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Tolkovsky A, Pardo K, Hellmann M, Lotan I, Auriel E, Wilf-Yarkoni A. Association between clinical characteristics, acute steroid treatment and oligoclonal bands result in multiple sclerosis: A retrospective study. Mult Scler Relat Disord 2024; 85:105554. [PMID: 38537510 DOI: 10.1016/j.msard.2024.105554] [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: 12/01/2023] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Detection of oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) is important for diagnosis of multiple sclerosis (MS). Previous studies reported that treatment with intravenous methylprednisolone (IVMP) before lumber puncture (LP) could suppress OCBs production. The aim of this study was to assess whether IVMP initiation prior to CSF collection affects OCBs results in patients with an acute demyelinating event. Additionally, we examined which clinical characteristics are associated with the presence of OCBs in the CSF. METHODS We retrospectively evaluated patients admitted to the neurology department at rabin medical center (RMC) between 2010 and 2022 who underwent LP with OCBs analysis as part of their demyelinating attack workup. Patients were divided into OCB-positive and OCB-negative groups and demographical and clinical characteristics (including timing and duration of acute steroid treatment and history of prior demyelinating attacks) were analyzed for association with OCBs results. RESULTS A total of 342 patients were included with a median age of 35 years (IQR, 27-46). Two hundred thirty-eight (69.6 %) were OCB-positive. Initiation of IVMP before LP was not associated with negative OCBs (11.8 % Vs. 13.5 %, P = 0.721), nor was it correlated with OCBs positivity (OR=0.86, P = 0.66). CSF cell count was higher in OCB-positive patients (5 Vs. 3, P = 0.001), and a history of prior demyelinating attacks was associated with- (33.6 % Vs. 20.2 %, P = 0.014) and predictive of OCBs positivity (OR=2, P = 0.013). CONCLUSIONS Timing of steroids was not associated with OCB positivity. However, pleocytosis and a prior attack were associated with OCB positivity in this cohort. Our results suggest that steroid treatment is unlikely to affect OCBs results. Ideally, larger prospective studies would be needed to confirm our observations.
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Affiliation(s)
- Assaf Tolkovsky
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keshet Pardo
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Hellmann
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Lotan
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Auriel
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Wilf-Yarkoni
- Departmet of Neurology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Kennedy PGE, George W, Yu X. The elusive nature of the oligoclonal bands in multiple sclerosis. J Neurol 2024; 271:116-124. [PMID: 37945762 DOI: 10.1007/s00415-023-12081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Intrathecal immunoglobulin G (IgG) and oligoclonal bands (OCBs) detected in both the brain and cerebrospinal fluid (CSF) are seminal features of multiple sclerosis (MS). The presence of OCBs correlates with elevated disease burden and severity and supports the diagnosis of MS. Despite numerous investigations into the potential viral and autoantigen targets, the precise antigenic specificity of OCBs has remained elusive. We have little knowledge of the nature regarding these oligoclonal IgG bands. Here, we present compelling evidence highlighting the key findings that both OCBs and intrathecal IgG antibodies are under genetic control and that OCBs originate from clonal B-cells in both the periphery and CNS. We propose that MS OCBs are IgG immune complexes composed of IgG1 and IgG3 antibodies and that the pathological role of OCB stems from the IgG effector functions of these complexes, leading to demyelination and axonal injuries. We present additional evidence regarding the nature of MS OCBs: (1) disease-modifying therapies have been shown to affect CSF OCB; (2) OCBs have also been detected in several neuroinfectious diseases; (3) Epstein-Barr virus (EBV) has been particularly linked with MS pathogenesis, and its association with OCB is an important area of study. Although OCBs are closely associated with MS, more meticulously planned research is necessary to clarify the precise role of OCB in MS, both in terms of disease pathogenesis and diagnosis.
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Affiliation(s)
- Peter G E Kennedy
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, G61 1QH, Scotland, UK
| | - Woro George
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Xiaoli Yu
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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3
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El-Sayed MM, Mohak S, Gala D, Fabian R, Peterfi Z, Fabian Z. The Role of the Intestinal Microbiome in Multiple Sclerosis-Lessons to Be Learned from Hippocrates. BIOLOGY 2023; 12:1463. [PMID: 38132289 PMCID: PMC10740531 DOI: 10.3390/biology12121463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
Based on recent advances in research of chronic inflammatory conditions, there is a growing body of evidence that suggests a close correlation between the microbiota of the gastrointestinal tract and the physiologic activity of the immune system. This raises the idea that disturbances of the GI ecosystem contribute to the unfolding of chronic diseases including neurodegenerative pathologies. Here, we overview our current understanding on the putative interaction between the gut microbiota and the immune system from the aspect of multiple sclerosis, one of the autoimmune conditions accompanied by severe chronic neuroinflammation that affects millions of people worldwide.
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Affiliation(s)
- Mohamed Mahmoud El-Sayed
- School of Medicine and Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Fylde Rd, Preston PR1 2HE, UK;
| | - Sidhesh Mohak
- Department of Clinical Sciences, Saint James School of Medicine, Park Ridge, IL 60068, USA;
| | - Dhir Gala
- American University of the Caribbean School of Medicine, 1 University Drive, Jordan Road, Cupecoy, St Marteen, The Netherlands;
| | - Reka Fabian
- Salerno, Secondary School, Threadneedle Road, H91 D9H3 Galway, Ireland;
| | - Zoltan Peterfi
- Division of Infectology, 1st Department of Internal Medicine, University of Pecs, Clinical Centre, 7623 Pécs, Hungary;
| | - Zsolt Fabian
- School of Medicine and Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Fylde Rd, Preston PR1 2HE, UK;
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4
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Bogers L, Engelenburg HJ, Janssen M, Unger PPA, Melief MJ, Wierenga-Wolf AF, Hsiao CC, Mason MRJ, Hamann J, van Langelaar J, Smolders J, van Luijn MM. Selective emergence of antibody-secreting cells in the multiple sclerosis brain. EBioMedicine 2023; 89:104465. [PMID: 36796230 PMCID: PMC9958261 DOI: 10.1016/j.ebiom.2023.104465] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Although distinct brain-homing B cells have been identified in multiple sclerosis (MS), it is unknown how these further evolve to contribute to local pathology. We explored B-cell maturation in the central nervous system (CNS) of MS patients and determined their association with immunoglobulin (Ig) production, T-cell presence, and lesion formation. METHODS Ex vivo flow cytometry was performed on post-mortem blood, cerebrospinal fluid (CSF), meninges and white matter from 28 MS and 10 control brain donors to characterize B cells and antibody-secreting cells (ASCs). MS brain tissue sections were analysed with immunostainings and microarrays. IgG index and CSF oligoclonal bands were measured with nephelometry, isoelectric focusing, and immunoblotting. Blood-derived B cells were cocultured under T follicular helper-like conditions to evaluate their ASC-differentiating capacity in vitro. FINDINGS ASC versus B-cell ratios were increased in post-mortem CNS compartments of MS but not control donors. Local presence of ASCs associated with a mature CD45low phenotype, focal MS lesional activity, lesional Ig gene expression, and CSF IgG levels as well as clonality. In vitro B-cell maturation into ASCs did not differ between MS and control donors. Notably, lesional CD4+ memory T cells positively correlated with ASC presence, reflected by local interplay with T cells. INTERPRETATION These findings provide evidence that local B cells at least in late-stage MS preferentially mature into ASCs, which are largely responsible for intrathecal and local Ig production. This is especially seen in active MS white matter lesions and likely depends on the interaction with CD4+ memory T cells. FUNDING Stichting MS Research (19-1057 MS; 20-490f MS), National MS Fonds (OZ2018-003).
