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Shayestehfar M, Salari M, Karimi S, Vosough M, Memari A, Nabavi SM. Sex hormone therapy in Multiple Sclerosis: A systematic review of randomized clinical trials. J Cent Nerv Syst Dis 2024; 16:11795735231223411. [PMID: 38188227 PMCID: PMC10768623 DOI: 10.1177/11795735231223411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background In spite of the observed immunomodulatory properties of different sex hormones on Multiple Sclerosis (MS) in different investigations, to date, there has been no study to systematically review the documents to add more powerful data to the field. Objectives Therefore, in this paper we aim to systematically review clinical and randomized controlled trials (RCT) assessing the effect of sex hormone therapies on individuals with MS. Design A comprehensive search of electronic databases including PubMed, EMBASE, and Scopus was conducted. Clinical trials and RCTs that assessed the impact of sex hormones on individuals with MS were selected and included in the systematic review. Data sources and methods In the final phase of the search strategy, 9 papers reached the criteria for entering in the systematic review. Two independent reviewers extracted the relevant data from each article according to the standardized data extraction form. Two reviewers also assessed the quality of each study independently using PEDro scale. Results We categorized three different classifications of outcomes including clinical, MRI, and immune system findings and put each measured outcome in the category which matched best. Conclusion In conclusion, the existed investigations on the effect of sex hormones on inflammatory and neurodegenerative components of MS are promising particularly in relapsing-remitting MS (RRMS).
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Affiliation(s)
- Monir Shayestehfar
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Salari
- Neuro Functional Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahedeh Karimi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
| | - Amirhossein Memari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Massood Nabavi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
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2
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Neuroprotective Effect of Glatiramer Acetate on Neurofilament Light Chain Leakage and Glutamate Excess in an Animal Model of Multiple Sclerosis. Int J Mol Sci 2021; 22:ijms222413419. [PMID: 34948217 PMCID: PMC8707261 DOI: 10.3390/ijms222413419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022] Open
Abstract
Axonal and neuronal pathologies are a central constituent of multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), induced by the myelin oligodendrocyte glycoprotein (MOG) 35–55 peptide. In this study, we investigated neurodegenerative manifestations in chronic MOG 35–55 induced EAE and the effect of glatiramer acetate (GA) treatment on these manifestations. We report that the neuronal loss seen in this model is not attributed to apoptotic neuronal cell death. In EAE-affected mice, axonal damage prevails from the early disease phase, as revealed by analysis of neurofilament light (NFL) leakage into the sera along the disease duration, as well as by immunohistological examination. Elevation of interstitial glutamate concentrations measured in the cerebrospinal fluid (CSF) implies that glutamate excess plays a role in the damage processes inflicted by this disease. GA applied as a therapeutic regimen to mice with apparent clinical symptoms significantly reduces the pathological manifestations, namely apoptotic cell death, NFL leakage, histological tissue damage, and glutamate excess, thus corroborating the neuroprotective consequences of this treatment.
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3
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Penner IK, Gass A, Schreiber H, Wattjes MP. [Neuropsychological and MRI diagnostics in secondary progressive multiple sclerosis]. DER NERVENARZT 2021; 92:1293-1301. [PMID: 33891150 PMCID: PMC8648628 DOI: 10.1007/s00115-021-01118-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
Hintergrund Die Multiple Sklerose ist im longitudinalen Verlauf oft ein Krankheitskontinuum mit initial schubförmig-remittierender Phase (RRMS) und späterer sekundärer Progredienz (SPMS). Die meisten bisher zugelassenen Therapien sind bei SPMS nicht ausreichend wirksam. Die frühe Erkennung der SPMS-Konversion ist daher entscheidend für die Therapiewahl. Wichtige Entscheidungshilfen können dabei die Testung kognitiver Teilleistungen und die Magnetresonanztomographie (MRT) sein. Ziel der Arbeit Darstellung der Bedeutung kognitiver Testungen und von MRT-Untersuchungen für Prädiktion und Erfassung der SPMS-Konversion. Ausarbeitung von Strategien der Verlaufsbeobachtung und Therapiesteuerung in der Praxis, insbesondere in der ambulanten Versorgung. Material und Methoden Übersichtsarbeit auf Basis einer unsystematischen Literaturrecherche. Ergebnisse Standardisierte kognitive Testung kann für die frühe SPMS-Diagnose hilfreich sein und die Verlaufsbewertung erleichtern. Eine jährliche Anwendung sensitiver Screeningtests wie Symbol Digit Modalities Test (SDMT) und Brief Visual Memory Test-Revised (BVMT‑R) oder der Brief International Cognitive Assessment for MS (BICAMS)-Testbatterie ist empfehlenswert. Persistierende inflammatorische Aktivität im MRT in den ersten drei Jahren der Erkrankung sowie das Vorhandensein kortikaler Läsionen sind prädiktiv für eine SPMS-Konversion. Ein standardisiertes MRT-Monitoring auf Merkmale einer progressiven MS kann den klinisch und neurokognitiv begründeten SPMS-Verdacht stützen. Diskussion Die interdisziplinäre Versorgung von MS-Patienten durch klinisch versierte Neurologen, unterstützt durch neuropsychologische Testung und MRT, hat einen hohen Stellenwert für die SPMS-Prädiktion und Diagnose. Letztere erlaubt eine frühe Umstellung auf geeignete Therapien, da bei SPMS andere Interventionen als für die RRMS notwendig sind. Nach erfolgter medikamentöser Umstellung erlaubt die klinische, neuropsychologische und bildgebende Vigilanz ein stringentes Monitoring auf neuroinflammatorische und -degenerative Aktivität sowie Therapiekomplikationen.
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Affiliation(s)
- I-K Penner
- Klinik für Neurologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland. .,COGITO Zentrum für angewandte Neurokognition und neuropsychologische Forschung, Merowingerplatz 1, 40225, Düsseldorf, Deutschland.
| | - A Gass
- Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - H Schreiber
- Nervenärztliche Gemeinschaftspraxis, Neuropoint Akademie und NTD, Ulm, Deutschland
| | - M P Wattjes
- Institut für diagnostische und interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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4
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Fujimori J, Fujihara K, Wattjes M, Nakashima I. Patterns of cortical grey matter thickness reduction in multiple sclerosis. Brain Behav 2021; 11:e02050. [PMID: 33506628 PMCID: PMC8035454 DOI: 10.1002/brb3.2050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/07/2021] [Accepted: 01/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the patterns of cortical gray matter thickness in multiple sclerosis (MS) patients. METHODS Seventy-four MS patients-clinically isolated syndrome (4%), relapsing-remitting MS (79%), and progressive MS (17%)-and 21 healthy controls (HCs) underwent 1.5 Tesla T1-weighted 3D MRI examinations to measure brain cortical thickness in a total of 68 regions of interest. Using hierarchical cluster analysis with multivariate cortical thickness data, cortical thickness reduction patterns were cross-sectionally investigated in MS patients. RESULTS The MS patients were grouped into three major clusters (Clusters 1, 2, and 3). Most of the regional cortical thickness values were equivalent between the HCs and Cluster 1, but decreased in the order of Clusters 2 and 3. Only the thicknesses of the temporal lobe cortices (the bilateral superior and left middle temporal cortex, as well as the left fusiform cortex) were significantly different among Clusters 1, 2, and 3. In contrast, temporal pole thickness reduction was evident exclusively in Cluster 3, which was also characterized by increased lesion loads in the temporal pole and the adjacent juxtacortical white matter, dilatation of the inferior horn of the lateral ventricle, severe whole-brain volume reduction, and longer disease duration. Although cortical atrophy was significantly more common in the progressive phase, approximately half of the MS patients with the severe cortical atrophy pattern had relapsing-remitting disease. CONCLUSION Cortical thickness reduction patterns in MS are mostly characterized by the degree of temporal lobe cortical atrophy, which may start in the relapsing-remitting phase. Among the temporal lobe cortices, the neurodegenerative change may accelerate in the temporal pole in the progressive phase.
