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York EN, Thrippleton MJ, Meijboom R, Hunt DPJ, Waldman AD. Quantitative magnetization transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis. Brain Commun 2022; 4:fcac088. [PMID: 35652121 PMCID: PMC9149789 DOI: 10.1093/braincomms/fcac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human in vivo quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (z-value: -8.99, P < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [β = 0.12 (-0.56 to 0.80), t-value = 0.35, P = 0.724, 14 studies] or normal-appearing white matter alone [β = 0.037 (-0.14 to 0.22), t-value = 0.41, P = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [r = -0.32 (95% CI -0.46 to -0.17); z-value = -4.33, P < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
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Affiliation(s)
- Elizabeth N. York
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic,
University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
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2
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Duncan GJ, Simkins TJ, Emery B. Neuron-Oligodendrocyte Interactions in the Structure and Integrity of Axons. Front Cell Dev Biol 2021; 9:653101. [PMID: 33763430 PMCID: PMC7982542 DOI: 10.3389/fcell.2021.653101] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
The myelination of axons by oligodendrocytes is a highly complex cell-to-cell interaction. Oligodendrocytes and axons have a reciprocal signaling relationship in which oligodendrocytes receive cues from axons that direct their myelination, and oligodendrocytes subsequently shape axonal structure and conduction. Oligodendrocytes are necessary for the maturation of excitatory domains on the axon including nodes of Ranvier, help buffer potassium, and support neuronal energy metabolism. Disruption of the oligodendrocyte-axon unit in traumatic injuries, Alzheimer's disease and demyelinating diseases such as multiple sclerosis results in axonal dysfunction and can culminate in neurodegeneration. In this review, we discuss the mechanisms by which demyelination and loss of oligodendrocytes compromise axons. We highlight the intra-axonal cascades initiated by demyelination that can result in irreversible axonal damage. Both the restoration of oligodendrocyte myelination or neuroprotective therapies targeting these intra-axonal cascades are likely to have therapeutic potential in disorders in which oligodendrocyte support of axons is disrupted.
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Affiliation(s)
- Greg J. Duncan
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Tyrell J. Simkins
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Vollum Institute, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, VA Portland Health Care System, Portland, OR, United States
| | - Ben Emery
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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3
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Abbatemarco JR, Fox RJ, Li H, Ontaneda D. Vitamin D and MRI measures in progressive multiple sclerosis. Mult Scler Relat Disord 2019; 35:276-282. [PMID: 31445221 DOI: 10.1016/j.msard.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D deficiency is a proposed risk factor for multiple sclerosis (MS), but its role in progressive MS is not well understood. OBJECTIVE To examine the association between vitamin D levels and MRI features in primary progressive (PPMS) and secondary progressive MS (SPMS). METHODS Serum 25-hydroxyvitamin D (25[OH]D) and 25-hydroxyvitamin D3 (25[OH]D3) levels were obtained from 267 subjects enrolled into the Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in Multiple Sclerosis (SPRINT-MS). Associations between imaging data and vitamin D levels was determined using Pearson or Spearman correlation and multivariate regression analyses. RESULTS 267 patients (age 55.6 ± 7.4, 47.2% male, and 51.3% PPMS) were evaluated with quantitative MRI and vitamin D levels. 25(OH)D and 25(OH)D3 were similar between PPMS and SPMS. There was no significant association between vitamin D and T1/2 lesion volume and brain parenchymal fraction. Modest associations were found between 25(OH)D3 and whole brain-magnetization transfer ratio (WB-MTR, r = 0.17, p = 0.007) and normal appearing grey matter MTR (NAGM-MTR, r = 0.15, p = 0.02). CONCLUSIONS 25(OH)D3 levels were not associated with brain volume or lesional measures in progressive MS contrary to what has been described in relapsing remitting MS. An association between WB-MTR and NAGM-MTR suggest higher vitamin D levels may exert a protective role on myelin content in progressive MS.
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Affiliation(s)
- Justin R Abbatemarco
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hong Li
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA.