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Affiliation(s)
- Laurens Bogers
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Hendrik J Engelenburg
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands
| | - Malou Janssen
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands; Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Peter-Paul A Unger
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Marie-José Melief
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Cheng-Chih Hsiao
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands
| | - Matthew R J Mason
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands
| | - Jörg Hamann
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands; Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, 1007 MB, Amsterdam, The Netherlands
| | - Jamie van Langelaar
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Joost Smolders
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands; Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands; Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Marvin M van Luijn
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands.
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5
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Belimezi M, Kalliaropoulos A, Mentis AFA, Chrousos GP. Diagnostic significance of IgG and albumin indices versus oligoclonal band types in demyelinating disorders. J Clin Pathol 2023; 76:166-171. [PMID: 34526372 DOI: 10.1136/jclinpath-2021-207766] [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: 06/14/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022]
Abstract
AIMS The laboratory diagnosis of demyelinating inflammatory disorders (DIDs) relies on both intrathecal oligoclonal band (OCB) positivity and IgG index. Although OCB typing remains the gold-standard test for DIDs, it can be laborious and ambiguous, complicating diagnostics, and unduly increasing diagnostic time. We examined whether serum or cerebrospinal fluid (CSF) parameters can classify OCB types and, thus, be used as a replacement test to standard OCB typing. METHODS We retrospectively analysed >1000 prospectively collected samples of patients with DIDs and quantified albumin and IgG levels in the CSF and serum. We determined OCB types by isoelectric focusing combined with immunofixation and evaluated the diagnostic accuracies of IgG and albumin indices in discriminating OCB types by receiver operating characteristic curves and multinomial regression. RESULTS An IgG index cut-off of 0.589 differentiated types 2/3 from types 1/4 (area under the curve 0.780, 95% CI 0.761 to 0.812, p<0.001; specificity: 71.10%, sensitivity: 73.45%). Albumin quotient cut-off values of 6.625 and of 6.707 discriminated type 1 from type 4 and type 2 from type 3, respectively (specificity: <55%, sensitivity: <75%). Female sex, age, IgG index, CSF IgG and serum albumin were associated with different OCB types. CONCLUSIONS Our study reveals that IgG and albumin index can differentiate OCB types with adequate accuracy, especially if refined by age and gender.
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Affiliation(s)
- Maria Belimezi
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece
| | | | - Alexios-Fotios A Mentis
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece .,University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
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6
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Arneth B, Kraus J. The Use of Kappa Free Light Chains to Diagnose Multiple Sclerosis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1512. [PMID: 36363469 PMCID: PMC9698214 DOI: 10.3390/medicina58111512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Background: The positive implications of using free light chains in diagnosing multiple sclerosis have increasingly gained considerable interest in medical research and the scientific community. It is often presumed that free light chains, particularly kappa and lambda free light chains, are of practical use and are associated with a higher probability of obtaining positive results compared to oligoclonal bands. The primary purpose of the current paper was to conduct a systematic review to assess the up-to-date methods for diagnosing multiple sclerosis using kappa and lambda free light chains. Method: An organized literature search was performed across four electronic sources, including Google Scholar, Web of Science, Embase, and MEDLINE. The sources analyzed in this systematic review and meta-analysis comprise randomized clinical trials, prospective cohort studies, retrospective studies, controlled clinical trials, and systematic reviews. Results: The review contains 116 reports that includes 1204 participants. The final selection includes a vast array of preexisting literature concerning the study topic: 35 randomized clinical trials, 21 prospective cohort studies, 19 retrospective studies, 22 controlled clinical trials, and 13 systematic reviews. Discussion: The incorporated literature sources provided integral insights into the benefits of free light chain diagnostics for multiple sclerosis. It was also evident that the use of free light chains in the diagnosis of clinically isolated syndrome (CIS) and multiple sclerosis is relatively fast and inexpensive in comparison to other conventional state-of-the-art diagnostic methods, e.g., using oligoclonal bands (OCBs).
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Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Justus Liebig University, Feulgenstr. 12, 35392 Giessen, Germany
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Strubergasse 21, 5020 Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
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7
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Nociti V, Romozzi M, Mirabella M. Update on Multiple Sclerosis Molecular Biomarkers to Monitor Treatment Effects. J Pers Med 2022; 12:549. [PMID: 35455665 PMCID: PMC9024668 DOI: 10.3390/jpm12040549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system characterized by broad inter- and intraindividual heterogeneity. The relapse rate, disability progression, and lesion load assessed through MRI are used to detect disease activity and response to treatment. Although it is possible to standardize these characteristics in larger patient groups, so far, this has been difficult to achieve in individual patients. Easily detectable molecular biomarkers can be powerful tools, permitting a tailored therapy approach for MS patients. However, only a few molecular biomarkers have been routinely used in clinical practice as the validation process, and their transfer into clinical practice takes a long time. This review describes the characteristics of an ideal MS biomarker, the challenges of establishing new biomarkers, and promising molecular biomarkers from blood or CSF samples used to monitor MS treatment effects in clinical practice.
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Affiliation(s)
- Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
| | - Massimiliano Mirabella
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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8
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Carta S, Ferraro D, Ferrari S, Briani C, Mariotto S. Oligoclonal bands: clinical utility and interpretation cues. Crit Rev Clin Lab Sci 2022; 59:391-404. [DOI: 10.1080/10408363.2022.2039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sara Carta
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Diana Ferraro
- Department of Biomedicine, Metabolic, and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Sara Mariotto
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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9
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Barakat B, Messina S, Nayak S, Kassa R, Sechi E, Flanagan EP, Kantarci O, Weinshenker BG, Keegan BM. Cerebrospinal fluid evaluation in patients with progressive motor impairment due to critical central nervous system demyelinating lesions. Mult Scler J Exp Transl Clin 2022; 8:20552173211052159. [PMID: 35047187 PMCID: PMC8761886 DOI: 10.1177/20552173211052159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Elevated intrathecal immunoglobulin G (IgG; oligoclonal bands (OCBs)) or IgG in people with progressive motor impairment due to “critical” demyelinating lesions are of uncertain significance. Objective Compare clinical/radiological features of people with “critical” demyelinating lesion-induced progressive motor impairment with/without elevated intrathecal IgG synthesis. Methods A total of 133 people with progressive motor impairment attributable to “critical” demyelinating lesions (corticospinal tract location, consistent with the progressive motor deficit) were compared regarding clinical and radiological presentation with and without ≥2 unique cerebrospinal fluid (CSF) OCB and/or IgG index ≥0.85. Results Ninety-eight (74%) had CSF-elevated OCB and/or IgG index, higher with increased magnetic resonance imaging-lesion burden. No differences were found with/without CSF abnormalities in sex (46 of 98 female (47%) vs. 22 of 35 (63%), p = 0.11), onset-age (median 49 vs. 50 years, p = 0.5), progression from onset (62 of 98 (63%) vs. 25 of 35 (71%)), progression post-relapse (36 of 98 (37%) vs. 10 of 35 (29%), p = 0.4), and duration between demyelinating disease onset and CSF examination (30 (0–359) vs. 48 (0–323) months p = 0.7). “Critical” lesions were radiologically similar, most commonly cervical spine located (72 of 98 (74%) vs. 19 of 35 (54%), p = 0.18) both with/without CSF abnormalities. Conclusions People with “critical” demyelinating lesion-induced progressive motor impairment typically have elevated intrathecal IgG (OCB and/or IgG) and similar clinical and radiological presentation regardless of CSF findings, therefore representing valid presentations of progressive demyelinating disease.
