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Kalia LV, Asis A, Arbour N, Bar-Or A, Bove R, Di Luca DG, Fon EA, Fox S, Gan-Or Z, Gommerman JL, Kang UJ, Klawiter EC, Koch M, Kolind S, Lang AE, Lee KK, Lincoln MR, MacDonald PA, McKeown MJ, Mestre TA, Miron VE, Ontaneda D, Rousseaux MWC, Schlossmacher MG, Schneider R, Stoessl AJ, Oh J. Disease-modifying therapies for Parkinson disease: lessons from multiple sclerosis. Nat Rev Neurol 2024:10.1038/s41582-024-01023-0. [PMID: 39375563 DOI: 10.1038/s41582-024-01023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 10/09/2024]
Abstract
The development of disease-modifying therapies (DMTs) for neurological disorders is an important goal in modern neurology, and the associated challenges are similar in many chronic neurological conditions. Major advances have been made in the multiple sclerosis (MS) field, with a range of DMTs being approved for relapsing MS and the introduction of the first DMTs for progressive MS. By contrast, people with Parkinson disease (PD) still lack such treatment options, relying instead on decades-old therapeutic approaches that provide only symptomatic relief. To address this unmet need, an in-person symposium was held in Toronto, Canada, in November 2022 for international researchers and experts in MS and PD to discuss strategies for advancing DMT development. In this Roadmap article, we highlight discussions from the symposium, which focused on therapeutic targets and preclinical models, disease spectra and subclassifications, and clinical trial design and outcome measures. From these discussions, we propose areas for novel or deeper exploration in PD using lessons learned from therapeutic development in MS. In addition, we identify challenges common to the PD and MS fields that need to be addressed to further advance the discovery and development of effective DMTs.
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Affiliation(s)
- Lorraine V Kalia
- Edmond J Safra Program in Parkinson's Disease, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Nathalie Arbour
- Department of Neurosciences, Université de Montreal, Montreal, Quebec, Canada
- Centre de Recherche du CHUM (CRCHUM), Montreal, Quebec, Canada
| | - Amit Bar-Or
- Division of MS and Related Disorders, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Centre for Neuroinflammation and Experimental Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel G Di Luca
- Edmond J Safra Program in Parkinson's Disease, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Edward A Fon
- The Neuro (Montreal Neurological Institute-Hospital), Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Susan Fox
- Edmond J Safra Program in Parkinson's Disease, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Jennifer L Gommerman
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Un Jung Kang
- Department of Neurology, Grossman School of Medicine, NYU Langone Health, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, Grossman School of Medicine, NYU Langone Health, New York, NY, USA
- Fresco Institute for Parkinson's and Movement Disorders, Grossman School of Medicine, NYU Langone Health, New York, NY, USA
- Department of Neuroscience and Physiology, Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcus Koch
- University of Calgary MS Clinic, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Matthew R Lincoln
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Barlo MS Centre, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Penny A MacDonald
- Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Clinic, Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Veronique E Miron
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- The United Kingdom Dementia Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Maxime W C Rousseaux
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael G Schlossmacher
- Parkinson's Disease and Movement Disorders Clinic, Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Raphael Schneider
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Barlo MS Centre, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Barlo MS Centre, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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2
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Rahdar S, Basir Z, Tabandeh MR, Ghotbeddin Z, Khazaeel K. Betaine alleviates cerebellar endoplasmic reticulum stress and oxidative imbalance in a cuprizone model of multiple sclerosis in rat. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03381-4. [PMID: 39249501 DOI: 10.1007/s00210-024-03381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/14/2024] [Indexed: 09/10/2024]
Abstract
Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system, especially the cerebellum, with numerous physical and mental symptoms. Oxidative stress caused by inflammation can play a role in the occurrence of this disease. Betaine, a natural methyl donor compound, has potent neuroprotective effects. Here, we investigated the effects of betaine on motor behavior, cerebellar histological changes, oxidative stress response, and endoplasmic reticulum stress in a cuprizone (CPZ)-induced multiple sclerosis model in male rats. Twenty Wistar adult male rats were randomly divided into four groups including control, MS, betaine-treated MS, and betaine groups. MS was induced by feeding animals with rodent chow containing 0.5% CPZ for 12 weeks. Betaine was daily administrated as 1% in drinking water for the last 6 weeks. The motor behavioral performance was evaluated by open field, rotarod, and reverse basket tests. Histological analysis of the cerebellum was performed by hematoxylin and eosin (H&E) and Cresyl violet (Nissl) staining. Oxidative stress factors (GSH, GSSG, GPX, GR, and GT) were assessed in the experimental groups and finally, the expression of ERS-associated proteins was measured using western blot analysis. Data showed that treatment with betaine could effectively prevent and reverse the adverse behavioral manifestation compared with the MS group. Betaine treatment protected cerebellar demyelination and neuron and Purkinje cell degeneration against CPZ-induced demyelination. Betaine attenuated the protein levels of ESR-related proteins in the cerebellum of MS rats and similarly increased the level of enzymes related to antioxidants in the cerebellum. Therefore, our results suggest that oral administration of betaine may be used as a novel adjunct therapy against cerebellar dysfunctions in an animal model of MS.
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Affiliation(s)
- Samaneh Rahdar
- Department of Basic Sciences, Division of Histology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Zahra Basir
- Department of Basic Sciences, Division of Histology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
| | - Mohammad Reza Tabandeh
- Department of Basic Sciences, Division of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Stem cells and Transgenic Technology Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Zohreh Ghotbeddin
- Stem cells and Transgenic Technology Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Department of Basic Sciences, Division of Physiology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Kaveh Khazaeel
- Stem cells and Transgenic Technology Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Department of Basic Sciences, Division of Anatomy and Embryology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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Fettig NM, Pu A, Osborne LC, Gommerman JL. The influence of aging and the microbiome in multiple sclerosis and other neurologic diseases. Immunol Rev 2024; 325:166-189. [PMID: 38890777 DOI: 10.1111/imr.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
The human gut microbiome is well-recognized as a key player in maintaining health. However, it is a dynamic entity that changes across the lifespan. How the microbial changes that occur in later decades of life shape host health or impact age-associated inflammatory neurological diseases such as multiple sclerosis (MS) is still unclear. Current understanding of the aging gut microbiome is largely limited to cross-sectional observational studies. Moreover, studies in humans are limited by confounding host-intrinsic and extrinsic factors that are not easily disentangled from aging. This review provides a comprehensive summary of existing literature on the aging gut microbiome and its known relationships with neurological diseases, with a specific focus on MS. We will also discuss preclinical animal models and human studies that shed light on the complex microbiota-host interactions that have the potential to influence disease pathology and progression in aging individuals. Lastly, we propose potential avenues of investigation to deconvolute features of an aging microbiota that contribute to disease, or alternatively promote health in advanced age.
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Affiliation(s)
- Naomi M Fettig
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lisa C Osborne
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
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Beck ES, Mullins WA, dos Santos Silva J, Filippini S, Parvathaneni P, Maranzano J, Morrison M, Suto DJ, Donnay C, Dieckhaus H, Luciano NJ, Sharma K, Gaitán MI, Liu J, de Zwart JA, van Gelderen P, Cortese I, Narayanan S, Duyn JH, Nair G, Sati P, Reich DS. Contribution of new and chronic cortical lesions to disability accrual in multiple sclerosis. Brain Commun 2024; 6:fcae158. [PMID: 38818331 PMCID: PMC11137753 DOI: 10.1093/braincomms/fcae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Cortical lesions are common in multiple sclerosis and are associated with disability and progressive disease. We asked whether cortical lesions continue to form in people with stable white matter lesions and whether the association of cortical lesions with worsening disability relates to pre-existing or new cortical lesions. Fifty adults with multiple sclerosis and no new white matter lesions in the year prior to enrolment (33 relapsing-remitting and 17 progressive) and a comparison group of nine adults who had formed at least one new white matter lesion in the year prior to enrolment (active relapsing-remitting) were evaluated annually with 7 tesla (T) brain MRI and 3T brain and spine MRI for 2 years, with clinical assessments for 3 years. Cortical lesions and paramagnetic rim lesions were identified on 7T images. Seven total cortical lesions formed in 3/30 individuals in the stable relapsing-remitting group (median 0, range 0-5), four total cortical lesions formed in 4/17 individuals in the progressive group (median 0, range 0-1), and 16 cortical lesions formed in 5/9 individuals in the active relapsing-remitting group (median 1, range 0-10, stable relapsing-remitting versus progressive versus active relapsing-remitting P = 0.006). New cortical lesions were not associated with greater change in any individual disability measure or in a composite measure of disability worsening (worsening Expanded Disability Status Scale or 9-hole peg test or 25-foot timed walk). Individuals with at least three paramagnetic rim lesions had a greater increase in cortical lesion volume over time (median 16 µl, range -61 to 215 versus median 1 µl, range -24 to 184, P = 0.007), but change in lesion volume was not associated with disability change. Baseline cortical lesion volume was higher in people with worsening disability (median 1010 µl, range 13-9888 versus median 267 µl, range 0-3539, P = 0.001, adjusted for age and sex) and in individuals with relapsing-remitting multiple sclerosis who subsequently transitioned to secondary progressive multiple sclerosis (median 2183 µl, range 270-9888 versus median 321 µl, range 0-6392 in those who remained relapsing-remitting, P = 0.01, adjusted for age and sex). Baseline white matter lesion volume was not associated with worsening disability or transition from relapsing-remitting to secondary progressive multiple sclerosis. Cortical lesion formation is rare in people with stable white matter lesions, even in those with worsening disability. Cortical but not white matter lesion burden predicts disability worsening, suggesting that disability progression is related to long-term effects of cortical lesions that form early in the disease, rather than to ongoing cortical lesion formation.
