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Alvarez E, Nair KV, Hoyt BD, Seale RA, Sillau S, Miravalle A, Engebretson E, Schurr B, Corboy JR, Vollmer TL, Honce JM. Brain atrophy rates in patients with multiple sclerosis on long term natalizumab resembles healthy controls. Mult Scler Relat Disord 2021; 55:103170. [PMID: 34364034 DOI: 10.1016/j.msard.2021.103170] [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: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinically stable multiple sclerosis (MS) patients often have negligible inflammatory MRI changes. Brain atrophy may provide insight into subclinical disease progression. The objective was to compare brain atrophy rates in stable patients on long term natalizumab treatment vs. age and gender matched healthy non-MS controls (HC) prospectively over two-years examining brain volume, cognition, and patient reported outcomes (PROs). METHODS MS patients treated with natalizumab for a minimum of 2 years, age 18-60 were recruited and compared with age- and gender-matched healthy controls (HC). Both groups were followed prospectively to obtain two years of consecutive magnetic resonance imaging, clinical and PRO data. Baseline normalized brain volume (NBV), yearly T2 lesion volume (T2LV), and percent brain volume change (PBVC) were measured using SIENAX, JIM 6.0, and SIENA respectively. Neuropsychological tests from the MACFIMS battery were selected to optimize assessments for impairments in the domains of information processing speed and memory. Patient reported outcomes (PROs) for domains of physical, mental and social quality of life were evaluated using the NeuroQol short forms. RESULTS Forty-eight natalizumab and 62 HC completed all study visits. At baseline, unadjusted mean NBV (natalizumab=1508.80cm (Popescu et al., 2013) vs. HC=1539.23cm (Popescu et al., 2013); p=0.033) and median baseline T2LV (natalizumab=1724.62mm (Popescu et al., 2013) vs. HC=44.20mm (Popescu et al., 2013); p=<0.0001) were different. The mean PBVC at year 2, adjusted for gender and baseline age was -0.57% (CI: 0.7620, -0.3716) for natalizumab and -0.50% (-0.7208, -0.2831) for HC, but the difference between groups was not statistically significant (0.073%; p=0.62). Over the 2-year period, HC demonstrated mild improvements in some cognitive tests vs. natalizumab subjects. However, PROs were similar between the two groups. CONCLUSION Stable MS patients on natalizumab have similar brain volume loss as people who do not have MS, suggesting normalization of brain atrophy.
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Affiliation(s)
- Enrique Alvarez
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Kavita V Nair
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA; Department of Clinical Pharmacy, University of Colorado, 12850 East Montview Boulevard, Aurora, CO 80045 USA
| | - Brian D Hoyt
- Department of Neurosurgery, University of Colorado, 12631 East 17th Avenue, Aurora, CO 80045 USA
| | - Rebecca A Seale
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Stefan Sillau
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Augusto Miravalle
- Advanced Neurology, 2121 E Harmony Rd Ste #180, Fort Collins, CO 80528 USA
| | - Eric Engebretson
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Brittany Schurr
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - John R Corboy
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Timothy L Vollmer
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Justin M Honce
- Department of Radiology, University of Colorado Hospital, 12401 East 17th Avenue, Aurora, CO 80045 USA.
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Kanko RM, Laende EK, Strutzenberger G, Brown M, Selbie WS, DePaul V, Scott SH, Deluzio KJ. Assessment of spatiotemporal gait parameters using a deep learning algorithm-based markerless motion capture system. J Biomech 2021; 122:110414. [PMID: 33915475 DOI: 10.1016/j.jbiomech.2021.110414] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/15/2022]
Abstract
Spatiotemporal parameters can characterize the gait patterns of individuals, allowing assessment of their health status and detection of clinically meaningful changes in their gait. Video-based markerless motion capture is a user-friendly, inexpensive, and widely applicable technology that could reduce the barriers to measuring spatiotemporal gait parameters in clinical and more diverse settings. Two studies were performed to determine whether gait parameters measured using markerless motion capture demonstrate concurrent validity with those measured using marker-based motion capture and a pressure-sensitive gait mat. For the first study, thirty healthy young adults performed treadmill gait at self-selected speeds while marker-based motion capture and synchronized video data were recorded simultaneously. For the second study, twenty-five healthy young adults performed over-ground gait at self-selected speeds while footfalls were recorded using a gait mat and synchronized video data were recorded simultaneously. Kinematic heel-strike and toe-off gait events were used to identify the same gait cycles between systems. Nine spatiotemporal gait parameters were measured by each system and directly compared between systems. Measurements were compared using Bland-Altman methods, mean differences, Pearson correlation coefficients, and intraclass correlation coefficients. The results indicate that markerless measurements of spatiotemporal gait parameters have good to excellent agreement with marker-based motion capture and gait mat systems, except for stance time and double limb support time relative to both systems and stride width relative to the gait mat. These findings indicate that markerless motion capture can adequately measure spatiotemporal gait parameters of healthy young adults during treadmill and over-ground gait.
