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Lorenzini T, Faigle W, Ruder J, Docampo MJ, Opitz L, Martin R. Alterations of Thymus-Derived Tregs in Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200251. [PMID: 38838284 PMCID: PMC11160584 DOI: 10.1212/nxi.0000000000200251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is considered a prototypic autoimmune disease of the CNS. It is the leading cause of chronic neurologic disability in young adults. Proinflammatory B cells and autoreactive T cells both play important roles in its pathogenesis. We aimed to study alterations of regulatory T cells (Tregs), which likely also contribute to the disease, but their involvement is less clear. METHODS By combining multiple experimental approaches, we examined the Treg compartments in 41 patients with relapsing-remitting MS and 17 healthy donors. RESULTS Patients with MS showed a reduced frequency of CD4+ T cells and Foxp3+ Tregs and age-dependent alterations of Treg subsets. Treg suppressive function was compromised in patients, who were treated with natalizumab, while it was unaffected in untreated and anti-CD20-treated patients. The changes in natalizumab-treated patients included increased proinflammatory cytokines and an altered transcriptome in thymus-derived (t)-Tregs, but not in peripheral (p)-Tregs. DISCUSSION Treg dysfunction in patients with MS might be related to an altered transcriptome of t-Tregs and a proinflammatory environment. Our findings contribute to a better understanding of Tregs and their subtypes in MS.
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Affiliation(s)
- Tiziana Lorenzini
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Wolfgang Faigle
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Josefine Ruder
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - María José Docampo
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Opitz
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Roland Martin
- From the Neuroimmunology and MS Research (T.L., W.F., J.R., M.J.D., R.M.), Neurology Clinic, University Hospital Zurich; Division of Immunology (T.L.), University Children's Hospital Zurich, University of Zurich; Cellerys AG (W.F., R.M.), Schlieren, Switzerland; Immunity and Cancer (U932) (W.F.), Immune Response to Cancer Laboratory, Institut Curie, 26 rue d'Ulm, CEDEX 05, Paris, France; Functional Genomics Center Zurich (L.O.), Swiss Federal Institute of Technology and University of Zurich; Institute of Experimental Immunology (R.M.), University of Zurich, Switzerland; and Therapeutic Design Unit (R.M.), Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
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Oh J, Giacomini PS, Yong VW, Costello F, Blanchette F, Freedman MS. From progression to progress: The future of multiple sclerosis. J Cent Nerv Syst Dis 2024; 16:11795735241249693. [PMID: 38711957 PMCID: PMC11072059 DOI: 10.1177/11795735241249693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Significant advances have been made in the diagnosis and treatment of multiple sclerosis in recent years yet challenges remain. The current classification of MS phenotypes according to disease activity and progression, for example, does not adequately reflect the underlying pathophysiological mechanisms that may be acting in an individual with MS at different time points. Thus, there is a need for clinicians to transition to a management approach based on the underlying pathophysiological mechanisms that drive disability in MS. A Canadian expert panel convened in January 2023 to discuss priorities for clinical discovery and scientific exploration that would help advance the field. Five key areas of focus included: identifying a mechanism-based disease classification system; developing biomarkers (imaging, fluid, digital) to identify pathologic processes; implementing a data-driven approach to integrate genetic/environmental risk factors, clinical findings, imaging and biomarker data, and patient-reported outcomes to better characterize the many factors associated with disability progression; utilizing precision-based treatment strategies to target different disease processes; and potentially preventing disease through Epstein-Barr virus (EBV) vaccination, counselling about environmental risk factors (e.g. obesity, exercise, vitamin D/sun exposure, smoking) and other measures. Many of the tools needed to meet these needs are currently available. Further work is required to validate emerging biomarkers and tailor treatment strategies to the needs of individual patients. The hope is that a more complete view of the individual's pathobiology will enable clinicians to usher in an era of truly personalized medicine, in which more informed treatment decisions throughout the disease course achieve better long-term outcomes.
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Affiliation(s)
- Jiwon Oh
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - V. Wee Yong
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | - Fiona Costello
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | | | - Mark S. Freedman
- Department of Medicine¸ University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, QC, Canada
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Önder C, Akdoğan N, Kurgan Ş, Balci N, Serdar CC, Serdar MA, Günhan M. Does smoking influence tryptophan metabolism in periodontal inflammation? A cross-sectional study. J Periodontal Res 2023; 58:1041-1051. [PMID: 37526075 DOI: 10.1111/jre.13166] [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: 03/26/2023] [Revised: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The aim of this study was to identify the effects of smoking and periodontal inflammation on tryptophan-kynurenine metabolism as well as the correlation between these findings and clinical periodontal parameters. BACKGROUND It has been shown that the tryptophan amino acid's primary catabolic pathway, the kynurenine pathway (KP), may serve as a key biomarker for periodontal disease. Although there are studies investigating the effect of smoking on KYN-TRP metabolism, the effect of smoking on periodontal disease through KP has not been revealed so far. METHODS The salivary and serum samples were gathered from 24 nonsmoker (NS-P) stage III, grade B generalized periodontitis and 22 smoker (S-P) stage III, grade C generalized periodontitis patients, in addition to 24 nonsmoker (NS-C) and 24 smoker (S-C) periodontally healthy control individuals. Saliva and serum IL-6, kynurenine (KYN), and tryptophan (TRP) values, and KYN/TRP ratio were analyzed by liquid chromatography-mass spectrometry. Clinical periodontal measurements were recorded. RESULTS Salivary TRP values were significantly higher in both periodontitis groups than control groups (p < .05). Salivary KYN values were highest in NS-P group (p < .05). Salivary KYN values did not differ significantly between periodontitis groups (p = .84). Salivary KYN/TRP ratio was significantly lower in NS-P group compared to other groups (p < .001). Serum TRP value is higher in S-P group than other groups; however, significant difference was found in S-C group (p < .05). Serum KYN values were significantly lower in smokers than nonsmokers. Serum KYN/TRP ratio is higher in NS-P group. NS-P group has the highest salivary IL-6 levels, NS-C group has the lowest values (p < .05). CONCLUSIONS Our results point out that smoking exacerbates inflammation in the periodontium and increases TRP destruction and decreases IDO activity by suppressing KP in serum. As a result, kynurenine and its metabolites may be significant biomarkers in the link between smoking and periodontal disease.
