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Nistri R, Ianniello A, Pozzilli V, Giannì C, Pozzilli C. Advanced MRI Techniques: Diagnosis and Follow-Up of Multiple Sclerosis. Diagnostics (Basel) 2024; 14:1120. [PMID: 38893646 PMCID: PMC11171945 DOI: 10.3390/diagnostics14111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Brain and spinal cord imaging plays a pivotal role in aiding clinicians with the diagnosis and monitoring of multiple sclerosis. Nevertheless, the significance of magnetic resonance imaging in MS extends beyond its clinical utility. Advanced imaging modalities have facilitated the in vivo detection of various components of MS pathogenesis, and, in recent years, MRI biomarkers have been utilized to assess the response of patients with relapsing-remitting MS to the available treatments. Similarly, MRI indicators of neurodegeneration demonstrate potential as primary and secondary endpoints in clinical trials targeting progressive phenotypes. This review aims to provide an overview of the latest advancements in brain and spinal cord neuroimaging in MS.
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Affiliation(s)
- Riccardo Nistri
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Antonio Ianniello
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Valeria Pozzilli
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Costanza Giannì
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- MS Center Sant’Andrea Hospital, 00189 Rome, Italy
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2
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Moazamian D, Shaterian Mohammadi H, Athertya JS, Shin SH, Lo J, Chang EY, Du J, Bydder GM, Ma Y. Myelin water quantification in multiple sclerosis using short repetition time adiabatic inversion recovery prepared-fast spin echo (STAIR-FSE) imaging. Quant Imaging Med Surg 2024; 14:1673-1685. [PMID: 38415151 PMCID: PMC10895142 DOI: 10.21037/qims-23-1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/01/2023] [Indexed: 02/29/2024]
Abstract
Background Myelin water imaging (MWI) is a myelin-specific technique, which has great potential for the assessment of demyelination and remyelination. This study develops a new MWI method, which employs a short repetition time adiabatic inversion recovery (STAIR) technique in combination with a commonly used fast spin echo (FSE) sequence and provides quantification of myelin water (MW) fractions. Method Whole-brain MWI was performed using the short repetition time adiabatic inversion recovery prepared-fast spin echo (STAIR-FSE) technique on eight healthy volunteers (mean age: 38±14 years, four-males) and seven patients with multiple sclerosis (MS) (mean age: 53.7±8.7 years, two-males) on a 3T clinical magnetic resonance imaging scanner. To facilitate the quantification of apparent myelin water fraction (aMWF), a proton density-weighted FSE was also used during the scans to allow total water imaging. The aMWF measurements of MS lesions and normal-appearing white matter (NAWM) regions in MS patients were compared with those measured in normal white matter (NWM) regions in healthy volunteers. Both the analysis of variance (ANOVA) test and paired comparison were performed for the comparison. Results The MW in the whole-brain was selectively imaged and quantified using the STAIR-FSE technique in all participants. MS lesions showed much lower signal intensities than NAWM in the STAIR-FSE images. ANOVA analysis revealed a significant difference in the aMWF measurements between the three groups. Moreover, the aMWF measurements in MS lesions were significantly lower than those in both NWM of healthy volunteers and NAWM of MS patients. Lower aMWF measurements in NAWM were also found in comparison with those in NWM. Conclusions The STAIR-FSE technique is capable of measuring aMWF values for the indirect detection of myelin loss in MS, thus facilitating clinical translation of whole brain MWI and quantification, which show great potential for the detection and evaluation of changes in myelin in the brain of patients with MS for future larger cohort studies.
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Affiliation(s)
- Dina Moazamian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | | | - Jiyo S Athertya
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Soo Hyun Shin
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - James Lo
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Graeme M Bydder
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
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3
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Branco LDMT, Rezende TJR, Reis F, França MC. Advanced Structural Magnetic Resonance Imaging of the Spinal Cord: Technical Aspects and Clinical Use. Semin Ultrasound CT MR 2023; 44:464-468. [PMID: 37581877 DOI: 10.1053/j.sult.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
For a long time, technical obstacles have hampered the acquisition of high-resolution images and the development of reliable processing protocols for spinal cord (SC) MRI. Fortunately, this scenario has changed in the past 5-10 years, due to hardware and software improvements. Nowadays, with advanced protocols, SC MRI is considered a useful tool for several inherited and acquired neurologic diseases, not only for diagnosis approach but also for pathophysiological unraveling and as a biomarker for disease monitoring and clinical trials. In this review, we address advanced SC MRI sequences for macrostructural and microstructural evaluation, useful semiautomatic and automatic processing tools and clinical applications on several neurologic conditions such as hereditary cerebellar ataxia, hereditary spastic paraplegia, motor neuron diseases and multiple sclerosis.
