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Sarkar SK, Willson AML, Jordan MA. The Plasticity of Immune Cell Response Complicates Dissecting the Underlying Pathology of Multiple Sclerosis. J Immunol Res 2024; 2024:5383099. [PMID: 38213874 PMCID: PMC10783990 DOI: 10.1155/2024/5383099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative autoimmune disease characterized by the destruction of the myelin sheath of the neuronal axon in the central nervous system. Many risk factors, including environmental, epigenetic, genetic, and lifestyle factors, are responsible for the development of MS. It has long been thought that only adaptive immune cells, especially autoreactive T cells, are responsible for the pathophysiology; however, recent evidence has indicated that innate immune cells are also highly involved in disease initiation and progression. Here, we compile the available data regarding the role immune cells play in MS, drawn from both human and animal research. While T and B lymphocytes, chiefly enhance MS pathology, regulatory T cells (Tregs) may serve a more protective role, as can B cells, depending on context and location. Cells chiefly involved in innate immunity, including macrophages, microglia, astrocytes, dendritic cells, natural killer (NK) cells, eosinophils, and mast cells, play varied roles. In addition, there is evidence regarding the involvement of innate-like immune cells, such as γδ T cells, NKT cells, MAIT cells, and innate-like B cells as crucial contributors to MS pathophysiology. It is unclear which of these cell subsets are involved in the onset or progression of disease or in protective mechanisms due to their plastic nature, which can change their properties and functions depending on microenvironmental exposure and the response of neural networks in damage control. This highlights the need for a multipronged approach, combining stringently designed clinical data with carefully controlled in vitro and in vivo research findings, to identify the underlying mechanisms so that more effective therapeutics can be developed.
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Affiliation(s)
- Sujan Kumar Sarkar
- Department of Anatomy, Histology and Physiology, Faculty of Animal Science and Veterinary Medicine, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
| | - Annie M. L. Willson
- Biomedical Sciences and Molecular Biology, CPHMVS, James Cook University, Townsville, Queensland 4811, Australia
| | - Margaret A. Jordan
- Biomedical Sciences and Molecular Biology, CPHMVS, James Cook University, Townsville, Queensland 4811, Australia
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Bigotte M, Gimenez M, Gavoille A, Deligiannopoulou A, El Hajj A, Croze S, Goumaidi A, Malleret G, Salin P, Giraudon P, Ruiz A, Marignier R. Ependyma: a new target for autoantibodies in neuromyelitis optica? Brain Commun 2022; 4:fcac307. [PMID: 36751497 PMCID: PMC9897195 DOI: 10.1093/braincomms/fcac307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/26/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disease of the central nervous system characterized by the presence of autoantibodies (called NMO-IgG) targeting aquaporin-4. Aquaporin-4 is expressed at the perivascular foot processes of astrocytes, in the glia limitans, but also at the ependyma. Most studies have focused on studying the pathogenicity of NMO-IgG on astrocytes, and NMO is now considered an astrocytopathy. However, periependymal lesions are observed in NMO suggesting that ependymal cells could also be targeted by NMO-IgG. Ependymal cells regulate CSF-parenchyma molecular exchanges and CSF flow, and are a niche for sub-ventricular neural stem cells. Our aim was to examine the effect of antibodies from NMO patients on ependymal cells. We exposed two models, i.e. primary cultures of rat ependymal cells and explant cultures of rat lateral ventricular wall whole mounts, to purified IgG of NMO patients (NMO-IgG) for 24 hours. We then evaluated the treatment effect using immunolabelling, functional assays, ependymal flow analysis and bulk RNA sequencing. For each experiment, the effects were compared with those of purified IgG from a healthy donors and non-treated cells. We found that: (i) NMO-IgG induced aquaporin-4 agglomeration at the surface of ependymal cells and induced cell enlargement in comparison to controls. In parallel, it induced an increase in gap junction connexin-43 plaque size; (ii) NMO-IgG altered the orientation of ciliary basal bodies and functionally impaired cilia motility; (iii) NMO-IgG activated the proliferation of sub-ventricular neural stem cells; (iv) treatment with NMO-IgG up-regulated the expression of pro-inflammatory cytokines and chemokines in the transcriptomic analysis. Our study showed that NMO-IgG can trigger an early and specific reactive phenotype in ependymal cells, with functional alterations of intercellular communication and cilia, activation of sub-ventricular stem cell proliferation and the secretion of pro-inflammatory cytokines. These findings suggest a key role for ependymal cells in the early phase of NMO lesion formation.
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Affiliation(s)
- Maxime Bigotte
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Marie Gimenez
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Antoine Gavoille
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuroinflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69500 Bron, France,Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, 69495 Pierre-Bénitem, France
| | - Adamantia Deligiannopoulou
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Aseel El Hajj
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Severine Croze
- Profilexpert, Genomic and Microgenomic Service, Claude Bernard Lyon 1 University, SFR santé LYON-EST, UCBL-INSERM US 7-CNRS UMS 3453, 69008 Lyon, France
| | | | - Gael Malleret
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Paul Salin
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Pascale Giraudon
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Anne Ruiz
- FORGETTING Team—Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Romain Marignier
- Correspondence to: Romain Marignier Centre de référence des maladies inflammatoires rares du cerveau et de la moelle Service de neurologie, sclérose en plaques pathologies de la myéline et neuro-inflammation Hôpital Neurologique Pierre Wertheimer 59 boulevard Pinel, 69677 Bron cedex, France E-mail:
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Jayaraman S, Jayaraman A. Impact of histone modifier-induced protection against autoimmune encephalomyelitis on multiple sclerosis treatment. Front Neurol 2022; 13:980758. [PMID: 36313502 PMCID: PMC9614082 DOI: 10.3389/fneur.2022.980758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis is a progressive demyelinating central nervous system disorder with unknown etiology. The condition has heterogeneous presentations, including relapsing-remitting multiple sclerosis and secondary and primary progressive multiple sclerosis. The genetic and epigenetic mechanisms underlying these various forms of multiple sclerosis remain elusive. Many disease-modifying therapies approved for multiple sclerosis are broad-spectrum immunomodulatory drugs that reduce relapses but do not halt the disease progression or neuroaxonal damage. Some are also associated with many severe side effects, including fatalities. Improvements in disease-modifying treatments especially for primary progressive multiple sclerosis remain an unmet need. Several experimental animal models are available to decipher the mechanisms involved in multiple sclerosis. These models help us decipher the advantages and limitations of novel disease-modifying therapies for multiple sclerosis.
