251
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Lorefice L, Coghe G, Fenu G, Porta M, Pilloni G, Frau J, Corona F, Sechi V, Barracciu MA, Marrosu MG, Pau M, Cocco E. 'Timed up and go' and brain atrophy: a preliminary MRI study to assess functional mobility performance in multiple sclerosis. J Neurol 2017; 264:2201-2204. [PMID: 28894919 DOI: 10.1007/s00415-017-8612-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Abstract
Motor and cognitive disabilities are related to brain atrophy in multiple sclerosis (MS). 'Timed up and go' (TUG) has been recently tested in MS as functional mobility test, as it is able to evaluate ambulation/coordination-related tasks, as well as cognitive function related to mobility. The objective of this study is to evaluate the relationship between brain volumes and TUG performances. Inclusion criteria were a diagnosis of MS and the ability to walk at least 20 m. TUG was performed using a wearable inertial sensor. Times and velocities of TUG sub-phases were calculated by processing trunk acceleration data. Patients underwent to a brain MRI, and volumes of whole brain, white matter (WM), grey matter (GM), and cortical GM (C) were estimated with SIENAX. Sixty patients were enrolled. Mean age was 41.5 ± 11.6 years and mean EDSS 2.3 ± 1.2. Total TUG duration was correlated to lower WM (ρ = 0.358, p = 0.005) and GM (ρ = 0.309, p = 0.017) volumes. A stronger association with lower GM volume was observed for intermediate (ρ = 0.427, p = 0.001) and final turning (ρ = 0.390, p = 0.002). TUG is a useful tool in a clinical setting as it can not only evaluate patients' disability in terms of impaired functional mobility, but also estimate pathological features, such as grey atrophy.
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Affiliation(s)
- Lorena Lorefice
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy.
| | - G Coghe
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - G Fenu
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - M Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - G Pilloni
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - F Corona
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - V Sechi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M G Marrosu
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - M Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
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252
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Zrzavy T, Hametner S, Wimmer I, Butovsky O, Weiner HL, Lassmann H. Loss of 'homeostatic' microglia and patterns of their activation in active multiple sclerosis. Brain 2017; 140:1900-1913. [PMID: 28541408 PMCID: PMC6057548 DOI: 10.1093/brain/awx113] [Citation(s) in RCA: 411] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/19/2017] [Indexed: 02/07/2023] Open
Abstract
Microglia and macrophages accumulate at the sites of active demyelination and neurodegeneration in the multiple sclerosis brain and are thought to play a central role in the disease process. We used recently described markers to characterize the origin and functional states of microglia/macrophages in acute, relapsing and progressive multiple sclerosis. We found microglia activation in normal white matter of controls and that the degree of activation increased with age. This microglia activation was more pronounced in the normal-appearing white matter of patients in comparison to controls and increased with disease duration. In contrast to controls, the normal-appearing white matter of patients with multiple sclerosis showed a significant reduction of P2RY12, a marker expressed in homeostatic microglia in rodents, which was completely lost in active and slowly expanding lesions. Early stages of demyelination and neurodegeneration in active lesions contained microglia with a pro-inflammatory phenotype, which expressed molecules involved in phagocytosis, oxidative injury, antigen presentation and T cell co-stimulation. In later stages, the microglia and macrophages in active lesions changed to a phenotype that was intermediate between pro- and anti-inflammatory activation. In inactive lesions, the density of microglia/macrophages was significantly reduced and microglia in part converted to a P2RY12+ phenotype. Analysis of TMEM119, which is expressed on microglia but not on recruited macrophages, demonstrated that on average 45% of the macrophage-like cells in active lesions were derived from the resident microglia pool. Our study demonstrates the loss of the homeostatic microglial signature in active multiple sclerosis with restoration associated with disease inactivity.
