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Molazadeh N, Akaishi T, Bose G, Nishiyama S, Chitnis T, Levy M. Progression independent of relapses in aquaporin4-IgG-seropositive neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, and multiple sclerosis. Mult Scler Relat Disord 2023; 80:105093. [PMID: 37949025 DOI: 10.1016/j.msard.2023.105093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To determine whether progression independent of relapse activity (PIRA) is present in Aquaporin4-IgG-seropositive neuromyelitis optica spectrum disorder (AQP4+NMOSD), Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and relapsing remitting Multiple sclerosis (RRMS). METHODS We retrospectively studied the change in EDSS, confirmed disability worsening (CDW) (i.e., PIRA), and new MRI lesions in AQP4+NMOSD, and MOGAD and MS patients. Linear mixed-effect regression model was used to compare the longitudinal changes in EDSS, and Cox regression was used to compare changes in MRI. RESULTS The estimated mean ΔEDSS in the AQP4+NMOSD and matched MS group were +0.06 (95%CI: -0.40, +0.52, p = 0.76), and +0.02 (95%CI: -0.05, +0.08, p = 0.6) respectively. The same estimate was -0.08 (95%CI: -0.18, +0.02, p = 0.12) in MOGAD and +0.05 (95%CI: -0.05, +0.15, p = 0.35) in matched MS group. Comparing groups for the presence of CDW (i.e., PIRA) showed that PIRA is more associated with MS compared to AQP4+NMOSD (p = 0.02) and MOGAD (p<0.001). Compared to their matched MS groups, the annualized rate of PIRA was significantly lower in AQP4 (0.08 vs 0.44; p<0.0001), and MOG groups (0.04 vs 0.13; p<0.0001). New T2 or enhancing lesions on brain MRI were higher in MS compared to AQP4+NMOSD and MOGAD patients. CONCLUSION Relapse-independent changes in the EDSS, CDW, and MRI activity are not common in AQP4+NMOSD and MOGAD, especially when compared with MS. Since our patients were on relapse prevention therapies at the time of EDSS measurements, our study supports the importance of preventing relapses in AQP4+NMOSD and MOGAD and suggests different pathologic mechanisms of relapse-free neurological damage between MS and AQP4+NMOSD/MOGAD.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Gauruv Bose
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa Hospital Research Institute, ON, Canada
| | - Shuhei Nishiyama
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - Tanuja Chitnis
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Child Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Bose G, Healy BC, Saxena S, Saleh F, Glanz BI, Bakshi R, Weiner HL, Chitnis T. Increasing Neurofilament and Glial Fibrillary Acidic Protein After Treatment Discontinuation Predicts Multiple Sclerosis Disease Activity. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200167. [PMID: 37813595 PMCID: PMC10574823 DOI: 10.1212/nxi.0000000000200167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/17/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Stable patients with multiple sclerosis (MS) may discontinue treatment, but the risk of disease activity is unknown. Serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) are biomarkers of subclinical disease activity and may help risk stratification. In this study, sNfL and sGFAP levels in stable patients were evaluated before and after treatment discontinuation to determine association with disease activity. METHODS This observational study included patients enrolled in the Comprehensive Longitudinal Investigation in MS at the Brigham and Women's Hospital who discontinued treatment after >2 years disease activity-free. Two serum samples within 2 years, before and after treatment stop, were sent for sNfL and sGFAP measurements by single-molecule array. Biannual neurologic examinations and yearly MRI scans determined disease activity by 3 time-to-event outcomes: 6-month confirmed disability worsening (CDW), clinical attacks, and MRI activity (new T2 or contrast-enhancing lesions). Associations between each outcome and log-transformed sNfL and sGFAP levels pretreatment stop and posttreatment stop and the percent change were estimated using multivariable Cox regression analysis adjusting for age, disability, disease duration, and duration from attack before treatment stop. RESULTS Seventy-eight patients (92% female) discontinued treatment at a median (interquartile range) age of 48.5 years (39.0-55.7) and disease duration of 12.3 years (7.5-18.8) and were followed up for 6.3 years (4.2-8.5). CDW occurred in 27 patients (35%), new attacks in 19 (24%), and new MRI activity in 26 (33%). Higher posttreatment stop sNfL level was associated with CDW (adjusted hazard ratio (aHR) 2.80, 95% CI 1.36-5.76, p = 0.005) and new MRI activity (aHR 3.09, 95% CI 1.42-6.70, p = 0.004). Patients who had >100% increase in sNfL level from pretreatment stop to posttreatment stop had greater risk of CDW (HR 3.87, 95% CI 1.4-10.7, p = 0.009) and developing new MRI activity (HR 4.02, 95% CI 1.51-10.7, p = 0.005). Patients who had >50% increase in sGFAP level also had greater risk of CDW (HR 5.34, 95% CI 1.4-19.9, p = 0.012) and developing new MRI activity (HR 5.16, 95% CI 1.71-15.6, p = 0.004). DISCUSSION Stable patients who discontinue treatment may be risk stratified by sNfL and sGFAP levels measured before and after discontinuing treatment. Further studies are needed to validate findings and determine whether resuming treatment in patients with increasing biomarker levels reduces risk of subsequent disease activity.
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Affiliation(s)
- Gauruv Bose
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Brian C Healy
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Shrishti Saxena
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Fermisk Saleh
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Bonnie I Glanz
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Rohit Bakshi
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Howard L Weiner
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada
| | - Tanuja Chitnis
- From the Department of Neurology (G.B., B.C.H., S.S., F.S., B.I.G., R.B., H.L.W., T.C.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (G.B., B.C.H., B.I.G., R.B., H.L.W., T.C.), Boston, MA; The University of Ottawa and Ottawa Hospital Research Institute (G.B.), Ottawa, Canada.
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Bose G, Healy BC, Barro C, Moreira Ferreira VF, Saxena S, Glanz BI, Lokhande HA, Polgar-Turcsanyi M, Bakshi R, Weiner HL, Chitnis T. Accuracy of serum neurofilament light to identify contrast-enhancing lesions in multiple sclerosis. Mult Scler 2023; 29:1418-1427. [PMID: 37712409 DOI: 10.1177/13524585231198751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Contrast-enhancing magnetic resonance imaging (MRI) lesions (CELs) indicate acute multiple sclerosis inflammation. Serum biomarkers, neurofilament light (sNfL), and glial fibrillary acidic protein (sGFAP) may increase in the presence of CELs, and indicate a need to perform MRI. OBJECTIVE We assessed the accuracy of biomarkers to detect CELs. METHODS Patients with two gadolinium-enhanced MRIs and serum biomarkers tested within 3 months were included (N = 557, 66% female). Optimal cut-points from Bland-Altman analysis for spot biomarker level and Youden's index for delta-change from remission were evaluated. RESULTS A total of 116 patients (21%) had CELs. A spot sNfL measurement >23.0 pg/mL corresponded to 7.0 times higher odds of CEL presence (95% CI: 3.8, 12.8), with 25.9% sensitivity, 95.2% specificity, operating characteristic curve (AUC) 0.61; while sNfL delta-change >30.8% from remission corresponded to 5.0 times higher odds (95% CI: 3.2, 7.8), 52.6% sensitivity, 81.9% specificity, AUC 0.67. sGFAP had poor CEL detection. In patients > 50 years, neither cut-point remained significant. sNfL delta-change outperformed spot levels at identifying asymptomatic CELs (AUC 0.67 vs 0.59) and in patients without treatment escalation between samples (AUC 0.67 vs 0.57). CONCLUSION Spot sNfL >23.0 pg/mL or a 30.8% increase from remission provides modest prediction of CELs in patients <50 years; however, low sNfL does not obviate the need for MRI.
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Affiliation(s)
- Gauruv Bose
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA/Department of Medicine, The University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Christian Barro
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Vanessa F Moreira Ferreira
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Bonnie I Glanz
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Hrishikesh A Lokhande
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Mariann Polgar-Turcsanyi
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
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Bose G, Healy BC, Saxena S, Saleh F, Paul A, Barro C, Lokhande HA, Polgar-Turcsanyi M, Anderson M, Glanz BI, Guttmann CRG, Bakshi R, Weiner HL, Chitnis T. Early neurofilament light and glial fibrillary acidic protein levels improve predictive models of multiple sclerosis outcomes. Mult Scler Relat Disord 2023; 74:104695. [PMID: 37060852 DOI: 10.1016/j.msard.2023.104695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/08/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Early risk-stratification in multiple sclerosis (MS) may impact treatment decisions. Current predictive models have identified that clinical and imaging characteristics of aggressive disease are associated with worse long-term outcomes. Serum biomarkers, neurofilament (sNfL) and glial fibrillary acidic protein (sGFAP), reflect subclinical disease activity through separate pathological processes and may contribute to predictive models of clinical and MRI outcomes. METHODS We conducted a retrospective analysis of the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB study), where patients with multiple sclerosis are seen every 6 months and undergo Expanded Disability Status Scale (EDSS) assessment, have annual brain MRI scans where volumetric analysis is conducted to calculate T2-lesion volume (T2LV) and brain parenchymal fraction (BPF), and donate a yearly blood sample for subsequent analysis. We included patients with newly diagnosed relapsing-remitting MS and serum samples obtained at baseline visit and 1-year follow-up (both within 3 years of onset), and were assessed at 10-year follow-up. We measured sNfL and sGFAP by single molecule array at baseline visit and at 1-year follow-up. A predictive clinical model was developed using age, sex, Expanded Disability Status Scale (EDSS), pyramidal signs, relapse rate, and spinal cord lesions at first visit. The main outcome was odds of developing of secondary progressive (SP)MS at year 10. Secondary outcomes included 10-year EDSS, brain T2LV and BPF. We compared the goodness-of-fit of the predictive clinical model with and without sNfL and sGFAP at baseline and 1-year follow-up, for each outcome by area under the receiver operating characteristic curve (AUC) or R-squared. RESULTS A total 144 patients with median MS onset at age 37.4 years (interquartile range: 29.4-45.4), 64% female, were included. SPMS developed in 25 (17.4%) patients. The AUC for the predictive clinical model without biomarker data was 0.73, which improved to 0.77 when both sNfL and sGFAP were included in the model (P = 0.021). In this model, higher baseline sGFAP associated with developing SPMS (OR=3.3 [95%CI:1.1,10.6], P = 0.04). Adding 1-year follow-up biomarker levels further improved the model fit (AUC = 0.79) but this change was not statistically significant (P = 0.15). Adding baseline biomarker data also improved the R-squared of clinical models for 10-year EDSS from 0.24 to 0.28 (P = 0.032), while additional 1-year follow-up levels did not. Baseline sGFAP was associated with 10-year EDSS (ß=0.58 [95%CI:0.00,1.16], P = 0.05). For MRI outcomes, baseline biomarker levels improved R-squared for T2LV from 0.12 to 0.27 (P<0.001), and BPF from 0.15 to 0.20 (P = 0.042). Adding 1-year follow-up biomarker data further improved T2LV to 0.33 (P = 0.0065) and BPF to 0.23 (P = 0.048). Baseline sNfL was associated with T2LV (ß=0.34 [95%CI:0.21,0.48], P<0.001) and 1-year follow-up sNfL with BPF (ß=-2.53% [95%CI:-4.18,-0.89], P = 0.003). CONCLUSIONS Early biomarker levels modestly improve predictive models containing clinical and MRI variables. Worse clinical outcomes, SPMS and EDSS, are associated with higher sGFAP levels and worse MRI outcomes, T2LV and BPF, are associated with higher sNfL levels. Prospective study implementing these predictive models into clinical practice are needed to determine if early biomarker levels meaningfully impact clinical practice.
