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Abstract
PURPOSE OF REVIEW Clinical MRI is of paramount importance for multiple sclerosis diagnosis but lacks the specificity to investigate the pathogenic mechanisms underlying disease onset and progression. The application of advanced MR sequences allows the characterization of diverse and complex pathological mechanisms, granting insights into multiple sclerosis natural history and response to treatment. RECENT FINDINGS This review provides an update on the most recent international guidelines for optimal standard imaging of multiple sclerosis and discusses advantages and limitations of advanced imaging approaches for investigating inflammation, demyelination and neurodegeneration. An overview is provided for methods devoted to imaging leptomeningeal enhancement, microglial activation, demyelination, neuronal metabolic damage and neuronal loss. SUMMARY The application of magnetic resonance (MR) guidelines to standard-of-care MR protocols, although still limited, would substantially contribute to the optimization of multiple sclerosis management. From an academic perspective, different mechanism-specific imaging techniques are available and offer a powerful tool to elucidate multiple sclerosis pathogenesis, monitor disease progression and guide therapeutic choices.
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202
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Abstract
Purpose of review Neuromyelitis optica spectrum disorders (NMOSD) are severe inflammatory diseases of the central nervous system (CNS), with the presence of aquaporin 4 (AQP4)-specific serum antibodies in the vast majority of patients, and with the presence of myelin oligodendrocyte glycoprotein (MOG)-specific antibodies in approximately 40% of all AQP4-antibody negative NMOSD patients. Despite differences in antigen recognition, the preferred sites of lesions are similar in both groups of patients: They localize to the spinal cord and to the anterior visual pathway including retina, optic nerves, chiasm, and optic tracts, and – to lesser extent – also to certain predilection sites in the brain. Recent findings The involvement of T cells in the formation of NMOSD lesions has been challenged for quite some time. However, several recent findings demonstrate the key role of T cells for lesion formation and localization. Studies on the evolution of lesions in the spinal cord of NMOSD patients revealed a striking similarity of early NMOSD lesions with those observed in corresponding T-cell-induced animal models, both in lesion formation and in lesion localization. Studies on retinal abnormalities in NMOSD patients and corresponding animals revealed the importance of T cells for the very early stages of retinal lesions which eventually culminate in damage to Müller cells and to the retinal nerve fiber layer. Finally, a study on cerebrospinal fluid (CSF) barrier pathology demonstrated that NMOSD immunopathology extends beyond perivascular astrocytic foot processes to include the pia, the ependyma, and the choroid plexus, and that diffusion of antibodies from the CSF could further influence lesion formation in NMOSD patients. Summary The pathological changes observed in AQP4-antibody positive and MOG-antibody positive NMOSD patients are strikingly similar to those found in corresponding animal models, and many mechanisms which determine lesion localization in experimental animals seem to closely reflect the human situation.
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203
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Wang Q, Wang J, Yang Z, Sui R, Miao Q, Li Y, Yu J, Liu C, Zhang G, Xiao B, Ma C. Therapeutic effect of oligomeric proanthocyanidin in cuprizone-induced demyelination. Exp Physiol 2019; 104:876-886. [PMID: 30811744 DOI: 10.1113/ep087480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Oligomeric proanthocyanidin has the capacity to alleviate abnormalities in neurological functioning. However, whether oligomeric proanthocyanidin can reduce the progression of demyelination or promote remyelination in demyelinating diseases remains unknown. What is the main finding and its importance? Oligomeric proanthocyanidin can improve cuprizone-induced demyelination by inhibiting immune cell infiltration, reversing overactivated microglia, decreasing the inflammatory cytokines secreted by inflammatory cells and decreasing the production of myelin oligodendrocyte glycoprotein35-55 -specific antibody in the brain. ABSTRACT Demyelinating diseases of the CNS, including multiple sclerosis, neuromyelitis optica and acute disseminated encephalomylitis, are characterized by recurrent primary demyelination-remyelination and progressive neurodegeneration. In the present study, we investigated the therapeutic effect of oligomeric proanthocyanidin (OPC), the most effective component of grape seed extract, in cuprizone-fed C57BL/6 mice, a classic demyelination-remyelination model. Our results showed that OPC attenuated abnormal behaviour, reduced demyelination and increased expression of myelin basic protein and expression of O4+ oligodendrocytes in the corpus callosum. Oligomeric proanthocyanidin also reduced the numbers of B and T cells, activated microglia in the corpus callosum and inhibited secretion of inflammatory factors. Furthermore, concentrations of myelin oligodendrocyte glycoprotein-specific antibodies were significantly reduced in serum and brain homogenates after OPC treatment. Together, these results demonstrate a potent therapeutic effect for OPC in cuprizone-mediated demyelination and clearly highlight multiple effects of this natural product in attenuating myelin-specific autoantibodies and the inflammatory microenvironment in the brain.
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Affiliation(s)
- Qing Wang
- The Key Research Laboratory Study of Beneficial Qi as a Blood Circulation Stimulator in the Treatment of Multiple Sclerosis, State Administration of Traditional Chinese Medicine, Shanxi University of Chinese Medicine, Jinzhong, 030619, China
| | - Jing Wang
- Department of Neurology, First Affiliated Hospital, Shanxi Medical University, Taiyuan, 030001, China
| | - Zhichao Yang
- The Key Research Laboratory Study of Beneficial Qi as a Blood Circulation Stimulator in the Treatment of Multiple Sclerosis, State Administration of Traditional Chinese Medicine, Shanxi University of Chinese Medicine, Jinzhong, 030619, China
| | - Ruoxuan Sui
- The Key Research Laboratory Study of Beneficial Qi as a Blood Circulation Stimulator in the Treatment of Multiple Sclerosis, State Administration of Traditional Chinese Medicine, Shanxi University of Chinese Medicine, Jinzhong, 030619, China
| | - Qiang Miao
- The Key Research Laboratory Study of Beneficial Qi as a Blood Circulation Stimulator in the Treatment of Multiple Sclerosis, State Administration of Traditional Chinese Medicine, Shanxi University of Chinese Medicine, Jinzhong, 030619, China
| | - Yanhua Li
- Institute of Brain Science, Shanxi Key Laboratory of Inflammatory Neurodegenerative Diseases, Shanxi Datong University,, Datong, 037009, China
| | - Jiezhong Yu
- Institute of Brain Science, Shanxi Key Laboratory of Inflammatory Neurodegenerative Diseases, Shanxi Datong University,, Datong, 037009, China
| | - Chunyun Liu
- Institute of Brain Science, Shanxi Key Laboratory of Inflammatory Neurodegenerative Diseases, Shanxi Datong University,, Datong, 037009, China
| | - Guangxian Zhang
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Baoguo Xiao
- Insitute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Fudan University,, Shanghai, 200040, China
| | - Cungen Ma
- The Key Research Laboratory Study of Beneficial Qi as a Blood Circulation Stimulator in the Treatment of Multiple Sclerosis, State Administration of Traditional Chinese Medicine, Shanxi University of Chinese Medicine, Jinzhong, 030619, China.,Department of Neurology, First Affiliated Hospital, Shanxi Medical University, Taiyuan, 030001, China.,Institute of Brain Science, Shanxi Key Laboratory of Inflammatory Neurodegenerative Diseases, Shanxi Datong University,, Datong, 037009, China
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204
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Lazo-Gomez R, Velázquez GDLLG, Mireles-Jacobo D, Sotomayor-Sobrino MA. Mechanisms of neurobehavioral abnormalities in multiple sclerosis: Contributions from neural and immune components. Clin Neurophysiol Pract 2019; 4:39-46. [PMID: 30911699 PMCID: PMC6416523 DOI: 10.1016/j.cnp.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/21/2018] [Accepted: 01/10/2019] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis-related neurobehavioral abnormalities are one of the main components of disability in this disease. The same pathological processes that explain demyelination periods and neurodegeneration also allow the comprehension of neurobehavioral abnormalities. Inflammation in the central nervous system caused by cells of the immune system, especially lymphocytes, and by resident cells, such as astrocytes and microglia, directly modulate neurotransmission and synaptic physiology, resulting in behavioral changes (such as sickness behavior) and amplifying the degenerative mechanisms that occur in multiple sclerosis. In addition, neuronal death caused by glutamate-mediated excitotoxicity, alterations in GABAergic, serotonergic, and dopaminergic neurotransmission, and the mechanisms of axon damage are of foremost importance to explain the reduction in brain volume and the associated cognitive decline. Neuroinflammation and neurodegeneration are not isolated phenomena and various instances of interaction between them have been described. This presents attractive targets for the development of therapeutic strategies for this neglected component of multiple sclerosis related disability.
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Affiliation(s)
- Rafael Lazo-Gomez
- Neuroscience franchise, Novartis Pharma México, Calzada de Tlalpan 1779, San Diego Churubusco, 04120 Coyoacán, CDMX, Mexico
| | | | - Diego Mireles-Jacobo
- Neuroscience franchise, Novartis Pharma México, Calzada de Tlalpan 1779, San Diego Churubusco, 04120 Coyoacán, CDMX, Mexico
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205
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Moderating effects of crocin on some stress oxidative markers in rat brain following demyelination with ethidium bromide. Heliyon 2019; 5:e01213. [PMID: 30815598 PMCID: PMC6378371 DOI: 10.1016/j.heliyon.2019.e01213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/22/2018] [Accepted: 02/01/2019] [Indexed: 12/27/2022] Open
Abstract
Background The purpose of this study was to investigate the effects of Crocin on oxidative markers (GPx, SOD, MDA) in animal model of demyelination with Ethidium bromide (EB). Methods Female Wistar rats were assigned in to 4 groups; Sham, with no receiving any agent (Sham), Sham Operated group with injection of EB into the brain received no agent (SO), Sham Treatment group with injection of EB and receiving PBS as vehicle and Treatment group with injection of EB and receiving Crocin (100 mg/kg). Demyelination was induced by single dose injection of 10 μl of EB 0.1% into the Cisterna magna of the brain. Crocin was diluted and applied to each animal for 21 days, once per day gavage. The levels of oxidative markers (GPx, SOD and MDA) were measured by related standard kits. Data were analyzed by paired t-test and ANOVA with post hoc test. Results The results showed that crocin decreases the levels of GPx and SOD significantly as well as MDA level after 21 days (α ≤ 0.05). In addition, results showed that there were significant differences in the GPx, SOD and MDA levels between all groups at post treatment phase (α ≤ 0.05). Conclusion It can be concluded that crocin can moderate the level of oxidative markers after demyelination of the brain cells in MS cases. Due to this effect, crocin can be considered as an effective anti-oxidant in management of degenerative nervous system diseases.
