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Foesleitner O, Knop KC, Lindenau M, Preisner F, Bäumer P, Heiland S, Bendszus M, Kronlage M. Quantitative MR Neurography in Multifocal Motor Neuropathy and Amyotrophic Lateral Sclerosis. Diagnostics (Basel) 2023; 13:diagnostics13071237. [PMID: 37046455 PMCID: PMC10093201 DOI: 10.3390/diagnostics13071237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The aim of this study was to assess the phenotype of multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS) in quantitative MR neurography. Methods: In this prospective study, 22 patients with ALS, 8 patients with MMN, and 10 healthy volunteers were examined with 3T MR neurography, using a high-resolution fat-saturated T2-weighted sequence, diffusion-tensor imaging (DTI), and a multi-echo T2-relaxometry sequence. The quantitative biomarkers fractional anisotropy (FA), radial and axial diffusivity (RD, AD), mean diffusivity (MD), cross-sectional area (CSA), T2-relaxation time, and proton spin density (PSD) were measured in the tibial nerve at the thigh and calf, and in the median, radial, and ulnar nerves at the mid-upper arm. Results: MMN showed a characteristic imaging pattern of decreased FA (p = 0.018), increased RD (p = 0.014), increased CSA (p < 0.001), increased T2-relaxation time (p < 0.001), and increased PSD (p = 0.025) in the upper arm nerves compared to ALS and controls. ALS patients did not differ from controls in any imaging marker, nor were there any group differences in the tibial nerve (p > 0.05). Conclusions: MMN shows a characteristic pattern of quantitative DTI and T2-relaxometry parameters in the upper-arm nerves, primarily indicating demyelination. Peripheral nerve changes in ALS seem to be below the detection level of current state-of-the-art quantitative MR neurography.
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Campbell CI, McGonigal R, Barrie JA, Delaere J, Bracke L, Cunningham ME, Yao D, Delahaye T, Van de Walle I, Willison HJ. Complement inhibition prevents glial nodal membrane injury in a GM1 antibody-mediated mouse model. Brain Commun 2022; 4:fcac306. [PMID: 36523267 PMCID: PMC9746686 DOI: 10.1093/braincomms/fcac306] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/09/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
The involvement of the complement pathway in Guillain-Barré syndrome pathogenesis has been demonstrated in both patient biosamples and animal models. One proposed mechanism is that anti-ganglioside antibodies mediate neural membrane injury through the activation of complement and the formation of membrane attack complex pores, thereby allowing the uncontrolled influx of ions, including calcium, intracellularly. Calcium influx activates the calcium-dependent protease calpain, leading to the cleavage of neural cytoskeletal and transmembrane proteins and contributing to subsequent functional failure. Complement inhibition has been demonstrated to provide effective protection from injury in anti-ganglioside antibody-mediated mouse models of axonal variants of Guillain-Barré syndrome; however, the role of complement in the pathogenesis of demyelinating variants has yet to be established. Thus, it is currently unknown whether complement inhibition would be an effective therapeutic for Guillain-Barré syndrome patients with injuries to the Schwann cell membrane. To address this, we recently developed a mouse model whereby the Schwann cell membrane was selectively targeted with an anti-GM1 antibody resulting in significant disruption to the axo-glial junction and cytoplasmic paranodal loops, presenting as conduction block. Herein, we utilize this Schwann cell nodal membrane injury model to determine the relevance of inhibiting complement activation. We addressed the early complement component C2 as the therapeutic target within the complement cascade by using the anti-C2 humanized monoclonal antibody, ARGX-117. This anti-C2 antibody blocks the formation of C3 convertase, specifically inhibiting the classical and lectin complement pathways and preventing the production of downstream harmful anaphylatoxins (C3a and C5a) and membrane attack complexes. Here, we demonstrate that C2 inhibition significantly attenuates injury to paranodal proteins at the node of Ranvier and improves respiratory function in ex vivo and in vivo Schwann cell nodal membrane injury models. In parallel studies, C2 inhibition also protects axonal integrity in our well-established model of acute motor axonal neuropathy mediated by both mouse and human anti-GM1 antibodies. These data demonstrate that complement inhibition prevents injury in a Schwann cell nodal membrane injury model, which is representative of neuropathies associated with anti-GM1 antibodies, including Guillain-Barré syndrome and multifocal motor neuropathy. This outcome suggests that both the motor axonal and demyelinating variants of Guillain-Barré syndrome should be included in future complement inhibition clinical trials.