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Affiliation(s)
- Juichi Fujimori
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine and Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Mike Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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5
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Aoki S, Fujimori J, Mikami R, Hoshi K, Kawakami J, Sato K, Nakashima I. Assisting the diagnosis of multiple sclerosis using a set of regional brain volumes: A classification model for patients and healthy controls. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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6
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Patterns of regional brain volume loss in multiple sclerosis: a cluster analysis. J Neurol 2019; 267:395-405. [DOI: 10.1007/s00415-019-09595-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/23/2022]
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7
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Winder K, Linker RA, Seifert F, Wang R, Lee DH, Engelhorn T, Dörfler A, Fröhlich K, Hilz M. Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis. Hum Brain Mapp 2019; 40:5083-5093. [PMID: 31403742 PMCID: PMC6865522 DOI: 10.1002/hbm.24759] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular autonomic dysfunction is common in multiple sclerosis (MS) and contributes significantly to disability. We hypothesized that cerebral MS‐lesions in specific areas of the central autonomic network might account for imbalance of the sympathetic and parasympathetic cardiovascular modulation. Therefore, we used voxel‐based lesion symptom mapping (VLSM) to determine associations between cardiovascular autonomic dysfunction and cerebral MS‐related lesion sites. In 74 MS‐patients (mean age 37.0 ± 10.5 years), we recorded electrocardiographic RR‐intervals and systolic and diastolic blood pressure. Using trigonometric regressive spectral analysis, we assessed low (0.04–0.15 Hz) and high (0.15–0.5 Hz) frequency RR‐interval‐and blood pressure‐oscillations and determined parasympathetically mediated RR‐interval–high‐frequency modulation, mainly sympathetically mediated RR‐interval–low‐frequency modulation, sympathetically mediated blood pressure‐low‐frequency modulation, and the ratios of sympathetic and parasympathetic RR‐interval‐modulation as an index of sympathetic‐parasympathetic balance. Cerebral MS‐lesions were analyzed on imaging scans. We performed a VLSM‐analysis correlating parameters of autonomic dysfunction with cerebral MS‐lesion sites. The VLSM‐analysis showed associations between increased RR‐interval low‐frequency/high‐frequency ratios and lesions most prominently in the left insular, hippocampal, and right frontal inferior opercular region, and a smaller lesion cluster in the right middle cerebellar peduncle. Increased blood pressure‐low‐frequency powers were associated with lesions primarily in the right posterior parietal white matter and again left insular region. Our data indicate associations between a shift of cardiovascular sympathetic‐parasympathetic balance toward increased sympathetic modulation and left insular and hippocampal lesions, areas of the central autonomic network. The VLSM‐analysis further distinguished between right inferior fronto‐opercular lesions disinhibiting cardiac sympathetic activation and right posterior parietal lesions increasing sympathetic blood pressure modulation.
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Affiliation(s)
- Klemens Winder
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf A Linker
- Department of Neurology, University Regensburg, Regensburg, Germany
| | - Frank Seifert
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ruihao Wang
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - De-Hyung Lee
- Department of Neurology, University Regensburg, Regensburg, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kilian Fröhlich
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Max Hilz
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Dekker I, Sombekke MH, Balk LJ, Moraal B, Geurts JJ, Barkhof F, Uitdehaag BM, Killestein J, Wattjes MP. Infratentorial and spinal cord lesions: Cumulative predictors of long-term disability? Mult Scler 2019; 26:1381-1391. [PMID: 31373535 PMCID: PMC7543019 DOI: 10.1177/1352458519864933] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS). Methods: We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2. Disability progression after 6 and 11 years was measured using the Expanded Disability Status Scale (EDSS) and EDSS-plus (including 25-foot walk and 9-hole peg test). Patients with spinal cord or infratentorial lesions were compared for the risk of 6- and 11-year disability progression to patients without spinal cord or infratentorial lesions, respectively. Subsequently, patients with lesions on both locations were compared to patients with only spinal cord or only infratentorial lesions. Results: Baseline spinal cord lesions show a higher risk of 6-year EDSS progression (odds ratio (OR): 3.6, p = 0.007) and EDSS-plus progression (OR: 2.5, p = 0.028) and 11-year EDSS progression (OR: 2.8, p = 0.047). Patients with both infratentorial and spinal cord lesions did not have a higher risk of 6-year disability progression than patients with only infratentorial or only spinal cord lesions. Conclusion: The presence of early spinal cord lesions seems to be a dominant risk factor of disability progression. Simultaneous presence of early infratentorial and spinal cord lesions did not undisputedly predict disability progression.
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Affiliation(s)
- Iris Dekker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Madeleine H Sombekke
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jeroen Jg Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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9
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Stone S, Yue Y, Stanojlovic M, Wu S, Karsenty G, Lin W. Neuron-specific PERK inactivation exacerbates neurodegeneration during experimental autoimmune encephalomyelitis. JCI Insight 2019; 4:124232. [PMID: 30674717 DOI: 10.1172/jci.insight.124232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), are chronic inflammatory demyelinating and neurodegenerative diseases of the CNS. Although neurodegeneration is the major contributor to chronic disability in MS, mechanisms governing the viability of axons and neurons in MS and EAE remain elusive. Data indicate that activation of pancreatic endoplasmic reticulum kinase (PERK) influences, positively or negatively, neuron and axon viability in various neurodegenerative diseases through induction of ATF4. In this study, we demonstrate that the PERK pathway was activated in neurons during EAE. We found that neuron-specific PERK inactivation impaired EAE resolution and exacerbated EAE-induced axon degeneration, neuron loss, and demyelination. Surprisingly, neuron-specific ATF4 inactivation did not alter EAE disease course or EAE-induced axon degeneration, neuron loss, and demyelination. These results suggest that PERK activation in neurons protects axons and neurons against inflammation in MS and EAE through ATF4-independent mechanisms.
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Affiliation(s)
- Sarrabeth Stone
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yuan Yue
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Milos Stanojlovic
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shuangchan Wu
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gerard Karsenty
- Department of Genetics and Development, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Wensheng Lin
- Department of Neuroscience and.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, USA
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10
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Fröhlich K, Linker RA, Engelhorn T, Dörfler A, Lee DH, Huhn K, Schwab S, Hilz MJ, Seifert F, Winder K. Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis. J Neuroimaging 2018; 29:211-217. [PMID: 30537408 DOI: 10.1111/jon.12589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Bowel incontinence in multiple sclerosis might be associated with specific lesion sites. This study intended to determine associations between bowel incontinence and cerebral multiple sclerosis lesions using a voxel-wise lesion symptom mapping analysis. METHODS We conducted a retrospective study of multiple sclerosis patients with self-reported bowel incontinence and matched controls. Lesions were manually outlined on T2-weighted MRI scans and transformed into stereotaxic space. We performed a voxel-wise subtraction analysis subtracting the lesion overlap of patients without from patients with bowel incontinence. Finally, we compared the absence or presence of bowel incontinence between patients with and without lesions in a given voxel using the Liebermeister test. RESULTS A total of 51 patients were included in the study. The analysis yielded associations between bowel incontinence and lesions in the supramarginal gyrus of the left secondary somatosensory cortex and another lesion cluster in the right parahippocampal gyrus and amygdala. CONCLUSIONS Our analysis indicates associations between bowel incontinence and lesions in the left supramarginal gyral area contributing to integrating anorectal-visceral sensation and in the right parahippocampal gyrus and amygdala contributing to generating visceral autonomic arousal states. Moreover, our results suggest left hemispheric dominance of sensory visceral integration, while limbic areas of the right hemisphere seem to contribute to the autonomic component of the defecation process. A limitation of our study is the retrospective evaluation of the bowel incontinence status based on medical records. Further research should evaluate the bowel incontinence status in multiple sclerosis patients prospectively to overcome the limitations of the current study.