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206
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Huhn K, Engelhorn T, Linker RA, Nagel AM. Potential of Sodium MRI as a Biomarker for Neurodegeneration and Neuroinflammation in Multiple Sclerosis. Front Neurol 2019; 10:84. [PMID: 30804885 PMCID: PMC6378293 DOI: 10.3389/fneur.2019.00084] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/22/2019] [Indexed: 01/18/2023] Open
Abstract
In multiple sclerosis (MS), experimental and ex vivo studies indicate that pathologic intra- and extracellular sodium accumulation may play a pivotal role in inflammatory as well as neurodegenerative processes. Yet, in vivo assessment of sodium in the microenvironment is hard to achieve. Here, sodium magnetic resonance imaging (23NaMRI) with its non-invasive properties offers a unique opportunity to further elucidate the effects of sodium disequilibrium in MS pathology in vivo in addition to regular proton based MRI. However, unfavorable physical properties and low in vivo concentrations of sodium ions resulting in low signal-to-noise-ratio (SNR) as well as low spatial resolution resulting in partial volume effects limited the application of 23NaMRI. With the recent advent of high-field MRI scanners and more sophisticated sodium MRI acquisition techniques enabling better resolution and higher SNR, 23NaMRI revived. These studies revealed pathologic total sodium concentrations in MS brains now even allowing for the (partial) differentiation of intra- and extracellular sodium accumulation. Within this review we (1) demonstrate the physical basis and imaging techniques of 23NaMRI and (2) analyze the present and future clinical application of 23NaMRI focusing on the field of MS thus highlighting its potential as biomarker for neuroinflammation and -degeneration.
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Affiliation(s)
- Konstantin Huhn
- Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Armin M Nagel
- Department of Radiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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207
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Ciccarelli O, Cohen JA, Reingold SC, Weinshenker BG, Amato MP, Banwell B, Barkhof F, Bebo B, Becher B, Bethoux F, Brandt A, Brownlee W, Calabresi P, Chatway J, Chien C, Chitnis T, Ciccarelli O, Cohen J, Comi G, Correale J, De Sèze J, De Stefano N, Fazekas F, Flanagan E, Freedman M, Fujihara K, Galetta S, Goldman M, Greenberg B, Hartung HP, Hemmer B, Henning A, Izbudak I, Kappos L, Lassmann H, Laule C, Levy M, Lublin F, Lucchinetti C, Lukas C, Marrie RA, Miller A, Miller D, Montalban X, Mowry E, Ourselin S, Paul F, Pelletier D, Ranjeva JP, Reich D, Reingold S, Rocca MA, Rovira A, Schlaerger R, Soelberg Sorensen P, Sormani M, Stuve O, Thompson A, Tintoré M, Traboulsee A, Trapp B, Trojano M, Uitdehaag B, Vukusic S, Waubant E, Weinshenker B, Wheeler-Kingshott CG, Xu J. Spinal cord involvement in multiple sclerosis and neuromyelitis optica spectrum disorders. Lancet Neurol 2019; 18:185-197. [DOI: 10.1016/s1474-4422(18)30460-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 12/13/2022]
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208
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Ohno N, Ikenaka K. Axonal and neuronal degeneration in myelin diseases. Neurosci Res 2019; 139:48-57. [DOI: 10.1016/j.neures.2018.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 12/14/2022]
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209
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Stone S, Yue Y, Stanojlovic M, Wu S, Karsenty G, Lin W. Neuron-specific PERK inactivation exacerbates neurodegeneration during experimental autoimmune encephalomyelitis. JCI Insight 2019; 4:124232. [PMID: 30674717 DOI: 10.1172/jci.insight.124232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), are chronic inflammatory demyelinating and neurodegenerative diseases of the CNS. Although neurodegeneration is the major contributor to chronic disability in MS, mechanisms governing the viability of axons and neurons in MS and EAE remain elusive. Data indicate that activation of pancreatic endoplasmic reticulum kinase (PERK) influences, positively or negatively, neuron and axon viability in various neurodegenerative diseases through induction of ATF4. In this study, we demonstrate that the PERK pathway was activated in neurons during EAE. We found that neuron-specific PERK inactivation impaired EAE resolution and exacerbated EAE-induced axon degeneration, neuron loss, and demyelination. Surprisingly, neuron-specific ATF4 inactivation did not alter EAE disease course or EAE-induced axon degeneration, neuron loss, and demyelination. These results suggest that PERK activation in neurons protects axons and neurons against inflammation in MS and EAE through ATF4-independent mechanisms.
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Affiliation(s)
- Sarrabeth Stone
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yuan Yue
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Milos Stanojlovic
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shuangchan Wu
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gerard Karsenty
- Department of Genetics and Development, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Wensheng Lin
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
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210
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Lassmann H. Pathogenic Mechanisms Associated With Different Clinical Courses of Multiple Sclerosis. Front Immunol 2019; 9:3116. [PMID: 30687321 PMCID: PMC6335289 DOI: 10.3389/fimmu.2018.03116] [Citation(s) in RCA: 364] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/17/2018] [Indexed: 01/02/2023] Open
Abstract
In the majority of patients multiple sclerosis starts with a relapsing remitting course (RRMS), which may at later times transform into secondary progressive disease (SPMS). In a minority of patients the relapsing remitting disease is skipped and the patients show progression from the onset (primary progressive MS, PPMS). Evidence obtained so far indicate major differences between RRMS and progressive MS, but no essential differences between SPMS and PPMS, with the exception of a lower incidence in the global load of focal white matter lesions and in particular in the presence of classical active plaques in PPMS. We suggest that in MS patients two types of inflammation occur, which develop in parallel but partially independent from each other. The first is the focal bulk invasion of T- and B-lymphocytes with profound blood brain barrier leakage, which predominately affects the white matter, and which gives rise to classical active demyelinated plaques. The other type of inflammation is a slow accumulation of T-cells and B-cells in the absence of major blood brain barrier damage in the connective tissue spaces of the brain, such as the meninges and the large perivascular Virchow Robin spaces, where they may form aggregates or in most severe cases structures in part resembling tertiary lymph follicles. This type of inflammation is associated with the formation of subpial demyelinated lesions in the cerebral and cerebellar cortex, with slow expansion of pre-existing lesions in the white matter and with diffuse neurodegeneration in the normal appearing white or gray matter. The first type of inflammation dominates in acute and relapsing MS. The second type of inflammation is already present in early stages of MS, but gradually increases with disease duration and patient age. It is suggested that CD8+ T-lymphocytes remain in the brain and spinal cord as tissue resident cells, which may focally propagate neuroinflammation, when they re-encounter their cognate antigen. B-lymphocytes may propagate demyelination and neurodegeneration, most likely by producing soluble neurotoxic factors. Whether lymphocytes within the brain tissue of MS lesions have also regulatory functions is presently unknown. Key open questions in MS research are the identification of the target antigen recognized by tissue resident CD8+ T-cells and B-cells and the molecular nature of the soluble inflammatory mediators, which may trigger tissue damage.
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Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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211
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Assessing the burden of vascular risk factors on brain atrophy in multiple sclerosis: A case- control MRI study. Mult Scler Relat Disord 2019; 27:74-78. [DOI: 10.1016/j.msard.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022]
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212
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Elliott C, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Wei W, Belachew S, Arnold DL. Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Mult Scler 2018; 25:1915-1925. [PMID: 30566027 PMCID: PMC6876256 DOI: 10.1177/1352458518814117] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). Objective: To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. Methods: We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. Results: Compared with RMS patients, PPMS patients had higher numbers of SELs (p = 0.002) and higher T2 volumes of SELs (p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. Conclusion: We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS.
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Affiliation(s)
| | - Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Stephen L Hauser
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands/Institutes of Biomedical Engineering and Neurology, University College London (UCL), London, UK
| | | | - Wei Wei
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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213
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Petracca M, Margoni M, Bommarito G, Inglese M. Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques. Neurol Ther 2018; 7:265-285. [PMID: 29956263 PMCID: PMC6283788 DOI: 10.1007/s40120-018-0103-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. In this review, we (1) provide an overview of the pathological features of PMS, (2) summarize the findings of research and clinical trials conducted in PMS which have applied conventional and advanced magnetic resonance imaging techniques and (3) discuss recent advancements and future perspectives in monitoring PMS with imaging techniques.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Margoni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital, University of Padua, Padua, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy.
