DOI: 10.14336/ad.2015.1025] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/25/2015] [Indexed: 11/01/2022] Open
Abstract
There is much evidence supporting the safety and benefits of physical activity in adults with multiple sclerosis (MS) and recent evidence of beneficial effects on physical function in older adults with MS. However, there is very little known about physical activity participation in older adults with conditions such as MS. This study compared levels of physical activity (i.e., sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) and rates of meeting public health guidelines for MVPA (i.e., ≥30 min/day) among young (i.e., ages 20-39 years), middle-aged (i.e., ages 40-59 years) and older adults (i.e., ages ≥60 years) with MS. The sample included 963 persons with MS who provided demographic and clinical information and wore an accelerometer for a 7-day period. The primary analysis involved a between-subjects ANOVA on accelerometer variables (i.e., accelerometer wear time; number of valid days; sedentary behavior in min/day; LPA in min/day; and MVPA in min/day). Collectively, our data indicated that older adults with MS engaged in less MVPA and more sedentary behavior than middle-aged and young adults with MS. Such results highlight the importance of developing physical activity interventions as an effective means for managing the progression and consequences of MS in older adults.
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Affiliation(s)
- Rachel E Klaren
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Emerson Sebastiao
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Chung-Yi Chiu
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | | | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Robert W Motl
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
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2292
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Papeix C, Lubetzki C. Integrated multidisciplinary clinics should be the gold standard in managing progressive MS - NO. Mult Scler 2016; 22:1128-30. [PMID: 27225675 DOI: 10.1177/1352458516643397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Caroline Papeix
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Lubetzki
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France/Sorbonne Universités, UPMC, Paris, France
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2293
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Zurawski J, Flinn A, Sklover L, Sloane JA. Relapse frequency in transitioning from natalizumab to dimethyl fumarate: assessment of risk factors. J Neurol 2016; 263:1511-7. [PMID: 27193310 DOI: 10.1007/s00415-016-8162-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 02/04/2023]
Abstract
Risk of relapse after natalizumab (NAT) cessation and switch to dimethyl fumarate (DMF) is unknown. The objective of this paper is to identify the risk and associated risk factors for relapse after switching from NAT to DMF in relapsing-remitting multiple sclerosis. Patients (n = 30) were treated with NAT for ≥12 months and then switched to DMF in a mean of 50 days. Patient age, annualized relapse rates (ARR), Expanded Disability Status Scale scores (EDSS), and lymphocyte counts were assessed. Overall, eight patients (27 %) had relapses after switching to DMF. Five patients (17 %) suffered severe relapses with multifocal clinical and radiological findings. New lesions by MRI (T2 hyperintense or enhancing) were observed in 35 % of patients. Relapses occurred at a mean of 3.5 months after NAT cessation. Patient age and elevated ARR prior to NAT use were significantly associated with risk of relapse after switch to DMF. Once on DMF for 4 months prior to relapse, lymphocyte count decreased more significantly in patients without relapses than those with relapses. Switching from NAT to DMF correlated with increased relapses. Young patient age, high ARR and stability of lymphocyte counts were risk factors for relapse after transition from NAT to DMF.
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Affiliation(s)
- Jonathan Zurawski
- Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Ashley Flinn
- Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Lindsay Sklover
- Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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2294
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Binder MD, Fox AD, Merlo D, Johnson LJ, Giuffrida L, Calvert SE, Akkermann R, Ma GZM, Perera AA, Gresle MM, Laverick L, Foo G, Fabis-Pedrini MJ, Spelman T, Jordan MA, Baxter AG, Foote S, Butzkueven H, Kilpatrick TJ, Field J. Common and Low Frequency Variants in MERTK Are Independently Associated with Multiple Sclerosis Susceptibility with Discordant Association Dependent upon HLA-DRB1*15:01 Status. PLoS Genet 2016; 12:e1005853. [PMID: 26990204 PMCID: PMC4798184 DOI: 10.1371/journal.pgen.1005853] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/18/2016] [Indexed: 01/31/2023] Open
Abstract
Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. The risk of developing MS is strongly influenced by genetic predisposition, and over 100 loci have been established as associated with susceptibility. However, the biologically relevant variants underlying disease risk have not been defined for the vast majority of these loci, limiting the power of these genetic studies to define new avenues of research for the development of MS therapeutics. It is therefore crucial that candidate MS susceptibility loci are carefully investigated to identify the biological mechanism linking genetic polymorphism at a given gene to the increased chance of developing MS. MERTK has been established as an MS susceptibility gene and is part of a family of receptor tyrosine kinases known to be involved in the pathogenesis of demyelinating disease. In this study we have refined the association of MERTK with MS risk to independent signals from both common and low frequency variants. One of the associated variants was also found to be linked with increased expression of MERTK in monocytes and higher expression of MERTK was associated with either increased or decreased risk of developing MS, dependent upon HLA-DRB1*15:01 status. This discordant association