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Affiliation(s)
- Kilian Fröhlich
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - De-Hyung Lee
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Konstantin Huhn
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Max J Hilz
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Seifert
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klemens Winder
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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11
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Winder K, Linker RA, Seifert F, Deutsch M, Engelhorn T, Dörfler A, Lee DH, Hösl KM, Hilz MJ. Insular multiple sclerosis lesions are associated with erectile dysfunction. J Neurol 2018; 265:783-792. [PMID: 29392463 DOI: 10.1007/s00415-018-8763-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
Erectile function (EF) is frequently compromised in men with multiple sclerosis (MS). Functional neuroimaging in healthy men identified a network of brain areas, such as the insula, visual and somatosensory association areas, cingulate gyrus, prefrontal cortex, as well as subcortical regions, contributing to EF. This study intended to determine associations between EF deterioration during MS and cerebral MS-associated lesion sites. In 31 men with MS (mean age 38.2 ± 11.2 years), we evaluated MS-related EF deterioration by comparing scores of the 5-item International Index of Erectile Function-5 questionnaire (IIEF5) at the time of study and retrospectively, 3 months prior to MS diagnosis, by calculating score differences as DeltaIIEF5 (DeltaIIEF5 score < 0 indicated EF deterioration). To assess the impact of confounding factors of EF, patient age, disease duration, disease severity, depressiveness, bladder and bowel symptoms, and total cerebral MS lesion volume were correlated with DeltaIIEF5 scores (Spearman rank correlation) and compared between patients with and without EF deterioration (t tests or Mann-Whitney U test). MS lesions were assessed on T2-weighted magnetic resonance imaging (MRI; 1.5 or 3 T). We determined the lesion overlap (prevalence of identical lesion sites among patients), subtracted lesion overlaps in patients without EF deterioration from overlaps in patients with EF deterioration, and compared DeltaIIEF5 scores voxel-wise between patients with and without lesions in a given voxel (t test; significance: p < 0.05). In 14 patients (45.2%), DeltaIIEF5 scores indicated EF deterioration. DeltaIIEF5 scores were not associated with age (ρ = 0.06; p = 0.74), disease duration (ρ = 0.26; p = 0.15), disease severity (ρ = - 0.19; p = 0.31), depressiveness (ρ = 0.07; p = 0.72), bladder symptoms (ρ = - 0.11; p = 0.57), bowel symptoms (ρ = 0.17; p = 0.37), and total lesion volume (ρ = - 0.13; p = 0.47). The voxel-wise analysis showed associations between EF deterioration and MS lesions primarily in the bilateral, and predominantly left juxtacortical insular region. In conclusion, MS lesions particularly in the left insular region, which is activated with sexual arousal, contribute to erectile dysfunction.
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Affiliation(s)
- Klemens Winder
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Frank Seifert
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Martina Deutsch
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - De-Hyung Lee
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Max J Hilz
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
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12
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Fröhlich K, Winder K, Linker RA, Engelhorn T, Dörfler A, Lee DH, Hilz MJ, Schwab S, Seifert F. Supratentorial lesions contribute to trigeminal neuralgia in multiple sclerosis. Cephalalgia 2017; 38:1326-1334. [DOI: 10.1177/0333102417737788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background It has been proposed that multiple sclerosis lesions afflicting the pontine trigeminal afferents contribute to trigeminal neuralgia in multiple sclerosis. So far, there are no imaging studies that have evaluated interactions between supratentorial lesions and trigeminal neuralgia in multiple sclerosis patients. Methods We conducted a retrospective study and sought multiple sclerosis patients with trigeminal neuralgia and controls in a local database. Multiple sclerosis lesions were manually outlined and transformed into stereotaxic space. We determined the lesion overlap and performed a voxel-wise subtraction analysis. Secondly, we conducted a voxel-wise non-parametric analysis using the Liebermeister test. Results From 12,210 multiple sclerosis patient records screened, we identified 41 patients with trigeminal neuralgia. The voxel-wise subtraction analysis yielded associations between trigeminal neuralgia and multiple sclerosis lesions in the pontine trigeminal afferents, as well as larger supratentorial lesion clusters in the contralateral insula and hippocampus. The non-parametric statistical analysis using the Liebermeister test yielded similar areas to be associated with multiple sclerosis-related trigeminal neuralgia. Conclusions Our study confirms previous data on associations between multiple sclerosis-related trigeminal neuralgia and pontine lesions, and showed for the first time an association with lesions in the insular region, a region involved in pain processing and endogenous pain modulation.
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Affiliation(s)
- Kilian Fröhlich
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Klemens Winder
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - De-Hyung Lee
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Max J Hilz
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
- Autonomic Unit, University College London, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Frank Seifert
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
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13
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Takemura MY, Hori M, Yokoyama K, Hamasaki N, Suzuki M, Kamagata K, Kamiya K, Suzuki Y, Kyogoku S, Masutani Y, Hattori N, Aoki S. Alterations of the optic pathway between unilateral and bilateral optic nerve damage in multiple sclerosis as revealed by the combined use of advanced diffusion kurtosis imaging and visual evoked potentials. Magn Reson Imaging 2017; 39:24-30. [DOI: 10.1016/j.mri.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 04/01/2016] [Accepted: 04/17/2016] [Indexed: 01/13/2023]
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14
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MacKenzie-Graham A, Kurth F, Itoh Y, Wang HJ, Montag MJ, Elashoff R, Voskuhl RR. Disability-Specific Atlases of Gray Matter Loss in Relapsing-Remitting Multiple Sclerosis. JAMA Neurol 2017; 73:944-53. [PMID: 27294295 DOI: 10.1001/jamaneurol.2016.0966] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Multiple sclerosis (MS) is characterized by progressive gray matter (GM) atrophy that strongly correlates with clinical disability. However, whether localized GM atrophy correlates with specific disabilities in patients with MS remains unknown. OBJECTIVE To understand the association between localized GM atrophy and clinical disability in a biology-driven analysis of MS. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, magnetic resonance images were acquired from 133 women with relapsing-remitting MS and analyzed using voxel-based morphometry and volumetry. A regression analysis was used to determine whether voxelwise GM atrophy was associated with specific clinical deficits. Data were collected from June 28, 2007, to January 9, 2014. MAIN OUTCOMES AND MEASURES Voxelwise correlation of GM change with clinical outcome measures (Expanded Disability Status Scale and Multiple Sclerosis Functional Composite scores). RESULTS Among the 133 female patients (mean [SD] age, 37.4 [7.5] years), worse performance on the Multiple Sclerosis Functional Composite correlated with voxelwise GM volume loss in the middle cingulate cortex (P < .001) and a cluster in the precentral gyrus bilaterally (P = .004). In addition, worse performance on the Paced Auditory Serial Addition Test correlated with volume loss in the auditory and premotor cortices (P < .001), whereas worse performance on the 9-Hole Peg Test correlated with GM volume loss in Brodmann area 44 (Broca area; P = .02). Finally, voxelwise GM loss in the right paracentral lobulus correlated with bowel and bladder disability (P = .03). Thus, deficits in specific clinical test results were directly associated with localized GM loss in clinically eloquent locations. CONCLUSIONS AND RELEVANCE These biology-driven data indicate that specific disabilities in MS are associated with voxelwise GM loss in distinct locations. This approach may be used to develop disability-specific biomarkers for use in future clinical trials of neuroprotective treatments in MS.