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Affiliation(s)
- Benan Barakat
- Department of Family Medicine, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Steve Messina
- Department of Radiology, Division of Neuroradiology Mayo Clinic Rochester, MN, USA
| | - Shreya Nayak
- St. Elizabeth Physicians, Crestview Hills, KY, USA
| | - Roman Kassa
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Elia Sechi
- Università degli Studi di Sassari, Sassari, Italy
| | | | | | | | - B Mark Keegan
- Department of Neurology Mayo Clinic Rochester, MN, USA
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Fransen NL, de Jong BA, Heß K, Kuhlmann T, Vincenten MCJ, Hamann J, Huitinga I, Smolders J. Absence of B Cells in Brainstem and White Matter Lesions Associates With Less Severe Disease and Absence of Oligoclonal Bands in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/2/e955. [PMID: 33504635 PMCID: PMC7862088 DOI: 10.1212/nxi.0000000000000955] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022]
Abstract
Objective To determine whether B-cell presence in brainstem and white matter (WM) lesions is associated with poorer pathological and clinical characteristics in advanced MS autopsy cases. Methods Autopsy tissue of 140 MS and 24 control cases and biopsy tissue of 24 patients with MS were examined for CD20+ B cells and CD138+ plasma cells. The presence of these cells was compared with pathological and clinical characteristics. In corresponding CSF and plasma, immunoglobulin (Ig) G ratio and oligoclonal band (OCB) patterns were determined. In a clinical cohort of 73 patients, the presence of OCBs was determined during follow-up and compared to status at diagnosis. Results In 34% of active and 71% of mixed active/inactive lesions, B cells were absent, which correlated with less pronounced meningeal B-cell infiltration (p < 0.0001). The absence of B cells and plasma cells in brainstem and WM lesions was associated with a longer disease duration (p = 0.001), less frequent secondary progressive MS compared with relapsing and primary progressive MS (p < 0.0001 and p = 0.046, respectively), a lower proportion of mixed active/inactive lesions (p = 0.01), and less often perivascular T-cell clustering (p < 0.0001). Moreover, a lower CSF IgG ratio (p = 0.006) and more frequent absence of OCBs (p < 0.0001) were noted. In a clinical cohort, numbers of patients without OCBs in CSF were increased at follow-up (27.4%). Conclusions The absence of B cells is associated with a favorable clinical and pathological profile. This finding may reflect extremes of a continuum of genetic or environmental constitution, but also a regression of WM humoral immunopathology in the natural course of advanced MS.
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Affiliation(s)
- Nina L Fransen
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Brigit A de Jong
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katharina Heß
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tanja Kuhlmann
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maria C J Vincenten
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jörg Hamann
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Inge Huitinga
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost Smolders
- From the Department of Neuroimmunology (N.L.F., M.C.J.V. J.H., I.H., J.S.), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Department of Neurology and MS Center, Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit (B.A.J.), The Netherlands; Institute for Neuropathology (K.H., T.K.), University Hospital Münster, Münster, Germany; Department of Experimental Immunology (J.H.), Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam (I.H.), The Netherlands; and MS Center ErasMS (J.S.), Departments of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands.
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11
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van der Poel M, Hoepel W, Hamann J, Huitinga I, Dunnen JD. IgG Immune Complexes Break Immune Tolerance of Human Microglia. THE JOURNAL OF IMMUNOLOGY 2020; 205:2511-2518. [PMID: 32967931 DOI: 10.4049/jimmunol.2000130] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
Microglia are phagocytic cells involved in homeostasis of the brain and are key players in the pathogenesis of multiple sclerosis (MS). A hallmark of MS diagnosis is the presence of IgG Abs, which appear as oligoclonal bands in the cerebrospinal fluid. In this study, we demonstrate that myelin obtained post mortem from 8 out of 11 MS brain donors is bound by IgG Abs. Importantly, we show that IgG immune complexes strongly potentiate activation of primary human microglia by breaking their tolerance for microbial stimuli, such as LPS and Poly I:C, resulting in increased production of key proinflammatory cytokines, such as TNF and IL-1β. We identified FcγRI and FcγRIIa as the two main responsible IgG receptors for the breaking of immune tolerance of microglia. Combined, these data indicate that IgG immune complexes potentiate inflammation by human microglia, which may play an important role in MS-associated inflammation and the formation of demyelinating lesions.
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Affiliation(s)
- Marlijn van der Poel
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, the Netherlands
| | - Willianne Hoepel
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, University Medical Centers, 1105 AZ Amsterdam, the Netherlands.,Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, the Netherlands; and
| | - Jörg Hamann
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, University Medical Centers, 1105 AZ Amsterdam, the Netherlands
| | - Inge Huitinga
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, the Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, 1090 GE Amsterdam, the Netherlands
| | - Jeroen den Dunnen
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, University Medical Centers, 1105 AZ Amsterdam, the Netherlands; .,Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, the Netherlands; and
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12
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Kassa RM, Sechi E, Flanagan EP, Kaufmann TJ, Kantarci OH, Weinshenker BG, Mandrekar J, Schmalstieg WF, Paz Soldan MM, Keegan BM. Onset of progressive motor impairment in patients with critical central nervous system demyelinating lesions. Mult Scler 2020; 27:895-902. [PMID: 32667237 DOI: 10.1177/1352458520940983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare progressive motor impairment onset attributable to a "critical" central nervous system (CNS) demyelinating lesion in patients with highly restricted versus unlimited magnetic resonance imaging (MRI) lesion burden. METHODS We identified 135 patients with progressive motor impairment for ⩾1 year attributable to a "critical" demyelinating lesion with: MRI burden of 1 lesion ("progressive solitary sclerosis"), 2-5 lesions ("progressive paucisclerosis"), or unrestricted (>5) lesions and "progressive unilateral hemiparesis." Neuroradiology review of brain and spinal cord MRI documented unequivocally demyelinating lesions. RESULTS A total of 33 (24.4%) patients had progressive solitary sclerosis; 56 (41.5%) patients had progressive paucisclerosis; and 46 (34.1%) patients had progressive unilateral hemiparesis. Median age at onset of progressive motor impairment was younger in progressive solitary sclerosis (49 years; range 24-73) and progressive paucisclerosis (50 years; range 30-64) than in progressive unilateral hemiparesis (54 years; range 39-77; p = 0.02 and p = 0.003, respectively). Within progressive unilateral hemiparesis, motor-progression onset was similar between those with 4-10, 11-20, or >20 brain lesions (55, 54, 53 years of age, respectively; p = 0.44). CONCLUSION Motor-progression age is similar, but paradoxically earlier, in cohorts with highly restricted CNS lesion burden than in those with unrestricted lesion burden with progressive unilateral hemiparetic MS. The "critical" demyelinating lesion rather than total brain MRI lesion burden is the major contributor to motor-progression onset in these cohorts.