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Affiliation(s)
- Robert M Kanko
- Mechanical and Materials Engineering, Queen's University, Kingston, Canada.
| | - Elise K Laende
- Mechanical and Materials Engineering, Queen's University, Kingston, Canada
| | - Gerda Strutzenberger
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | | | | | - Vincent DePaul
- Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Stephen H Scott
- Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| | - Kevin J Deluzio
- Mechanical and Materials Engineering, Queen's University, Kingston, Canada
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Pajoohesh-Ganji A, Karl M, Garrison E, Osei-Bonsu NA, Clarkson-Paredes C, Ahn J, Miller RH. Developmental ablation of mature oligodendrocytes exacerbates adult CNS demyelination. Brain Behav Immun Health 2020; 7:100110. [PMID: 34589870 PMCID: PMC8474627 DOI: 10.1016/j.bbih.2020.100110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/28/2022] Open
Abstract
Multiple sclerosis (MS) is a CNS neurodegenerative autoimmune disease characterized by loss of oligodendrocytes and myelin in the brain and the spinal cord that results in localized functional deficits. Several risk factors have been associated with MS, however none fully explain the enhanced susceptibility seen in older individuals. Epidemiological data, based on geographical prevalence studies suggest that susceptibility is established early in life and frequently long before the diagnosis of disease raising the possibility that developmental events influence adult disease onset and progression. Here we test the hypothesis that selective loss of mature oligodendrocytes during postnatal development results in enhanced susceptibility to a demyelinating insult to the mature CNS. A transgenic mouse model was utilized to specifically induce apoptotic cell death in a subset of mature oligodendrocytes (MBP-iCP9) during the first 2 postnatal weeks followed by either a local LPC spinal cord injection or the induction of EAE in the adult animal. Immunostaining, immunoblotting, behavioral testing, and electron microscopy were utilized to examine the differences in the response between animals with developmental loss of oligodendrocytes and controls. We show that during development, oligodendrocyte apoptosis results in transient reductions in myelination and functional deficits that recover after 10–14 days. Compared to animals in which oligodendrocyte development was unperturbed, animals subjected to postnatal oligodendrocyte loss showed delayed recovery from an LPC lesion to the mature spinal cord. Unexpectedly, the induction and severity of MOG induced EAE was not significantly altered in animals following oligodendrocyte developmental loss even though there was a substantial increase in spinal cord tissue damage and CNS inflammation. It is unclear why the elevated glial responses seen in developmentally compromised animals were not reflected in enhanced functional deficits. These observations suggest that developmental loss of oligodendrocytes results in long lasting tissue changes that alter its response to subsequent insults and the capacity for repair in the adult. Developmental oligodendrocyte apoptosis induces transient myelin and functional loss. Developmental loss of oligodendrocytes compromises adult remyelination after LPC. Developmental loss of oligodendrocytes enhances CNS immune response in EAE. Elevated CNS glial reactivity does not alter course of EAE.
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Affiliation(s)
- Ahdeah Pajoohesh-Ganji
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Molly Karl
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Eric Garrison
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Nana Adwoa Osei-Bonsu
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Cheryl Clarkson-Paredes
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Julie Ahn
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Robert H Miller
- Department of Anatomy and Cell Biology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
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