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4
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Rocca MA, Preziosa P, Filippi M. Application of advanced MRI techniques to monitor pharmacologic and rehabilitative treatment in multiple sclerosis: current status and future perspectives. Expert Rev Neurother 2018; 19:835-866. [PMID: 30500303 DOI: 10.1080/14737175.2019.1555038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Advances in magnetic resonance imaging (MRI) technology and analyses are improving our understanding of the pathophysiology of multiple sclerosis (MS). Due to their ability to grade the presence of irreversible tissue loss, microstructural tissue abnormalities, metabolic changes and functional plasticity, the application of these techniques is also expanding our knowledge on the efficacy and mechanisms of action of different pharmacological and rehabilitative treatments. Areas covered: This review discusses recent findings derived from the application of advanced MRI techniques to evaluate the structural and functional substrates underlying the effects of pharmacologic and rehabilitative treatments in patients with MS. Current applications as outcome in clinical trials and observational studies, their interpretation and possible pitfalls in their use are discussed. Finally, how these techniques could evolve in the future to improve monitoring of disease progression and treatment response is examined. Expert commentary: The number of treatments currently available for MS is increasing. The application of advanced MRI techniques is providing reliable and specific measures to better understand the targets of different treatments, including neuroprotection, tissue repair, and brain plasticity. This is a fundamental progress to move toward personalized medicine and individual treatment selection.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
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5
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Petracca M, Margoni M, Bommarito G, Inglese M. Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques. Neurol Ther 2018; 7:265-285. [PMID: 29956263 PMCID: PMC6283788 DOI: 10.1007/s40120-018-0103-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. In this review, we (1) provide an overview of the pathological features of PMS, (2) summarize the findings of research and clinical trials conducted in PMS which have applied conventional and advanced magnetic resonance imaging techniques and (3) discuss recent advancements and future perspectives in monitoring PMS with imaging techniques.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Margoni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital, University of Padua, Padua, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy.
- Departments of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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6
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Bauer IE, Suchting R, Cazala F, Alpak G, Sanches M, Nery FG, Zunta-Soares GB, Soares JC. Changes in amygdala, cerebellum, and nucleus accumbens volumes in bipolar patients treated with lamotrigine. Psychiatry Res Neuroimaging 2018; 278:13-20. [PMID: 29944976 DOI: 10.1016/j.pscychresns.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 12/21/2022]
Abstract
The neural mechanisms underlying the therapeutic effects of lamotrigine in bipolar depression are still unexplored. This preliminary study compares the effects of a 12-week treatment with lamotrigine on brain volumes in adults with bipolar disorder (BD).12 BD type II patients (age: 49.33 ± 9.95 years, 3 males, 9 females) and 12 age and gender-matched healthy controls (HC) (HC; age: 41 ± 8.60 years, 3 males, 9 females). BD patients were initially administered 25 mg/day of lamotrigine, which was progressively escalated to 200 mg/d. BD participants underwent brain imaging prior to and following lamotrigine treatment. A 50% reduction in depressive scores indicated "remission". Bayesian general linear models controlled for age, gender and intracranial volume were used to examine changes in relevant brain region following treatment. A posterior probability > 0.90 indicated evidence that there was an effect of diagnosis or remission on brain volumes. Probability distributions of interaction effects between remission and time indicated that BD responders displayed decreased amygdala, cerebellum and nucleus accumbens volumes following lamotrigine treatment. No serious adverse side effects were reported. The antidepressant effects of lamotrigine may be linked to volumetric changes in brain regions involved in mood and emotional regulation. These findings are preliminary and replication in a larger sample is warranted.
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Affiliation(s)
- Isabelle E Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States.
| | - Robert Suchting
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Fadwa Cazala
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Gokay Alpak
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Fabiano G Nery
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
| | - Giovana B Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Jair C Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
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7
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Alonso R, Gonzalez-Moron D, Garcea O. Optical coherence tomography as a biomarker of neurodegeneration in multiple sclerosis: A review. Mult Scler Relat Disord 2018; 22:77-82. [PMID: 29605802 DOI: 10.1016/j.msard.2018.03.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/27/2022]
Abstract
Neurodegeneration is one the most important pathological factors which contributes to permanent disability in multiple sclerosis (MS). Optical coherence tomography (OCT) measurements of macular ganglion cell layer (mGCL) and retinal nerve fiber layer (RNFL) have been proposed as biomarkers of axonal damage in MS. The aim of this review is to describe the most relevant findings regarding OCT and axonal damage in MS. We have selected studies that describe retina impairment in MS patients, and those which quantitatively assess the relationship between OCT and physical disability, cognitive impairment and relationship between OCT and magnetic resonance imaging (MRI). Results show that there is a relationship between the degree of retinal layers reduction and physical or cognitive disability and degenerative changes in MRI.