- Departments of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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214
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Bevan RJ, Evans R, Griffiths L, Watkins LM, Rees MI, Magliozzi R, Allen I, McDonnell G, Kee R, Naughton M, Fitzgerald DC, Reynolds R, Neal JW, Howell OW. Meningeal inflammation and cortical demyelination in acute multiple sclerosis. Ann Neurol 2018; 84:829-842. [DOI: 10.1002/ana.25365] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Ryan J. Bevan
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Rhian Evans
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Lauren Griffiths
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Lewis M. Watkins
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Mark I. Rees
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Roberta Magliozzi
- Neurology Unit, University of Verona; Verona Italy
- Division of Brain Sciences, Faculty of Medicine; Imperial College London; London United Kingdom
| | - Ingrid Allen
- Wellcome-Wolfson Institute for Experimental Medicine; School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast; Belfast United Kingdom
| | - Gavin McDonnell
- Belfast Health and Social Care Trust; Belfast United Kingdom
| | - Rachel Kee
- Belfast Health and Social Care Trust; Belfast United Kingdom
| | - Michelle Naughton
- Wellcome-Wolfson Institute for Experimental Medicine; School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast; Belfast United Kingdom
| | - Denise C. Fitzgerald
- Wellcome-Wolfson Institute for Experimental Medicine; School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast; Belfast United Kingdom
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine; Imperial College London; London United Kingdom
| | - James W. Neal
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
| | - Owain W. Howell
- Institute of Life Sciences; Swansea University Medical School; Swansea United Kingdom
- Division of Brain Sciences, Faculty of Medicine; Imperial College London; London United Kingdom
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215
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Kiljan S, Meijer KA, Steenwijk MD, Pouwels PJW, Schoonheim MM, Schenk GJ, Geurts JJG, Douw L. Structural network topology relates to tissue properties in multiple sclerosis. J Neurol 2018; 266:212-222. [PMID: 30467603 PMCID: PMC6342882 DOI: 10.1007/s00415-018-9130-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Abnormalities in segregative and integrative properties of brain networks have been observed in multiple sclerosis (MS) and are related to clinical functioning. This study aims to investigate the micro-scale correlates of macro-scale network measures of segregation and integration in MS. METHODS Eight MS patients underwent post-mortem in situ whole-brain diffusion tensor (DT) imaging and subsequent brain dissection. Macro-scale structural network topology was derived from DT data using graph theory. Clustering coefficient and mean white matter (WM) fiber length were measures of nodal segregation and integration. Thirty-three tissue blocks were collected from five cortical brain regions. Using immunohistochemistry micro-scale tissue properties were evaluated, including, neuronal size, neuronal density, axonal density and total cell density. Nodal network properties and tissue properties were correlated. RESULTS A negative correlation between clustering coefficient and WM fiber length was found. Higher clustering coefficient was associated with smaller neuronal size and lower axonal density, and vice versa for fiber length. Higher whole-brain WM lesion load was associated with higher whole-brain clustering, shorter whole-brain fiber length, lower neuronal size and axonal density. CONCLUSION Structural network properties on MRI associate with neuronal size and axonal density, suggesting that macro-scale network measures may grasp cortical neuroaxonal degeneration in MS.
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Affiliation(s)
- Svenja Kiljan
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands.
| | - Kim A Meijer
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Petra J W Pouwels
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Geert J Schenk
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands.,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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216
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MRI visualization of neuroinflammation using VCAM-1 targeted paramagnetic micelles. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:2341-2350. [DOI: 10.1016/j.nano.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 01/29/2023]
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217
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Jakimovski D, Weinstock-Guttman B, Hagemeier J, Vaughn CB, Kavak KS, Gandhi S, Bennett SE, Fuchs TA, Bergsland N, Dwyer MG, Benedict RH, Zivadinov R. Walking disability measures in multiple sclerosis patients: Correlations with MRI-derived global and microstructural damage. J Neurol Sci 2018; 393:128-134. [DOI: 10.1016/j.jns.2018.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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218
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Spanò B, Giulietti G, Pisani V, Morreale M, Tuzzi E, Nocentini U, Francia A, Caltagirone C, Bozzali M, Cercignani M. Disruption of neurite morphology parallels MS progression. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e502. [PMID: 30345330 PMCID: PMC6192688 DOI: 10.1212/nxi.0000000000000502] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022]
Abstract
Objectives To apply advanced diffusion MRI methods to the study of normal-appearing brain tissue in MS and examine their correlation with measures of clinical disability. Methods A multi-compartment model of diffusion MRI called neurite orientation dispersion and density imaging (NODDI) was used to study 20 patients with relapsing-remitting MS (RRMS), 15 with secondary progressive MS (SPMS), and 20 healthy controls. Maps of NODDI were analyzed voxel-wise to assess the presence of abnormalities within the normal-appearing brain tissue and the association with disease severity. Standard diffusion tensor imaging (DTI) parameters were also computed for comparing the 2 techniques. Results Patients with MS showed reduced neurite density index (NDI) and increased orientation dispersion index (ODI) compared with controls in several brain areas (p < 0.05), with patients with SPMS having more widespread abnormalities. DTI indices were also sensitive to some changes. In addition, patients with SPMS showed reduced ODI in the thalamus and caudate nucleus. These abnormalities were associated with scores of disease severity (p < 0.05). The association with the MS functional composite score was higher in patients with SPMS compared with patients with RRMS. Conclusions NODDI and DTI findings are largely overlapping. Nevertheless, NODDI helps interpret previous findings of increased anisotropy in the thalamus of patients with MS and are consistent with the degeneration of selective axon populations.
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Affiliation(s)
- Barbara Spanò
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Giovanni Giulietti
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Valerio Pisani
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Manuela Morreale
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Elisa Tuzzi
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Ugo Nocentini
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Ada Francia
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Carlo Caltagirone
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Marco Bozzali
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
| | - Mara Cercignani
- Neuroimaging Laboratory (B.S., G.G., M.B., M.C.), Santa Lucia Foundation, IRCCS; Department of Clinical and Behavioural Neurology (V.P., U.N., C.C.), Santa Lucia Foundation, IRCCS; Neurovascular Diagnosis Unit (M.M.), Department of Medical and Surgical Sciences and Biotechnology, Section of Neurology, Sapienza, University of Rome; Department of Neurology and Psychiatry (M.M., A.F.), Multiple Sclerosis Center, Sapienza, University of Rome, Italy; High Field Magnetic Resonance (E.T.), Max Planck Institute for Biological Cybernetics, Tuebingen, Germany; Department of System Medicine (U.N., C.C.), University of Rome "Tor Vergata," Italy; and Department of Neuroscience (M.B., M.C.), Brighton & Sussex Medical School, Falmer, United Kingdom
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219
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Krotenkova IA, Bryukhov VV, Krotenkova MV, Zakharova MN, Askarova LS. [Brain atrophy and perfusion changes in patients with remitting and secondary progressive multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:47-54. [PMID: 30160668 DOI: 10.17116/jnevro201811808247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the relationship of brain atrophy and changes in perfusion with an increase in the level of disability in patients with multiple sclerosis (MS). MATERIAL AND METHODS Twenty patients with remitting MS, 20 patients with secondary progressive multiple sclerosis (SPMS) and 20 healthy people were studied. The level of neurological deficit was assessed with EDSS and cognitive status with PASAT. MRI of the brain (standard impulse sequences and 3D-T1-MPR for voxel MRI-morphometry) and perfusion computed tomography with the assessment of visually intact white matter (VIWM) and thalamus were performed. RESULTS Compared to the control group, patients with MS had a significant atrophy of subcortical gray matter. Patients with SPMS in addition had an atrophy of some cortical areas which was correlated with EDSS scores (p<0.05). The correlation between cognitive impairment and the volume of the left inferior parietal lobule (r=0.677; p=0.011) and worsening of perfusion of VIWM of frontal and parietal lobes, thalamus on both sides was observed in patients with SPMS compared to those with remitting MS. That was correlated with cognitive performance assessed by PASAT. CONCLUSION Patterns of atrophy distribution in different types of MS were determined. The level of disability is correlated with the severity of brain atrophy. Hypoperfusion of VIWM that was correlated with cognitive impairment was found in patients with SPMS.
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220
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Spirou A, Liu PP, Natsheh JY, Neuteboom E, Dobryakova E. Neural Correlates of Outcome Anticipation in Multiple Sclerosis. Front Neurol 2018; 9:572. [PMID: 30140247 PMCID: PMC6094992 DOI: 10.3389/fneur.2018.00572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Outcome anticipation is not only a mental preparation for upcoming consequences, but also an essential component of learning and decision-making. Thus, anticipation of consequences is a key process in everyday functioning. The striatum and the ventromedial prefrontal cortex are among the key regions that have been shown to be involved in outcome anticipation. However, while structural abnormalities of these regions as well as altered decision-making have been noted in individuals with multiple sclerosis (MS), neural correlates of outcome anticipation have not been explored in this population. Thus, we examined the neural correlates of outcome anticipation in MS by analyzing brain activation in individuals with MS while they performed a modified version of a card-guessing task. Seventeen MS and 13 healthy controls performed the task while functional magnetic resonance imaging (fMRI) was obtained. To achieve maximal anticipatory response and prevent the possibility of differential performance on the task, participants were presented with monetary rewards only on 50% of the trials. While replicating previous evidence of structural abnormalities of the striatum in MS, our results further showed that individuals with MS exhibited greater activation in the putamen, right hippocampus, and posterior cingulate cortex during outcome anticipation compared to healthy controls. Furthermore, even though there was no strategy that participants could learn in order to predict outcomes, 76% of participants with MS indicated that they used strategies while performing the task. We thus propose that the increased neural activation observed in MS during outcome anticipation might be explained by a failure in recognizing the lack of regularity in the task structure that could result in using strategies to perform the task.