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Affiliation(s)
- Roman M Kassa
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA/Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Elia Sechi
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Orhun H Kantarci
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay Mandrekar
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - B Mark Keegan
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
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13
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Rejdak K, Stelmasiak Z, Grieb P. Cladribine induces long lasting oligoclonal bands disappearance in relapsing multiple sclerosis patients: 10-year observational study. Mult Scler Relat Disord 2018; 27:117-120. [PMID: 30368223 DOI: 10.1016/j.msard.2018.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been long-term interest in cladribine as a drug for the treatment of MS. The current study focused on the effect of cladribine on oligoclonal bands (OCB) expression in the CSF in relapsing-remitting MS (RRMS) patients observed over 10 years. METHODS 29 treatment-naive subjects with RRMS were prospectively enrolled and received induction therapy with subcutaneous parenteral cladribine (at a cumulative dose of 1.8 mg/kg; divided into 6 courses every 5 weeks given for 4-6 days, depending on patients' body weight). Selected patients received maintenance doses in the follow-up period. RESULTS Isoelectric focusing revealed that 55% of patients did not have OCB in CSF after cladribine treatment as compared to baseline testing when 100% of patients were positive for OCB. There were no significant differences in Expanded Disability Status Scale scores at baseline and at the end of treatment cycle between OCB-positive vs. OCB-negative subgroups. At the last follow-up, OCB-negative patients had lower disability compared to OCB-positive patients (p = 0.03). CONCLUSION Cladribine-induced immune reconstitution leads to long lasting suppression of intrathecal humoral response, which might be an additional mechanism that enhances the therapeutic effect on disease progression in RRMS patients.
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Affiliation(s)
- Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland; Department of Experimental Pharmacology, Medical Research Center. Polish Academy of Sciences, Warsaw, Poland.
| | | | - Paweł Grieb
- Department of Experimental Pharmacology, Medical Research Center. Polish Academy of Sciences, Warsaw, Poland
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14
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Casanova B, Lacruz L, Villar ML, Domínguez JA, Gadea MC, Gascón F, Mallada J, Hervás D, Simó-Castelló M, Álvarez-Cermeño JC, Calles C, Olascoaga J, Ramió-Torrentà L, Alcalá C, Cervelló A, Boscá I, Pérez-Mirallles FC, Coret F. Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients. Neurol Sci 2018; 39:1423-1430. [PMID: 29882169 DOI: 10.1007/s10072-018-3442-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the efficacy of interferon beta (IFNβ) and glatiramer acetate (GA) related to the presence of oligoclonal M bands (OCMB) in the cerebrospinal fluid in relapsing-remitting multiple sclerosis (RRMS). METHOD This is an observational, multicenter and retrospective study with prospectively collected data of patients that started treatment with IFNβ or GA. Treatment decision was made blinded to the OCMB status. Time to first attack after starting therapy was compared by using Kaplan-Meier curves, and adjustment by Cox regression analysis was performed. RESULTS Two hundred and fifty-six patients entered in the study (141-55% received IFNβ; 115-45% received GA). After a mean follow-up of 41 and 65 months, 54.7% of patients remained free from further attacks (RF). The proportion of RF patients was higher in the GA group than in the IFNβ group (72.2 vs. 40.4%, p < 0.001). The IFNβ patients with OCMB+ presented the poorest response, 31.3% RF vs. 48.1% in IFNβ without OCMB, p = 0.03. CONCLUSION OCMB in CSF could be a biomarker of treatment response in multiple sclerosis.
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Affiliation(s)
| | - Laura Lacruz
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | | | | | | | - Francisco Gascón
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
| | | | - David Hervás
- Biostatistical Unit, Institut d'Investigació Sanitaria La Fe, Valencia, Spain
| | - María Simó-Castelló
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Carmen Calles
- Neurological Service, Hospital Son Espases, Mallorca, Spain
| | | | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Dr. Josep Trueta, IDIBGI, Girona, Spain
| | - Carmen Alcalá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Angeles Cervelló
- Neurological Service, Hospital General de València, Valencia, Spain
| | - Isabel Boscá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Coret
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
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15
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Voortman MM, Stojakovic T, Pirpamer L, Jehna M, Langkammer C, Scharnagl H, Reindl M, Ropele S, Seifert-Held T, Archelos JJ, Fuchs S, Enzinger C, Fazekas F, Khalil M. Prognostic value of free light chains lambda and kappa in early multiple sclerosis. Mult Scler 2016; 23:1496-1505. [DOI: 10.1177/1352458516681503] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cerebrospinal fluid (CSF) immunoglobulin free light chains (FLC) have been suggested as quantitative alternative to oligoclonal bands (OCB) in the diagnosis of multiple sclerosis (MS). However, little is known on their role in predicting clinical and paraclinical disease progression, particularly in early stages. Objective: To assess the prognostic value of FLC in OCB-positive patients with clinically isolated syndrome (CIS) suggestive of MS and early MS. Methods: We determined FLC kappa (KFLC) and lambda (LFLC) in CSF and serum by nephelometry in 61 patients (CIS ( n = 48), relapsing-remitting multiple sclerosis ( n = 13)) and 60 non-inflammatory neurological controls. Median clinical follow-up time in CIS was 4.8 years (interquartile range (IQR), 1.5–6.5 years). Patients underwent 3T magnetic resonance imaging (MRI) at baseline and follow-up (median time interval, 2.2 years; IQR, 1.0–3.7 years) to determine T2 lesion load (T2LL) and percent brain volume change (PBVC). Results: CSF FLC were significantly increased in CIS/MS compared to controls (all p < 0.001). A lower KFLC/LFLC CSF ratio was associated with CIS-clinically definite multiple sclerosis (CDMS) conversion (hazard ratio (HR) = 2.89; 95% confidence interval (CI) = 1.17–7.14; p < 0.05). No correlations were found for FLC variables with T2LL or PBVC. Conclusion: Our study confirms increased intrathecal synthesis of FLC in CIS/MS which supports their diagnostic contribution. The KFLC/LFLC CSF ratio appears to have a prognostic value in CIS beyond OCB.