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Affiliation(s)
- Erin S Beck
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - W Andrew Mullins
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Stefano Filippini
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurosciences, Drug, and Child Health, University of Florence, Florence 50121, Italy
| | - Prasanna Parvathaneni
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
- Department of Anatomy, University of Quebec, Trois-Rivieres, QC G9A5H7, Canada
| | - Mark Morrison
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel J Suto
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Corinne Donnay
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Henry Dieckhaus
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicholas J Luciano
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kanika Sharma
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - María Ines Gaitán
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jiaen Liu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jacco A de Zwart
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter van Gelderen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Irene Cortese
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
| | - Jeff H Duyn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pascal Sati
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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Barakovic M, Weigel M, Cagol A, Schaedelin S, Galbusera R, Lu PJ, Chen X, Melie-Garcia L, Ocampo-Pineda M, Bahn E, Stadelmann C, Palombo M, Kappos L, Kuhle J, Magon S, Granziera C. A novel imaging marker of cortical "cellularity" in multiple sclerosis patients. Sci Rep 2024; 14:9848. [PMID: 38684744 PMCID: PMC11059177 DOI: 10.1038/s41598-024-60497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
Pathological data showed focal inflammation and regions of diffuse neuronal loss in the cortex of people with multiple sclerosis (MS). In this work, we applied a novel model ("soma and neurite density imaging (SANDI)") to multishell diffusion-weighted MRI data acquired in healthy subjects and people with multiple sclerosis (pwMS), in order to investigate inflammation and degeneration-related changes in the cortical tissue of pwMS. We aimed to (i) establish whether SANDI is applicable in vivo clinical data; (ii) investigate inflammatory and degenerative changes using SANDI soma fraction (fsoma)-a marker of cellularity-in both cortical lesions and in the normal-appearing-cortex and (iii) correlate SANDI fsoma with clinical and biological measures in pwMS. We applied a simplified version of SANDI to a clinical scanners. We then provided evidence that pwMS exhibited an overall decrease in cortical SANDI fsoma compared to healthy subjects, suggesting global degenerative processes compatible with neuronal loss. On the other hand, we have found that progressive pwMS showed a higher SANDI fsoma in the outer part of the cortex compared to relapsing-remitting pwMS, possibly supporting current pathological knowledge of increased innate inflammatory cells in these regions. A similar finding was obtained in subpial lesions in relapsing-remitting patients, reflecting existing pathological data in these lesion types. A significant correlation was found between SANDI fsoma and serum neurofilament light chain-a biomarker of inflammatory axonal damage-suggesting a relationship between SANDI soma fraction and inflammatory processes in pwMS again. Overall, our data show that SANDI fsoma is a promising biomarker to monitor changes in cellularity compatible with neurodegeneration and neuroinflammation in the cortex of MS patients.
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Affiliation(s)
- Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Xinjie Chen
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mario Ocampo-Pineda
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Erik Bahn
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | | | - Marco Palombo
- School of Psychology, Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefano Magon
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
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6
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Beck ES, Mullins WA, Dos Santos Silva J, Filippini S, Parvathaneni P, Maranzano J, Morrison M, Suto DJ, Donnay C, Dieckhaus H, Luciano NJ, Sharma K, Gaitán MI, Liu J, de Zwart JA, van Gelderen P, Cortese I, Narayanan S, Duyn JH, Nair G, Sati P, Reich DS. Cortical lesions uniquely predict motor disability accrual and form rarely in the absence of new white matter lesions in multiple sclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295974. [PMID: 37886541 PMCID: PMC10602044 DOI: 10.1101/2023.09.22.23295974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background and objectives Cortical lesions (CL) are common in multiple sclerosis (MS) and associate with disability and progressive disease. We asked whether CL continue to form in people with stable white matter lesions (WML) and whether the association of CL with worsening disability relates to pre-existing or new CL. Methods A cohort of adults with MS were evaluated annually with 7 tesla (T) brain magnetic resonance imaging (MRI) and 3T brain and spine MRI for 2 years, and clinical assessments for 3 years. CL were identified on 7T images at each timepoint. WML and brain tissue segmentation were performed using 3T images at baseline and year 2. Results 59 adults with MS had ≥1 7T follow-up visit (mean follow-up time 2±0.5 years). 9 had "active" relapsing-remitting MS (RRMS), defined as new WML in the year prior to enrollment. Of the remaining 50, 33 had "stable" RRMS, 14 secondary progressive MS (SPMS), and 3 primary progressive MS. 16 total new CL formed in the active RRMS group (median 1, range 0-10), 7 in the stable RRMS group (median 0, range 0-5), and 4 in the progressive MS group (median 0, range 0-1) (p=0.006, stable RR vs PMS p=0.88). New CL were not associated with greater change in any individual disability measure or in a composite measure of disability worsening (worsening Expanded Disability Status Scale or 9-hole peg test or 25-foot timed walk). Baseline CL volume was higher in people with worsening disability (median 1010μl, range 13-9888 vs median 267μl, range 0-3539, p=0.001, adjusted for age and sex) and in individuals with RRMS who subsequently transitioned to SPMS (median 2183μl, range 270-9888 vs median 321μl, range 0-6392 in those who remained RRMS, p=0.01, adjusted for age and sex). Baseline WML volume was not associated with worsening disability or transition from RRMS to SPMS. Discussion CL formation is rare in people with stable WML, even in those with worsening disability. CL but not WML burden predicts future worsening of disability, suggesting that the relationship between CL and disability progression is related to long-term effects of lesions that form in the earlier stages of disease, rather than to ongoing lesion formation.
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Affiliation(s)
- Erin S Beck
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Andrew Mullins
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Stefano Filippini
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Department of Neurosciences, Drug, and Child Health, University of Florence, Florence, Italy
| | - Prasanna Parvathaneni
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Department of Anatomy, University of Quebec, Trois-Rivieres, QC, Canada
| | - Mark Morrison
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Suto
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Corinne Donnay
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Henry Dieckhaus
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Nicholas J Luciano
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kanika Sharma
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - María Ines Gaitán
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jiaen Liu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacco A de Zwart
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Peter van Gelderen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Irene Cortese
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jeff H Duyn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Govind Nair
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pascal Sati
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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7
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Reeve K, On BI, Havla J, Burns J, Gosteli-Peter MA, Alabsawi A, Alayash Z, Götschi A, Seibold H, Mansmann U, Held U. Prognostic models for predicting clinical disease progression, worsening and activity in people with multiple sclerosis. Cochrane Database Syst Rev 2023; 9:CD013606. [PMID: 37681561 PMCID: PMC10486189 DOI: 10.1002/14651858.cd013606.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that affects millions of people worldwide. The disease course varies greatly across individuals and many disease-modifying treatments with different safety and efficacy profiles have been developed recently. Prognostic models evaluated and shown to be valid in different settings have the potential to support people with MS and their physicians during the decision-making process for treatment or disease/life management, allow stratified and more precise interpretation of interventional trials, and provide insights into disease mechanisms. Many researchers have turned to prognostic models to help predict clinical outcomes in people with MS; however, to our knowledge, no widely accepted prognostic model for MS is being used in clinical practice yet. OBJECTIVES To identify and summarise multivariable prognostic models, and their validation studies for quantifying the risk of clinical disease progression, worsening, and activity in adults with MS. SEARCH METHODS We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews from January 1996 until July 2021. We also screened the reference lists of included studies and relevant reviews, and references citing the included studies. SELECTION CRITERIA We included all statistically developed multivariable prognostic models aiming to predict clinical disease progression, worsening, and activity, as measured by disability, relapse, conversion to definite MS, conversion to progressive MS, or a composite of these in adult individuals with MS. We also included any studies evaluating the performance of (i.e. validating) these models. There were no restrictions based on language, data source, timing of prognostication, or timing of outcome. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles/abstracts and full texts, extracted data using a piloted form based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS), assessed risk of bias using the Prediction Model Risk Of Bias Assessment Tool (PROBAST), and assessed reporting deficiencies based on the checklist items in Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD). The characteristics of the included models and their validations are described narratively. We planned to meta-analyse the discrimination and calibration of models with at least three external validations outside the model development study but no model met this criterion. We summarised between-study heterogeneity narratively but again could not perform the planned meta-regression. MAIN RESULTS We included 57 studies, from which we identified 75 model developments, 15 external validations corresponding to only 12 (16%) of the models, and six author-reported validations. Only two models were externally validated multiple times. None of the identified external validations were performed by researchers independent of those that developed the model. The outcome was related to disease progression in 39 (41%), relapses in 8 (8%), conversion to definite MS in 17 (18%), and conversion to progressive MS in 27 (28%) of the 96 models or validations. The disease and treatment-related characteristics of included participants, and definitions of considered predictors and outcome, were highly heterogeneous amongst the studies. Based on the publication year, we observed an increase in the percent of participants on treatment, diversification of the diagnostic criteria used, an increase in consideration of biomarkers or treatment as predictors, and increased use of machine learning methods over time. Usability and reproducibility All identified models contained at least one predictor requiring the skills of a medical specialist for measurement or assessment. Most of the models (44; 59%) contained predictors that require specialist equipment likely to be absent from primary care or standard hospital settings. Over half (52%) of the developed models were not accompanied by model coefficients, tools, or instructions, which hinders their application, independent validation or reproduction. The data used in model developments were made publicly available or reported to be available on request only in a few studies (two and six, respectively). Risk of bias We rated all but one of the model developments or validations as having high overall risk of bias. The main reason for this was the statistical methods used for the development or evaluation of prognostic models; we rated all but two of the included model developments or validations as having high risk of bias in the analysis domain. None of the model developments that were externally validated or these models' external validations had low risk of bias. There were concerns related to applicability of the models to our research question in over one-third (38%) of the models or their validations. Reporting deficiencies Reporting was poor overall and there was no observable increase in the quality of reporting over time. The items that were unclearly reported or not reported at all for most of the included models or validations were related to sample size justification, blinding of outcome assessors, details of the full model or how to obtain predictions from it, amount of missing data, and treatments received by the participants. Reporting of preferred model performance measures of discrimination and calibration was suboptimal. AUTHORS' CONCLUSIONS The current evidence is not sufficient for recommending the use of any of the published prognostic prediction models for people with MS in clinical routine today due to lack of independent external validations. The MS prognostic research community should adhere to the current reporting and methodological guidelines and conduct many more state-of-the-art external validation studies for the existing or newly developed models.
