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Di Stefano V, Tubiolo C, Gagliardo A, Presti RL, Montana M, Todisco M, Lupica A, Caimi G, Tassorelli C, Fierro B, Brighina F, Cosentino G. Metalloproteinases and Tissue Inhibitors in Generalized Myasthenia Gravis. A Preliminary Study. Brain Sci 2022; 12:1439. [PMID: 36358365 PMCID: PMC9688860 DOI: 10.3390/brainsci12111439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have recently been proposed as promising biomarkers in different immune-mediated disorders. We evaluated the plasma levels of MMP-9 and MMP-2 and their tissue inhibitors TIMP-1 and TIMP-2 in a patients' cohort with generalized myasthenia gravis (MG). METHODS Plasma concentrations of MMP-9, MMP-2, TIMP-1 and TIMP-2 were evaluated in 14 patients with generalized MG and 13 age- and sex-matched healthy controls. The severity of disease was assessed by the modified Osserman classification. RESULTS Compared to the healthy subjects, MG patients had increased plasma concentrations of MMP-9, but reduced plasma levels of MMP-2 and TIMP-1. MG patients also showed a positive correlation between MMP-2 concentrations and disease severity. An increase in MMP-9 levels and MMP-9/TIMP-1 ratio and a decrease in MMP-2 levels and MMP-2/TIMP-2 ratio were detected in patients with generalized MG. Higher levels of MMP-2 correlated with greater disease severity. DISCUSSION Our preliminary findings suggest that MMPs and TIMPs could play a role in the pathogenesis of MG and might be associated with the risk of clinical deterioration.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Chiara Tubiolo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Andrea Gagliardo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Rosalia Lo Presti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Maria Montana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Massimiliano Todisco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Antonino Lupica
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Gregorio Caimi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Brigida Fierro
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
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Thomas AM, Barkhof F, Bulte JWM. Opportunities for Molecular Imaging in Multiple Sclerosis Management: Linking Probe to Treatment. Radiology 2022; 303:486-497. [PMID: 35471110 PMCID: PMC9131169 DOI: 10.1148/radiol.211252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging has been a critical component of multiple sclerosis (MS) management for nearly 40 years. The visual information derived from structural MRI, that is, signs of blood-brain barrier disruption, inflammation and demyelination, and brain and spinal cord atrophy, are the primary metrics used to evaluate therapeutic efficacy in MS. The development of targeted imaging probes has expanded our ability to evaluate and monitor MS and its therapies at the molecular level. Most molecular imaging probes evaluated for MS applications are small molecules initially developed for PET, nearly half of which are derived from U.S. Food and Drug Administration-approved drugs and those currently undergoing clinical trials. Superparamagnetic and fluorinated particles have been used for tracking circulating immune cells (in situ labeling) and immunosuppressive or remyelinating therapeutic stem cells (ex vivo labeling) clinically using proton (hydrogen 1 [1H]) and preclinically using fluorine 19 MRI. Translocator protein PET and 1H MR spectroscopy have been demonstrated to complement imaging metrics from structural (gadolinium-enhanced) MRI in nine and six trials for MS disease-modifying therapies, respectively. Still, despite multiple demonstrations of the utility of molecular imaging probes to evaluate the target location and to elucidate the mechanisms of disease-modifying therapies for MS applications, their use has been sparse in both preclinical and clinical settings.
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Affiliation(s)
- Aline M Thomas
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
| | - Frederik Barkhof
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
| | - Jeff W M Bulte
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
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Li A, Wu Y, Pulli B, Wojtkiewicz GR, Iwamoto Y, Wang C, Li JH, Ali M, Feng X, Yao Z, Chen JW. Myeloperoxidase Molecular MRI Reveals Synergistic Combination Therapy in Murine Experimental Autoimmune Neuroinflammation. Radiology 2019; 293:158-165. [PMID: 31478802 PMCID: PMC6776885 DOI: 10.1148/radiol.2019182492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 01/13/2023]
Abstract
Background Despite advances in immunomodulatory agents, most current therapies for multiple sclerosis target lymphocytes or lymphocytic function. However, therapy response may be less than optimal due to demyelination and axonal damage caused by myeloid cells. Purpose To determine if myeloperoxidase (MPO) molecular MRI can evaluate whether combination therapy targeting both lymphoid and myeloid inflammation can improve autoimmune neuroinflammation compared with either drug alone, even at suboptimal doses. Materials and Methods Four groups of 94 female mice (8-10 weeks old) were induced with experimental autoimmune encephalomyelitis (EAE) from August 2, 2016, to March 30, 2018, and divided into saline control (n = 22), 4-aminobenzoic acid hydrazide (ABAH) therapy group (n = 19), glatiramer acetate (GA) therapy group (n = 22), and combination therapy group (n = 31). Mice were administered suboptimal doses of ABAH, an irreversible inhibitor of MPO; GA, a first-line multiple sclerosis drug; both ABAH and GA; or saline (control). Mice were imaged with bis-5-hydroxytryptamide-diethylenetriaminepentaacetate gadolinium (hereafter, MPO-Gd) MRI. One-way analysis of variance, two-way analysis of variance, Kurskal-Wallis, and log-rank tests were used. P < .05 was considered to indicate statistical significance. Results The combination-treated group showed delayed disease onset (day 11.3 vs day 9.8 for ABAH, day 10.4 for GA, day 9.9 for control; P < .05) and reduced disease severity (clinical score during the acute exacerbation period of 1.8 vs 3.8 for ABAH, 3.1 for GA, 3.9 for control; P < .05). The combination-treated group demonstrated fewer MPO-positive lesions (30.2 vs 73.7 for ABAH, 64.8 for GA, 67.2 for control; P < .05), smaller MPO-positive lesion volume (16.7 mm3 vs 65.2 mm3 for ABAH, 69.9 mm3 for GA, 66.0 mm3 for control; P < .05), and lower intensity of MPO-Gd lesion activation ratio (0.7 vs 1.9 for ABAH, 3.2 for GA, 2.3 for control; P < .05). Reduced disease severity in the combination group was confirmed at histopathologic analysis, where MPO expression (1779 vs 2673 for ABAH, 2898 for GA; P < .05) and demyelination (5.3% vs 9.0% for ABAH, 10.6% for GA; P < .05) were ameliorated. Conclusion Myeloperoxidase molecular MRI can track the treatment response from immunomodulatory drugs even if the drug does not directly target myeloperoxidase, and establishes that combination therapy targeting both myeloid and lymphocytic inflammation is effective for murine autoimmune neuroinflammation, even at suboptimal doses. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Walczak in this issue.
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Affiliation(s)
- Anning Li
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Yue Wu
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Benjamin Pulli
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Gregory R. Wojtkiewicz
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Yoshiko Iwamoto
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Cuihua Wang
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Jing-Hui Li
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Muhammad Ali
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Xiaoyuan Feng
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - Zhenwei Yao
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
| | - John W. Chen
- From the Center for Systems Biology, Massachusetts General Hospital
and Harvard Medical School, 185 Cambridge St, Boston, Mass 02114 (A.L., Y.W.,
B.P., G.R.W., Y.I., C.W., J.L., M.A., J.W.C.); Institute for Innovation in
Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass
(B.P., C.W., J.W.C.); Department of Radiology, Qilu Hospital of Shandong
University, Jinan, China (A.L.); and Department of Radiology, Huashan Hospital,
Fudan University, Shanghai, China (A.L., Y.W., X.F., Z.Y.)
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