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Affiliation(s)
- Allan MacKenzie-Graham
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | - Florian Kurth
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | - Yuichiro Itoh
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | - He-Jing Wang
- Department of Biomathematics, David Geffen School of Medicine at University of California, Los Angeles
| | - Michael J Montag
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | - Robert Elashoff
- Department of Biomathematics, David Geffen School of Medicine at University of California, Los Angeles
| | - Rhonda R Voskuhl
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
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15
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Rougon G, Brasselet S, Debarbieux F. Advances in Intravital Non-Linear Optical Imaging of the Central Nervous System in Rodents. Brain Plast 2016; 2:31-48. [PMID: 29765847 PMCID: PMC5928564 DOI: 10.3233/bpl-160028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose of review: Highly coordinated cellular interactions occur in the healthy or pathologic adult rodent central nervous system (CNS). Until recently, technical challenges have restricted the analysis of these events to largely static modes of study such as immuno-fluorescence and electron microscopy on fixed tissues. The development of intravital imaging with subcellular resolution is required to probe the dynamics of these events in their natural context, the living brain. Recent findings: This review focuses on the recently developed live non-linear optical imaging modalities, the core principles involved, the identified technical challenges that limit their use and the scope of their applications. We highlight some practical applications for these modalities with a specific attention given to Experimental Autoimmune Encephalomyelitis (EAE), a rodent model of a chronic inflammatory disease of the CNS characterized by the formation of disseminated demyelinating lesions accompanied by axonal degeneration. Summary: We conclude that label-free nonlinear optical imaging combined to two photon imaging will continue to contribute richly to comprehend brain function and pathogenesis and to develop effective therapeutic strategies.
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Affiliation(s)
- Geneviève Rougon
- Aix-Marseille Université, CNRS, Institut des Neurosciences de la Timone, UMR 7289, Marseille, France
| | - Sophie Brasselet
- Aix-Marseille Université, CNRS, Centrale Marseille, Institut Fresnel, UMR 7249, Marseille, France
| | - Franck Debarbieux
- Aix-Marseille Université, CNRS, Institut des Neurosciences de la Timone, UMR 7289, Marseille, France
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16
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Odenthal C, Simpson S, Oughton J, van der Mei I, Rose S, Fripp J, Lucas R, Taylor B, Dear K, Ponsonby AL, Coulthard A. Midsagittal corpus callosum area and conversion to multiple sclerosis after clinically isolated syndrome: A multicentre Australian cohort study. J Med Imaging Radiat Oncol 2016; 61:453-460. [DOI: 10.1111/1754-9485.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Cara Odenthal
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Steve Simpson
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Justin Oughton
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Stephen Rose
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Jurgen Fripp
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health; Australian National University; Canberra Australian Capital Territory Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | | | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute; Royal Children's Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Alan Coulthard
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Analysis of ageing-associated grey matter volume in patients with multiple sclerosis shows excess atrophy in subcortical regions. NEUROIMAGE-CLINICAL 2016; 13:9-15. [PMID: 27896065 PMCID: PMC5121150 DOI: 10.1016/j.nicl.2016.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/05/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022]
Abstract
Age of onset in multiple sclerosis (MS) exerts an influence on the course of disease. This study examined whether global and regional brain volumes differed between "younger" and "older" onset MS subjects who were matched for short disease duration, mean 1.9 years and burden as measured by the MS Severity Score and relapses. 21 younger-onset MS subjects (age 30.4 ± 3.2 years) were compared with 17 older-onset (age 48.7 ± 3.3 years) as well as age-matched controls (n = 31, 31.9 ± 3.5 years and n = 21, 47.3 ± 4.0 years). All subjects underwent 3D volumetric T1 and T2-FLAIR imaging. White matter (WM) and grey matter (GM) lesions were outlined manually. Lesions were filled prior to tissue and structural segmentation to reduce classification errors. Volume loss versus control was predominantly in the subcortical GM, at > 13% loss. Younger and older-onset MS subjects had similar, strong excess loss in the putamen, thalamus, and nucleus accumbens. No excess loss was detected in the amygdala or pallidum. The hippocampus and caudate showed significant excess loss in the younger group (p < 0.001) and a strong trend in the older-onset group. These results provide a potential imaging correlate of published neuropsychological studies that reported the association of younger age at disease onset with impaired cognitive performance, including decreased working memory.
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18
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Obert D, Helms G, Sättler MB, Jung K, Kretzschmar B, Bähr M, Dechent P, Diem R, Hein K. Brain Metabolite Changes in Patients with Relapsing-Remitting and Secondary Progressive Multiple Sclerosis: A Two-Year Follow-Up Study. PLoS One 2016; 11:e0162583. [PMID: 27636543 PMCID: PMC5026363 DOI: 10.1371/journal.pone.0162583] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/25/2016] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance spectroscopy (MRS) provides the unique ability to monitor several disease-related pathological processes via their characteristic metabolic markers in vivo. In the present study metabolic compositions were assessed every six months over the period of two years in 36 patients with Multiple Sclerosis (MS) including 21 relapsing-remitting (RR), 15 secondary progressive (SP) patients and 12 normal subjects. The concentrations of the main MRS-detectable metabolites N-acetylaspartate and N-acetylaspartylglutamate (tNAA), creatine and phosphocreatine (tCr), choline containing compounds (Cho), myo-Inositol (Ins), glutamine and glutamate (Glx) and their ratios were calculated in the normal appearing white matter (NAWM) and in selected non-enhancing white matter (WM) lesions. Association between metabolic concentrations in the NAWM and disability were investigated. Concentration of tNAA, a marker for neuroaxonal integrity, did not show any difference between the investigated groups. However, the patients with SPMS showed significant reduction of tNAA in the NAWM over the investigation period of two years indicating diffuse neuroaxonal loss during the disease course. Furthermore, we found a significant increase of Ins, Ins/tCr and Ins/tNAA in WM lesions independently from the course of the disease suggesting ongoing astrogliosis in silent-appearing WM lesions. Analyzing correlations between MRS metabolites in the NAWM and patients clinical status we found the positive correlation of Ins/tNAA with disability in patients with RRMS. In SPMS positive correlation of Cho with disability was found.