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Affiliation(s)
- Canan Önder
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Nihan Akdoğan
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Şivge Kurgan
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Nur Balci
- Department of Periodontology, Faculty of Dentistry, Medipol University, İstanbul, Turkey
| | - Ceyhan Ceran Serdar
- Department of Medical Biology and Genetics, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
| | - Muhittin A Serdar
- Department of Medical Biochemistry, Faculty of Medicine, Acıbadem University, Ankara, Turkey
| | - Meral Günhan
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Göcmen A, Ethemoglu O. The relationship between sleep disorders with patients' demographic-clinical characteristics and quality of life in patients with multiple sclerosis. Clin Neurol Neurosurg 2023; 232:107888. [PMID: 37453283 DOI: 10.1016/j.clineuro.2023.107888] [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: 12/06/2022] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES In this study, the effect of sleep disturbance on the quality of life in MS patients and its relationship between demographic and clinical characteristics of the patients were investigated. METHODS 67 MS patients and 51 healthy individuals were included in our study. The patient group consisted of 43 women and 24 men. The control group consisted of 32 women and 19 men. Demographic and clinical characteristics of the patients; age, gender, duration of illness, annual number of attacks, treatments, and medical history were recorded and neurological examinations of all patients were performed and disability was determined for each patient with Kurtzke's expanded disability status scale (EDSS). Evaluations were made using demographic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Expanded Disability Status Scale (EDSS), Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Berlin Questionnaire and Multiple Sclerosis Quality of Life (MSYK) - 54 Instrument. RESULTS We found that the quality of life was significantly impaired in MS patients compared to healthy controls (p < 0.001). And we found that this was related to the presence of progressive MS and chronic fatigue among the clinical features of the patient, sleep-disordered breathing among sleep disorders, poor sleep quality, comorbid anxiety and depression (p = 0.001, p:0.009, p = 0.022, p = 0.007, p < 0.001 and p = 0.001, respectively). CONCLUSION All these findings show that sleep disorders in patients with MS are a condition that should be questioned and treated in the follow up of the disease, otherwise it may affect the quality of life of patients negatively.
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Affiliation(s)
- Adalet Göcmen
- Sanlıurfa Training and Research Hospital, Department of Neurology, Sanlıurfa, Turkey
| | - Ozlem Ethemoglu
- Harran University School of Medicine, Department of Neurology, Sanlıurfa, Turkey.
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Tanaka E, Watanabe M, Fukumoto S, Masaki K, Yamasaki R, Matsushita T, Isobe N. Effect of smoking on disease activity in multiple sclerosis patients treated with dimethyl fumarate or fingolimod. Mult Scler Relat Disord 2023; 70:104513. [PMID: 36689892 DOI: 10.1016/j.msard.2023.104513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/22/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND In relapsing-remitting multiple sclerosis (RRMS), smoking is a known risk factor for disease susceptibility and disability progression. However, its impact on the efficacy of oral disease-modifying drugs (DMDs) is unclear. Therefore, we initiated a single-center, retrospective, observational study to investigate the relationship between smoking and disease activity in RRMS patients under oral DMDs. METHODS We retrospectively enrolled RRMS patients who initiated oral DMDs (fingolimod or dimethyl fumarate) at our hospital between January 2012 and December 2019. Clinical data and smoking status at oral DMD initiation were collected up to December 2020. We conducted survival analyses for relapse and any disease activity, defined as relapse or MRI disease activity, among patients with distinct smoking statuses. RESULTS We enrolled 103 RRMS patients under oral DMDs including 19 (18.4%) current smokers at baseline. Proportions of relapses and any disease activity during follow-up were higher in current smokers (relapse: p = 0.040, any disease activity: p = 0.004) and time from initiating oral DMDs to relapse was shorter in current smokers (log-rank test: p = 0.011; Cox proportional hazard analysis: hazard ratio (HR) 2.72 [95% confidence interval (CI) 1.22-6.09], p = 0.015) than in non-smokers. Time from initiating oral DMDs to any disease activity was also shorter in current smokers (log-rank test: p = 0.016; Cox proportional hazard analysis: HR 2.18 [95% CI 1.14-4.19], p = 0.019) than in non-smokers. The survival curves for relapse and any disease activity were not different between the former smoker and never-smoker groups. Multivariate survival analysis showed current smoking was an independent risk factor for relapse or any disease activity after adjusting for covariates (relapse: HR 2.54 [95% CI 1.06-6.10], p = 0.037; any disease activity: HR 3.47 [95% CI 1.27-9.50], p = 0.015). CONCLUSION Smoking was a risk factor for disease activity in RRMS patients under oral DMD treatment. RRMS patients should be advised to stop smoking even after the initiation of DMDs.
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Affiliation(s)
- Eizo Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shoko Fukumoto
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Katsuhisa Masaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Dahdah A, Jaggers RM, Sreejit G, Johnson J, Kanuri B, Murphy AJ, Nagareddy PR. Immunological Insights into Cigarette Smoking-Induced Cardiovascular Disease Risk. Cells 2022; 11:3190. [PMID: 36291057 PMCID: PMC9600209 DOI: 10.3390/cells11203190] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 01/19/2023] Open
Abstract
Smoking is one of the most prominent addictions of the modern world, and one of the leading preventable causes of death worldwide. Although the number of tobacco smokers is believed to be at a historic low, electronic cigarette use has been on a dramatic rise over the past decades. Used as a replacement for cigarette smoking, electronic cigarettes were thought to reduce the negative effects of burning tobacco. Nonetheless, the delivery of nicotine by electronic cigarettes, the most prominent component of cigarette smoke (CS) is still delivering the same negative outcomes, albeit to a lesser extent than CS. Smoking has been shown to affect both the structural and functional aspects of major organs, including the lungs and vasculature. Although the deleterious effects of smoking on these organs individually is well-known, it is likely that the adverse effects of smoking on these organs will have long-lasting effects on the cardiovascular system. In addition, smoking has been shown to play an independent role in the homeostasis of the immune system, leading to major sequela. Both the adaptive and the innate immune system have been explored regarding CS and have been demonstrated to be altered in a way that promotes inflammatory signals, leading to an increase in autoimmune diseases, inflammatory diseases, and cancer. Although the mechanism of action of CS has not been fully understood, disease pathways have been explored in both branches of the immune system. The pathophysiologically altered immune system during smoking and its correlation with cardiovascular diseases is not fully understood. Here we highlight some of the important pathological mechanisms that involve cigarette smoking and its many components on cardiovascular disease and the immune systems in order to have a better understanding of the mechanisms at play.
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Affiliation(s)
- Albert Dahdah
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Robert M. Jaggers
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Gopalkrishna Sreejit
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jillian Johnson
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Babunageswararao Kanuri
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Andrew J. Murphy
- Division of Immunometabolism, Baker Heart and Diabetes Institute, Melbourne, VIC 3010, Australia
| | - Prabhakara R. Nagareddy
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Aspectos del estilo de vida en personas con esclerosis múltiple antes y durante la pandemia COVID-19: resultado de una encuesta en Argentina. NEUROLOGÍA ARGENTINA 2022. [PMCID: PMC8603073 DOI: 10.1016/j.neuarg.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introducción Un estilo de vida poco saludable tendría influencia negativa en la evolución de la esclerosis múltiple (EM). La pandemia de COVID-19 ha producido cambios que podrían haber modificado el mismo. Los objetivos fueron evaluar aspectos del estilo de vida de personas con EM (pcEM) integrantes de una asociación de pacientes de Argentina, previo y durante la pandemia, las causas de este y si recibieron consejos médicos sobre el tema. Sujetos y métodos Estudio observacional, las pcEM fueron convocadas a través de una asociación de pacientes para responder encuestas on line en noviembre de 2019 y octubre de 2020. Se recolectaron datos demográficos, de la enfermedad, talla, peso, tabaquismo, alimentación, actividad física, consumo de alcohol y sobre la atención médica. Resultados 208 pcEM. Mujeres: 76,4%. 43,76 años (± 10,7). Cumple con la actividad física recomendada el 40,4%, 5 porciones de frutas y verduras diarias el 13,9%, tabaquismo el 24,5%, consumo de alcohol de riesgo el 12,5%, sobrepeso + obesidad el 53,4%. En pandemia disminuyó el tabaquismo (24,9% vs 20%; p = 0,004), aumentó el peso (BMI = 26,1 vs 27,4; p = 0,001) y disminuyó la actividad física (39,3% vs 31,5%; p = 0,016). Recibieron regularmente consejos sobre ejercicio físico el 54,3%, sobre dieta saludable el 32,4% y sobre cesación tabáquica el 33,3%. Conclusiones Un importante porcentaje de las pcEM presentan aspectos del estilo de vida no saludables. En pandemia se observó: aumento de peso, aumento del sedentarismo y disminución del tabaquismo. No se realizaron frecuentemente los consejos sobre estilo de vida. Son necesarios nuevos estudios para evaluar cómo mejorar el estilo de vida y su implicancia en la evolución y la calidad de vida.