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Affiliation(s)
- Tobias Zrzavy
- Center for Brain Research, Medical University of Vienna, Austria
| | - Simon Hametner
- Center for Brain Research, Medical University of Vienna, Austria
| | - Isabella Wimmer
- Center for Brain Research, Medical University of Vienna, Austria
| | - Oleg Butovsky
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Austria
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253
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Louapre C, Govindarajan ST, Giannì C, Madigan N, Sloane JA, Treaba CA, Herranz E, Kinkel RP, Mainero C. Heterogeneous pathological processes account for thalamic degeneration in multiple sclerosis: Insights from 7 T imaging. Mult Scler 2017; 24:1433-1444. [PMID: 28803512 DOI: 10.1177/1352458517726382] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thalamic degeneration impacts multiple sclerosis (MS) prognosis. OBJECTIVE To investigate heterogeneous thalamic pathology, its correlation with white matter (WM), cortical lesions and thickness, and as function of distance from cerebrospinal fluid (CSF). METHODS In 41 MS subjects and 17 controls, using 3 and 7 T imaging, we tested for (1) differences in thalamic volume and quantitative T2* (q-T2*) (2) globally and (3) within concentric bands originating from the CSF/thalamus interface; (4) the relation between thalamic, cortical, and WM metrics; and (5) the contribution of magnetic resonance imaging (MRI) metrics to clinical scores. We also assessed MS thalamic lesion distribution as a function of distance from CSF. RESULTS Thalamic lesions were mainly located next to the ventricles. Thalamic volume was decreased in MS versus controls ( p < 10-2); global q-T2* was longer in secondary progressive multiple sclerosis (SPMS) only ( p < 10-2), indicating myelin and/or iron loss. Thalamic atrophy and longer q-T2* correlated with WM lesion volume ( p < 0.01). In relapsing-remitting MS, q-T2* thalamic abnormalities were located next to the WM ( p < 0.01 (uncorrected), p = 0.09 (corrected)), while they were homogeneously distributed in SPMS. Cortical MRI metrics were the strongest predictors of clinical outcome. CONCLUSION Heterogeneous pathological processes affect the thalamus in MS. While focal lesions are likely mainly driven by CSF-mediated factors, overall thalamic degeneration develops in association with WM lesions.
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Affiliation(s)
- Céline Louapre
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Sindhuja T Govindarajan
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Costanza Giannì
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Nancy Madigan
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jacob A Sloane
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Constantina A Treaba
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Elena Herranz
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Revere P Kinkel
- Department of Neuroscience, University of California San Diego, San Diego, CA, USA
| | - Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
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254
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Lisak RP, Nedelkoska L, Benjamins JA, Schalk D, Bealmear B, Touil H, Li R, Muirhead G, Bar-Or A. B cells from patients with multiple sclerosis induce cell death via apoptosis in neurons in vitro. J Neuroimmunol 2017; 309:88-99. [DOI: 10.1016/j.jneuroim.2017.05.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/26/2022]
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255
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Metabolomic analysis identifies altered metabolic pathways in Multiple Sclerosis. Int J Biochem Cell Biol 2017; 93:148-155. [PMID: 28720279 DOI: 10.1016/j.biocel.2017.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/17/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis (MS) is a chronic, demyelinating disease that affects the central nervous system and is characterized by a complex pathogenesis and difficult management. The identification of new biomarkers would be clinically useful for more accurate diagnoses and disease monitoring. Metabolomics, the identification of small endogenous molecules, offers an instantaneous molecular snapshot of the MS phenotype. Here the metabolomic profiles (utilizing plasma from patients with MS) were characterized with a Gas cromatography-mass spectrometry-based platform followed by a multivariate statistical analysis and comparison with a healthy control (HC) population. The obtained partial least square discriminant analysis (PLS-DA) model identified and validated significant metabolic differences between individuals with MS and HC (R2X=0.223, R2Y=0.82, Q2=0.562; p<0.001). Among discriminant metabolites phosphate, fructose, myo-inositol, pyroglutamate, threonate, l-leucine, l-asparagine, l-ornithine, l-glutamine, and l-glutamate were correctly identified, and some resulted as unknown. A receiver operating characteristic (ROC) curve with AUC 0.84 (p=0.01; CI: 0.75-1) generated with the concentrations of the discriminant metabolites, supported the strength of the model. Pathway analysis indicated asparagine and citrulline biosynthesis as the main canonical pathways involved in MS. Changes in the citrulline biosynthesis pathway suggests the involvement of oxidative stress during neuronal damage. The results confirmed metabolomics as a useful approach to better understand the pathogenesis of MS and to provide new biomarkers for the disease to be used together with clinical data.
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256
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Kavčič A, Hofmann WE. Unprovoked seizures in multiple sclerosis: Why are they rare? Brain Behav 2017; 7:e00726. [PMID: 28729933 PMCID: PMC5516601 DOI: 10.1002/brb3.726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/19/2017] [Accepted: 03/31/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The frequency of seizures in patients with multiple sclerosis (MS) ranges from 1.5% to 7.8% and is considerably more common than chance events. The etiopathogenesis of seizures in MS is still poorly understood. METHOD A review of the literature on seizures and MS using PubMed. RESULTS Cortical gray matter involvement appears to be an all-too-common pathological finding in MS to play a primary role in the pathogenesis of seizures in MS patients. There is no clear relationship between seizures and the severity of MS. In approximately 10% of cases, a seizure is actually an initial neurological symptom of MS. CONCLUSION Searching for coherence in the occurrence of unprovoked seizures in MS directs attention to the dichotomy in MS pathology characterized by a complex intertwining of neuroinflammatory and neurodegenerative processes. The appearance (or nonappearance) of seizures in MS in relation to disease activity and disease progression indicates a distinct clinical phenotype of MS that opens up new perspectives in MS research.
