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Paolicelli D, Borriello G, Clerici R, Colombo E, Croce D, D'Amico E, De Rossi N, Di Sapio A, Fenu G, Maimone D, Marfia GA, Moccia M, Perini P, Piscaglia MG, Razzolini L, Riccaboni M, Signoriello E, Agostoni G, Farina A, Mondino M, Berruto F, Tettamanti A, Donnaloja F, Tortorella C. Predicted Expenditure for Prescription Drugs for Multiple Sclerosis in the Italian Market Between 2023 and 2028: Results of the Oracle Project. Neurol Ther 2024:10.1007/s40120-024-00644-3. [PMID: 39093539 DOI: 10.1007/s40120-024-00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic neurodegenerative disease that leads to impaired cognitive function and accumulation of disability, with significant socioeconomic burden. Serious unmet need in the context of managing MS has given rise to ongoing research efforts, leading to the launch of new drugs planned for the near future, and subsequent concerns about the sustainability of healthcare systems. This study assessed the changes in the Italian MS market and their impact on the expenditures of the Italian National Healthcare Service between 2023 and 2028. METHODS A horizon-scanning model was developed to estimate annual expenditure from 2023 to 2028. Annual expenditure for MS was calculated by combining the number of patients treated with each product (clinical inputs) and the yearly costs of therapy (economic inputs). Baseline inputs (2020-2022) were collected from IQVIA® real-world data, while input estimation for the 5-year forecast was integrated with analog analyses and the insights of clinicians and former payers. RESULTS The number of equivalent patients treated in 2028 in Italy was estimated at around 67,000, with an increase of 10% versus 2022. In terms of treatment pattern evolution, first-line treatments are expected to reduce their shares from 47% in 2022 to 27% in 2028, and Bruton tyrosine kinase inhibitors are expected to reach 23% of patient shares. Overall, expenditure for MS is estimated to decrease from €721 million in 2022 to €551 million in 2028, mainly due to losses of exclusivity and renegotiation of drug prices. CONCLUSION Despite the increase in the number of patients treated for MS and the launch of new molecules that will reach high market penetration, the model confirmed sustainability for the Italian National Healthcare Service.
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Affiliation(s)
- Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Giovanna Borriello
- Multiple Sclerosis Center, San Pietro Fatebenefratelli Hospital, Rome, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | | | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Croce
- Centre for Health Economics, Social and Health Care Management, University Carlo Castanea - LIUC, Castellanza, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia - P.O. Montichiari, Montichiari, Italy
| | - Alessia Di Sapio
- Department of Neurology and CRESM (Regional Referral Multiple Sclerosis Centre), University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Giuseppe Fenu
- Department of Neurology, Brotzu Hospital, Cagliari, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marcello Moccia
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital of Naples, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Paola Perini
- Department of Neurology, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Maria G Piscaglia
- Multiple Sclerosis Center, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | | | - Carla Tortorella
- Department of Neurosciences, Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Rome, Italy
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Puthenparampil M, Stivanello C, Bano MC, Tessarin M, Martello T, Rinaldi F, Perini P, Gallo P. Telehealth Feasibility, Interest, and Satisfaction of Patients with Multiple Sclerosis Living in the Veneto Region, Italy, During the COVID-19 Pandemic. Telemed J E Health 2024. [PMID: 39049787 DOI: 10.1089/tmj.