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Fauver M, Clark EM, Schwartz CE. A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis. Front Integr Neurosci 2024; 18:1365672. [PMID: 38957213 PMCID: PMC11218666 DOI: 10.3389/fnint.2024.1365672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.
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Affiliation(s)
- Michelle Fauver
- Integral Health Program, California Institute for Human Science, Encinitas, CA, United States
| | - Eva M. Clark
- MIND based Healing, Santa Cruz, CA, United States
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Medicine and Departments of Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
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Dadvar A, Jameie M, Azizmohammad Looha M, Parsaei M, Zeynali Bujani M, Amanollahi M, Babaei M, Khosravi A, Amirifard H. Potential efficacy of caffeine ingestion on balance and mobility in patients with multiple sclerosis: Preliminary evidence from a single-arm pilot clinical trial. PLoS One 2024; 19:e0297235. [PMID: 38349929 PMCID: PMC10863863 DOI: 10.1371/journal.pone.0297235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/26/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Caffeine's potential benefits on multiple sclerosis (MS), as well as on the ambulatory performance of non-MS populations, prompted us to evaluate its potential effects on balance, mobility, and health-related quality of life (HR-QoL) of persons with MS (PwMS). METHODS This single-arm pilot clinical trial consisted of a 2-week placebo run-in and a 12-week caffeine treatment (200 mg/day) stage. The changes in outcome measures during the study period (weeks 0, 2, 4, 8, and 12) were evaluated using the Generalized Estimation Equation (GEE). The outcome measures were the 12-item Multiple Sclerosis Walking Scale (MSWS-12) for self-reported ambulatory disability, Berg Balance Scale (BBS) for static and dynamic balance, Timed Up and Go (TUG) for dynamic balance and functional mobility, Multiple Sclerosis Impact Scale (MSIS-29) for patient's perspective on MS-related QoL (MS-QoL), and Patients' Global Impression of Change (PGIC) for subjective assessment of treatment efficacy. GEE was also used to evaluate age and sex effect on the outcome measures over time. (Iranian Registry of Clinical Trials, IRCT2017012332142N1). RESULTS Thirty PwMS were included (age: 38.89 ± 9.85, female: 76.7%). Daily caffeine consumption significantly improved the objective measures of balance and functional mobility (BBS; P-value<0.001, and TUG; P-value = 0.002) at each study time point, and the subjective measure of MS-related QoL (MSIS-29; P-value = 0.005) two weeks after the intervention. Subjective measures of ambulatory disability (MSWS-12) and treatment efficacy (PGIC) did not significantly change. The effect of age and sex on the outcome measures were also assessed; significant sex-time interaction effects were found for MSWS-12 (P-value = 0.001) and PGIC (P-value<0.001). The impact of age on BBS scores increased as time progressed (P-value = 0.006). CONCLUSIONS Caffeine may enhance balance, functional mobility, and QoL in PwMS. Being male was associated with a sharper increase in self-reported ambulatory disability over time. The effects of aging on balance get more pronounced over time. TRIAL REGISTRATION This study was registered with the Iranian Registry of Clinical Trials (Registration number: IRCT2017012332142N1), a Primary Registry in the WHO Registry Network.
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Affiliation(s)
- Afsoon Dadvar
- Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Babaei
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khosravi
- Clinical Immunology Research Centre, Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Gauffin H, Boström I, Berntsson SG, Kristoffersson A, Fredrikson M, Landtblom AM. Characterization of the Increase in Narcolepsy following the 2009 H1N1 Pandemic in Sweden. J Clin Med 2024; 13:652. [PMID: 38337347 PMCID: PMC10856509 DOI: 10.3390/jcm13030652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: In the context of the H1N1 pandemic and the Pandemrix vaccination campaign, an increased number of narcolepsy cases were noted in several countries. In Sweden, this phenomenon was attributed to the effect of the Pandemrix vaccination in the first place. Studies from China indicated that narcolepsy could occur as a consequence of the H1N1 infection itself. We performed an analysis of the increase, with a specific interest in age and sex distribution. We also aimed to validate the origin of the excess cases, post hoc. (2) Methods: Data for narcolepsy patients (ICD code G 47.4, both type 1 and type 2) distributed by sex and age at 5-year intervals, annually between 2005 and 2017, were retrieved from the National Patient Register. Information on the total population was collected from the Swedish Population Register. (3) Results: The number of narcolepsy cases increased markedly from 2009 to 2014 compared to the period before 2009. A particular increase in 2011 among children and teenagers was observed. The sex ratio did not change significantly during the study period. (4) Conclusions: Our results support an association between the increased prevalence of narcolepsy cases and Pandemrix vaccination, but the effect of the virus itself cannot be ruled out as a contributing factor.
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Affiliation(s)
- Helena Gauffin
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health, Linköping University, 58185 Linköping, Sweden; (H.G.); (I.B.); (M.F.); (A.-M.L.)
| | - Inger Boström
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health, Linköping University, 58185 Linköping, Sweden; (H.G.); (I.B.); (M.F.); (A.-M.L.)
| | | | - Anna Kristoffersson
- Department of Medical Sciences, Neurology, Uppsala University, 75185 Uppsala, Sweden;
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health, Linköping University, 58185 Linköping, Sweden; (H.G.); (I.B.); (M.F.); (A.-M.L.)
| | - Anne-Marie Landtblom
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health, Linköping University, 58185 Linköping, Sweden; (H.G.); (I.B.); (M.F.); (A.-M.L.)
- Department of Medical Sciences, Neurology, Uppsala University, 75185 Uppsala, Sweden;
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Hosseinpour Z, Oladosu O, Liu WQ, Pike GB, Yong VW, Metz LM, Zhang Y. Distinct characteristics and severity of brain magnetic resonance imaging lesions in women and men with multiple sclerosis assessed using verified texture analysis measures. Front Neurol 2023; 14:1213377. [PMID: 37638198 PMCID: PMC10449451 DOI: 10.3389/fneur.2023.1213377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background and goal In vivo characterization of brain lesion types in multiple sclerosis (MS) has been an ongoing challenge. Based on verified texture analysis measures from clinical magnetic resonance imaging (MRI), this study aimed to develop a method to identify two extremes of brain MS lesions that were approximately severely demyelinated (sDEM) and highly remyelinated (hREM), and compare them in terms of common clinical variables. Method Texture analysis used an optimized gray-level co-occurrence matrix (GLCM) method based on FLAIR MRI from 200 relapsing-remitting MS participants. Two top-performing metrics were calculated: texture contrast and dissimilarity. Lesion identification applied a percentile approach according to texture values calculated: ≤ 25 percentile for hREM and ≥75 percentile for sDEM. Results The sDEM had a greater total normalized volume yet smaller average size, and worse MRI texture than hREM. In lesion distribution mapping, the two lesion types appeared to overlap largely in location and were present the most in the corpus callosum and periventricular regions. Further, in sDEM, the normalized volume was greater and in hREM, the average size was smaller in men than women. There were no other significant results in clinical variable-associated analyses. Conclusion Percentile statistics of competitive MRI texture measures may be a promising method for probing select types of brain MS lesion pathology. Associated findings can provide another useful dimension for improved measurement and monitoring of disease activity in MS. The different characteristics of sDEM and hREM between men and women likely adds new information to the literature, deserving further confirmation.