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Affiliation(s)
- Lucas de M T Branco
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Thiago J R Rezende
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Marcondes C França
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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4
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Eva L, Pleș H, Covache-Busuioc RA, Glavan LA, Bratu BG, Bordeianu A, Dumitrascu DI, Corlatescu AD, Ciurea AV. A Comprehensive Review on Neuroimmunology: Insights from Multiple Sclerosis to Future Therapeutic Developments. Biomedicines 2023; 11:2489. [PMID: 37760930 PMCID: PMC10526343 DOI: 10.3390/biomedicines11092489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
This review delves into neuroimmunology, focusing on its relevance to multiple sclerosis (MS) and potential treatment advancements. Neuroimmunology explores the intricate relationship between the immune system and the central nervous system (CNS). Understanding these mechanisms is vital for grasping the pathophysiology of diseases like MS and for devising innovative treatments. This review introduces foundational neuroimmunology concepts, emphasizing the role of immune cells, cytokines, and blood-brain barrier in CNS stability. It highlights how their dysregulation can contribute to MS and discusses genetic and environmental factors influencing MS susceptibility. Cutting-edge research methods, from omics techniques to advanced imaging, have revolutionized our understanding of MS, offering valuable diagnostic and prognostic tools. This review also touches on the intriguing gut-brain axis, examining how gut microbiota impacts neuroimmunological processes and its potential therapeutic implications. Current MS treatments, from immunomodulatory drugs to disease-modifying therapies, are discussed alongside promising experimental approaches. The potential of personalized medicine, cell-based treatments, and gene therapy in MS management is also explored. In conclusion, this review underscores neuroimmunology's significance in MS research, suggesting that a deeper understanding could pave the way for more tailored and effective treatments for MS and similar conditions. Continued research and collaboration in neuroimmunology are essential for enhancing patient outcomes.
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Affiliation(s)
- Lucian Eva
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania;
| | - Horia Pleș
- Department of Neurosurgery, Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
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5
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Carmichael O. The Role of fMRI in Drug Development: An Update. ADVANCES IN NEUROBIOLOGY 2023; 30:299-333. [PMID: 36928856 DOI: 10.1007/978-3-031-21054-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Functional magnetic resonance imaging (fMRI) of the brain is a technology that holds great potential for increasing the efficiency of drug development for the central nervous system (CNS). In preclinical studies and both early- and late-phase human trials, fMRI has the potential to improve cross-species translation of drug effects, help to de-risk compounds early in development, and contribute to the portfolio of evidence for a compound's efficacy and mechanism of action. However, to date, the utilization of fMRI in the CNS drug development process has been limited. The purpose of this chapter is to explore this mismatch between potential and utilization. This chapter provides introductory material related to fMRI and drug development, describes what is required of fMRI measurements for them to be useful in a drug development setting, lists current capabilities of fMRI in this setting and challenges faced in its utilization, and ends with directions for future development of capabilities in this arena. This chapter is the 5-year update of material from a previously published workshop summary (Carmichael et al., Drug DiscovToday 23(2):333-348, 2018).