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Affiliation(s)
- Angela Spirou
- Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States
| | - Pei-Pei Liu
- Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Joman Y Natsheh
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.,Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
| | - Eliane Neuteboom
- Department of Anatomy & Neurosciences, University of Amsterdam, Amsterdam, Netherlands
| | - Ekaterina Dobryakova
- Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
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221
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Manconi B, Liori B, Cabras T, Vincenzoni F, Iavarone F, Lorefice L, Cocco E, Castagnola M, Messana I, Olianas A. Top-down proteomic profiling of human saliva in multiple sclerosis patients. J Proteomics 2018; 187:212-222. [PMID: 30086402 DOI: 10.1016/j.jprot.2018.07.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis is a chronic disease of the central nervous system characterized by inflammation, demyelination and neurodegeneration which is of undetermined origin. To date a single diagnostic test of multiple sclerosis does not exists and novel biomarkers are demanded for a more accurate and early diagnosis. In this study, we performed the quantitative analysis of 119 salivary peptides/proteins from 49 multiple sclerosis patients and 54 healthy controls by a mass spectrometry-based top-down proteomic approach. Statistical analysis evidenced different levels on 23 proteins: 8 proteins showed lower levels in multiple sclerosis patients with respect to controls and they were mono- and di-oxidized cystatin SN, mono- and di-oxidized cystatin S1, mono-oxidized cystatin SA and mono-phosphorylated statherin. 15 proteins showed higher levels in multiple sclerosis patients with respect to controls and they were antileukoproteinase, two proteoforms of Prolactin-Inducible Protein, P-C peptide (Fr.1-14, Fr. 26-44, and Fr. 36-44), SV1 fragment of statherin, cystatin SN Des1-4, cystatin SN P11 → L variant, and cystatin A T96 → M variant. The differences observed between the salivary proteomic profile of patients suffering from multiple sclerosis and healthy subjects is consistent with the inflammatory condition and altered immune response typical of the pathology. Data are available via ProteomeXchange with identifier PXD009440. SIGNIFICANCE To date a single diagnostic test of multiple sclerosis does not exist, and diagnosis is based on multiple tests which mainly include the analysis of cerebrospinal fluid. However, the need for lumbar puncture makes the analysis of cerebrospinal fluid impractical for monitoring disease activity and response to treatment. The possible use of saliva as a diagnostic fluid for oral and systemic diseases has been largely investigated, but only marginally in multiple sclerosis compared to other body fluids. Our study demonstrates that the salivary proteome of multiple sclerosis patients differs considerably compared to that of sex and age matched healthy individuals and suggests that some differences might be associated with the different disease-modifying therapy used to treat multiple sclerosis patients.
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Affiliation(s)
- Barbara Manconi
- Department of Life and Environmental Sciences, Biomedical Section, University of Cagliari, Monserrato Campus, 09042 Monserrato, Cagliari, Italy.
| | - Barbara Liori
- Department of Life and Environmental Sciences, Biomedical Section, University of Cagliari, Monserrato Campus, 09042 Monserrato, Cagliari, Italy
| | - Tiziana Cabras
- Department of Life and Environmental Sciences, Biomedical Section, University of Cagliari, Monserrato Campus, 09042 Monserrato, Cagliari, Italy
| | - Federica Vincenzoni
- Biochemistry and Clinical Biochemistry Institute, Medicine Faculty, Catholic University of Rome, L.go F. Vito 1, 00168 Rome, Italy
| | - Federica Iavarone
- Biochemistry and Clinical Biochemistry Institute, Medicine Faculty, Catholic University of Rome, L.go F. Vito 1, 00168 Rome, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, University of Cagliari, via Is Guadazzonis 2, 09126 Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, University of Cagliari, via Is Guadazzonis 2, 09126 Cagliari, Italy
| | - Massimo Castagnola
- Biochemistry and Clinical Biochemistry Institute, Medicine Faculty, Catholic University of Rome, L.go F. Vito 1, 00168 Rome, Italy; Institute of Chemistry of the Molecular Recognition CNR, L.go F. Vito 1, 00168 Rome, Italy
| | - Irene Messana
- Biochemistry and Clinical Biochemistry Institute, Medicine Faculty, Catholic University of Rome, L.go F. Vito 1, 00168 Rome, Italy; Institute of Chemistry of the Molecular Recognition CNR, L.go F. Vito 1, 00168 Rome, Italy
| | - Alessandra Olianas
- Department of Life and Environmental Sciences, Biomedical Section, University of Cagliari, Monserrato Campus, 09042 Monserrato, Cagliari, Italy
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222
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Tomassini V, Fanelli F, Prosperini L, Cerqua R, Cavalla P, Pozzilli C. Predicting the profile of increasing disability in multiple sclerosis. Mult Scler 2018; 25:1306-1315. [PMID: 30070597 PMCID: PMC6681428 DOI: 10.1177/1352458518790397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Effective therapeutic strategies to preserve function and delay progression
in multiple sclerosis (MS) require early recognition of individual disease
trajectories. Objectives: To determine the profiles of disability evolution, identify their early
predictors and develop a risk score of increasing disability. Methods: We analysed demographic, clinical and magnetic resonance imaging (MRI) data
from patients with relapsing MS, Expanded Disability Status Scale (EDSS)
score of 3.0–4.0 and follow-up ≥ 2 years. Attaining EDSS = 6.0 defined
increasing disability; relapses and/or MRI defined
disease activity. Results: In total, 344 out of 542 (63.5%) patients reached EDSS ≥ 6.0; of these, 220
(64.0%) showed disease activity. In patients with activity, the number of
relapses before reaching EDSS 3.0–4.0 predicted increasing disability;
age > 45 at baseline predicted increasing disability without activity.
Combining age and number of relapses increased the risk of and shortened the
time to EDSS = 6.0. Conclusion: Increasing disability is frequently associated with persistent activity. The
high number of relapses identifies early those patients worsening in the
presence of activity. Age predicts increasing disability in the absence of
activity. The presence of both factors increases the risk of developing
severe disability. As this study likely describes the transition to
progression, our findings contribute to improving patient management and
stratification in trials on progressive MS.
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Affiliation(s)
- Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
| | - Fulvia Fanelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/Department of Neurosciences, San Camillo- Forlanini Hospital, Rome, Italy
| | - Raffaella Cerqua
- Neurological Clinic, Marche Polytechnic University, Ancones, Italy
| | - Paola Cavalla
- Department of Neurosciences, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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223
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Cerqueira JJ, Compston DAS, Geraldes R, Rosa MM, Schmierer K, Thompson A, Tinelli M, Palace J. Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? J Neurol Neurosurg Psychiatry 2018; 89:844-850. [PMID: 29618493 PMCID: PMC6204938 DOI: 10.1136/jnnp-2017-317509] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/02/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022]
Affiliation(s)
- João J Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mario M Rosa
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Klaus Schmierer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Alan Thompson
- Faculty of Brain Sciences, University College London, London, UK
| | - Michela Tinelli
- LSE Enterprise, London School of Economics, London, UK
- Personal Social Services research Unit (PSSRU), London School of Economics and Political Science, London, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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224
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Abstract
Hypoxia has been associated with multiple sclerosis (MS) and is an important area of research. Hypoxia can exacerbate inflammation via the prolylhydroxylase pathway. Inflammation can also trigger hypoxia by damaging mitochondria and endothelial cells to impair blood flow regulation. We hypothesize that there is a “hypoxia–inflammation cycle” in MS which plays an important role in MS disease progression. Therapies that break this cycle may be an interesting area of exploration for treatment of MS.
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Affiliation(s)
- Runze Yang
- Department of Radiology, University of Calgary, Calgary, AB, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada/Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeff F Dunn
- Department of Radiology, University of Calgary, Calgary, AB, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada/Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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225
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Pelizzari L, Jakimovski D, Laganà MM, Bergsland N, Hagemeier J, Baselli G, Weinstock-Guttman B, Zivadinov R. Five-Year Longitudinal Study of Neck Vessel Cross-Sectional Area in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:1703-1709. [PMID: 30049718 DOI: 10.3174/ajnr.a5738] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Alterations of neck vessel cross-sectional area in multiple sclerosis have been reported. Our aim was to investigate the evolution of the neck vessel cross-sectional area in patients with MS and healthy controls during 5 years. MATERIALS AND METHODS Sixty-nine patients with MS (44 relapsing-remitting MS, 25 progressive MS) and 22 age- and sex-matched healthy controls were examined twice, 5 years apart, on a 3T MR imaging scanner using 2D neck MR angiography. Cross-sectional areas were computed for the common carotid/internal carotid arteries, vertebral arteries, and internal jugular veins for all slices between the C3 and C7 cervical levels. Longitudinal cross-sectional area differences at each cervical level and the whole-vessel course were tested within study groups and between patients with MS with and without cardiovascular disease using mixed-model analysis and the related-samples Wilcoxon singed rank test. The Benjamini-Hochberg procedure was performed to correct for multiple comparisons. RESULTS No significant cross-sectional area differences were seen between patients with MS and healthy controls at baseline or at follow-up. During the follow-up, significant cross-sectional area decrease was found in patients with MS for the common carotid artery-ICAs (C4: P = .048; C7: P = .005; whole vessel: P = .012), for vertebral arteries (C3: P = .028; C4: P = .028; C7: P = .028; whole vessel: P = .012), and for the internal jugular veins (C3: P = .014; C4: P = .008; C5: P = .010; C6: P = .010; C7: P = .008; whole vessel: P = .002). Patients with MS without cardiovascular disease had significantly greater change than patients with MS with cardiovascular disease for internal jugular veins at all levels. CONCLUSIONS For 5 years, patients with MS showed significant cross-sectional area decrease of all major neck vessels, regardless of the disease course and cardiovascular status.