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Affiliation(s)
- Sundararajan Jayaraman
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, United States
- *Correspondence: Sundararajan Jayaraman
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Ma W, Huang C, Yang L, Luo J. MRI findings of autoimmune glial fibrillary acidic protein astrocytopathy involving infratentorial: Case report. Radiol Case Rep 2022; 17:2515-2518. [PMID: 35601378 PMCID: PMC9114157 DOI: 10.1016/j.radcr.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 10/25/2022] Open
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Plowman RS, Varma H. Prognostic factors in Tumefactive demyelinating lesions: A retrospective study. J Neurol Sci 2021; 428:117591. [PMID: 34333380 DOI: 10.1016/j.jns.2021.117591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined. METHODS We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course. RESULTS An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC. CONCLUSIONS We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.
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Affiliation(s)
- R Skipper Plowman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Nakazawa M, Ishikawa H, Sakamoto T. Current understanding of the epidemiologic and clinical characteristics of optic neuritis. Jpn J Ophthalmol 2021; 65:439-447. [PMID: 34021411 DOI: 10.1007/s10384-021-00840-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
Optic neuritis is an ocular disorder whose pathogenesis has not been fully determined, although autoimmune mechanisms have been suggested to be involved in its development. In recent years, anti-aquaporin-4 antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab) have been shown to play major roles in the development of optic neuritis. Because these two antibodies target different tissues, optic neuritis can be classified by the type of antibody. AQP4-Ab-positive optic neuritis responds poorly to steroid therapy and has a poor prognosis in terms of visual acuity. On the other hand, MOG-Ab-positive optic neuritis responds favorably to steroid therapy but is likely to recur when the dosage of steroids is reduced or discontinued. We first present the high incidence of idiopathic optic neuritis and discuss these relatively newer disease concepts of AQP4-Ab-positive optic neuritis and MOG-Ab-positive optic neuritis.
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Affiliation(s)
- Masanori Nakazawa
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hitoshi Ishikawa
- Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Şen M, Akbayır E, Mercan Ö, Arsoy E, Gencer M, Yılmaz V, Küçükali Cİ, Tüzün E, Türkoğlu R. Cytokine-chemokine and cognitive profile of multiple sclerosis patients with predominant optic nerve and spinal cord involvement. J Spinal Cord Med 2021; 44:411-417. [PMID: 31556809 PMCID: PMC8081324 DOI: 10.1080/10790268.2019.1666238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Context/Objective: Clinical disease activity in multiple sclerosis (MS) may manifest as predominant involvement of optic nerves and spinal cord, as exemplified by opticospinal multiple sclerosis (OSMS) often encountered in Asian countries. Our aim was to compare the clinical features, neuropsychological profile and cytokine/chemokine levels of patients with conventional MS (CMS) and MS presenting predominantly with spinal cord and optic nerve attacks (MS-SCON).Design: Cross-sectional study.Setting: MS Outpatient Clinic.Participants: Fourteen MS-SCON patients, 20 CMS patients without myelitis and optic neuritis attacks and 21 healthy individuals.Outcome measures: IL-8, IL-10, IFN-γ, IL-17 and TNF-α levels were measured by multiplex assay and CXCL2 and CXCL5 levels were measured by ELISA. A panel of neuropsychological tests, Beck depression inventory, 9-hole peg and timed 25-foot walk tests were employed.Results: CMS and MS-SCON patients showed similar clinical features. Both CMS and MS-SCON patients displayed reduced IL-8 and CXCL2 and increased TNF-α levels, while IL-10 and CXCL5 levels were identical among all groups.Conclusion: Neuropsychological and motor function test performances of CMS and MS-SCON patients were highly comparable. CMS and MS-SCON present with similar clinical, neuropsychological and immunological features. Therefore, optic nerve and spinal cord-dominant form of MS does not necessarily establish a distinct entity in our region. Cognitive networks of the central nervous system may be damaged during the disease course of MS, despite the absence of cerebral or cerebellar clinical attacks.
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Affiliation(s)
- Melis Şen
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ece Akbayır
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Özlem Mercan
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Erdil Arsoy
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Gencer
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Vuslat Yılmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey,Correspondence to: Erdem Tüzün, Department of Neuroscience, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Ph: +90-2124142000-33356, +90-2124142001.
| | - Recai Türkoğlu
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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8
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Richard C, Ruiz A, Cavagna S, Bigotte M, Vukusic S, Masaki K, Suenaga T, Kira JI, Giraudon P, Marignier R. Connexins in neuromyelitis optica: a link between astrocytopathy and demyelination. Brain 2021; 143:2721-2732. [PMID: 32889550 DOI: 10.1093/brain/awaa227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/01/2020] [Accepted: 05/06/2020] [Indexed: 01/26/2023] Open
Abstract
Neuromyelitis optica, a rare neuroinflammatory demyelinating disease of the CNS, is characterized by the presence of specific pathogenic autoantibodies directed against the astrocytic water channel aquaporin 4 (AQP4) and is now considered as an astrocytopathy associated either with complement-dependent astrocyte death or with astrocyte dysfunction. However, the link between astrocyte dysfunction and demyelination remains unclear. We propose glial intercellular communication, supported by connexin hemichannels and gap junctions, to be involved in demyelination process in neuromyelitis optica. Using mature myelinated cultures, we demonstrate that a treatment of 1 h to 48 h with immunoglobulins purified from patients with neuromyelitis optica (NMO-IgG) is responsible for a complement independent demyelination, compared to healthy donors' immunoglobulins (P < 0.001). In parallel, patients' immunoglobulins induce an alteration of connexin expression characterized by a rapid loss of astrocytic connexins at the membrane followed by an increased size of gap junction plaques (+60%; P < 0.01). This was co-observed with connexin dysfunction with gap junction disruption (-57%; P < 0.001) and increased hemichannel opening (+17%; P < 0.001), associated with glutamate release. Blocking connexin 43 hemichannels with a specific peptide was able to prevent demyelination in co-treatment with patients compared to healthy donors' immunoglobulins. By contrast, the blockade of connexin 43 gap junctions with another peptide was detrimental for myelin (myelin density -48%; P < 0.001). Overall, our results suggest that dysregulation of connexins would play a pathogenetic role in neuromyelitis optica. The further identification of mechanisms leading to connexin dysfunction and soluble factors implicated, would provide interesting therapeutic strategies for demyelinating disorders.