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Affiliation(s)
- Owen Carmichael
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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6
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Alshehri A, Al-iedani O, Arm J, Gholizadeh N, Billiet T, Lea R, Lechner-Scott J, Ramadan S. Neural diffusion tensor imaging metrics correlate with clinical measures in people with relapsing-remitting MS. Neuroradiol J 2022; 35:592-599. [PMID: 35118885 PMCID: PMC9513917 DOI: 10.1177/19714009211067400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion tensor imaging (DTI) can detect microstructural changes of white matter in multiple sclerosis (MS) and might clarify mechanisms responsible for disability. Thus, we aimed to compare DTI metrics in relapsing-remitting MS patients (RRMS) with healthy controls (HCs), and explore the correlations between DTI metrics, total brain white matter (TBWM) and white matter lesion (WML) with clinical parameters compared to volumetric measures. MATERIAL AND METHODS 37 RRMS patients and 19 age/sex-matched HCs were included. All participants had clinical assessments, structural and diffusion scans on a 3T MRI. Volumetric and white matter DTI metrics; fractional anisotropy (FA), mean, radial and axial diffusivities (MD, RD and AD) were estimated and correlated with clinical parameters. The mean group differences were calculated using t-tests, and univariate correlations with Pearson correlation coefficients. RESULTS Compared to HCs, statistically significant increases in MD (+3.6%), RD (+4.8%), AD (+2.7%) and a decrease in FA (-4.3%) for TBWM in RRMS was observed (p < .01). MD and RD in TBWM and AD in WML correlated moderately with disability status. Volumetric segmentation indicated a decrease in the total brain volume, GM and WM(-5%) with a reciprocal increase in CSF(+26%) in RRMS(p < .01). Importantly, DTI parameters showed a medium correlation with cognitive domains in contrast to white matter-related volumetric measurements in RRMS(Pearson correlation, p < .05). CONCLUSIONS Our study shows a correlation of DTI metrics with clinical symptoms of MS, in particular cognition. More generally, these findings indicated that DTI is a useful and unique technique for evaluating the clinical features of white matter disease and warrants further investigation into its clinical role.
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Affiliation(s)
- Abdulaziz Alshehri
- School of Health Sciences, College
of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
- Department of Radiology, King Fahad
University Hospital, Imam Abdulrahman Bin Faisal
University, Dammam, Saudi Arabia
| | - Oun Al-iedani
- School of Health Sciences, College
of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
| | - Jameen Arm
- School of Health Sciences, College
of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
| | - Neda Gholizadeh
- School of Mathematical and Physical
Science, Faculty of Science, University of Newcastle, Callaghan, NSW, Australia
| | - Thibo Billiet
- Research and Development
Department, Icometrix, Leuven, Belgium
| | - Rodney Lea
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia
- School of Medicine and Public
Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Saadallah Ramadan
- School of Health Sciences, College
of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research
Institute, New Lambton Heights, NSW, Australia
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7
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Abstract
PURPOSE OF REVIEW This article provides an update on progressive forms of multiple sclerosis (MS) commonly referred to as primary progressive MS and secondary progressive MS. It discusses the importance of diagnosing and detecting progression early, the similarities between progressive forms, challenges in detecting progression, factors that could augment progression, and the importance of disease-modifying therapies in patients with evidence of active progressive MS. It also discusses the overall care of progressive MS. RECENT FINDINGS The pathogenesis of primary progressive MS and secondary progressive MS is overlapping, and in both presentations, patients with relapses or focal MRI activity are classified as having active, progressive MS. All currently approved disease-modifying therapies are indicated for active secondary progressive MS. The therapeutic opportunity of anti-inflammatory drugs for the treatment of progressive MS is enhanced in those who are younger and have a shorter disease duration. Vascular comorbidities may contribute to progression in MS. SUMMARY Several challenges remain in the diagnosis, follow-up, and treatment of progressive MS. Early identification of active progressive MS is needed to maximize treatment benefit. The advantages of optimal comorbidity management (eg, hypertension, hyperlipidemia) in delaying progression are uncertain. Clinical care guidelines for advanced, severe MS are lacking.
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8
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Casanova B, Quintanilla-Bordás C, Gascón F. Escalation vs. Early Intense Therapy in Multiple Sclerosis. J Pers Med 2022; 12:jpm12010119. [PMID: 35055434 PMCID: PMC8778390 DOI: 10.3390/jpm12010119] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 02/01/2023] Open
Abstract
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The “escalation strategy” consists of starting treatment with drugs of low side-effect profile and low efficacy, and “escalating” to drugs of higher efficacy—with more potential side-effects—if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, “early intense therapy” strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called “window of opportunity” in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion.