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Affiliation(s)
- Gauruv Bose
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Brian C Healy
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Shrishti Saxena
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Fermisk Saleh
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Anu Paul
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Christian Barro
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Hrishikesh A Lokhande
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mariann Polgar-Turcsanyi
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mark Anderson
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Bonnie I Glanz
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Charles R G Guttmann
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Rohit Bakshi
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Howard L Weiner
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Tanuja Chitnis
- Harvard Medical School, 60 Fenwood Road, 9002 K, Boston, MA 02115, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Kaplan T, Feldman T, Healey B, Behn M, Glanz B, Chitnis T. Sexual Problems in MS: Sex Differences and Their Impact on Quality of Life. Mult Scler Relat Disord 2023; 74:104672. [PMID: 37031553 DOI: 10.1016/j.msard.2023.104672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/04/2023] [Accepted: 03/25/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Low sexual function and satisfaction are common problems among people with multiple sclerosis (PwMS), but the literature on which patient variables are associated with these issues is inconsistent. OBJECTIVE To investigate the associations between sexual function and satisfaction in PwMS with clinical, demographic, and patient-reported quality of life (QOL) measures and determine if sex differences exist. METHODS This analysis includes PwMS enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB), who completed patient-reported outcome measures: Multiple Sclerosis Quality of Life-54 (MSQOL-54), Modified Fatigue Impact Scale (MFIS), and Center for Epidemiologic Studies Depression Scale (CES-D). Regression models were used to analyze associations between patient variables and function and satisfaction. Results were stratified by sex. Cross-sectional and longitudinal data were used. RESULTS 702 PwMS (526 females,176 males, mean age 42.2 +/-11.1, median EDSS 1.5) were included in the cross-sectional analysis. Data from 341 PwMS were used in the three-year longitudinal analysis. Increasing age, disease duration, and disability were associated with reduced sexual function and satisfaction to the same degree in males and females. However, sex differences existed in the strength of associations with QOL variables. There was no significant longitudinal change in females or males. CONCLUSIONS Age and disease duration were associated with reduced sexual function and satisfaction in males and females. In females, function was significantly associated with disability and satisfaction with fatigue. Males had stronger associations with sexual function in domains related to emotional well-being, health perceptions, and overall QOL. Males had stronger associations with satisfaction in emotional and social functioning and physical health domains. These findings can help better understand the multidimensional problems of sexual function and satisfaction in PwMS and better guide patient care.
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Barro C, Healy BC, Saxena S, Glanz BI, Paul A, Polgar-Turcsanyi M, Guttmann CR, Bakshi R, Weiner HL, Chitnis T. Serum NfL but not GFAP predicts cognitive decline in active progressive multiple sclerosis patients. Mult Scler 2023; 29:206-211. [PMID: 36448331 DOI: 10.1177/13524585221137697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cognitive decline is inadequately captured by the standard neurological examination. Serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are biomarkers of neuronal damage and astrocytic reactivity that may offer an accessible measure of the multiple sclerosis (MS) pathology linked to cognitive decline. OBJECTIVE To investigate the association of sNfL and sGFAP with cognitive decline in MS patients at high risk for progressive pathology. METHODS We included 94 MS patients with sustained Expanded Disability Status Score (EDSS) ⩾ 3, available serum samples and cognitive assessment performed by symbol digit modalities test (SDMT) over a median of 3.1 years. The visit for sGFAP/sNfL quantification was at confirmed EDSS ⩾ 3. Linear regression analysis on log-transformed sGFAP/sNfL assessed the association with current and future SDMT. Analyses were adjusted for age, sex, EDSS, treatment group, and recent relapse. RESULTS sNfL was significantly associated with concurrent SDMT (adjusted change in mean SDMT = -4.5; 95% confidence interval (CI): -8.7, -0.2; p = 0.039) and predicted decline in SDMT (adjusted change in slope: -1.14; 95% CI: -1.83, -0.44; p = 0.001), particularly in active patients. sGFAP was not associated with concurrent or future SDMT. CONCLUSIONS Higher levels of sNfL were associated with cognitive impairment and predicted cognitive decline in MS patients at high risk for having an underlying progressive pathology.
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Affiliation(s)
- Christian Barro
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shrishti Saxena
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Bonnie I Glanz
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Anu Paul
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariann Polgar-Turcsanyi
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Rg Guttmann
- Harvard Medical School, Boston, MA, USA/Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA/Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Barro C, Healy BC, Liu Y, Saxena S, Paul A, Polgar-Turcsanyi M, Guttmann CR, Bakshi R, Kropshofer H, Weiner HL, Chitnis T. Serum GFAP and NfL Levels Differentiate Subsequent Progression and Disease Activity in Patients With Progressive Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200052. [DOI: 10.1212/nxi.0000000000200052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
Background and ObjectivesNeurodegeneration and astrocytic activation are pathologic hallmarks of progressive multiple sclerosis (MS) and can be quantified by serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP). We investigated sNfL and sGFAP as tools for stratifying patients with progressive MS based on progression and disease activity status.MethodsWe leveraged our Comprehensive Longitudinal Investigation of MS at the Brigham and Women's Hospital (CLIMB) natural history study, which includes clinical, MRI data and serum samples collected over more than 20 years. We included patients with MS with a confirmed Expanded Disability Status Scale (EDSS) score ≥3 that corresponds with our classifier for patients at high risk of underlying progressive pathology. We analyzed sNfL and sGFAP within 6 months from the confirmed EDSS score ≥3 corresponding with our baseline visit. Patients who further developed 6-month confirmed disability progression (6mCDP) were classified as progressors. We further stratified our patients into active/nonactive based on new brain/spinal cord lesions or relapses in the 2 years before baseline or during follow-up. Statistical analysis on log-transformed sGFAP/sNfL assessed the baseline association with demographic, clinical, and MRI features and associations with future disability.ResultsWe included 257 patients with MS who had an average EDSS score of 4.0 and a median follow-up after baseline of 7.6 years. sNfL was higher in patients with disease activity in the 2 years before baseline (adjusted β = 1.21; 95% CI 1.04–1.42;p= 0.016), during the first 2 years of follow-up (adjusted β = 1.17; 95% CI = 1.01–1.36;p= 0.042). sGFAP was not increased in the presence of disease activity. Higher sGFAP levels, but not sNfL levels, were associated with higher risk of 6mCDP (adjusted hazard ratio [HR] = 1.71; 95% CI = 1.19–2.45;p= 0.004). The association was stronger in patients with low sNfL (adjusted HR = 2.44; 95% CI 1.32–4.52;p= 0.005) and patients who were nonactive in the 2 years prior or after the sample.DiscussionHigher levels of sGFAP correlated with subsequent progression, particularly in nonactive patients, whereas sNfL reflected acute disease activity in patients with MS at high risk of underlying progressive pathology. Thus, sGFAP and sNfL levels may be used to stratify patients with progressive MS for clinical research studies and clinical trials and may inform clinical care.
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8
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Bose G, Healy BC, Barro C, Glanz BI, Lokhande HA, Polgar-Turcsanyi M, Guttmann CR, Bakshi R, Weiner HL, Chitnis T. Younger age at multiple sclerosis onset is associated with worse outcomes at age 50. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329353. [PMID: 35953266 DOI: 10.1136/jnnp-2022-329353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Older age at multiple sclerosis (MS) onset has been associated with worse 10-year outcomes. However, disease duration often exceeds 10 years and age-related comorbidities may also contribute to disability. We investigated patients with>10 years disease duration to determine how age at MS onset is associated with clinical, MRI and occupational outcomes at age 50. METHODS We included patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital with disease duration>10 years. Outcomes at age 50 included the Expanded Disability Status Scale (EDSS), development of secondary-progressive multiple sclerosis (SPMS), brain T2-lesion volume (T2LV) and brain parenchymal fraction (BPF), and occupational status. We assessed how onset age was independently associated with each outcome when adjusting for the date of visit closest to age 50, sex, time to first treatment, number of treatments by age 50 and exposure to high-efficacy treatments by age 50. RESULTS We included 661 patients with median onset at 31.4 years. The outcomes at age 50 were worse the younger first symptoms developed: for every 5 years earlier, the EDSS was 0.22 points worse (95% CI: 0.04 to 0.40; p=0.015), odds of SPMS 1.33 times higher (95% CI: 1.08 to 1.64; p=0.008), T2LV 1.86 mL higher (95% CI: 1.02 to 2.70; p<0.001), BPF 0.97% worse (95% CI: 0.52 to 1.42; p<0.001) and odds of unemployment from MS 1.24 times higher (95% CI: 1.01 to 1.53; p=0.037). CONCLUSIONS All outcomes at age 50 were worse in patients with younger age at onset. Decisions to provide high-efficacy treatments should consider younger age at onset, equating to a longer expected disease duration, as a poor prognostic factor.
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Affiliation(s)
- Gauruv Bose
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | - Christian Barro
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Mariann Polgar-Turcsanyi
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Rohit Bakshi
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
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9
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Sattarnezhad N, Healy BC, Baharnoori M, Diaz-Cruz C, Stankiewicz J, Weiner HL, Chitnis T. Comparison of dimethyl fumarate and interferon outcomes in an MS cohort. BMC Neurol 2022; 22:252. [PMID: 35820822 PMCID: PMC9277810 DOI: 10.1186/s12883-022-02761-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background To compare the effectiveness of dimethyl fumarate (DMF) with subcutaneous interferon beta-1a (IFNβ-1a) in controlling disease activity in patients with relapsing–remitting Multiple Sclerosis (MS). Methods Clinical and imaging data from patients treated with either IFNβ-1a or DMF for at least one year were reviewed. The proportion of patients with at least one clinical relapse within 3–15 months after treatment onset, the proportion of patients with new T2 or gadolinium-enhancing lesions, and the proportion of subjects who achieved no evidence of disease activity (NEDA) status were assessed. Results Three hundred sixteen (98 on IFNβ-1a, 218 on DMF) subjects were included. Baseline demographics were comparable between groups except for age, disease duration, and the number of previous treatments being higher and relapse rate in the prior year being lower in the DMF-treated group. The proportion of patients having a clinical relapse (24.5% vs. 9.6%; OR = 3.04; P < 0.001) or a new MRI lesion (28.6% vs. 8.7%; OR = 4.19, P < 0.001) at 15 months were higher on IFNβ-1a. 79.9% of the patients achieved NEDA status at 15 months on DMF (vs. 51.1% for IFNβ-1a; OR = 0.26, P < 0.001). Further adjustment for demographics, disease characteristics, treatment and relapse history, and subgroup analyses confirmed these findings. Conclusion DMF was associated with less clinical and radiological disease activity compared to IFNβ-1a. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02761-8.
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Affiliation(s)
- Neda Sattarnezhad
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA.,Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moogeh Baharnoori
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Camilo Diaz-Cruz
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - James Stankiewicz
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Tanuja Chitnis
- Harvard Medical School, Boston, Massachusetts, 02115, USA. .,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA.
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10
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Plati D, Tripoliti E, Zelilidou S, Vlachos K, Konitsiotis S, Fotiadis DI. Multiple Sclerosis Severity Estimation and Progression Prediction Based on Machine Learning Techniques. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1109-1112. [PMID: 36085783 DOI: 10.1109/embc48229.2022.9871213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the study is to address the Multiple Sclerosis (MS) severity estimation problem based on EDSS score and the prediction of the disease's progression with the application of Machine Learning (ML) approaches. Several ML techniques are implemented. The data are provided by the Neurology Clinic of the University Hospital of Ioannina and were collected in the framework of the ProMiSi project. The features recorded are grouped into: general demographic information, MS clinical related data, results of special tests, treatment, and comorbidities. The records from 30 patients are utilized and are recorded in three time points. The ML methods provided quite high results with 94.87% accuracy for the MS severity estimation and 83.33% for the disease's progression prediction.
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11
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Zhang Y, Lv J, Zhang S, Yang H, Shen J, Du C, Jiang X, Aisa HA. Synthesis and biological evaluation of artemisinin derivatives as potential MS agents. Bioorg Med Chem Lett 2022; 64:128682. [PMID: 35304225 DOI: 10.1016/j.bmcl.2022.128682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
In this paper, a series of artemisinin derivatives were synthesized and evaluated. Studies have shown that IFN-γ produced by Th1 CD4+ T cells and IL-17A secreted by Th17 CD4+ T cells played critical roles in the treatment of multiple sclerosis. We used different concentrations of artemisinin derivatives to inhibit Th1 / Th17 differentiation in naive CD4+ T cells and to characterize IFN-γ / IL-17A in in vitro experiments. The preliminary screening results showed that ester compound 5 exhibited obvious inhibitory activities on Th1 and Th17 (IFN-γ decreased from 41% to 3% and IL-17A decreased from 24% to 8% at the concentration of 10 nM to 10 μM), and carbamate compounds also had obvious inhibitory activities against Th17 at high concentration. Moreover, we investigated the effect of compound 5 on myelin oligodendrocyte glycoprotein (MOG)-induced mice experimental autoimmune encephalomyelitis (EAE) model in vivo. 100 mg/kg compound 5 effectively reduced the disease severity of EAE compared with the vehicle group. This research revealed that compound 5 could be a promising avenue as potential MS inhibitor.
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Affiliation(s)
- Yan Zhang
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, and Key Laboratory of Plant Resources and Chemistry in Arid Regions, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, South Beijing Road 40-1, Urumqi 830011, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China
| | - Jie Lv
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai 200092, China
| | - Suqing Zhang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China
| | - Hanxi Yang
- College of Chemistry, Zhengzhou University, 100 Kexuedadao Road, Zhengzhou 450001, China
| | - Jingshan Shen
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China
| | - Changsheng Du
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai 200092, China.
| | - Xiangrui Jiang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China.
| | - Haji A Aisa
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, and Key Laboratory of Plant Resources and Chemistry in Arid Regions, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, South Beijing Road 40-1, Urumqi 830011, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China.