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Affiliation(s)
- Dorothea Obert
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Gunther Helms
- Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Muriel B. Sättler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Klaus Jung
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Benedikt Kretzschmar
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Dechent
- Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ricarda Diem
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Katharina Hein
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
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19
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Winder K, Linker RA, Seifert F, Deutsch M, Engelhorn T, Dörfler A, Lee DH, Hösl KM, Hilz MJ. Neuroanatomic Correlates of Female Sexual Dysfunction in Multiple Sclerosis. Ann Neurol 2016; 80:490-8. [DOI: 10.1002/ana.24746] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/09/2016] [Accepted: 07/24/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Klemens Winder
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Ralf A. Linker
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Frank Seifert
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Martina Deutsch
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Tobias Engelhorn
- Department of Neuroradiology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Arnd Dörfler
- Department of Neuroradiology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - De-Hyung Lee
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Katharina M. Hösl
- Department of Psychiatry and Psychotherapy; Paracelsus Medical University; Nürnberg Germany
| | - Max J. Hilz
- Department of Neurology; University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
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20
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Gold R, Toumi M, Meesen B, Fogarty E. The payer’s perspective: What is the burden of MS and how should the patient’s perspective be integrated in health technology assessment conducted for taking decisions on access to care and treatment? Mult Scler 2016; 22:60-70. [DOI: 10.1177/1352458516650743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/15/2022]
Abstract
Background: In Europe, there exists considerable variability in access to care and treatment for multiple sclerosis (MS). Objectives: To improve this situation, we identified key issues payers should take into account when making decisions on access to care and treatment for MS. We also give an overview of the different dimensions determining total MS burden and discuss why it is key to integrate the patient’s perspective in estimating this burden. Results: The total burden of MS relates to three dimensions: clinical, humanistic and economic. Although the clinical burden is extensively studied, crucial information is still missing about MS pathophysiology, how MS-related symptoms will develop during the disease course and which patients will progress more rapidly. With regard to the humanistic burden, information on patient-reported quality of life systematically collected in clinical trials for registration purposes is still scarce. Early engagement between pharmaceutical companies, the European Medicines Agency and health technology agencies to prospectively identify key evidence needs for the regulatory and reimbursement processes is required as a first step towards more equal access to care and treatment in MS in Europe. Patients’ expectations regarding treatment outcomes should be better researched and integrated into decision-making and patients should be counselled in this process.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Mondher Toumi
- Department of Complex Decision Sciences and Health Policies, University of Lyon, Lyon, France
| | | | - Emer Fogarty
- National Centre for Pharmacoeconomics (NCPE), Dublin, Ireland
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21
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Petzold A, Steenwijk MD, Eikelenboom JM, Wattjes MP, Uitdehaag BMJ. Elevated CSF neurofilament proteins predict brain atrophy: A 15-year follow-up study. Mult Scler 2016; 22:1154-62. [DOI: 10.1177/1352458516645206] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/26/2016] [Indexed: 11/15/2022]
Abstract
Background: Body fluid and structural imaging biomarkers give information on neurodegeneration. The relationship over time is not known in multiple sclerosis. Objective: To investigate the temporal relationship of elevated cerebrospinal fluid (CSF) neurofilament (Nf) protein levels, a biomarker for axonal loss, with magnetic resonance imaging (MRI) atrophy measures. Methods: In patients with multiple sclerosis, CSF Nf heavy chain (NfH) phosphoform levels were quantified at baseline and dichotomised into ‘normal’ and ‘high’. Atrophy was assessed by MRI at baseline and 15-year follow-up using SIENAX and FreeSurfer software. Results: High baseline CSF NfH SMI35 levels predicted pronounced atrophy at 15-year follow-up (odds ratio (OR): 36, p < 0.01), in the absence of baseline brain atrophy (OR: 28, p < 0.05), for the averaged MRI normalised brain volume (1.44 L vs 1.33 L, p < 0.05), normalised grey matter volume (0.77 L vs 0.69 L, p < 0.01) and putamen (12.7 mL vs 10.7 mL, p < 0.05). Region-specific calculations including the spinal cord showed that a power of >80% is reached with 14–50 patients. Conclusion: These data suggest that high CSF NfH levels are an early predictor of later brain and spinal cord atrophy using structural imaging biomarkers and can be investigated in reasonably sized patient cohorts.
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Affiliation(s)
- Axel Petzold
- Department of Neurology and Ophthalmology, VUmc MS Center Amsterdam, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands/Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands/Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, VUmc MS Center Amsterdam, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
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22
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Kilsdonk ID, Jonkman LE, Klaver R, van Veluw SJ, Zwanenburg JJM, Kuijer JPA, Pouwels PJW, Twisk JWR, Wattjes MP, Luijten PR, Barkhof F, Geurts JJG. Increased cortical grey matter lesion detection in multiple sclerosis with 7 T MRI: a post-mortem verification study. Brain 2016; 139:1472-81. [PMID: 26956422 DOI: 10.1093/brain/aww037] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/20/2016] [Indexed: 01/10/2023] Open
Abstract
The relevance of cortical grey matter pathology in multiple sclerosis has become increasingly recognized over the past decade. Unfortunately, a large part of cortical lesions remain undetected on magnetic resonance imaging using standard field strength. In vivo studies have shown improved detection by using higher magnetic field strengths up to 7 T. So far, a systematic histopathological verification of ultra-high field magnetic resonance imaging pulse sequences has been lacking. The aim of this study was to determine the sensitivity of 7 T versus 3 T magnetic resonance imaging pulse sequences for the detection of cortical multiple sclerosis lesions by directly comparing them to histopathology. We obtained hemispheric coronally cut brain sections of 19 patients with multiple sclerosis and four control subjects after rapid autopsy and formalin fixation, and scanned them using 3 T and 7 T magnetic resonance imaging systems. Pulse sequences included T1-weighted, T2-weighted, fluid attenuated inversion recovery, double inversion recovery and T2*. Cortical lesions (type I-IV) were scored on all sequences by an experienced rater blinded to histopathology and clinical data. Staining was performed with antibodies against proteolipid protein and scored by a second reader blinded to magnetic resonance imaging and clinical data. Subsequently, magnetic resonance imaging images were matched to histopathology and sensitivity of pulse sequences was calculated. Additionally, a second unblinded (retrospective) scoring of magnetic resonance images was performed. Regardless of pulse sequence, 7 T magnetic resonance imaging detected more cortical lesions than 3 T. Fluid attenuated inversion recovery (7 T) detected 225% more cortical lesions than 3 T fluid attenuated inversion recovery (Z = 2.22, P < 0.05) and 7 T T2* detected 200% more cortical lesions than 3 T T2* (Z = 2.05, P < 0.05). Sensitivity of 7 T magnetic resonance imaging was influenced by cortical lesion type: 100% for type I (T2), 11% for type II (FLAIR/T2), 32% for type III (T2*), and 68% for type IV (T2). We conclude that ultra-high field 7 T magnetic resonance imaging more than doubles detection of cortical multiple sclerosis lesions, compared to 3 T magnetic resonance imaging. Unfortunately, (subpial) cortical pathology remains more extensive than 7 T magnetic resonance imaging can reveal.
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Affiliation(s)
- Iris D Kilsdonk
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Laura E Jonkman
- Department of Anatomy and Neurosciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Roel Klaver
- Department of Anatomy and Neurosciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Susanne J van Veluw
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joost P A Kuijer
- Department of Physics and Medical Technology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Petra J W Pouwels
- Department of Physics and Medical Technology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter R Luijten
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VU University Medical Centre, Amsterdam, The Netherlands
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What you cannot get from routine MRI of MS patient and why – The growing need for atrophy assessment and seeing beyond the plaque. Neurol Neurochir Pol 2016; 50:123-30. [DOI: 10.1016/j.pjnns.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 01/09/2016] [Accepted: 01/13/2016] [Indexed: 11/23/2022]
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24
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Winder K, Seifert F, Koehn J, Deutsch M, Engelhorn T, Dörfler A, Lee DH, Linker RA, Hilz MJ. Site and size of multiple sclerosis lesions predict enhanced or decreased female orgasmic function. J Neurol 2015; 262:2731-8. [DOI: 10.1007/s00415-015-7907-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
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25
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Kieseier BC. Multiple sclerosis--a dynamic field with a need for excellent education. Eur J Neurol 2015; 22 Suppl 2:1-2. [PMID: 26374507 DOI: 10.1111/ene.12802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- B C Kieseier
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.