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Affiliation(s)
- Anamarija Kavčič
- Gemeinschaftspraxis Dr. Hofmann & Olschewski Aschaffenburg Germany
| | - Werner E Hofmann
- Gemeinschaftspraxis Dr. Hofmann & Olschewski Aschaffenburg Germany
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257
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Lagumersindez-Denis N, Wrzos C, Mack M, Winkler A, van der Meer F, Reinert MC, Hollasch H, Flach A, Brühl H, Cullen E, Schlumbohm C, Fuchs E, Linington C, Barrantes-Freer A, Metz I, Wegner C, Liebetanz D, Prinz M, Brück W, Stadelmann C, Nessler S. Differential contribution of immune effector mechanisms to cortical demyelination in multiple sclerosis. Acta Neuropathol 2017; 134:15-34. [PMID: 28386765 PMCID: PMC5486638 DOI: 10.1007/s00401-017-1706-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/08/2017] [Accepted: 03/25/2017] [Indexed: 12/16/2022]
Abstract
Cortical demyelination is a widely recognized hallmark of multiple sclerosis (MS) and correlate of disease progression and cognitive decline. The pathomechanisms initiating and driving gray matter damage are only incompletely understood. Here, we determined the infiltrating leukocyte subpopulations in 26 cortical demyelinated lesions of biopsied MS patients and assessed their contribution to cortical lesion formation in a newly developed mouse model. We find that conformation-specific anti-myelin antibodies contribute to cortical demyelination even in the absence of the classical complement pathway. T cells and natural killer cells are relevant for intracortical type 2 but dispensable for subpial type 3 lesions, whereas CCR2+ monocytes are required for both. Depleting CCR2+ monocytes in marmoset monkeys with experimental autoimmune encephalomyelitis using a novel humanized CCR2 targeting antibody translates into significantly less cortical demyelination and disease severity. We conclude that biologics depleting CCR2+ monocytes might be attractive candidates for preventing cortical lesion formation and ameliorating disease progression in MS.
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258
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Danikowski KM, Jayaraman S, Prabhakar BS. Regulatory T cells in multiple sclerosis and myasthenia gravis. J Neuroinflammation 2017; 14:117. [PMID: 28599652 PMCID: PMC5466736 DOI: 10.1186/s12974-017-0892-8] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/29/2017] [Indexed: 01/09/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic debilitating disease of the central nervous system primarily mediated by T lymphocytes with specificity to neuronal antigens in genetically susceptible individuals. On the other hand, myasthenia gravis (MG) primarily involves destruction of the neuromuscular junction by antibodies specific to the acetylcholine receptor. Both autoimmune diseases are thought to result from loss of self-tolerance, which allows for the development and function of autoreactive lymphocytes. Although the mechanisms underlying compromised self-tolerance in these and other autoimmune diseases have not been fully elucidated, one possibility is numerical, functional, and/or migratory deficits in T regulatory cells (Tregs). Tregs are thought to play a critical role in the maintenance of peripheral immune tolerance. It is believed that Tregs function by suppressing the effector CD4+ T cell subsets that mediate autoimmune responses. Dysregulation of suppressive and migratory markers on Tregs have been linked to the pathogenesis of both MS and MG. For example, genetic abnormalities have been found in Treg suppressive markers CTLA-4 and CD25, while others have shown a decreased expression of FoxP3 and IL-10. Furthermore, elevated levels of pro-inflammatory cytokines such as IL-6, IL-17, and IFN-γ secreted by T effectors have been noted in MS and MG patients. This review provides several strategies of treatment which have been shown to be effective or are proposed as potential therapies to restore the function of various Treg subsets including Tr1, iTr35, nTregs, and iTregs. Strategies focusing on enhancing the Treg function find importance in cytokines TGF-β, IDO, interleukins 10, 27, and 35, and ligands Jagged-1 and OX40L. Likewise, strategies which affect Treg migration involve chemokines CCL17 and CXCL11. In pre-clinical animal models of experimental autoimmune encephalomyelitis (EAE) and experimental autoimmune myasthenia gravis (EAMG), several strategies have been shown to ameliorate the disease and thus appear promising for treating patients with MS or MG.