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Affiliation(s)
- Bonaventura Casanova
- Unitat de Neuroimmunologia, Hospital Universitari i Politècnic La Fe. València, la Universitat de València, 46026 Valencia, Spain;
- Correspondence:
| | - Carlos Quintanilla-Bordás
- Unitat de Neuroimmunologia, Hospital Universitari i Politècnic La Fe. València, la Universitat de València, 46026 Valencia, Spain;
| | - Francisco Gascón
- Unitat de Neuroimmunologia, Hospital Clínic Universitari de València, 46010 Valencia, Spain;
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Amer B, Baidoo EEK. Omics-Driven Biotechnology for Industrial Applications. Front Bioeng Biotechnol 2021; 9:613307. [PMID: 33708762 PMCID: PMC7940536 DOI: 10.3389/fbioe.2021.613307] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Biomanufacturing is a key component of biotechnology that uses biological systems to produce bioproducts of commercial relevance, which are of great interest to the energy, material, pharmaceutical, food, and agriculture industries. Biotechnology-based approaches, such as synthetic biology and metabolic engineering are heavily reliant on "omics" driven systems biology to characterize and understand metabolic networks. Knowledge gained from systems biology experiments aid the development of synthetic biology tools and the advancement of metabolic engineering studies toward establishing robust industrial biomanufacturing platforms. In this review, we discuss recent advances in "omics" technologies, compare the pros and cons of the different "omics" technologies, and discuss the necessary requirements for carrying out multi-omics experiments. We highlight the influence of "omics" technologies on the production of biofuels and bioproducts by metabolic engineering. Finally, we discuss the application of "omics" technologies to agricultural and food biotechnology, and review the impact of "omics" on current COVID-19 research.
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Affiliation(s)
- Bashar Amer
- Lawrence Berkeley National Laboratory, Joint BioEnergy Institute, Emeryville, CA, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
| | - Edward E. K. Baidoo
- Lawrence Berkeley National Laboratory, Joint BioEnergy Institute, Emeryville, CA, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- U.S. Department of Energy, Agile BioFoundry, Emeryville, CA, United States
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10
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Al-Saeed O, Albogami M, Hatem M. Multiple Sclerosis in Saudi Arabia: A literature Review. SAUDI JOURNAL FOR HEALTH SCIENCES 2021. [DOI: 10.4103/sjhs.sjhs_163_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Leutritz T, Seif M, Helms G, Samson RS, Curt A, Freund P, Weiskopf N. Multiparameter mapping of relaxation (R1, R2*), proton density and magnetization transfer saturation at 3 T: A multicenter dual-vendor reproducibility and repeatability study. Hum Brain Mapp 2020; 41:4232-4247. [PMID: 32639104 PMCID: PMC7502832 DOI: 10.1002/hbm.25122] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/08/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023] Open
Abstract
Multicenter clinical and quantitative magnetic resonance imaging (qMRI) studies require a high degree of reproducibility across different sites and scanner manufacturers, as well as time points. We therefore implemented a multiparameter mapping (MPM) protocol based on vendor's product sequences and demonstrate its repeatability and reproducibility for whole‐brain coverage. Within ~20 min, four MPM metrics (magnetization transfer saturation [MT], proton density [PD], longitudinal [R1], and effective transverse [R2*] relaxation rates) were measured using an optimized 1 mm isotropic resolution protocol on six 3 T MRI scanners from two different vendors. The same five healthy participants underwent two scanning sessions, on the same scanner, at each site. MPM metrics were calculated using the hMRI‐toolbox. To account for different MT pulses used by each vendor, we linearly scaled the MT values to harmonize them across vendors. To determine longitudinal repeatability and inter‐site comparability, the intra‐site (i.e., scan‐rescan experiment) coefficient of variation (CoV), inter‐site CoV, and bias across sites were estimated. For MT, R1, and PD, the intra‐ and inter‐site CoV was between 4 and 10% across sites and scan time points for intracranial gray and white matter. A higher intra‐site CoV (16%) was observed in R2* maps. The inter‐site bias was below 5% for all parameters. In conclusion, the MPM protocol yielded reliable quantitative maps at high resolution with a short acquisition time. The high reproducibility of MPM metrics across sites and scan time points combined with its tissue microstructure sensitivity facilitates longitudinal multicenter imaging studies targeting microstructural changes, for example, as a quantitative MRI biomarker for interventional clinical trials.