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Affiliation(s)
- Chloé Richard
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Anne Ruiz
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Sylvie Cavagna
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Maxime Bigotte
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle, Lyon, France
| | - Katsuhisa Masaki
- Department of Neurology, Neurological institute, Graduate School of Medical Sciences, Kyushu University
| | | | - Jun-Ichi Kira
- Department of Neurology, Neurological institute, Graduate School of Medical Sciences, Kyushu University
| | - Pascale Giraudon
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Romain Marignier
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle, Lyon, France
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Takahashi S. Metabolic compartmentalization between astroglia and neurons in physiological and pathophysiological conditions of the neurovascular unit. Neuropathology 2020; 40:121-137. [PMID: 32037635 PMCID: PMC7187297 DOI: 10.1111/neup.12639] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
Abstract
Astroglia or astrocytes, the most abundant cells in the brain, are interposed between neuronal synapses and microvasculature in the brain gray matter. They play a pivotal role in brain metabolism as well as in the regulation of cerebral blood flow, taking advantage of their unique anatomical location. In particular, the astroglial cellular metabolic compartment exerts supportive roles in dedicating neurons to the generation of action potentials and protects them against oxidative stress associated with their high energy consumption. An impairment of normal astroglial function, therefore, can lead to numerous neurological disorders including stroke, neurodegenerative diseases, and neuroimmunological diseases, in which metabolic derangements accelerate neuronal damage. The neurovascular unit (NVU), the major components of which include neurons, microvessels, and astroglia, is a conceptual framework that was originally used to better understand the pathophysiology of cerebral ischemia. At present, the NVU is a tool for understanding normal brain physiology as well as the pathophysiology of numerous neurological disorders. The metabolic responses of astroglia in the NVU can be either protective or deleterious. This review focuses on three major metabolic compartments: (i) glucose and lactate; (ii) fatty acid and ketone bodies; and (iii) D- and L-serine. Both the beneficial and the detrimental roles of compartmentalization between neurons and astroglia will be discussed. A better understanding of the astroglial metabolic response in the NVU is expected to lead to the development of novel therapeutic strategies for diverse neurological diseases.
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Affiliation(s)
- Shinichi Takahashi
- Department of Neurology and StrokeSaitama Medical University International Medical CenterSaitamaJapan
- Department of PhysiologyKeio University School of MedicineTokyoJapan
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10
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Yang Q, Zhou J. Neuroinflammation in the central nervous system: Symphony of glial cells. Glia 2018; 67:1017-1035. [DOI: 10.1002/glia.23571] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/26/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Qiao‐qiao Yang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology Chinese Academy of Sciences Shanghai China
| | - Jia‐wei Zhou
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology Chinese Academy of Sciences Shanghai China
- University of Chinese Academy of Sciences Shanghai 200031 China
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11
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Thomas DL, Manners J, Marker D, Mettenburg J, Murdoch G, Stevens B, Wang G, Wiley C. CD8-Positive T-Cell Leukoencephalitis With Astrocytopathy Clinically Presenting as Neuromyelitis Optica. J Neuropathol Exp Neurol 2017; 76:347-357. [PMID: 28340257 DOI: 10.1093/jnen/nlx015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a novel disease entity with the clinical and radiologic presentation of neuromyelitis optica (NMO) and widespread CD8-positive T-cell leukoencephalitis and astrocytopathy. The 59-year-old female patient had a complex 2-year neurological history that included early changes in cognition and memory, progressive lower extremity motor dysfunction, and multimodal sensory involvement. MRI of the spinal cord showed increased T2 signal in the central cord extending from C2 through T4. MRI of the brain showed symmetric radial enhancement in periventricular deep white matter without evidence of demyelinating lesions. The constellation of findings met clinical criteria for NMO. Steroid treatment was initiated with subjective improvement but she developed urosepsis and died at age 61 years. At autopsy, the spinal cord showed typical NMO findings but no evidence of complement deposition or neutrophil infiltration. There was diffuse CD8-positive T-cell infiltration and CD68-positive macrophage activation throughout subcortical white matter, optic chiasm, brainstem, and spinal cord. This was accompanied by marked astrocytopathy in all areas. Serum was negative for aquaporin-4 autoantibodies suggesting a nonhumoral basis of astrocyte damage. This first example of CD8-positive T-cell leukoencephalitis in a patient with a clinical presentation of NMO may explain the recalcitrance of some patients to therapies targeting humoral immunity.
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Affiliation(s)
- Diana L Thomas
- From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jody Manners
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel Marker
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Mettenburg
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Geoffrey Murdoch
- From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan Stevens
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Guoji Wang
- From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Clayton Wiley
- From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Th1 cells downregulate connexin 43 gap junctions in astrocytes via microglial activation. Sci Rep 2016; 6:38387. [PMID: 27929069 PMCID: PMC5143974 DOI: 10.1038/srep38387] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022] Open
Abstract
We previously reported early and extensive loss of astrocytic connexin 43 (Cx43) in acute demyelinating lesions of multiple sclerosis (MS) patients. Because it is widely accepted that autoimmune T cells initiate MS lesions, we hypothesized that infiltrating T cells affect Cx43 expression in astrocytes, which contributes to MS lesion formation. Primary mixed glial cell cultures were prepared from newborn mouse brains, and microglia were isolated by anti-CD11b antibody-conjugated magnetic beads. Next, we prepared astrocyte-rich cultures and astrocyte/microglia-mixed cultures. Treatment of primary mixed glial cell cultures with interferon (IFN) γ, interleukin (IL)-4, or IL-17 showed that only IFNγ or IL-17 at high concentrations reduced Cx43 protein levels. Upon treatment of astrocyte-rich cultures and astrocyte/microglia-mixed cultures with IFNγ, Cx43 mRNA/protein levels and the function of gap junctions were reduced only in astrocyte/microglia-mixed cultures. IFNγ-treated microglia-conditioned media and IL-1β, which was markedly increased in IFNγ-treated microglia-conditioned media, reduced Cx43 protein levels in astrocyte-rich cultures. Finally, we confirmed that Th1 cell-conditioned medium decreased Cx43 protein levels in mixed glial cell cultures. These findings suggest that Th1 cell-derived IFNγ activates microglia to release IL-1β that reduces Cx43 gap junctions in astrocytes. Thus, Th1-dominant inflammatory states disrupt astrocytic intercellular communication and may exacerbate MS.
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13
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Elevated fibrinogen levels in neuromyelitis optica is associated with severity of disease. Neurol Sci 2016; 37:1823-1829. [DOI: 10.1007/s10072-016-2628-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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Mangiatordi GF, Alberga D, Trisciuzzi D, Lattanzi G, Nicolotti O. Human Aquaporin-4 and Molecular Modeling: Historical Perspective and View to the Future. Int J Mol Sci 2016; 17:ijms17071119. [PMID: 27420052 PMCID: PMC4964494 DOI: 10.3390/ijms17071119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 12/26/2022] Open
Abstract
Among the different aquaporins (AQPs), human aquaporin-4 (hAQP4) has attracted the greatest interest in recent years as a new promising therapeutic target. Such a membrane protein is, in fact, involved in a multiple sclerosis-like immunopathology called Neuromyelitis Optica (NMO) and in several disorders resulting from imbalanced water homeostasis such as deafness and cerebral edema. The gap of knowledge in its functioning and dynamics at the atomistic level of detail has hindered the development of rational strategies for designing hAQP4 modulators. The application, lately, of molecular modeling has proved able to fill this gap providing a breeding ground to rationally address compounds targeting hAQP4. In this review, we give an overview of the important advances obtained in this field through the application of Molecular Dynamics (MD) and other complementary modeling techniques. The case studies presented herein are discussed with the aim of providing important clues for computational chemists and biophysicists interested in this field and looking for new challenges.