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Affiliation(s)
- Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Begum Irmak On
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joachim Havla
- lnstitute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | - Albraa Alabsawi
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Zoheir Alayash
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Health Services Research in Dentistry, University of Münster, Muenster, Germany
| | - Andrea Götschi
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | | | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
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8
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Sabathé C, Casey R, Vukusic S, Leray E, Mathey G, De Sèze J, Ciron J, Wiertlewski S, Ruet A, Pelletier J, Zéphir H, Michel L, Lebrun-Frenay C, Moisset X, Thouvenot E, Camdessanché JP, Bakchine S, Stankoff B, Al Khedr A, Cabre P, Maillart E, Berger E, Heinzlef O, Hankiewicz K, Moreau T, Gout O, Bourre B, Wahab A, Labauge P, Montcuquet A, Defer G, Maurousset A, Maubeuge N, Dimitri Boulos D, Ben Nasr H, Nifle C, Casez O, Laplaud DA, Foucher Y. Improving the decision to switch from first- to second-line therapy in multiple sclerosis: A dynamic scoring system. Mult Scler 2023; 29:236-247. [PMID: 36515394 DOI: 10.1177/13524585221139156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In relapsing-remitting multiple sclerosis (RRMS), early identification of suboptimal responders can prevent disability progression. OBJECTIVE We aimed to develop and validate a dynamic score to guide the early decision to switch from first- to second-line therapy. METHODS Using time-dependent propensity scores (PS) from a French cohort of 12,823 patients with RRMS, we constructed one training and two validation PS-matched cohorts to compare the switched patients to second-line treatment and the maintained patients. We used a frailty Cox model for predicting individual hazard ratios (iHRs). RESULTS From the validation PS-matched cohort of 348 independent patients with iHR ⩽ 0.69, we reported the 5-year relapse-free survival at 0.14 (95% confidence interval (CI) 0.09-0.22) for the waiting group and 0.40 (95% CI 0.32-0.51) for the switched group. From the validation PS-matched cohort of 518 independent patients with iHR > 0.69, these values were 0.37 (95% CI 0.30-0.46) and 0.44 (95% CI 0.37-0.52), respectively. CONCLUSIONS By using the proposed dynamic score, we estimated that at least one-third of patients could benefit from an earlier switch to prevent relapse.
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Affiliation(s)
- Camille Sabathé
- Université de Nantes, Université de Tours, Inserm, UMR1246 Sphere, Nantes, France
| | - Romain Casey
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France/Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Lyon, France/Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, Lyon, France/EUGENE DEVIC EDMUS Foundation against Multiple Sclerosis, State-Approved Foundation, Lyon, France
| | - Sandra Vukusic
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Lyon, France/Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, Lyon, France/Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Hôpital Central, Service de Neurologie, Nancy, France/Université de Lorraine, Nancy, France
| | - Jérôme De Sèze
- Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, Strasbourg, France
| | - Jonathan Ciron
- Department of Neurology, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Sandrine Wiertlewski
- Université de Nantes, Nantes, France/Service de Neurologie, Centre de Ressources et de Compétences Sclérose en Plaques, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Ruet
- University of Bordeaux, Bordeaux, France/Department of Neurology, CHU de Bordeaux, Bordeaux, France
| | - Jean Pelletier
- Aix Marseille University, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | | | - Laure Michel
- Clinical Neuroscience Centre, Rennes University Hospital, Rennes, France/Microenvironment, Cell Differentiation, Immunology and Cancer Unit, Rennes, France/Neurology Department, Rennes University Hospital, Rennes, France
| | | | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, Nimes, France/Institut de Génomique Fonctionnelle, Université de Montpellier, Montpellier, France
| | | | | | - Bruno Stankoff
- Sorbonne Universités, Brain and Spine Institute, ICM, Hôpital de la Pitié Salpêtrière, Paris, France/Department of Neurology, AP-HP, Saint-Antoine Hospital, Paris, France
| | | | - Philippe Cabre
- Department of Neurology, CHU de la Martinique, Fort-de-France, France
| | - Elisabeth Maillart
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France/Centre de Ressources et de Compétences SEP, Paris, France
| | - Eric Berger
- Service de Neurologie Besançon, CHU de Besançon, Besançon, France
| | | | - Karolina Hankiewicz
- Department of Neurology, Centre Hospitalier de Saint-Denis, Hôpital Pierre Delafontaine, Saint-Denis, France
| | | | - Olivier Gout
- Department of Neurology, Fondation Rothschild, Paris, France
| | | | - Abir Wahab
- Department of Neurology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Pierre Labauge
- CRC SEP, Montpellier University Hospital, INSERM, Université de Montpellier, Montpellier, France
| | - Alexis Montcuquet
- Department of Neurology, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | - Gilles Defer
- CHU de Caen, MS Expert Centre, Department of Neurology, Normandy University, Caen, France
| | - Aude Maurousset
- CRC SEP and Department of Neurology, Hôpital Bretonneau, CHU de Tours, Tours, France
| | - Nicolas Maubeuge
- Department of Neurology, Hôpital Jean Bernard, CHU La Milétrie, Poitiers, France
| | | | - Haïfa Ben Nasr
- Department of Neurology, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Chantal Nifle
- Department of Neurology, Hopital Andre Mignot, Le Chesnay, France
| | - Olivier Casez
- Department of Neurology, CHU Grenoble Alpes, Grenoble, France
| | - David-Axel Laplaud
- Université de Nantes, Nantes, France/Service de Neurologie, Centre de Ressources et de Compétences Sclérose en Plaques, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Yohann Foucher
- Yohann Foucher CIC 1402, CHU de Poitiers, Université de Poitiers, Poitiers, France
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9
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Ziccardi S, Pisani AI, Schiavi GM, Guandalini M, Crescenzo F, Colombi A, Peloso A, Tamanti A, Bertolazzo M, Marastoni D, Calabrese M. Cortical lesions at diagnosis predict long-term cognitive impairment in multiple sclerosis: A 20-year study. Eur J Neurol 2023; 30:1378-1388. [PMID: 36692863 DOI: 10.1111/ene.15697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Although cognitive impairment (CI) is frequent in multiple sclerosis (MS) patients, few studies (and with conflicting results) have evaluated early predictors of CI in the long term. We aimed at determining associations between early clinical/neuroradiological variables with reference to CI after 20 years of MS. METHODS We investigated in 170 MS patients the relationship between clinical/magnetic resonance imaging (MRI) data at diagnosis and cognitive status almost 20 years after MS onset. Among others, number and volume of both white matter lesions (WMLs) and cortical lesions (CLs) were evaluated at diagnosis and after 2 years. All MS patients were followed over time and underwent a comprehensive neuropsychological assessment at the end of study. Advanced statistical methods (unsupervised cluster analysis and random forest model) were conducted. RESULTS CI patients showed higher focal cortical pathology at diagnosis compared to cognitively normal subjects (p < 0.001). Volumes of both WMLs and CLs emerged as the MRI metrics most associated with long-term CI. Moreover, number of CLs (especially ≥3) was also strongly associated with long-term CI (≥3 CLs: odds ratio [OR] = 3.7, 95% confidence interval = 1.8-7.5, p < 0.001), more than number of WMLs; the optimal cutoff of three CLs (area under the curve = 0.67, specificity = 75%, sensitivity = 55%) was estimated according to the risk of developing CI. CONCLUSIONS These results highlight the impact of considering both white and gray matter focal damage from early MS stages. Given the low predictive value of WML number and the poor clinical applicability of lesion volume estimation in the daily clinical context, the evaluation of number of CLs could represent a reliable prognostic marker of CI.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Isabella Pisani
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Marco Schiavi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Annalisa Colombi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Peloso
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Bertolazzo
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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10
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Chandler HL, Stickland RC, Patitucci E, Germuska M, Chiarelli AM, Foster C, Bhome-Dhaliwal S, Lancaster TM, Saxena N, Khot S, Tomassini V, Wise RG. Reduced brain oxygen metabolism in patients with multiple sclerosis: Evidence from dual-calibrated functional MRI. J Cereb Blood Flow Metab 2023; 43:115-128. [PMID: 36071645 PMCID: PMC9875355 DOI: 10.1177/0271678x221121849] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 01/28/2023]
Abstract
Cerebral energy deficiency is increasingly recognised as an important feature of multiple sclerosis (MS). Until now, we have lacked non-invasive imaging methods to quantify energy utilisation and mitochondrial function in the human brain. Here, we used novel dual-calibrated functional magnetic resonance imaging (dc-fMRI) to map grey-matter (GM) deoxy-haemoglobin sensitive cerebral blood volume (CBVdHb), cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen consumption (CMRO2) in patients with MS (PwMS) and age/sex matched controls. By integrating a flow-diffusion model of oxygen transport, we evaluated the effective oxygen diffusivity of the capillary network (DC) and the partial pressure of oxygen at the mitochondria (PmO2). Significant between-group differences were observed as decreased CBF (p = 0.010), CMRO2 (p < 0.001) and DC (p = 0.002), and increased PmO2 (p = 0.043) in patients compared to controls. No significant differences were observed for CBVdHb (p = 0.389), OEF (p = 0.358), or GM volume (p = 0.302). Regional analysis showed widespread reductions in CMRO2 and DC for PwMS. Our findings may be indicative of reduced oxygen demand or utilisation in the MS brain and mitochondrial dysfunction. Our results suggest changes in brain physiology may precede MRI-detectable GM loss and may contribute to disease progression and neurodegeneration.
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Affiliation(s)
| | - Rachael C Stickland
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Department of Physical Therapy and Human Movement Sciences,
Northwestern University, Chicago, IL, USA
| | | | | | - Antonio M Chiarelli
- Institute for Advanced Biomedical Technologies, University “G.
d'Annunzio” of Chieti-Pescara, Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences,
University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Catherine Foster
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Wales Institute of Social and Economic Research and Data,
Cardiff University, Cardiff, UK
| | | | - Thomas M Lancaster
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Department of Psychology, University of Bath, Bath, UK
| | - Neeraj Saxena
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Department of Anaesthetics, Intensive Care and Pain Medicine,
Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Sharmila Khot
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Cardiff University School of Medicine, Cardiff, UK
| | - Valentina Tomassini
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Institute for Advanced Biomedical Technologies, University “G.
d'Annunzio” of Chieti-Pescara, Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences,
University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
- MS Centre, Neurology Unit, “SS. Annunziata” University Hospital,
Chieti, Italy
- Division of Psychological Medicine and Clinical Neurosciences,
School of Medicine, Cardiff University, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital
of Wales, Cardiff, UK
| | - Richard G Wise
- CUBRIC, School of Psychology, Cardiff University, Cardiff,
UK
- Institute for Advanced Biomedical Technologies, University “G.
d'Annunzio” of Chieti-Pescara, Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences,
University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
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11
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La Rosa F, Wynen M, Al-Louzi O, Beck ES, Huelnhagen T, Maggi P, Thiran JP, Kober T, Shinohara RT, Sati P, Reich DS, Granziera C, Absinta M, Bach Cuadra M. Cortical lesions, central vein sign, and paramagnetic rim lesions in multiple sclerosis: Emerging machine learning techniques and future avenues. Neuroimage Clin 2022; 36:103205. [PMID: 36201950 PMCID: PMC9668629 DOI: 10.1016/j.nicl.2022.103205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
The current diagnostic criteria for multiple sclerosis (MS) lack specificity, and this may lead to misdiagnosis, which remains an issue in present-day clinical practice. In addition, conventional biomarkers only moderately correlate with MS disease progression. Recently, some MS lesional imaging biomarkers such as cortical lesions (CL), the central vein sign (CVS), and paramagnetic rim lesions (PRL), visible in specialized magnetic resonance imaging (MRI) sequences, have shown higher specificity in differential diagnosis. Moreover, studies have shown that CL and PRL are potential prognostic biomarkers, the former correlating with cognitive impairments and the latter with early disability progression. As machine learning-based methods have achieved extraordinary performance in the assessment of conventional imaging biomarkers, such as white matter lesion segmentation, several automated or semi-automated methods have been proposed as well for CL, PRL, and CVS. In the present review, we first introduce these MS biomarkers and their imaging methods. Subsequently, we describe the corresponding machine learning-based methods that were proposed to tackle these clinical questions, putting them into context with respect to the challenges they are facing, including non-standardized MRI protocols, limited datasets, and moderate inter-rater variability. We conclude by presenting the current limitations that prevent their broader deployment and suggesting future research directions.