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Affiliation(s)
- Tobias Leutritz
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryam Seif
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Gunther Helms
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rebecca S Samson
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
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12
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Macaron G, Baldassari LE, Nakamura K, Rao SM, McGinley MP, Moss BP, Li H, Miller DM, Jones SE, Bermel RA, Cohen JA, Ontaneda D, Conway DS. Cognitive processing speed in multiple sclerosis clinical practice: association with patient-reported outcomes, employment and magnetic resonance imaging metrics. Eur J Neurol 2020; 27:1238-1249. [PMID: 32222019 DOI: 10.1111/ene.14239] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/19/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE To analyze the relationship between cognitive processing speed, patient-reported outcome measures (PROMs), employment and magnetic resonance imaging (MRI) metrics in a large multiple sclerosis cohort. METHODS Cross-sectional clinical data, PROMs, employment and MRI studies within 90 days of completion of the Processing Speed Test (PST), a technology-enabled adaptation of the Symbol Digit Modalities Test, were collected. MRI was analyzed using semi-automated methods. Correlations of PST score with PROMs and MRI metrics were examined using Spearman's rho. Wilcoxon rank sum testing compared MRI metrics across PST score quartiles and linear regression models identified predictors of PST performance. Effects of employment and depression were also investigated. RESULTS In 721 patients (mean age 47.6 ± 11.4 years), PST scores were significantly correlated with all MRI metrics, including cord atrophy and deep gray matter volumes. Linear regression demonstrated self-reported physical disability, cognitive function, fatigue and social domains (adjusted R2 = 0.44, P < 0.001) as the strongest clinical predictors of PST score, whereas that of MRI variables included T2 lesion volume, whole-brain fraction and cord atrophy (adjusted R2 = 0.42, P < 0.001). An inclusive model identified T2 lesion volume, whole-brain fraction, self-reported upper extremity function, cognition and social participation as the strongest predictors of PST score (adjusted R2 = 0.51, P < 0.001). There was significant effect modification by depression on the relationship between self-reported cognition and PST performance. Employment status was associated with PST scores independent of age and physical disability. CONCLUSION The PST score correlates with PROMs, MRI measures of focal and diffuse brain injury, and employment. The PST score is a feasible and meaningful measure for routine multiple sclerosis care.
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Affiliation(s)
- G Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Faculty of Medicine, Université Saint Joseph de Beyrouth, Beirut, Lebanon
| | - L E Baldassari
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - K Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S M Rao
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M P McGinley
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - B P Moss
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - H Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - D M Miller
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S E Jones
- Neuroradiology Department, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R A Bermel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J A Cohen
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D S Conway
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Mayssam EN, Eid C, Khoury SJ, Hannoun S. "No evidence of disease activity": Is it an aspirational therapeutic goal in multiple sclerosis? Mult Scler Relat Disord 2020; 40:101935. [PMID: 31951861 DOI: 10.1016/j.msard.2020.101935] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 01/01/2023]
Abstract
'No evidence of disease activity' (NEDA) that has been identified as a potential outcome measure for the evaluation of DMTs effects. The concept has been adopted from other diseases such as cancer where treatment is intended to free the patient from the disease. Disease-free status has been substituted by NEDA in MS, since we are limited when it comes to fully evaluating the underlying disease. In general, NEDA, otherwise termed as NEDA-3, is defined by the lack of disease activity based on the absence of clinical relapses, disability progression with the expanded disability status score (EDSS), and radiological activity. Recently, brain atrophy, a highly predictive marker of disability progression, has been added as a fourth component (NEDA-4). The use of this composite allowed a more comprehensive assessment of the disease activity. Indeed, it has an important role in clinical trials as a secondary outcome in addition to primary endpoints. However, the evidence is insufficient regarding the ability of NEDA to predict future disability and treatment response. Moreover, combining different composites does not eliminate the limitation of each, therefore the use of NEDA in clinical routine is still not implemented. The aim of this review is first to report from the literature the available definitions of NEDA and its different variants, and second, evaluate the importance of its use as a surrogate marker to assess the efficacy of different DMTs.