potentially extended beyond MS susceptibility to alterations in disease course in established MS. This study provides clear evidence that distinct polymorphisms within MERTK are associated with MS susceptibility, one of which has the potential to alter MERTK transcription, which in turn can alter both susceptibility and disease course in MS patients. Multiple sclerosis (MS) is the most common neurological disease of young Caucasian adults. Oligodendrocytes are the key cell type damaged in MS, a process that is accompanied by loss of the myelin sheath that these cells produce, resulting in demyelination and ultimately in secondary damage to nerve cells. Susceptibility to MS is strongly influenced by genes, and over 100 genes have now been linked with the risk of developing MS. However, surprisingly little is known about the biological mechanism by which any one of these genes increases the probability of developing MS. In this study we have explored in detail the links between one known MS risk gene, MERTK, and MS susceptibility. We found that a number of different alterations in the MERTK gene are independently associated with the risk of developing MS. One these changes was also linked with changes in the level of expression of MERTK in monocytes, an immune cell type known to be involved in the etiology of MS. In an unexpected result, we found this expression-linked alteration in MERTK was either protective or risk-associated, depending on the genotype of the individual at another well known MS risk gene known as HLA-DRB1. In addition, we found that not only were alterations in MERTK associated with MS susceptibility, but potentially with ongoing disease course, indicating that MERTK may be a good target for the development of novel MS therapeutics.
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Affiliation(s)
- Michele D. Binder
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - Andrew D. Fox
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Bioinformatics Core, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Daniel Merlo
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Laura J. Johnson
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Lauren Giuffrida
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah E. Calvert
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Rainer Akkermann
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Gerry Z. M. Ma
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | | | - Ashwyn A. Perera
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Melissa M. Gresle
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Laverick
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Grace Foo
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | | | - Timothy Spelman
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Margaret A. Jordan
- Comparative Genomics Centre, James Cook University, Townsville, Queensland, Australia
| | - Alan G. Baxter
- Comparative Genomics Centre, James Cook University, Townsville, Queensland, Australia
| | - Simon Foote
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Trevor J. Kilpatrick
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Judith Field
- Multiple Sclerosis Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
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2295
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Prosperini L, Pontecorvo S. Dimethyl fumarate in the management of multiple sclerosis: appropriate patient selection and special considerations. Ther Clin Risk Manag 2016; 12:339-50. [PMID: 27042079 PMCID: PMC4780395 DOI: 10.2147/tcrm.s85099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Delayed-release dimethyl fumarate (DMF), also known as gastroresistant DMF, is the most recently approved oral disease-modifying treatment (DMT) for relapsing multiple sclerosis. Two randomized clinical trials (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing-Remitting MS [DEFINE] and Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis [CONFIRM]) demonstrated significant efficacy in reducing relapse rate and radiological signs of disease activity, as seen on magnetic resonance imaging. The DEFINE study also indicated a significant effect of DMF on disability worsening, while the low incidence of confirmed disability worsening in the CONFIRM trial rendered an insignificant reduction among the DMF-treated groups when compared to placebo. DMF also demonstrated a good safety profile and acceptable tolerability, since the most common side effects (gastrointestinal events and flushing reactions) are usually transient and mild to moderate in severity. Here, we discuss the place in therapy of DMF for individuals with relapsing multiple sclerosis, providing a tentative therapeutic algorithm to manage newly diagnosed patients and those who do not adequately respond to self-injectable DMTs. Literature data supporting the potential role of DMF as a first-line therapy are presented. The possibility of using DMF as switching treatment or even as an add-on strategy in patients with breakthrough disease despite self-injectable DMTs will also be discussed. Lastly, we argue about the role of DMF as an exit strategy from natalizumab-treated patients who are considered at risk for developing multifocal progressive leukoencephalopathy.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Simona Pontecorvo
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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2296
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Ziemssen T, Derfuss T, de Stefano N, Giovannoni G, Palavra F, Tomic D, Vollmer T, Schippling S. Optimizing treatment success in multiple sclerosis. J Neurol 2015; 263:1053-65. [PMID: 26705122 PMCID: PMC4893374 DOI: 10.1007/s00415-015-7986-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/25/2015] [Indexed: 01/01/2023]
Abstract