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Affiliation(s)
- Zahra Hosseinpour
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Olayinka Oladosu
- Department of Neuroscience, Faculty of Graduate Studies, University of Calgary, Calgary, AB, Canada
| | - Wei-qiao Liu
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - G. Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - V. Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Luanne M. Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yunyan Zhang
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Tokarska N, Tottenham I, Baaklini C, Gawryluk JR. How does the brain age in individuals with multiple sclerosis? A systematic review. Front Neurol 2023; 14:1207626. [PMID: 37456635 PMCID: PMC10349663 DOI: 10.3389/fneur.2023.1207626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Multiple Sclerosis (MS) is a complex neurological disorder that involves demyelination, lesions and atrophy in both white and gray matter. Such changes in the central nervous system are diagnostic in MS and has a strong relationship with both physical and cognitive symptoms. As a result, magnetic resonance imaging (MRI) scans as a metric of brain atrophy have emerged as an important outcome measure in MS studies. Recently, research has begun to focus on the contribution of aging to the structural changes in the brain associated with MS; prompting questions about whether there is an amplifying effect of aging superimposed on MS-related brain atrophy. To examine current evidence of how the brain ages in individuals with MS, a systematic review of the literature was performed. Specific questions were focused on how aging affects gray and white matter structure, whether patterns of brain atrophy differ in younger and older cohorts and if there are structural differences in the brain as a function of sex in aging people with MS. This review considered studies that used MRI to examine the effects of aging in adults with MS. Twenty-one studies met eligibility criteria. Findings across these studies revealed that gray matter atrophy was more pronounced in older adults with MS, particularly in subcortical regions such as the thalamus; that the rates of atrophy were similar but varied by region for younger and older cohorts; and that males may experience more brain atrophy than females. Further studies that use multimodal MRI acquisition methods are needed to capture changes in both males and females over time, particularly in middle to older adulthood.
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Affiliation(s)
- Nataliya Tokarska
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Isabelle Tottenham
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Charbel Baaklini
- Department of Neuroscience, University of Alberta, Edmonton, AB, Canada
| | - Jodie R. Gawryluk
- Department of Psychology, University of Victoria, Victoria, BC, Canada
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Nooraei A, Khazaeel K, Darvishi M, Ghotbeddin Z, Basir Z. Dimorphic evaluation of hippocampal changes in rat model of demyelination: A comparative functional, morphometric, and histological study. Brain Behav 2022; 12:e32723. [PMID: 35861689 PMCID: PMC9392515 DOI: 10.1002/brb3.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common autoimmune disease. Progressive depletion of the brain and spinal cord tissue appears at the onset of the disease. Several studies have shown the increased size of the ventricles of the brain and decreases in the area of the corpus callosum and the width of the brain. Other important symptoms of this disease are cognitive, learning, and memory disorders. AIM The aim of this study was to compare morphometric, histological, and functional changes in the demyelination model in both sexes. MATERIALS AND METHODS In this experimental study, male and female Wistar rats were studied in four experimental groups. Demyelination was induced by the injection of ethidium bromide in the ventricular region. The chronic effect of demyelination on spatial memory, movement, and coordination was investigated using the Morris Water Maze (MWM), and clinical and balance beam tests, respectively. Myelin degradation, cell death and neurogenesis were estimated using Luxol Fast Blue staining and immunohistochemistry (Caspase-3 and Nestin markers). In addition, morphometric findings were recorded for the brain and hippocampus (weight, volume, length, width). RESULT Demyelination increased the time and distance index and decreased the residence time in the target quarter in the water maze test (p < .001). It also increases the neuromuscular and modified neurological severity score (p < .01). Demyelination increases caspase-3 (p < .05) expression and decreases Nestin expression (p < .001), which are directly related to the extent of damage. CONCLUSION This study showed an interaction between hippocampal structural and functional networks in explaining spatial learning and memory in the early stages of MS.
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Affiliation(s)
- Aref Nooraei
- Faculty of Veterinary Medicine, Department of Basic Sciences, Shahid Chamran University of Ahvaz, Iran
| | - Kaveh Khazaeel
- Faculty of Veterinary Medicine, Department of Basic Sciences, Shahid Chamran University of Ahvaz, Iran.,Stem Cell and Transgenic Technology Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Marzieh Darvishi
- Faculty of Medicine, Department of Anatomy, Ilam University of Medical Sciences, Ilam, Iran.,Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Zohreh Ghotbeddin
- Faculty of Veterinary Medicine, Department of Basic Sciences, Shahid Chamran University of Ahvaz, Iran.,Stem Cell and Transgenic Technology Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Zahra Basir
- Faculty of Veterinary Medicine, Department of Basic Sciences, Shahid Chamran University of Ahvaz, Iran
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Umair M, Fazazi MR, Rangachari M. Biological Sex As a Critical Variable in CD4 + Effector T Cell Function in Preclinical Models of Multiple Sclerosis. Antioxid Redox Signal 2022; 37:135-149. [PMID: 34538129 PMCID: PMC9293683 DOI: 10.1089/ars.2021.0202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Significance: T cells play a pivotal role in maintaining adaptive immune responses against pathogens. However, misdirected T cell responses against self-tissues may lead to autoimmune disease. Biological sex has profound effects on T cell function and is an important determinant of disease incidence and severity in autoimmune diseases such as multiple sclerosis (MS). Recent Advances: Many autoimmune diseases skew toward higher female incidence, including MS; however, it is has become increasingly more accepted that men living with MS are more prone to developing a progressive disease course and to having worsened disease outcomes. Critical Issues: In this review, we discuss what is known about the role of biological sex on T cell development and differentiation, examining evidence that male sex can augment T helper 17 (Th17) responses. Next, we outline what is known about sex differences in animal models of MS, and about the distinct roles played by sex hormones versus sex chromosomes in pathogenesis in these models. Finally, we discuss recent advances that examine the molecular basis for worsened disease outcomes in males, with a particular focus on the role played by Th17 cells in these models. Future Directions: Better understanding the role of biological sex in T cell function may pave the way to effective personalized treatment strategies in MS and other autoimmune diseases. Antioxid. Redox Signal. 37, 135-149.