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Affiliation(s)
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical
Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | - Margit Jehna
- Division of Neuroradiology, Vascular and
Interventional Radiology, Medical University of Graz, Graz, Austria
| | | | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical
Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical
University of Innsbruck, Innsbruck, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | | | | | - Siegrid Fuchs
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of
Graz, Graz, Austria/Division of Neuroradiology, Vascular and Interventional
Radiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of
Graz, Graz, Austria
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16
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Michel L, Touil H, Pikor NB, Gommerman JL, Prat A, Bar-Or A. B Cells in the Multiple Sclerosis Central Nervous System: Trafficking and Contribution to CNS-Compartmentalized Inflammation. Front Immunol 2015; 6:636. [PMID: 26732544 PMCID: PMC4689808 DOI: 10.3389/fimmu.2015.00636] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/03/2015] [Indexed: 12/25/2022] Open
Abstract
Clinical trial results of peripheral B cell depletion indicate abnormal proinflammatory B cell properties, and particularly antibody-independent functions, contribute to relapsing MS disease activity. However, potential roles of B cells in progressive forms of disease continue to be debated. Prior work indicates that presence of B cells is fostered within the inflamed MS central nervous system (CNS) environment, and that B cell-rich immune cell collections may be present within the meninges of patients. A potential association is reported between such meningeal immune cell collections and the subpial pattern of cortical injury that is now considered important in progressive disease. Elucidating the characteristics of B cells that populate the MS CNS, how they traffic into the CNS and how they may contribute to progressive forms of the disease has become of considerable interest. Here, we will review characteristics of human B cells identified within distinct CNS subcompartments of patients with MS, including the cerebrospinal fluid, parenchymal lesions, and meninges, as well as the relationship between B cell populations identified in these subcompartments and the periphery. We will further describe the different barriers of the CNS and the possible mechanisms of migration of B cells across these barriers. Finally, we will consider the range of human B cell responses (including potential for antibody production, cytokine secretion, and antigen presentation) that may contribute to propagating inflammation and injury cascades thought to underlie MS progression.
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Affiliation(s)
- Laure Michel
- Département de Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montréal, QC , Canada
| | - Hanane Touil
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University , Montréal, QC , Canada
| | - Natalia B Pikor
- Department of Immunology, University of Toronto , Toronto, ON , Canada
| | | | - Alexandre Prat
- Département de Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montréal, QC , Canada
| | - Amit Bar-Or
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
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17
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Does cerebrospinal fluid analysis add predictive value to magnetic resonance imaging for long term irreversible disability in patients with early multiple sclerosis? J Neurol Sci 2015; 354:51-5. [DOI: 10.1016/j.jns.2015.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/07/2015] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
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18
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Becker M, Latarche C, Roman E, Debouverie M, Malaplate-Armand C, Guillemin F. No prognostic value of routine cerebrospinal fluid biomarkers in a population-based cohort of 407 multiple sclerosis patients. BMC Neurol 2015; 15:79. [PMID: 25966681 PMCID: PMC4430897 DOI: 10.1186/s12883-015-0330-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value. Methods We followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof’s criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m). Results For 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2–7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46–0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis. Conclusion Routine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.
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Affiliation(s)
- Madlyne Becker
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France.
| | - Clotilde Latarche
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France.
| | - Emilie Roman
- Metz-Thionville Hospital, Bel Air Hospital, Departement of Biology, F-57 100, Thionville, France.
| | - Marc Debouverie
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France. .,Department of Neurology, Nancy University Hospital, F-54 000, Nancy, France.
| | | | - Francis Guillemin
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France. .,Department of Clinical Epidemiology and Evaluation, CHU de Nancy, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre Les, Nancy, France.
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19
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Arrambide G, Sastre-Garriga J. Predictive markers of disease evolution after a CIS in everyday practice. J Neurol Sci 2014; 343:8-14. [DOI: 10.1016/j.jns.2014.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 01/04/2023]
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20
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Kappa free light chains: diagnostic and prognostic relevance in MS and CIS. PLoS One 2014; 9:e89945. [PMID: 24651567 PMCID: PMC3940961 DOI: 10.1371/journal.pone.0089945] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/23/2014] [Indexed: 11/19/2022] Open
Abstract
Background Quantification of kappa free light chains (KFLC) in cerebrospinal fluid shows high diagnostic sensitivity in multiple sclerosis and clinically isolated syndrome patients. However, a clearly defined threshold value is still missing and a possible prognostic value of the KFLC levels in these patients remains undefined. Methods Results of KFLC quantification in 420 controls were used to set an upper limit of normal KFLC concentration in CSF under different blood-CSF-barrier conditions. Additionally, KFLC values of MS and CIS patients were assessed and results were evaluated with reference to the patients corresponding disease courses. Results The calculated upper limit of normal KFLC-concentration covers 98% of these control patients. Using this cut-off, plasma cell activity in CSF can be detected in 97% of MS patients and in 97% of CIS patients. However, there is no evidence that the extent of KFLC elevation provides prognostic value in MS and CIS patients in this study. Conclusion KFLC determination should become a first line screen in the diagnostic algorithms of MS and CIS. The extent of elevation of intrathecal KFLC has no prognostic value on the disease course in MS and CIS patients.
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Abstract
The cerebrospinal fluid (CSF) is a bodily fluid, which is both easily accessible and the most proximate to the pathological alterations of multiple sclerosis (MS). Consequently, the analysis of this fluid provides an important window into the pathological underpinnings of this disease. For example, for years, it has been known that the CSF of MS patients contains oligoclonal gamma immunoglobulins (IgG), which are synthesized within the central nervous system and presumably relate to the immune dysfunction, which is characteristically found in MS. This insight has lead to the introduction of highly-effective anti-B-cell therapies into the field of MS therapeutics. Moreover, the presence of an oligoclonal IgG response in the CSF, although not specific for MS, is a very sensitive finding and, as a result, its presence can be quite helpful for establishing an MS diagnosis in the right clinical context. In addition, this finding has predictive value. Thus, patients without a definite diagnosis who have CSF IgG bands are significantly more likely to develop definite MS compared to those patients without such a banding pattern. Other biological molecules can also be found in the CSF including neurofiliment, myelin basic protein (MBP), glial fibrillary acidic protein (GFAP), tau, neuronal cell adhesion molecule (NCAM), and the growth associated protein (GAP-43). However, the value of measuring these (and other) CSF constituents for both diagnostic and prognostic purposes and for following response to therapy is still to be determined.
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Affiliation(s)
- Gavin Giovannoni
- Centre for Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
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22
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Bonnan M. Intrathecal immune reset in multiple sclerosis: exploring a new concept. Med Hypotheses 2013; 82:300-9. [PMID: 24417802 DOI: 10.1016/j.mehy.2013.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/10/2013] [Accepted: 12/19/2013] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis impairment is mainly driven by the progressive phase, whose pathology remains elusive. No drug has yet been able to halt this phase so therapeutic management remains challenging. It was recently demonstrated that late disability correlates with the spreading of cortical subpial lesions, and tertiary lymphoid organs (TLO) were identified in close apposition with these lesions. TLO are of crucial importance since they are able to mount a complete local immune response, as observed in the intrathecal compartment from the moment MS is diagnosed (i.e. oligoclonal bands). This article examines the consequences of this intrathecal response: giving a worst clinical prognostic value and bearing arguments for possible direct brain toxicity, intrathecal secretion should be targeted by drugs abating both B-lymphocytes and plasma cells. Another consequence is that intrathecal secretion has value as a surrogate marker of the persistence of an ongoing intrathecal immune reaction after treatment. Although it is still unsure which mechanism or byproduct secreted by TLO triggers cortical lesions, we propose to target TLO components as a new therapeutic avenue in progressive MS. Whereas it was long considered that the inability of therapies to penetrate the blood-brain-barrier was a crucial obstacle, our proposed strategy will take advantage of the properties of the BBB to safely reset the intrathecal immune system in order to halt the slow axonal burning underlying secondary MS. We review the literature in support of the rationale for treating MS with intrathecal drugs dedicated to clearing the local immune response. Since many targets are involved, achieving this goal may require a combination of monoclonal antibodies targeting each cell sub-type. Hope might be rekindled with a one-shot intrathecal multi-drug treatment in progressive MS.