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Affiliation(s)
- El Najjar Mayssam
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Riad El Solh 1107 2020. P.O.Box: 11-0236, Beirut, Lebanon
| | - Cynthia Eid
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Riad El Solh 1107 2020. P.O.Box: 11-0236, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Riad El Solh 1107 2020. P.O.Box: 11-0236, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Riad El Solh 1107 2020. P.O.Box: 11-0236, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, Beirut, Lebanon.
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14
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Freedman MS, Comi G, Coyle PK, Aldridge J, Chen L, Marhardt K, Kappos L. No evidence of disease activity status in patients treated with early vs. delayed subcutaneous interferon β-1a. Mult Scler Relat Disord 2019; 39:101891. [PMID: 31864098 DOI: 10.1016/j.msard.2019.101891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clinically isolated syndrome (CIS) is defined as a monophasic clinical episode highly suggestive of multiple sclerosis (MS). Regardless, studies have shown that treatment at this early stage of MS can delay a second event and prolong the transition to clinically diagnosed MS. The objective of this post-hoc analysis was to determine the effect of early CIS treatment with once weekly (qw) or three times weekly (tiw) subcutaneous interferon (scIFN) β-1a vs. delayed treatment (DT) on the composite endpoint of no evidence of disease activity (NEDA)-3. METHODS In REFLEX, patients with CIS were randomized to double-blind scIFN β-1a 44 µg tiw, qw, or placebo for 24 months. Upon clinically-definite MS, patients switched to open-label scIFN β-1a tiw. Patients who completed REFLEX entered an extension (REFLEXION). Patients initially randomized to placebo switched to tiw (DT); scIFN β-1a patients continued their initial qw/tiw regimen for up to 60-months post-randomization. This post-hoc analysis was conducted in the integrated intent-to-treat REFLEX plus REFLEXION population (tiw, n = =171; qw, n = =175; DT, n = =171). All p values are nominal. CIS was defined using the McDonald 2010 criteria. RESULTS Patients receiving early treatment (ET) with scIFN β-1a tiw and qw were more likely to achieve NEDA-3 than DT at year 2 (tiw vs. DT: OR 4.26, 95% CI 2.02-8.98, p = =0.0001; qw vs. DT: OR 2.99, 95% CI 1.39-6.43, p = =0.005). Compared with DT, ET with scIFN β-1a tiw was more likely to achieve NEDA-3 at year 3 (OR 3.73, 95% CI 1.63-8.55, p = =0.002) and year 5 (OR 12.96, 95% CI 1.66-101.04, p = =0.015). Between ET regimens, the odds of achieving NEDA-3 were not significantly improved by scIFN β-1a 44 µg tiw at year 2 (OR 1.42, 95% CI 0.81-2.50, p = =0.22) but were at year 3 (OR 2.26, 95% CI 1.11-4.60, p = =0.024) and year 5 (OR 3.22, 95% CI 1.01-10.22, p = =0.048), indicating that the beneficial effects of more frequent scIFN β-1a dosing become more apparent over time in patients with CIS. In the subgroup of patients with Gd+ lesions at baseline the odds for achieving NEDA-3 were higher for ET up to year 2 compared with DT (tiw: OR 10.21, 95% CI 1.23-84.82, p = =0.03; qw: OR 8.97, 95% CI 1.08-74.28, p = =0.04). In patients without Gd+ lesions at baseline, those receiving ET were more likely to achieve NEDA-3 at year 2 (OR 3.56, 95% CI 1.56-8.10, p = =0.003), year 3 (OR 2.54, 95% CI 1.05-6.18, p = =0.04) and year 5 (OR 9.63, 95% CI 1.19-77.79, p = =0.034) than patients who received DT. CONCLUSIONS ET with scIFN β-1a tiw was associated with a higher likelihood of achieving NEDA-3 not only at 2 but also at 3 and 5 years.
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Affiliation(s)
- Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8l6, Canada.