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Affiliation(s)
- Muhammad Umair
- Axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Quebec, Canada
| | - Mohamed Reda Fazazi
- Axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Quebec, Canada
| | - Manu Rangachari
- Axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec, Canada
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Immune Cell Contributors to the Female Sex Bias in Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis. Curr Top Behav Neurosci 2022; 62:333-373. [PMID: 35467295 DOI: 10.1007/7854_2022_324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS) that leads to axonal damage and accumulation of disability. Relapsing-remitting MS (RR-MS) is the most frequent presentation of MS and this form of MS is three times more prevalent in females than in males. This female bias in MS is apparent only after puberty, suggesting a role for sex hormones in this regulation; however, very little is known of the biological mechanisms that underpin the sex difference in MS onset. Experimental autoimmune encephalomyelitis (EAE) is an animal model of RR-MS that presents more severely in females in certain mouse strains and thus has been useful to study sex differences in CNS autoimmunity. Here, we overview the immunopathogenesis of MS and EAE and how immune mechanisms in these diseases differ between a male and female. We further describe how females exhibit more robust myelin-specific T helper (Th) 1 immunity in MS and EAE and how this sex bias in Th cells is conveyed by sex hormone effects on the T cells, antigen presenting cells, regulatory T cells, and innate lymphoid cell populations.
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Batzdorf CS, Morr AS, Bertalan G, Sack I, Silva RV, Infante-Duarte C. Sexual Dimorphism in Extracellular Matrix Composition and Viscoelasticity of the Healthy and Inflamed Mouse Brain. BIOLOGY 2022; 11:biology11020230. [PMID: 35205095 PMCID: PMC8869215 DOI: 10.3390/biology11020230] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/13/2022]
Abstract
Simple Summary In multiple sclerosis (MS), an autoimmune disease of the central nervous system that primarily affects women, gender differences in disease course and in brain softening have been reported. It has been shown that the molecular network found between the cells of the tissue, the extracellular matrix (ECM), influences tissue stiffness. However, it is still unclear if sex influences ECM composition. Therefore, here we investigated how brain ECM and stiffness differ between sexes in the healthy mouse, and in an MS mouse model. We applied multifrequency magnetic resonance elastography and gene expression analysis for associating in vivo brain stiffness with ECM protein content in the brain, such as collagen and laminin. We found that the cortex was softer in males than in females in both healthy and sick mice. Softening was associated with sex differences in expression levels of collagen and laminin. Our findings underscore the importance of considering sex when studying the constitution of brain tissue in health and disease, particularly when investigating the processes underlying gender differences in MS. Abstract Magnetic resonance elastography (MRE) has revealed sexual dimorphism in brain stiffness in healthy individuals and multiple sclerosis (MS) patients. In an animal model of MS, named experimental autoimmune encephalomyelitis (EAE), we have previously shown that inflammation-induced brain softening was associated with alterations of the extracellular matrix (ECM). However, it remained unclear whether the brain ECM presents sex-specific properties that can be visualized by MRE. Therefore, here we aimed at quantifying sexual dimorphism in brain viscoelasticity in association with ECM changes in healthy and inflamed brains. Multifrequency MRE was applied to the midbrain of healthy and EAE mice of both sexes to quantitatively map regional stiffness. To define differences in brain ECM composition, the gene expression of the key basement membrane components laminin (Lama4, Lama5), collagen (Col4a1, Col1a1), and fibronectin (Fn1) were investigated by RT-qPCR. We showed that the healthy male cortex expressed less Lama4, Lama5, and Col4a1, but more Fn1 (all p < 0.05) than the healthy female cortex, which was associated with 9% softer properties (p = 0.044) in that region. At peak EAE cortical softening was similar in both sexes compared to healthy tissue, with an 8% difference remaining between males and females (p = 0.006). Cortical Lama4, Lama5 and Col4a1 expression increased 2 to 3-fold in EAE in both sexes while Fn1 decreased only in males (all p < 0.05). No significant sex differences in stiffness were detected in other brain regions. In conclusion, sexual dimorphism in the ECM composition of cortical tissue in the mouse brain is reflected by in vivo stiffness measured with MRE and should be considered in future studies by sex-specific reference values.
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Affiliation(s)
- Clara Sophie Batzdorf
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125 Berlin, Germany; (C.S.B.); (R.V.S.)
| | - Anna Sophie Morr
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (A.S.M.); (G.B.); (I.S.)
| | - Gergely Bertalan
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (A.S.M.); (G.B.); (I.S.)
| | - Ingolf Sack
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (A.S.M.); (G.B.); (I.S.)
| | - Rafaela Vieira Silva
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125 Berlin, Germany; (C.S.B.); (R.V.S.)
- Einstein Center for Neurosciences Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125 Berlin, Germany; (C.S.B.); (R.V.S.)
- Correspondence:
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The impairment of the functional system and fatigue at the onset of the disease predict reaching disability milestones in relapsing-remitting multiple sclerosis differently in female and male patients. Acta Neurol Belg 2021; 121:1699-1706. [PMID: 32997326 DOI: 10.1007/s13760-020-01478-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with variable types of disability progression (DP). Previous studies, defining different disability milestones (DMs), have reported symptoms at MS onset to be the predictors of DP and sex as a risk factor. Meanwhile, accounting for sex differences in MS, predictors in female and male patients might differ. To investigate whether the symptoms at MS onset predict reaching DMs in patients with relapsing-remitting (RR) MS and whether the predictors vary between different DMs and female and male patients. Data from 128 RR MS patients (84 females, 44 males) was retrospectively studied. EDSS scores 4 and 6 (associated with impaired ambulation) were taken as DMs. Association between symptoms at MS onset and time to reach DMs was assessed with Cox multiple regression model. Pyramidal symptoms and fatigue at MS onset predicted the progression to EDSS 4 in the whole study population (HR 1.84, 95% CI 1.07-3.2, p = 0.028 and HR 2.01, 95% CI 1.12-3.4, p = 0.011, correspondingly). The same symptoms predicted reaching DM in female, but not male patients. Bowel/bladder symptoms predicted reaching EDSS 6 in the whole study population (HR 4.31, 95% CI 1.47-12.6, p = 0.008) and female patients only (HR 3.93, 95% CI 1.04-14.8, p = 0.043). In female patients, fatigue was also the predictor of reaching EDSS 6 (HR 3.54, 95% CI 1.16-10.8, p = 0.026). Impairment of functional symptoms at MS onset can predict reaching DMs in patients with RR-MS, but the predictors for EDSS 4 and EDSS 6 differ in female and male patients.