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26
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Freeman L, Garcia-Lorenzo D, Bottin L, Leroy C, Louapre C, Bodini B, Papeix C, Assouad R, Granger B, Tourbah A, Dollé F, Lubetzki C, Bottlaender M, Stankoff B. The neuronal component of gray matter damage in multiple sclerosis: A [(11) C]flumazenil positron emission tomography study. Ann Neurol 2015; 78:554-67. [PMID: 26292991 DOI: 10.1002/ana.24468] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Using positron emission tomography (PET) with [(11) C]flumazenil ([(11) C]FMZ), an antagonist of the central benzodiazepine site located within the GABAA receptor, we quantified and mapped neuronal damage in the gray matter (GM) of patients with multiple sclerosis (MS) at distinct disease stages. We investigated the relationship between neuronal damage and white matter (WM) lesions and evaluated the clinical relevance of this neuronal PET metric. METHODS A cohort of 18 MS patients (9 progressive and 9 relapsing-remitting) was compared to healthy controls and underwent neurological and cognitive evaluations, high-resolution dynamic [(11) C]FMZ PET imaging and brain magnetic resonance imaging. [(11) C]FMZ binding was estimated using the partial saturation protocol providing voxel-wise absolute quantification of GABAA receptor concentration. PET data were evaluated using a region of interest (ROI) approach as well as on a vertex-by-vertex basis. RESULTS [(11) C]FMZ binding was significantly decreased in the cortical GM of MS patients, compared to controls (-10%). Cortical mapping of benzodiazepine receptor concentration ([(11) C]FMZ Bmax) revealed significant intergroup differences in the bilateral parietal cortices and right frontal areas. ROI analyses taking into account GM volume changes showed extensive decrease in [(11) C]FMZ binding in bilateral parietal, cingulate, and insular cortices as well as in the thalami, amygdalae, and hippocampi. These changes were significant in both progressive and relapsing-remitting forms of the disease and correlated with WM T2-weighted lesion load. [(11) C]FMZ cortical binding correlated with cognitive performance. INTERPRETATION This pilot study showed that PET with [(11) C]FMZ could be a promising and sensitive quantitative marker to assess and map the neuronal substrate of GM pathology in MS.
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Affiliation(s)
- Léorah Freeman
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France.,Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France.,Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Daniel Garcia-Lorenzo
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,Institut des Neurosciences translationnelles de Paris (IHU-A-ICM), Paris, France
| | - Laure Bottin
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France.,Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France
| | - Claire Leroy
- Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France
| | - Céline Louapre
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France
| | - Benedetta Bodini
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France.,Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France
| | - Caroline Papeix
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France
| | - Rana Assouad
- AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France
| | - Benjamin Granger
- AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France
| | - Ayman Tourbah
- Centre Hospitalo-Universitaire de Reims, Université Champagne Ardennes, Reims, France
| | - Frédéric Dollé
- Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France
| | - Catherine Lubetzki
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France.,Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France.,Institut des Neurosciences translationnelles de Paris (IHU-A-ICM), Paris, France
| | | | - Bruno Stankoff
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, and CNRS UMR 7225, and ICM, Paris, France.,AP-HP, Hopital Saint-Antoine and Hopital Pitié Salpêtrière, Paris, France.,Service Hospitalier Frederic Joliot, DSV, CEA, Orsay, France
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Thyroid Hormone Potentially Benefits Multiple Sclerosis via Facilitating Remyelination. Mol Neurobiol 2015; 53:4406-16. [PMID: 26243185 DOI: 10.1007/s12035-015-9375-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 07/22/2015] [Indexed: 01/23/2023]
Abstract
Myelin destruction due to inflammatory damage of oligodendrocytes (OLs) in conjunction with axonal degeneration is one of the major histopathological hallmarks of multiple sclerosis (MS), a common autoimmune disorder affecting the central nervous system (CNS). Therapies over the last 20 years mainly focus on the immune system and, more specifically, on the modulation of immune cell behavior. It seems to be effective in MS with relapse, while it is of little benefit to progressive MS in which neurodegeneration following demyelination outweighs inflammation. Otherwise, remyelination, as a result of oligodendrocyte production from oligodendrocyte precursor cells (OPCs), is considered to be a potential target for the treatment of progressive MS. In this review, positive effects of remyelination on MS will be discussed in view of the critical role played by thyroid hormone (TH), focusing on the following points: (1) promising treatment of TH on MS that potentially targets to remyelination; (2) the active role of TH that is able to promote remyelination; (3) the regulative role of TH that works on endogenous stem and precursor cells; (4) the effect of TH on gene transcription; and (5) a working hypothesis which is developed that TH can alleviate MS by promoting remyelination, and the mechanism of which is its regulative role in gene transcription of OPCs.
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28
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Stone S, Lin W. The unfolded protein response in multiple sclerosis. Front Neurosci 2015; 9:264. [PMID: 26283904 PMCID: PMC4518158 DOI: 10.3389/fnins.2015.00264] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/14/2015] [Indexed: 01/08/2023] Open
Abstract
The unfolded protein response (UPR) occurs in response to endoplasmic reticulum (ER) stress caused by the accumulation of unfolded or misfolded proteins in the ER. The UPR is comprised of three signaling pathways that promote cytoprotective functions to correct ER stress; however, if ER stress cannot be resolved the UPR results in apoptosis of affected cells. The UPR is an important feature of various human diseases, including multiple sclerosis (MS). Recent studies have shown several components of the UPR are upregulated in the multiple cell types in MS lesions, including oligodendrocytes, T cells, microglia/macrophages, and astrocytes. Data from animal model studies, particularly studies of experimental autoimmune encephalomyelitis (EAE) and the cuprizone model, imply an important role of the UPR activation in oligodendrocytes in the development of MS. In this review we will cover current literature on the UPR and the evidence for its role in the development of MS.
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Affiliation(s)
- Sarrabeth Stone
- Department of Neuroscience, University of Minnesota Minneapolis, MN, USA ; Institute for Translational Neuroscience, University of Minnesota Minneapolis, MN, USA
| | - Wensheng Lin
- Department of Neuroscience, University of Minnesota Minneapolis, MN, USA ; Institute for Translational Neuroscience, University of Minnesota Minneapolis, MN, USA
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29
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Zhen C, Feng X, Li Z, Wang Y, Li B, Li L, Quan M, Wang G, Guo L. Suppression of murine experimental autoimmune encephalomyelitis development by 1,25-dihydroxyvitamin D3 with autophagy modulation. J Neuroimmunol 2015; 280:1-7. [DOI: 10.1016/j.jneuroim.2015.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/28/2015] [Indexed: 12/21/2022]
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30
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Lobsien D, Ettrich B, Sotiriou K, Classen J, Then Bergh F, Hoffmann KT. Whole-brain diffusion tensor imaging in correlation to visual-evoked potentials in multiple sclerosis: a tract-based spatial statistics analysis. AJNR Am J Neuroradiol 2014; 35:2076-81. [PMID: 24994830 DOI: 10.3174/ajnr.a4034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Functional correlates of microstructural damage of the brain affected by MS are incompletely understood. The purpose of this study was to evaluate correlations of visual-evoked potentials with microstructural brain changes as determined by DTI in patients with demyelinating central nervous disease. MATERIALS AND METHODS Sixty-one patients with clinically isolated syndrome or MS were prospectively recruited. The mean P100 visual-evoked potential latencies of the right and left eyes of each patient were calculated and used for the analysis. For DTI acquisition, a single-shot echo-planar imaging pulse sequence with 80 diffusion directions was performed at 3T. Fractional anisotropy, radial diffusivity, and axial diffusivity were calculated and correlated with mean P100 visual-evoked potentials by tract-based spatial statistics. RESULTS Significant negative correlations between mean P100 visual-evoked potentials and fractional anisotropy and significant positive correlations between mean P100 visual-evoked potentials and radial diffusivity were found widespread over the whole brain. The highest significance was found in the optic radiation, frontoparietal white matter, and corpus callosum. Significant positive correlations between mean P100 visual-evoked potentials and axial diffusivity were less widespread, notably sparing the optic radiation. CONCLUSIONS Microstructural changes of the whole brain correlated significantly with mean P100 visual-evoked potentials. The distribution of the correlations showed clear differences among axial diffusivity, fractional anisotropy, and radial diffusivity, notably in the optic radiation. This finding suggests a stronger correlation of mean P100 visual-evoked potentials to demyelination than to axonal damage.