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Affiliation(s)
- Ricardo Alonso
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina.
| | - Dolores Gonzalez-Moron
- Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina; Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Orlando Garcea
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina
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8
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Zheng Y, Lee JC, Rudick R, Fisher E. Long-Term Magnetization Transfer Ratio Evolution in Multiple Sclerosis White Matter Lesions. J Neuroimaging 2017; 28:191-198. [PMID: 29076591 DOI: 10.1111/jon.12480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetization transfer ratio (MTR), a magnetic resonance imaging technique used to assess tissue integrity, correlates with demyelination and axonal loss in multiple sclerosis (MS) lesions. In acute white matter lesions, short-term MTR changes mainly reflect demyelination and remyelination, in addition to edema and axonal and glial changes. Long-term MTR changes in MS lesions have not been studied extensively. METHODS A new quantitative image analysis method was developed to measure long-term MTR changes in MS lesions. The method was applied to a group of 59 patients and 14 healthy control subjects followed for 4 years. MTR changes in white matter lesions were analyzed, where lesion voxels were classified into six categories based on starting MTR and change over time. For each patient, the proportion of lesion voxels in each MTR-change category was calculated. Correlations between long-term MTR evolution, disability progression, and brain atrophy were investigated. RESULTS The proportion of lesion voxels in the high stable category correlated with less atrophy progression, while the proportion with low and increasing MTR correlated with increased atrophy. The proportion of lesion voxels in the high and stable MTR lesion category was significantly different between MS disease subgroups. The group with disability progression had a higher proportion of lesion voxels with low and increasing MTR. CONCLUSIONS These results suggest that long-term changes in MTR in white matter lesions can be used to distinguish lesion subtypes associated with MS disease progression and improve understanding of the temporal evolution of MS pathology.
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Affiliation(s)
- Yufan Zheng
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.,Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH
| | - Jar-Chi Lee
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Richard Rudick
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH
| | - Elizabeth Fisher
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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9
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Correale J, Gaitán MI, Ysrraelit MC, Fiol MP. Progressive multiple sclerosis: from pathogenic mechanisms to treatment. Brain 2017; 140:527-546. [PMID: 27794524 DOI: 10.1093/brain/aww258] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/18/2016] [Indexed: 12/30/2022] Open
Abstract
During the past decades, better understanding of relapsing-remitting multiple sclerosis disease mechanisms have led to the development of several disease-modifying therapies, reducing relapse rates and severity, through immune system modulation or suppression. In contrast, current therapeutic options for progressive multiple sclerosis remain comparatively disappointing and challenging. One possible explanation is a lack of understanding of pathogenic mechanisms driving progressive multiple sclerosis. Furthermore, diagnosis is usually retrospective, based on history of gradual neurological worsening with or without occasional relapses, minor remissions or plateaus. In addition, imaging methods as well as biomarkers are not well established. Magnetic resonance imaging studies in progressive multiple sclerosis show decreased blood-brain barrier permeability, probably reflecting compartmentalization of inflammation behind a relatively intact blood-brain barrier. Interestingly, a spectrum of inflammatory cell types infiltrates the leptomeninges during subpial cortical demyelination. Indeed, recent magnetic resonance imaging studies show leptomeningeal contrast enhancement in subjects with progressive multiple sclerosis, possibly representing an in vivo marker of inflammation associated to subpial demyelination. Treatments for progressive disease depend on underlying mechanisms causing central nervous system damage. Immunity sheltered behind an intact blood-brain barrier, energy failure, and membrane channel dysfunction may be key processes in progressive disease. Interfering with these mechanisms may provide neuroprotection and prevent disability progression, while potentially restoring activity and conduction along damaged axons by repairing myelin. Although most previous clinical trials in progressive multiple sclerosis have yielded disappointing results, important lessons have been learnt, improving the design of novel ones. This review discusses mechanisms involved in progressive multiple sclerosis, correlations between histopathology and magnetic resonance imaging studies, along with possible new therapeutic approaches.