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Joseph B, Nandakumar AL, Ahmed AT, Gopal N, Murad MH, Frye MA, Tobin WO, Singh B. Prevalence of bipolar disorder in multiple sclerosis: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2021; 24:88-94. [PMID: 33328183 PMCID: PMC10231514 DOI: 10.1136/ebmental-2020-300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. OBJECTIVE To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. METHODS We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. FINDINGS Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). CONCLUSIONS This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
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Affiliation(s)
- Boney Joseph
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed T Ahmed
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Clinical and Translational Science Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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12
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Longitudinal analysis of disability outcomes among young people with MS. Mult Scler Relat Disord 2021; 52:102966. [PMID: 33934012 DOI: 10.1016/j.msard.2021.102966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The age of onset of MS appears to influence the course of disease progression and people with younger age of onset might have a different disability trajectory. OBJECTIVES To identify longitudinal patterns of disability progression, as measured by changes in the Multiple Sclerosis Functional Composite (MSFC), of young people in MS drug trials and to estimate the extent to which disability progression differ in two age groups (≤25 years and 26 - 35 years). METHODS Data from the Multiple Sclerosis Outcomes Assessment Consortium (MSOAC) was used. Longitudinal patterns on the MSFC were identified using group-based trajectory models (GBTM). For difference between the expected and observed proportions of people with pediatric-onset MS chi-square statistic was used. Linear mixed models were used to estimate the average change in performance over time, age and sex. RESULTS GBTM results showed little variability in performance over time. Mixed modeling showed that the younger group performed better for gait speed, dexterity, and cognition. Men performed poorer on dexterity and cognition. Distribution of people with pediatric-onset MS differed from expected on dexterity, cognition, and the EDSS. CONCLUSIONS The combined use of trajectory models and linear mixed models provided rich information about the variability in function over time.
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13
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Xu L, Chen L, Wang S, Feng J, Liu L, Liu G, Wang J, Zhan S, Fan D. Urban prevalence of multiple sclerosis in China: A population-based study in six provinces. Eur J Neurol 2021; 28:1636-1644. [PMID: 33539586 DOI: 10.1111/ene.14764] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 01/03/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a rare neurological disease addressed by only few epidemiological studies in China. This population-based study aimed to estimate the prevalence of MS in China by using national medical insurance databases. METHODS Data from the Urban Employee Basic Medical Insurance database and the Urban Residence Basic Medical Insurance database, which were collected during 2012 to 2016 and included approximately 0.20 billion residents in six provinces, were used in this population-based study. The prevalent patients with MS were identified via diagnostic text or disease codes. RESULTS The crude prevalence in 2016 was 2.44 per 100,000 population (95% confidence interval (CI) 2.18-2.72), with the prevalence in females being higher than that in males. The standardized prevalence (based on 2010 Chinese census data) was 2.29 (95% CI 2.21-2.38). The prevalence in both sexes in 2016 increased up to the age range of 30-34 years. Subsequently, the female prevalence declined with increasing age, but male prevalence stabilized with increasing age. During the 5-year time period, prevalence ranged from 2.32 (95% CI 2.06-2.60) in 2015 to 2.91 (95% CI 2.39-3.47) in 2012. CONCLUSIONS The prevalence of MS in China was lower than that in Europe and North America. The temporal trend of prevalence in China was also observed to be stable. As the first prevalence study of MS in mainland China, this population-based study can provide useful information for worldwide healthcare services and prevention of MS.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, Beijing, China
| | - Jinxi Wang
- Beijing Healthcom Data Technology Co. Ltd, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
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14
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Manera C, Bertini S. Cannabinoid-Based Medicines and Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1264:111-129. [PMID: 33332007 DOI: 10.1007/978-3-030-57369-0_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The emerging role of the endocannabinoid system (ECS) in the control of symptoms and disease progression in multiple sclerosis (MS) has been highlighted by recent studies. MS is a chronic, immune-mediated, and demyelinating disorder of the central nervous system with no cure so far. It is widely reported that cannabinoids might be used to control MS symptoms and that they also might exert neuroprotective effects and slow down disease progression. The aim of this chapter is to give an overview of the main endogenous and synthetic cannabinoids used for the symptomatic amelioration of MS and their beneficial outcomes, providing new possible perspectives for the treatment of this disease.
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15
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Zhao Z, Zhang Y, Du Q, Chen H, Shi Z, Wang J, Qiu Y, Yan C, Zhou H. Differences in physical, mental, and social functions between males and females in multiple sclerosis: A multicenter cross-sectional study in China. Mult Scler Relat Disord 2020; 48:102693. [PMID: 33406448 DOI: 10.1016/j.msard.2020.102693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 02/05/2023]
Abstract
Background Sex-specific differences in multiple sclerosis (MS) have been recognized, but few were known about how sex influences the characteristics of MS in Asian and the social burden of MS. This study aimed to investigate the symptoms, mental health, and social functions of Chinese MS patients and find differences between sexes. Methods MS patients were enrolled from January 2004 to September 2018. A questionnaire was distributed by 47 medical centers. Patients' physical symptoms, negative emotions, interpersonal communication, social intercourse, employment condition, and suicidal thoughts and behavior were collected. Patients were asked to fill in the questionnaire independently and undergo Expanded Disability Status Scale (EDSS) measurement. Unpaired t-tests between sexes were conducted for normally distributed continuous variables. Mann-Whitney u-tests were conducted for non-normally distributed data. Chi-square tests, Fisher exact tests and rank sum tests were performed for categorical variables. Results 931 patients were enrolled and 631 were female. Frequency of fatigue and pain were higher in female MS patients (P<0.05), while male patients complained more weakness, diplopia, sexual dysfunction, and micturition and defecation dysfunction (P<0.05). Females were more likely to experience sadness and helplessness than males (P<0.05) while males were more likely to experience nonacceptance than females (P<0.05). MS had a worse influence on male patients in relationships with family and friends (P<0.05). The employment rate of MS patients was 39.31%. The frequency of suicidal attempt was 2.36%, which was higher than general population. Conclusions The study provided evidence that characteristics of MS were different between males and females, and influence in mental and social function was a common problem among MS patients. More attention should be paid to the mental health and social function of MS patients.
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Affiliation(s)
- Zhengyang Zhao
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Jiancheng Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Yuhan Qiu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Chao Yan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China 610041.
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16
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Kavaliunas A, Manouchehrinia A, Gyllensten H, Alexanderson K, Hillert J. Importance of early treatment decisions on future income of multiple sclerosis patients. Mult Scler J Exp Transl Clin 2020; 6:2055217320959116. [PMID: 33110615 PMCID: PMC7564625 DOI: 10.1177/2055217320959116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background Early initiation of disease-modifying treatment (DMT) is associated with
better disability outcomes in multiple sclerosis (MS). However, little is
known of how treatment decisions affect socio-economic outcomes. Objective To estimate the long-term impact of early initiation of DMT on the income of
MS patients. Methods In total, 3610 MS patients were included in this register-based cohort study.