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Key Words
- ms, multiple sclerosis
- mri, magnetic resonance imaging
- dl, deep learning
- ml, machine learning
- cl, cortical lesions
- prl, paramagnetic rim lesions
- cvs, central vein sign
- wml, white matter lesions
- flair, fluid-attenuated inversion recovery
- mprage, magnetization prepared rapid gradient-echo
- gm, gray matter
- wm, white matter
- psir, phase-sensitive inversion recovery
- dir, double inversion recovery
- mp2rage, magnetization-prepared 2 rapid gradient echoes
- sels, slowly evolving/expanding lesions
- cnn, convolutional neural network
- xai, explainable ai
- pv, partial volume
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Affiliation(s)
- Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Switzerland; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Maxence Wynen
- CIBM Center for Biomedical Imaging, Switzerland; ICTeam, UCLouvain, Louvain-la-Neuve, Belgium; Louvain Inflammation Imaging Lab (NIL), Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium; Radiology Department, Lausanne University and University Hospital, Switzerland
| | - Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erin S Beck
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Till Huelnhagen
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Pietro Maggi
- Louvain Inflammation Imaging Lab (NIL), Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium; Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Department of Neurology, CHUV, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland
| | - Tobias Kober
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analysis (CBICA), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Switzerland; Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martina Absinta
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meritxell Bach Cuadra
- CIBM Center for Biomedical Imaging, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland
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12
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Misin O, Matilainen M, Nylund M, Honkonen E, Rissanen E, Sucksdorff M, Airas L. Innate Immune Cell–Related Pathology in the Thalamus Signals a Risk for Disability Progression in Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/4/e1182. [PMID: 35581004 PMCID: PMC9128041 DOI: 10.1212/nxi.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives Our aim was to investigate whether 18-kDa translocator protein (TSPO) radioligand binding in gray matter (GM) predicts later disability progression in multiple sclerosis (MS). Methods In this prospective imaging study, innate immune cells were investigated in the MS patient brain using PET imaging. The distribution volume ratio (DVR) of the TSPO-binding radioligand [11C]PK11195 was determined in 5 GM regions: thalamus, caudate, putamen, pallidum, and cortical GM. Volumetric brain MRI parameters were obtained for comparison. The Expanded Disability Status Scale (EDSS) score was assessed at baseline and after follow-up of 3.0 ± 0.3 (mean ± SD) years. Disability progression was defined as an EDSS score increase of 1.0 point or 0.5 point if the baseline EDSS score was ≥6.0. A forward-type stepwise logistic regression model was constructed to compare multiple imaging and clinical variables in their ability to predict later disability progression. Results The cohort consisted of 66 patients with MS and 18 healthy controls. Patients with later disability progression (n = 17) had more advanced atrophy in the thalamus, caudate, and putamen at baseline compared with patients with no subsequent worsening. TSPO binding was significantly higher in the thalamus among the patients with later worsening. The thalamic DVR was the only measured imaging variable that remained a significant predictor of disability progression in the regression model. The final model predicted disability progression with 52.9% sensitivity and 93.9% specificity with an area under the curve value of 0.82 (receiver operating characteristic curve). Discussion Increased TSPO radioligand binding in the thalamus has potential in predicting short-term disability progression in MS and seems to be more sensitive for this than GM atrophy measures.
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13
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Zuo M, Fettig NM, Bernier LP, Pössnecker E, Spring S, Pu A, Ma XI, Lee DS, Ward LA, Sharma A, Kuhle J, Sled JG, Pröbstel AK, MacVicar BA, Osborne LC, Gommerman JL, Ramaglia V. Age-dependent gray matter demyelination is associated with leptomeningeal neutrophil accumulation. JCI Insight 2022; 7:e158144. [PMID: 35536649 PMCID: PMC9309059 DOI: 10.1172/jci.insight.158144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
People living with multiple sclerosis (MS) experience episodic CNS white matter lesions instigated by autoreactive T cells. With age, patients with MS show evidence of gray matter demyelination and experience devastating nonremitting symptomology. What drives progression is unclear and studying this has been hampered by the lack of suitable animal models. Here, we show that passive experimental autoimmune encephalomyelitis (EAE) induced by an adoptive transfer of young Th17 cells induced a nonremitting clinical phenotype that was associated with persistent leptomeningeal inflammation and cortical pathology in old, but not young, SJL/J mice. Although the quantity and quality of T cells did not differ in the brains of old versus young EAE mice, an increase in neutrophils and a decrease in B cells were observed in the brains of old mice. Neutrophils were also found in the leptomeninges of a subset of progressive MS patient brains that showed evidence of leptomeningeal inflammation and subpial cortical demyelination. Taken together, our data show that while Th17 cells initiate CNS inflammation, subsequent clinical symptoms and gray matter pathology are dictated by age and associated with other immune cells, such as neutrophils.
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Affiliation(s)
- Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Naomi M. Fettig
- Department of Microbiology and Immunology and Life Sciences Institute, and
| | - Louis-Philippe Bernier
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabeth Pössnecker
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Shoshana Spring
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Xianjie I. Ma
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Dennis S.W. Lee
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Ward
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Anshu Sharma
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Jens Kuhle
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - John G. Sled
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Katrin Pröbstel
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Brian A. MacVicar
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa C. Osborne
- Department of Microbiology and Immunology and Life Sciences Institute, and
| | | | - Valeria Ramaglia
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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14
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Andica C, Hagiwara A, Yokoyama K, Kato S, Uchida W, Nishimura Y, Fujita S, Kamagata K, Hori M, Tomizawa Y, Hattori N, Aoki S. Multimodal magnetic resonance imaging quantification of gray matter alterations in relapsing-remitting multiple sclerosis and neuromyelitis optica spectrum disorder. J Neurosci Res 2022; 100:1395-1412. [PMID: 35316545 DOI: 10.1002/jnr.25035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/08/2022]
Abstract
Herein, we combined neurite orientation dispersion and density imaging (NODDI) and synthetic magnetic resonance imaging (SyMRI) to evaluate the spatial distribution and extent of gray matter (GM) microstructural alterations in patients with relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica spectrum disorder (NMOSD). The NODDI (neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISOVF]) and SyMRI (myelin volume fraction [MVF]) measures were compared between age- and sex-matched groups of 30 patients with RRMS (6 males and 24 females; mean age, 51.43 ± 8.02 years), 18 patients with anti-aquaporin-4 antibody-positive NMOSD (2 males and 16 females; mean age, 52.67 ± 16.07 years), and 19 healthy controls (6 males and 13 females; mean age, 51.47 ± 9.25 years) using GM-based spatial statistical analysis. Patients with RRMS showed reduced NDI and MVF and increased ODI and ISOVF, predominantly in the limbic and paralimbic regions, when compared with healthy controls, while only increases in ODI and ISOVF were observed when compared with NMOSD. Compared to NDI and MVF, the changes in ODI and ISOVF were observed more widely, including in the cerebellar cortex. These abnormalities were associated with disease progression and disability. In contrast, patients with NMOSD only showed reduced NDI mainly in the cerebellar, limbic, and paralimbic cortices when compared with healthy controls and patients with RRMS. Taken together, our study supports the notion that GM pathologies in RRMS are distinct from those of NMOSD. However, owing to the limitations of the study, the results should be cautiously interpreted.
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Affiliation(s)
- Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shimpei Kato
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuma Nishimura
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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15
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Cooze BJ, Dickerson M, Loganathan R, Watkins LM, Grounds E, Pearson BR, Bevan RJ, Morgan BP, Magliozzi R, Reynolds R, Neal JW, Howell OW. The association between neurodegeneration and local complement activation in the thalamus to progressive multiple sclerosis outcome. Brain Pathol 2022; 32:e13054. [PMID: 35132719 PMCID: PMC9425007 DOI: 10.1111/bpa.13054] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 01/22/2023] Open
Abstract
The extent of grey matter demyelination and neurodegeneration in the progressive multiple sclerosis (PMS) brains at post‐mortem associates with more severe disease. Regional tissue atrophy, especially affecting the cortical and deep grey matter, including the thalamus, is prognostic for poor outcomes. Microglial and complement activation are important in the pathogenesis and contribute to damaging processes that underlie tissue atrophy in PMS. We investigated the extent of pathology and innate immune activation in the thalamus in comparison to cortical grey and white matter in blocks from 21 cases of PMS and 10 matched controls. Using a digital pathology workflow, we show that the thalamus is invariably affected by demyelination and had a far higher proportion of active inflammatory lesions than forebrain cortical tissue blocks from the same cases. Lesions were larger and more frequent in the medial nuclei near the ventricular margin, whilst neuronal loss was greatest in the lateral thalamic nuclei. The extent of thalamic neuron loss was not associated with thalamic demyelination but correlated with the burden of white matter pathology in other forebrain areas (Spearman r = 0.79, p < 0.0001). Only thalamic neuronal loss, and not that seen in other forebrain cortical areas, correlated with disease duration (Spearman r = −0.58, p = 0.009) and age of death (Spearman r = −0.47, p = 0.045). Immunoreactivity for the complement pattern recognition molecule C1q, and products of complement activation (C4d, Bb and C3b) were elevated in thalamic lesions with an active inflammatory pathology. Complement regulatory protein, C1 inhibitor, was unchanged in expression. We conclude that active inflammatory demyelination, neuronal loss and local complement synthesis and activation in the thalamus, are important to the pathological and clinical disease outcomes of PMS.