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12
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Sorosina M, Barizzone N, Clarelli F, Anand S, Lupoli S, Salvi E, Mangano E, Bordoni R, Roostaei T, Mascia E, Zuccalà M, Vecchio D, Cavalla P, Santoro S, Ferrè L, Zollo A, Barlassina C, Cusi D, Martinelli V, Comi G, Leone M, Filippi M, Patsopoulos NA, De Jager PL, De Bellis G, Esposito F, D'Alfonso S, Martinelli Boneschi F. A multi-step genomic approach prioritized TBKBP1 gene as relevant for multiple sclerosis susceptibility. J Neurol 2022; 269:4510-4522. [PMID: 35545683 PMCID: PMC9294010 DOI: 10.1007/s00415-022-11109-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
Background Over 200 genetic loci have been associated with multiple sclerosis (MS) explaining ~ 50% of its heritability, suggesting that additional mechanisms may account for the “missing heritability” phenomenon. Objective To analyze a large cohort of Italian individuals to identify markers associated with MS with potential functional impact in the disease. Methods We studied 2571 MS and 3234 healthy controls (HC) of continental Italian origin. Discovery phase included a genome wide association study (1727 MS, 2258 HC), with SNPs selected according to their association in the Italian cohort only or in a meta-analysis of signals with a cohort of European ancestry (4088 MS, 7144 HC). Top associated loci were then tested in two Italian cohorts through array-based genotyping (903 MS, 884 HC) and pool-based target sequencing (588 MS, 408 HC). Finally, functional prioritization through conditional eQTL and mQTL has been performed. Results Top associated signals overlap with already known MS loci on chromosomes 3 and 17. Three SNPs (rs4267364, rs8070463, rs67919208), all involved in the regulation of TBKBP1, were prioritized to be functionally relevant. Conclusions No evidence of novel signal of association with MS specific for the Italian continental population has been found; nevertheless, two MS loci seems to play a relevant role, raising the interest to further investigations for TBKBP1 gene. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11109-8.
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Affiliation(s)
- Melissa Sorosina
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Nadia Barizzone
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Avogadro University, 28100, Novara, Italy
| | - Ferdinando Clarelli
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Santosh Anand
- Department of Informatics, Systems and Communications (DISCo), University of Milano-Bicocca, Milan, Italy
| | - Sara Lupoli
- Department of Health Sciences, University of Milan, 20139, Milan, Italy
| | - Erika Salvi
- Department of Health Sciences, University of Milan, 20139, Milan, Italy
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133, Milan, Italy
| | - Eleonora Mangano
- National Research Council of Italy, Institute for Biomedical Technologies, Segrate, 20090, Milan, Italy
| | - Roberta Bordoni
- National Research Council of Italy, Institute for Biomedical Technologies, Segrate, 20090, Milan, Italy
| | - Tina Roostaei
- Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research On Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Elisabetta Mascia
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Miriam Zuccalà
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Avogadro University, 28100, Novara, Italy
| | - Domizia Vecchio
- MS Centre, SCDU Neurology, AOU Maggiore Della Carità, Department of Translational Medicine, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont Avogadro, 28100, Novara, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, 10126, Turin, Italy
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Laura Ferrè
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Alen Zollo
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, 20122, Milan, Italy
| | | | - Daniele Cusi
- National Research Council of Italy, Institute for Biomedical Technologies, Segrate, 20090, Milan, Italy
- Bio4Dreams, Business Nursery for Life Sciences, Piazzale Principessa Clotilde 4/A, 20121, Milan, Italy
| | - Vittorio Martinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Giancarlo Comi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Maurizio Leone
- SC Neurologia, Dipartimento Di Scienze Mediche, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Nikolaos A Patsopoulos
- Systems Biology and Computer Science Program, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Division of Genetics, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Philip L De Jager
- Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research On Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Gianluca De Bellis
- National Research Council of Italy, Institute for Biomedical Technologies, Segrate, 20090, Milan, Italy
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Avogadro University, 28100, Novara, Italy
| | - Filippo Martinelli Boneschi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, 20122, Milan, Italy.
- Neurology Unit and MS Centre, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
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Bose G, Healy BC, Lokhande HA, Sotiropoulos MG, Polgar‐Turcsanyi M, Anderson M, Glanz BI, Guttman CRG, Bakshi R, Weiner HL, Chitnis T. Early predictors of clinical and MRI outcomes using LASSO in multiple sclerosis. Ann Neurol 2022; 92:87-96. [DOI: 10.1002/ana.26370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Gauruv Bose
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Brian C. Healy
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Hrishikesh A. Lokhande
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Marinos G. Sotiropoulos
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Mariann Polgar‐Turcsanyi
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Mark Anderson
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Bonnie I. Glanz
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Charles R. G. Guttman
- Harvard Medical School Boston MA US
- Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital Boston MA US
| | - Rohit Bakshi
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Howard L. Weiner
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Tanuja Chitnis
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
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Artemisinin derivative TPN10466 suppresses immune cell migration and Th1/Th17 differentiation to ameliorate disease severity in experimental autoimmune encephalomyelitis. Cell Immunol 2022; 373:104500. [DOI: 10.1016/j.cellimm.2022.104500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022]
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15
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Lokhande H, Rosso M, Tauhid S, Chu R, Healy BC, Saxena S, Barro C, Paul A, Polgar-Turcsanyi M, Anderson M, Glanz BI, Kropshofer H, Granziera C, Leppert D, Kappos L, Kuhle J, Weiner HL, Bakshi R, Chitnis T. Serum NfL levels in the first five years predict 10-year thalamic fraction in patients with MS. Mult Scler J Exp Transl Clin 2022; 8:20552173211069348. [PMID: 35035990 PMCID: PMC8753083 DOI: 10.1177/20552173211069348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Serum neurofilament light chain (sNfL) levels are associated with relapses, MRI lesions, and brain volume in multiple sclerosis (MS). Objective To explore the value of early serum neurofilament light (sNfL) measures in prognosticating 10-year regional brain volumes in MS. Methods Patients with MS enrolled in the Comprehensive Longitudinal Investigations in MS at Brigham and Women's Hospital (CLIMB) study within five years of disease onset who had annual blood samples from years 1–10 (n = 91) were studied. sNfL was measured with a single molecule array (SIMOA) assay. We quantified global cortical thickness and normalized deep gray matter (DGM) volumes (fractions of the thalamus, caudate, putamen, and globus pallidus) from high-resolution 3 T MRI at 10 years. Correlations between yearly sNfL levels and 10-year MRI outcomes were assessed using linear regression models. Results sNfL levels from years 1 and 2 were associated with 10-year thalamus fraction. Early sNfL levels were not associated with 10-year putamen, globus pallidus or caudate fractions. At 10 years, cortical thickness was not associated with early sNfL levels, but was weakly correlated with total DGM fraction. Conclusions Early sNfL levels correlate with 10-year thalamic volume, supporting its role as a prognostic biomarker in MS.
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Affiliation(s)
| | - Mattia Rosso
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | - Renxin Chu
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christian Barro
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | | | - Mark Anderson
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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16
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Liang L, Kim N, Hou J, Cai T, Dahal K, Lin C, Finan S, Savovoa G, Rosso M, Polgar-Tucsanyi M, Weiner H, Chitnis T, Cai T, Xia Z. Temporal trends of multiple sclerosis disease activity: Electronic health records indicators. Mult Scler Relat Disord 2022; 57:103333. [PMID: 35158446 PMCID: PMC8849591 DOI: 10.1016/j.msard.2021.103333] [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: 03/16/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Long-term data on multiple sclerosis (MS) inflammatory disease activity are limited. We examined electronic health records (EHR) indicators of disease activity in people with MS. METHODS We analyzed prospectively collected research registry data and linked EHR data in a clinic-based cohort from 2000 to 2016. We used the trend of the yearly incident relapse rate from the registry data as benchmark. We then calculated the temporal trends of potentially relevant EHR measures, including mean count of the MS diagnostic code, mentions of MS-related concepts, MS-related health utilizations and selected prescriptions. RESULTS 1,555 MS patients had both registry and EHR data. Between 2000 and 2016, the registry data showed a declining trend in the yearly incident relapse rate, parallel to an increasing trend of DMT usage. Among the EHR measures, covariate-adjusted frequency of diagnostic code of MS, procedure codes of MS-related imaging studies and emergency room visits, and electronic prescription for steroids declined over time, mirroring the temporal trend of the benchmark yearly incident relapse rate. CONCLUSION This study highlights EHR indicators of MS relapse that could enable large-scale examination of long-term disease activities or inform individual patient monitoring in clinical settings where EHR data are available.
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Affiliation(s)
- Liang Liang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Nicole Kim
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jue Hou
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Tianrun Cai
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kumar Dahal
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Chen Lin
- Clinical Natural Language Processing Program, Boston Children’s Hospital, Boston, MA, USA
| | - Sean Finan
- Clinical Natural Language Processing Program, Boston Children’s Hospital, Boston, MA, USA
| | - Guergana Savovoa
- Clinical Natural Language Processing Program, Boston Children’s Hospital, Boston, MA, USA
| | - Mattia Rosso
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Howard Weiner
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Zongqi Xia
- Department of Neurology and Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Roostaei T, Klein HU, Ma Y, Felsky D, Kivisäkk P, Connor SM, Kroshilina A, Yung C, Kaskow BJ, Shao X, Rhead B, Ordovás JM, Absher DM, Arnett DK, Liu J, Patsopoulos N, Barcellos LF, Weiner HL, De Jager PL. Proximal and distal effects of genetic susceptibility to multiple sclerosis on the T cell epigenome. Nat Commun 2021; 12:7078. [PMID: 34873174 PMCID: PMC8648735 DOI: 10.1038/s41467-021-27427-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/18/2021] [Indexed: 01/29/2023] Open
Abstract
Identifying the effects of genetic variation on the epigenome in disease-relevant cell types can help advance our understanding of the first molecular contributions of genetic susceptibility to disease onset. Here, we establish a genome-wide map of DNA methylation quantitative trait loci in CD4+ T-cells isolated from multiple sclerosis patients. Utilizing this map in a colocalization analysis, we identify 19 loci where the same haplotype drives both multiple sclerosis susceptibility and local DNA methylation. We also identify two distant methylation effects of multiple sclerosis susceptibility loci: a chromosome 16 locus affects PRDM8 methylation (a chromosome 4 region not previously associated with multiple sclerosis), and the aggregate effect of multiple sclerosis-associated variants in the major histocompatibility complex influences DNA methylation near PRKCA (chromosome 17). Overall, we present a new resource for a key cell type in inflammatory disease research and uncover new gene targets for the study of predisposition to multiple sclerosis.
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Affiliation(s)
- Tina Roostaei
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Hans-Ulrich Klein
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Yiyi Ma
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Daniel Felsky
- grid.17063.330000 0001 2157 2938Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Pia Kivisäkk
- grid.32224.350000 0004 0386 9924Alzheimer’s Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - Sarah M. Connor
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Alexandra Kroshilina
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Christina Yung
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
| | - Belinda J. Kaskow
- grid.62560.370000 0004 0378 8294Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Xiaorong Shao
- grid.47840.3f0000 0001 2181 7878Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, CA USA
| | - Brooke Rhead
- grid.47840.3f0000 0001 2181 7878Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, CA USA
| | - José M. Ordovás
- grid.429997.80000 0004 1936 7531Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA USA
| | - Devin M. Absher
- grid.417691.c0000 0004 0408 3720HudsonAlpha Institute for Biotechnology, Huntsville, AL USA
| | - Donna K. Arnett
- grid.266539.d0000 0004 1936 8438College of Public Health, University of Kentucky, Lexington, KY USA
| | - Jia Liu
- grid.212340.60000000122985718Advanced Science Research Center at the Graduate Center, Neuroscience Initiative, City University of New York, New York, NY USA
| | - Nikolaos Patsopoulos
- grid.62560.370000 0004 0378 8294Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Lisa F. Barcellos
- grid.47840.3f0000 0001 2181 7878Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, CA USA
| | - Howard L. Weiner
- grid.62560.370000 0004 0378 8294Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Philip L. De Jager
- grid.21729.3f0000000419368729Center for Translational and Computational Neuroimmunology, Department of Neurology and the Taub Institute for Research on Alzheimer’s disease and the Aging brain, Columbia University Irving Medical Center, New York, NY USA
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18
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Healy BC, Zurawski J, Chitnis T, Weiner HL, Glanz BI. Patient-reported outcomes associated with transition to secondary progressive multiple sclerosis. Qual Life Res 2021; 31:1799-1805. [PMID: 34783972 DOI: 10.1007/s11136-021-03034-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate patient-reported outcome (PRO) measures in patients with relapsing-remitting multiple sclerosis (RRMS) who transition to secondary progressive multiple sclerosis (SPMS). METHODS Subjects enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital (CLIMB) who completed PRO measures in the RRMS and SPMS phases were identified (n = 52). The PRO measures were Medical Outcomes Study Short-Form 36 Health Survey (SF-36), the Modified Fatigue Impact Scale (MFIS), and the Center for Epidemiologic Studies Depression Scale (CESD). Two control groups of RRMS CLIMB patients who did not progress to SPMS were identified based on different matching criteria related to age, sex, disease duration and Expanded Disability Status Scale (EDSS). Summary statistics for each PRO were calculated at the last RRMS measurement and first SPMS measurement, and the change over this transition was calculated using a paired t-test. Patients who transitioned were compared to the control groups using linear regression to adjust for age, disease duration and EDSS and a mixed model to further account for the matching with a random effect for matched group. RESULTS Patients who transitioned from RRMS to SPMS had noticeable deficits in terms of Quality of Life (QOL) and fatigue at the visit prior to the transition. Patients worsened in terms of SF-36 Role Physical (- 3.6 [- 6.6, - 0.7]), Social Functioning (- 3.7 [- 6.4, - 1.0]), and Physical Component Summary (- 2.3 [- 4.5, - 0.1]) during the transition from RRMS to SPMS. When patients who transitioned were compared to the matched subjects, they had worse scores on several outcomes, including Physical Functioning (adjusted mean difference = - 10.8 [- 14.1, - 7.5]), Physical Component Summary (- 5.2 [- 9.3, - 1.0]), fatigue (8.9 [1.7, 16.1]), and depression (3.1 [0.3, 5.9]). CONCLUSIONS Patients in the period closely preceding transition from RRMS to SPMS have worse physical QOL and fatigue compared to subjects who remain RRMS.