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10
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Bhise V, Dhib-Jalbut S. Further understanding of the immunopathology of multiple sclerosis: impact on future treatments. Expert Rev Clin Immunol 2016; 12:1069-89. [PMID: 27191526 DOI: 10.1080/1744666x.2016.1191351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The understanding of the immunopathogenesis of multiple sclerosis (MS) has expanded with more research into T-cell subtypes, cytokine contributors, B-cell participation, mitochondrial dysfunction, and more. Treatment options have rapidly expanded with three relatively recent oral therapy alternatives entering the arena. AREAS COVERED In the following review, we discuss current mechanisms of immune dysregulation in MS, how they relate to current treatments, and the impact these findings will have on the future of therapy. Expert commentary: The efficacy of these medications and understanding their mechanisms of actions validates the immunopathogenic mechanisms thought to underlie MS. Further research has exposed new targets, while new promising therapies have shed light on new aspects into the pathophysiology of MS.
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Affiliation(s)
- Vikram Bhise
- a Rutgers Biomedical and Health Sciences - Departments of Pediatrics , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Suhayl Dhib-Jalbut
- b Rutgers Biomedical and Health Sciences - Departments of Neurology , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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11
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Enzinger C, Barkhof F, Ciccarelli O, Filippi M, Kappos L, Rocca MA, Ropele S, Rovira À, Schneider T, de Stefano N, Vrenken H, Wheeler-Kingshott C, Wuerfel J, Fazekas F. Nonconventional MRI and microstructural cerebral changes in multiple sclerosis. Nat Rev Neurol 2015; 11:676-86. [PMID: 26526531 DOI: 10.1038/nrneurol.2015.194] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MRI has become the most important paraclinical tool for diagnosing and monitoring patients with multiple sclerosis (MS). However, conventional MRI sequences are largely nonspecific in the pathology they reveal, and only provide a limited view of the complex morphological changes associated with MS. Nonconventional MRI techniques, such as magnetization transfer imaging (MTI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) promise to complement existing techniques by revealing more-specific information on microstructural tissue changes. Past years have witnessed dramatic advances in the acquisition and analysis of such imaging data, and numerous studies have used these tools to probe tissue alterations associated with MS. Other MRI-based techniques-such as myelin-water imaging, (23)Na imaging, magnetic resonance elastography and magnetic resonance perfusion imaging-might also shed new light on disease-associated changes. This Review summarizes the rapid technical progress in the use of MRI in patients with MS, with a focus on nonconventional structural MRI. We critically discuss the present utility of nonconventional MRI in MS, and provide an outlook on future applications, including clinical practice. This information should allow appropriate selection of advanced MRI techniques, and facilitate their use in future studies of this disease.
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Affiliation(s)
- Christian Enzinger
- Division of Neuroradiology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.,Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Frederik Barkhof
- VU University MS Center Amsterdam, Department of Radiology and Nuclear Medicine and Department of Physics &Medical Technology, VU University Medical Center, Netherlands
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, University College London Institute of Neurology, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Ludwig Kappos
- Department of Neurology, University of Basel, Switzerland
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Àlex Rovira
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Spain
| | - Torben Schneider
- NMR Research Unit, Queen Square MS Centre, University College London Institute of Neurology, UK
| | - Nicola de Stefano
- Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Hugo Vrenken
- VU University MS Center Amsterdam, Department of Radiology and Nuclear Medicine and Department of Physics &Medical Technology, VU University Medical Center, Netherlands
| | | | - Jens Wuerfel
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
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12