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Affiliation(s)
- Benjamin J Cooze
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | - Matthew Dickerson
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | | | - Lewis M Watkins
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | - Ethan Grounds
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | - Ben R Pearson
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | - Ryan Jack Bevan
- UK Dementia Research Institute at Cardiff University, Cardiff, UK
| | - B Paul Morgan
- UK Dementia Research Institute at Cardiff University, Cardiff, UK
| | - Roberta Magliozzi
- Department of Neurological and Movement Sciences, University of Verona, Italy
| | | | - James W Neal
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
| | - Owain W Howell
- Faculty of Medical, Health and Life Sciences, Swansea University, Swansea, UK
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16
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Age-related changes in multiple sclerosis and experimental autoimmune encephalomyelitis. Semin Immunol 2022; 59:101631. [PMID: 35752572 DOI: 10.1016/j.smim.2022.101631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/15/2023]
Abstract
A better understanding of the pathological mechanisms that drive neurodegeneration in people living with multiple sclerosis (MS) is needed to design effective therapies to treat and/or prevent disease progression. We propose that CNS-intrinsic inflammation and re-modelling of the sub-arachnoid space of the leptomeninges sets the stage for neurodegeneration from the earliest stages of MS. While neurodegenerative processes are clinically silent early in disease, ageing results in neurodegenerative changes that become clinically manifest as progressive disability. Here we review pathological correlates of MS disease progression, highlight emerging mouse models that mimic key progressive changes in MS, and provide new perspectives on therapeutic approaches to protect against MS-associated neurodegeneration.
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17
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Möck EEA, Honkonen E, Airas L. Synaptic Loss in Multiple Sclerosis: A Systematic Review of Human Post-mortem Studies. Front Neurol 2021; 12:782599. [PMID: 34912290 PMCID: PMC8666414 DOI: 10.3389/fneur.2021.782599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Gray matter pathology plays a central role in the progression of multiple sclerosis (MS). The occurrence of synaptic loss appears to be important but, to date, still poorly investigated aspect of MS pathology. In this systematic review, we drew from the recent knowledge about synaptic loss in human post-mortem studies. Methods: We conducted a systematic search with PubMed to identify relevant publications. Publications available from15 June 2021 were taken into account. We selected human post-mortem studies that quantitatively assessed the synapse number in MS tissue. Results: We identified 14 relevant publications out of which 9 reported synaptic loss in at least one investigated subregion. The most commonly used synaptic marker was synaptophysin; non-etheless, we found substantial differences in the methodology and the selection of reference tissue. Investigated regions included the cortex, the hippocampus, the cerebellum, the thalamus, and the spinal cord. Conclusion: Synaptic loss seems to take place throughout the entire central nervous system. However, the results are inconsistent, probably due to differences in the methodology. Moreover, synaptic loss appears to be a dynamic process, and thus the nature of this pathology might be captured using in vivo synaptic density measurements.
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Affiliation(s)
- E E Amelie Möck
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Eveliina Honkonen
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
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18
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Mani A, Santini T, Puppala R, Dahl M, Venkatesh S, Walker E, DeHaven M, Isitan C, Ibrahim TS, Wang L, Zhang T, Gong E, Barrios-Martinez J, Yeh FC, Krafty R, Mettenburg JM, Xia Z. Applying Deep Learning to Accelerated Clinical Brain Magnetic Resonance Imaging for Multiple Sclerosis. Front Neurol 2021; 12:685276. [PMID: 34646227 PMCID: PMC8504490 DOI: 10.3389/fneur.2021.685276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Magnetic resonance (MR) scans are routine clinical procedures for monitoring people with multiple sclerosis (PwMS). Patient discomfort, timely scheduling, and financial burden motivate the need to accelerate MR scan time. We examined the clinical application of a deep learning (DL) model in restoring the image quality of accelerated routine clinical brain MR scans for PwMS. Methods: We acquired fast 3D T1w BRAVO and fast 3D T2w FLAIR MRI sequences (half the phase encodes and half the number of slices) in parallel to conventional parameters. Using a subset of the scans, we trained a DL model to generate images from fast scans with quality similar to the conventional scans and then applied the model to the remaining scans. We calculated clinically relevant T1w volumetrics (normalized whole brain, thalamic, gray matter, and white matter volume) for all scans and T2 lesion volume in a sub-analysis. We performed paired t-tests comparing conventional, fast, and fast with DL for these volumetrics, and fit repeated measures mixed-effects models to test for differences in correlations between volumetrics and clinically relevant patient-reported outcomes (PRO). Results: We found statistically significant but small differences between conventional and fast scans with DL for all T1w volumetrics. There was no difference in the extent to which the key T1w volumetrics correlated with clinically relevant PROs of MS symptom burden and neurological disability. Conclusion: A deep learning model that improves the image quality of the accelerated routine clinical brain MR scans has the potential to inform clinically relevant outcomes in MS.
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Affiliation(s)
- Ashika Mani
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tales Santini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Radhika Puppala
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Megan Dahl
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shruthi Venkatesh
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth Walker
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Megan DeHaven
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cigdem Isitan
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tamer S. Ibrahim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Long Wang
- Subtle Medical Inc., Menlo Park, CA, United States
| | - Tao Zhang
- Subtle Medical Inc., Menlo Park, CA, United States
| | - Enhao Gong
- Subtle Medical Inc., Menlo Park, CA, United States
| | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Joseph M. Mettenburg
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zongqi Xia
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
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19
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Barzegar M, Najdaghi S, Afshari-Safavi A, Nehzat N, Mirmosayyeb O, Shaygannejad V. Early predictors of conversion to secondary progressive multiple sclerosis. Mult Scler Relat Disord 2021; 54:103115. [PMID: 34216997 DOI: 10.1016/j.msard.2021.103115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We conducted this study to estimated the time of conversion from relapsing-remitting MS (RRMS) to SPMS and its early predictor factors. METHODS In this retrospective study, demographic, clinical, and imaging data from MS patients at diagnosis were extracted. Cox proportional hazards model was used to assess the association between various baseline characteristics and conversion to SPMS. We also assessed the association brtween escalation and early intensive therapy approaches with transition to progressive phase. RESULTS Out of 1903 patients with RRMS at baseline, 293 (15.4%) patients progressed to SPMS during follow-up. The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years. On multivariate Cox regression analysis older age at onset (HR: 1.067, 95%CI: 1.048-1.085, p < 0.001), smoking (HR: 2.120, 95%CI: 1.203-3.736, p = 0.009), higher EDSS at onset (HR: 1.199, 95%CI: 1.109-1.295, p < 0.001), motor dysfunction (HR: 2.470, 95%CI: 1.605-3.800, p < 0.001), cerebellar dysfunction (HR: 3.096, 95%CI: 1.840-5.211, p < 0.001), and presence of lesions in spinal cord (HR: 0.573, 95%CI: 0.297-0.989, p = 0.042) increased the risk of conversion from RRMS to SPMS. No significant difference between escalation and EIT groups in the risk of transition to progressive phase (weighted HR = 1.438; 95% CI: 0.963, 2.147; p = 0.076) was found. CONCLUSION Our data support previous observations that smoking is a modifiable risk factor for secondary progressive MS and confirms that spinal cord involvement, age, and more severe disease at onset are prognostic factors for converting to secondary progressive MS.
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Affiliation(s)
- Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soroush Najdaghi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
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20
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Pisani AI, Scalfari A, Crescenzo F, Romualdi C, Calabrese M. A novel prognostic score to assess the risk of progression in relapsing-remitting multiple sclerosis patients. Eur J Neurol 2021; 28:2503-2512. [PMID: 33835665 PMCID: PMC8360167 DOI: 10.1111/ene.14859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND At the patient level, the prognostic value of several features that are known to be associated with an increased risk of converting from relapsing-remitting (RR) to secondary phase (SP) multiple sclerosis (MS) remains limited. METHODS Among 262 RRMS patients followed up for 10 years, we assessed the probability of developing the SP course based on clinical and conventional and non-conventional magnetic resonance imaging (MRI) parameters at diagnosis and after 2 years. We used a machine learning method, the random survival forests, to identify, according to their minimal depth (MD), the most predictive factors associated with the risk of SP conversion, which were then combined to compute the secondary progressive risk score (SP-RiSc). RESULTS During the observation period, 69 (26%) patients converted to SPMS. The number of cortical lesions (MD = 2.47) and age (MD = 3.30) at diagnosis, the global cortical thinning (MD = 1.65), the cerebellar cortical volume loss (MD = 2.15) and the cortical lesion load increase (MD = 3.15) over the first 2 years exerted the greatest predictive effect. Three patients' risk groups were identified; in the high-risk group, 85% (46/55) of patients entered the SP phase in 7 median years. The SP-RiSc optimal cut-off estimated was 17.7 showing specificity and sensitivity of 87% and 92%, respectively, and overall accuracy of 88%. CONCLUSIONS The SP-RiSc yielded a high performance in identifying MS patients with high probability to develop SPMS, which can help improve management strategies. These findings are the premise of further larger prospective studies to assess its use in clinical settings.
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Affiliation(s)
- Anna Isabella Pisani
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Francesco Crescenzo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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21
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Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is a clinically heterogeneous disease, which complicates expectant management as well as treatment decisions. This review provides an overview of both well established and emerging predictors of disability worsening, including clinical factors, imaging factors, biomarkers and treatment strategies. RECENT FINDINGS In addition to well known clinical predictors (age, male sex, clinical presentation, relapse behaviour), smoking, obesity, vascular and psychiatric comorbidities are associated with subsequent disability worsening in persons with MS. A number of imaging features are predictive of disability worsening and are present to varying degrees in relapsing and progressive forms of MS. These include brain volumes, spinal cord atrophy, lesion volumes and optical coherence tomography features. Cerebrospinal and more recently blood biomarkers including neurofilament light show promise as more easily attainable biomarkers of future disability accumulation. Importantly, recent observational studies suggest that initiation of early-intensive therapy, as opposed to escalation based on breakthrough disease, is associated with decreased accumulation of disability overall, although randomized controlled trials investigating this question are underway. SUMMARY Understanding risk factors associated with disability progression can help to both counsel patients and enhance the clinician's availability to provide evidence-based treatment recommendations.