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Affiliation(s)
- Brian C Healy
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Neurology, Harvard Medical School, Boston, MA, USA. .,Biostatistics Center, Massachusetts General Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - Jonathan Zurawski
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
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19
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Hou J, Kim N, Cai T, Dahal K, Weiner H, Chitnis T, Cai T, Xia Z. Comparison of Dimethyl Fumarate vs Fingolimod and Rituximab vs Natalizumab for Treatment of Multiple Sclerosis. JAMA Netw Open 2021; 4:e2134627. [PMID: 34783826 PMCID: PMC8596196 DOI: 10.1001/jamanetworkopen.2021.34627] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023] Open
Abstract
Importance As disease-modifying treatment options for multiple sclerosis increase, comparisons of the options based on real-world evidence may guide clinical decision-making. Objective To compare the relapse outcomes between 2 pairs of disease-modifying treatments: dimethyl fumarate vs fingolimod and natalizumab vs rituximab. Design, Setting, and Participants This comparative effectiveness study integrated data from a clinic-based multiple sclerosis research registry and its linked electronic health records (EHR) system between January 1, 2006, and December 31, 2016, and built treatment groups for each pairwise disease-modifying treatment comparison according to both registry records and electronic prescriptions. Parallel analyses were conducted from October 11, 2019, to July 7, 2021. Main Outcomes and Measures The main outcomes were the 1-year and 2-year relapse rates as well as the time to relapse. To compare relapse outcomes, the study adjusted for covariates from 2 sources (registry and EHR) and corrected for confounding biases among the covariates by the doubly robust estimation. Results The study included 4 treatment groups: dimethyl fumarate (n = 260; 198 women [76.2%]; 227 non-Hispanic White individuals [87.3%]; mean [SD] age at diagnosis, 41.7 [10.4] years), fingolimod (n = 267; 190 women [71.2%]; 222 non-Hispanic White individuals [83.1%]; mean [SD] age at diagnosis, 37.9 [9.9] years), natalizumab (n = 204; 160 women [78.4%]; 172 non-Hispanic White individuals [84.3%]; mean [SD] age at diagnosis, 37.2 [10.6] years), and rituximab (n = 115; 83 women [72.2%]; 99 non-Hispanic White individuals [86.1%]; mean [SD] age at diagnosis, 44.1 [11.1] years). No significant differences were found in the relapse outcomes between dimethyl fumarate and fingolimod after correcting for confounding biases and multiple testing (difference in 1-year relapse rate, 0.028 [95% CI, -0.031 to 0.084]; difference in 2-year relapse rate, 0.071 [95% CI, 0.008-0.128]; relative risk of 2-year non-relapse, 0.957 [95% CI, 0.884-1.035] with dimethyl fumarate as reference). When compared with rituximab, natalizumab was associated with a higher relapse rate for all 3 outcomes after bias correction and multiple testing (difference in 1-year relapse rate, 0.080 [95% CI, 0.013-0.137]; difference in 2-year relapse rate, 0.132 [95% CI, 0.043-0.189]; relative risk of 2-year non-relapse, 0.903 [95% CI, 0.822-0.944]). Confounders were identified from EHR data not recorded in the registry data through data-driven feature selection. Conclusions and Relevance This study reports real-world evidence of equivalent relapse outcomes between dimethyl fumarate and fingolimod and relapse reduction in favor of rituximab relative to natalizumab. This approach illustrates the value of incorporating EHR data as high-dimensional covariates in real-world treatment comparison.
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Affiliation(s)
- Jue Hou
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicole Kim
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tianrun Cai
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kumar Dahal
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Howard Weiner
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Rammohan KW, Halper J, Lang S, Murphy SM, Patton L, Goodman C, Li DK. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS). Int J MS Care 2021; 23:269-275. [PMID: 35035298 PMCID: PMC8745232 DOI: 10.7224/1537-2073.2021-021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although many regional multiple sclerosis (MS) databases existed in the United States and Canada, there was no single clinician-derived registry that examined this disease as a group across the North American continent. This distinction is important because information that results from such a database can potentially give perspectives about MS that cannot be derived from any single regional registry. A partnership was forged between the pharmaceutical industry and the Consortium of Multiple Sclerosis Centers (CMSC) to create a registry of patients with MS from Canada and the United States, including Puerto Rico. Case report forms were created to collect physician-derived information, and the Patient-Reported Outcomes Measurement Information System (PROMIS) was selected to capture patient-reported outcomes. As of November 2021, 754 of 1000 patients have been enrolled. Completion of recruitment is expected by the end of 2021. Twenty-five centers are participating, with an expected total of 30, including five centers from Canada. Clinical status, health economic outcomes, magnetic resonance images, and, soon, biomarkers relevant to understanding relapses and progression are collected. The short-term goal is to understand and better treat MS disease progression, and the long-term goal is its prevention. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is one of few clinician/patient-generated registries that examines MS across North America, including Puerto Rico. Information derived from the natural history studies should help physicians, the pharmaceutical industry, and regulatory bodies understand MS better and improve quality of life for patients with MS worldwide.
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Affiliation(s)
| | - June Halper
- Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - Steven Lang
- From the University of Miami, Miami, FL, USA (KWR, SL, CG)
| | | | - Lisa Patton
- Social & Scientific Systems, Silver Spring, MD, USA (SMM, LP)
| | | | - David K.B. Li
- University of British Columbia, Vancouver, BC, Canada (DKBL)
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21
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Bohmwald K, Gálvez NMS, Andrade CA, Mora VP, Muñoz JT, González PA, Riedel CA, Kalergis AM. Modulation of Adaptive Immunity and Viral Infections by Ion Channels. Front Physiol 2021; 12:736681. [PMID: 34690811 PMCID: PMC8531258 DOI: 10.3389/fphys.2021.736681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022] Open
Abstract
Most cellular functions require of ion homeostasis and ion movement. Among others, ion channels play a crucial role in controlling the homeostasis of anions and cations concentration between the extracellular and intracellular compartments. Calcium (Ca2+) is one of the most relevant ions involved in regulating critical functions of immune cells, allowing the appropriate development of immune cell responses against pathogens and tumor cells. Due to the importance of Ca2+ in inducing the immune response, some viruses have evolved mechanisms to modulate intracellular Ca2+ concentrations and the mobilization of this cation through Ca2+ channels to increase their infectivity and to evade the immune system using different mechanisms. For instance, some viral infections require the influx of Ca2+ through ionic channels as a first step to enter the cell, as well as their replication and budding. Moreover, through the expression of viral proteins on the surface of infected cells, Ca2+ channels function can be altered, enhancing the pathogen evasion of the adaptive immune response. In this article, we review those ion channels and ion transporters that are essential for the function of immune cells. Specifically, cation channels and Ca2+ channels in the context of viral infections and their contribution to the modulation of adaptive immune responses.
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Affiliation(s)
- Karen Bohmwald
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás M. S. Gálvez
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina A. Andrade
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valentina P. Mora
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José T. Muñoz
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo A. González
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Millennium Institute on Immunology and Immunotherapy, Universidad Andres Bello, Santiago, Chile
| | - Alexis M. Kalergis
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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22
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Sotiropoulos MG, Lokhande H, Healy BC, Polgar-Turcsanyi M, Glanz BI, Bakshi R, Weiner HL, Chitnis T. Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability. Mult Scler J Exp Transl Clin 2021; 7:20552173211015503. [PMID: 34104471 PMCID: PMC8165535 DOI: 10.1177/20552173211015503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although recovery from relapses in MS appears to contribute to disability, it has largely been ignored as a treatment endpoint and disability predictor. Objective To identify demographic and clinical predictors of relapse recovery in the first 3 years and examine its contribution to 10-year disability and MRI outcomes. Methods Relapse recovery was retrospectively assessed in 360 patients with MS using the return of the Expanded Disability Status Scale (EDSS), Functional System Scale and neurologic signs to baseline at least 6 months after onset. Univariate and multivariable models were used to associate recovery with demographic and clinical factors and predict 10-year outcomes. Results Recovery from relapses in the first 3 years was better in patients who were younger, on disease-modifying treatment, with a longer disease duration and without bowel or bladder symptoms. For every incomplete recovery, 10-year EDSS increased by 0.6 and 10-year timed 25-foot walk increased by 0.5 s. These outcomes were also higher with older age and higher baseline BMI. Ten-year MRI brain atrophy was associated only with older age, and MRI lesion volume was only associated with smoking. Conclusions Early initiation of disease-modifying treatment in MS was associated with improved relapse recovery, which in turn prevented long-term disability.
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Affiliation(s)
- Marinos G Sotiropoulos
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Hrishikesh Lokhande
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mariann Polgar-Turcsanyi
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rohit Bakshi
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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23
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Palotai M, Wallack M, Kujbus G, Dalnoki A, Guttmann C. Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study. JMIR Mhealth Uhealth 2021; 9:e19564. [PMID: 33861208 PMCID: PMC8087974 DOI: 10.2196/19564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/10/2020] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity.
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Affiliation(s)
- Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Max Wallack
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | - Charles Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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24
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Healy BC, Glanz BI, Swallow E, Signorovitch J, Hagan K, Silva D, Pelletier C, Chitnis T, Weiner H. Confirmed disability progression provides limited predictive information regarding future disease progression in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:2055217321999070. [PMID: 33953937 PMCID: PMC8042549 DOI: 10.1177/2055217321999070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although confirmed disability progression (CDP) is a common outcome in multiple sclerosis (MS) clinical trials, its predictive value for long-term outcomes is uncertain. Objective To investigate whether CDP at month 24 predicts subsequent disability accumulation in MS. Methods The Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital includes participants with relapsing-remitting MS or clinically isolated syndrome with Expanded Disability Status Scale (EDSS) scores ≤5 (N = 1214). CDP was assessed as a predictor of time to EDSS score 6 (EDSS 6) and to secondary progressive MS (SPMS) using a Cox proportional hazards model; adjusted models included additional clinical/participant characteristics. Models were compared using Akaike's An Information Criterion. Results CDP was directionally associated with faster time to EDSS 6 in univariate analysis (HR = 1.61 [95% CI: 0.83, 3.13]). After adjusting for month 24 EDSS, CDP was directionally associated with slower time to EDSS 6 (adjusted HR = 0.65 [0.32, 1.28]). Models including CDP had worse fit statistics than those using EDSS scores without CDP. When models included clinical and magnetic resonance imaging measures, T2 lesion volume improved fit statistics. Results were similar for time to SPMS. Conclusions CDP was less predictive of time to subsequent events than other MS clinical features.