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Affiliation(s)
- Clare I Campbell
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
| | - Rhona McGonigal
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
| | - Jennifer A Barrie
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
| | | | | | - Madeleine E Cunningham
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
| | - Denggao Yao
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
| | | | | | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK
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Illes Z, Blaabjerg M. Cerebrospinal fluid findings in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2017; 146:125-138. [PMID: 29110767 DOI: 10.1016/b978-0-12-804279-3.00009-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The classic immunologic alteration of the cerebrospinal fluid (CSF) in Guillain-Barré syndrome (GBS), albuminocytologic dissociation, has been known since the original paper by Guillain, Barré, and Strohl. Albuminocytologic dissociation has been also described in other forms of the GBS spectrum, such as axonal motor or motor-sensory forms (AMAN, AMSAN), the anti-GQ1b spectrum of Miller Fisher syndrome, and Bickerstaff brainstem encephalitis. Cytokines, chemokines, antibodies, complement components, and molecules with a putative neuroprotective role or indicating axonal damage have also been examined using different methods. Besides these candidate approaches, proteomics has been recently applied to discover potential biomarkers. The overall results support the immunopathogenesis of GBS, but albuminocytologic dissociation remained the only consistent CSF biomarker supporting the diagnosis of GBS. Chronic inflammatory neuropathies also comprise a heterogeneous group of diseases. Increased protein in the CSF is a supportive factor of chronic inflammatory demyelinating polyneuropathy, especially in the absence of definite electrophysiologic criteria. A number of other markers have also been investigated in the CSF of patients with chronic inflammatory neuropathies, similar to GBS. However, none has been used in supporting diagnosis, differentiating among syndromes, or predicting the clinical course and treatment responses.
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Affiliation(s)
- Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Vlam L, Cats EA, Harschnitz O, Jansen MD, Piepers S, Veldink JH, Franssen H, Stork ACJ, Heezius E, Rooijakkers SHM, Herpers BL, van Strijp JA, van den Berg LH, van der Pol WL. Complement activity is associated with disease severity in multifocal motor neuropathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e119. [PMID: 26161430 PMCID: PMC4484896 DOI: 10.1212/nxi.0000000000000119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Objective: To investigate whether high innate activity of the classical and lectin pathways of complement is associated with multifocal motor neuropathy (MMN) and whether levels of innate complement activity or the potential of anti-GM1 antibodies to activate the complement system correlate with disease severity. Methods: We performed a case-control study including 79 patients with MMN and 79 matched healthy controls. Muscle weakness was documented with Medical Research Council scale sum score and axonal loss with nerve conduction studies. Activity of the classical and lectin pathways of complement was assessed by ELISA. We also determined serum mannose-binding lectin (MBL) concentrations and polymorphisms in the MBL gene (MBL2) and quantified complement-activating properties of anti-GM1 IgM antibodies by ELISA. Results: Activity of the classical and lectin pathways, MBL2 genotypes, and serum MBL concentrations did not differ between patients and controls. Complement activation by anti-GM1 IgM antibodies was exclusively mediated through the classical pathway and correlated with antibody titers (p < 0.001). Logistic regression analysis showed that both high innate activity of the classical pathway of complement and high complement-activating capacity of anti-GM1 IgM antibodies were significantly associated with more severe muscle weakness and axonal loss. Conclusion: High innate activity of the classical pathway of complement and efficient complement-activating properties of anti-GM1 IgM antibodies are determinants of disease severity in patients with MMN. These findings underline the importance of anti-GM1 antibody–mediated complement activation in the pathogenesis and clinical course of MMN.
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Affiliation(s)
- Lotte Vlam
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Elisabeth A Cats
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Oliver Harschnitz
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Marc D Jansen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Sanne Piepers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jan Herman Veldink
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Hessel Franssen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Abraham C J Stork
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Erik Heezius
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Suzan H M Rooijakkers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Bjorn L Herpers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jos A van Strijp
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - W Ludo van der Pol
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
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