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Introduction: Synchronous telehealth (ST) consists of the remote real-time delivery of health services. COVID-19 pandemic has pressed the use of ST and forced neurologists to deliver telehealth services. The aim of this study was to obtain the actual picture of ST accessibility/interest and to evaluate the user satisfaction in patients with multiple sclerosis (MS) during the COVID-19 pandemic. Methods: The study consisted of two phases. First, a hard-copy questionnaire ("Telehealth Identity Card" [TIC]), including only yes/no questions, filled in the presence of a neurologist, and investigating the technical/practical access and the willingness/interest of MS patients to the telehealth services, was obtained from 600 consecutive outpatients, with no time limit for answering. Second, a fully filled "Televisit Satisfaction Questionnaire" (TSQ) was obtained from 100 consecutive patients that underwent a televisit. Statistical analysis applied the t test for normally distributed variables and the Mann-Whitney U test for ordinal. Logistic univariate and multivariate regressions were applied to predict televisit availability on the base of demographic variables. Results: Statistical analysis was performed on 552/600 consecutive TIC (92%). Of them, 464/552 (84%) of the MS patients declared to possess the tools and to be interested in telehealth services. Compared with noninterested patients, they were younger (mean age: 44.0 vs. 49.8, p < 0.001) and with lower disability (mean Expanded Disability Status Scale: 2.5 vs. 3.3, p < 0.01). From TSQ, it emerged that 95% agree or strongly agree that televisit respected timelines, saved time and money, was conducted with respect to privacy, can be a useful tool for monitoring disease and therapy, and expressed their availability for further televisits. Discussion: A great majority of MS patients living in Padua Province were interested in telehealth. High satisfaction and the willingness for further televist were expressed. Telehealth services can help neurologists to manage the increasing number of MS patients and their complex therapeutic monitoring.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Celeste Stivanello
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Maria Chiara Bano
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Michele Tessarin
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Tiziano Martello
- Hospital Medical Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paola Perini
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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Maple PA, Tanasescu R, Constantinescu CS, Valentino P, Capobianco M, D’Orso S, Borsellino G, Battistini L, Ristori G, Mechelli R, Salvetti M, Gran B. Cytomegalovirus, Epstein-Barr Virus, Herpes Simplex Virus, and Varicella Zoster Virus Infection Dynamics in People with Multiple Sclerosis from Northern Italy. Pathogens 2024; 13:499. [PMID: 38921797 PMCID: PMC11206421 DOI: 10.3390/pathogens13060499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Previous exposure to Epstein-Barr virus (EBV) is strongly associated with the development of multiple sclerosis (MS). By contrast, past cytomegalovirus (CMV) infection may have no association, or be negatively associated with MS. This study aimed to investigate the associations of herpesvirus infections with MS in an Italian population. Serum samples (n = 200) from Italian people with multiple sclerosis (PwMS) classified as the relapsing-and-remitting clinical phenotype and (n = 137) healthy controls (HCs) were obtained from the CRESM Biobank, Orbassano, Italy. Both PwMS and HCs samples were selected according to age group (20-39 years, and 40 or more years) and sex. EBV virus capsid antigen (VCA) IgG, EBV nucleic acid-1 antigen (EBNA-1) IgG, CMV IgG, herpes simplex virus (HSV) IgG, and varicella zoster virus (VZV) IgG testing was undertaken using commercial ELISAs. EBV VCA IgG and EBNA-1 IgG seroprevalences were 100% in PwMS and 93.4% and 92.4%, respectively, in HCs. EBV VCA IgG and EBNA-1 IgG levels were higher (p < 0.001) in PwMS compared with HCs. For PwMS, the EBNA-1 IgG levels decreased with age, particularly in females. The CMV IgG seroprevalence was 58.7% in PwMS and 62.9% in HCs. CMV IgG seroprevalence increased with age. The HSV IgG seroprevalence was 71.2% in PwMS and 70.8% in HCs. HSV IgG levels were lower (p = 0.0005) in PwMS compared with HCs. VZV IgG seroprevalence was 97.5% in PwMS and 98.5% in HCs. In the population studied, several herpesvirus infections markers may have been influenced by the age and sex of the groups studied. The lack of a negative association of MS with CMV infection, and the observation of lower levels of HSV IgG in PwMS compared with HCs are findings worthy of further investigation.
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Affiliation(s)
- Peter A. Maple
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Radu Tanasescu
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Cris S. Constantinescu
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Cooper Neurological Institute, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Paola Valentino
- Neuroscience Institute, Cavalieri Ottolenghi, 10043 Orbassano, Italy; (P.V.)
| | - Marco Capobianco
- Neuroscience Institute, Cavalieri Ottolenghi, 10043 Orbassano, Italy; (P.V.)