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Affiliation(s)
- Giuseppe Felice Mangiatordi
- Dipartimento di Farmacia-Scienze del Farmaco, Via Orabona, 4, University of Bari "Aldo Moro", 70126 Bari, Italy.
| | - Domenico Alberga
- Institut de Recherche de Chimie Paris CNRS Chimie ParisTech, PSL Research University, 11 rue P. et M. Curie, F-75005 Paris, France.
| | - Daniela Trisciuzzi
- Dipartimento di Farmacia-Scienze del Farmaco, Via Orabona, 4, University of Bari "Aldo Moro", 70126 Bari, Italy.
| | - Gianluca Lattanzi
- INFN-Sez. di Bari and Dipartimento di Medicina Clinica e Sperimentale, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Orazio Nicolotti
- Dipartimento di Farmacia-Scienze del Farmaco, Via Orabona, 4, University of Bari "Aldo Moro", 70126 Bari, Italy.
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Tomizawa Y, Nakamura R, Hoshino Y, Sasaki F, Nakajima S, Kawajiri S, Noda K, Takanashi M, Fujita N, Yokoyama K, Hattori N, Takahashi T, Okuma Y. Tumefactive demyelinating brain lesions with multiple closed-ring enhancement in the course of neuromyelitis optica. J Neurol Sci 2016; 361:49-51. [DOI: 10.1016/j.jns.2015.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
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16
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Sato S, Yamamoto K, Matsushita T, Isobe N, Kawano Y, Iinuma K, Niino M, Fukazawa T, Nakamura Y, Watanabe M, Yonekawa T, Masaki K, Yoshimura S, Murai H, Yamasaki R, Kira JI. Copy number variations in multiple sclerosis and neuromyelitis optica. Ann Neurol 2015; 78:762-74. [PMID: 26296936 DOI: 10.1002/ana.24511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To clarify the potential association of copy number variations (CNVs) with multiple sclerosis (MS) and neuromyelitis optica (NMO) in Japanese cases. METHODS Genome-wide association analyses of CNVs among 277 MS patients, 135 NMO/NMO spectrum disorder (NMOSD) patients, and 288 healthy individuals as a discovery cohort, and among 296 MS patients, 76 NMO/NMOSD patients, and 790 healthy individuals as a replication cohort were performed using high-density single nucleotide polymorphism microarrays. RESULTS A series of discovery and replication studies revealed that most identified CNVs were 5 to 50kb deletions at particular T cell receptor (TCR) gamma and alpha loci regions. Among these CNVs, a TCR gamma locus deletion was found in 16.40% of MS patients (p = 2.44E-40, odds ratio [OR] = 52.6), and deletion at the TCR alpha locus was found in 17.28% of MS patients (p = 1.70E-31, OR = 13.0) and 13.27% of NMO/NMOSD patients (p = 5.79E-20, OR = 54.6). These CNVs were observed in peripheral blood T-cell subsets only, suggesting the CNVs were somatically acquired. NMO/NMOSD patients carrying the CNV tended to be seronegative for anti-aquaporin-4 antibody or had significantly lower titers than those without CNV. INTERPRETATION Deletion-type CNVs at specific TCR loci regions contribute to MS and NMO susceptibility.
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Affiliation(s)
- Shinya Sato
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ken Yamamoto
- Department of Medical Chemistry, Kurume University School of Medicine, Kurume
| | - Takuya Matsushita
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Yuji Kawano
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Kyoko Iinuma
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Masaaki Niino
- Department of Clinical Research, Hokkaido Medical Center, Hokkaido
| | | | - Yuri Nakamura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Tomomi Yonekawa
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Katsuhisa Masaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Satoshi Yoshimura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Hiroyuki Murai
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ryo Yamasaki
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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Detection of Antibodies against Human and Plant Aquaporins in Patients with Multiple Sclerosis. Autoimmune Dis 2015; 2015:905208. [PMID: 26290755 PMCID: PMC4529886 DOI: 10.1155/2015/905208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the body's central nervous system. Around 90% of MS sufferers are diagnosed with relapsing-remitting MS (RRMS). We used ELISA to measure IgG, IgA, and IgM antibodies against linear epitopes of human and plant aquaporins (AQP4) as well as neural antigens in RRMS patients and controls to determine whether patients suffering from RRMS have simultaneous elevations in antibodies against these peptides and antigens. In comparison to controls, significant elevations in isotype-specific antibodies against human and plant AQP4 and neural antigens such as MBP, MOG, and S100B were detected in RRMS patients, indicating a high correlation in antibody reaction between plant aquaporins and brain antigens. This correlation between the reactivities of RRMS patients with various tested antigens was the most significant for the IgM isotype. We conclude that a subclass of patients with RRMS reacts to both plant and human AQP4 peptides. This immune reaction against different plant aquaporins may help in the development of dietary modifications for patients with MS and other neuroimmune disorders.
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Masaki K. Early disruption of glial communication via connexin gap junction in multiple sclerosis, Baló's disease and neuromyelitis optica. Neuropathology 2015; 35:469-80. [DOI: 10.1111/neup.12211] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/09/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Katsuhisa Masaki
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Simaniv TO, Vorob’eva AA, Smirnova NV, Zigangirova NA, Zakharova MN. Neuromyelitis optica and aquaporin-associated syndromes. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:31-37. [DOI: 10.17116/jnevro20151152231-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Vaknin-Dembinsky A, Karussis D, Avichzer J, Abramsky O. NMO spectrum of disorders: A paradigm for astrocyte-targeting autoimmunity and its implications for MS and other CNS inflammatory diseases. J Autoimmun 2014; 54:93-9. [DOI: 10.1016/j.jaut.2014.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 01/18/2023]
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Jayarangaiah A, Sehgal R, Epperla N. Sjögren's syndrome and neuromyelitis optica spectrum disorders (NMOSD)--a case report and review of literature. BMC Neurol 2014; 14:200. [PMID: 25291981 PMCID: PMC4193162 DOI: 10.1186/s12883-014-0200-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/29/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a rare relapsing auto-immune disease of the central nervous system which is sometimes found in association with other autoimmune disorders including Sjogren's syndrome. We present the case of a middle aged female with Sjogren's syndrome (SS) and Neuromyelitis optica spectrum disorders (NMOSD) who had a rapidly declining neurological illness that responded to immunosuppressive therapy. CASE PRESENTATION A 51-year-old female with Sjogren's syndrome and recent history of varicella zoster infection presented with right upper and lower extremity weakness of one week duration. She was noted to have contrast enhancement at C2-C4 cord levels on cervico-thoracic MRI. Comprehensive work up was negative except for presence of a mild lymphocytic pleocytosis and oligoclonal bands in the CSF. She was diagnosed with transverse myelitis secondary to varicella zoster infection and was treated with high dose steroids in addition to acyclovir with improvement in her symptoms. Two months later she developed left upper and lower extremity weakness, bilateral dysesthesias and urinary incontinence. Repeat MRI of the cervico-thoracic spine revealed worsening enhancement at lower cervical cord levels (C5-7) with extension to T1. CSF analysis was unchanged; however immunological work up was abnormal for elevated NMO-IgG/AQP4 antibody. She was diagnosed with NMOSD and was treated with immunosuppressive therapy. Initially with IV methylprednisone and Cyclophosphamide therapy followed by Mycophenolate mofetil (MMF) maintenance therapy with good response. Repeat MRI 6 months later showed near complete resolution of previous abnormal cord signal changes. CONCLUSION One needs to recognize the relationship between autoimmune diseases especially SS and NMOSD. The presence of NMO antibody has been associated with a relapsing disease course and a careful follow-up, besides use of remission maintenance agents such as MMF and Azathioprine are important to consider.