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Kleiter I, Ayzenberg I, Havla J, Lukas C, Penner IK, Stadelmann C, Linker RA. The transitional phase of multiple sclerosis: Characterization and conceptual framework. Mult Scler Relat Disord 2020; 44:102242. [DOI: 10.1016/j.msard.2020.102242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
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Havas J, Leray E, Rollot F, Casey R, Michel L, Lejeune F, Wiertlewski S, Laplaud D, Foucher Y. Predictive medicine in multiple sclerosis: A systematic review. Mult Scler Relat Disord 2020; 40:101928. [DOI: 10.1016/j.msard.2020.101928] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/05/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
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Oh J, Alikhani K, Bruno T, Devonshire V, Giacomini PS, Giuliani F, Nakhaipour HR, Schecter R, Larochelle C. Diagnosis and management of secondary-progressive multiple sclerosis: time for change. Neurodegener Dis Manag 2019; 9:301-317. [PMID: 31769344 DOI: 10.2217/nmt-2019-0024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Identifying the transition of relapsing-remitting multiple sclerosis (MS) to the secondary-progressive MS form remains a clinical challenge due to the gradual nature of the transition, superimposed relapses, the heterogeneous course of disease among patients and the absence of validated biomarkers and diagnostic tools. The uncertainty associated with the transition makes clinical care challenging for both patients and physicians. The emergence of new disease-modifying treatments for progressive MS and the increasing emphasis of nonpharmacological strategies mark a new era in the treatment of progressive MS. This article summarizes challenges in diagnosis and management, discusses novel treatment strategies and highlights the importance of establishing a clear diagnosis and instituting an interdisciplinary management plan in the care of patients with progressive MS.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tania Bruno
- Division of Physiatry, Department of Medicine, University Health Network - Toronto Rehabilitation Institute, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Virginia Devonshire
- Division of Neurology, Department of Medicine, University of British Columbia MS/NMO Center, Vancouver, BC V6T 1Z3, Canada
| | - Paul S Giacomini
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Fabrizio Giuliani
- Division of Neurology, Neuroscience & Mental Health Institute, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Robyn Schecter
- Novartis Pharmaceuticals Canada, Montreal, QC H9S 1A9, Canada
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Stereological Investigation of Regional Brain Volumes after Acute and Chronic Cuprizone-Induced Demyelination. Cells 2019; 8:cells8091024. [PMID: 31484353 PMCID: PMC6770802 DOI: 10.3390/cells8091024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 02/03/2023] Open
Abstract
Brain volume measurement is one of the most frequently used biomarkers to establish neuroprotective effects during pre-clinical multiple sclerosis (MS) studies. Furthermore, whole-brain atrophy estimates in MS correlate more robustly with clinical disability than traditional, lesion-based metrics. However, the underlying mechanisms leading to brain atrophy are poorly understood, partly due to the lack of appropriate animal models to study this aspect of the disease. The purpose of this study was to assess brain volumes and neuro-axonal degeneration after acute and chronic cuprizone-induced demyelination. C57BL/6 male mice were intoxicated with cuprizone for up to 12 weeks. Brain volume, as well as total numbers and densities of neurons, were determined using design-based stereology. After five weeks of cuprizone intoxication, despite severe demyelination, brain volumes were not altered at this time point. After 12 weeks of cuprizone intoxication, a significant volume reduction was found in the corpus callosum and diverse subcortical areas, particularly the internal capsule and the thalamus. Thalamic volume loss was accompanied by glucose hypermetabolism, analyzed by [18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography. This study demonstrates region-specific brain atrophy of different subcortical brain regions after chronic cuprizone-induced demyelination. The chronic cuprizone demyelination model in male mice is, thus, a useful tool to study the underlying mechanisms of subcortical brain atrophy and to investigate the effectiveness of therapeutic interventions.
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Bargiela D, Chinnery PF. Mitochondria in neuroinflammation – Multiple sclerosis (MS), leber hereditary optic neuropathy (LHON) and LHON-MS. Neurosci Lett 2019; 710:132932. [DOI: 10.1016/j.neulet.2017.06.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/27/2017] [Indexed: 01/12/2023]
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Nomura T, Bando Y, Nakazawa H, Kanemoto S, Yoshida S. Pathological changes in mice with long term cuprizone administration. Neurochem Int 2019; 126:229-238. [PMID: 30940543 DOI: 10.1016/j.neuint.2019.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). In MS, a long disease duration is known to be a strong risk factor for converting the clinical course of the disease from relapse remitting MS to secondary progressing MS. There is a hypothesis that long sustained demyelination may exhaust neurons, however, pathological changes induced in neurons following demyelination remain unknown. Cuprizone administration can induce and sustain demyelination in the mouse CNS. We examined pathological changes in mice following long sustained demyelination caused by up to 34-week cuprizone administration. Twelve-week cuprizone administration induced severe demyelination in the cerebral cortex, corpus callosum and deep cerebellar nuclei. Demyelination persisted up to 34 weeks, as shown by myelin basic protein immunohistochemistry. In contrast, cuprizone administration developed demyelination in the striatum by week 34. In these demyelinated regions, no neuronal loss was observed. However, in the striatum and deep cerebellar nuclei, cuprizone-induced demyelination changed the intracellular distribution of parvalbumin (PV). Furthermore, in the striatum, there was an increase in PV in the demyelinated axons and most PV immunoreactivity did not co-localize with SMI32 immunoreactivity in mice with 34-week cuprizone administration. Further, mice with 34-week cuprizone administration showed motor coordination dysfunction in the balance beam test. However, 12-week withdrawal from the cuprizone diet induced remyelination in the regions and motor coordination dysfunction recovered. These results indicate that 34-week cuprizone administration induces and sustains demyelination and results in reversible motor coordination dysfunction. The change of intracellular PV distribution suggests that PV may protect demyelinated axons by Ca2+ buffering. This model may be useful to investigate pathological and behavioral changes following demyelination in the CNS.
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Affiliation(s)
- Taichi Nomura
- Department of Functional Anatomy and Neuroscience, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Yoshio Bando
- Department of Anatomy, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hitomi Nakazawa
- Department of Functional Anatomy and Neuroscience, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Soshi Kanemoto
- Department of Functional Anatomy and Neuroscience, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shigetaka Yoshida
- Department of Functional Anatomy and Neuroscience, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Effect of glatiramer acetate on cerebral grey matter pathology in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2019; 27:305-311. [DOI: 10.1016/j.msard.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 01/17/2023]
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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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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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Bajrami A, Pitteri M, Castellaro M, Pizzini F, Romualdi C, Montemezzi S, Monaco S, Calabrese M. The effect of fingolimod on focal and diffuse grey matter damage in active MS patients. J Neurol 2018; 265:2154-2161. [PMID: 29938336 DOI: 10.1007/s00415-018-8952-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The mechanism of action of fingolimod within the central nervous system and its efficacy in reducing/preventing both focal and diffuse grey matter (GM) damage in active multiple sclerosis (MS) are not completely understood. METHODS In this longitudinal, 2-year prospective, phase IV, single-blind study, 40 MS patients treated with fingolimod and 39 untreated age, gender, and disability-matched MS patients were enrolled. Each patient underwent a neurological examination every 6 months and a 3T MRI at the beginning of the treatment and after 24 months. The accumulation of new cortical lesions (CLs) and the progression of regional GM atrophy were compared between the two groups. RESULTS At the end of the study (T24), the percentage of patients with new CLs (13.5 vs. 89%, p < 0.001) and the percentage of GM volume change was lower in the treated group (p < 0.001). The regional analysis revealed that the treated group had also less volume loss in thalamus, caudatus, globus pallidus, cingulate cortex, and hippocampus (p < 0.001), as well as in, cerebellum, superior frontal gyrus, and insular-long gyrus (p < 0.05). Patients with no evidence of disease activity were 60% in the treated group and 10% in the untreated group (p < 0.001). CONCLUSIONS These results suggest a possible protective effect of fingolimod on focal and diffuse GM damage.
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Affiliation(s)
- Albulena Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Marco Pitteri
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Marco Castellaro
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
- Department of Information Engineering, University of Padova, Padua, Italy
| | - Francesca Pizzini
- Neuroradiology and Radiology Units, Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | | | - Stefania Montemezzi
- Neuroradiology and Radiology Units, Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - Salvatore Monaco
- Neurology B, Department of Neurosciences, Biomedicine 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 Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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Scalfari A, Romualdi C, Nicholas RS, Mattoscio M, Magliozzi R, Morra A, Monaco S, Muraro PA, Calabrese M. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology 2018; 90:e2107-e2118. [PMID: 29769373 DOI: 10.1212/wnl.0000000000005685] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship among cortical radiologic changes, the number of early relapses (ERs), and the long-term course of multiple sclerosis (MS). METHODS In this cohort study, we assessed the number of cortical lesions (CLs) and white matter (WM) lesions and the cortical thickness (Cth) at clinical onset and after 7.9 mean years among 219 patients with relapsing remitting (RR) MS with 1 (Low-ER), 2 (Mid-ER), and ≥3 (High-ER) ERs during the first 2 years. Kaplan-Meier and Cox regression analyses investigated early factors influencing the risk of secondary progressive (SP) MS. RESULTS Fifty-nine patients (27%) converted to SPMS in 6.1 mean years. A larger number of CLs at onset predicted a higher risk of SPMS (hazard ratio [HR] 2.16, 4.79, and 12.3 for 2, 5, and 7 CLs, respectively, p < 0.001) and shorter latency to progression. The High-ER compared to the Low-ER and Mid-ER groups had a larger volume of WM lesions and CLs at onset, accrued more CLs, experienced more severe cortical atrophy over time, and entered the SP phase more rapidly. In the multivariate model, older age at onset (HR 1.97, p < 0.001), a larger baseline CL (HR 2.21, p = 0.005) and WM lesion (HR 1.32, p = 0.03) volume, early changes of global Cth (HR 1.36, p = 0.03), and ≥3 ERs (HR 6.08, p < 0.001) independently predicted a higher probability of SP. CONCLUSIONS Extensive cortical damage at onset is associated with florid inflammatory clinical activity and predisposes to a rapid occurrence of the progressive phase. Age at onset, the number of early attacks, and the extent of baseline focal cortical damage can identify groups at high risk of progression who may benefit from more active therapy.
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Affiliation(s)
- Antonio Scalfari
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Chiara Romualdi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Richard S Nicholas
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Miriam Mattoscio
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Roberta Magliozzi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Aldo Morra
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Salvatore Monaco
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Paolo A Muraro
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Massimiliano Calabrese
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy.