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Seasonal variation in attacks of neuromyelitis optica spectrum disorders and multiple sclerosis: Evaluation of 794 attacks from a nationwide registry in Argentina. Mult Scler Relat Disord 2021; 58:103466. [PMID: 34929456 DOI: 10.1016/j.msard.2021.103466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders. METHODS A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference. RESULTS A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p < 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p < 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p < 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS. CONCLUSIONS Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina.
| | - Pablo A Lopez
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Criniti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina; Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - Alejandro Caride
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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9
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Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport 2021; 25:146-154. [PMID: 34538565 DOI: 10.1016/j.jsams.2021.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. DESIGN AND METHODS Synthesis of published works within the field of exercise training in MS. RESULTS Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. CONCLUSIONS Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA), Australia; Australian Catholic University, Australia; Multiple Sclerosis Limited, Australia; School of Population Health, University of New South Wales, Australia.
| | - Stephen Lord
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
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10
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Abstract
Multiple sclerosis (MS) is a common, severe neurological disease that affects millions of people worldwide. Nevertheless, the actual cause of MS remains unknown. Smoking has been studied with respect to MS development and progression. The objectives of this review were to examine the relationship between smoking and MS and to understand the possible molecular mechanisms underlying the association. PubMed was searched for articles related to the study topic published between 2012 and 2020 using the search terms "multiple sclerosis," "smoking," "risk factors," "cigarettes," and "molecular mechanisms." Studies show a significant relationship between smoking and the risk of MS. Furthermore, smoking has been linked to the progression of MS at the patient and population levels. However, the underlying mechanism remains to be explored in further studies; researchers still disagree on how the relationship between smoking and MS arises in different populations. Evidence from randomized controlled trials, systematic reviews, and epidemiological studies shows that smokers have a higher risk of developing MS and experiencing related adverse symptoms and complications.
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Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Hospital of the Universities of Giessen and Marburg UKGM, Justus Liebig University Giessen, Giessen, Hessen Germany.
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11
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Affiliation(s)
- Mattia Rosso
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Identifying the culprits in neurological autoimmune diseases. J Transl Autoimmun 2019; 2:100015. [PMID: 32743503 PMCID: PMC7388404 DOI: 10.1016/j.jtauto.2019.100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022] Open
Abstract
The target organ of neurological autoimmune diseases (NADs) is the central or peripheral nervous system. Multiple sclerosis (MS) is the most common NAD, whereas Guillain-Barré syndrome (GBS), myasthenia gravis (MG), and neuromyelitis optica (NMO) are less common NADs, but the incidence of these diseases has increased exponentially in the last few years. The identification of a specific culprit in NADs is challenging since a myriad of triggering factors interplay with each other to cause an autoimmune response. Among the factors that have been associated with NADs are genetic susceptibility, epigenetic mechanisms, and environmental factors such as infection, microbiota, vitamins, etc. This review focuses on the most studied culprits as well as the mechanisms used by these to trigger NADs. Neurological autoimmune diseases are caused by a complex interaction between genes, environmental factors, and epigenetic deregulation. Infectious agents can cause an autoimmune reaction to myelin epitopes through molecular mimicry and/or bystander activation. Gut microbiota dysbiosis contributes to neurological autoimmune diseases. Smoking increases the risk of NADs through inflammatory signaling pathways, oxidative stress, and Th17 differentiation. Deficiency in vitamin D favors NAD development through direct damage to the central and peripheral nervous system.
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13
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Jakimovski D, Guan Y, Ramanathan M, Weinstock-Guttman B, Zivadinov R. Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings. Neurodegener Dis Manag 2019; 9:149-172. [PMID: 31116081 DOI: 10.2217/nmt-2018-0046] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a lifelong inflammatory and neurodegenerative disease influenced by multiple lifestyle-based factors. We provide a narrative review of the effects of modifiable risk factors that are identified as being associated with risk to develop MS and/or influencing the future clinical disease outcomes. The emerging data regarding the beneficial effects of diet modifications and exercise are further reviewed. In contrast, obesity and comorbid cardiovascular diseases are associated with increased MS susceptibility and worse disease progression. In addition, the potential influence of smoking, coffee and alcohol consumption on MS onset and disability development are discussed. Successful management of the modifiable risk factors may lead to better long-term outcomes and improve patients' quality of life. MS specialists should participate in educating and facilitating lifestyle-based modifications as part of their neurological consults.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Yi Guan
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
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14
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Lifestyle and Environmental Factors in Multiple Sclerosis. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a028944. [PMID: 29735578 DOI: 10.1101/cshperspect.a028944] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lifestyle and environmental factors potently influence the risk of multiple sclerosis (MS), because genetic predisposition only explains a fraction of the risk increase. There is strong evidence for associations of Epstein-Barr virus (EBV) infection, smoking, sun exposure/vitamin D, and adolescent obesity to risk of MS. There is also circumstantial evidence on organic solvents and shift work, all associate with greater risk, although certain factors like nicotine, alcohol, and a high coffee consumption associate with a reduced risk. Certain factors, smoking, EBV infection, and obesity interact with human leukocyte antigen (HLA) risk genes, arguing for a pathogenic pathway involving adaptive immunity. There is a potential for prevention, in particular for people at greater risk such as relatives of individuals with MS. All of the described factors for MS may influence adaptive and/or innate immunity, as has been argued for MS risk gene variants.
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15
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Ivashynka A, Copetti M, Naldi P, D'Alfonso S, Leone MA. The Impact of Lifetime Alcohol and Cigarette Smoking Loads on Multiple Sclerosis Severity. Front Neurol 2019; 10:866. [PMID: 31456737 PMCID: PMC6700269 DOI: 10.3389/fneur.2019.00866] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The association between lifestyle factors and Multiple Sclerosis (MS) disease severity and progression has been investigated to a lesser extent compared with susceptibility to the disease. Objective: We aimed to assess the impact of lifetime alcohol and cigarette smoking load on MS severity. Methods: Design: a cross-sectional study. Three hundred fifty-one patients consecutively admitted to the Department of Neurology were asked to complete the "Questionnaire of Lifestyle" (part of the European Prospective Investigation into Cancer and Nutrition project). An estimation of the cumulative lifetime cigarette smoking and alcohol load was calculated as the weighted sum of the mean number of cigarettes smoked and standard alcoholic drinks consumed per day at different ages. The measure of exposure was expressed in terms of pack-year and drink-year. Disease severity was estimated by the Multiple Sclerosis Severity Score (MSSS). Logistic regression analyses were performed using MSSS (first tertile vs. third tertile) as the outcome. Results: The median MSSS was higher (3.2 vs. 2.3, p = 0.002) in ever- vs. never-smokers, but we did not find a difference between ever- and never-drinkers (2.7 vs. 2.8, p = ns). Ever-smokers were almost twice as likely to fall in the upper MSSS tertile than never-smokers. Ever-drinkers did not show a statistically significant association between alcohol intake and MS severity. The risk of falling in the worst MSSS tertile for smokers was 10.81 (2.0-58.48; p < 0.01) if they were never-drinkers, whereas it was only 1.65 (0.89-3.03, p = 0.11) if they were also drinkers. On the other side, the risk of falling in the worst MSSS tertile for drinkers did not change as much, whether they also were smokers (0.46; 0.13-1.65; p = 0.23) or not (1.49; 0.55-4.04, p = 0.43). Conclusions: Cigarette smoking, unlike alcohol consumption, is associated with MS severity. Alcohol consumption may attenuate the effect of smoking on disease severity, acting as an effect modifier. The biological background of this effect is unknown. The limitations of our study are mostly due to its cross-sectional design.