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Muto M, Mori M, Sato Y, Uzawa A, Masuda S, Uchida T, Kuwabara S. Current symptomatology in multiple sclerosis and neuromyelitis optica. Eur J Neurol 2014; 22:299-304. [DOI: 10.1111/ene.12566] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/25/2014] [Indexed: 01/18/2023]
Affiliation(s)
- M. Muto
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - M. Mori
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Y. Sato
- Clinical Research Center; Chiba University Hospital; Chiba Japan
| | - A. Uzawa
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - S. Masuda
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - T. Uchida
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - S. Kuwabara
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
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Tradtrantip L, Asavapanumas N, Phuan PW, Verkman AS. Potential therapeutic benefit of C1-esterase inhibitor in neuromyelitis optica evaluated in vitro and in an experimental rat model. PLoS One 2014; 9:e106824. [PMID: 25191939 PMCID: PMC4156393 DOI: 10.1371/journal.pone.0106824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022] Open
Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disease of the central nervous system in which binding of anti-aquaporin-4 (AQP4) autoantibodies (NMO-IgG) to astrocytes causes complement-dependent cytotoxicity (CDC) and inflammation resulting in oligodendrocyte and neuronal injury. There is compelling evidence for a central role of complement in NMO pathogenesis. Here, we evaluated the potential of C1-esterase inhibitor (C1-inh) for complement-targeted therapy of NMO. C1-inh is an anti-inflammatory plasma protein with serine protease inhibition activity that has a broad range of biological activities on the contact (kallikrein), coagulation, fibrinolytic and complement systems. C1-inh is approved for therapy of hereditary angioedema (HAE) and has been studied in a small safety trial in acute NMO relapses (NCT 01759602). In vitro assays of NMO-IgG-dependent CDC showed C1-inh inhibition of human and rat complement, but with predicted minimal complement inhibition activity at a dose of 2000 units in humans. Inhibition of complement by C1-inh was potentiated by ∼10-fold by polysulfated macromolecules including heparin and dextran sulfate. In rats, intravenous C1-inh at a dose 30-fold greater than that approved to treat HAE inhibited serum complement activity by <5%, even when supplemented with heparin. Also, high-dose C1-inh did not reduce pathology in a rat model of NMO produced by intracerebral injection of NMO-IgG. Therefore, although C1r and C1s are targets of C1-inh, our in vitro data with human serum and in vivo data in rats suggest that the complement inhibition activity of C1-inh in serum is too low to confer clinical benefit in NMO.
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Affiliation(s)
- Lukmanee Tradtrantip
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, California, United States of America
| | - Nithi Asavapanumas
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, California, United States of America
| | - Puay-Wah Phuan
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, California, United States of America
| | - A. S. Verkman
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Simaniv TO, Vtorova NV, Vorobyeva AA, Zigangirova NA, Zakharova MN. The diagnostic value of aquaporin-4 antibodies in central nervous system diseases. NEUROCHEM J+ 2014. [DOI: 10.1134/s181971241403012x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Amor S, Woodroofe MN. Innate and adaptive immune responses in neurodegeneration and repair. Immunology 2014; 141:287-91. [PMID: 23758741 DOI: 10.1111/imm.12134] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 12/17/2022] Open
Abstract
Emerging evidence suggests important roles of the innate and adaptive immune responses in the central nervous system (CNS) in neurodegenerative diseases. In this special review issue, five leading researchers discuss the evidence for the beneficial as well as the detrimental impact of the immune system in the CNS in disorders including Alzheimer's disease, multiple sclerosis and CNS injury. Several common pathological mechanisms emerge indicating that these pathways could provide important targets for manipulating the immune reposes in neurodegenerative disorders. The articles highlight the role of the traditional resident immune cell of the CNS - the microglia - as well as the role of other glia astrocytes and oligodendrocytes in immune responses and their interplay with other immune cells including, mast cells, T cells and B cells. Future research should lead to new discoveries which highlight targets for therapeutic interventions which may be applicable to a range of neurodegenerative diseases.
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Affiliation(s)
- Sandra Amor
- Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands; Neuroimmunology Unit, Blizard Institute Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ingram G, Loveless S, Howell OW, Hakobyan S, Dancey B, Harris CL, Robertson NP, Neal JW, Morgan BP. Complement activation in multiple sclerosis plaques: an immunohistochemical analysis. Acta Neuropathol Commun 2014; 2:53. [PMID: 24887075 PMCID: PMC4048455 DOI: 10.1186/2051-5960-2-53] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/02/2014] [Indexed: 01/22/2023] Open
Abstract
Introduction Inflammation and complement activation are firmly implicated in the pathology of multiple sclerosis; however, the extent and nature of their involvement in specific pathological processes such as axonal damage, myelin loss and disease progression remains uncertain. This study aims to bring clarity to these questions. Results We describe a detailed immunohistochemical study to localise a strategically selected set of complement proteins, activation products and regulators in brain and spinal cord tissue of 17 patients with progressive multiple sclerosis and 16 control donors, including 9 with central nervous system disease. Active, chronic active and chronic inactive multiple sclerosis plaques (35 in total) and non-plaque areas were examined. Multiple sclerosis plaques were consistently positive for complement proteins (C3, factor B, C1q), activation products (C3b, iC3b, C4d, terminal complement complex) and regulators (factor H, C1-inhibitor, clusterin), suggesting continuing local complement synthesis, activation and regulation despite the absence of other evidence of ongoing inflammation. Complement staining was most apparent in plaque and peri-plaque but also present in normal appearing white matter and cortical areas to a greater extent than in control tissue. C1q staining was present in all plaques suggesting a dominant role for the classical pathway. Cellular staining for complement components was largely restricted to reactive astrocytes, often adjacent to clusters of microglia in close apposition to complement opsonised myelin and damaged axons. Conclusions The findings demonstrate the ubiquity of complement involvement in multiple sclerosis, suggest a pathogenic role for complement contributing to cell, axon and myelin damage and make the case for targeting complement for multiple sclerosis monitoring and therapy. Electronic supplementary material The online version of this article (doi:10.1186/2051-5960-2-53) contains supplementary material, which is available to authorized users.