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Affiliation(s)
- D Lobsien
- From the Departments of Neuroradiology (D.L., K.-T.H., K.S.)
| | - B Ettrich
- Neurology (B.E., F.T.B., K.S., J.C.), University and University Hospital Leipzig, Leipzig, Germany
| | - K Sotiriou
- From the Departments of Neuroradiology (D.L., K.-T.H., K.S.) Neurology (B.E., F.T.B., K.S., J.C.), University and University Hospital Leipzig, Leipzig, Germany
| | - J Classen
- Neurology (B.E., F.T.B., K.S., J.C.), University and University Hospital Leipzig, Leipzig, Germany
| | - F Then Bergh
- Neurology (B.E., F.T.B., K.S., J.C.), University and University Hospital Leipzig, Leipzig, Germany
| | - K-T Hoffmann
- From the Departments of Neuroradiology (D.L., K.-T.H., K.S.)
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31
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Abstract
Multiple sclerosis (MS) is a common disease of the central nervous system, with various clinical symptoms and a heterogeneous disease course. MRI can depict focal and diffuse manifestations of the disease, and accurately measure progression over time. The precise pathogenesis of MS is unknown. Nevertheless, genetic influences have been found for susceptibility to MS in linkage and association studies. More recent genome-wide association studies have revealed other genes to be related to disease susceptibility and severity, explaining part of the variability in symptoms, radiological manifestations and disease course. Studies relating genetics and imaging in MS are discussed in this paper.
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32
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Spence RD, Kurth F, Itoh N, Mongerson CRL, Wailes SH, Peng MS, MacKenzie-Graham AJ. Bringing CLARITY to gray matter atrophy. Neuroimage 2014; 101:625-32. [PMID: 25038439 DOI: 10.1016/j.neuroimage.2014.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/09/2014] [Accepted: 07/10/2014] [Indexed: 01/03/2023] Open
Abstract
Gray matter atrophy has been shown to be a strong correlate to clinical disability in multiple sclerosis (MS) and its most commonly used animal model, experimental autoimmune encephalomyelitis (EAE). However, the relationship between gray mater atrophy and the spinal cord pathology often observed in EAE has never been established. Here EAE was induced in Thy1.1-YFP mice and their brains imaged using in vivo magnetic resonance imaging (MRI). The brains and spinal cords were subsequently optically cleared using Clear Lipid-exchanged Acrylamide-hybridized Rigid Imaging-compatible Tissue-hYdrogel (CLARITY). Axons were followed 5mm longitudinally in three dimensions in intact spinal cords revealing that 61% of the axons exhibited a mean of 22 axonal ovoids and 8% of the axons terminating in axonal end bulbs. In the cerebral cortex, we observed a decrease in the mean number of layer V pyramidal neurons and a decrease in the mean length of the apical dendrites of the remaining neurons, compared to healthy controls. MRI analysis demonstrated decreased cortical volumes in EAE. Cross-modality correlations revealed a direct relationship between cortical volume loss and axonal end bulb number in the spinal cord, but not ovoid number. This is the first report of the use of CLARITY in an animal model of disease and the first report of the use of both CLARITY and MRI.
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Affiliation(s)
- Rory D Spence
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Florian Kurth
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Noriko Itoh
- Multiple Sclerosis Program, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chandler R L Mongerson
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shannon H Wailes
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mavis S Peng
- Multiple Sclerosis Program, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Allan J MacKenzie-Graham
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.
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33
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Aharoni R. Immunomodulation neuroprotection and remyelination - the fundamental therapeutic effects of glatiramer acetate: a critical review. J Autoimmun 2014; 54:81-92. [PMID: 24934599 DOI: 10.1016/j.jaut.2014.05.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 01/04/2023]
Abstract
Multiple sclerosis (MS) is a multifaceted heterogeneous disease with various patterns of tissue damage. In addition to inflammation and demyelination, widespread axonal and neuronal pathologies are central components of this disease. MS therapies aim to restrain the pathological processes, enhance protective mechanisms, and prevent disease progression. The amino acid copolymer, glatiramer acetate (GA, Copaxone), an approved treatment for MS, has a unique mode of action. Evidence from the animal model experimental autoimmune encephalomyelitis (EAE) and from MS patients indicates that GA affects various levels of the innate and the adaptive immune response, inducing deviation from the pro-inflammatory to the anti-inflammatory pathways. This includes competition for the binding of antigen presenting cells, driving dendritic cells, monocytes, and B-cells towards anti-inflammatory responses, induction of Th2/3 and T-regulatory cells, and downregulating of both Th1 and Th-17 cells. The immune cells induced by GA reach the inflamed disease organ and secrete in situ anti-inflammatory cytokines alleviating the pathological processes. Furthermore, cumulative findings have revealed that in addition to its immunomodulatory activities GA promotes neuroprotective repair processes such as neurotrophic factors secretion and remyelination. This review aims to provide a comprehensive overview on the diverse mechanism of action of GA in EAE/MS, in particular on the in situ effect of GA and its ability to generate neuroprotection and repair in the CNS. In view of its immunomodulatory activity, the beneficial effects of GA in various models of additional autoimmune related pathologies, such as immune rejection and inflammatory bowel disease (IBD), are also presented.
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Affiliation(s)
- Rina Aharoni
- Department of Immunology, The Weizmann Institute of Science, Rehovot 76100, Israel.
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34
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Kurth F, Luders E, Sicotte NL, Gaser C, Giesser BS, Swerdloff RS, Montag MJ, Voskuhl RR, Mackenzie-Graham A. Neuroprotective effects of testosterone treatment in men with multiple sclerosis. NEUROIMAGE-CLINICAL 2014; 4:454-60. [PMID: 24634831 PMCID: PMC3952353 DOI: 10.1016/j.nicl.2014.03.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. While current medication reduces relapses and inflammatory activity, it has only a modest effect on long-term disability and gray matter atrophy. Here, we have characterized the potential neuroprotective effects of testosterone on cerebral gray matter in a pilot clinical trial. Ten men with relapsing-remitting MS were included in this open-label phase II trial. Subjects were observed without treatment for 6 months, followed by testosterone treatment for another 12 months. Focal gray matter loss as a marker for neurodegeneration was assessed using voxel-based morphometry. During the non-treatment phase, significant voxel-wise gray matter decreases were widespread (p≤ 0.05 corrected). However, during testosterone treatment, gray matter loss was no longer evident. In fact, a significant gray matter increase in the right frontal cortex was observed (p≤ 0.05 corrected). These observations support the potential of testosterone treatment to stall (and perhaps even reverse) neurodegeneration associated with MS. Furthermore, they warrant the investigation of testosterone's neuroprotective effects in larger, placebo controlled MS trials as well as in other neurodegenerative diseases. This is the first report of gray matter increase as the result of treatment in MS.