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Affiliation(s)
- Andrei Ivashynka
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Neurology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- *Correspondence: Andrei Ivashynka
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Naldi
- Department of Neurology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Interdisciplinary Research Center of Autoimmune Diseases, University of Eastern Piedmont, Novara, Italy
| | - Maurizio A. Leone
- Neurology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- Interdisciplinary Research Center of Autoimmune Diseases, University of Eastern Piedmont, Novara, Italy
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16
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Effects of cigarette smoke on immunity, neuroinflammation and multiple sclerosis. J Neuroimmunol 2018; 329:24-34. [PMID: 30361070 DOI: 10.1016/j.jneuroim.2018.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 09/30/2018] [Accepted: 10/05/2018] [Indexed: 12/18/2022]
Abstract
Cigarette smoking is the most prominent significant cause of death and morbidity. It is recognised as a risk factor for a number of immune mediated, inflammatory diseases including multiple sclerosis (MS). Here, we review the complex immunological effects of smoking on the immune system, which include enhancement of inflammatory responses with a parallel reduction of some immune defences, resulting in an increased susceptibility to infection and a persistent proinflammatory environment. We discuss the effect of smoking on the susceptibility, clinical course, disability, and mortality in MS, the likely benefits of smoking cessation, and the specific immunological effects of smoking in MS. In conclusion, smoking is an important environmental risk factor for MS occurrence and outcome, and it acts in significant part through immunological mechanisms.
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17
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Aktan R, Ozalevli S, Ozakbas S. Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients. Mult Scler Relat Disord 2018; 25:271-275. [DOI: 10.1016/j.msard.2018.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/15/2018] [Indexed: 01/05/2023]
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18
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Ammitzbøll C, von Essen MR, Börnsen L, Petersen ER, McWilliam O, Ratzer R, Romme Christensen J, Oturai AB, Søndergaard HB, Sellebjerg F. GPR15 + T cells are Th17 like, increased in smokers and associated with multiple sclerosis. J Autoimmun 2018; 97:114-121. [PMID: 30245027 DOI: 10.1016/j.jaut.2018.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 01/15/2023]
Abstract
Smoking is a risk factor for the development and progression of multiple sclerosis (MS); however, the pathogenic effects of smoking are poorly understood. We studied the smoking-associated chemokine receptor-like molecule GPR15 in relation to relapsing-remitting MS (RRMS). Using microarray analyses and qPCR we found elevated GPR15 in blood cells from smokers, and increased GPR15 expression in RRMS. By flow cytometry we detected increased frequencies of GPR15 expressing T and B cells in smokers, but no difference between patients with RRMS and healthy controls. However, after cell culture with the autoantigens myelin basic protein (MBP) and myelin oligodendrocyte glycoprotein, frequencies of MBP-reactive and non-proliferating GPR15+CD4+ T cells were increased in patients with RRMS compared with healthy controls. GPR15+CD4+ T cells produced IL-17 and were enriched in the cerebrospinal fluid (CSF). Furthermore, in the CSF of patients with RRMS, GPR15+ T cells were associated with CCR6+CXCR3+/CCR6-CXCR3+ phenotypes and correlated positively with concentrations of the newly identified GPR15-ligand (GPR15L), myelin degradation and disability. In conclusion, we have identified a proinflammatory cell type linking smoking with pathogenic immune cell functions in RRMS.
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Affiliation(s)
- Cecilie Ammitzbøll
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Marina R von Essen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Lars Börnsen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Eva Rosa Petersen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Oskar McWilliam
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Rikke Ratzer
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Annette B Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Helle B Søndergaard
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Denmark.
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19
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Petersen ER, Søndergaard HB, Laursen JH, Olsson AG, Börnsen L, Soelberg Sørensen P, Sellebjerg F, Bang Oturai A. Smoking is associated with increased disease activity during natalizumab treatment in multiple sclerosis. Mult Scler 2018; 25:1298-1305. [DOI: 10.1177/1352458518791753] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Smoking has been associated with increased multiple sclerosis (MS) risk, disease worsening, and progression in MS patients. Furthermore, interactions between smoking and human leukocyte antigen (HLA) genes have been shown for MS risk. Recently, we found that smoking was associated with an increased relapse rate in interferon-beta-treated relapsing-remitting multiple sclerosis (RRMS) patients. Objectives: We examined the association between smoking and relapses in natalizumab-treated RRMS patients. Second, we investigated if an interaction between smoking and HLA-DRB1*15:01 or HLA-A*02:01 affected the number of relapses during treatment. Methods: In this observational cohort study, 355 natalizumab-treated RRMS patients were assessed. Prespecified criteria excluded 62 patients. Clinical data from the starting of treatment to the two-year follow-up visit were collected. Smoking status was obtained by a questionnaire survey. TaqMan allelic discrimination was used for genotyping of tag single-nucleotide polymorphisms (SNPs) for HLA-DRB1*15:01 and HLA-A*02:01. Negative binomial regression analysis was used to analyze the association between relapse rate and smoking intensity and HLA. Results: One pack of cigarettes (20 cigarettes) per day during natalizumab treatment increased the relapse rate during treatment with 38% (incidence rate ratio (IRR) = 1.38, 95% confidence interval (CI): 1.08–1.77, p = 0.01). No association or interaction was found between smoking and HLA-DRB1*15:01 or HLA-A*02:01, respectively. Conclusion: Smoking intensity was significantly associated with the number of relapses during natalizumab treatment.