We measured the association between the time to treatment and the outcome,
defined as time from treatment initiation to a 95% decrease in annual
earnings compared to each patient´s baseline level. Additionally, the
association between time to treatment and increase of social benefits
(sickness absence, disability pension) was investigated. A Cox model was
adjusted for sex, onset age, education, family situation, country of birth,
living area, and disability. Results MS patients initiating treatment later had a higher risk of reaching the
outcome- those who started treatment after 2 years from MS onset lost 95% of
their earnings sooner (HR, 1.19; 95% CI, 1.04–1.37). Furthermore, risk to
receive an annual compensation of SEK 100,000 (≈EUR 10,500) was higher for
the delayed treatment group. Conclusion Early treatment initiation in MS is associated with better socioeconomic
outcome, adding to previous studies showing benefits regarding
disability.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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17
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Rommer PS, Ellenberger D, Hellwig K, Haas J, Pöhlau D, Stahmann A, Zettl UK. Relapsing and progressive MS: the sex-specific perspective. Ther Adv Neurol Disord 2020; 13:1756286420956495. [PMID: 33029201 PMCID: PMC7521047 DOI: 10.1177/1756286420956495] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative
disease whose aetiology is not fully understood. The female sex
is clearly predominant, with a sex ratio between 2 and 3. In
primary progressive MS the sex ratio almost balances out. Since
the age at onset is higher for patients with progressive onset
(POMS) than for relapsing onset (ROMS), it can be hypothesized
that the age at onset is a decisive factor for the sex
ratio. Methods: To address this aspect, we compare clinical and demographic data
between females and males for the different disease courses
within the population of the German MS Register by the German MS
Society. Only patients with complete details in mandatory data
items and a follow-up visit since 01. Jan 2018 were
included. Results: A total of 18,728 patients were included in our analyses, revealing
a female-to-male ratio of 2.6 (2.7 for patients with ROMS and
1.3 for POMS). The age at diagnosis is higher in patients with
POMS (43.3 and 42.3 years for females and males
versus 32.1 and 33.2 years,
respectively). Females irrespective of disease course are
statistically significantly more often affected by cognitive
impairment (POMS: p = 0.013, ROMS:
p = 0.001) and depression (POMS:
p = 0.002, ROMS: 0.001) and suffer more
often from pain (POMS and ROMS: p < 0.001).
Fatigue is significantly more often seen in females with ROMS
(p < 0.001) but not in POMS. Females
with ROMS retire significantly (p < 0.001)
earlier (42.8 versus 44.2 years) and to a
greater extent than males (28 versus 24%).
Disease progression was similar for women and men. Conclusion: Our analysis shows that clinical and demographic data differ more
between disease courses than between men and women. For pain,
depression and cognitive impairment the female sex is the
decisive factor. Whether these factors are responsible for the
earlier retirement of females with ROMS is not clear.
Appropriate measures for optimization of symptomatic treatment
as well as to promote employment should be taken.
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Affiliation(s)
- Paulus Stefan Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Gehlsheimer Straße 20, Rostock, 18147, Germany
| | - David Ellenberger
- German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Haas
- Centre for Multiple Sclerosis, Jewish Hospital Berlin, Berlin, Germany
| | - Dieter Pöhlau
- Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany
| | - Alexander Stahmann
- German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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18
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Gilli F, DiSano KD, Pachner AR. SeXX Matters in Multiple Sclerosis. Front Neurol 2020; 11:616. [PMID: 32719651 PMCID: PMC7347971 DOI: 10.3389/fneur.2020.00616] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory and neurodegenerative disease of the central nervous system (CNS). An interesting feature that this debilitating disease shares with many other inflammatory disorders is that susceptibility is higher in females than in males, with the risk of MS being three times higher in women compared to men. Nonetheless, while men have a decreased risk of developing MS, many studies suggest that males have a worse clinical outcome. MS exhibits an apparent sexual dimorphism in both the immune response and the pathophysiology of the CNS damage, ultimately affecting disease susceptibility and progression differently. Overall, women are predisposed to higher rates of inflammatory relapses than men, but men are more likely to manifest signs of disease progression and worse CNS damage. The observed sexual dimorphism in MS may be due to sex hormones and sex chromosomes, acting in parallel or combination. In this review, we outline current knowledge on the sexual dimorphism in MS and discuss the interplay of sex chromosomes, sex hormones, and the immune system in driving MS disease susceptibility and progression.
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Affiliation(s)
- Francesca Gilli
- Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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19
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Boyko A, Melnikov M. Prevalence and Incidence of Multiple Sclerosis in Russian Federation: 30 Years of Studies. Brain Sci 2020; 10:E305. [PMID: 32443404 PMCID: PMC7288193 DOI: 10.3390/brainsci10050305] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
In the Russian Federation, multiple sclerosis prevalence rates vary from 10 to 80 cases per 100,000, depending on region and the nationality of the population. The main characteristics of multiple sclerosis epidemiology in the XX century in this big territory are: (1) steady increase in multiple sclerosis prevalence and incidence rates, maybe because of better diagnosis and treatment, but also changes in environmental/epigenetic risk profile and/or lifestyle factors; (2) increase of the female to male ratio, increase in multiple sclerosis incidence mainly in females; (3) appearance and increasing frequency of multiple sclerosis in ethnic groups, previously free of multiple sclerosis (Northern Tribes, Yakuts and others). The latest data show that in European Russia, the multiple sclerosis prevalence varies from 30 to 80 cases, in Siberia-from 20 to 70 cases, with steady increases, especially in women.