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Affiliation(s)
- Mickael Bonnan
- Service de Neurologie, Hôpital F. Mitterrand, 4 bd Hauterive, 64046 Pau, France.
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24
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Mero IL, Gustavsen MW, Sæther HS, Flåm ST, Berg-Hansen P, Søndergaard HB, Jensen PEH, Berge T, Bjølgerud A, Muggerud A, Aarseth JH, Myhr KM, Celius EG, Sellebjerg F, Hillert J, Alfredsson L, Olsson T, Oturai AB, Kockum I, Lie BA, Andreassen BK, Harbo HF. Oligoclonal band status in Scandinavian multiple sclerosis patients is associated with specific genetic risk alleles. PLoS One 2013; 8:e58352. [PMID: 23472185 PMCID: PMC3589422 DOI: 10.1371/journal.pone.0058352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/03/2013] [Indexed: 12/24/2022] Open
Abstract
The presence of oligoclonal bands (OCB) in cerebrospinal fluid (CSF) is a typical finding in multiple sclerosis (MS). We applied data from Norwegian, Swedish and Danish (i.e. Scandinavian) MS patients from a genome-wide association study (GWAS) to search for genetic differences in MS relating to OCB status. GWAS data was compared in 1367 OCB positive and 161 OCB negative Scandinavian MS patients, and nine of the most associated SNPs were genotyped for replication in 3403 Scandinavian MS patients. HLA-DRB1 genotypes were analyzed in a subset of the OCB positive (n = 2781) and OCB negative (n = 292) MS patients and compared to 890 healthy controls. Results from the genome-wide analyses showed that single nucleotide polymorphisms (SNPs) from the HLA complex and six other loci were associated to OCB status. In SNPs selected for replication, combined analyses showed genome-wide significant association for two SNPs in the HLA complex; rs3129871 (p = 5.7×10(-15)) and rs3817963 (p = 5.7×10(-10)) correlating with the HLA-DRB1*15 and the HLA-DRB1*04 alleles, respectively. We also found suggestive association to one SNP in the Calsyntenin-2 gene (p = 8.83×10(-7)). In HLA-DRB1 analyses HLA-DRB1*15∶01 was a stronger risk factor for OCB positive than OCB negative MS, whereas HLA-DRB1*04∶04 was associated with increased risk of OCB negative MS and reduced risk of OCB positive MS. Protective effects of HLA-DRB1*01∶01 and HLA-DRB1*07∶01 were detected in both groups. The groups were different with regard to age at onset (AAO), MS outcome measures and gender. This study confirms both shared and distinct genetic risk for MS subtypes in the Scandinavian population defined by OCB status and indicates different clinical characteristics between the groups. This suggests differences in disease mechanisms between OCB negative and OCB positive MS with implications for patient management, which need to be further studied.
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Affiliation(s)
- Inger-Lise Mero
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Marte W. Gustavsen
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hanne S. Sæther
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Siri T. Flåm
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helle B. Søndergaard
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Poul Erik H. Jensen
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tone Berge
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anja Bjølgerud
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aslaug Muggerud
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan H. Aarseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Kjell-Morten Myhr
- The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Finn Sellebjerg
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, The Multiple Sclerosis Research Group, Center for Molecular Medicine, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, The Neuroimmunology Research Group, Stockholm, Sweden
| | - Annette Bang Oturai
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, The Neuroimmunology Research Group, Stockholm, Sweden
| | - Benedicte A. Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Bettina Kulle Andreassen
- Department of Clinical Molecular Biology and Laboratory Sciences (EpiGen), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Biostiatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hanne F. Harbo
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
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Harbo HF, Mero IL. From genes to characteristics of multiple sclerosis. Acta Neurol Scand 2012:76-83. [PMID: 23278661 DOI: 10.1111/ane.12027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2012] [Indexed: 02/03/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory, demyelinating heterogeneous disease of the central nervous system, probably caused by an interaction of common genetic and environmental factors. Much progress has been made through the last few years in genetic studies of MS, and a growing list of genetic risk factors is now available. Biobanking and large collaborations have been prerequisites for this research, and detailed genetic and molecular characterizations are underway, with hopes for to translating new knowledge about MS pathogenesis and characteristics of the disease to personalized, better treatment options for each patient with MS.
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Affiliation(s)
- H F Harbo
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
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26
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Lechner-Scott J, Spencer B, de Malmanche T, Attia J, Fitzgerald M, Trojano M, Grand'Maison F, Gomez JAC, Izquierdo G, Duquette P, Girard M, Grammond P, Oreja-Guevara C, Hupperts R, Bergamaschi R, Boz C, Giuliani G, van Pesch V, Iuliano G, Fiol M, Cristiano E, Verheul F, Saladino ML, Slee M, Barnett M, Deri N, Flechter S, Vella N, Shaw C, Herbert J, Moore F, Petkovska-Boskova T, Jokubaitis V, Butzkueven H. The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude. Mult Scler 2011; 18:974-82. [PMID: 22185806 DOI: 10.1177/1352458511431729] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the advent of MRI scanning, the value of lumbar puncture to assess oligoclonal band (OCB) status-for the diagnosis of multiple sclerosis (MS) is increasingly uncertain. One major issue is that the reported frequency of cerebrospinal fluid (CSF)-restricted oligoclonal banding for the diagnosis of MS varies considerably in different studies. In addition, the relationship between OCB positivity and disease outcome remains uncertain, as reported studies are generally too small to assess comparative disability outcomes with sufficient power. METHODS In order to further investigate variation of OCB positivity in patients with MS, we utilized MSBase, a longitudinal, Web-based collaborative MS outcomes registry following clinical cohorts in several continents and latitudes. We also assessed whether OCB positivity affects long-term disability outcome. RESULTS A total of 13,242 patient records were obtained from 37 MS specialist centres in 19 different countries. OCB status was documented in 4481 (34%) patients and 80% of these were OCB positive. The presence of OCB was associated with degree of latitude (p = 0.02). Furthermore, the outcome of patients negative for CSF-specific OCB was significantly better in comparison to the OCB positive patients, as assessed by Expanded Disability Status Scale change (p < 0.001). CONCLUSIONS The results of this study indicate that latitude could explain some of the inconsistencies in OCB status reported in different populations. The study confirms that OCB positivity in MS is associated with a worse long-term prognosis.