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Affiliation(s)
- Eva Rosa Petersen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bach Søndergaard
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Hejgaard Laursen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Gabriella Olsson
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Börnsen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annette Bang Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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20
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Heydarpour P, Manouchehrinia A, Beiki O, Mousavi SE, Abdolalizadeh A, -Lakeh MM, Sahraian MA. Smoking and worsening disability in multiple sclerosis: A meta-analysis. Acta Neurol Scand 2018. [PMID: 29542102 DOI: 10.1111/ane.12916] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic demyelinating disorder affecting young adults. Environmental factors and lifestyle behaviors are pivotal in MS pathophysiology. Smoking has been considered as an important risk factor in MS. Various recent studies have been conducted to measure the role of smoking on worsening disability in patients with MS, thus we intended to systematically assess effect of smoking on evolution of disability in this study. MATERIALS & METHODS We queried MEDLINE, EMBASE and Cochrane Library with following keywords "Multiple Sclerosis, Smoking, Tobacco Use, Disability" on December 1st 2016. Original articles were included when smoking history was mentioned, disability was measured via expanded disability status scale (EDSS) or multiple sclerosis severity score (MSSS). Studies with insufficient outcome data, non-human, or in other languages than English were excluded. RESULTS Through literature review after duplicate removals, 268 articles were retrieved. A total of 56 articles were screened and 15 articles were assessed for eligibility, finally, eleven articles were included in this systematic review and meta-analysis. Ever smoking was significantly associated with increased EDSS (standardized mean difference (SMD) = 0.15, 95% CI = 0.01-0.28), but had no significant association with risk of reaching EDSS 4 (HR = 1.24, 95% CI = 0.89-1.72) or EDSS 6 (HR = 1.17, 95% CI = 0.88-1.57). Smoking had no effect on MSSS (SMD = 0.14, 95% CI = -0.04-0.32) or T2 lesion volume (SMD = 0.07, 95% CI = -0.08-0.22). CONCLUSIONS This meta-analysis showed smoking increased EDSS, insignificant findings were possibly due to the small number of studies, significant differences in methodologies, and variations in reporting of disability outcomes.
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Affiliation(s)
- P. Heydarpour
- MS Research Center; Neuroscience Institute; Tehran University of Medical Sciences; Tehran Iran
| | - A. Manouchehrinia
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - O. Beiki
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Kermanshah University of Medical Sciences; Kermanshah Iran
| | - S. E. Mousavi
- Social Health Determinants Research Center; Shahrekord University of Medical Sciences; Shahrekord Iran
| | - A. Abdolalizadeh
- MS Research Center; Neuroscience Institute; Tehran University of Medical Sciences; Tehran Iran
| | - M. Moradi -Lakeh
- Department of Community Medicine; Iran University of Medical Sciences; Tehran Iran
| | - M. A. Sahraian
- MS Research Center; Neuroscience Institute; Tehran University of Medical Sciences; Tehran Iran
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21
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Smoking at time of CIS increases the risk of clinically definite multiple sclerosis. J Neurol 2018; 265:1010-1015. [PMID: 29464378 PMCID: PMC5937895 DOI: 10.1007/s00415-018-8780-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cigarette smoking is a modifiable risk factor that influences the disease course of patients with multiple sclerosis (MS). However, in patients with a clinically isolated syndrome (CIS), there are conflicting results about the association between smoking and the risk of a subsequent MS diagnosis. The aim of this study was to determine the risk of clinically definite MS (CDMS) in smoking and non-smoking patients at time of a first demyelinating event. METHODS Two hundred and fifty patients, aged 18-50 years, were included in our prospective CIS cohort. At time of the first neurological symptoms, patients completed a questionnaire about smoking habits. Cox regression analyses were performed to calculate univariate and multivariate hazard ratios for CDMS diagnosis in smoking and non-smoking CIS patients. RESULTS One hundred and fourteen (46%) CIS patients were diagnosed with CDMS during a mean follow-up of 58 months. In total, 79 (32%) patients smoked at time of CIS. Sixty-seven % of the smoking CIS patients were diagnosed with CDMS during follow-up compared to 36% of the non-smoking CIS patients (p < 0.001). Smoking at time of CIS was an independent predictor for CDMS diagnosis (HR 2.3; p = 0.002). Non-smoking CIS patients who had a history of smoking did not have a higher risk for CDMS than those who had never smoked. CONCLUSIONS Smoking at time of CIS was an independent risk factor for a future CDMS diagnosis. This is an additional argument to quit smoking at time of the first attack of suspected MS.
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22
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The link between smoking status and co-morbid conditions in individuals with multiple sclerosis (MS). Disabil Health J 2017; 10:587-591. [DOI: 10.1016/j.dhjo.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 12/27/2016] [Accepted: 03/10/2017] [Indexed: 12/16/2022]
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23
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Degelman ML, Herman KM. Smoking and multiple sclerosis: A systematic review and meta-analysis using the Bradford Hill criteria for causation. Mult Scler Relat Disord 2017; 17:207-216. [DOI: 10.1016/j.msard.2017.07.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/26/2022]
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24
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Bergamaschi R, Cortese A, Pichiecchio A, Berzolari FG, Borrelli P, Mallucci G, Bollati V, Romani A, Nosari G, Villa S, Montomoli C. Air pollution is associated to the multiple sclerosis inflammatory activity as measured by brain MRI. Mult Scler 2017; 24:1578-1584. [PMID: 28805546 DOI: 10.1177/1352458517726866] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Some environmental factors have been already associated to increased risk of multiple sclerosis (MS), but it is plausible that additional factors might play a role. OBJECTIVE To investigate in MS patients the relationship between inflammatory activity, detected by brain magnetic resonance imaging (MRI) with gadolinium (Gd), and air pollution, namely, particulate matters with diameter less than 10 μm (PM10). METHODS We analyzed from 52 remitting MS patients 226 brain MRIs, 34% with (Gd+MRI) and 66% without (Gd-MRI) T1-Gd-enhancing lesions. Daily recording of PM10 in the 30 days before MRI examination was obtained by monitors depending on the residence of subjects. RESULTS PM10 levels in the 5, 10, 15, 20, and 25 days before brain MRIs were higher (plus 16%, 21%, 24%, 25%, and 21%, respectively) with reference to Gd+MRI versus Gd-MRI. There was a significant association between Gd+MRI and PM10 levels ( p = 0.013), independent of immune therapies, smoker status, and season. In patients who had two repeated MRIs with opposite outcomes (Gd-MRI and Gd+MRI), PM10 levels were strongly higher in concurrence with Gd+MRI ( p < 0.0001). CONCLUSION Our findings suggest that air pollution may be a risk factor for MS favoring inflammatory exacerbations.