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Affiliation(s)
- Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetic, Prirogov Russian National Research Medical University, 1 Ostrovityanova st., Moscow 117997, Russia;
- Department of Neuroimmunology, Federal Center of Brain and Neurotechnology, Federal Medical-Biological Agency of Russia, 1-10 Ostrovityanova st., Moscow 117997, Russia
- Scientific-Practical Center of Pediatric Psychoneurology, Michurinsky Prospekt 74, Moscow 119602, Russia
| | - Mikhail Melnikov
- Department of Neurology, Neurosurgery and Medical Genetic, Prirogov Russian National Research Medical University, 1 Ostrovityanova st., Moscow 117997, Russia;
- Department of Neuroimmunology, Federal Center of Brain and Neurotechnology, Federal Medical-Biological Agency of Russia, 1-10 Ostrovityanova st., Moscow 117997, Russia
- Laboratory of Clinical Immunology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Kashirskoe shosse 24, Moscow 115478, Russia
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20
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Lioudyno V, Abdurasulova I, Negoreeva I, Stoliarov I, Kudriavtsev I, Serebryakova M, Klimenko V, Lioudyno M. A common genetic variant rs2821557 in KCNA3 is linked to the severity of multiple sclerosis. J Neurosci Res 2020; 99:200-208. [PMID: 32056271 DOI: 10.1002/jnr.24596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 12/31/2022]
Abstract
The rate of symptom accumulation distinguishes between slowly and rapidly progressing forms of multiple sclerosis (MS). Given that a patient's genetics can affect the rate of disease progression, identification of genetic variants associated with rapid disease progression should provide valuable information for timely prognosis and development of optimal treatment plans. We hypothesized that the polymorphism rs2821557 in the human KCNA3 gene encoding a voltage-gated potassium channel Kv1.3 might be one of these genetic variants, given the role of Kv1.3 in neuroinflammation, as well as the location and gain-of-function effect of this polymorphism. To test this hypothesis we performed an analytic study exploring the relationships between rs2821557 polymorphism and disease progression in a cohort of MS patients. The rs2821557 genotype and the rate of disease progression based on Multiple Sclerosis Severity Score (MSSS) were determined for 101 patients (68 females and 33 males). Peripheral blood CD4+ lymphocyte subpopulations (Tnaive , TCM , TEM ) and the expression of chemokine receptors (CXCR5, CXCR3, CCR6, CCR4) were estimated by flow cytometry. The comparisons between groups by genotype (TT, TC, CC) and allelic approach analysis (T vs. C) revealed a significantly higher incidence of the rapid disease course (MSSS ≥ 7.5) among minor C allele carriers (CC and TC) compared to patients with the TT genotype. Furthermore, C allele carriers had higher counts of CXCR3+ TEM cells than homozygous T allele carriers. In conclusion, accelerated MS progression in C allele carriers is likely linked to enhanced Kv1.3-mediated accumulation of pathogenic CXCR3+ TEM cells and exacerbated neuroinflammation.
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Affiliation(s)
- Victoria Lioudyno
- Pavlov Department of Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", S-Petersburg, Russia
| | - Irina Abdurasulova
- Pavlov Department of Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", S-Petersburg, Russia
| | - Irina Negoreeva
- Laboratory of Neuroimmunology, N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences, S-Petersburg, Russia
| | - Igor Stoliarov
- Laboratory of Neuroimmunology, N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences, S-Petersburg, Russia
| | - Igor Kudriavtsev
- Department of Immunology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", S-Petersburg, Russia
| | - Maria Serebryakova
- Department of Immunology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", S-Petersburg, Russia
| | - Victor Klimenko
- Pavlov Department of Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", S-Petersburg, Russia
| | - Maria Lioudyno
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
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21
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Chu T, Zhang YP, Tian Z, Ye C, Zhu M, Shields LBE, Kong M, Barnes GN, Shields CB, Cai J. Dynamic response of microglia/macrophage polarization following demyelination in mice. J Neuroinflammation 2019; 16:188. [PMID: 31623610 PMCID: PMC6798513 DOI: 10.1186/s12974-019-1586-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/11/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The glial response in multiple sclerosis (MS), especially for recruitment and differentiation of oligodendrocyte progenitor cells (OPCs), predicts the success of remyelination of MS plaques and return of function. As a central player in neuroinflammation, activation and polarization of microglia/macrophages (M/M) that modulate the inflammatory niche and cytokine components in demyelination lesions may impact the OPC response and progression of demyelination and remyelination. However, the dynamic behaviors of M/M and OPCs during demyelination and spontaneous remyelination are poorly understood, and the complex role of neuroinflammation in the demyelination-remyelination process is not well known. In this study, we utilized two focal demyelination models with different dynamic patterns of M/M to investigate the correlation between M/M polarization and the demyelination-remyelination process. METHODS The temporal and spatial features of M/M activation/polarization and OPC response in two focal demyelination models induced by lysolecithin (LPC) and lipopolysaccharide (LPS) were examined in mice. Detailed discrimination of morphology, sensorimotor function, diffusion tensor imaging (DTI), inflammation-relevant cytokines, and glial responses between these two models were analyzed at different phases. RESULTS The results show that LPC and LPS induced distinctive temporal and spatial lesion patterns. LPS produced diffuse demyelination lesions, with a delayed peak of demyelination and functional decline compared to LPC. Oligodendrocytes, astrocytes, and M/M were scattered throughout the LPS-induced demyelination lesions but were distributed in a layer-like pattern throughout the LPC-induced lesion. The specific M/M polarization was tightly correlated to the lesion pattern associated with balance beam function. CONCLUSIONS This study elaborated on the spatial and temporal features of neuroinflammation mediators and glial response during the demyelination-remyelination processes in two focal demyelination models. Specific M/M polarization is highly correlated to the demyelination-remyelination process probably via modulations of the inflammatory niche, cytokine components, and OPC response. These findings not only provide a basis for understanding the complex and dynamic glial phenotypes and behaviors but also reveal potential targets to promote/inhibit certain M/M phenotypes at the appropriate time for efficient remyelination.
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Affiliation(s)
- Tianci Chu
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Donald Baxter Building, Suite 321B, 570 S. Preston Street, Louisville, KY, 40202, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY, 40202, USA
| | - Zhisen Tian
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Donald Baxter Building, Suite 321B, 570 S. Preston Street, Louisville, KY, 40202, USA
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, 130033, People's Republic of China
| | - Chuyuan Ye
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Donald Baxter Building, Suite 321B, 570 S. Preston Street, Louisville, KY, 40202, USA
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Mingming Zhu
- Department of Radiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY, 40202, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY, 40202, USA
| | - Gregory N Barnes
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Donald Baxter Building, Suite 321B, 570 S. Preston Street, Louisville, KY, 40202, USA
- Department of Neurology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, 40202, USA
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY, 40202, USA.
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, 40202, USA.
| | - Jun Cai
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Donald Baxter Building, Suite 321B, 570 S. Preston Street, Louisville, KY, 40202, USA.
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, 40202, USA.
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22
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Itoh Y, Golden LC, Itoh N, Matsukawa MA, Ren E, Tse V, Arnold AP, Voskuhl RR. The X-linked histone demethylase Kdm6a in CD4+ T lymphocytes modulates autoimmunity. J Clin Invest 2019; 129:3852-3863. [PMID: 31403472 DOI: 10.1172/jci126250] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/11/2019] [Indexed: 01/05/2023] Open
Abstract
Multiple sclerosis (MS) is a putative T cell-mediated autoimmune disease. As with many autoimmune diseases, females are more susceptible than males. Sexual dimorphisms may be due to differences in sex hormones, sex chromosomes, or both. Regarding sex chromosome genes, a small percentage of X chromosome genes escape X inactivation and have higher expression in females (XX) compared with males (XY). Here, high-throughput gene expression analysis in CD4+ T cells showed that the top sexually dimorphic gene was Kdm6a, a histone demethylase on the X chromosome. There was higher expression of Kdm6a in females compared with males in humans and mice, and the four core genotypes (FCG) mouse model showed higher expression in XX compared with XY. Deletion of Kdm6a in CD4+ T cells ameliorated clinical disease and reduced neuropathology in the classic CD4+ T cell-mediated autoimmune disease experimental autoimmune encephalomyelitis (EAE). Global transcriptome analysis in CD4+ T cells from EAE mice with a specific deletion of Kdm6a showed upregulation of Th2 and Th1 activation pathways and downregulation of neuroinflammation signaling pathways. Together, these data demonstrate that the X escapee Kdm6a regulates multiple immune response genes, providing a mechanism for sex differences in autoimmune disease susceptibility.