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Affiliation(s)
- L Pelizzari
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - D Jakimovski
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - M M Laganà
- Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - N Bergsland
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - J Hagemeier
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - G Baselli
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy
| | - B Weinstock-Guttman
- Jacobs Multiple Sclerosis Center (B.W.-G.), Department of Neurology, School of Medicine and Biomedical Sciences
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences .,Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
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226
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Solana E, Martinez-Heras E, Martinez-Lapiscina EH, Sepulveda M, Sola-Valls N, Bargalló N, Berenguer J, Blanco Y, Andorra M, Pulido-Valdeolivas I, Zubizarreta I, Saiz A, Llufriu S. Magnetic resonance markers of tissue damage related to connectivity disruption in multiple sclerosis. NEUROIMAGE-CLINICAL 2018; 20:161-168. [PMID: 30094165 PMCID: PMC6072676 DOI: 10.1016/j.nicl.2018.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 01/16/2023]
Abstract
Patients with multiple sclerosis (MS) display reduced structural connectivity among brain regions, but the pathogenic mechanisms underlying network disruption are still unknown. We aimed to investigate the association between the loss of diffusion-based structural connectivity, measured with graph theory metrics, and magnetic resonance (MR) markers of microstructural damage. Moreover, we evaluated the cognitive consequences of connectivity changes. We analysed the frontoparietal network in 102 MS participants and 25 healthy volunteers (HV). MR measures included radial diffusivity (RD), as marker of demyelination, and ratios of myo-inositol, N-acetylaspartate and glutamate+glutamine with creatine in white (WM) and grey matter as markers of astrogliosis, neuroaxonal integrity and glutamatergic neurotoxicity. Patients showed decreased global and local efficiency, and increased assortativity (p < 0.01) of the network, as well as increased RD and myo-inositol, and decreased N-acetylaspartate in WM compared with HV (p < 0.05). In patients, the age-adjusted OR of presenting abnormal global and local efficiency was increased for each increment of 0.01 points in RD and myo-inositol, while it was decreased for each increment of 0.01 points in N-acetylaspartate (the increase of N-acetylaspartate reduced the risk of having abnormal connectivity), all in WM. In a multiple logistic regression analysis, the OR of presenting abnormal global efficiency was 0.95 (95% confidence interval, CI: 0.91–0.99, p = 0.011) for each 0.01 increase in N-acetylaspartate, and the OR of presenting abnormal local efficiency was 1.39 (95% CI: 1.14–1.71, p = 0.001) for each 0.01 increase in RD. Patients with abnormal efficiency had worse performance in attention, working memory and processing speed (p < 0.05). In conclusion, patients with MS exhibit decreased structural network efficiency driven by diffuse microstructural impairment of the WM, probably related to demyelination, astroglial and neuroaxonal damage. The accumulation of neuroaxonal pathological burden seems to magnify the risk of global network collapse, while demyelination may contribute to the regional disorganization. These network modifications have negative consequences on cognition. The pathogenic mechanisms underlying structural network disruption in MS are unknown. The microstructural damage of the white matter contributes to network impairment. The worsening of global efficiency is associated with markers of neuroaxonal burden. Local efficiency impairment is related to MR measures of demyelination. The described network modifications contribute to cognitive dysfunction.
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Affiliation(s)
- Elisabeth Solana
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Eloy Martinez-Heras
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Maria Sepulveda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Nuria Sola-Valls
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Nuria Bargalló
- Magnetic Resonance Image Core Facility, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Joan Berenguer
- Magnetic Resonance Image Core Facility, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Magi Andorra
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Irati Zubizarreta
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Barcelona, Spain.
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227
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Regional Distribution of CNS Antigens Differentially Determines T-Cell Mediated Neuroinflammation in a CX3CR1-Dependent Manner. J Neurosci 2018; 38:7058-7071. [PMID: 29959236 DOI: 10.1523/jneurosci.0366-18.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 01/29/2023] Open
Abstract
T cells continuously sample CNS-derived antigens in the periphery, yet it is unknown how they sample and respond to CNS antigens derived from distinct brain areas. We expressed ovalbumin (OVA) neoepitopes in regionally distinct CNS areas (Cnp-OVA and Nes-OVA mice) to test peripheral antigen sampling by OVA-specific T cells under homeostatic and neuroinflammatory conditions. We show that antigen sampling in the periphery is independent of regional origin of CNS antigens in both male and female mice. However, experimental autoimmune encephalomyelitis (EAE) is differentially influenced in Cnp-OVA and Nes-OVA female mice. Although there is the same frequency of CD45high CD11b+ CD11c+ CX3CL1+ myeloid cell-T-cell clusters in neoepitope-expressing areas, EAE is inhibited in Nes-OVA female mice and accelerated in CNP-OVA female mice. Accumulation of OVA-specific T cells and their immunomodulatory effects on EAE are CX3C chemokine receptor 1 (CX3CR1) dependent. These data show that despite similar levels of peripheral antigen sampling, CNS antigen-specific T cells differentially influence neuroinflammatory disease depending on the location of cognate antigens and the presence of CX3CL1/CX3CR1 signaling.SIGNIFICANCE STATEMENT Our data show that peripheral T cells similarly recognize neoepitopes independent of their origin within the CNS under homeostatic conditions. Contrastingly, during ongoing autoimmune neuroinflammation, neoepitope-specific T cells differentially influence clinical score and pathology based on the CNS regional location of the neoepitopes in a CX3CR1-dependent manner. Altogether, we propose a novel mechanism for how T cells respond to regionally distinct CNS derived antigens and contribute to CNS autoimmune pathology.
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228
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Al Hussona M, Kearney H, Fisher A, Lynch J, Looby S, Delanty N. New onset seizures as a sole clinical presentation of multiple sclerosis. Mult Scler 2018; 25:295-299. [PMID: 29916293 DOI: 10.1177/1352458518781994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Epileptic seizures frequently occur in people with multiple sclerosis (MS) and are thought to represent a manifestation of cortical pathology. However, at present, seizures are not considered to be a typical clinical presentation of demyelination. METHODS AND RESULTS In this case series, we identified four people, who presented with seizures as a sole presenting feature, with demyelinating imaging abnormalities that satisfy current diagnostic criteria for a clinically isolated syndrome (CIS) or early MS. CONCLUSION Based on this case series, we propose that people presenting with de novo seizures, with concurrent radiological abnormalities suggestive of demyelination could potentially be considered to have a CIS.
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Affiliation(s)
| | - Hugh Kearney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Arie Fisher
- Department of Neurology, University Hospital Galway, Galway, Ireland
| | - John Lynch
- Department of Neurology, University Hospital Galway, Galway, Ireland
| | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
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229
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De Angelis F, Plantone D, Chataway J. Pharmacotherapy in Secondary Progressive Multiple Sclerosis: An Overview. CNS Drugs 2018; 32:499-526. [PMID: 29968175 DOI: 10.1007/s40263-018-0538-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Multiple sclerosis is an immune-mediated inflammatory disease of the central nervous system characterised by demyelination, neuroaxonal loss and a heterogeneous clinical course. Multiple sclerosis presents with different phenotypes, most commonly a relapsing-remitting course and, less frequently, a progressive accumulation of disability from disease onset (primary progressive multiple sclerosis). The majority of people with relapsing-remitting multiple sclerosis, after a variable time, switch to a stage characterised by gradual neurological worsening known as secondary progressive multiple sclerosis. We have a limited understanding of the mechanisms underlying multiple sclerosis, and it is believed that multiple genetic, environmental and endogenous factors are elements driving inflammation and ultimately neurodegeneration. Axonal loss and grey matter damage have been regarded as amongst the leading causes of irreversible neurological disability in the progressive stages. There are over a dozen disease-modifying therapies currently licenced for relapsing-remitting multiple sclerosis, but none of these has provided evidence of effectiveness in secondary progressive multiple sclerosis. Recently, there has been some early modest success with siponimod in secondary progressive multiple sclerosis and ocrelizumab in primary progressive multiple sclerosis. Finding treatments to delay or prevent the courses of secondary progressive multiple sclerosis is an unmet and essential goal of the research in multiple sclerosis. In this review, we discuss new findings regarding drugs with immunomodulatory, neuroprotective or regenerative properties and possible treatment strategies for secondary progressive multiple sclerosis. We examine the field broadly to include trials where participants have progressive or relapsing phenotypes. We summarise the most relevant results from newer investigations from phase II and III randomised controlled trials over the past decade, with particular attention to the last 5 years.
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Affiliation(s)
- Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.
| | - Domenico Plantone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
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230
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van Wageningen TA, van Dam AM. Much, if not all, of the cortical damage in MS can be attributed to the microglial cell - Yes. Mult Scler 2018; 24:895-896. [PMID: 29754520 PMCID: PMC6029145 DOI: 10.1177/1352458517739139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Thecla A van Wageningen
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne-Marie van Dam
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
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231
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Luchetti S, Fransen NL, van Eden CG, Ramaglia V, Mason M, Huitinga I. Progressive multiple sclerosis patients show substantial lesion activity that correlates with clinical disease severity and sex: a retrospective autopsy cohort analysis. Acta Neuropathol 2018; 135:511-528. [PMID: 29441412 PMCID: PMC5978927 DOI: 10.1007/s00401-018-1818-y] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 01/12/2023]
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease with large inter-individual differences in disease course. MS lesion pathology shows considerable heterogeneity in localization, cellular content and degree of demyelination between patients. In this study, we investigated pathological correlates of disease course in MS using the autopsy cohort of the Netherlands Brain Bank (NBB), containing 182 MS brain donors. Using a standardized autopsy procedure including systematic dissection from standard locations, 3188 tissue blocks containing 7562 MS lesions were dissected. Unbiased measurements of lesion load were made using the tissue from standard locations. Lesion demyelinating and innate inflammatory activity were visualized by immunohistochemistry for proteolipid protein and human leukocyte antigen. Lesions were classified into active, mixed active/inactive (also known as chronic active), inactive or remyelinated, while microglia/macrophage morphology was classified as ramified, amoeboid or foamy. The severity score was calculated from the time from first symptoms to EDSS-6. Lesion type prevalence and microglia/macrophage morphology were analyzed in relation to clinical course, disease severity, lesion load and sex, and in relation to each other. This analysis shows for the first time that (1) in progressive MS, with a mean disease duration of 28.6 ± 13.3 years (mean ± SD), there is substantial inflammatory lesion activity at time to death. 57% of all lesions were either active or mixed active/inactive and 78% of all patients had a mixed active/inactive lesion present; (2) patients that had a more severe disease course show a higher proportion of mixed active/inactive lesions (p = 6e-06) and a higher lesion load (p = 2e-04) at the time of death, (3) patients with a progressive disease course show a higher lesion load (p = 0.001), and a lower proportion of remyelinated lesions (p = 0.03) compared to patients with a relapsing disease course, (4) males have a higher incidence of cortical grey matter lesions (p = 0.027) and a higher proportion of mixed active/inactive lesions compared to females across the whole cohort (p = 0.007). We confirm that there is a higher proportion of mixed active/inactive lesions (p = 0.006) in progressive MS compared to relapsing disease. Identification of mixed active/inactive lesions on MRI is necessary to determine whether they can be used as a prognostic tool in living MS patients.
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Affiliation(s)
- Sabina Luchetti
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
| | - Nina L Fransen
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
| | - Corbert G van Eden
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
| | - Valeria Ramaglia
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
- Department of Immunology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Matthew Mason
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
| | - Inge Huitinga
- Laboratory of Neuroimmunology, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands.