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Affiliation(s)
- K M Danikowski
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - S Jayaraman
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - B S Prabhakar
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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259
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Harrison DM, Wang KY, Fiol J, Naunton K, Royal W, Hua J, Izbudak I. Leptomeningeal Enhancement at 7T in Multiple Sclerosis: Frequency, Morphology, and Relationship to Cortical Volume. J Neuroimaging 2017; 27:461-468. [PMID: 28464368 DOI: 10.1111/jon.12444] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Perform an investigation of the frequency and distribution of leptomeningeal enhancement on postgadolinium magnetization-prepared FLAIR (MPFLAIR) in multiple sclerosis (MS) on 7 Tesla (7T) MRI and to relate this finding to measures of brain structure and lesion volumes. METHODS Twenty-nine participants with MS underwent 7T MRI of the brain. Three healthy volunteers (HVs) were scanned for comparison. Areas of postcontrast leptomeningeal enhancement were identified. Images were segmented for brain structure and lesion volumes. The relationship between leptomeningeal enhancement and clinical and volumetric data was explored. RESULTS Two patterns of enhancement were found: "nodular" (discrete, spherical nodules at the pial surface or subarachnoid space) and "spread/fill" (appearance of contrast spread through the local subarachnoid space). Twenty-six of 29 (90%) MS participants had at least one focus of leptomeningeal enhancement. Nodular foci were present in 15 of 29 (51%) MS participants. Spread/fill foci were present in 22 of 29 (76%) MS participants. Two HVs had examples of nodular foci, but none had spread/fill enhancement. MS participants with spread/fill foci were older (48.9 years [SD 8.3]) than those without (33.3 years [SD 11.5], P = .005). MS participants with spread/fill foci had reduced cortical gray matter volume compared to those without (P = .020). CONCLUSIONS Leptomeningeal enhancement on postcontrast 7T MPFLAIR is more prevalent than prior reports at 3T-occurring at frequencies closer to histopathologic data. Spread/fill foci are associated with reduced cortical gray matter volumes and may represent blood-meningeal barrier breakdown near sites of meningeal inflammation, whereas nodular foci may be a normal variant.
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Affiliation(s)
- Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Kevin Y Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Julie Fiol
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kerry Naunton
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Walter Royal
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Jun Hua
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Izlem Izbudak
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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260
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Geraldes R, Esiri MM, DeLuca GC, Palace J. Age-related small vessel disease: a potential contributor to neurodegeneration in multiple sclerosis. Brain Pathol 2017; 27:707-722. [PMID: 27864848 DOI: 10.1111/bpa.12460] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system wherein, after an initial phase of transient neurological defects, slow neurological deterioration due to progressive neuronal loss ensues. Age is a major determinant of MS progression onset and disability. Over the past years, several mechanisms have been proposed to explain the key drivers of neurodegeneration and disability accumulation in MS. However, the effect of commonly encountered age-related cerebral vessel disease, namely small vessel disease (SVD), has been largely neglected and constitutes the aim of this review. SVD shares some features with MS, that is, white matter demyelination and brain atrophy, and has been shown to contribute to the neuronal damage seen in vascular cognitive impairment. Several lines of evidence suggest that an interaction between MS and SVD may influence MS-related neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular reactivity and tissue hypoxia, features seen in MS. Venule and endothelium abnormalities have been documented in MS but the role of arterioles and of other neurovascular unit structures, such as the pericyte, has not been explored. Vascular risk factors (VRF) have recently been associated with faster progression in MS, though the mechanisms are unclear since very few studies have addressed the impact of VRF and SVD on MS imaging and pathology outcomes. Therapeutic agents targeting the microvasculature and the neurovascular unit may impact both SVD and MS and may benefit patients with dual pathology.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Margaret M Esiri
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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261
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Farina G, Magliozzi R, Pitteri M, Reynolds R, Rossi S, Gajofatto A, Benedetti MD, Facchiano F, Monaco S, Calabrese M. Increased cortical lesion load and intrathecal inflammation is associated with oligoclonal bands in multiple sclerosis patients: a combined CSF and MRI study. J Neuroinflammation 2017; 14:40. [PMID: 28222766 PMCID: PMC5319028 DOI: 10.1186/s12974-017-0812-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although IgG oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) are a frequent phenomenon in multiple sclerosis (MS) patients, their relationship with grey matter lesions, intrathecal/meningeal inflammation and clinical evolution has not been clarified yet. The aim of our study was to assess the relationship between the OCBs, the inflammatory/neurodegenerative CSF profile at diagnosis, the cortical lesion load and the clinical evolution after 10 years. METHODS This is a 10-year observational, cross-sectional study based on a combined MRI, cognitive and CSF profiling of the examined patients. Forty consecutive OCB-negative (OCB-) and 50 OCB-positive (OCB+) MS patients