| | - Silvia D’Orso
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Giovanna Borsellino
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Luca Battistini
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Giovanni Ristori
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, 00185 Rome, Italy;
| | - Rosella Mechelli
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- IRCCS, San Raffaele Roma, 00166 Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, 00185 Rome, Italy;
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - Bruno Gran
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
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Dhar D, Mm S, Parvin N, Dey T, Pal A, Pal PK. Islands and Neurology: An Exploration into a Unique Association. Neuroscientist 2024:10738584241257927. [PMID: 38842035 DOI: 10.1177/10738584241257927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The current study investigates the intricate connection between neurology and islands shedding light on the historical, epidemiological, and genetic aspects. Based on an elaborate literature review, we identified neurological conditions having a significant clustering in an island(s), confined to a particular island(s), named after an island, and described first in an island. The genetic factors played a crucial role, uncovering disorders like Cayman ataxia, Machado Joseph disease, SGCE-mediated dystonia-myoclonus syndrome, X-linked dystonia parkinsonism, hereditary transthyretinrelated amyloidosis, Charcot Marie Tooth 4F, and progressive myoclonic epilepsy syndromes, that exhibited remarkable clustering in diverse islands. Local customs also left enduring imprints. Practices such as cannibalism in Papua New Guinea led to Kuru, while cycad seed consumption in Guam triggered Lytico-Bodig disease. Toxin-mediated neurologic disorders exhibited intricate island connections, exemplified by Minamata disease in Kyushu islands and atypical parkinsonism in French Caribbean islands. Additionally, the Cuban epidemic of amblyopia and neuropathy was associated with severe nutritional deficiencies. This study pioneers a comprehensive review narrating the genetic, environmental, and cultural factors highlighting the spectrum of neurological disorders in island settings. It enriches the medical literature with a unique understanding of the diverse influences shaping neurological health in island environments.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Samim Mm
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Naznin Parvin
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Treshita Dey
- Department of Radiation Oncology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anantini Pal
- Department of Internal Medicine, Bangalore Institute of Medical College and Research Institute, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Öztürk B, Taşkıran E, Demir S, Tuncer MA, Kürtüncü M, Karabudak R, Siva A, Efendi H, Ata N, Ülgü MM, Birinci Ş. Prevalence and incidence of multiple sclerosis in Turkey: A nationwide epidemiologic study. Mult Scler 2024; 30:790-799. [PMID: 38616518 DOI: 10.1177/13524585241245318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Many studies on multiple sclerosis (MS) reveal different prevalence and epidemiologic results. OBJECTIVES In this study, we aimed to determine the epidemiologic profile of MS using official health records in Turkey. METHODS Patients diagnosed with MS from the official health data of the Ministry of Health, representing the entire population of Turkey, were included in the study. Prevalence and incidence calculations were performed using the data on gender, age, year of birth, city of residence, and year of diagnosis. RESULTS As a result of the study, the number of patients with the ICD code G35 was determined as 201,061 and the number of patients with this code entered at least three times was determined as 82,225. The prevalence of MS in Turkey was calculated as 96.4 per 100,000 and the female/male ratio as 2.1/1. The incidence of MS in 2022 was 6.2 per 100,000 and the mean patient age was 43.1 ± 13.3 years (female: 43.0 ± 13.1 vs male: 43.2 ± 13.7) while the mean age at first diagnosis was 34.0 ± 13.0 (female: 33.6 ± 12.6 vs male: 34.9 ± 13.7). CONCLUSION The research was conducted via Official Database of Turkey, which includes population of 85 million and provides valuable insights into the prevalence and incidence rates of this chronic disease.
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Affiliation(s)
- Bilgin Öztürk
- Department of Neurology, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey
| | - Esra Taşkıran
- Department of Neurology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Serkan Demir
- Department of Neurology, University of Health Sciences Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Meryem Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aksel Siva
- Department of Neurology, Faculty of Medicine, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Hüsnü Efendi
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Naim Ata
- Ministry of Health, Ankara, The Republic of Turkey
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CALABRÒ GIOVANNAELISA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, PAPPALARDO CIRO, SCARDIGNO ANNA, RUMI FILIPPO, FIORE ALESSANDRA, RICCIARDI ROBERTO, CICCHETTI AMERICO. Feasibility study on a new enhanced device for patients with intermittent catheterization (LUJA). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E89. [PMID: 38125911 PMCID: PMC10730013 DOI: 10.15167/2421-4248/jpmh2023.64.3s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - FLORIANA D’AMBROSIO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FRANCESCA ORSINI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - CIRO PAPPALARDO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ANNA SCARDIGNO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FILIPPO RUMI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSANDRA FIORE
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ROBERTO RICCIARDI
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - AMERICO CICCHETTI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Caria P, Pilotto S, D'Alterio MN, Fronza M, Murgia F, Frau J, Fenu G, Dettori T, Frau DV, Atzori L, Angioni S, Cocco E, Lorefice L. Leukocyte telomere length in women with multiple sclerosis: Comparison with healthy women during pregnancy and puerperium. J Neuroimmunol 2023; 381:578137. [PMID: 37356355 DOI: 10.1016/j.jneuroim.2023.578137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Several studies indicated leukocyte telomere length (LTL) as a biomarker of multiple sclerosis (MS) evolution. This study aimed to investigate LTL in women with multiple sclerosis (MS) compared to that in healthy women (HW) across different reproductive phases, and to evaluate its relationship with MS activity. METHODS Blood samples were collected from women with MS and HW during the fertile phase, pregnancy, and puerperium. LTL was determined using quantitative fluorescence in situ hybridization (Q-FISH). RESULTS Blood samples from 68 women with MS (22 during fertile life, 23 during pregnancy, and 23 post-partum) and 52 HW (23 during fertile life, 20 during pregnancy, and 9 post-partum) were analyzed. During pregnancy, LTL in MS women and HW was 84.7 ± 10.5 and 77.6 ± 11.5, respectively (p < 0.005). Regression analysis showed that shorter LTL was associated with pregnancy in HW (p = 0.021); this relationship was not observed in MS women, for whom shorter LTL was related to a higher EDSS (p = 0.036). A longitudinal analysis was performed in eight MS women, showing LTL shortening from pregnancy to puerperium (p = 0.003), which was related to MS reactivation (p = 0.042). CONCLUSION Our results highlight the possible associations between LTL, reproductive biological phases, and MS activity after delivery.