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Affiliation(s)
- Roberto Bergamaschi
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Andrea Cortese
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Francesca Gigli Berzolari
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Paola Borrelli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Valentina Bollati
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alfredo Romani
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Guido Nosari
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Silvia Villa
- Inter-Department Research Center for Multiple Sclerosis, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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25
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Correale J, Farez MF, Gaitán MI. Environmental factors influencing multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017. [PMID: 28638627 PMCID: PMC5472234 DOI: 10.1177/2055217317715049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
It is generally accepted that autoimmune diseases like multiple sclerosis (MS) arise from complex interactions between genetic susceptibility and environmental factors. Genetic variants confer predisposition to develop MS, but cannot be therapeutically modified. On the other hand, several studies have shown that different lifestyle and environmental factors influence disease development, as well as activity levels and progression. Unlike genetic risk factors, these can be modified, with potential for prevention, particularly in high-risk populations. Most studies identifying particular lifestyle and environmental factors have been carried out in Caucasian patients with MS. Little or no data is available on the behavior of these factors in Latin American populations. Ethnic and geographic differences between Latin America and other world regions suggest potential regional variations in MS, at least with respect to some of these factors. Furthermore, particular environmental characteristics observed more frequently in Latin America could explain regional differences in MS prevalence. Site-specific studies exploring influences of local environmental factors are warranted.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Mauricio F Farez
- Department of Neurology, Institute for Neurological Research Dr Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - María Inés Gaitán
- Center for Research on Neuroimmunological Diseases (CIEN) from the Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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26
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Xiao J, Yang R, Biswas S, Zhu Y, Qin X, Zhang M, Zhai L, Luo Y, He X, Mao C, Deng W. Neural Stem Cell-Based Regenerative Approaches for the Treatment of Multiple Sclerosis. Mol Neurobiol 2017; 55:3152-3171. [PMID: 28466274 DOI: 10.1007/s12035-017-0566-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/19/2017] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is a chronic, autoimmune, inflammatory, and demyelinating disorder of the central nervous system (CNS), which ultimately leads to axonal loss and permanent neurological disability. Current treatments for MS are largely comprised of medications that are either immunomodulatory or immunosuppressive and are aimed at reducing the frequency and intensity of relapses. Neural stem cells (NSCs) in the adult brain can differentiate into oligodendrocytes in a context-specific manner and are shown to be involved in the remyelination in these patients. NSCs may exert their beneficial effects not only through oligodendrocyte replacement but also by providing trophic support and immunomodulation, a phenomenon now known as "therapeutic plasticity." In this review, we first provided an update on the current knowledge regarding MS pathogenesis and the role of immune cells, microglia, and oligodendrocytes in MS disease progression. Next, we reviewed the current progress on research aimed toward stimulating endogenous NSC proliferation and differentiation to oligodendrocytes in vivo and in animal models of demyelination. In addition, we explored the neuroprotective and immunomodulatory effects of transplanted exogenous NSCs on T cell activation, microglial activation, and endogenous remyelination and their effects on the pathological process and prognosis in animal models of MS. Finally, we examined various protocols to generate genetically engineered NSCs as a potential therapy for MS. Overall, this review highlights the studies involving the immunomodulatory, neurotrophic, and regenerative effects of NSCs and novel methods aiming at stimulating the potential of NSCs for the treatment of MS.
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Affiliation(s)
- Juan Xiao
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China.,Department of Biological Treatment, Handan Central Hospital, Handan, Hebei, China
| | - Rongbing Yang
- Department of Biological Treatment, Handan Central Hospital, Handan, Hebei, China
| | - Sangita Biswas
- School of Pharmaceutical Sciences, Sun Yat-sen University, Shenzhen, Guangdong, China. .,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, 2425 Stockton Boulevard, Sacramento, CA, 95817, USA.
| | - Yunhua Zhu
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xin Qin
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Min Zhang
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Lihong Zhai
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yi Luo
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaoming He
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Chun Mao
- Department of Neurology, Xiang Yang Central Hospital, Medical College of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Wenbin Deng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Shenzhen, Guangdong, China. .,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, 2425 Stockton Boulevard, Sacramento, CA, 95817, USA.
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27
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Aliomrani M, Sahraian MA, Shirkhanloo H, Sharifzadeh M, Khoshayand MR, Ghahremani MH. Correlation between heavy metal exposure and GSTM1 polymorphism in Iranian multiple sclerosis patients. Neurol Sci 2017; 38:1271-1278. [PMID: 28432518 DOI: 10.1007/s10072-017-2934-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis (MS) is an immune-mediated chronic inflammatory disease of the central nervous system. Various exposures to heavy metals can lead to toxicity and oxidative stress. While glutathione-S-transferases are known as oxidative stress-related genes and involved in metal biotransformation. The aim of the present study is to investigate the correlation of GSTM1 polymorphism in MS patients and the possible association with blood concentration of arsenic (As) and cadmium (Cd) as major heavy metal pollutants. This study included 69 relapsing-remitting multiple sclerosis patients and 74 age/gender-matched healthy subjects. The genetic profile was analyzed by PCR, and heavy metal concentrations were measured by electrothermal atomic absorption spectrometry. Our results demonstrated that patients with the GSTM1 null genotype had considerably lower age of onset. However, the frequency of the GSTM1 null genotype was not significantly different between MS and control groups. In addition, the blood As and Cd concentrations were considerably higher in MS patients in comparison with healthy individuals. Also, it revealed that the GSTM1 null genotype associated with high Cd level in MS patients. There was also a trend toward an increase in As level in MS patients. These data may point to susceptibility to cadmium toxicity especially in RR-MS patients with smoking habit. Furthermore, the M1 null genotype will help in a prognosis of MS considering the age of onset. It confirms that the long-term prognosis in MS and patient's disability are influenced by their ability to remove the toxic products and perhaps to decrease oxidative stress.
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Affiliation(s)
- Mehdi Aliomrani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences, Room J-309, P.O. Box: 14155-6451, Tehran, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad A Sahraian
- MS Research Center, Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Shirkhanloo
- Iranian Petroleum Industry Health Research Institute (IPIHRI), Tehran, Iran
| | - Mohammad Sharifzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences, Room J-309, P.O. Box: 14155-6451, Tehran, Iran
| | - Mohammad R Khoshayand
- Department of Drug & Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Ghahremani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences, Room J-309, P.O. Box: 14155-6451, Tehran, Iran.
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28
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Javizian O, Metz LM, Deighton S, Koch MW. Smoking does not influence disability accumulation in primary progressive multiple sclerosis. Eur J Neurol 2017; 24:624-630. [PMID: 28239937 DOI: 10.1111/ene.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The modifiable risk factor cigarette smoking has been associated with an increased risk of developing multiple sclerosis (MS) and with disease activity in relapsing-remitting MS. However, less is known about the effect of smoking on disease progression in progressive MS. Here the association between cigarette smoking and disability accumulation in primary progressive MS (PPMS) is investigated. METHODS Kaplan-Meier survival analyses and Cox proportional hazard modelling were used to investigate the influence of cigarette smoking on the risk of reaching Expanded Disability Status Scale (EDSS) 4 and 6 as well as the time from EDSS 4 to 6 in patients with PPMS. RESULTS In all, 416 patients with PPMS and available smoking history were identified. Median time to EDSS 4 was 4 years in ever-smokers and 5 years in never-smokers (P = 0.27), and it was 9 years to EDSS 6 in both ever-smokers and never-smokers (P = 0.48). Smokers were not at increased risk of faster progression to EDSS 4, 6 and from EDSS 4 to 6. Age at disease onset was the strongest risk factor for progression to EDSS 4, 6 and from EDSS 4 to 6. CONCLUSIONS Our investigation of a large and well-characterized population based PPMS cohort suggests that cigarette smoking does not influence disability accumulation in PPMS. Our findings support the idea that PPMS is driven by different underlying pathomechanisms than relapsing-remitting MS.