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Beck ES, Sati P, Sethi V, Kober T, Dewey B, Bhargava P, Nair G, Cortese IC, Reich DS. Improved Visualization of Cortical Lesions in Multiple Sclerosis Using 7T MP2RAGE. AJNR Am J Neuroradiol 2018; 39:459-466. [PMID: 29439120 DOI: 10.3174/ajnr.a5534] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cortical lesions are common and often extensive in multiple sclerosis but are difficult to visualize by MRI, leaving important questions about their clinical implications and response to therapy unanswered. Our aim was to determine whether cortical lesions are better visualized using magnetization prepared 2 rapid acquisition gradient echoes (MP2RAGE) than T2*-weighted imaging on 7T MR imaging. MATERIALS AND METHODS Brain MR imaging using T1-weighted MP2RAGE at 500-μm isotropic resolution, T2*-weighted gradient-echo, and T2*-weighted segmented echo-planar imaging sequences were collected for 13 patients with MS and 5 age-matched neurologically healthy controls on a 7T research system. One MS case underwent postmortem MR imaging including gradient-echo and MP2RAGE sequences, after which cortical lesions seen on MR imaging were assessed with immunohistochemistry. RESULTS MP2RAGE detected 203 cortical lesions (median, 16 lesions/case; interquartile range, 15), compared to 92 with T2*gradient-echo (median, 7; interquartile range, 8; P < .001) and 81 with T2*EPI (median, 7; interquartile range, 5; P < .001). This increase in lesion number detected on MP2RAGE versus T2* was observed for juxtacortical, leukocortical, and intracortical lesions. Forty-three percent of all cortical lesions were identified only on MP2RAGE. White matter lesion volume correlated with total juxtacortical (r = 0.86, P < .001) and leukocortical lesion volume (r = 0.70, P < .01) but not intracortical lesion volume, suggesting that pathophysiology may differ by lesion type. Of 4 suspected lesions seen on postmortem imaging, 3 were found to be true cortical lesions while 1 represented postmortem tissue damage. CONCLUSIONS A combination of MP2RAGE and T2*-weighted imaging at 7T improved detection of cortical lesions and should enable longitudinal studies to elucidate their spatiotemporal dynamics and clinical implications.
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Affiliation(s)
- E S Beck
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
| | - P Sati
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
| | - V Sethi
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
| | - T Kober
- Advanced Clinical Imaging Technology Group (T.K.), Siemens Healthcare Switzerland, Lausanne, Switzerland.,Department of Radiology (T.K.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,LTS5, Ecole Polytechnique Fédérale de Lausanne (T.K.), Lausanne, Switzerland
| | - B Dewey
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
| | - P Bhargava
- Department of Neurology (P.B.), Johns Hopkins University, Baltimore, Maryland
| | - G Nair
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
| | - I C Cortese
- Neuroimmunology Clinic (I.C.C.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- From the Translational Neuroradiology Section (E.S.B., P.S., V.S., B.D., G.N., D.S.R.)
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Favaretto A, Lazzarotto A, Margoni M, Poggiali D, Gallo P. Effects of disease modifying therapies on brain and grey matter atrophy in relapsing remitting multiple sclerosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40893-017-0033-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
PURPOSE OF REVIEW Studies of large longitudinal cohorts of patients with multiple sclerosis (MS) have emphasized the prognostic value of conventional MRI markers, at least during early stages. Advanced imaging metrics derived from quantitative MRI and PET provide relevant information about microstructural damage within and outside visible lesions that may be more sensitive to predict long-term disability. Here, we summarize the most recent findings regarding the prognostic value of imaging markers throughout MS stages. RECENT FINDINGS In clinically isolated syndrome, the presence of at least one brain or spinal cord T2 lesion strongly increases the risk of conversion to clinically definite MS (hazard ratio ranging from 5 to 11). Similarly, the occurrence of new white matter lesions is strongly predictive of subsequent relapse rate and response to current disease modifying therapies. Beyond white matter lesions, volumetric changes in the grey matter and normal-appearing tissue damage are more sensitive prognostic markers for physical and cognitive disability, especially in progressive MS. SUMMARY Although white matter lesion number and volume still remains the imaging metric used in daily clinical practice, further development of advanced imaging predictors of long-term disability should allow a better stratification of patients in future clinical trials aimed at promoting repair or neuroprotection.
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36
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Mainero C, Louapre C. Unraveling cortical pathology in multiple sclerosis using the T1-/T2-weighted ratio? Ann Neurol 2017; 82:516-518. [PMID: 28976603 DOI: 10.1002/ana.25063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA.,Harvard Medical School, Cambridge, MA
| | - Céline Louapre
- UPMC University Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,APHP, Hôpital Pitié-Salpêtriere, Neurology Department, Paris, France
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37
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Righart R, Biberacher V, Jonkman LE, Klaver R, Schmidt P, Buck D, Berthele A, Kirschke JS, Zimmer C, Hemmer B, Geurts JJG, Mühlau M. Cortical pathology in multiple sclerosis detected by the T1/T2-weighted ratio from routine magnetic resonance imaging. Ann Neurol 2017; 82:519-529. [PMID: 28833433 PMCID: PMC5698772 DOI: 10.1002/ana.25020] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In multiple sclerosis, neuropathological studies have shown widespread changes in the cerebral cortex. In vivo imaging is critical, because the histopathological substrate of most measurements is unknown. METHODS Using a novel magnetic resonance imaging analysis technique, based on the ratio of T1- and T2-weighted signal intensities, we studied the cerebral cortex of a large cohort of patients in early stages of multiple sclerosis. A total of 168 patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis (Expanded Disability Status Scale: median = 1, range = 0-3.5) and 80 age- and sex-matched healthy controls were investigated. We also searched for the histopathological substrate of the T1/T2-weighted ratio by combining postmortem imaging and histopathology in 9 multiple sclerosis brain donors. RESULTS Patients showed lower T1/T2-weighted ratio values in parietal and occipital areas. The 4 most significant clusters appeared in the medial occipital and posterior cingulate cortex (each left and right). The decrease of the T1/T2-weighted ratio in the posterior cingulate was related to performance in attention. Analysis of the T1/T2-weighted ratio values of postmortem imaging yielded a strong correlation with dendrite density but none of the other parameters including myelin. INTERPRETATION The T1/T2-weighted ratio decreases in early stages of multiple sclerosis in a widespread manner, with a preponderance of posterior areas and with a contribution to attentional performance; it seems to reflect dendrite pathology. As the method is broadly available and applicable to available clinical scans, we believe that it is a promising candidate for studying and monitoring cortical pathology or therapeutic effects in multiple sclerosis. Ann Neurol 2017;82:519-529.
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Affiliation(s)
- Ruthger Righart
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,TUM Neuroimaging Center, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Viola Biberacher
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,TUM Neuroimaging Center, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Laura E Jonkman
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel Klaver
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Schmidt
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,TUM Neuroimaging Center, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,Department of Statistics, Ludwig Maximilian University of Munich, Munich, Germany
| | - Dorothea Buck
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark Mühlau
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,TUM Neuroimaging Center, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
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38
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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: 59] [Impact Index Per Article: 8.4] [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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Puthenparampil M, Poggiali D, Causin F, Rolma G, Rinaldi F, Perini P, Gallo P. Cortical relapses in multiple sclerosis. Mult Scler 2016; 22:1184-91. [DOI: 10.1177/1352458514564483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/24/2014] [Indexed: 01/14/2023]
Abstract
Background: Multiple sclerosis (MS) is a white and grey matter disease of the central nervous system (CNS). It is recognized that cortical damage (i.e. focal lesions and atrophy) plays a role in determining the accumulation of physical and cognitive disability that is observed in patients with progressive MS. To date, an association of cortical lesions with clinical relapses has not been described. Results: We report clinical and magnetic resonance imaging (MRI) findings of five relapsing–remitting MS (RRMS) patients who had clinical relapses characterized by the acute appearance of cortical symptoms, due to the development of large, snake-like, cortical inflammatory lesions. Symptoms were: acute Wernicke’s aphasia mimicking stroke; agraphia with acalculia, not associated to a motor deficit nor linguistic disturbance; hyposthenia of the left arm, followed by muscle twitching of the hand, spreading to arm and face; acute onset of left lower limb paroxysmal hypertonia; and temporal lobe status epilepticus, with psychotic symptoms. Conclusions: Cortical relapses may occur in MS. MRI examination in MS should include sequences, such as double inversion recovery (DIR) or phase sensitive inversion recovery (PSIR), that are aimed at visualizing cortical lesions, especially in the presence of symptoms of cortical dysfunction. Our observation further stresses and extends the clinical relevance of cortical pathology in MS.
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Affiliation(s)
- Marco Puthenparampil
- Department of Neurosciences NPSRR, Multiple Sclerosis Centre Veneto Region, First Neurology Clinic, University of Padova, Italy
| | - Davide Poggiali
- The Multiple Sclerosis Centre of the Veneto Region of Italy (CeSMuV), Padova, Italy
| | - Francesco Causin
- Department of Neurosciences, University Hospital, University of Padova, Italy
| | - Giuseppe Rolma
- Department of Neurosciences, University Hospital, University of Padova, Italy
| | - Francesca Rinaldi
- The Multiple Sclerosis Centre of the Veneto Region of Italy (CeSMuV), Padova, Italy
| | - Paola Perini
- The Multiple Sclerosis Centre of the Veneto Region of Italy (CeSMuV), Padova, Italy
| | - Paolo Gallo
- The Multiple Sclerosis Centre of the Veneto Region of Italy (CeSMuV), Padova, Italy
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40
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Nourbakhsh B, Azevedo C, Maghzi AH, Spain R, Pelletier D, Waubant E. Subcortical grey matter volumes predict subsequent walking function in early multiple sclerosis. J Neurol Sci 2016; 366:229-233. [DOI: 10.1016/j.jns.2016.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/04/2016] [Accepted: 04/28/2016] [Indexed: 01/28/2023]
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41
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Watkins LM, Neal JW, Loveless S, Michailidou I, Ramaglia V, Rees MI, Reynolds R, Robertson NP, Morgan BP, Howell OW. Complement is activated in progressive multiple sclerosis cortical grey matter lesions. J Neuroinflammation 2016; 13:161. [PMID: 27333900 PMCID: PMC4918026 DOI: 10.1186/s12974-016-0611-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The symptoms of multiple sclerosis (MS) are caused by damage to myelin and nerve cells in the brain and spinal cord. Inflammation is tightly linked with neurodegeneration, and it is the accumulation of neurodegeneration that underlies increasing neurological disability in progressive MS. Determining pathological mechanisms at play in MS grey matter is therefore a key to our understanding of disease progression. METHODS We analysed complement expression and activation by immunocytochemistry and in situ hybridisation in frozen or formalin-fixed paraffin-embedded post-mortem tissue blocks from 22 progressive MS cases and made comparisons to inflammatory central nervous system disease and non-neurological disease controls. RESULTS Expression of the transcript for C1qA was noted in neurons and the activation fragment and opsonin C3b-labelled neurons and glia in the MS cortical and deep grey matter. The density of immunostained cells positive for the classical complement pathway protein C1q and the alternative complement pathway activation fragment Bb was significantly increased in cortical grey matter lesions in comparison to control grey matter. The number of cells immunostained for the membrane attack complex was elevated in cortical lesions, indicating complement activation to completion. The numbers of classical (C1-inhibitor) and alternative (factor H) pathway regulator-positive cells were unchanged between MS and controls, whilst complement anaphylatoxin receptor-bearing microglia in the MS cortex were found closely apposed to cortical neurons. Complement immunopositive neurons displayed an altered nuclear morphology, indicative of cell stress/damage, supporting our finding of significant neurodegeneration in cortical grey matter lesions. CONCLUSIONS Complement is activated in the MS cortical grey matter lesions in areas of elevated numbers of complement receptor-positive microglia and suggests that complement over-activation may contribute to the worsening pathology that underlies the irreversible progression of MS.