were included in this study. Both groups had mean disease duration of 10 years and were age and gender matched. Each patient underwent neurological and neuropsychological evaluation and 3-T MRI. Analysis of the presence and levels of 28 inflammatory mediators was performed in the CSF obtained from 10 OCB- MS, 11 OCB+ MS and 10 patients with other neurological conditions. RESULTS Increased number of CLs was found in OCB+ compared to OCB- patients (p < 0.0001), whereas no difference was found in white matter lesion (WML) load (p = 0.36). The occurrence of OCB was also associated with increased levels of neurofilament light chains and of several inflammatory mediators linked to B lymphocyte activity and lymphoid-neogenesis (CXCL13, CXCL12, CXCL10, TNFSF13, TNFSF13B, IL6, IL10) and other pro-inflammatory molecules, such as IFN-γ, TNF, MMP2, GM-CSF, osteopontin and sCD163. Finally, the occurrence of OCB was found associated with poor prognosis, from both physical and cognitive points of view. CONCLUSIONS OCB at MS onset are associated with more severe GM pathology and with a more severe physical disability and cognitive impairment after 10 years. Increased levels of cytokines linked to B cell activation, lymphoid-neogenesis, and pro-inflammatory immune response in the CSF of OCB+ patients support the hypothesis of crucial role played by compartmentalized, intrathecal B cell response in the pathogenesis of CLs and OCB production.
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Affiliation(s)
- Gabriele Farina
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Unit of Neurology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Roberta Magliozzi
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Marco Pitteri
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stefania Rossi
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Department EOMM, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Gajofatto
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Maria Donata Benedetti
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | | | - Salvatore Monaco
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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262
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Lassmann H, Bradl M. Multiple sclerosis: experimental models and reality. Acta Neuropathol 2017; 133:223-244. [PMID: 27766432 PMCID: PMC5250666 DOI: 10.1007/s00401-016-1631-4] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 01/01/2023]
Abstract
One of the most frequent statements, provided in different variations in the introduction of experimental studies on multiple sclerosis (MS), is that "Multiple sclerosis is a demyelinating autoimmune disease and experimental autoimmune encephalomyelitis (EAE) is a suitable model to study its pathogenesis". However, so far, no single experimental model covers the entire spectrum of the clinical, pathological, or immunological features of the disease. Many different models are available, which proved to be highly useful for studying different aspects of inflammation, demyelination, remyelination, and neurodegeneration in the central nervous system. However, the relevance of results from such models for MS pathogenesis has to be critically validated. Current EAE models are mainly based on inflammation, induced by auto-reactive CD4+ T-cells, and these models reflect important aspects of MS. However, pathological data and results from clinical trials in MS indicate that CD8+ T-cells and B-lymphocytes may play an important role in propagating inflammation and tissue damage in established MS. Viral models may reflect key features of MS-like inflammatory demyelination, but are difficult to use due to their very complex pathogenesis, involving direct virus-induced and immune-mediated mechanisms. Furthermore, evidence for a role of viruses in MS pathogenesis is indirect and limited, and an MS-specific virus infection has not been identified so far. Toxic models are highly useful to unravel mechanisms of de- and remyelination, but do not reflect other important aspects of MS pathology and pathogenesis. For all these reasons, it is important to select the right experimental model to answer specific questions in MS research.
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Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
| | - Monika Bradl
- Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria
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263
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Kawachi I, Lassmann H. Neurodegeneration in multiple sclerosis and neuromyelitis optica. J Neurol Neurosurg Psychiatry 2017; 88:137-145. [PMID: 27671902 DOI: 10.1136/jnnp-2016-313300] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022]
Abstract
Multiple sclerosis (MS) and neuromyelitis optica (NMO) are autoimmune demyelinating diseases of the central nervous system (CNS), having distinct immunological and pathological features. They have two pathogenic components, 'inflammation' and 'neurodegeneration', with different degrees of severity and pathogenetic mechanisms. The target antigen of autoimmunity in NMO is the water channel aquaporin-4 (AQP4), and antibodies directed against this antigen result in astrocyte damage. MS is a disease primarily affecting myelin and oligodendrocytes, but thus far, no MS-specific autoantigen has been identified. The distinct inflammatory processes in these diseases may trigger cascades of events leading to disease-specific neurodegeneration. Damage of the CNS tissue appears to be amplified by mechanisms that are in part shared by the two conditions and involve oxidative burst activation in microglia/macrophages, mitochondrial damage and axonal energy failure, Wallerian degeneration and meningeal inflammation. However, they appear to differ regarding the nature of the inflammatory response, the type and extent of cortical injury, and the type of astrocyte reaction and damage. Here, we provide a detailed comparison of the pathology between MS and NMO, which may help to define shared and disease-specific mechanisms of neurodegeneration in these diseases.