Despite important advances in the treatment of multiple sclerosis (MS) over recent years, the introduction of several disease-modifying therapies (DMTs), the burden of progressive disability and premature mortality associated with the condition remains substantial. This burden, together with the high healthcare and societal costs associated with MS, creates a compelling case for early treatment optimization with highly efficacious therapies. Often, patients receive several first-line therapies, while more recent and in part more effective treatments are still being introduced only after these have failed. However, with the availability of highly efficacious therapies, a novel treatment strategy has emerged, where the aim is to achieve no evidence of disease activity (NEDA). Achieving NEDA necessitates regular monitoring of relapses, disability and functionality. However, there is only a poor correlation between conventional magnetic resonance imaging measures like T2 hyperintense lesion burden and the level of clinical disability. Hence, MRI-based measures of brain atrophy have emerged in recent years potentially reflecting the magnitude of MS-related neuroaxonal damage. Currently available DMTs differ markedly in their effects on brain atrophy: some, such as fingolimod, have been shown to significantly slow brain volume loss, compared to placebo, whereas others have shown either no, inconsistent, or delayed effects. In addition to regular monitoring, treatment optimization also requires early intervention with efficacious therapies, because accumulating evidence shows that effective intervention during a limited period early in the course of MS is critical for maintaining neurological function and preventing subsequent disability. Together, the advent of new MS therapies and evolving management strategies offer exciting new opportunities to optimize treatment outcomes.
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Affiliation(s)
- Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Tobias Derfuss
- MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gavin Giovannoni
- Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Filipe Palavra
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Tim Vollmer
- University of Colorado Health Sciences Center, Aurora, CO, USA
| | - Sven Schippling
- Department of Neurology, Neuroimmunology and Multiple Sclerosis Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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2297
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Motl RW, Learmonth YC, Wójcicki TR, Fanning J, Hubbard EA, Kinnett-Hopkins D, Roberts SA, McAuley E. Preliminary validation of the short physical performance battery in older adults with multiple sclerosis: secondary data analysis. BMC Geriatr 2015; 15:157. [PMID: 26630923 PMCID: PMC4668658 DOI: 10.1186/s12877-015-0156-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/23/2015] [Indexed: 01/02/2024] Open
Abstract
Background There are relatively few standard, objective measures for studying physical function among older adults with multiple sclerosis (MS), yet such measures are necessary considering the shift in prevalence and associated consequences of both MS and older age on physical function. We undertook a preliminary examination of the construct validity of Short Physical Performance Battery (SPPB) scores in older adults with MS based on an expected differential pattern of associations with measures of lower and upper extremity function. Methods The sample included 48 persons with MS aged 50 years and older who were enrolled in a pilot, randomized controlled trial of exercise training. Participants completed the SPPB and other objective and self-report measures of lower and upper extremity function as part of baseline testing. Results SPPB scores demonstrated strong associations with measures of lower extremity function (|rs| = .66–.79), and weak associations with measures of upper extremity function (|rs| = .03–.33). Conclusions We provide preliminary evidence that supports the validity of scores from the SPPB as a measure of lower extremity function for inclusion in clinical research and practice involving older adults with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Yvonne C Learmonth
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Thomas R Wójcicki
- Exercise Science Department, Bellarmine University, Louisville, Kentucky, USA.
| | - Jason Fanning
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Elizabeth A Hubbard
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Dominique Kinnett-Hopkins
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Sarah A Roberts
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
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2298
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Longbrake EE, Ramsbottom MJ, Cantoni C, Ghezzi L, Cross AH, Piccio L. Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients. Mult Scler 2015; 22:1061-1070. [PMID: 26459150 DOI: 10.1177/1352458515608961] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) alters the phenotype of circulating immune cells and causes lymphopenia in a subpopulation of treated multiple sclerosis (MS) patients. OBJECTIVE To phenotypically characterize circulating leukocytes in DMF-treated MS patients. METHODS Cross-sectional observational comparisons of peripheral blood from DMF-treated MS patients (n = 17 lymphopenic and n = 24 non-lymphopenic), untreated MS patients (n = 17) and healthy controls (n = 23); immunophenotyped using flow cytometry. Longitudinal samples were analyzed for 13 DMF-treated patients. RESULTS Lymphopenic DMF-treated patients had significantly fewer circulating CD8(+) and CD4(+) T cells, CD56(dim) natural killer (NK) cells, CD19(+) B cells and plasmacytoid dendritic cells when compared to controls. CXCR3(+) and CCR6(+) expression was disproportionately reduced among CD4(+) T cells, while the proportion of T-regulatory (T-reg) cells was unchanged. DMF did not affect circulating CD56(hi) NKcells, monocytes or myeloid dendritic cells. Whether lymphopenic or not, DMF-treated patients had a lower proportion of circulating central and effector memory T cells and concomitant expansion of naïve T cells compared to the controls. CONCLUSIONS DMF shifts the immunophenotypes of circulating T cells, causing a reduction of memory cells and a relative expansion of naïve cells, regardless of the absolute lymphocyte count. This may represent one mechanism of action of the drug. Lymphopenic patients had a disproportionate loss of CD8(+) T-cells, which may affect their immunocompetence.