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Ontaneda D, Fox RJ, Chataway J. Clinical trials in progressive multiple sclerosis: lessons learned and future perspectives. Lancet Neurol 2015; 14:208-23. [PMID: 25772899 PMCID: PMC4361791 DOI: 10.1016/s1474-4422(14)70264-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Progressive multiple sclerosis is characterised clinically by the gradual accrual of disability independent of relapses and can occur with disease onset (primary progressive) or can be preceded by a relapsing disease course (secondary progressive). An effective disease-modifying treatment for progressive multiple sclerosis has not yet been identified, and so far the results of clinical trials have generally been disappointing. Ongoing advances in the knowledge of pathogenesis, in the identification of novel targets for neuroprotection, and in improved outcome measures could lead to effective treatments for progressive multiple sclerosis. In this Series paper, we summarise the lessons learned from completed clinical trials and perspectives from trials in progress in progressive multiple sclerosis. We review promising clinical, imaging, and biological markers, along with novel designs, for clinical trials. The use of more refined outcomes and truly neuroprotective drugs, coupled with more efficient trial design, has the capacity to deliver a new era of therapeutic discovery in this challenging area.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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13
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Abstract
PURPOSE OF REVIEW We summarize MRI measures currently available to assess treatment efficacy and safety in multiple sclerosis (MS) clinical trials and discuss novel metrics that could enter the clinical arena in the near future. RECENT FINDINGS In relapsing remitting MS, MRI measures of disease activity (new T2 and gadolinium-enhancing lesions) provide a good surrogacy of treatment effect on relapse rate and disability progression; however, their value in progressive MS remains elusive. For the progressive disease forms, these measures need to be combined with quantities assessing the extent of irreversible tissue loss, which have already been introduced in some clinical trials (e.g., evolution of active lesions into permanent black holes and brain atrophy). Novel measures (e.g., quantification of gray matter and spinal cord atrophy) have demonstrated a great value in explaining patients' clinical outcome, but still need to be fully validated. Despite showing promise, evaluations of cortical lesions, of microscopic tissue abnormalities, and of functional cortical reorganization are still some way off for monitoring of treatment effects. SUMMARY Trial outcomes in MS should include measures of inflammation and neurodegeneration, which should be combined according to the disease clinical phenotype, phase of the study, and the supposed mechanism of action of the drug tested.
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14
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Ellwardt E, Zipp F. Molecular mechanisms linking neuroinflammation and neurodegeneration in MS. Exp Neurol 2014; 262 Pt A:8-17. [DOI: 10.1016/j.expneurol.2014.02.006] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 12/21/2022]
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Neuroprotection in a novel mouse model of multiple sclerosis. PLoS One 2013; 8:e79188. [PMID: 24223903 PMCID: PMC3817036 DOI: 10.1371/journal.pone.0079188] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 09/24/2013] [Indexed: 01/16/2023] Open
Abstract
Multiple sclerosis is an immune-mediated, demyelinating and neurodegenerative disease that currently lacks any neuroprotective treatments. Innovative neuroprotective trial designs are required to hasten the translational process of drug development. An ideal target to monitor the efficacy of strategies aimed at treating multiple sclerosis is the visual system, which is the most accessible part of the human central nervous system. A novel C57BL/6 mouse line was generated that expressed transgenes for a myelin oligodendrocyte glycoprotein-specific T cell receptor and a retinal ganglion cell restricted-Thy1 promoter-controlled cyan fluorescent protein. This model develops spontaneous or induced optic neuritis, in the absence of paralytic disease normally associated with most rodent autoimmune models of multiple sclerosis. Demyelination and neurodegeneration could be monitored longitudinally in the living animal using electrophysiology, visual sensitivity, confocal scanning laser ophthalmoscopy and optical coherence tomography all of which are relevant to human trials. This model offers many advantages, from a 3Rs, economic and scientific perspective, over classical experimental autoimmune encephalomyelitis models that are associated with substantial suffering of animals. Optic neuritis in this model led to inflammatory damage of axons in the optic nerve and subsequent loss of retinal ganglion cells in the retina. This was inhibited by the systemic administration of a sodium channel blocker (oxcarbazepine) or intraocular treatment with siRNA targeting caspase-2. These novel approaches have relevance to the future treatment of neurodegeneration of MS, which has so far evaded treatment.
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Alvarez S, Moldovan M, Krarup C. Prolonged high frequency electrical stimulation is lethal to motor axons of mice heterozygously deficient for the myelin protein P0 gene. Exp Neurol 2013; 247:552-61. [DOI: 10.1016/j.expneurol.2013.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/09/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
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Rocca MA, Messina R, Filippi M. Multiple sclerosis imaging: recent advances. J Neurol 2012; 260:929-35. [DOI: 10.1007/s00415-012-6788-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 01/28/2023]
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