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Affiliation(s)
- Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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264
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Nakahara J. Remyelination in multiple sclerosis: Pathology and treatment strategies. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jin Nakahara
- Departments of Neurology; Keio University School of Medicine; Tokyo Japan
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265
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Shahsavar F, Mapar S, Ahmadi SAY. Multiple sclerosis is accompanied by lack of KIR2DS1 gene: A meta-analysis. GENOMICS DATA 2016; 10:75-78. [PMID: 27747156 PMCID: PMC5054263 DOI: 10.1016/j.gdata.2016.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 01/23/2023]
Abstract
Multiple sclerosis (MS) is a disease in which we can recognize destruction of the myelin that is around nerve cells of brain and spinal cord called as oligodendrocytes. Both genetic and environmental factors play roles in MS. One of these genes is the killer-cell immunoglobulin-like receptor (KIR) which expressed on surface of natural killer cells (NKs). These genes have loci (not locus) in human genome, so they inherit as haplotypes. The results of previous studies show that different genes of KIR may affect both susceptibility and resistance to such autoimmune disorders that their pathogenesis in MS is still unclear. Since NKs play key roles in immune tolerance, we intend to perform a meta-analysis for the correlation of KIR genes and MS. We used the software comprehensive meta-analysis for data of totally 568 MS patients and 280 controls. Among the 14 genes of KIR in the human genome, lack of KIR2DS1 is accompanied by MS. No KIR gene found to be a risk factor for MS. Further studies on other molecules of NKs like CD94 and NKG2a is suggested.
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Affiliation(s)
- Farhad Shahsavar
- Associate Professor, Department of Immunology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Shaghayegh Mapar
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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266
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Jellinger KA, Wenning GK. Overlaps between multiple system atrophy and multiple sclerosis: A novel perspective. Mov Disord 2016; 31:1767-1771. [DOI: 10.1002/mds.26870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/30/2016] [Accepted: 10/02/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Gregor K. Wenning
- Division of Clinical Neurobiology, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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267
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Stephan KE, Manjaly ZM, Mathys CD, Weber LAE, Paliwal S, Gard T, Tittgemeyer M, Fleming SM, Haker H, Seth AK, Petzschner FH. Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression. Front Hum Neurosci 2016; 10:550. [PMID: 27895566 PMCID: PMC5108808 DOI: 10.3389/fnhum.2016.00550] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023] Open
Abstract
This paper outlines a hierarchical Bayesian framework for interoception, homeostatic/allostatic control, and meta-cognition that connects fatigue and depression to the experience of chronic dyshomeostasis. Specifically, viewing interoception as the inversion of a generative model of viscerosensory inputs allows for a formal definition of dyshomeostasis (as chronically enhanced surprise about bodily signals, or, equivalently, low evidence for the brain's model of bodily states) and allostasis (as a change in prior beliefs or predictions which define setpoints for homeostatic reflex arcs). Critically, we propose that the performance of interoceptive-allostatic circuitry is monitored by a metacognitive layer that updates beliefs about the brain's capacity to successfully regulate bodily states (allostatic self-efficacy). In this framework, fatigue and depression can be understood as sequential responses to the interoceptive experience of dyshomeostasis and the ensuing metacognitive diagnosis of low allostatic self-efficacy. While fatigue might represent an early response with adaptive value (cf. sickness behavior), the experience of chronic dyshomeostasis may trigger a generalized belief of low self-efficacy and lack of control (cf. learned helplessness), resulting in depression. This perspective implies alternative pathophysiological mechanisms that are reflected by differential abnormalities in the effective connectivity of circuits for interoception and allostasis. We discuss suitably extended models of effective connectivity that could distinguish these connectivity patterns in individual patients and may help inform differential diagnosis of fatigue and depression in the future.