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Affiliation(s)
- P Caria
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - S Pilotto
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - M N D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - M Fronza
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - F Murgia
- Clinical Metabolomics Unit, Department of Biomedical Sciences, University of Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - T Dettori
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - D V Frau
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - L Atzori
- Clinical Metabolomics Unit, Department of Biomedical Sciences, University of Cagliari, Italy
| | - S Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
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Nova A, Fazia T, Saddi V, Piras M, Bernardinelli L. Multiple Sclerosis Heritability Estimation on Sardinian Ascertained Extended Families Using Bayesian Liability Threshold Model. Genes (Basel) 2023; 14:1579. [PMID: 37628630 PMCID: PMC10454167 DOI: 10.3390/genes14081579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Heritability studies represent an important tool to investigate the main sources of variability for complex diseases, whose etiology involves both genetics and environmental factors. In this paper, we aimed to estimate multiple sclerosis (MS) narrow-sense heritability (h2), on a liability scale, using extended families ascertained from affected probands sampled in the Sardinian province of Nuoro, Italy. We also investigated the sources of MS liability variability among shared environment effects, sex, and categorized year of birth (<1946, ≥1946). The latter can be considered a proxy for different early environmental exposures. To this aim, we implemented a Bayesian liability threshold model to obtain posterior distributions for the parameters of interest adjusting for ascertainment bias. Our analysis highlighted categorized year of birth as the main explanatory factor, explaining ~70% of MS liability variability (median value = 0.69, 95% CI: 0.64, 0.73), while h2 resulted near to 0% (median value = 0.03, 95% CI: 0.00, 0.09). By performing a year of birth-stratified analysis, we found a high h2 only in individuals born on/after 1946 (median value = 0.82, 95% CI: 0.68, 0.93), meaning that the genetic variability acquired a high explanatory role only when focusing on this subpopulation. Overall, the results obtained highlighted early environmental exposures, in the Sardinian population, as a meaningful factor involved in MS to be further investigated.
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Affiliation(s)
- Andrea Nova
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
| | - Valeria Saddi
- Divisione di Neurologia, Presidio Ospedaliero S. Francesco, ASL Numero 3 Nuoro, 08100 Nuoro, Italy; (V.S.); (M.P.)
| | - Marialuisa Piras
- Divisione di Neurologia, Presidio Ospedaliero S. Francesco, ASL Numero 3 Nuoro, 08100 Nuoro, Italy; (V.S.); (M.P.)