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Lv J, Zhuang W, Zhang Y, Xie L, Xiang Z, Zhao Q, Jiang X, Shen J, Du C. 9,10-Anhydrodehydroartemisinin Attenuates Experimental Autoimmune Encephalomyelitis by Inhibiting Th1 and Th17 Cell Differentiation. Inflammation 2021; 44:1793-1802. [PMID: 33788130 DOI: 10.1007/s10753-021-01456-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
Human inflammatory disease, multiple sclerosis (MS), is a demyelinating disease of central nervous system (CNS). The experimental autoimmune encephalomyelitis (EAE) is the most commonly used as experimental model because of its key pathological features' approximation of MS. The interaction between complex elements in immune system and in the CNS determines the MS pathogenesis. However, there is no cure for MS and the treatment for MS still encounters great challenges. Thus, finding a more effective disease-modifying treatment is imminent. In the present study, we investigated whether 9,10-Anhydrodehydroartemisin (ADART), a compound derived from artemisinin, could decrease demyelination in EAE and the underlying mechanisms. In established EAE mice, 100 mg/kg 9,10-Anhydrodehydroartemisinin (ADART) effectively reduced CNS and peripheral immune system infiltration inflammatory cells including CD4+ IFN-γ+ Th1 cells and CD4+ IL-17A+ Th17 cells. Correspondingly, the serum level of IFN-γ and IL-17A was also reduced. In vitro, ADART almost completely inhibited Th17 differentiation, and partially inhibited Th1 differentiation in 10 μM. This research revealed that ADART could be a great promising avenue among current therapies for MS.
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Affiliation(s)
- Jie Lv
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China
| | - Wei Zhuang
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China.,National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100049, China
| | - Yan Zhang
- Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, 40-1 Beijing Road, Urumqi, 830011, Xinjiang, China
| | - Ling Xie
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China
| | - Zhenglong Xiang
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China
| | - Qingjie Zhao
- CAS Key Laboratory for Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai, 201203, China
| | - Xiangrui Jiang
- University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100049, China. .,CAS Key Laboratory for Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai, 201203, China.
| | - Jingshan Shen
- University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100049, China.,State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai, 201203, China
| | - Changsheng Du
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China. .,State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai, 201203, China.
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26
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Chu DT, Rosso M, Gonzalez CT, Saxena S, Healy BC, Weiner HL, Chitnis T. Obesity is associated with the Optic Neuritis severity in Male patients with Multiple Sclerosis. Mult Scler Relat Disord 2021; 51:102910. [PMID: 33799288 DOI: 10.1016/j.msard.2021.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/27/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is an important modifiable risk factor of MS; a deeper biological understanding of this association is needed. OBJECTIVE To evaluate the determinants of acute optic neuritis (AON) severity and recovery in multiple sclerosis (MS). METHODS We included 61 patients with MS with recorded AON severity and recovery according to visual acuity outcomes before, at, and, after the relapse. We measured body mass index (BMI) and the serum concentration of estrogen, leptin, testosterone, sex hormone-binding globulin, and vitamin D. We tested the association between BMI and serum hormones and AON severity and recovery with logistic regressions. RESULTS In males, moderate/severe AON was associated with higher BMI (31.26 kg/m2 vs 25.73 kg/m2, logistic regression, p= 0.03), higher serum estrogen levels (32.24 nmol/L vs 23.06 nmol/L, logistic regression, p=0.04), and higher serum leptin levels (12.29 ng/mL vs mild AON: 4.1 ng/mL, logistic regression, p=0.06) than mild AON. These observations were not seen in female patients. We did not find an association with BMI or hormone levels and AON recovery. CONCLUSION BMI, serum leptin, and serum estrogen were associated with AON severity in male patients but not in female patients. No association of these factors and AON recovery was observed.
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Affiliation(s)
- Duong T Chu
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Mattia Rosso
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Cindy T Gonzalez
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Shrishti Saxena
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts, US; Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US.
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27
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Ahuja Y, Kim N, Liang L, Cai T, Dahal K, Seyok T, Lin C, Finan S, Liao K, Savovoa G, Chitnis T, Cai T, Xia Z. Leveraging electronic health records data to predict multiple sclerosis disease activity. Ann Clin Transl Neurol 2021; 8:800-810. [PMID: 33626237 PMCID: PMC8045951 DOI: 10.1002/acn3.51324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/26/2020] [Accepted: 02/01/2021] [Indexed: 12/26/2022] Open
Abstract
Objective No relapse risk prediction tool is currently available to guide treatment selection for multiple sclerosis (MS). Leveraging electronic health record (EHR) data readily available at the point of care, we developed a clinical tool for predicting MS relapse risk. Methods Using data from a clinic‐based research registry and linked EHR system between 2006 and 2016, we developed models predicting relapse events from the registry in a training set (n = 1435) and tested the model performance in an independent validation set of MS patients (n = 186). This iterative process identified prior 1‐year relapse history as a key predictor of future relapse but ascertaining relapse history through the labor‐intensive chart review is impractical. We pursued two‐stage algorithm development: (1) L1‐regularized logistic regression (LASSO) to phenotype past 1‐year relapse status from contemporaneous EHR data, (2) LASSO to predict future 1‐year relapse risk using imputed prior 1‐year relapse status and other algorithm‐selected features. Results The final model, comprising age, disease duration, and imputed prior 1‐year relapse history, achieved a predictive AUC and F score of 0.707 and 0.307, respectively. The performance was significantly better than the baseline model (age, sex, race/ethnicity, and disease duration) and noninferior to a model containing actual prior 1‐year relapse history. The predicted risk probability declined with disease duration and age. Conclusion Our novel machine‐learning algorithm predicts 1‐year MS relapse with accuracy comparable to other clinical prediction tools and has applicability at the point of care. This EHR‐based two‐stage approach of outcome prediction may have application to neurological disease beyond MS.
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Affiliation(s)
- Yuri Ahuja
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Nicole Kim
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Liang Liang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Tianrun Cai
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kumar Dahal
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thany Seyok
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chen Lin
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Sean Finan
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Katherine Liao
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savovoa
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Zongqi Xia
- Department of Neurology and Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Chitnis T, Aaen G, Belman A, Benson L, Gorman M, Goyal MS, Graves JS, Harris Y, Krupp L, Lotze T, Mar S, Ness J, Rensel M, Schreiner T, Tillema JM, Waubant E, Weinstock-Guttman B, Roalstad S, Rose J, Weiner HL, Casper TC, Rodriguez M. Improved relapse recovery in paediatric compared to adult multiple sclerosis. Brain 2021; 143:2733-2741. [PMID: 32810215 DOI: 10.1093/brain/awaa199] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/01/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022] Open
Abstract
Incomplete relapse recovery contributes to disability accrual and earlier onset of secondary progressive multiple sclerosis. We sought to investigate the effect of age on relapse recovery. We identified patients with multiple sclerosis from two longitudinal prospective studies, with an Expanded Disability Status Scale (EDSS) score within 30 days after onset of an attack, and follow-up EDSS 6 months after attack. Adult patients with multiple sclerosis (n = 632) were identified from the Comprehensive Longitudinal Investigations in Multiple Sclerosis at Brigham study (CLIMB), and paediatric patients (n = 132) from the US Network of Paediatric Multiple Sclerosis Centers (NPMSC) registry. Change in EDSS was defined as the difference in EDSS between attack and follow-up. Change in EDSS at follow-up compared to baseline was significantly lower in children compared to adults (P = 0.001), as were several functional system scores. Stratification by decade at onset for change in EDSS versus age found for every 10 years of age, EDSS recovery is reduced by 0.15 points (P < 0.0001). A larger proportion of children versus adults demonstrated improvement in EDSS following an attack (P = 0.006). For every 10 years of age, odds of EDSS not improving increase by 1.33 times (P < 0.0001). Younger age is associated with improved recovery from relapses. Age-related mechanisms may provide novel therapeutic targets for disability accrual in multiple sclerosis.
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Affiliation(s)
- Tanuja Chitnis
- Partners Paediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg Aaen
- Paediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Anita Belman
- Paediatric MS Center at NYU Langone Health, New York, NY, USA
| | - Leslie Benson
- Paediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, MA, USA
| | - Mark Gorman
- Paediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, MA, USA
| | | | - Jennifer S Graves
- Paediatric Multiple Sclerosis Center, University of California San Diego, San Diego, CA, USA
| | - Yolanda Harris
- UAB Center for Paediatric-Onset Demyelinating Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Krupp
- Paediatric MS Center at NYU Langone Health, New York, NY, USA
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- Washington University, St. Louis, MO, USA
| | - Jayne Ness
- UAB Center for Paediatric-Onset Demyelinating Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center, Children's Hospital Colorado, University of Colorado at Denver, Aurora, CO, USA
| | - Jan-Mendelt Tillema
- Mayo Clinic Paediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - Emmanuelle Waubant
- Paediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- Jacobs Paediatric Multiple Sclerosis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shelly Roalstad
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - John Rose
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, MA, USA.,Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Moses Rodriguez
- Mayo Clinic Paediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
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29
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Palotai M, Small C, Makris N, Somes NG, Pinzon AM, Rathi Y, Marzullo A, Levitt JJ, Bakshi R, Chitnis T, Guttmann CRG. Microstructural Changes in the Left Mesocorticolimbic Pathway are Associated with the Comorbid Development of Fatigue and Depression in Multiple Sclerosis. J Neuroimaging 2021; 31:501-507. [PMID: 33522683 DOI: 10.1111/jon.12832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/07/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Lower reward responsiveness has been associated with fatigue in multiple sclerosis (MS). However, association of MS-related fatigue with damage to the mesocorticolimbic reward pathway (superolateral medial forebrain bundle [slMFB]) has not been assessed. We investigated the association of fatigue and depression with slMFB damage in MS patients stratified based on longitudinal fatigue patterns. METHODS Patient stratification: 1. Sustained Fatigue (SF): latest two Modified Fatigue Impact Scale (MFIS) ≥ 38 (n = 26); 2. Reversible Fatigue (RF): latest MFIS < 38, and at least one previous MFIS ≥ 38 (n = 25); 3. Never Fatigued (NF): ≥ 5 consecutive MFIS < 38 (n = 42); 4. Healthy Controls (n = 6). Diffusion MRI-derived measures of fractional anisotropy (FA), axial (AD), mean (MD), and radial diffusivity (RD) of the slMFB were compared between the groups. Depression was assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D). RESULTS Depressed (CES-D ≥ 16) SF patients showed significantly higher MD and RD than nondepressed SF and RF, and depressed RF patients, and significantly lower FA than nondepressed SF and depressed RF patients in their left slMFB. Depressed SF patients showed significantly higher left slMFB MD and AD than healthy controls. CONCLUSION Microstructural changes to the left slMFB may play a role in the comorbid development of fatigue and depression in MS.
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Affiliation(s)
- Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Catherine Small
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nikolaos Makris
- Psychiatry Neuroimaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Morphometric Analysis, Departments of Psychiatry and Neurology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA
| | - Nathaniel G Somes
- Psychiatry Neuroimaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - James J Levitt
- Psychiatry Neuroimaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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30
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Rosso M, Healy BC, Saxena S, Paul A, Bjornevik K, Kuhle J, Benkert P, Leppert D, Guttmann C, Bakshi R, Weiner HL, Chitnis T. MRI Lesion State Modulates the Relationship Between Serum Neurofilament Light and Age in Multiple Sclerosis. J Neuroimaging 2021; 31:388-393. [DOI: 10.1111/jon.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Mattia Rosso
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Brian C. Healy
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Biostatistics Center Massachusetts General Hospital Boston MA
| | - Shrishti Saxena
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Anu Paul
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Kjetil Bjornevik
- Harvard T.H. Chan School of Public Health Harvard University Boston MA
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research University Hospital Basel University of Basel Basel Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel University of Basel Basel Switzerland
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research University Hospital Basel University of Basel Basel Switzerland
| | - Charles Guttmann
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Rohit Bakshi
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Howard L. Weiner
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Tanuja Chitnis
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
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31
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Wu X, Zhang K, Xing Y, Zhou W, Shao Y, Li G, Rui Q. Dysregulated thyroid hormones correlate with anxiety and depression risk in patients with autoimmune disease. J Clin Lab Anal 2020; 35:e23573. [PMID: 33210405 PMCID: PMC7843266 DOI: 10.1002/jcla.23573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/29/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Autoimmune disease (AID) patients always present with increased risk of psychiatric disorders, and thyroid function or thyroid hormone may play a critical role in the development of anxiety and depression. Thus, this study aimed to assess the free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid‐stimulating hormone (TSH) levels, and their correlations with anxiety/depression in patients with AID. Methods Ninety‐eight AID patients and 100 health controls (HCs) were recruited. Serum samples were obtained from all the participants to detect FT3, FT4, and TSH levels. Anxiety and depression were determined using the HADS assessment. Results HADS‐Anxiety score, anxiety subject percentage, HADS‐Depression score, and depression subject proportion were elevated in AID patients compared with HCs. FT3 and FT4 were downregulated while TSH was upregulated in AID patients compared with HCs. In AID patients, FT3 and FT4 negatively correlated with HADS‐Anxiety score, and they were downregulated in patients with anxiety compared to patients without anxiety. Meanwhile, FT3 and FT4 were negatively associated while TSH level positively associated with HADS‐Depression score. Besides, FT3 and FT4 reduced, but TSH level was of no difference in patients with depression compared to patients without depression. Additionally, increased FT4 independently correlated with both reduced anxiety risk and depression risk. Conclusions FT3, FT4, and TSH are dysregulated, and FT4 has the potential to serve as an independent biomarker related to anxiety as well as depression in AID patients. These findings may provide some information on the values of thyroid hormones in facilitating the management of AID patients with anxiety/depression.