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Asavapanumas N, Verkman AS. Neuromyelitis optica pathology in rats following intraperitoneal injection of NMO-IgG and intracerebral needle injury. Acta Neuropathol Commun 2014; 2:48. [PMID: 24758159 PMCID: PMC4234989 DOI: 10.1186/2051-5960-2-48] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/17/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction Animal models of neuromyelitis optica (NMO) are needed for drug testing and evaluation of NMO disease pathogenesis mechanisms. Results We describe a novel passive-transfer model of NMO in which rats made seropositive for human anti-aquaporin-4 (AQP4) immunoglobulin G antibody (NMO-IgG) by intraperitoneal (IP) injections were subject to intracerebral needle injury. Following a single IP injection, NMO-IgG distributed rapidly to peripheral AQP4-expressing cells (kidney collecting duct, gastric glands, airways, skeletal muscle) and area postrema in brain, but not elsewhere in the central nervous system; however, no pathology was seen in brain, spinal cord, optic nerve or peripheral tissues. After testing various maneuvers to produce NMO-IgG-dependent pathology in brain, we found that transient puncture of brain parenchyma with a 28-gauge needle in NMO-IgG seropositive rats produced robust NMO pathology around the needle track, with loss of AQP4 and glial fibrillary acidic protein, granulocyte and macrophage infiltration, centrovascular deposition of activated complement, and blood–brain barrier disruption, with demyelination by 5 days. Pathology was not seen in rats receiving control (non-NMO) human IgG or in NMO-IgG-seropositive rats made complement-deficient by cobra venom factor. Interestingly, at 1 day a reversible, multifocal astrocytopathy was seen with loss of AQP4 and GFAP (but not myelin) in areas away from the needle track. Conclusions NMO-IgG-seropositivity alone is not sufficient to cause NMO pathology in rats, but a single intracerebral needle insertion, without pre-existing inflammation or infusion of pro-inflammatory factors, was sufficient to produce robust NMO pathology in seropositive rats.
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Unique neuromyelitis optica pathology produced in naïve rats by intracerebral administration of NMO-IgG. Acta Neuropathol 2014; 127:539-51. [PMID: 24190619 DOI: 10.1007/s00401-013-1204-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/26/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Abstract
Animal models of neuromyelitis optica (NMO) are needed for elucidation of disease mechanisms and for testing new therapeutics. Prior animal models of NMO involved administration of human anti-aquaporin-4 immunoglobulin G antibody (NMO-IgG) to rats with pre-existing neuroinflammation, or to naïve mice supplemented with human complement. We report here the development of NMO pathology following passive transfer of NMO-IgG to naïve rats. A single intracerebral infusion of NMO-IgG to adult Lewis rats produced robust lesions around the needle track in 100 % of rats; at 5 days there was marked loss of aquaporin-4 (AQP4), glial fibrillary acidic protein (GFAP) and myelin, granulocyte and macrophage infiltration, vasculocentric complement deposition, blood-brain barrier disruption, microglial activation and neuron death. Remarkably, a distinct 'penumbra' was seen around lesions, with loss of AQP4 but not of GFAP or myelin. No lesions or penumbra were seen in rats receiving control IgG. The size of the main lesion with loss of myelin was greatly reduced in rats made complement-deficient by cobra venom factor or administered NMO-IgG lacking complement-dependent cytotoxicity (CDC) effector function. However, the penumbra was seen under these conditions, suggesting a complement-independent pathogenesis mechanism. The penumbra was absent with NMO-IgG lacking both CDC and antibody-dependent cellular cytotoxicity (ADCC) effector functions. Finally, lesion size was significantly reduced after macrophage depletion with clodronate liposomes. These results: (i) establish a robust, passive-transfer model of NMO in rats that does not require pre-existing neuroinflammation or complement administration; (ii) implicate ADCC as responsible for a unique type of pathology also seen in human NMO; and (iii) support a pathogenic role of macrophages in NMO.
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Asavapanumas N, Ratelade J, Papadopoulos MC, Bennett JL, Levin MH, Verkman AS. Experimental mouse model of optic neuritis with inflammatory demyelination produced by passive transfer of neuromyelitis optica-immunoglobulin G. J Neuroinflammation 2014; 11:16. [PMID: 24468108 PMCID: PMC3909205 DOI: 10.1186/1742-2094-11-16] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/13/2014] [Indexed: 11/14/2022] Open
Abstract
Background Although optic neuritis (ON) is a defining feature of neuromyelitis optica (NMO), appropriate animal models of NMO ON are lacking. Most NMO patients are seropositive for immunoglobulin G autoantibodies (NMO-IgG) against the astrocyte water channel aquaporin-4 (AQP4). Methods Several approaches were tested to develop a robust, passive-transfer mouse model of NMO ON, including NMO-IgG and complement delivery by: (i) retrobulbar infusion; (ii) intravitreal injection; (iii) a single intracranial injection near the optic chiasm; and (iv) 3-days continuous intracranial infusion near the optic chiasm. Results Little ON or retinal pathology was seen using approaches (i) to (iii). Using approach (iv), however, optic nerves showed characteristic NMO pathology, with loss of AQP4 and glial fibrillary acidic protein immunoreactivity, granulocyte and macrophage infiltration, deposition of activated complement, demyelination and axonal injury. Even more extensive pathology was created in mice lacking complement inhibitor protein CD59, or using a genetically modified NMO-IgG with enhanced complement effector function, including significant loss of retinal ganglion cells. In control studies, optic nerve pathology was absent in treated AQP4-deficient mice, or in wild-type mice receiving control (non-NMO) IgG and complement. Conclusion Passive transfer of NMO-IgG and complement by continuous infusion near the optic chiasm in mice is sufficient to produce ON with characteristic NMO pathology. The mouse model of NMO ON should be useful in further studies of NMO pathogenesis mechanisms and therapeutics.
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Affiliation(s)
| | | | | | | | | | - Alan S Verkman
- Department of Medicine and Physiology, University of California, 1246 Health Sciences East Tower, San Francisco, CA 94143-0521, USA.