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Affiliation(s)
- Florian Kurth
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ; Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Eileen Luders
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ; Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nancy L Sicotte
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christian Gaser
- Department of Psychiatry, Jena University Hospital, Jena, Germany ; Department of Neurology, Jena University Hospital, Jena, Germany
| | - Barbara S Giesser
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ronald S Swerdloff
- Department of Medicine, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Michael J Montag
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rhonda R Voskuhl
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Allan Mackenzie-Graham
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ; Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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35
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Aharoni R. New findings and old controversies in the research of multiple sclerosis and its model experimental autoimmune encephalomyelitis. Expert Rev Clin Immunol 2014; 9:423-40. [DOI: 10.1586/eci.13.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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36
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Simon JH. MRI outcomes in the diagnosis and disease course of multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:405-25. [PMID: 24507528 DOI: 10.1016/b978-0-444-52001-2.00017-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite major advances in MRI, including practical implementations of multiple quantitative MRI methods, the conventional measures of focal, macroscopic disease remain the core MRI outcome measures in clinical trials. MRI enhancing lesion counts are used to assess inflammation, and new T2-lesions provide an index of (interval) activity between scans. These simple MRI measures also have immediate significance for early diagnosis as components of the 2010 revised dissemination in space and time criteria, and they provide a mechanism to monitor the subclinical disease in patients, including after treatment is initiated. The focal macroscopic injury, which includes demyelination and axonal damage, is at least partially linked to the diffuse injury through pathophysiologic mechanisms, such as secondary degeneration, but the diffuse diseases is largely independent. Quantitative measures of the more widespread pathology of the normal appearing white and gray matter currently remain applicable to populations of patients rather than individuals. Gray matter pathology, including focal lesions of the cortical gray matter and diffuse changes in the deep and cortical gray has emerged as both early and clinically relevant, as has atrophy. Major technical improvements in MRI hardware and pulse sequence design allow more specific and potentially more sensitive treatment metrics required for targeting outcomes most relevant to neuronal degeneration, remyelination and repair.
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Affiliation(s)
- Jack H Simon
- Oregon Health and Sciences University and Portland VA Medical Center, Portland, OR, USA.
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37
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Disease Influence on BBB Transport in Neurodegenerative Disorders. DRUG DELIVERY TO THE BRAIN 2014. [DOI: 10.1007/978-1-4614-9105-7_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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38
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Cognition, Cognitive Dysfunction, and Cognitive Rehabilitation in Multiple Sclerosis. Phys Med Rehabil Clin N Am 2013; 24:663-72. [DOI: 10.1016/j.pmr.2013.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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39
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Giorgio A, Stromillo ML, Bartolozzi ML, Rossi F, Battaglini M, De Leucio A, Guidi L, Maritato P, Portaccio E, Sormani MP, Amato MP, De Stefano N. Relevance of hypointense brain MRI lesions for long-term worsening of clinical disability in relapsing multiple sclerosis. Mult Scler 2013; 20:214-9. [PMID: 23877971 DOI: 10.1177/1352458513494490] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accrual of brain focal pathology is considered a good substrate of disability in relapsing-remitting multiple sclerosis (RRMS). However, knowledge on long-term lesion evolution and its relationship with disability progression is poor. OBJECTIVE The objective of this paper is to evaluate in RRMS the long-term clinical relevance of brain lesion evolution. METHODS In 58 RRMS patients we acquired, using the same scanner and protocol, brain magnetic resonance imaging (MRI) at baseline and 10±0.5 years later. MRI data were correlated with disability changes as measured by the Expanded Disability Status Scale (EDSS). RESULTS The annualized 10-year lesion volume (LV) growth was +0.25±0.5 cm(3) (+6.7±8.7%) for T2-weighted (T2-W) lesions and +0.20±0.31 cm(3) (+11.5±12.3%) for T1-weighted (T1-W) lesions. The univariate analysis showed moderate correlations between baseline MRI measures and EDSS at 10 years (p < 0.001). Also, 10-year EDSS worsening correlated with LV growth and the number of new/enlarging lesions measured over the same period (p < 0.005). In the stepwise multiple regression analysis, EDSS worsening over 10 years was best correlated with the combination of baseline T1-W lesion count and increasing T1-W LV (R = 0.61, p < 0.001). CONCLUSION In RRMS patients, long-term brain lesion accrual is associated with worsening in clinical disability. This is particularly true for hypointense, destructive lesions.
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Affiliation(s)
- Antonio Giorgio
- Department of Neurological and Behavioral Sciences, University of Siena, Italy
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40
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Aharoni R, Sasson E, Blumenfeld-Katzir T, Eilam R, Sela M, Assaf Y, Arnon R. Magnetic resonance imaging characterization of different experimental autoimmune encephalomyelitis models and the therapeutic effect of glatiramer acetate. Exp Neurol 2013; 240:130-44. [DOI: 10.1016/j.expneurol.2012.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/16/2012] [Accepted: 11/05/2012] [Indexed: 01/10/2023]
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41
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D'hooghe MB, D'Hooghe T, De Keyser J. Female gender and reproductive factors affecting risk, relapses and progression in multiple sclerosis. Gynecol Obstet Invest 2013; 75:73-84. [PMID: 23343711 DOI: 10.1159/000346319] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/05/2012] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS), a chronic inflammatory demyelina-ting and degenerative disease of the central nervous system, is a frequent cause of neurological disability in young adults. Female predominance has increased over the last decades. Although female gender carries a higher risk of developing relapsing remitting MS, being female and at child-bearing age also appears to provide some protection against cognitive decline and against progressive onset MS, an adverse predictive factor when considering long-term disability in MS. The risk of MS in women has been associated with an earlier age at menarche. In most studies, parity did not impact MS risk. However, the recently published association of higher parity and offspring number with a reduced risk of a first demyelinating event suggests a potential suppressive effect. Pregnancy in MS patients has been associated with a reduced relapse rate and a reduction of neurological symptoms, especially in the third trimester. Despite the increased relapse risk in the postpartum period, there is no indication of an adverse effect of childbirth on the long-term course of MS. Fertility treatment in MS has been associated with an increased relapse risk in the following 3-month period, especially when the procedure did not result in pregnancy and gonadotrophin-releasing hormone agonists were used. Altogether, there is substantial evidence to support a regulatory role of sex steroid hormones in MS. In the absence of correlations with single hormone blood levels, we can only speculate about the underlying mechanisms. In conclusion, the increased MS risk in women and the changes in relapse and progression risk in association with reproductive events suggest significant and complex interactions between immune, neuroendocrine and reproductive systems in MS.
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Affiliation(s)
- M B D'hooghe
- National Center for Multiple Sclerosis, Melsbroek, Belgium.
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42
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Yoshida M, Hori M, Yokoyama K, Fukunaga I, Suzuki M, Kamagata K, Shimoji K, Nakanishi A, Hattori N, Masutani Y, Aoki S. Diffusional kurtosis imaging of normal-appearing white matter in multiple sclerosis: preliminary clinical experience. Jpn J Radiol 2012; 31:50-5. [PMID: 23086313 DOI: 10.1007/s11604-012-0147-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated diffusional changes in normal-appearing white matter (NAWM) regions remote from multiple sclerosis (MS) plaques by using diffusional kurtosis imaging (DKI) to investigate the non-Gaussian behavior of water diffusion. MATERIALS AND METHODS Participants were 11 MS patients and 6 age-matched healthy volunteers. DKI was performed on a 3-T MR imager. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and diffusional kurtosis (DK) maps were computed. Regions of interest (ROIs) were compared in 24 cerebral regions, including the frontal, parietal, and temporal lobe white matter (WM) in controls and NAWM in MS patients. RESULTS The mean FA of all ROIs was 0.468 ± 0.014 (SD) (controls) or 0.431 ± 0.029 (MS group) (P = 0.016). Mean ADC was 0.785 ± 0.034 × 10(-3) mm(2)/s (controls) or 0.805 ± 0.041 × 10(-3) mm(2)/s (MS group). The mean DK of all ROIs was 0.878 ± 0.020 (controls) or 0.823 ± 0.032 (MS group) (P = 0.002). Analysis of individual ROIs revealed significant differences in DK in 3 ROIs between normal WM and NAWM, but significant differences in ADC and FA in only one ROI each. CONCLUSION DKI may be a new sensitive indicator for detecting tissue damage in MS patients in addition to conventional diffusional evaluations, for example diffusion tensor imaging.
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Affiliation(s)
- Mariko Yoshida
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.
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