Familial multiple sclerosis in a Brazilian sample: Is HLA-DR15 involved in susceptibility to the disease?

A Deep Learning Approach for Predicting Multiple Sclerosis

This paper proposes a deep learning model based on an artificial neural network with a single hidden layer for predicting the diagnosis of multiple sclerosis. The hidden layer includes a regularization term that prevents overfitting and reduces the model complexity. The purposed learning model achieved higher prediction accuracy and lower loss than four conventional machine learning techniques. A dimensionality reduction method was used to select the most relevant features from 74 gene expression profiles for training the learning models. The analysis of variance test was performed to identify the statistical difference between the mean of the proposed model and the compared classifiers. The experimental results show the effectiveness of the proposed artificial neural network.

Epidemiology of familial multiple sclerosis in Iran: a national registry-based study

Background

Admittedly, little is known about the epidemiological signatures of familial multiple sclerosis (FMS) in different geographical regions of Iran.

Objective

To determine the epidemiology and the risk of FMS incidence in several provinces of Iran with a different ethnic population including, Fars, Tehran, Isfahan (Persians), and Mazandaran (Mazanis), Kermanshah (Kurds), and Chaharmahal and Bakhtiari (Lors).

Methods

This cross-sectional registry-based study was performed on nationwide MS registry of Iran (NMSRI) data collected from 2018 to 2021. This system, registers baseline characteristics, clinical presentations and symptoms, diagnostic and treatments at regional and national levels.

Results

A total of 9200 patients including, 7003 (76.1%) female and 2197 (23.9%) male, were participated. About 19% of patients reported a family history of MS; the order from highest to lowest FMS prevalence was as follows: Fars (26.5%), Chaharmahal and Bakhtiari (21.1%), Tehran (20.5%), Isfahan (20.3%), Mazandaran (18.0%), and Kermanshah (12.5%). Of all FMS cases, 74.7% (1308 cases) were female and 25.3% (442 cases) were male. FMS occurrence was much more common in females than males (P-value = 0.001). Further, the mean age at onset was 30 years among FMS cases. A substantially higher probability of relapsing-remitting MS and secondary-progressive MS was found among FMS cases than sporadic MS (SMS) (P_value = 0.001). There was no significant difference in Expanded Disability Status Scale (EDSS) scores between FMS and SMS. The majority of FMS cases were observed among first-degree relatives, with the highest rate in siblings. There was a significant association between MS risk and positive familial history in both maternal and paternal aunt/uncle (P_value = 0.043 and P_value = 0.019, respectively). Multiple sclerosis occurrence among offspring of females was higher than males (P_value = 0.027).

Conclusions

In summary, our findings imply a noteworthy upward trend of FMS in Iran, even more than the global prevalence, which suggests a unique Atlas of FMS prevalence in this multi-ethnic population. Despite the highest rate of FMS within Persian and Lor ethnicities, no statistically significant difference was observed among the provinces.

The Gut-Brain Axis: How Microbiota and Host Inflammasome Influence Brain Physiology and Pathology

The human microbiota has a fundamental role in host physiology and pathology. Gut microbial alteration, also known as dysbiosis, is a condition associated not only with gastrointestinal disorders but also with diseases affecting other distal organs. Recently it became evident that the intestinal bacteria can affect the central nervous system (CNS) physiology and inflammation. The nervous system and the gastrointestinal tract are communicating through a bidirectional network of signaling pathways called the gut-brain axis, which consists of multiple connections, including the vagus nerve, the immune system, and bacterial metabolites and products. During dysbiosis, these pathways are dysregulated and associated with altered permeability of the blood-brain barrier (BBB) and neuroinflammation. However, numerous mechanisms behind the impact of the gut microbiota in neuro-development and -pathogenesis remain poorly understood. There are several immune pathways involved in CNS homeostasis and inflammation. Among those, the inflammasome pathway has been linked to neuroinflammatory conditions such as multiple sclerosis, Alzheimer's and Parkinson's diseases, but also anxiety and depressive-like disorders. The inflammasome complex assembles upon cell activation due to exposure to microbes, danger signals, or stress and lead to the production of pro-inflammatory cytokines (interleukin-1β and interleukin-18) and to pyroptosis. Evidences suggest that there is a reciprocal influence of microbiota and inflammasome activation in the brain. However, how this influence is precisely working is yet to be discovered. Herein, we discuss the status of the knowledge and the open questions in the field focusing on the function of intestinal microbial metabolites or products on CNS cells during healthy and inflammatory conditions, such as multiple sclerosis, Alzheimer's and Parkinson's diseases, and also neuropsychiatric disorders. In particular, we focus on the innate inflammasome pathway as immune mechanism that can be involved in several of these conditions, upon exposure to certain microbes.

Clinical and diagnostic features of patients with familial multiple sclerosis

BACKGROUND

Multiple Sclerosis (MS) is a demyelinating CNS disease. Most MS cases are sporadic, however about 20 percent of them are hereditary (Ramagopalan and Sadovnick, 2011). The incidence of familial MS is greater in regions with the highest prevalence of this disease (in North America, Europe) (Ramagopalan and Sadovnick, 2011). It is still unclear whether heredity affects the progression and severity of the disease. The aim of this study is to assess the effect of heredity on the development of multiple sclerosis and on the course of disease by analyzing the results of disability and severity scales, as well as clinical studies, and comparing them with sporadic cases.

METHODS

Our study included 104 patients with MS. The study group was comprised of 38 patients with history of first degree relative also affected by MS; the control group consisted of 66 patients with no family history (sporadic case). The anonymous survey included questions about demographic and clinical characteristics. Diagnostic results of magnetic resonance imaging (MRI), oligoclonal bands (OCBs) and visual evoked potentials (VEP) were evaluated retrospectively from medical records. Disability assessment was made according to expanded disability status scale (EDSS). Multiple Sclerosis Severity Score (MSSS) score was calculated using conversion table based on EDSS score and duration of disease in years.

RESULTS

MS patients with first degree relative affected by MS tend to have slower onset of the disease, while control group is more likely to have an acute onset (p < 0.001). The majority of MS with family history considered that their disease is caused by certain factors, while patients in the control group considered that the disease started without any identifiable cause (p < 0.05). Study group more often complained of pyramidal disorders (74% vs. 50%), symptoms related to brainstem (68% vs. 20%) and cortical lesions (47% vs. 20%), headache (37% vs. 9%), back pain (32% vs. 9%) than those in control group, p < 0.05. The degree of disability according to EDSS and MSSS scores were higher in the group of patients with first degree relative with MS (p < 0.05). The number of exacerbations per year was also higher in study group than in the control group (1.4 vs. 0.8; p < 0.05). Patients with a family history have a higher incidence of MRI changes in brainstem (74% vs. 30%) and cerebellum (58% vs. 30%) than the control group (p < 0.01).

CONCLUSIONS

MS patients with a family history of MS tend to have slower onset of the disease, while control group is more likely to have an acute onset. Patients with a family history of MS more often complained of brainstem and cortical dysfunction, and pain in head or back. Both the degree of disability according to EDSS and MSSS scores were higher in familial cases. They also have a higher number of exacerbations per year. Patients with a history of first degree relative with MS have a higher incidence of MRI changes in brainstem and cerebellum.