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Collongues N, Marignier R, Jacob A, Leite MI, Siva A, Paul F, Zephir H, Akman-Demir G, Elsone L, Jarius S, Papeix C, Mutch K, Saip S, Wildemann B, Kitley J, Karabudak R, Aktas O, Kuscu D, Altintas A, Palace J, Confavreux C, De Seze J. Characterization of neuromyelitis optica and neuromyelitis optica spectrum disorder patients with a late onset. Mult Scler 2013; 20:1086-94. [PMID: 24323817 DOI: 10.1177/1352458513515085] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few data are available for patients with a late onset (≥ 50 years) of neuromyelitis optica (LONMO) or neuromyelitis optica spectrum disease (LONMOSD), defined by an optic neuritis/longitudinally extensive transverse myelitis with aquaporin-4 antibodies (AQP4-Ab). OBJECTIVE To characterize LONMO and LONMOSD, and to analyze their predictive factors of disability and death. METHODS We identified 430 patients from four cohorts of NMO/NMOSD in France, Germany, Turkey and UK. We extracted the late onset patients and analyzed them for predictive factors of disability and death, using the Cox proportional model. RESULTS We followed up on 63 patients with LONMO and 45 with LONMOSD during a mean of 4.6 years. This LONMO/LONMOSD cohort was mainly of Caucasian origin (93%), women (80%), seropositive for AQP4-Ab (85%) and from 50 to 82.5 years of age at onset. No progressive course was noted. At last follow-up, the median Expanded Disability Status Scale (EDSS) scores were 5.5 and 6 in the LONMO and LONMOSD groups, respectively. Outcome was mainly characterized by motor disability and relatively good visual function. At last follow-up, 14 patients had died, including seven (50%) due to acute myelitis and six (43%) because of opportunistic infections. The EDSS 4 score was independently predicted by an older age at onset, as a continuous variable after 50 years of age. Death was predicted by two independent factors: an older age at onset and a high annualized relapse rate. CONCLUSION LONMO/LONMOSD is particularly severe, with a high rate of motor impairment and death.
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Affiliation(s)
- N Collongues
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
| | - R Marignier
- Department of Neurology, Pierre Wertheimer Hospital, University of Lyon, France
| | - A Jacob
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - M I Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - F Paul
- Neurocure, Charité University Medicine Berlin, Germany
| | - H Zephir
- Department of Neurology, Robert Salengro Hospital, University of Lille Nord de France, France
| | - G Akman-Demir
- Department of Neurology, Istanbul University, Turkey
| | - L Elsone
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Jarius
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - C Papeix
- Department of Neurology, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - K Mutch
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - B Wildemann
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - J Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - R Karabudak
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - O Aktas
- Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany
| | - D Kuscu
- Department of Neurology, Bakýrkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | | | - J De Seze
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
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Masaki K. Connexin pathology in acute multiple sclerosis, Baló's disease and neuromyelitis optica. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cen3.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Katsuhisa Masaki
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Masaki K, Suzuki SO, Matsushita T, Matsuoka T, Imamura S, Yamasaki R, Suzuki M, Suenaga T, Iwaki T, Kira JI. Connexin 43 astrocytopathy linked to rapidly progressive multiple sclerosis and neuromyelitis optica. PLoS One 2013; 8:e72919. [PMID: 23991165 PMCID: PMC3749992 DOI: 10.1371/journal.pone.0072919] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/13/2013] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) and neuromyelitis optica (NMO) occasionally have an extremely aggressive and debilitating disease course; however, its molecular basis is unknown. This study aimed to determine a relationship between connexin (Cx) pathology and disease aggressiveness in Asian patients with MS and NMO. METHODS/PRINCIPAL FINDINGS Samples included 11 autopsied cases with NMO and NMO spectrum disorder (NMOSD), six with MS, and 20 with other neurological diseases (OND). Methods of analysis included immunohistochemical expression of astrocytic Cx43/Cx30, oligodendrocytic Cx47/Cx32 relative to AQP4 and other astrocytic and oligodendrocytic proteins, extent of demyelination, the vasculocentric deposition of complement and immunoglobulin, and lesion staging by CD68 staining for macrophages. Lesions were classified as actively demyelinating (n=59), chronic active (n=58) and chronic inactive (n=23). Sera from 120 subjects including 30 MS, 30 NMO, 40 OND and 20 healthy controls were examined for anti-Cx43 antibody by cell-based assay. Six NMO/NMOSD and three MS cases showed preferential loss of astrocytic Cx43 beyond the demyelinated areas in actively demyelinating and chronic active lesions, where heterotypic Cx43/Cx47 astrocyte oligodendrocyte gap junctions were extensively lost. Cx43 loss was significantly associated with a rapidly progressive disease course as six of nine cases with Cx43 loss, but none of eight cases without Cx43 loss regardless of disease phenotype, died within two years after disease onset (66.7% vs. 0%, P=0.0090). Overall, five of nine cases with Cx43 loss and none of eight cases without Cx43 loss had distal oligodendrogliopathy characterized by selective myelin associated glycoprotein loss (55.6% vs. 0.0%, P=0.0296). Loss of oligodendrocytic Cx32 and Cx47 expression was observed in most active and chronic lesions from all MS and NMO/NMOSD cases. Cx43-specific antibodies were absent in NMO/NMOSD and MS patients. CONCLUSIONS These findings suggest that autoantibody-independent astrocytic Cx43 loss may relate to disease aggressiveness and distal oligodendrogliopathy in both MS and NMO.
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Affiliation(s)
- Katsuhisa Masaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi O. Suzuki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Matsuoka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shihoko Imamura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makiko Suzuki
- Department of Neurology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Toru Iwaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- * E-mail:
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Phuan PW, Zhang H, Asavapanumas N, Leviten M, Rosenthal A, Tradtrantip L, Verkman AS. C1q-targeted monoclonal antibody prevents complement-dependent cytotoxicity and neuropathology in in vitro and mouse models of neuromyelitis optica. Acta Neuropathol 2013; 125:829-40. [PMID: 23677375 DOI: 10.1007/s00401-013-1128-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune disorder with inflammatory demyelinating lesions in the central nervous system, particularly in the spinal cord and optic nerve. NMO pathogenesis is thought to involve binding of anti-aquaporin-4 (AQP4) autoantibodies to astrocytes, which causes complement-dependent cytotoxicity (CDC) and downstream inflammation leading to oligodendrocyte and neuronal injury. Vasculocentric deposition of activated complement is a prominent feature of NMO pathology. Here, we show that a neutralizing monoclonal antibody against the C1q protein in the classical complement pathway prevents AQP4 autoantibody-dependent CDC in cell cultures and NMO lesions in ex vivo spinal cord slice cultures and in mice. A monoclonal antibody against human C1q with 11 nM binding affinity prevented CDC caused by NMO patient serum in AQP4-transfected cells and primary astrocyte cultures, and prevented complement-dependent cell-mediated cytotoxicity (CDCC) produced by natural killer cells. The anti-C1q antibody prevented astrocyte damage and demyelination in mouse spinal cord slice cultures exposed to AQP4 autoantibody and human complement. In a mouse model of NMO produced by intracerebral injection of AQP4 autoantibody and human complement, the inflammatory demyelinating lesions were greatly reduced by intracerebral administration of the anti-C1q antibody. These results provide proof-of-concept for C1q-targeted monoclonal antibody therapy in NMO. Targeting of C1q inhibits the classical complement pathway directly and causes secondary inhibition of CDCC and the alternative complement pathway. As C1q-targeted therapy leaves the lectin complement activation pathway largely intact, its side-effect profile is predicted to differ from that of therapies targeting downstream complement proteins.