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Affiliation(s)
- Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Wellcome Trust Centre for Neuroimaging, University College LondonLondon, UK; Max Planck Institute for Metabolism ResearchCologne, Germany
| | - Zina M Manjaly
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Department of Neurology, Schulthess ClinicZurich, Switzerland
| | - Christoph D Mathys
- Wellcome Trust Centre for Neuroimaging, University College London London, UK
| | - Lilian A E Weber
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Saee Paliwal
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Tim Gard
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Center for Complementary and Integrative Medicine, University Hospital ZurichZurich, Switzerland
| | | | - Stephen M Fleming
- Wellcome Trust Centre for Neuroimaging, University College London London, UK
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Anil K Seth
- Sackler Centre for Consciousness Science, School of Engineering and Informatics, University of Sussex Brighton, UK
| | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
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268
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Guise C, Fernandes MM, Nóbrega JM, Pathak S, Schneider W, Fangueiro R. Hollow Polypropylene Yarns as a Biomimetic Brain Phantom for the Validation of High-Definition Fiber Tractography Imaging. ACS APPLIED MATERIALS & INTERFACES 2016; 8:29960-29967. [PMID: 27723307 DOI: 10.1021/acsami.6b09809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Current brain imaging methods largely fail to provide detailed information about the location and severity of axonal injuries and do not anticipate recovery of the patients with traumatic brain injury. High-definition fiber tractography appears as a novel imaging modality based on water motion in the brain that allows for direct visualization and quantification of the degree of axons damage, thus predicting the functional deficits due to traumatic axonal injury and loss of cortical projections. This neuroimaging modality still faces major challenges because it lacks a "gold standard" for the technique validation and respective quality control. The present work aims to study the potential of hollow polypropylene yarns to mimic human white matter axons and construct a brain phantom for the calibration and validation of brain diffusion techniques based on magnetic resonance imaging, including high-definition fiber tractography imaging. Hollow multifilament polypropylene yarns were produced by melt-spinning process and characterized in terms of their physicochemical properties. Scanning electronic microscopy images of the filaments cross section has shown an inner diameter of approximately 12 μm, confirming their appropriateness to mimic the brain axons. The chemical purity of polypropylene yarns as well as the interaction between the water and the filament surface, important properties for predicting water behavior and diffusion inside the yarns, were also evaluated. Restricted and hindered water diffusion was confirmed by fluorescence microscopy. Finally, the yarns were magnetic resonance imaging scanned and analyzed using high-definition fiber tractography, revealing an excellent choice of these hollow polypropylene structures for simulation of the white matter brain axons and their suitability for constructing an accurate brain phantom.
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Affiliation(s)
- Catarina Guise
- Centre for Textile Science and Technology (2C2T), University of Minho , Campus de Azurém, 4800-058 Guimarães, Portugal
| | - Margarida M Fernandes
- Centre for Textile Science and Technology (2C2T), University of Minho , Campus de Azurém, 4800-058 Guimarães, Portugal
| | - João M Nóbrega
- Institute for Polymers and Composites/I3N, University of Minho , Campus of Azurém, 4800-058 Guimarães, Portugal
| | - Sudhir Pathak
- Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania 15260, United States
| | - Walter Schneider
- Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania 15260, United States
| | - Raul Fangueiro
- Centre for Textile Science and Technology (2C2T), University of Minho , Campus de Azurém, 4800-058 Guimarães, Portugal
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269
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Pardini M, Sudre CH, Prados F, Yaldizli Ö, Sethi V, Muhlert N, Samson RS, van de Pavert SH, Cardoso MJ, Ourselin S, Gandini Wheeler-Kingshott CAM, Miller DH, Chard DT. Relationship of grey and white matter abnormalities with distance from the surface of the brain in multiple sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:1212-1217. [PMID: 27601434 DOI: 10.1136/jnnp-2016-313979] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/14/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the association between proximity to the inner (ventricular and aqueductal) and outer (pial) surfaces of the brain and the distribution of normal appearing white matter (NAWM) and grey matter (GM) abnormalities, and white matter (WM) lesions, in multiple sclerosis (MS). METHODS 67 people with relapse-onset MS and 30 healthy controls were included in the study. Volumetric T1 images and high-resolution (1 mm3) magnetisation transfer ratio (MTR) images were acquired and segmented into 12 bands between the inner and outer surfaces of the brain. The first and last bands were discarded to limit partial volume effects with cerebrospinal fluid. MTR values were computed for all bands in supratentorial NAWM, cerebellar NAWM and brainstem NA tissue, and deep and cortical GM. Band WM lesion volumes were also measured. RESULTS Proximity to the ventricular surfaces was associated with progressively lower MTR values in the MS group but not in controls in supratentorial and cerebellar NAWM, brainstem NA and in deep and cortical GM. The density of WM lesions was associated with proximity to the ventricles only in the supratentorial compartment, and no link was found with distance from the pial surfaces. CONCLUSIONS In MS, MTR abnormalities in NAWM and GM are related to distance from the inner and outer surfaces of the brain, and this suggests that there is a common factor underlying their spatial distribution. A similar pattern was not found for WM lesions, raising the possibility that different factors promote their formation.