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Affiliation(s)
- Yuichiro Itoh
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Lisa C Golden
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.,Molecular Biology Institute, UCLA, Los Angeles, California, USA
| | - Noriko Itoh
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Macy Akiyo Matsukawa
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Emily Ren
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Vincent Tse
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Arthur P Arnold
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
| | - Rhonda R Voskuhl
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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23
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Interferon Beta-1b for the Treatment of Multiple Sclerosis – More than 10 Years of Experience. ACTA MEDICA MARISIENSIS 2019. [DOI: 10.2478/amma-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: Interferon beta-1b (IFNβ-1b) was the first disease-modifying agent (DMT) used for the treatment of multiple sclerosis (MS). We aimed to evaluate the first patients with MS that started treatment in our clinic.
Methods: An observational, retrospective study was performed on 78 patients that had continuous treatment with IFNβ-1b for more than 10 years. The collection of the demographical data and periodical clinical evaluation was performed on all patients. The disability was quantified using the Expanded Disability Status Scale (EDSS), creating two groups of patients, G1: EDSS < 4.0 and G2: EDSS ≥ 4.0. The hallmarks of the disability evolution were gathered by direct patient interview, such as the symptoms at onset and relapse frequency.
Results: After more than 17 years of disease evolution, more than half (65.38%) of the patients present a mild disability score. The majority (54.90%) started treatment in the first three years after the onset, while the patients in G2 started treatment after more than 3 years from the onset. The initiation of IFNβ-1b lead to a significant reduction of the relapse rates. A reduced number of patients (<25%) transitioned from RRMS to SPMS.
Discussion: Continuous evaluation of MS patients allows us to assess the possibility of prolonged treatment with IFNβ-1b and to differentiate the responders from non-responders. The clear reduction in relapse rates and disability progression, notably in patients that started treatment early ensure us into continuing administering this medication. Compared to historical cohorts, our lot had a slower disability evolution and a significant proportion hadn’t reach an important disability score.
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24
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Valadkeviciene D, Kavaliunas A, Kizlaitiene R, Jocys M, Jatuzis D. Incidence rate and sex ratio in multiple sclerosis in Lithuania. Brain Behav 2019; 9:e01150. [PMID: 30485721 PMCID: PMC6346727 DOI: 10.1002/brb3.1150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine the temporal changes in incidence rates of multiple sclerosis (MS) over the past 15 years in Lithuania with prediction up to 2020, and to estimate female-to-male sex ratio and its changes among MS patients. MATERIALS AND METHODS We conducted a descriptive incidence study. The crude incidence rates (CIR) were calculated using 15-year period, sex, age-groups, and the number of newly registered MS patients. Standardized incidence rates (SIR) were calculated using European standard in order to evaluate the influence of resident structure changes on incidence of MS during the last 15 years. The data were processed using Minitab set to estimate a linear trend model for the temporal changes of 16 parameters. RESULTS The data showed a substantial growth of the incidence rate of MS in Lithuania during the period of 2001-2015. In 2001, MS was diagnosed to 162 new individuals, whereas 343 new cases of MS were diagnosed in 2015. During 2001-2015, the incidence of MS was on average 6.5 (95% CI 5.70-7.30) cases per 100,000 residents, and 4.9 (95% CI 4.46-5.34) and 8.1 (5.86-9.34) for 100,000 male and female, respectively. Female-to-male sex ratio in MS in Lithuania had a tendency to increase over the period. Females were affected from 1.5 to 2 times more often than males. CONCLUSIONS In 2020, the incidence rate of MS is estimated to reach 13 cases per 100,000 persons and females are expected to be diagnosed with MS two times more often than males.
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Affiliation(s)
- Daiva Valadkeviciene
- Department of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rasa Kizlaitiene
- Department of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Mykolas Jocys
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dalius Jatuzis
- Department of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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25
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Miclea A, Salmen A, Zoehner G, Diem L, Kamm CP, Chaloulos-Iakovidis P, Miclea M, Briner M, Kilidireas K, Stefanis L, Chan A, Evangelopoulos ME, Hoepner R. Age-dependent variation of female preponderance across different phenotypes of multiple sclerosis: A retrospective cross-sectional study. CNS Neurosci Ther 2018; 25:527-531. [PMID: 30411534 PMCID: PMC6488902 DOI: 10.1111/cns.13083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is an autoimmune disease of the CNS, which predominantly affects women. Studies investigating the sex distribution in MS are sparse. We aim to analyze the female‐to‐male ratio (F/M ratio) in different MS phenotypes in association with age at diagnosis and year of birth. Methods We performed a retrospective cross‐sectional analysis by cumulating data (sex, year of birth, age at diagnosis, and MS phenotypes) from unpublished and published studies of the participating centers. Results Datasets of 945 patients were collected. The overall F/M ratio was 1.9:1.0 and female preponderance was present in all phenotypes except for primary progressive MS (PPMS), in which men were predominantly affected (F/M ratio: 0.5:1.0). Female preponderance declined with increasing age at diagnosis and was no longer present in relapsing‐remitting MS (RRMS) patients > 58 years of age. Conclusion Our data demonstrate an age dependency of female preponderance in MS except for PPMS. This could be influenced by the lifecycle of sex hormone secretion in women. In PPMS, a male preponderance was observed in all age‐groups, which might point to pathophysiological mechanisms being less influenced by sex hormones.