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232
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Siller N, Kuhle J, Muthuraman M, Barro C, Uphaus T, Groppa S, Kappos L, Zipp F, Bittner S. Serum neurofilament light chain is a biomarker of acute and chronic neuronal damage in early multiple sclerosis. Mult Scler 2018. [PMID: 29542376 DOI: 10.1177/1352458518765666] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monitoring neuronal injury remains one key challenge in early relapsing-remitting multiple sclerosis (RRMS) patients. Upon axonal damage, neurofilament - a major component of the neuro-axonal cytoskeleton - is released into the cerebrospinal fluid (CSF) and subsequently peripheral blood. OBJECTIVE To investigate the relevance of serum neurofilament light chain (sNfL) for acute and chronic axonal damage in early RRMS. METHODS sNfL levels were determined in 74 patients (63 therapy-naive) with recently diagnosed clinically isolated syndrome (CIS) or RRMS using Single Molecule Array technology. Standardized 3 T magnetic resonance imaging (MRI) was performed at baseline and 1-3 consecutive follow-ups (42 patients; range: 6-37 months). RESULTS Baseline sNfL correlated significantly with T2 lesion volume ( r = 0.555, p < 0.0001). There was no correlation between baseline sNfL and age, Expanded Disability Status Scale (EDSS) score or other calculated MRI measures. However, T2 lesion volume increased ( r = 0.67, p < 0.0001) and brain parenchymal volume decreased more rapidly in patients with higher baseline sNfL ( r = -0.623, p = 0.0004). Gd-enhancing lesions correlated positively with sNfL levels. Initiation of disease-modifying treatment led to a significant decrease in sNfL levels. CONCLUSION sNfL indicates acute inflammation as demonstrated by correlation with Gd+ lesions. It is a promising biomarker for neuro-axonal damage in early multiple sclerosis (MS) patients, since higher baseline sNfL levels predicted future brain atrophy within 2 years.
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Affiliation(s)
- Nelly Siller
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Kuhle
- Neurologic Clinic and Policlinic and Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Muthuraman Muthuraman
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Barro
- Neurologic Clinic and Policlinic and Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Timo Uphaus
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic and Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frauke Zipp
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Research Center for Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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233
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Autoimmune comorbidities in multiple sclerosis: what is the influence on brain volumes? A case-control MRI study. J Neurol 2018; 265:1096-1101. [PMID: 29508133 DOI: 10.1007/s00415-018-8811-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several studies indicated that multiple sclerosis (MS) is frequently associated with other autoimmune diseases. However, it is little known if the coexistence of these conditions may influence the radiologic features of MS, and in particular the brain volumes. OBJECTIVES To evaluate the effect of autoimmune comorbidities on brain atrophy in a large case-control MS population. METHODS A group of MS patients affected by a second autoimmune disorder, and a control MS group without any comorbidity, were recruited. Patients underwent a brain MRI and volumes of whole brain (WB), white matter (WM), and gray matter (GM) with cortical GM were estimated by SIENAX. RESULTS The sample included 286 MS patients, of which 30 (10.5%) subjects with type 1 diabetes (T1D), 53 (18.5%) with autoimmune thyroiditis (AT) and 4 (0.1%) with celiac disease. Multiple regression analysis found an association between T1D and lower GM (p = 0.038) and cortical GM (p = 0.036) volumes, independent from MS clinical features and related to T1D duration (p < 0.01), while no association was observed with AT and celiac disease. CONCLUSIONS Our data support the importance of considering T1D as possible factors influencing the brain atrophy in MS. Further studies are needed to confirm our data and to clarify the underlying mechanisms.
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234
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Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS), which gives rise to focal lesions in the gray and white matter and to diffuse neurodegeneration in the entire brain. In this review, the spectrum of MS lesions and their relation to the inflammatory process is described. Pathology suggests that inflammation drives tissue injury at all stages of the disease. Focal inflammatory infiltrates in the meninges and the perivascular spaces appear to produce soluble factors, which induce demyelination or neurodegeneration either directly or indirectly through microglia activation. The nature of these soluble factors, which are responsible for demyelinating activity in sera and cerebrospinal fluid of the patients, is currently undefined. Demyelination and neurodegeneration is finally accomplished by oxidative injury and mitochondrial damage leading to a state of "virtual hypoxia."
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Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, A-1090 Wien, Austria
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235
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Eshaghi A, Prados F, Brownlee WJ, Altmann DR, Tur C, Cardoso MJ, De Angelis F, van de Pavert SH, Cawley N, De Stefano N, Stromillo ML, Battaglini M, Ruggieri S, Gasperini C, Filippi M, Rocca MA, Rovira A, Sastre‐Garriga J, Vrenken H, Leurs CE, Killestein J, Pirpamer L, Enzinger C, Ourselin S, Wheeler‐Kingshott CAG, Chard D, Thompson AJ, Alexander DC, Barkhof F, Ciccarelli O. Deep gray matter volume loss drives disability worsening in multiple sclerosis. Ann Neurol 2018; 83:210-222. [PMID: 29331092 PMCID: PMC5838522 DOI: 10.1002/ana.25145] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Gray matter (GM) atrophy occurs in all multiple sclerosis (MS) phenotypes. We investigated whether there is a spatiotemporal pattern of GM atrophy that is associated with faster disability accumulation in MS. METHODS We analyzed 3,604 brain high-resolution T1-weighted magnetic resonance imaging scans from 1,417 participants: 1,214 MS patients (253 clinically isolated syndrome [CIS], 708 relapsing-remitting [RRMS], 128 secondary-progressive [SPMS], and 125 primary-progressive [PPMS]), over an average follow-up of 2.41 years (standard deviation [SD] = 1.97), and 203 healthy controls (HCs; average follow-up = 1.83 year; SD = 1.77), attending seven European centers. Disability was assessed with the Expanded Disability Status Scale (EDSS). We obtained volumes of the deep GM (DGM), temporal, frontal, parietal, occipital and cerebellar GM, brainstem, and cerebral white matter. Hierarchical mixed models assessed annual percentage rate of regional tissue loss and identified regional volumes associated with time-to-EDSS progression. RESULTS SPMS showed the lowest baseline volumes of cortical GM and DGM. Of all baseline regional volumes, only that of the DGM predicted time-to-EDSS progression (hazard ratio = 0.73; 95% confidence interval, 0.65, 0.82; p < 0.001): for every standard deviation decrease in baseline DGM volume, the risk of presenting a shorter time to EDSS worsening during follow-up increased by 27%. Of all longitudinal measures, DGM showed the fastest annual rate of atrophy, which was faster in SPMS (-1.45%), PPMS (-1.66%), and RRMS (-1.34%) than CIS (-0.88%) and HCs (-0.94%; p < 0.01). The rate of temporal GM atrophy in SPMS (-1.21%) was significantly faster than RRMS (-0.76%), CIS (-0.75%), and HCs (-0.51%). Similarly, the rate of parietal GM atrophy in SPMS (-1.24-%) was faster than CIS (-0.63%) and HCs (-0.23%; all p values <0.05). Only the atrophy rate in DGM in patients was significantly associated with disability accumulation (beta = 0.04; p < 0.001). INTERPRETATION This large, multicenter and longitudinal study shows that DGM volume loss drives disability accumulation in MS, and that temporal cortical GM shows accelerated atrophy in SPMS than RRMS. The difference in regional GM atrophy development between phenotypes needs to be taken into account when evaluating treatment effect of therapeutic interventions. Ann Neurol 2018;83:210-222.
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Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Wallace J. Brownlee
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel R. Altmann
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Medical Statistics DepartmentLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Carmen Tur
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - M. Jorge Cardoso
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Steven H. van de Pavert
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Niamh Cawley
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Nicola De Stefano
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - M. Laura Stromillo
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Marco Battaglini
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Serena Ruggieri
- Department of NeurosciencesS Camillo Forlanini HospitalRomeItaly
- Department of Neurology and PsychiatryUniversity of Rome SapienzaRomeItaly
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Maria A. Rocca
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Alex Rovira
- MR Unit and Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Jaume Sastre‐Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Hugo Vrenken
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Cyra E. Leurs
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Lukas Pirpamer
- Department of NeurologyMedical University of GrazGrazAustria
| | - Christian Enzinger
- Department of NeurologyMedical University of GrazGrazAustria
- Division of Neuroradiology, Vascular & Interventional Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Sebastien Ourselin
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Claudia A.M. Gandini Wheeler‐Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Brain MRI 3T Mondino Research CenterC. Mondino National Neurological InstitutePaviaItaly
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Alan J. Thompson
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel C. Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
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236
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O'Loughlin E, Madore C, Lassmann H, Butovsky O. Microglial Phenotypes and Functions in Multiple Sclerosis. Cold Spring Harb Perspect Med 2018; 8:8/2/a028993. [PMID: 29419406 DOI: 10.1101/cshperspect.a028993] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Microglia are the resident immune cells that constantly survey the central nervous system. They can adapt to their environment and respond to injury or insult by altering their morphology, phenotype, and functions. It has long been debated whether microglial activation is detrimental or beneficial in multiple sclerosis (MS). Recently, the two opposing yet connected roles of microglial activation have been described with the aid of novel microglial markers, RNA profiling, and in vivo models. In this review, microglial phenotypes and functions in the context of MS will be discussed with evidence from both human pathological studies, in vitro and in vivo models. Microglial functional diversity-phagocytosis, antigen presentation, immunomodulation, support, and repair-will also be examined in detail. In addition, this review discusses the emerging evidence for microglia-related targets as biomarkers and therapeutic targets for MS.