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Affiliation(s)
- O Javizian
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - L M Metz
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - S Deighton
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - M W Koch
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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29
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Hammer A, Stegbauer J, Linker RA. Macrophages in neuroinflammation: role of the renin-angiotensin-system. Pflugers Arch 2017; 469:431-444. [PMID: 28190090 DOI: 10.1007/s00424-017-1942-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 12/12/2022]
Abstract
Macrophages are essential players of the innate immune system which are involved in the initiation and progression of various inflammatory and autoimmune diseases including neuroinflammation. In the past few years, it has become increasingly clear that the regulation of macrophage responses by the local tissue milieu is also influenced by mediators which were first discovered as regulators in the nervous or also cardiovascular system. Here, the renin-angiotensin system (RAS) is a major focus of current research. Besides its classical role in blood pressure control, body fluid, and electrolyte homeostasis, the RAS may influence (auto)immune responses, modulate T cells, and particularly act on macrophages via different signaling pathways. Activation of classical RAS pathways including angiotensin (Ang) II and AngII type 1 (AT1R) receptors may drive pro-inflammatory macrophage responses in neuroinflammation via regulation of chemokines. More recently, alternative RAS pathways were described, such as binding of Ang-(1-7) to its receptor Mas. Signaling via Mas pathways may counteract some of the AngII/AT1R-mediated effects. In macrophages, the Ang-(1-7)/Mas exerts beneficial effects on neuroinflammation via modulating macrophage polarization, migration, and T cell activation in vitro and in vivo. These data delineate a pivotal role of the RAS in inflammation of the nervous system and identify RAS modulation as a potential new target for immunotherapy with a special focus on macrophages.
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Affiliation(s)
- Anna Hammer
- Department of Neurology, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Stegbauer
- Department of Nephrology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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30
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Briggs FB, Gunzler DD, Ontaneda D, Marrie RA. Smokers with MS have greater decrements in quality of life and disability than non-smokers. Mult Scler 2017; 23:1772-1781. [PMID: 28059618 DOI: 10.1177/1352458516685169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tobacco smoke plays a pathogenic role in multiple sclerosis (MS) and may accelerate disease progression, yet, some people with MS continue to smoke after disease onset. The average smoker reports diminished health-related quality of life (HRQOL) across many populations. OBJECTIVES To describe the relationships between smoking status and HRQOL, disease activity, and global disability in a US population with MS. METHODS We compared smokers to non-smokers in 950 responders to the Spring 2014 update survey completed by North American Research Committee on Multiple Sclerosis (NARCOMS) registry participants. HRQOL was assessed using Short Form-12 version 2 (SF-12v2), disease activity was investigated using eight Performance Scales (PS) and three Functionality Scales (FS). Global disability was evaluated using Patient Determined Disease Steps (PDDS) and an item response theory (IRT) summed score based on the PS and FS. RESULTS Smokers had lower HRQOL ( p < 0.0001), reported more disease activity ( p < 0.05) and greater deficits in all PS and FS ( p = 6 × 10-7 to 0.05), except mobility. Smokers and non-smokers did not differ by PDDS but had substantially greater IRT global disability ( p = 2 × 10-7). CONCLUSION Active smoking is meaningfully associated with deficits across multiple domains in people with MS and adds to the growing literature of the need for MS-tailored smoking cessation programs.
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Affiliation(s)
- Farren Bs Briggs
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas D Gunzler
- Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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31
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Nadalin S, Buretić-Tomljanović A, Lavtar P, Starčević Čizmarević N, Hodžić A, Sepčić J, Kapović M, Peterlin B, Ristić S. The lack of association between angiotensin-converting enzyme gene insertion/deletion polymorphism and nicotine dependence in multiple sclerosis. Brain Behav 2017; 7:e00600. [PMID: 28127518 PMCID: PMC5256183 DOI: 10.1002/brb3.600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/14/2016] [Accepted: 10/03/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Blood-borne angiotensin II is generated from angiotensinogen via cleavage by renin and angiotensin-converting enzyme (ACE), an enzymatic cascade known as the renin-angiotensin system (RAS). Several lines of evidence indicate that ACE, beyond its classical role of mediating blood pressure regulation, might contribute to the etiology of substance addictions by influencing dopaminergic signaling. A functional insertion/deletion (I/D) polymorphism of the ACE gene was associated with risk for being a smoker among individuals with depression and with smoking severity in studies comprising patients with depression and healthy controls. Several reports have described significantly increased ACE activity in cerebrospinal fluid and serum among MS patients. Furthermore, in our previous work with MS patients from Croatian and Slovenian populations, we demonstrated that the ACE-I/D polymorphism contributes to an elevated MS risk among male patients. Here we investigated whether the ACE-I/D polymorphism might influence smoking behavior among patients with MS. PATIENTS AND METHODS Genotyping was performed in 521 patients (males/females: 139/382) using polymerase chain reaction. RESULTS We revealed no significant differences in ACE genotype and allele frequencies between smokers and nonsmokers and no significant association between the ACE-I/D polymorphism and either pack-year smoking history or number of cigarettes smoked daily (p > .05, respectively). CONCLUSION The ACE-I/D polymorphism does not contribute either to risk for nicotine dependence or to smoking severity among MS patients. In the context of reports on the ACE-I/D polymorphism and nicotine dependence among healthy controls and patients with depression, we may speculate that the mechanism by which this polymorphism influences nicotine dependence risk differs in MS compared to depression, although not compared to a healthy population. In addition to angiotensin II, other potential ACE substrates, such as substance P and neurotensin, which also influence dopaminergic neurotransmission (and are proposed to be associated with MS), may deserve study in future.
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Affiliation(s)
- Sergej Nadalin
- Department of Biology and Medical Genetics School of Medicine University of Rijeka Rijeka Croatia
| | | | - Polona Lavtar
- Clinical Institute of Medical Genetics University Medical Centre Ljubljana Slovenia
| | | | - Alenka Hodžić
- Clinical Institute of Medical Genetics University Medical Centre Ljubljana Slovenia
| | - Juraj Sepčić
- Postgraduate Studies School of Medicine University of Rijeka Rijeka Croatia
| | - Miljenko Kapović
- Department of Biology and Medical Genetics School of Medicine University of Rijeka Rijeka Croatia
| | - Borut Peterlin
- Clinical Institute of Medical Genetics University Medical Centre Ljubljana Slovenia
| | - Smiljana Ristić
- Department of Biology and Medical Genetics School of Medicine University of Rijeka Rijeka Croatia
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32
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Paz-Ballesteros WC, Monterrubio-Flores EA, de Jesús Flores-Rivera J, Corona-Vázquez T, Hernández-Girón C. Cigarette Smoking, Alcohol Consumption and Overweight in Multiple Sclerosis: Disability Progression. Arch Med Res 2017; 48:113-120. [DOI: 10.1016/j.arcmed.2017.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/02/2017] [Indexed: 01/07/2023]
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33
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Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 2016; 13:25-36. [PMID: 27934854 DOI: 10.1038/nrneurol.2016.187] [Citation(s) in RCA: 664] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.
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34
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Bjørnevik K, Riise T, Bostrom I, Casetta I, Cortese M, Granieri E, Holmøy T, Kampman MT, Landtblom AM, Magalhaes S, Pugliatti M, Wolfson C, Myhr KM. Negative interaction between smoking and EBV in the risk of multiple sclerosis: The EnvIMS study. Mult Scler 2016; 23:1018-1024. [DOI: 10.1177/1352458516671028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Results from previous studies on a possible interaction between smoking and Epstein–Barr virus (EBV) in the risk of multiple sclerosis (MS) are conflicting. Objectives: To examine the interaction between smoking and infectious mononucleosis (IM) in the risk of MS. Methods: Within the case–control study on Environmental Factors In Multiple Sclerosis (EnvIMS), 1904 MS patients and 3694 population-based frequency-matched healthy controls from Norway, Italy, and Sweden reported on prior exposure to smoking and history of IM. We examined the interaction between the two exposures on the additive and multiplicative scale. Results: Smoking and IM were each found to be associated with an increased MS risk in all three countries, and there was a negative multiplicative interaction between the two exposures in each country separately as well as in the pooled analysis ( p = 0.001). Among those who reported IM, there was no increased risk associated with smoking (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.66–1.37). The direction of the estimated interactions on the additive scale was consistent with a negative interaction in all three countries (relative excess risk due to interaction (RERI): −0.98, 95% CI: −2.05–0.15, p = 0.09). Conclusion: Our findings indicate competing antagonism, where the two exposures compete to affect the outcome.