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Affiliation(s)
- Andrei Miclea
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Greta Zoehner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian P Kamm
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Marius Miclea
- Neurological Outpatient Department, Neurocenter Peine, Peine, Germany
| | - Myriam Briner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Kostas Kilidireas
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Chan
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maria Eleftheria Evangelopoulos
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Hoepner
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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26
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Pappalardo LW, Samad OA, Liu S, Zwinger PJ, Black JA, Waxman SG. Nav1.5 in astrocytes plays a sex-specific role in clinical outcomes in a mouse model of multiple sclerosis. Glia 2018; 66:2174-2187. [PMID: 30194875 DOI: 10.1002/glia.23470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
Abstract
Astrogliosis is a hallmark of neuroinflammatory disorders such as multiple sclerosis (MS). A detailed understanding of the underlying molecular mechanisms governing astrogliosis might facilitate the development of therapeutic targets. We investigated whether Nav1.5 expression in astrocytes plays a role in the pathogenesis of experimental autoimmune encephalomyelitis (EAE), a murine model of MS. We created a conditional knockout of Nav1.5 in astrocytes and determined whether this affects the clinical course of EAE, focal macrophage and T cell infiltration, and diffuse activation of astrocytes. We show that deletion of Nav1.5 from astrocytes leads to significantly worsened clinical outcomes in EAE, with increased inflammatory infiltrate in both early and late stages of disease, unexpectedly, in a sex-specific manner. Removal of Nav1.5 in astrocytes leads to increased inflammation in female mice with EAE, including increased astroglial response and infiltration of T cells and phagocytic monocytes. These cellular changes are consistent with more severe EAE clinical scores. Additionally, we found evidence suggesting possible dysregulation of the immune response-particularly with regard to infiltrating macrophages and activated microglia-in female Nav1.5 KO mice compared with WT littermate controls. Together, our results show that deletion of Nav1.5 from astrocytes leads to significantly worsened clinical outcomes in EAE, with increased inflammatory infiltrate in both early and late stages of disease, in a sex-specific manner.
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Affiliation(s)
- Laura W Pappalardo
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
| | - Omar A Samad
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
| | - Shujun Liu
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
| | - Pamela J Zwinger
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
| | - Joel A Black
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
| | - Stephen G Waxman
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut, 06510.,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, 06516
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27
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Traditional Uses of Cannabinoids and New Perspectives in the Treatment of Multiple Sclerosis. MEDICINES 2018; 5:medicines5030091. [PMID: 30111755 PMCID: PMC6164967 DOI: 10.3390/medicines5030091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/24/2022]
Abstract
Recent findings highlight the emerging role of the endocannabinoid system in the control of symptoms and disease progression in multiple sclerosis (MS). MS is a chronic, immune-mediated, demyelinating disorder of the central nervous system with no cure so far. It is widely reported in the literature that cannabinoids might be used to control MS symptoms and that they also might exert neuroprotective effects and slow down disease progression. This review aims to give an overview of the principal cannabinoids (synthetic and endogenous) used for the symptomatic amelioration of MS and their beneficial outcomes, providing new potentially possible perspectives for the treatment of this disease.
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28
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Yousuf F, Dupuy SL, Tauhid S, Chu R, Kim G, Tummala S, Khalid F, Weiner HL, Chitnis T, Healy BC, Bakshi R. A two-year study using cerebral gray matter volume to assess the response to fingolimod therapy in multiple sclerosis. J Neurol Sci 2017; 383:221-229. [DOI: 10.1016/j.jns.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/14/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023]
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29
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Ford JL, Stowe RP. Depressive symptoms are associated with salivary shedding of Epstein-Barr virus in female adolescents: The role of sex differences. Psychoneuroendocrinology 2017; 86:128-133. [PMID: 28954244 PMCID: PMC5905709 DOI: 10.1016/j.psyneuen.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adolescent females have a higher prevalence of depression in comparison to their male peers - a disparity that has been increasing over the past decade. Depression is of concern as it is associated with chronic disease and to immune dysregulation, which may be one mechanism linking depression to future pathology. This study examined the extent to which sex moderated the association between depressive symptoms and immune dysregulation during adolescence using Epstein-Barr virus (EBV) reactivation, a biomarker of cellular immune response, as a model. METHODS A representative community sample of 259 female and 279 male adolescents aged 11-17 years who were EBV IgG positive were examined. Trained interviewers collected the data during two home visits, one week apart. Depressive symptoms were measured at the first visit using the 9 item short-form of the Center for Epidemiologic Studies-Depression scale. EBV biomarkers were collected via saliva at the second visit and included a qualitative measure of EBV viral capsid antigen immunoglobulin G to assess prior EBV infection and a quantitative measure of EBV DNA to assess the number of viral copies shed in the saliva. RESULTS In multivariable logistic regression analyses, increasing depressive symptoms were significantly associated with salivary shedding of EBV DNA for adolescent females only (logit=0.66, se=0.30, p<0.05), and the interaction between sex and depressive symptoms on salivary shedding of EBV DNA was statistically significant (logit=-1.19, se=0.42, p<0.01). Sensitivity analyses were conducted in which sex was examined as a moderator in the relationship between depressive symptoms and salivary EBV DNA quantitative copies via Tobit regression; results were consistent with the presented findings. CONCLUSIONS Depressive symptoms are associated with EBV reactivation among EBV positive female adolescents, but not males. Future research is needed to examine EBV reactivation in female adolescents as a mechanism linking depression to future chronic disease and the role of sex hormones in explaining sex differences in the relationship between depressive symptoms and EBV reactivation.
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Affiliation(s)
- Jodi L Ford
- The Ohio State University College of Nursing, 1585 Neil Ave. Columbus, OH, 43210 614-292-6862, United States.
| | - Raymond P Stowe
- Senior Scientist, Microgen Laboratories,903 Texas Avenue, La Marque, TX, 77568, United States.
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30
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Murta V, Ferrari C. Peripheral Inflammation and Demyelinating Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 949:263-285. [PMID: 27714694 DOI: 10.1007/978-3-319-40764-7_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In recent decades, several neurodegenerative diseases have been shown to be exacerbated by systemic inflammatory processes. There is a wide range of literature that demonstrates a clear but complex relationship between the central nervous system (CNS) and the immunological system, both under naïve or pathological conditions. In diseased brains, peripheral inflammation can transform "primed" microglia into an "active" state, which can trigger stronger pathological responses. Demyelinating diseases are a group of neurodegenerative diseases characterized by inflammatory lesions associated with demyelination, which in turn induces axonal damage, neurodegeneration, and progressive loss of function. Among them, the most important are multiple sclerosis (MS) and neuromyelitis optica (NMO). In this review, we will analyze the effect of specific peripheral inflammatory stimuli in the progression of demyelinating diseases and discuss their animal models. In most cases, peripheral immune stimuli are exacerbating.
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Affiliation(s)
- Verónica Murta
- Laboratorio de Neuropatología Molecular, Instituto de Biología Celular y Neurociencias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carina Ferrari
- Instituto de Ciencias Básicas y Medicina Experimental, Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina.
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31
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Sex effects on inflammatory and neurodegenerative processes in multiple sclerosis. Neurosci Biobehav Rev 2016; 67:137-46. [DOI: 10.1016/j.neubiorev.2015.12.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 01/14/2023]
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