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Affiliation(s)
- Matteo Pardini
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Carole H Sudre
- Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, London, UK Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Ferran Prados
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Özgür Yaldizli
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Varun Sethi
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - Nils Muhlert
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK School of Psychological Sciences, University of Manchester, Manchester UK
| | - Rebecca S Samson
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - Steven H van de Pavert
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - M Jorge Cardoso
- Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, London, UK Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Sebastien Ourselin
- Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, London, UK Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK Brain MRI 3T Center, C. Mondino National Neurological Institute, Pavia, Italy Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - David H Miller
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Declan T Chard
- Department of Neuroinflammation, NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
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270
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Moreno Torres I, García-Merino A. Anti-CD20 monoclonal antibodies in multiple sclerosis. Expert Rev Neurother 2016; 17:359-371. [DOI: 10.1080/14737175.2017.1245616] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Irene Moreno Torres
- Neuroimmunology unit, Neurology department, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | - Antonio García-Merino
- Neuroimmunology unit, Neurology department, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
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271
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Bittner S, Ruck T, Wiendl H, Grauer OM, Meuth SG. Targeting B cells in relapsing-remitting multiple sclerosis: from pathophysiology to optimal clinical management. Ther Adv Neurol Disord 2016; 10:51-66. [PMID: 28450895 DOI: 10.1177/1756285616666741] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that is caused by an autoimmune response against central nervous system (CNS) structures. Traditionally considered a T-cell-mediated disorder, the contribution of B cells to the pathogenesis of MS has long been debated. Based on recent promising clinical results from CD20-depleting strategies by three therapeutic monoclonal antibodies in clinical phase II and III trials (rituximab, ocrelizumab and ofatumumab), targeting B cells in MS is currently attracting growing interest among basic researchers and clinicians. Many questions about the role of B and plasma cells in MS remain still unanswered, ranging from the role of specific B-cell subsets and functions to the optimal treatment regimen of B-cell depletion and monitoring thereafter. Here, we will assess our current knowledge of the mechanisms implicating B cells in multiple steps of disease pathology and examine current and future therapeutic approaches for the treatment of MS.
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Affiliation(s)
- Stefan Bittner
- Department of Neurology, University of Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Oliver M Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Münster, Germany
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272
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Lassmann H. Demyelination and neurodegeneration in multiple sclerosis: The role of hypoxia. Ann Neurol 2016; 79:520-1. [PMID: 26967708 DOI: 10.1002/ana.24632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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273
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Desai RA, Davies AL, Tachrount M, Kasti M, Laulund F, Golay X, Smith KJ. Cause and prevention of demyelination in a model multiple sclerosis lesion. Ann Neurol 2016; 79:591-604. [PMID: 26814844 PMCID: PMC4949637 DOI: 10.1002/ana.24607] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 12/24/2022]
Abstract
Objective Demyelination is a cardinal feature of multiple sclerosis, but it remains unclear why new lesions form, and whether they can be prevented. Neuropathological evidence suggests that demyelination can occur in the relative absence of lymphocytes, and with distinctive characteristics suggestive of a tissue energy deficit. The objective was to examine an experimental model of the early multiple sclerosis lesion and identify pathogenic mechanisms and opportunities for therapy. Methods Demyelinating lesions were induced in the rat spinal dorsal column by microinjection of lipopolysaccharide, and examined immunohistochemically at different stages of development. The efficacy of treatment with inspired oxygen for 2 days following lesion induction was evaluated. Results Demyelinating lesions were not centered on the injection site, but rather formed 1 week later at the white–gray matter border, preferentially including the ventral dorsal column watershed. Lesion formation was preceded by a transient early period of hypoxia and increased production of superoxide and nitric oxide. Oligodendrocyte numbers decreased at the site shortly afterward, prior to demyelination. Lesions formed at a site of inherent susceptibility to hypoxia, as revealed by exposure of naive animals to a hypoxic environment. Notably, raising the inspired oxygen (80%, normobaric) during the hypoxic period significantly reduced or prevented the demyelination. Interpretation Demyelination characteristic of at least some early multiple sclerosis lesions can arise at a vascular watershed following activation of innate immune mechanisms that provoke hypoxia, and superoxide and nitric oxide formation, all of which can compromise cellular energy sufficiency. Demyelination can be reduced or eliminated by increasing inspired oxygen to alleviate the transient hypoxia. Ann Neurol 2016;79:591–604
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Affiliation(s)
- Roshni A Desai
- Department of Neuroinflammation and Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - Andrew L Davies
- Department of Neuroinflammation and Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - Mohamed Tachrount
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Marianne Kasti
- Department of Neuroinflammation and Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - Frida Laulund
- Department of Neuroinflammation and Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Kenneth J Smith
- Department of Neuroinflammation and Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
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