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Affiliation(s)
- Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Inger Bostrom
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Ilaria Casetta
- Department of Biomedical and Specialist Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Marianna Cortese
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Enrico Granieri
- Department of Biomedical and Specialist Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Trygve Holmøy
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Margitta T Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Anne-Marie Landtblom
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden/Department of Neuroscience/Neurology, Uppsala University, Uppsala, Sweden
| | - Sandra Magalhaes
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Maura Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy/Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada/Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kjell-Morten Myhr
- The Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
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35
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Kvistad S, Myhr KM, Holmøy T, Benth JŠ, Løken-Amsrud KI, Wergeland S, Beiske AG, Bjerve KS, Hovdal H, Lilleås F, Midgard R, Pedersen T, Bakke SJ, Torkildsen Ø. No association of tobacco use and disease activity in multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e260. [PMID: 27458599 PMCID: PMC4946773 DOI: 10.1212/nxi.0000000000000260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/02/2016] [Indexed: 01/20/2023]
Abstract
Objective: To study whether tobacco use is associated with MRI and clinical disease activity in patients with multiple sclerosis (MS). Methods: Prospective cohort study of 87 patients with relapsing-remitting MS originally included in a randomized placebo-controlled trial of omega-3 fatty acids in MS (the OFAMS Study). Serum levels of cotinine (biomarker of tobacco use) were analyzed at baseline and every 6 months for 2 years. MRI activity was assessed at baseline and monthly for 9 months and after 12 and 24 months. Results: Fifty-three patients (61%) had serum cotinine levels ≥85 nmol/L on ≥60% of the measurements and were considered tobacco users and 34 (39%) had cotinine levels <85 nmol/L, consistent with non–tobacco use. There was no association between tobacco use and the occurrence of new gadolinium-enhancing T1 lesions, new or enlarging T2 lesions, or their aggregate (combined unique activity). Furthermore, there was no association between cotinine levels and MRI activity for the tobacco users, and tobacco users did not have more relapses or Expanded Disability Status Scale progression. Conclusion: Our results indicate that tobacco use does not directly influence MRI activity or relapse rate in MS. This may implicate that the reported association between smoking and MS disease progression could be mediated through other mechanisms.
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Affiliation(s)
- Silje Kvistad
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kjell-Morten Myhr
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Trygve Holmøy
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Jūratė Šaltytė Benth
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kristin I Løken-Amsrud
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Stig Wergeland
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Antonie G Beiske
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Kristian S Bjerve
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Harald Hovdal
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Finn Lilleås
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Rune Midgard
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Tom Pedersen
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Søren J Bakke
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
| | - Øivind Torkildsen
- Department of Immunology and Transfusion Medicine (S.K.), Norwegian Multiple Sclerosis Competence Centre, Department of Neurology (S.K., S.W., Ø.T.), and Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology (K.-M.M., S.W., Ø.T.), Haukeland University Hospital, Bergen; KG Jebsen MS Research Centre (S.K., K.-M.M., Ø.T.), Department of Clinical Medicine, University of Bergen; Department of Neurology (T.H.), and HØKH, Research Centre (J.Š.B.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., J.Š.B.), University of Oslo; Department of Neurology (K.I.L.-A.), Innlandet Hospital Trust, Lillehammer; Multiple Sclerosis Centre Hakadal (A.G.B.); Clinic of Laboratory Medicine (K.S.B.) and Department of Neurology (H.H.), St. Olavs Hospital, Trondheim University Hospital; Department of Laboratory Medicine (K.S.B.), Children's and Women's Health, Norwegian University of Science and Technology, Trondheim; Curato Oslo (F.L.); Department of Neurology (R.M.), Molde Hospital; Unit for Applied Clinical Research (R.M.), Norwegian University of Science and Technology, Trondheim; Unilabs Drammen (T.P.), Drammen; and Department of Neuroradiology (S.J.B.), Oslo University Hospital Rikshospitalet, Norway
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Bhise V, Dhib-Jalbut S. Further understanding of the immunopathology of multiple sclerosis: impact on future treatments. Expert Rev Clin Immunol 2016; 12:1069-89. [PMID: 27191526 DOI: 10.1080/1744666x.2016.1191351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The understanding of the immunopathogenesis of multiple sclerosis (MS) has expanded with more research into T-cell subtypes, cytokine contributors, B-cell participation, mitochondrial dysfunction, and more. Treatment options have rapidly expanded with three relatively recent oral therapy alternatives entering the arena. AREAS COVERED In the following review, we discuss current mechanisms of immune dysregulation in MS, how they relate to current treatments, and the impact these findings will have on the future of therapy. Expert commentary: The efficacy of these medications and understanding their mechanisms of actions validates the immunopathogenic mechanisms thought to underlie MS. Further research has exposed new targets, while new promising therapies have shed light on new aspects into the pathophysiology of MS.
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Affiliation(s)
- Vikram Bhise
- a Rutgers Biomedical and Health Sciences - Departments of Pediatrics , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Suhayl Dhib-Jalbut
- b Rutgers Biomedical and Health Sciences - Departments of Neurology , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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Perricone C, Versini M, Ben-Ami D, Gertel S, Watad A, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y. Smoke and autoimmunity: The fire behind the disease. Autoimmun Rev 2016; 15:354-74. [DOI: 10.1016/j.autrev.2016.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
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Xin N, Namaka MP, Dou C, Zhang Y. Exploring the role of interleukin-22 in neurological and autoimmune disorders. Int Immunopharmacol 2015; 28:1076-83. [PMID: 26311525 DOI: 10.1016/j.intimp.2015.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Interleukin-22 (IL-22) is a member of the IL-10 cytokine family that has recently gained attention in regard to its recognized pathogenic role in neurological and autoimmune disorders. The pathological involvement of IL-22 has been linked to Th17 cells that are involved in its production. Its biological activity results from its ability to bind to a heterodimeric receptor consisting of IL-22 receptor 1 (IL-22R1) and IL-10R2. Emerging evidence has identified IL-22 involvement in neurological diseases and autoimmune disorders such as Guillain-Barré Syndrome (GBS), multiple sclerosis (MS), Alzheimer's disease (AD), encephalitis, inflammatory myopathies, myasthenia gravis (MG), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjogren's syndrome (SS), psoriasis and Crohn's disease (CD). However, the biological activity of IL-22 is variable resulting in protective or pathogenic effects in different disease states. As such, the development of therapeutic targeting strategies to modify the biological activity of IL-22 is being explored as a promising interventional approach to treat neurological and autoimmune diseases.
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Affiliation(s)
- Ning Xin
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu Province 215021, China
| | - Michael Peter Namaka
- College of Pharmacy and Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Changxin Dou
- Department of Neurology, Shouguang People's Hospital, Shouguang, Shandong, China
| | - Yong Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.
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