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Affiliation(s)
- Xiaorong Wu
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kaikai Zhang
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yulong Xing
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Zhou
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yanqiu Shao
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guizheng Li
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Rui
- Department of Rheumatology, Gaochun Branch, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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32
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Ratajska A, Glanz BI, Chitnis T, Weiner HL, Healy BC. Social support in multiple sclerosis: Associations with quality of life, depression, and anxiety. J Psychosom Res 2020; 138:110252. [PMID: 32971435 DOI: 10.1016/j.jpsychores.2020.110252] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 09/04/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Social support plays a role in the well-being of persons with multiple sclerosis (PwMS). The aims of this study were to compare social support in PwMS with relapsing versus progressive disease, examine the relationships with patient reported outcomes (PROs), and investigate social support longitudinally. METHODS For this study, we have performed an analysis of data routinely collected from subjects enrolled in the CLIMB at the Partners MS Center. Subjects (n = 789) completed measures of social support, quality of life (QOL), depression, and anxiety. Relapsing and progressive PwMS were compared using a two sample t-test, and linear regression was used to adjust for other variables. Correlations between social support and PROs were assessed using partial Pearson's correlation coefficient. A random intercept and slope model with a linear trend with time estimated the change over time. RESULTS Subjects with relapsing MS reported higher overall social support than subjects with progressive disease (difference in means = -6.7; 95% CI: -10.3, -3.1) as well as higher levels of 3 of the 4 dimensions of social support measured. These differences remained after adjusting for age and gender only, but were attenuated adjusting for age, gender, and depression (adjusted difference in means = -1.2; 95% CI: -5.0, 2.6). Higher overall social support was associated with higher QOL (r = 0.16-0.27), lower depression (r = -0.36), and lower state (r = -0.27) and trait (r = -0.29) anxiety. Social support was mostly stable over time. CONCLUSION Social support was associated with QOL, depression, and anxiety in PwMS.
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Affiliation(s)
- Adrianna Ratajska
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
| | - Bonnie I Glanz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Howard L Weiner
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Neurology, Harvard Medical School, Boston, MA, United States of America; Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States of America.
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Li S, Weinstein G, Zare H, Teumer A, Völker U, Friedrich N, Knol MJ, Satizabal CL, Petyuk VA, Adams HHH, Launer LJ, Bennett DA, De Jager PL, Grabe HJ, Ikram MA, Gudnason V, Yang Q, Seshadri S. The genetics of circulating BDNF: towards understanding the role of BDNF in brain structure and function in middle and old ages. Brain Commun 2020; 2:fcaa176. [PMID: 33345186 PMCID: PMC7734441 DOI: 10.1093/braincomms/fcaa176] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays an important role in brain development and function. Substantial amounts of BDNF are present in peripheral blood, and may serve as biomarkers for Alzheimer’s disease incidence as well as targets for intervention to reduce Alzheimer’s disease risk. With the exception of the genetic polymorphism in the BDNF gene, Val66Met, which has been extensively studied with regard to neurodegenerative diseases, the genetic variation that influences circulating BDNF levels is unknown. We aimed to explore the genetic determinants of circulating BDNF levels in order to clarify its mechanistic involvement in brain structure and function and Alzheimer’s disease pathophysiology in middle-aged and old adults. Thus, we conducted a meta-analysis of genome-wide association study of circulating BDNF in 11 785 middle- and old-aged individuals of European ancestry from the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES), the Framingham Heart Study (FHS), the Rotterdam Study and the Study of Health in Pomerania (SHIP-Trend). Furthermore, we performed functional annotation analysis and related the genetic polymorphism influencing circulating BDNF to common Alzheimer’s disease pathologies from brain autopsies. Mendelian randomization was conducted to examine the possible causal role of circulating BDNF levels with various phenotypes including cognitive function, stroke, diabetes, cardiovascular disease, physical activity and diet patterns. Gene interaction networks analysis was also performed. The estimated heritability of BDNF levels was 30% (standard error = 0.0246, P-value = 4 × 10−48). We identified seven novel independent loci mapped near the BDNF gene and in BRD3, CSRNP1, KDELC2, RUNX1 (two single-nucleotide polymorphisms) and BDNF-AS. The expression of BDNF was associated with neurofibrillary tangles in brain tissues from the Religious Orders Study and Rush Memory and Aging Project (ROSMAP). Seven additional genes (ACAT1, ATM, NPAT, WDR48, TTC21A, SCN114 and COX7B) were identified through expression and protein quantitative trait loci analyses. Mendelian randomization analyses indicated a potential causal role of BDNF in cardioembolism. Lastly, Ingenuity Pathway Analysis placed circulating BDNF levels in four major networks. Our study provides novel insights into genes and molecular pathways associated with circulating BDNF levels and highlights the possible involvement of plaque instability as an underlying mechanism linking BDNF with brain neurodegeneration. These findings provide a foundation for a better understanding of BDNF regulation and function in the context of brain aging and neurodegenerative pathophysiology.
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Affiliation(s)
- Shuo Li
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Galit Weinstein
- School of Public Health, University of Haifa, Haifa 3498838, Israel
| | - Habil Zare
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, TX, USA.,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, 78229 TX, USA
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Uwe Völker
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Maria J Knol
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, 78229 TX, USA.,Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA.,The Framingham Study, Framingham, MA 01702, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Hieab H H Adams
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam 3015 CN, The Netherlands
| | - Lenore J Launer
- Department of Health and Human Services, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - David A Bennett
- Department of Neurology, Rush University Medical Center, Chicago, IL 60612, USA.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Philip L De Jager
- Department of Neurology, Center for Translational and Computational Neuroimmunology, Columbia University Medical Center, New York, NY 10032, USA.,Program in Population and Medical Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02141, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany.,German Center for Neurodegererative Diseases (DZNE), Rostock/Greifswald, Germany
| | - M Arfan Ikram
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Vilmundur Gudnason
- Faculty of Medicine, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland.,Icelandic Heart Association, 201 Kopavogur, Iceland
| | - Qiong Yang
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, 78229 TX, USA.,The Framingham Study, Framingham, MA 01702, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
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Zhao Y, Wang T, Bove R, Cree B, Henry R, Lokhande H, Polgar-Turcsanyi M, Anderson M, Bakshi R, Weiner HL, Chitnis T. Ensemble learning predicts multiple sclerosis disease course in the SUMMIT study. NPJ Digit Med 2020; 3:135. [PMID: 33083570 PMCID: PMC7567781 DOI: 10.1038/s41746-020-00338-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
The rate of disability accumulation varies across multiple sclerosis (MS) patients. Machine learning techniques may offer more powerful means to predict disease course in MS patients. In our study, 724 patients from the Comprehensive Longitudinal Investigation in MS at Brigham and Women's Hospital (CLIMB study) and 400 patients from the EPIC dataset, University of California, San Francisco, were included in the analysis. The primary outcome was an increase in Expanded Disability Status Scale (EDSS) ≥ 1.5 (worsening) or not (non-worsening) at up to 5 years after the baseline visit. Classification models were built using the CLIMB dataset with patients' clinical and MRI longitudinal observations in first 2 years, and further validated using the EPIC dataset. We compared the performance of three popular machine learning algorithms (SVM, Logistic Regression, and Random Forest) and three ensemble learning approaches (XGBoost, LightGBM, and a Meta-learner L). A "threshold" was established to trade-off the performance between the two classes. Predictive features were identified and compared among different models. Machine learning models achieved 0.79 and 0.83 AUC scores for the CLIMB and EPIC datasets, respectively, shortly after disease onset. Ensemble learning methods were more effective and robust compared to standalone algorithms. Two ensemble models, XGBoost and LightGBM were superior to the other four models evaluated in our study. Of variables evaluated, EDSS, Pyramidal Function, and Ambulatory Index were the top common predictors in forecasting the MS disease course. Machine learning techniques, in particular ensemble methods offer increased accuracy for the prediction of MS disease course.
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Affiliation(s)
- Yijun Zhao
- Department of Computer and Information Science, Fordham University, New York, NY USA
| | - Tong Wang
- Department of Computer and Information Science, Fordham University, New York, NY USA
| | - Riley Bove
- University of California, San Francisco, MA USA
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
| | - Bruce Cree
- University of California, San Francisco, MA USA
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
| | - Roland Henry
- University of California, San Francisco, MA USA
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
| | - Hrishikesh Lokhande
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Mariann Polgar-Turcsanyi
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Mark Anderson
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Rohit Bakshi
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Howard L Weiner
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Tanuja Chitnis
- SUMMIT Consortium, Boston, MA USA
- SUMMIT Consortium, San Francisco, CA USA
- Brigham Multiple Sclerosis Center, Ann Romney Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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Freedman ME, Healy BC, Huffman JC, Chitnis T, Weiner HL, Glanz BI. An At-home Positive Psychology Intervention for Individuals with Multiple Sclerosis: A Phase 1 Randomized Controlled Trial. Int J MS Care 2020; 23:128-134. [PMID: 34177385 DOI: 10.7224/1537-2073.2020-020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Positive psychology (PP) uses targeted activities to increase the frequency and intensity of positive feelings and may improve overall well-being in medically ill populations. In this phase 1 randomized controlled trial, we examined the feasibility, acceptability, and potential impact of a 5-week, telephone-delivered PP intervention for individuals with multiple sclerosis (MS). Methods Participants were randomized 1:1 to a 5-week at-home PP intervention or a waitlist control condition. Participants engaged in weekly telephone calls with a study trainer and completed one PP exercise, such as recalling a past success, each week. Feasibility was determined by the number of sessions completed, and acceptability was assessed by weekly postexercise participant ratings of ease and utility. Efficacy was explored by examining between-group differences in changes from baseline on psychological variables, health-related quality of life, and self-reported functional activities at 5 and 10 weeks. Results Of 30 patients enrolled in the study, 28 (93%) completed all exercises. Ease scores ranged from 7.7 to 8.7 of 10 and utility scores ranged from 8.2 to 8.7 of 10. The PP intervention was associated with significantly greater increases (P < .05) in positive affect, optimism, state and trait anxiety, general health, and resilience in the intervention group versus the control group. Approximately half of the PP participants maintained at least 50% of the improvement at 10 weeks. Conclusions This 5-week, telephone-based PP intervention was feasible and acceptable to individuals with MS. Larger randomized controlled trials are warranted to further investigate the utility of this intervention to improve well-being and other health outcomes in MS.
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Zhang T, Goodman M, Zhu F, Healy B, Carruthers R, Chitnis T, Weiner H, Cai T, De Jager P, Tremlett H, Xia Z. Phenome-wide examination of comorbidity burden and multiple sclerosis disease severity. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e864. [PMID: 32817202 PMCID: PMC7673286 DOI: 10.1212/nxi.0000000000000864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
Objective We assessed the comorbidity burden associated with multiple sclerosis (MS) severity by performing a phenome-wide association study (PheWAS). Methods We conducted a PheWAS in 2 independent cohorts: a discovery (Boston, United States; 1993–2014) and extension cohort (British Columbia, Canada; 1991–2008). We included adults with MS, ≥1 Expanded Disability Status Scale (EDSS) score, and ≥1 International Classification of Diseases (ICD) code other than MS. We calculated the Multiple Sclerosis Severity Score (MSSS) using the EDSS. We mapped ICD codes into PheCodes (phenotypes), using a published system with each PheCode representing a unique medical condition. Association between the MSSS and the presence of each condition was assessed using logistic regression adjusted for covariates. Results The discovery and extension cohorts included 3,439 and 4,876 participants, respectively. After Bonferroni correction and covariate adjustments, a higher MSSS was associated with 37 coexisting conditions in the discovery cohort. Subsequently, 16 conditions, including genitourinary, infectious, metabolic, epilepsy, and movement disorders, met the reporting criteria, reaching the Bonferroni threshold of significance with the same direction of effect in the discovery and extension cohort. Notably, benign neoplasm of the skin was inversely associated with the MSSS. Conclusion The phenome-wide approach enabled a systematic interrogation of the comorbidity burden and highlighted clinically relevant medical conditions associated with MS severity (beyond MS-specific consequences) and defines a roadmap for comprehensive investigation of comorbidities in chronic neurologic diseases. Further prospective investigation of the bidirectional relationship between disability and comorbidities could inform the individualized patient management.