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Affiliation(s)
- E E Longbrake
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - M J Ramsbottom
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - C Cantoni
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - L Ghezzi
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri.,Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - A H Cross
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - L Piccio
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
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2299
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Wang M, Björkenstam C, Alexanderson K, Runeson B, Tinghög P, Mittendorfer-Rutz E. Trajectories of Work-Related Functional Impairment prior to Suicide. PLoS One 2015; 10:e0139937. [PMID: 26444997 PMCID: PMC4596705 DOI: 10.1371/journal.pone.0139937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Work-related functional impairment in terms of sickness absence and disability pension (SA/DP) has been reported to be associated with subsequent suicide. However, there is only limited knowledge on SA/DP patterns prior to suicide. The aim was to identify trajectories of work-related functional impairment prior to suicide and to describe associations of socio-demographic and medical factors with such trajectories. Methods This is a population-based retrospective cohort study of the 4 209 individuals aged 22–65 years who committed suicide during 2007–2010 in Sweden. Work-related functional impairment was measured as mean annual number of months of SA/DP. We analyzed trajectories of SA/DP during five years prior to suicide (i.e., 2002–2009) by a group-based trajectory method. Associations between socio-demographic and medical factors with different groups of trajectories were estimated by chi2-test and multinomial logistic regression. Results Five different functional impairment trajectory groups were identified prior to suicide. One group had constant low levels of SA/DP (46%), while 30% had constant high levels of SA/DP. Two groups (16%) showed increasing number of SA/DP months. The remaining 7% showed decreasing number of SA/DP months before the suicide. Sex, age, educational level, family situation, and diagnosis-specific healthcare were significantly associated with different trajectory groups (Likelihood ratio X2 tests <0.05). A larger proportion of higher educated and younger men with a lower proportion of previous suicide attempts were found in the group with constant low levels. Opposite characteristics were displayed in the group with constant high levels. Conclusions This study identified five different groups of work-related functional impairment trajectories before suicide. These differences might be partly explained by the variations in socio-demographic profiles and health care consumptions five years before suicide.
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Affiliation(s)
- Mo Wang
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Charlotte Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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2300
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Dorr M, Wille M, Viulet T, Sanchez E, Bex PJ, Lu ZL, Lesmes L. Next-generation vision testing: the quick CSF. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2015. [DOI: 10.1515/cdbme-2015-0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe Contrast Sensitivity Function relates the spatial frequency and contrast of a spatial pattern to its visibility and thus provides a fundamental description of visual function. However, the current clinical standard of care typically restricts assessment to visual acuity, i.e. the smallest stimulus size that can be resolved at full contrast; alternatively, tests of contrast sensitivity are typically restricted to assessment of the lowest visible contrast for a fixed letter size. This restriction to one-dimensional subspaces of a two-dimensional space was necessary when stimuli were printed on paper charts and simple scoring rules were applied manually. More recently, however, computerized testing and electronic screens have enabled more flexible stimulus displays and more complex test algorithms. For example, the quick CSF method uses a Bayesian adaptive procedure and an information maximization criterion to select only informative stimuli; testing times to precisely estimate the whole contrast sensitivity function are reduced to 2-5 minutes. Here, we describe the implementation of the quick CSF method in a medical device. We make several usability enhancements to make it suitable for use in clinical settings. A first usability study shows excellent results, with a mean System Usability Scale score of 86.5.
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Affiliation(s)
- Michael Dorr
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Manuel Wille
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Tiberiu Viulet
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Edward Sanchez
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Peter J Bex
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Zhong-Lin Lu
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Luis Lesmes
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
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