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Gama PDD, Machado LDR, Livramento JA, Gomes HR, Adoni T, Lino AMM, Marchiori PE, Morales RDR, Lana-Peixoto MA, Callegaro D. Study of oligoclonal bands restricted to the cerebrospinal fluid in multiple sclerosis patients in the city of São Paulo. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 67:1017-22. [PMID: 20069212 DOI: 10.1590/s0004-282x2009000600011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 08/07/2009] [Indexed: 11/21/2022]
Abstract
The frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid (CSF) from patients with multiple sclerosis (MS) varies widely in different populations. The objective of this study was to determine the frequency of these OCB in a group of MS patients in the city of São Paulo. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. Oligoclonal bands were found in 49 (54.4%) out of 90 patients with clinically definite MS; in (31.2%) of the 16 patients with clinically isolated syndrome; in 7 (17.9%) of 39 patients with inflammatory disorders of the central nervous system (IDCNS), and in none of the individuals with no neurological condition (control group). The specificity of the method was 100% when compared to the control group and 82.1% when compared to the IDCNS group. These results suggest that the frequency of CSF OCB is much lower in Brazilian MS patients from São Paulo city than that reported in MS series from Caucasian populations.
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Affiliation(s)
- Paulo Diniz da Gama
- Department of Neurology and Neurosurgery, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Siritho S, Freedman MS. The prognostic significance of cerebrospinal fluid in multiple sclerosis. J Neurol Sci 2009; 279:21-5. [PMID: 19181345 DOI: 10.1016/j.jns.2008.12.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) patients lacking CSF oligoclonal bands are purported to have a milder course of disease. We reviewed the natural history of oligoclonal band (OCB) - negative (OCB-) compared to OCB positive (OCB+) patients. METHOD A retrospective study of 451 MS patients. RESULTS Only 48/451 patients (10.6%) were CSF OCB-. The mean age at onset was 37.1+/-8.8 years with female:male ratio=2. First CNS location presentation was less well defined in OCB- vs. OCB+ patients with significantly more supratentorial presentation. The clinical course of OCB- vs OCB+ was somewhat different; 22.9 vs 15.1% PPMS; 18.8 vs 12.4% SPMS; and 56.3 vs 71% RRMS, respectively. There were significantly fewer WBC, less IgG and a lower IgG index in OCB- cases. Fewer OCB- cases fulfilled McDonald MRI criteria. There were no discernable differences in disease severity between the two groups as determined by the EDSS, progression index, MSSS, number of relapses or annualized relapse rate. CONCLUSION The presence of OCB correlates better with other indications of acute inflammatory MS, especially an RR course. This study suggests that the simple lack of OCB positivity does not necessarily insure a more benign disease course.
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Affiliation(s)
- Sasitorn Siritho
- The Ottawa Hospital, General Campus, 4th Floor, Multiple Sclerosis Research Unit, Ottawa, ON, Canada
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29
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Matsuoka T, Matsushita T, Osoegawa M, Kawano Y, Minohara M, Mihara F, Nishimura Y, Ohyagi Y, Kira J. Association of the HLA-DRB1 alleles with characteristic MRI features of Asian multiple sclerosis. Mult Scler 2008; 14:1181-90. [DOI: 10.1177/1352458508097818] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In Asian patients with multiple sclerosis (MS), a paucity of brain lesions and longitudinally extensive spinal cord lesions (LESCLs) extending three or more vertebral segments are characteristic findings on magnetic resonance imaging (MRI). We aimed to disclose possible factors contributing to the development of such MRI features. Method Genotyping of HLA-DRB1 and -DPB1 alleles was performed in 121 consecutive Japanese patients with clinically definite MS based on the Poser criteria and 125 healthy controls. Possible factors associated with MRI features were determined by multiple logistic analysis. Patients with MS were classified based on the presence or absence of brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) and LESCLs. Barkhof brain lesion–negative (−) patients had a markedly lower frequency of HLA-DRB1*0901 than controls ( Pcorr < 0.05), whereas the frequency of DRB1*1501 was increased in the Barkhof brain lesion–positive (+) group, although this increase was not significant after correction. No Barkhof(−)LESCL(+) patients carried DRB1*0901 ( Pcorr < 0.05), despite this being the most common allele in Japanese. The Barkhof(−)LESCL(−) group showed a significant increase in the frequency of DRB1*0405 compared with controls ( Pcorr < 0.05). None of the DPB1 alleles were significantly different among the groups. Using multiple logistic analysis, the absence of oligoclonal bands was positively associated with an absence of Barkhof brain lesions, whereas a higher EDSS score was positively associated with the presence of LESCLs; however, the presence of anti-aquaporin-4 antibodies was not associated with either feature. Conclusion The characteristic MRI features in Asians are partly related to distinct HLA-DRB1 gene alleles and an absence of oligoclonal bands.
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Affiliation(s)
- T Matsuoka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Osoegawa
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Kawano
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Minohara
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - F Mihara
- Division of Neuroradiology, Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Nishimura
- Division of Immunogenetics, Department of Neuroscience and Immunology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Y Ohyagi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - J Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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[De Seze et al. criteria: application to a series of 14 patients presenting a first severe acute demyelinating event]. Rev Neurol (Paris) 2008; 165:38-47. [PMID: 18835615 DOI: 10.1016/j.neurol.2008.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 04/18/2008] [Accepted: 06/30/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The application of de Seze et al. criteria (2007) to patients presenting a first severe acute demyelinating event helps to distinguish acute disseminated encephalomyelitis (ADEM) from other CNS inflammatory diseases, with 83% sensitivity and 95% specificity. We applied these criteria to 14 patients who presented a first severe acute demyelinating event and whose later clinical course enabled clear identification of the neurological diagnosis. METHOD/PATIENTS This study concerned 14 patients who presented a first acute demyelinating event. Initially, there were 16 patients but two were excluded because their initial clinical condition (isolated acute retrobulbar optic neuritis in one and acute cervical myelitis in the other) would have excluded them in the princeps article. We identified 11 women (78.6%) and three men (21.4%) with a mean age of 33.7+/-12.5 years. Follow-up ranged from three months to 11.5 years after the initial episode (average four years). At last follow-up, the diagnosis was ADEM in seven patients (50%) and multiple sclerosis (MS) in seven (50%). Five of seven patients in the MS group had a tumor-like presentation (71.4%), this parameter partly explaining the initial discrepancy in diagnosis. When applied to our series, de Seze criteria for ADEM exhibited 85.7% sensitivity and 71.4% specificity. CONCLUSION Applying the new criteria, we did not find the same sensitivity, specificity, and positive and negative predictive values as in the original article. The lack of specificity arose from the misclassification of MS patients with a tumor-like presentation (two out of five false negatives). One of the explanations is that the clinical criteria used can be part of atypical forms of MS, in particular in its tumor-like presentation. De Seze et al. criteria can be an invaluable help for the clinician in the diagnosis of a first severe demyelinating event. Considering our results, these criteria should not be applied for patients with a tumor-like form of MS. A prospective study in a larger cohort is needed to confirm or invalidate these preliminary results.