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Ospedale San Raffaele, Milan, Italy.
| | | | | | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Clinical Research and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland.
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15
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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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16
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Macaron G, Ontaneda D. Diagnosis and Management of Progressive Multiple Sclerosis. Biomedicines 2019; 7:E56. [PMID: 31362384 PMCID: PMC6784028 DOI: 10.3390/biomedicines7030056] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system that results in varying degrees of disability. Progressive multiple sclerosis, characterized by a steady increase in neurological disability independently of relapses, can occur from onset (primary progressive) or after a relapsing-remitting course (secondary progressive). As opposed to active inflammation seen in the relapsing-remitting phases of the disease, the gradual worsening of disability in progressive multiple sclerosis results from complex immune mechanisms and neurodegeneration. A few anti-inflammatory disease-modifying therapies with a modest but significant effect on measures of disease progression have been approved for the treatment of progressive multiple sclerosis. The treatment effect of anti-inflammatory agents is particularly observed in the subgroup of patients with younger age and evidence of disease activity. For this reason, a significant effort is underway to develop molecules with the potential to induce myelin repair or halt the degenerative process. Appropriate trial methodology and the development of clinically meaningful disability outcome measures along with imaging and biological biomarkers of progression have a significant impact on the ability to measure the efficacy of potential medications that may reverse disease progression. In this issue, we will review current evidence on the physiopathology, diagnosis, measurement of disability, and treatment of progressive multiple sclerosis.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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17
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Therapeutic Advances and Challenges in the Treatment of Progressive Multiple Sclerosis. Drugs 2018; 78:1549-1566. [DOI: 10.1007/s40265-018-0984-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Wintermark M, Colen R, Whitlow CT, Zaharchuk G. The vast potential and bright future of neuroimaging. Br J Radiol 2018; 91:20170505. [PMID: 29848016 DOI: 10.1259/bjr.20170505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Significant advances in anatomical and functional neuroimaging techniques have allowed researchers and clinicians to visualize the brain in action. The field of neuroimaging currently includes newer and faster scanners, improved image quality, higher spatial and temporal resolution and diverse methods of acquisition and analysis. Beyond simply imaging brain structures, these developments enable quantitative assessment of the microstructural and functional architecture, perfusion and metabolism of the brain. The resultant highly granular data have the potential to greatly improve characterization of neurological, neurosurgical and psychiatric disorders without invasive neurosurgery. However, the surge in neuroimaging data that can be collected over a relatively short acquisition period has led to a "big data" problem, where novel methods are needed to appropriately extract and analyze information and integrate data with other types of big data, such as genomic and proteomic data. Another challenge is the translation of these new technologies from basic science into clinical practice, so that they can be leveraged to improve patient outcomes and alleviate human disease. Critical to this endeavor is research comparing the effectiveness and outcomes of these advancements to allow widespread acceptance in the modern, economically constrained healthcare system. This review aims to illustrate the different facets of cutting edge neuroimaging techniques, as well as the potential role of these methods as clinical tools for evaluating the breadth of diseases that affect the brain.
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Affiliation(s)
- Max Wintermark
- 1 Department of Radiology, Division of Neuroradiology, Stanford University , Palo Alto, CA , USA
| | - Rivka Colen
- 2 Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Christopher T Whitlow
- 3 Departments of Radiology and Biomedical Engineering and Clinical Translational Science Institute, Wake Forest School of Medicine , Winston-Salem, NC , USA
| | - Greg Zaharchuk
- 1 Department of Radiology, Division of Neuroradiology, Stanford University , Palo Alto, CA , USA
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19
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Bateman EM, Schleicher WE, Smith EJ, Sweet DR, Gaudet AD. Journal Club: MRI reveals acute inflammation in cortical lesions during early MS. Neurology 2018; 90:e724-e726. [PMID: 29459454 PMCID: PMC5818168 DOI: 10.1212/wnl.0000000000005001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early multiple sclerosis is characterized by immune-associated demyelination of CNS axons. In a recent Neurology® article, Maranzano et al. evaluated MRI scans of patients with early multiple sclerosis to study the evolution of leukocortical lesions. Their novel data suggest that acute inflammation after blood-brain barrier leakage may contribute to gray matter cortical lesions in early multiple sclerosis.