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Affiliation(s)
- Elaine O'Loughlin
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Charlotte Madore
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, A-1090 Vienna, Austria
| | - Oleg Butovsky
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.,Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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237
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Pulse steroid therapy in multiple sclerosis and mood changes: An exploratory prospective study. Mult Scler Relat Disord 2018; 20:104-108. [PMID: 29360061 DOI: 10.1016/j.msard.2018.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several reports suggest a higher risk of psychiatric disorders after high-dose corticosteroids (HDC), routinely used to treat clinical relapses in multiple sclerosis (MS). The present study aimed to examine the possible effect of HDC on mood in patients with MS and to determine the specific factors that influence mood changes. METHODS The study included MS patients prior to receive HDC. The presence of depressive and bipolar symptoms was determined with the Beck Depression Inventory-Second Edition (BDI-II) and the Mood Disorder Questionnaire (MDQ). These assessments were made at three time points: prior to HDC initiation, after HDC completion, and 1 month after HDC. RESULTS The study included 101 MS patients. At baseline, 32 (31.7%) patients had depressive symptoms (BDI-II scores ≥ 14) and 20 (19.8%) patients had bipolar symptoms (MDQ scores ≥ 7). While it was observed a reduction of BDI-II scores after HDC, an increase in MDQ score was found in patients with MDQ positivity at baseline, resulting associated with a higher number of HDC infusions (p 0.018). CONCLUSIONS Our results emphasize the importance of accurate screening for mood disorders in patients with MS prior to HDC initiation, and indicate that HDC should be used with caution in patients with MDQ positivity.
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238
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Pentón-Rol G, Marín-Prida J, Falcón-Cama V. C-Phycocyanin and Phycocyanobilin as Remyelination Therapies for Enhancing Recovery in Multiple Sclerosis and Ischemic Stroke: A Preclinical Perspective. Behav Sci (Basel) 2018; 8:bs8010015. [PMID: 29346320 PMCID: PMC5791033 DOI: 10.3390/bs8010015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 12/21/2022] Open
Abstract
Myelin loss has a crucial impact on behavior disabilities associated to Multiple Sclerosis (MS) and Ischemic Stroke (IS). Although several MS therapies are approved, none of them promote remyelination in patients, limiting their ability for chronic recovery. With no available therapeutic options, enhanced demyelination in stroke survivors is correlated with a poorer behavioral recovery. Here, we show the experimental findings of our group and others supporting the remyelinating effects of C-Phycocyanin (C-PC), the main biliprotein of Spirulina platensis and its linked tetrapyrrole Phycocyanobilin (PCB), in models of these illnesses. C-PC promoted white matter regeneration in rats and mice affected by experimental autoimmune encephalomyelitis. Electron microscopy analysis in cerebral cortex from ischemic rats revealed a potent remyelinating action of PCB treatment after stroke. Among others biological processes, we discussed the role of regulatory T cell induction, the control of oxidative stress and pro-inflammatory mediators, gene expression modulation and COX-2 inhibition as potential mechanisms involved in the C-PC and PCB effects on the recruitment, differentiation and maturation of oligodendrocyte precursor cells in demyelinated lesions. The assembled evidence supports the implementation of clinical trials to demonstrate the recovery effects of C-PC and PCB in these diseases.
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Affiliation(s)
- Giselle Pentón-Rol
- Center for Genetic Engineering and Biotechnology (CIGB), Ave. 31 e/158 y 190, Cubanacan, P.O. Box 6162, Playa, Havana 10600, Cuba.
| | - Javier Marín-Prida
- Center for Research and Biological Evaluations (CEIEB), Institute of Pharmacy and Food, University of Havana, Ave. 23 e/214 y 222, La Lisa, PO Box 430, Havana 13600, Cuba.
| | - Viviana Falcón-Cama
- Center for Genetic Engineering and Biotechnology (CIGB), Ave. 31 e/158 y 190, Cubanacan, P.O. Box 6162, Playa, Havana 10600, Cuba.
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239
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Abstract
PURPOSE OF REVIEW Understanding the mechanisms underlying progression in multiple sclerosis (MS) and identifying appropriate therapeutic targets is a key challenge facing the MS community. This challenge has been championed internationally by organizations such as the Progressive MS Alliance, which has raised the profile of progressive MS and identified the key obstacles to treatment. This review will outline the considerable progress against these challenges. RECENT FINDINGS New insights into mechanisms underlying progression have opened up potential therapeutic opportunities. This has been complemented by ongoing validation of clinical and imaging outcomes for Phase II trials of progression, coupled with the development of innovative trial designs. The field has been greatly encouraged by recent positive Phase III trials in both primary and secondary progressive MS, albeit with modest benefit. Early trials of neuroprotection and repair have provided important new data with which to drive the field. Improving symptom management and advancing rehabilitation approaches, critical for this patient population which, taken together with identifying and managing comorbidities and risk factors, has an appreciable impact on health-related quality of life. SUMMARY Raising the profile of progressive MS has resulted in the first effective treatments with the promise of more to come.
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240
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Lapointe E, Li DKB, Traboulsee AL, Rauscher A. What Have We Learned from Perfusion MRI in Multiple Sclerosis? AJNR Am J Neuroradiol 2018; 39:994-1000. [PMID: 29301779 DOI: 10.3174/ajnr.a5504] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
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Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
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241
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Spencer JI, Bell JS, DeLuca GC. Vascular pathology in multiple sclerosis: reframing pathogenesis around the blood-brain barrier. J Neurol Neurosurg Psychiatry 2018; 89:42-52. [PMID: 28860328 DOI: 10.1136/jnnp-2017-316011] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/20/2022]
Abstract
Blood-brain barrier (BBB) disruption has long been recognised as an important early feature of multiple sclerosis (MS) pathology. Traditionally, this has been seen as a by-product of the myelin-specific immune response. Here, we consider whether vascular changes instead play a central role in disease pathogenesis, rather than representing a secondary effect of neuroinflammation or neurodegeneration. Importantly, this is not necessarily mutually exclusive from current hypotheses. Vascular pathology in a genetically predisposed individual, influenced by environmental factors such as pathogens, hypovitaminosis D and smoking, may be a critical initiator of a series of events including hypoxia, protein deposition and immune cell egress that allows the development of a CNS-specific immune response and the classical pathological and clinical hallmarks of disease. We review the changes that occur in BBB function and cerebral perfusion in patients with MS and highlight genetic and environmental risk factors that, in addition to modulating immune function, may also converge to act on the vasculature. Further context is provided by contrasting these changes with other neurological diseases in which there is also BBB malfunction, and highlighting current disease-modifying therapies that may also have an effect on the BBB. Indeed, in reframing current evidence in this model, the vasculature could become an important therapeutic target in MS.
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Affiliation(s)
- Jonathan I Spencer
- University of Oxford Medical School, Level 2 Academic Centre, John Radcliffe Hospital, Oxford, UK
| | - Jack S Bell
- University of Oxford Medical School, Level 2 Academic Centre, John Radcliffe Hospital, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Level 1 West Wing, John Radcliffe Hospital, Oxford, UK
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242
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Fenu G, Lorefice L, Sechi V, Loi L, Contu F, Cabras F, Coghe G, Frau J, Secci M, Melis C, Schirru L, Costa G, Melas V, Arru M, Barracciu M, Marrosu M, Cocco E. Brain volume in early MS patients with and without IgG oligoclonal bands in CSF. Mult Scler Relat Disord 2018; 19:55-58. [DOI: 10.1016/j.msard.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/03/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
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243
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Höftberger R, Lassmann H. Inflammatory demyelinating diseases of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2018; 145:263-283. [PMID: 28987175 PMCID: PMC7149979 DOI: 10.1016/b978-0-12-802395-2.00019-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory demyelinating diseases are a heterogeneous group of disorders, which occur against the background of an acute or chronic inflammatory process. The pathologic hallmark of multiple sclerosis (MS) is the presence of focal demyelinated lesions with partial axonal preservation and reactive astrogliosis. Demyelinated plaques are present in the white as well as gray matter, such as the cerebral or cerebellar cortex and brainstem nuclei. Activity of the disease process is reflected by the presence of lesions with ongoing myelin destruction. Axonal and neuronal destruction in the lesions is a major substrate for permanent neurologic deficit in MS patients. The MS pathology is qualitatively similar in different disease stages, such as relapsing remitting MS or secondary or primary progressive MS, but the prevalence of different lesion types differs quantitatively. Acute MS and Balo's type of concentric sclerosis appear to be variants of classic MS. In contrast, neuromyelitis optica (NMO) and spectrum disorders (NMOSD) are inflammatory diseases with primary injury of astrocytes, mediated by aquaporin-4 antibodies. Finally, we discuss the histopathology of other inflammatory demyelinating diseases such as acute disseminated encephalomyelitis and myelin oligodendrocyte glycoprotein antibody-associated demyelination. Knowledge of the heterogenous immunopathology in demyelinating diseases is important, to understand the clinical presentation and disease course and to find the optimal treatment for an individual patient.
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Affiliation(s)
- Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria,Correspondence to: Hans Lassmann, MD, Center for Brain Research, Medical University of Vienna, Spitalgasse, 1090 Vienna, Austria
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244
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Lorefice L, Fenu G, Sardu C, Frau J, Coghe G, Costa G, Schirru L, Secci MA, Sechi V, Barracciu MA, Marrosu MG, Cocco E. Multiple sclerosis and HLA genotypes: A possible influence on brain atrophy. Mult Scler 2017; 25:23-30. [PMID: 29111883 DOI: 10.1177/1352458517739989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The strongest genetic determinant for multiple sclerosis (MS) is located at the human leukocyte antigen (HLA) class II DRB1 and DQB1 loci. OBJECTIVES To investigate the possible role of predisposing HLA genotypes in determining brain atrophy. METHODS HLA genotypes were categorized as high risk (two predisposing haplotypes) or medium/low risk (one or no predisposing haplotypes). Patients underwent a brain magnetic resonance imaging (MRI) study and volumes of white matter (WM), gray matter (GM), and whole brain (WB) were estimated with SIENAX. Longitudinal atrophy was also assessed with SIENA. RESULTS The study included 240 MS patients. In 51/240 (21%) subjects, a high-risk HLA genotype was observed, while medium- and low-risk HLA genotypes were 109/240 (45%) and 80/240 (34%), respectively. Multiple regression analysis found that the high-risk HLA genotype was associated with significant reduction in WB ( p = 0.02) and GM ( p = 0.03) volumes compared with the medium-/low-risk HLA genotypes, independently from MS clinical features. The longitudinal study included 60 patients and showed a brain volume loss of -0.79% in high-risk HLA genotype group versus -0.56% in low-risk HLA genotype. CONCLUSION Our results suggest an influence of HLA genotype on WB and GM atrophy. Further investigations are necessary to confirm these findings.