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Affiliation(s)
- Lewis M Watkins
- Institute of Life Sciences, Swansea University School of Medicine, Swansea, SA2 8PP, UK
| | - James W Neal
- Institute of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Sam Loveless
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Iliana Michailidou
- Department of Genome Analysis, Academic Medical Centre, Amsterdam, The Netherlands
| | - Valeria Ramaglia
- Department of Genome Analysis, Academic Medical Centre, Amsterdam, The Netherlands
| | - Mark I Rees
- Institute of Life Sciences, Swansea University School of Medicine, Swansea, SA2 8PP, UK
| | | | - Neil P Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - B Paul Morgan
- Institute of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Owain W Howell
- Institute of Life Sciences, Swansea University School of Medicine, Swansea, SA2 8PP, UK. .,Division of Brain Sciences, Imperial College London, London, UK.
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42
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Affiliation(s)
- Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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43
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Larochelle C, Uphaus T, Prat A, Zipp F. Secondary Progression in Multiple Sclerosis: Neuronal Exhaustion or Distinct Pathology? Trends Neurosci 2016; 39:325-339. [PMID: 26987259 DOI: 10.1016/j.tins.2016.02.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/08/2023]
Abstract
Prevention of progression in neurological diseases, particularly in multiple sclerosis (MS) but also in neurodegenerative diseases, remains a significant challenge. MS patients switch from a relapsing-remitting to a progressive disease course, but it is not understood why and how this conversion occurs and why some patients never experience disease progression. Do aging and accumulation of neuronal damage induce progression, or do cognitive symptoms and accelerated grey matter (GM) atrophy point to distinct processes affecting networks? This review weighs accepted dogma against real data on the secondary progressive phase of the disease, highlighting current challenges in this important field and directions towards development of treatment strategies to slow or prevent progression of disability.
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Affiliation(s)
- Catherine Larochelle
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn(2)), University Medical Centre of the Johannes Gutenberg University Mainz, Germany; Neuroimmunology Unit, Department of Neuroscience, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn(2)), University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Alexandre Prat
- Neuroimmunology Unit, Department of Neuroscience, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn(2)), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
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44
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Hutchinson M. Modeling the course and outcomes of MS is statistical twaddle--Commentary. Mult Scler 2016; 22:144-5. [PMID: 26830395 DOI: 10.1177/1352458516628332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Hutchinson
- School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland
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45
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Wiggermann V, Hernández-Torres E, Traboulsee A, Li DKB, Rauscher A. FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection. AJNR Am J Neuroradiol 2016; 37:259-65. [PMID: 26450539 DOI: 10.3174/ajnr.a4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/21/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR. MATERIALS AND METHODS 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR(2)). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10). RESULTS The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR(2) than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR(2). Furthermore, the 3D nature of FLAIR(2) allowed reliable visualization of callosal and infratentorial lesions. CONCLUSIONS We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR(2) can be computed retrospectively if T2 and FLAIR scans are available.
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Affiliation(s)
- V Wiggermann
- From the Departments of Physics and Astronomy (V.W.) Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | - E Hernández-Torres
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | | | - D K B Li
- Medicine (Neurology) (A.T., D.K.B.L.) Radiology (D.K.B.L.) Centre for Brain Health (D.K.B.L., A.R.)
| | - A Rauscher
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.) Centre for Brain Health (D.K.B.L., A.R.) Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.
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46
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Jürgens T, Jafari M, Kreutzfeldt M, Bahn E, Brück W, Kerschensteiner M, Merkler D. Reconstruction of single cortical projection neurons reveals primary spine loss in multiple sclerosis. Brain 2015; 139:39-46. [DOI: 10.1093/brain/awv353] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/16/2015] [Indexed: 11/13/2022] Open
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47
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Hutchinson M. Neurodegeneration in multiple sclerosis is a process separate from inflammation: No. Mult Scler 2015; 21:1628-31. [DOI: 10.1177/1352458515612244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Hutchinson
- St Vincent’s University Hospital, Dublin; School of Medicine and Medical Sciences, University College Dublin, Ireland
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48
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Guglielmetti C, Veraart J, Roelant E, Mai Z, Daans J, Van Audekerke J, Naeyaert M, Vanhoutte G, Delgado Y Palacios R, Praet J, Fieremans E, Ponsaerts P, Sijbers J, Van der Linden A, Verhoye M. Diffusion kurtosis imaging probes cortical alterations and white matter pathology following cuprizone induced demyelination and spontaneous remyelination. Neuroimage 2015; 125:363-377. [PMID: 26525654 DOI: 10.1016/j.neuroimage.2015.10.052] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/21/2022] Open
Abstract
Although MRI is the gold standard for the diagnosis and monitoring of multiple sclerosis (MS), current conventional MRI techniques often fail to detect cortical alterations and provide little information about gliosis, axonal damage and myelin status of lesioned areas. Diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) provide sensitive and complementary measures of the neural tissue microstructure. Additionally, specific white matter tract integrity (WMTI) metrics modelling the diffusion in white matter were recently derived. In the current study we used the well-characterized cuprizone mouse model of central nervous system demyelination to assess the temporal evolution of diffusion tensor (DT), diffusion kurtosis tensor (DK) and WMTI-derived metrics following acute inflammatory demyelination and spontaneous remyelination. While DT-derived metrics were unable to detect cuprizone induced cortical alterations, the mean kurtosis (MK) and radial kurtosis (RK) were found decreased under cuprizone administration, as compared to age-matched controls, in both the motor and somatosensory cortices. The MK remained decreased in the motor cortices at the end of the recovery period, reflecting long lasting impairment of myelination. In white matter, DT, DK and WMTI-derived metrics enabled the detection of cuprizone induced changes differentially according to the stage and the severity of the lesion. More specifically, the MK, the RK and the axonal water fraction (AWF) were the most sensitive for the detection of cuprizone induced changes in the genu of the corpus callosum, a region less affected by cuprizone administration. Additionally, microgliosis was associated with an increase of MK and RK during the acute inflammatory demyelination phase. In regions undergoing severe demyelination, namely the body and splenium of the corpus callosum, DT-derived metrics, notably the mean diffusion (MD) and radial diffusion (RD), were among the best discriminators between cuprizone and control groups, hence highlighting their ability to detect both acute and long lasting changes. Interestingly, WMTI-derived metrics showed the aptitude to distinguish between the different stages of the disease. Both the intra-axonal diffusivity (Da) and the AWF were found to be decreased in the cuprizone treated group, Da specifically decreased during the acute inflammatory demyelinating phase whereas the AWF decrease was associated to the spontaneous remyelination and the recovery period. Altogether our results demonstrate that DKI is sensitive to alterations of cortical areas and provides, along with WMTI metrics, information that is complementary to DT-derived metrics for the characterization of demyelination in both white and grey matter and subsequent inflammatory processes associated with a demyelinating event.
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Affiliation(s)
- C Guglielmetti
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | - J Veraart
- iMinds - Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium; Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - E Roelant
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Z Mai
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | - J Daans
- Experimental Cell Transplantation Group, Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Antwerp, Belgium
| | | | - M Naeyaert
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | - G Vanhoutte
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | | | - J Praet
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | - E Fieremans
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - P Ponsaerts
- Experimental Cell Transplantation Group, Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Antwerp, Belgium
| | - J Sijbers
- iMinds - Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium
| | | | - M Verhoye
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
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Longitudinal associations between brain structural changes and fatigue in early MS. Mult Scler Relat Disord 2015; 5:29-33. [PMID: 26856940 DOI: 10.1016/j.msard.2015.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fatigue is a common and disabling symptom of multiple sclerosis (MS) patients. Structural changes in several brain areas have been reported to correlate with fatigue in MS patients but none consistently. OBJECTIVE To study the association between global and regional measures of brain atrophy and fatigue in patients with early relapsing MS. METHODS Clinically isolated syndrome and relapsing MS patients within 12 months of clinical onset were enrolled in a neuroprotection trial of riluzole versus placebo with up to 36 months of follow-up. MRI metrics included brain volumes measured by SIENAX normalized measurements [normalized brain parenchymal volume (nBPV), normalized normal-appearing white and gray matter volume (nNAWMV and nGMV)] and T2 lesion volume (T2LV). Cortical thickness, thalamic volume and cerebellar cortical volume were measured using Freesurfer's longitudinal pipeline (v5.3) and a lesion inpainting approach. Fatigue was evaluated using the Modified Fatigue Impact Scale (MFIS). Mixed model regression measured time trends and associations between imaging and fatigue severity, adjusting for age and sex. RESULTS Forty-three patients (mean age 36 years; 31 females) were enrolled within 7.5 ± 4.9 months of symptom onset. Baseline and change over baseline in lesion volumes, grey matter, white matter, basal ganglia and total parenchymal volumes were not associated with change in MFIS score over time. Lower thalamic volume at baseline predicted increasing physical subscale of MFIS score during the study (p=0.017). There was a trend toward baseline thalamic volume and cerebellar cortical volume predicting subsequent change in total MFIS score (p=0.055 and 0.082 respectively). On-study change in thalamic or cerebellar cortical volume was not associated with on-study change in MFIS score. CONCLUSION Global measures of tissue loss are not strongly associated with fatigue in patients with early MS. However, thalamic and cerebellar cortical atrophy may be predictive of subsequent changes in fatigue in these patients.
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50
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Scalfari A. Multiple sclerosis relapse phenotype is an important, neglected, determinant of disease outcome – NO. Mult Scler 2015; 21:1371-4. [DOI: 10.1177/1352458515599452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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