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Affiliation(s)
- Emily M Bateman
- From the Department of Psychology and Neuroscience (E.M.B., W.E.S., E.J.S., A.D.G.), University of Colorado Boulder; and Medical Scientist Training Program (D.R.S.), Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Wolfgang E Schleicher
- From the Department of Psychology and Neuroscience (E.M.B., W.E.S., E.J.S., A.D.G.), University of Colorado Boulder; and Medical Scientist Training Program (D.R.S.), Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Elana J Smith
- From the Department of Psychology and Neuroscience (E.M.B., W.E.S., E.J.S., A.D.G.), University of Colorado Boulder; and Medical Scientist Training Program (D.R.S.), Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - David R Sweet
- From the Department of Psychology and Neuroscience (E.M.B., W.E.S., E.J.S., A.D.G.), University of Colorado Boulder; and Medical Scientist Training Program (D.R.S.), Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Andrew D Gaudet
- From the Department of Psychology and Neuroscience (E.M.B., W.E.S., E.J.S., A.D.G.), University of Colorado Boulder; and Medical Scientist Training Program (D.R.S.), Department of Pathology, Case Western Reserve University, Cleveland, OH.
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20
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Bove RM. Why monkeys do not get multiple sclerosis (spontaneously): An evolutionary approach. EVOLUTION MEDICINE AND PUBLIC HEALTH 2018; 2018:43-59. [PMID: 29492266 PMCID: PMC5824939 DOI: 10.1093/emph/eoy002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
Abstract
The goal of this review is to apply an evolutionary lens to understanding the origins of multiple sclerosis (MS), integrating three broad observations. First, only humans are known to develop MS spontaneously. Second, humans have evolved large brains, with characteristically large amounts of metabolically costly myelin. This myelin is generated over long periods of neurologic development—and peak MS onset coincides with the end of myelination. Third, over the past century there has been a disproportionate increase in the rate of MS in young women of childbearing age, paralleling increasing westernization and urbanization, indicating sexually specific susceptibility in response to changing exposures. From these three observations about MS, a life history approach leads us to hypothesize that MS arises in humans from disruption of the normal homeostatic mechanisms of myelin production and maintenance, during our uniquely long myelination period. This review will highlight under-explored areas of homeostasis in brain development, that are likely to shed new light on the origins of MS and to raise further questions about the interactions between our ancestral genes and modern environments.
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Affiliation(s)
- Riley M Bove
- Department of Neurology, UCSF, San Francisco, CA, USA
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21
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Conway DS, Hua LH, Cohen JA. Multiple Sclerosis: Unprecedented Progress But Significant Challenges Ahead. Neurotherapeutics 2017; 14:832-834. [PMID: 28956322 PMCID: PMC5722778 DOI: 10.1007/s13311-017-0576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
| | - Le H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, 89106, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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22
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Abstract
We have witnessed major successes in the development of effective immunomodulatory therapies capable of reducing adaptive immune-mediated myelin damage in MS over the last 30 years. However, until it is possible to prevent MS or initiate treatment before it has already caused lesions there is a need to repair myelin damage to prevent further axonal loss. The past decade has brought remarkable advances in our understanding of oligodendrocyte biology and the related search for remyelinating therapies in humans. In this review, we first outline the basic biology of central nervous system myelin and remyelination, including a discussion of the major identified pathways and targets that might help yield CNS remyelinating drugs. In conjunction, we provide an overview of techniques that have helped identify compounds capable of promoting oligodendrocyte precursor cell differentiation and myelination. This includes the methods for both initial in vitro screening and subsequent in vivo confirmation of the target. We then review methods proposed to quantify human remyelination in vivo, including visual evoked potentials and putative imaging modalities. As the remyelination era approaches, with the announcement of the first positive trial in remyelination, we are now tasked with answering new questions regarding patient-specific factors (e.g., age) that may influence the extent and optimal therapeutic window for remyelination.
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Affiliation(s)
- Riley M Bove
- Department of Neurology Weill Institute for the Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Ari J Green
- Department of Neurology Weill Institute for the Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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