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Affiliation(s)
- Tingting Zhang
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Matthew Goodman
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Feng Zhu
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Brian Healy
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Robert Carruthers
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Tanuja Chitnis
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Howard Weiner
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Tianxi Cai
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Philip De Jager
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Helen Tremlett
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Zongqi Xia
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA.
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Sádaba MC, Rothhammer V, Muñoz Ú, Sebal C, Escudero E, Kivisäkk P, Garcia Sanchez MI, Izquierdo G, Hauser SL, Baranzini SE, Oksenberg JR, Álvarez-Lafuente R, Bakshi R, Weiner HL, Quintana FJ. Serum antibodies to phosphatidylcholine in MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e765. [PMID: 32518205 PMCID: PMC7309529 DOI: 10.1212/nxi.0000000000000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the value of serum immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies reactive with phosphatidylcholine (PC) and lactosylceramide (LC) as biomarkers in MS. METHODS We developed an ultrasensitive ELISA technique to analyze serum IgG and IgM antibodies to LC and PC, which we used to analyze samples from 362 patients with MS, 10 patients with non-MS myelin diseases (Non-MSMYDs), 11 patients with nonmyelin neurologic diseases (Non-MYNDs), and 80 controls. MS serum samples included clinically isolated syndrome (CIS, n = 17), relapsing-remitting MS (RRMS, n = 62), secondary progressive MS (SPMS, n = 50), primary progressive MS (PPMS, n = 37), and benign MS (BENMS, n = 36). RESULTS We detected higher levels of serum IgM antibodies to PC (IgM-PC) in MS than control samples; patients with CIS and RRMS showed higher IgM-PC levels than patients with SPMS, PPMS, and BENMS and controls. MS and control samples did not differ in serum levels of IgM antibodies reactive with LC, nor in IgG antibodies reactive with LC or PC. CONCLUSIONS Serum IgM-PC antibodies are elevated in patients with MS, particularly during the CIS and RRMS phases of the disease. Thus, serum IgM-PC is a candidate biomarker for early inflammatory stages of MS. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that serum antibodies to PC are elevated in patients with MS. The study is rated Class III because of the case control design and the risk of spectrum bias: antibody levels in patients with MS were compared with healthy controls.
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Affiliation(s)
- Maria Cruz Sádaba
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA.
| | - Veit Rothhammer
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Úrsula Muñoz
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Cristina Sebal
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Esther Escudero
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Pia Kivisäkk
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Maria Isabel Garcia Sanchez
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Guillermo Izquierdo
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Stephen L Hauser
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Sergio E Baranzini
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Jorge R Oksenberg
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Roberto Álvarez-Lafuente
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Rohit Bakshi
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Howard L Weiner
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA
| | - Francisco J Quintana
- From the Ann Romney Center for Neurologic Diseases (M.C.S., V.R., P.K., R.B., H.L.W., F.J.Q.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Facultad de Medicina (M.C.S., U.M., C.S., E.E.), Instituto de Medicina Molecular Aplicada (INMA), Universidad San Pablo-CEU, CEU Universities, Madrid; Molecular Biology Service and MS Unit (M.I.G.S., G.I.), University of Sevilla; Department of Neurology (S.L.H., S.E.B., J.R.O.), University of California, San Francisco; Instituto de Investigación Sanitaria San Carlos (IdISSC) (R.Á.-L.), Hospital Clínico San Carlos, Madrid, Spain; and The Broad Institute of Harvard and MIT (F.J.Q.), Cambridge, MA.
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Rosso M, Gonzalez CT, Healy BC, Saxena S, Paul A, Bjornevik K, Kuhle J, Benkert P, Leppert D, Guttmann C, Bakshi R, Weiner HL, Chitnis T. Temporal association of sNfL and gad-enhancing lesions in multiple sclerosis. Ann Clin Transl Neurol 2020; 7:945-955. [PMID: 32452160 PMCID: PMC7318095 DOI: 10.1002/acn3.51060] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/26/2020] [Accepted: 04/25/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Multiple sclerosis (MS) is an autoimmune demyelinating disorder, which is characterized by relapses and remissions. Serum neurofilament light chain (sNfL) is an emerging biomarker of disease activity but its clinical use is still limited. In this study, we aim to characterize the temporal association between sNfL and new clinical relapses and new gadolinium‐enhancing (Gd+) lesions. Methods Annual sNfL levels were measured with a single‐molecule array (SIMOA) assay in 94 patients with MS enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB) study. We used a multivariable linear mixed‐effects model to test the temporal association of sNfL with clinical relapses and/or new Gd+ lesions. We adjusted this model for age, disease duration, sex, and disease‐modifying therapies (DMTs) use. Results In the 3 months after a Gd+ lesion, we observed an average 35% elevation in sNfL (P < 0.0001) compared to remission samples. We also observed an average 32.3% elevation in sNfL at the time of or prior to a Gd+ lesion (P = 0.002) compared to remission. We observed a significant elevation in sNfL after a clinical relapse only when associated with a Gd+ lesion. Interpretation Our findings support sNfL as a marker of clinical relapses and Gd+ lesions. sNfL peaks in a 3‐month window around Gd+ lesions. sNfL shows promise as a biomarker of neurological inflammation and possibly of simultaneous Gd+ lesions during a clinical relapse.
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Affiliation(s)
- Mattia Rosso
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Cindy T Gonzalez
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA.,Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
| | - Shrishti Saxena
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Anu Paul
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Kjetil Bjornevik
- Department on Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jens Kuhle
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Leppert
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Charles Guttmann
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Rohit Bakshi
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA.,Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA.,Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tanuja Chitnis
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, 02115, USA.,Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Clinical outcome measures in multiple sclerosis: A review. Autoimmun Rev 2020; 19:102512. [DOI: 10.1016/j.autrev.2020.102512] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023]
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Healy BC, Barker L, Bakshi R, Benedict RHB, Gonzalez CT, Chitnis T, Weiner HL, Glanz BI. Trajectories of Symbol Digit Modalities Test performance in individuals with multiple sclerosis. Mult Scler 2020; 27:593-602. [DOI: 10.1177/1352458520913439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Although cognitive problems have been identified in people with multiple sclerosis (PwMS), few studies have investigated the long-term change in cognitive functioning. Objective: To identify trajectories of change in cognitive functioning for PwMS. Methods: Participants enrolled in the quality-of-life subgroup from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) were eligible for our analysis. In 2006, participants in this group began to complete the Symbol Digit Modalities Test (SDMT) annually. Latent trajectory models were used to identify groups of participants with similar longitudinal change in SDMT scores. Linear and quadratic trajectory models were fit, and the models were compared. Latent trajectory models were also fit adjusting for baseline age and disease duration as well as using normalized SDMT scores. The groups identified across the approaches were compared. Results: We found that classes with higher-than-average baseline values improved, classes with average baseline values remained relatively constant, and classes with lower baseline values experienced cognitive worsening. Similar results were observed in the alternative latent trajectory models accounting for other variables. Conclusion: Our models show that subjects with higher SDMT scores at baseline showed improvement, while subjects with lower SDMT scores at baseline showed worsening. Baseline age and disease duration were also associated with SDMT performance.
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Affiliation(s)
- Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Lindsay Barker
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Ralph H B Benedict
- Department of Neurology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Cindy T Gonzalez
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
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Abstract
Multiple sclerosis (MS) affects approximately 1 million persons in the United States, and is the leading cause of neurological disability in young adults. The concept of precision medicine is now being applied to MS and has the promise of improved care. MS patients experience a variety of neurological symptoms, and disease severity ranges from mild to severe, and the biological underpinnings of these phenotypes are now starting to be elucidated. Precision medicine involves the classification of disease subtypes based on the underlying biology, rather than clinical phenotypes alone, and may govern disease course and treatment response. Over 18 disease-modifying drugs have been approved for the treatment of MS, and several biomarkers of treatment response are emerging. This article provides an overview of the concepts of precision medicine and emerging biological markers and their evolving role in decision-making in MS management.
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Affiliation(s)
- Tanuja Chitnis
- Tanuja Chitnis Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexandre Prat
- Alexandre Prat Department of Neurology, Université de Montréal, Montréal, QC, Canada
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Bove R, Rankin K, Lin C, Zhao C, Correale J, Hellwig K, Michel L, Laplaud DA, Chitnis T. Effect of assisted reproductive technology on multiple sclerosis relapses: Case series and meta-analysis. Mult Scler 2019; 26:1410-1419. [PMID: 31368394 DOI: 10.1177/1352458519865118] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Five case series reported increased relapse risk after assisted reproductive technologies (ART) in women with multiple sclerosis (MS), but small numbers and heterogeneous study design limit broader conclusions. OBJECTIVE To evaluate the risk of relapses after ART in an independent case series and in aggregated analyses of existing studies. METHODS We compared annualized relapse rate (ARR) in the 3 months after, and 12 months before, ART in (1) an unpublished cohort (Boston: prospectively collected relapses; 22 ART cycles), (2i) data pooled from Boston and five published studies (164 cycles), and (2ii) a meta-analysis of all case series published by 2017 (220 cycles; PRISMA and MOOSE guidelines). RESULTS In the Boston cohort, mean ARR was not higher after ART than before (mean: 0.18 ± 0.85 vs 0.27 ± 0.55, p = 0.58). In the pooled analyses, ARR was significantly higher after ART for all clinical scenarios, including varying ART protocols (p ⩽ 0.01 for each). The meta-analysis confirmed an increased ARR after ART (mean difference (MD) = 0.92, 95% confidence interval (CI) = [0.33, 1.51], p = 0.01). CONCLUSION These pooled data support an increase in ARR following ART. Reasons for local variation in ARR after ART, and consideration of MS treatments during conception attempts, will be pursued.
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Affiliation(s)
- Riley Bove
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelsey Rankin
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Chris Lin
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Chao Zhao
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Jorge Correale
- Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | | | - Laure Michel
- CRTI Inserm U1064, Nantes, France; Service de Neurologie, CHU Nantes, Nantes, France
| | - David A Laplaud
- CRTI Inserm U1064, Nantes, France; Service de Neurologie, CHU Nantes, Nantes, France
| | - Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Discontinuation of disease-modifying therapy for patients with relapsing-remitting multiple sclerosis: Effect on clinical and MRI outcomes. Mult Scler Relat Disord 2019; 35:119-127. [PMID: 31374460 DOI: 10.1016/j.msard.2019.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disease-modifying therapy (DMT) for patients with relapsing-remitting multiple sclerosis (RRMS) have been shown to reduce relapses and new MRI lesions. However, few studies have assessed the impact of discontinuing DMT after a period of disease inactivity. OBJECTIVE To investigate the impact of DMT discontinuation on clinical and radiological outcomes in RRMS patients. METHODS 69 RRMS patients who discontinued DMT after a period of disease inactivity were identified from the Comprehensive Longitudinal Investigation of MS study at the Brigham and Women's Hospital, based on the following inclusion criteria: age 18 or older; treated with DMT ≥2 years; no clinical and radiological relapse ≥2 years until the discontinuation; not restarting DMT for ≥6 months after discontinuation. Patients matched by age, gender, treatment, treatment duration, disease duration and Expanded Disability Status Scale score who remained on DMT were identified. Univariate and multivariable Cox proportional hazard models with robust standard errors to account for the paired data were used to test the differences based on DMT discontinuation with the outcome measures: time to clinical relapse, MRI event, disability progression, and disease activity (either clinical relapse or MRI event). RESULTS Based on the 69 pairs of patients, discontinuation was not associated with time to clinical relapse (HR = 0.87, 95% CI = 0.44-1.72, p = 0.69), MRI event (HR = 0.95, 95% CI = 0.57 to 1.59, p = 0.84), disability progression (HR = 1.24, 95% CI = 0.61 to 2.53, p = 0.55) and disease activity (HR = 0.89, 95% CI = 0.56 to 1.42, p = 0.62). When we performed subgroup analysis to compare the impact of DMT discontinuation between older (age > 45) and younger (age ≤ 45) patients, we found a significant difference in the association between young and old for time to MRI event (p = 0.012) and time to new disease activity (p = 0.0005). CONCLUSIONS This study found that patients who discontinued treatment after a period of disease inactivity had a similar time to next event compared to subjects who remained on first-generation DMTs. In our cohort, we found that discontinuation after age 45 was associated with a stable disease course, while patients younger than age 45 who discontinued treatment were more likely to experience a new clinical relapse or MRI event.