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Lucchinetti CF, Gavrilova RH, Metz I, Parisi JE, Scheithauer BW, Weigand S, Thomsen K, Mandrekar J, Altintas A, Erickson BJ, König F, Giannini C, Lassmann H, Linbo L, Pittock SJ, Brück W. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain 2008; 131:1759-75. [PMID: 18535080 PMCID: PMC2442427 DOI: 10.1093/brain/awn098] [Citation(s) in RCA: 311] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Atypical imaging features of multiple sclerosis lesions include size >2 cm, mass effect, oedema and/or ring enhancement. This constellation is often referred to as ‘tumefactive multiple sclerosis’. Previous series emphasize their unifocal and clinically isolated nature, however, evolution of these lesions is not well defined. Biopsy may be required for diagnosis. We describe clinical and radiographic features in 168 patients with biopsy confirmed CNS inflammatory demyelinating disease (IDD). Lesions were analysed on pre- and post-biopsy magnetic resonance imaging (MRI) for location, size, mass effect/oedema, enhancement, multifocality and fulfilment of Barkhof criteria. Clinical data were correlated to MRI. Female to male ratio was 1.2 : 1, median age at onset, 37 years, duration between symptom onset and biopsy, 7.1 weeks and total disease duration, 3.9 years. Clinical course prior to biopsy was a first neurological event in 61%, relapsing–remitting in 29% and progressive in 4%. Presentations were typically polysymptomatic, with motor, cognitive and sensory symptoms predominating. Aphasia, agnosia, seizures and visual field defects were observed. At follow-up, 70% developed definite multiple sclerosis, and 14% had an isolated demyelinating syndrome. Median time to second attack was 4.8 years, and median EDSS at follow-up was 3.0. Multiple lesions were present in 70% on pre-biopsy MRI, and in 83% by last MRI, with Barkhof criteria fulfilled in 46% prior to biopsy and 55% by follow-up. Only 17% of cases remained unifocal. Median largest lesion size on T2-weighted images was 4 cm (range 0.5–12), with a discernible size of 2.1 cm (range 0.5–7.5). Biopsied lesions demonstrated mass effect in 45% and oedema in 77%. A strong association was found between lesion size, and presence of mass effect and/or oedema (P< 0.001). Ring enhancement was frequent. Most tumefactive features did not correlate with gender, course or diagnosis. Although lesion size >5 cm was associated with a slightly higher EDSS at last follow-up, long-term prognosis in patients with disease duration >10 years was better (EDSS 1.5) compared with a population-based multiple sclerosis cohort matched for disease duration (EDSS 3.5; P< 0.001). Given the retrospective nature of the study, the precise reason for biopsy could not always be determined. This study underscores the diagnostically challenging nature of CNS IDDs that present with atypical clinical or radiographic features. Most have multifocal disease at onset, and develop RRMS by follow-up. Although increased awareness of this broad spectrum may obviate need for biopsy in many circumstances, an important role for diagnostic brain biopsy may be required in some cases.
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Affiliation(s)
- C F Lucchinetti
- Department of Neurology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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32
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Abstract
The role B cells and humoral immunity play in multiple sclerosis (MS) is continually evolving. Recent discoveries include advances in lesion classification, identification of B cell clonal expansion in the central nervous system with evidence of antigen targeting, identification of chemokines in MS lesions, and expansion of information on the roles of autoantibodies and complement. Strong indications are accumulating that a greater degree of humoral dysfunction may lead to worsened long-term prognosis in MS. Effects of established MS treatments on B cells and their products have been further defined. Treatments that specifically target B cells are being implemented and hold promise.
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Affiliation(s)
- Eric C Klawiter
- Department of Neurology, Washington University School of Medicine, Box 8111, 660 S. Euclid Avenue, Saint Louis, MO 63110, USA.
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33
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Abstract
Prognostic factors to determine the patient's likelihood of developing MS are important for several reasons. Prognostic factors are important to the patient who wants to be informed about his/her prospects, to the clinician who needs to individuate the patients who deserve immune treatments, and to the researcher who needs to improve the design and the analysis of the therapeutic trials. In addition, with the development of new immune therapies, whose early use is strongly encouraged, it is crucial to dispose of reliable clinical predictors to identify the patients who are candidates for early or aggressive therapies. Several studies have indicated that a poor prognosis is related to male gender; a late age at onset; motor, cerebellar, and sphincter involvement at onset; a progressive course at onset; a short inter-attack interval; a high number of early attacks; and a relevant early residual disability. Paraclinical support for MS prognosis is given by imaging techniques, cerebrospinal fluid analysis, and evoked potential examinations. The most sensitive paraclinical test to predict conversion from suspected demyelinating disease to definite MS is MRI.
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Affiliation(s)
- Roberto Bergamaschi
- Department of Clinical Neurology, Multiple Sclerosis Center, Neurological Institute, C. Mondino, Via Mondino 2, Pavia 27100, Italy
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Link H, Huang YM. Oligoclonal bands in multiple sclerosis cerebrospinal fluid: An update on methodology and clinical usefulness. J Neuroimmunol 2006; 180:17-28. [PMID: 16945427 DOI: 10.1016/j.jneuroim.2006.07.006] [Citation(s) in RCA: 244] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 07/03/2006] [Indexed: 12/17/2022]
Abstract
Two or more oligoclonal IgG bands (OB) detected by separation of cerebrospinal fluid (CSF) proteins while not demonstrable in corresponding serum reflect a local B-cell response accompanying central nervous system (CNS) inflammation. Using optimized, standardized methodology, preferentially protein separation by isoelectric focusing followed by immunoblotting, more than 95% of patients with multiple sclerosis (MS) have CSF OB of IgG class not detectable in serum, thereby providing powerful evidence for the diagnosis of MS. Once present, CSF OB persists in the individual patient irrespective of MS course or therapy. Because of the high sensitivity of CSF OB in MS as well as its high specificity in the appropriate clinical setting, examination of CSF for OB of IgG class can be strongly recommended to obtain support for the diagnosis of MS and identify patients with clinically isolated syndrome (CIS) at increased risk of developing MS. The IgG index equal to CSF/serum IgG:CSF/serum albumin is elevated in about 70% of MS patients, but rarely in CSF OB-negative MS. Because of lower diagnostic sensitivity, IgG index cannot be recommended as replacement of CSF OB in the diagnosis of MS but, when elevated, as additional evidence for an augmented B-cell response within the CNS that is compatible with MS. Although the clinical picture as well as findings from magnetic resonance imaging of the brain and spinal cord are essential for an MS diagnosis, this should be re-evaluated in CSF OB-negative patients, keeping in mind the many disease entities imitating MS. Recommended diagnostic criteria for MS must include definitions of the role of lumbar puncture and of clearly specified, optimized and standardized routine CSF investigations including for the presence of CSF IgG OB. There is a need for concerted long-term follow-up studies of the subgroup of MS patients without CSF OB regarding e.g. prognostic and immunologic features. For inclusion in trials of disease-modulating drugs, it is recommended that patients with MS or CIS are selected regarding presence vs. absence of CSF OB. Development and evaluation of new technologies to define local vs. systemic B-cell responses in patients with MS or CIS vs. patients with other inflammatory neurological diseases should shed new light on the role of CSF OB, which remains enigmatic.
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Affiliation(s)
- Hans Link
- Karolinska Institute, 14185 Stockholm, Sweden.
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