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Affiliation(s)
- Lorena Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudia Sardu
- Unit of Epidemiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gianna Costa
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Lucia Schirru
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Antonietta Secci
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Vincenzo Sechi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | | | - Maria Giovanna Marrosu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Cagliari, Italy/Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
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245
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Granberg T, Fan Q, Treaba CA, Ouellette R, Herranz E, Mangeat G, Louapre C, Cohen-Adad J, Klawiter EC, Sloane JA, Mainero C. In vivo characterization of cortical and white matter neuroaxonal pathology in early multiple sclerosis. Brain 2017; 140:2912-2926. [PMID: 29053798 DOI: 10.1093/brain/awx247] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/05/2017] [Indexed: 12/12/2022] Open
Abstract
Neuroaxonal pathology is a main determinant of disease progression in multiple sclerosis; however, its underlying pathophysiological mechanisms, including its link to inflammatory demyelination and temporal occurrence in the disease course are still unknown. We used ultra-high field (7 T), ultra-high gradient strength diffusion and T1/T2-weighted myelin-sensitive magnetic resonance imaging to characterize microstructural changes in myelin and neuroaxonal integrity in the cortex and white matter in early stage multiple sclerosis, their distribution in lesional and normal-appearing tissue, and their correlations with neurological disability. Twenty-six early stage multiple sclerosis subjects (disease duration ≤5 years) and 24 age-matched healthy controls underwent 7 T T2*-weighted imaging for cortical lesion segmentation and 3 T T1/T2-weighted myelin-sensitive imaging and neurite orientation dispersion and density imaging for assessing microstructural myelin, axonal and dendrite integrity in lesional and normal-appearing tissue of the cortex and the white matter. Conventional mean diffusivity and fractional anisotropy metrics were also assessed for comparison. Cortical lesions were identified in 92% of early multiple sclerosis subjects and they were characterized by lower intracellular volume fraction (P = 0.015 by paired t-test), lower myelin-sensitive contrast (P = 0.030 by related-samples Wilcoxon signed-rank test) and higher mean diffusivity (P = 0.022 by related-samples Wilcoxon signed-rank test) relative to the contralateral normal-appearing cortex. Similar findings were observed in white matter lesions relative to normal-appearing white matter (all P < 0.001), accompanied by an increased orientation dispersion (P < 0.001 by paired t-test) and lower fractional anisotropy (P < 0.001 by related-samples Wilcoxon signed-rank test) suggestive of less coherent underlying fibre orientation. Additionally, the normal-appearing white matter in multiple sclerosis subjects had diffusely lower intracellular volume fractions than the white matter in controls (P = 0.029 by unpaired t-test). Cortical thickness did not differ significantly between multiple sclerosis subjects and controls. Higher orientation dispersion in the left primary motor-somatosensory cortex was associated with increased Expanded Disability Status Scale scores in surface-based general linear modelling (P < 0.05). Microstructural pathology was frequent in early multiple sclerosis, and present mainly focally in cortical lesions, whereas more diffusely in white matter. These results suggest early demyelination with loss of cells and/or cell volumes in cortical and white matter lesions, with additional axonal dispersion in white matter lesions. In the cortex, focal lesion changes might precede diffuse atrophy with cortical thinning. Findings in the normal-appearing white matter reveal early axonal pathology outside inflammatory demyelinating lesions.
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Affiliation(s)
- Tobias Granberg
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Qiuyun Fan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Constantina Andrada Treaba
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Russell Ouellette
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elena Herranz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Gabriel Mangeat
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Céline Louapre
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Julien Cohen-Adad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Eric C Klawiter
- Harvard Medical School, Cambridge, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jacob A Sloane
- Harvard Medical School, Cambridge, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
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246
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Qureshi M, Al-Suhaimi EA, Wahid F, Shehzad O, Shehzad A. Therapeutic potential of curcumin for multiple sclerosis. Neurol Sci 2017; 39:207-214. [PMID: 29079885 DOI: 10.1007/s10072-017-3149-5] [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: 12/07/2016] [Accepted: 10/07/2017] [Indexed: 01/08/2023]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system (CNS), characterized by demyelination, neuronal injury, and breaching of the blood-brain barrier (BBB). Epidemiological studies have shown that immunological, genetic, and environmental factors contribute to the progression and development of MS. T helper 17 (Th17) cells are crucial immunological participant in the pathophysiology of MS. The aberrant production of IL-17 and IL-22 by Th17 cells crosses BBB promotes its disruption and interferes with transmission of nerve signals through activation of neuroinflammation in the CNS. These inflammatory responses promote demyelination through transcriptional activation of signal transducers and activators of transcription-1 (STAT-1), nuclear factor kappa-B (NF-κB), matrix metalloproteinases (MMPs), interferon ϒ (IFNϒ), and Src homology region 2 domain-containing phosphatase-1 (SHP-1). B cells also contribute to disease progression through abnormal regulation of antibodies, cytokines, and antigen presentation. Additionally, oxidative stress has been known as a causative agent for the MS. Curcumin is a hydrophobic yellowish diphenolic component of turmeric, which can interact and modulate multiple cell signaling pathways and prevent the development of various autoimmune neurological diseases including MS. Studies have reported curcumin as a potent anti-inflammatory, antioxidant agent that could modulate cell cycle regulatory proteins, enzymes, cytokines, and transcription factors in CNS-related disorders including MS. The current study summarizes the reported knowledge on therapeutic potential of curcumin against MS, with future indication as neuroprotective and neuropharmacological drug.
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Affiliation(s)
- Munibah Qureshi
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Ebtesam A Al-Suhaimi
- Department of Biology, Sciences College, University of Dammam, Dammam, Saudi Arabia
| | - Fazli Wahid
- Biotechnology Program, Department of Environmental Sciences, COMSATS Institute of Information Technology, Abbottabad, 22060, Pakistan
| | - Omer Shehzad
- Department of pharmacy, Abdul Wali Khan University , Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Adeeb Shehzad
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan.
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247
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Plemel JR, Michaels NJ, Weishaupt N, Caprariello AV, Keough MB, Rogers JA, Yukseloglu A, Lim J, Patel VV, Rawji KS, Jensen SK, Teo W, Heyne B, Whitehead SN, Stys PK, Yong VW. Mechanisms of lysophosphatidylcholine-induced demyelination: A primary lipid disrupting myelinopathy. Glia 2017; 66:327-347. [PMID: 29068088 DOI: 10.1002/glia.23245] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/28/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
Abstract
For decades lysophosphatidylcholine (LPC, lysolecithin) has been used to induce demyelination, without a clear understanding of its mechanisms. LPC is an endogenous lysophospholipid so it may cause demyelination in certain diseases. We investigated whether known receptor systems, inflammation or nonspecific lipid disruption mediates LPC-demyelination in mice. We found that LPC nonspecifically disrupted myelin lipids. LPC integrated into cellular membranes and rapidly induced cell membrane permeability; in mice, LPC injury was phenocopied by other lipid disrupting agents. Interestingly, following its injection into white matter, LPC was cleared within 24 hr but by five days there was an elevation of endogenous LPC that was not associated with damage. This elevation of LPC in the absence of injury raises the possibility that the brain has mechanisms to buffer LPC. In support, LPC injury in culture was significantly ameliorated by albumin buffering. These results shed light on the mechanisms of LPC injury and homeostasis.
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Affiliation(s)
- Jason R Plemel
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Nathan J Michaels
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Nina Weishaupt
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A5C1, Canada
| | - Andrew V Caprariello
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Michael B Keough
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - James A Rogers
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Aran Yukseloglu
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Jaehyun Lim
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Vikas V Patel
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A5C1, Canada
| | - Khalil S Rawji
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Samuel K Jensen
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Wulin Teo
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Belinda Heyne
- Department of Chemistry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A5C1, Canada
| | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
| | - V Wee Yong
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N4N4, Canada
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248
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Abstract
Highly effective anti-inflammatory therapies have so far been developed for patients with relapsing/remitting multiple sclerosis, which also show some benefits in the early progressive stage of the disease. However, treatment options for patients, who have entered the progressive phase, are still limited. Disease starts as an inflammatory process, which induces focal demyelinating lesions in the gray and white matter. This stage of the disease dominates in the relapsing phase, extends into the early stages of progressive disease, and can be targeted by current anti-inflammatory treatments. In parallel, inflammation accumulates behind a closed or repaired blood brain barrier, and this process peaks in the late relapsing and early progressive stage and then declines. Some data suggest that this process may be targeted by immune ablation and hematopoietic stem cell transplantation. In the late stage, inflammation may decline to levels seen in age-matched controls, but age and disease burden–related neurodegeneration ensues. Such neurodegeneration affects the damaged brain and spinal cord, in which functional reserve capacity is exhausted, giving rise to further disability progression. Anti-inflammatory treatments are unlikely to be beneficial in this stage of the disease, but neuroprotective and repair-inducing strategies may still be effective.
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Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Wien, Austria
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249
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Abstract
Understanding the clinico-radiological paradox is important in the search for more sensitive and specific surrogates of relapses and disability progression (such that they can be used to inform treatment choices in individual people with multiple sclerosis) and to gain a better understanding of the pathophysiological basis of disability in multiple sclerosis (to identify and assess key therapeutic targets). In this brief review, we will consider themes and issues underlying the clinico-radiological paradox and recent advances in its resolution.
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Affiliation(s)
- Declan Chard
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH), Biomedical Research Centre, London, UK.,NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - S Anand Trip
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH), Biomedical Research Centre, London, UK.,NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
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250
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Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis. Clin Sci (Lond) 2017; 131:2503-2524. [PMID: 29026001 DOI: 10.1042/cs20170981] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022]
Abstract
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.
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