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A Pilot Study to Assess At-Home Speed of Processing Training for Individuals with Multiple Sclerosis. Mult Scler Int 2019; 2019:3584259. [PMID: 31275652 PMCID: PMC6582794 DOI: 10.1155/2019/3584259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Cognitive impairment is a common symptom of multiple sclerosis (MS), yet treatment is currently limited. The primary goal of this pilot study was to assess the feasibility and acceptability of an at-home, five-week computerized speed of processing (SOP) training intervention for MS patients. In addition, we examined the utility of the intervention to improve speed of information processing, memory, executive function, and health-related quality of life (HRQOL). Method Fifteen subjects were assigned five weeks of SOP training, two times per week, for a total of ten sessions. Subjects were trained on five computerized SOP tasks that required processing of increasingly complex visual stimuli in successively shorter presentation times. Subjects were given a neuropsychological test battery that included measures of speed of information processing, verbal memory, visual spatial memory, and executive function. Subjects were also administered patient-reported outcome (PRO) measures to assess HRQOL, depression, and work productivity. Neuropsychological and PRO batteries were completed at baseline and after five weeks. Results Eighty percent of subjects completed the five-week intervention (n = 12). Significant improvements were observed on some, but not all, measures of speed of information processing, verbal memory, and executive function. There were no significant changes in HRQOL. Conclusion This pilot study supports the feasibility of an at-home SOP training intervention for individuals with MS. SOP training was associated with improvements in several cognitive domains. Larger, randomized controlled trials are warranted.
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Fakih R, Diaz-Cruz C, Chua AS, Gonzalez C, Healy BC, Sattarnezhad N, Glanz BI, Weiner HL, Chitnis T. Food allergies are associated with increased disease activity in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:629-635. [PMID: 30563943 DOI: 10.1136/jnnp-2018-319301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The association between allergy and multiple sclerosis (MS) is still unclear. In our study, we assessed the association between a self-reported history of allergic conditions with MS clinical and MRI disease activity. METHODS A subset of 1349 patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB) study completed a self-administered questionnaire on environmental, food and drug allergies. Patients were distributed among four allergy groups: (1) environmental, (2) food, (3) drug, (4) no known allergies (NKA). Clinical (number of attacks, expanded disability status scale (EDSS), MS severity score (MSSS)) and radiological variables (presence of gadolinium-enhancing lesions and lesion count), and their associations with the different allergy groups or those with NKA, were assessed. RESULTS The food allergy group had a 1.38 times higher rate for cumulative number of attacks compared with the NKA group (P=0.0062); this difference remained significant in the adjusted analysis (relapse rate ratio 1.27, P=0.0305). The food allergy group showed more than twice the likelihood (OR 2.53, P=0.0096) of having gadolinium-enhancing lesions on MRI. The environmental and drug allergy groups did not show significant differences when compared with the NKA group. The EDSS and MSSS were not affected by any type of allergy. CONCLUSIONS MS patients with food allergy had more relapses and a higher likelihood of gadolinium-enhancing lesions compared with patients with no known allergy. Future prospective studies are needed to confirm our findings and investigate underlying biological mechanisms, which may unveil new therapeutic and preventative strategies for MS.
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Affiliation(s)
- Rami Fakih
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Brian C Healy
- Partners MS Center, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, Massachusetts, USA
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Alehashemi A, Mostafavian Z, Dareini N. Sexual Function in Iranian Female Multiple Sclerosis Patients. Open Access Maced J Med Sci 2019; 7:1303-1308. [PMID: 31110574 PMCID: PMC6514335 DOI: 10.3889/oamjms.2019.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: One of the typical complaints in females with multiple sclerosis (MS) is Sexual dysfunction (SD). AIM: This study aimed to compare the sexual function of women with and without MS and to recognise factors that possibly related to sexual dysfunction of women with MS. MATERIAL AND METHODS: Sexual function of 64 women with MS as a case study group were compared to a group of control comprised of 64 women. Female Sexual Function Inventory (FSFI) and Beck Depression Inventory (BDI) were used accordingly to assess sexual function and severity of depression of case and control groups. Functional status of MS Patients was assessed by the Expanded Disability Status Scale (EDSS). The data were analysed using chi-square, independent Samples t, Pearson’s correlation coefficients, and multiple linear regression tests. RESULTS: There were no differences in the Total FSFI and 4 FSFI subscale scores (i.e. sexual desire, arousal, lubrication and satisfaction) between women with MS and controls. The only significant difference between the two groups was the dimension of orgasm (p = 0.016). Multivariate analysis demonstrated that only BDI and FSFI total scores have significantly related (B = -0.436, P < 0.001). In women with MS, a significant negative correlation was found between FSFI and EDSS scores (rho = -0.35, P = 0.032), as well as between FSFI scores and disease duration (rho = -0.25, P = 0.01). CONCLUSION: Depression was associated to sexual dysfunction in women. It could be advantageous to evaluate and treat depression in women with MS who suffer from sexual dysfunction.
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Affiliation(s)
- Alireza Alehashemi
- Department of Neurology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Zahra Mostafavian
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Najmeh Dareini
- Department of Medical School, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Zurawski J, Glanz BI, Healy BC, Tauhid S, Khalid F, Chitnis T, Weiner HL, Bakshi R. The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis. J Neurol Sci 2019; 403:38-43. [PMID: 31207364 DOI: 10.1016/j.jns.2019.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/04/2019] [Accepted: 04/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Spinal cord demyelination is common in multiple sclerosis (MS) and has been linked to increased disability and progressive clinical course. Spinal cord atrophy shows an especially close relationship to MS-related physical disability, though the relationship between spinal cord lesions/atrophy and health-related quality of life (QOL) has not been explored. METHODS 62 patients (53 relapsing MS, 7 secondary progressive, 2 clinically isolated syndrome) from our center underwent 3 T MRI within 30 days of clinical examination and QOL assessment. Upper cervical (C1-C3) spinal cord area (UCCA) was obtained from 3D high-resolution MPRAGE sequences (1 mm isotropic voxels). Cervical spinal cord (C1-C7) lesion count, and cervical and brain T2 hyperintense lesion volumes were calculated. Brain parenchymal fraction (BPF) was obtained from an automated segmentation pipeline. Spearman correlations were assessed between MRI and clinical data. Partial Spearman correlations adjusting for age, disease duration, and BPF assessed the independent association between MRI variables and QOL domains. RESULTS UCCA showed an inverse relationship with age (r = -0.330, p = .009), disease duration, (r = -0.444, p < .001), and nine-hole peg test (r = -0.353, p = .005). The Upper Extremity Function QOL domain showed the strongest relationship to UCCA (r = 0.333, p = .008), with Lower Extremity Function QOL (r = 0.234, p = .067) and Satisfaction with Social Roles and Activities (r = 0.245, p = .055) correlations bordering significance. The association between UCCA and Upper Extremity QOL remained significant after adjustment for BPF, age, and disease duration. QOL domains reflective of psychological health (Depression, Anxiety, Emotional and Behavioral Dyscontrol, Positive Affect and Wellbeing) showed no relationship to UCCA. Cervical and brain lesion volume related to impairment in Stigma while cervical lesion count was unrelated to NeuroQOL impairment. Brain atrophy correlated with conventional markers of disability and cognition but did not have a significant relationship to QOL. CONCLUSION Cervical spinal cord volume is independently associated with impaired upper extremity-related QOL in patients with MS. These findings suggest specific clinical relevance of MS-related spinal cord atrophy as compared to brain or cervical spinal cord lesions, or whole brain atrophy.
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Affiliation(s)
- Jonathan Zurawski
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Bonnie I Glanz
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fariha Khalid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hemond CC, Glanz BI, Bakshi R, Chitnis T, Healy BC. The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis. BMC Neurol 2019; 19:23. [PMID: 30755165 PMCID: PMC6371437 DOI: 10.1186/s12883-019-1245-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Serum hematological indices such as the neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) have been used as biomarkers of pathogenic inflammation and prognostication in multiple areas of medicine; recent evidence shows correlation with psychological parameters as well. OBJECTIVES/AIMS To characterize clinical, neuroimaging, and psycho-neuro-immunological associations with NLR and MLR in persons with multiple sclerosis (MS). METHODS We identified a large cohort of clinically well-defined patients from our longitudinal database that included MS-related outcomes, disease-modifying therapy, patient-reported outcome (PRO) measures, and quantified cerebral MRI at 1.5 T. We queried hospital records for complete blood counts within 2 months of each clinic visit and excluded those obtained during clinical relapses. Four hundred eighty-three patients, with a mean of 3 longitudinal observations each, were identified who met these criteria. Initial analyses assessed the association between NLR and MLR as the outcomes, and psychological and demographic predictors in univariable and multivariable models controlling for age, gender and treatment. The second set of analyses assessed the association between clinical and MRI outcomes including whole brain atrophy and T2-hyperintense lesion volume, with NLR and MLR as predictors in univariable and multivariable models. All analyses used a mixed effects linear or logistic regression model with repeated measures. RESULTS Unadjusted analyses demonstrated significant associations between higher (log-transformed) NLR (but not MLR) and PRO measures including increasing depression (p = 0.01), fatigue (p < 0.01), and decreased physical quality of life (p < 0.01). Higher NLR and MLR strongly predicted increased MS-related disability as assessed by the Expanded Disability Status Scale, independent of all demographic, clinical, treatment-related, and psychosocial variables (p < 0.001). Lastly, higher NLR and MLR significantly discriminated progressive from relapsing status (p ≤ 0.01 for both), and higher MLR correlated with increased whole-brain atrophy (p < 0.05) but not T2 hyperintense lesion volume (p > 0.05) even after controlling for all clinical and demographic covariates. Sensitivity analyses using a subset of untreated patients (N = 146) corroborated these results. CONCLUSIONS Elevated NLR and MLR may represent hematopoetic bias toward increased production and pro-inflammatory priming of the myeloid innate immune system (numerator) in conjunction with dysregulated adaptive immune processes (denominator), and consequently reflect a complementary and independent marker for severity of MS-related neurological disability and MRI outcomes.
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Affiliation(s)
- Christopher C. Hemond
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655 USA
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Bonnie I. Glanz
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Rohit Bakshi
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
- Department of Radiology, Harvard Medical School, Boston, MA USA
| | - Tanuja Chitnis
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Brian C. Healy
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
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Odabaş FÖ, Gümüş H, Akkurt HE, Uca AU, Yilmaz H. The Assessment of Sexual Dysfunction in Male Patients with Multiple Sclerosis. ACTA ACUST UNITED AC 2019; 55:349-353. [PMID: 30622392 DOI: 10.5152/npa.2017.19335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/20/2016] [Indexed: 01/22/2023]
Abstract
Introduction To investigate the effects of multiple sclerosis (MS) on male sexuality. Methods While 61 men with MS were included into the study group, 60 healthy men constituted the control group in the study. In MS patients, such parameters as functional status and depression levels were assessed with the Expanded Disability Status Scala (EDSS) and the Beck Depression Scale (BDS), other parameters such as pain levels, sexual function and quality of life (QoL) were evaluated with the Visual Analog Scala (VAS), the International Index of Erectile Function (IIEF) and the short form-36 (SF-36), respectively. Results Patients with MS were classified as 45 with EDSS <5.5 and 19 with EDSS >5.5. Mean VAS and BDI scores patients with MS were found statistically significantly higher, compared with those of the controls (p<0.05). Mean IIEF and all sub-group scores of SF-36 of patients with MS were found to be statistically significantly lower, compared with those of the control group (p<0.05). Mean EDSS in patients with MS was 2.75±2.42. While there was a positive correlation between IIEF scores of patients with MS, and mean mental and physical components of SF-36, a negative correlation was found between IIEF scores in MS patients, and age, disease duration, number of attacks, number of marital years and scores of EDSS, VAS and BDI (p<0.00). When BDI ≥17 was accepted as the threshold for depression, the depression was detected in 62.5% of patients with MS and 11.7% of the controls (p<0.001). Conclusion Sexual functions are affected negatively in male patients with MS and seem to be associated with increased disability, pain and accompanying depression. Therefore, male patients with MS should also be evaluated with regard to sexual function, as well as disability during their follow-ups.
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Affiliation(s)
- Faruk Ömer Odabaş
- Department of Neurology, SBÜ Konya Training and Research Hospital, Konya, Turkey
| | - Haluk Gümüş
- Department of Neurology, Karatay University School of Medicine, Medicana Hospital, Konya, Turkey
| | - Halil Ekrem Akkurt
- Department of Physical Medicine and Rehabilitation, SBÜ Konya Training and Research Hospital, Konya, Turkey
| | - Ali Ulvi Uca
- Department of Neurology, NEÜ Meram Medical Faculty, Konya, Turkey
| | - Halim Yilmaz
- Department of Physical Medicine and Rehabilitation, SBÜ Konya Training and Research Hospital, Konya, Turkey
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