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
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Cavalla P, Vercellino M. May Mediterranean diet contribute to reduce risk of multiple sclerosis? Mult Scler 2023; 29:1045-1046. [PMID: 37515480 DOI: 10.1177/13524585231190342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Affiliation(s)
- Paola Cavalla
- Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Marco Vercellino
- Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
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Davis GE, Davis MJ, Lowell WE. Triggering multiple sclerosis at conception and early gestation: The variation in ultraviolet radiation is as important as its intensity. Heliyon 2023; 9:e16954. [PMID: 37346332 PMCID: PMC10279836 DOI: 10.1016/j.heliyon.2023.e16954] [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: 11/26/2022] [Revised: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
Background and objectives Medical science needs to further elucidate the role of ultraviolet radiation (UVR), geographic latitude, and the role of vitamin D in the autoimmune disease multiple sclerosis (MS). We separated several papers into categories out of the thousands published and used their conclusions to explore the relationship between UVR and MS. Relevance MS is increasing in incidence, particularly in women where MS is two to three times that in men and particularly severe in African Americans. Methods We collected UVR data at our observatory in Central Maine and calculated the average coefficient of variation (CVUVR) for each month for 15 years (2007-2021, inclusive). Results The month of conception (MOC) is more important than the month of birth (MOB) in explaining how UVR triggers the variable genetic predisposition to MS. We hypothesize that the rapidly increasing CVUVR is important in preventing an increase in the activity of the vitamin D receptor (VDR) from August to December, which then requires a higher intensity of UVR later in life to suppress the immune system, therefore predisposing to more MS. Limitations One observatory at about 44° latitude. Conclusions While variation in UVR is important at the MOC if UVR exceeds a threshold (e.g., if the sunspot number equals or is greater than 90, usually at a solar cycle MAX, or at elevations above approximately 3,000 feet above sea level), the MS mitigating vitamin D-VDR mechanism is overwhelmed and the genotoxic effects of higher-intensity UVR promote MS in those with a genetic predisposition. What is new in this research This paper offers a new concept in MS research.
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Affiliation(s)
- George E. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Matthew J. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Walter E. Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
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Do patients’ and referral centers’ characteristics influence multiple sclerosis phenotypes? Results from the Italian multiple sclerosis and related disorders register. Neurol Sci 2022; 43:5459-5469. [PMID: 35672479 PMCID: PMC9385759 DOI: 10.1007/s10072-022-06169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
Background
Multiple sclerosis (MS) is characterized by phenotypical heterogeneity, partly resulting from demographic and environmental risk factors. Socio-economic factors and the characteristics of local MS facilities might also play a part. Methods This study included patients with a confirmed MS diagnosis enrolled in the Italian MS and Related Disorders Register in 2000–2021. Patients at first visit were classified as having a clinically isolated syndrome (CIS), relapsing–remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP). Demographic and clinical characteristics were analyzed, with centers’ characteristics, geographic macro-areas, and Deprivation Index. We computed the odds ratios (OR) for CIS, PP/PR, and SP phenotypes, compared to the RR, using multivariate, multinomial, mixed effects logistic regression models. Results In all 35,243 patients from 106 centers were included. The OR of presenting more advanced MS phenotypes than the RR phenotype at first visit significantly diminished in relation to calendar period. Females were at a significantly lower risk of a PP/PR or SP phenotype. Older age was associated with CIS, PP/PR, and SP. The risk of a longer interval between disease onset and first visit was lower for the CIS phenotype, but higher for PP/PR and SP. The probability of SP at first visit was greater in the South of Italy. Discussion Differences in the phenotype of MS patients first seen in Italian centers can be only partly explained by differences in the centers’ characteristics. The demographic and socio-economic characteristics of MS patients seem to be the main determinants of the phenotypes at first referral. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06169-7.
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Mirmosayyeb O, Shaygannejad V, Bagherieh S, Hosseinabadi AM, Ghajarzadeh M. Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis. Neurol Sci 2021; 43:233-241. [PMID: 34787755 DOI: 10.1007/s10072-021-05750-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prevalence of multiple sclerosis (MS) is increasing world-wide. Iran is not exception. As the prevalence reported differently in various provinces, we designed this systematic review and meta-analysis to estimate pooled prevalence of MS in Iran. METHODS Two researchers systematically searched Scientific Information Database (SID), PubMed, Scopus, EMBASE, Web of Science, and google scholar. They also searched references of the included studies, and conference abstracts which were published up to April 2021. The search strategy included the MeSH and text words as ((((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Dis-seminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating)) AND (prevalence OR prevalences OR period prevalence OR prevalence, period OR point prevalence OR point prevalences OR prevalence, point) AND (Iran OR Islamic Republic of Iran)))). RESULTS The literature search revealed 2817 articles, after deleting duplicates 2184 remained. For the systematic review, 34 studies were included. The prevalence is highest in Tehran and lowest in Khuzestan and Sistan-Baluchestan provinces. The pooled prevalence was 0.001 (95% CI: 0.000-0.001) (I2=0, P<0.001). CONCLUSION The results of this study show that the pooled prevalence of MS in Iran is 100 in 100,000 which is high. The prevalence in provinces increases dramatically.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mahdi Hosseinabadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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