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Affiliation(s)
- Puay-Wah Phuan
- Departments of Medicine and Physiology, University of California, 1246 Health Sciences East Tower, San Francisco, CA 941143-0521, USA
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Alexopoulos H, Kampylafka EI, Chatzi I, Travasarou M, Karageorgiou KE, Dalakas MC, Tzioufas AG. Reactivity to AQP4 epitopes in relapsing-remitting multiple sclerosis. J Neuroimmunol 2013; 260:117-20. [PMID: 23673145 DOI: 10.1016/j.jneuroim.2013.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/11/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022]
Abstract
Autoantibodies against the water channel AQP4, expressed predominately in central nervous system astrocytes, are markers and pathogenic factors in Devic's disease. In this study we examined whether Multiple Sclerosis (MS) patients recognize antigenic epitopes on AQP4 that may define distinct disease subsets. We screened sera from 45 patients with relapsing-remitting MS (RRMS) and 13 patients with primary progressive MS (PMS). 23 Neuromyelitis Optica (NMO) patients previously characterized were used as assay positive/negative controls. Sera from 23 patients with Systemic Lupus Erythematosus, 23 with primary Sjogren syndrome without neurological involvement and from 28 healthy individuals were also used as controls. NMO-positive sera exhibited reactivity against the intracellular epitope AQPaa252-275, confirming previous observations. All RRMS sera tested negative for anti-AQP4 antibodies using a cell-based assay, but surprisingly, 13% of them reacted with the epitope AQPaa252-275. PMS, healthy and disease controls showed no specific reactivity. Whether these antibodies define distinct MS subsets and have a pathogenic potential pointing to convergent pathogenetic mechanism with NMO, or are simply markers of astrocytic damage, remains to be determined.
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Affiliation(s)
- H Alexopoulos
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
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Tradtrantip L, Asavapanumas N, Verkman AS. Therapeutic cleavage of anti-aquaporin-4 autoantibody in neuromyelitis optica by an IgG-selective proteinase. Mol Pharmacol 2013; 83:1268-75. [PMID: 23571414 DOI: 10.1124/mol.113.086470] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system caused by binding of pathogenic IgG autoantibodies (NMO-IgG) to astrocyte water channel aquaporin-4 (AQP4). Astrocyte damage and downstream inflammation require NMO-IgG effector function to initiate complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC). Here, we evaluated the potential therapeutic utility of the bacterial enzyme IdeS (IgG-degrading enzyme of Streptococcus pyogenes), which selectively cleaves IgG antibodies to yield Fc and F(ab')(2) fragments. In AQP4-expressing cell cultures, IdeS treatment of monoclonal NMO-IgGs and NMO patient sera abolished CDC and ADCC, even when IdeS was added after NMO-IgG was bound to AQP4. Binding of NMO-IgG to AQP4 was similar to that of the NMO-F(ab')(2) generated by IdeS cleavage. NMO-F(ab')(2) competitively displaced pathogenic NMO-IgG, preventing cytotoxicity, and the Fc fragments generated by IdeS cleavage reduced CDC and ADCC. IdeS efficiently cleaved NMO-IgG in mice in vivo, and greatly reduced NMO lesions in mice administered NMO-IgG and human complement. IgG-selective cleavage by IdeS thus neutralizes NMO-IgG pathogenicity, and yields therapeutic F(ab')(2) and Fc fragments. IdeS treatment, by therapeutic apheresis or direct administration, may be beneficial in NMO.
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Affiliation(s)
- Lukmanee Tradtrantip
- Departments of Medicine and Physiology, University of California, San Francisco, CA, USA
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36
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González C, González-Buitrago JM, Izquierdo G. Aquaporins, anti-aquaporin-4 autoantibodies and neuromyelitis optica. Clin Chim Acta 2013; 415:350-60. [DOI: 10.1016/j.cca.2012.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 12/24/2022]
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Kageyama T, Komori M, Miyamoto K, Ozaki A, Suenaga T, Takahashi R, Kusunoki S, Matsumoto S, Kondo T. Combination of cyclosporine A with corticosteroids is effective for the treatment of neuromyelitis optica. J Neurol 2012; 260:627-34. [PMID: 23076828 DOI: 10.1007/s00415-012-6692-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/24/2012] [Accepted: 09/25/2012] [Indexed: 11/26/2022]
Abstract
Neuromyelitis optica (NMO) and associated NMO spectrum disorders (NMOSDs) are neuroinflammatory diseases that frequently result in severe neurological disabilities. The aim of this study was to explore additional treatment options for NMO/NMOSD patients who are seropositive for anti-aquaporin 4 (AQP4) antibodies. We retrospectively evaluated the efficacy of immunosuppressants for NMO/NMOSDs by reviewing the clinical records of 52 patients confirmed as seropositive for anti-AQP4 antibodies. Of the 52 patients, 26 (23 women, three men) had received at least one kind of immunosuppressant other than corticosteroids. After eliminating ineligible cases, we evaluated the following 24 treatments in 22 patients (20 women, two men) that used azathioprine (AZA) (n = 9), cyclophosphamide (n = 1), cyclosporine A (CyA) (n = 9), tacrolimus (n = 2), methotrexate (n = 1), and mizoribine (n = 2). Both AZA and CyA treatments allowed us to decrease the median dose of the coadministered prednisone without affecting the expanded disability severity scale scores. In patients with relapsing-remitting courses, the annual relapse rate decreased from 1.7 (1.2-2.7) to 0.47 (0.36-0.59) after AZA treatments (n = 6, P = 0.028), and also showed a significant decrease from 2.7 (1.8-4.3) to 0.38 (0-0.97) after CyA treatment (n = 8, P = 0.012). These results indicate that CyA as well as AZA may help stabilize the disease activity in NMO/NMOSD patients seropositive for anti-AQP4 antibodies. This is the first case series study demonstrating the efficacy of CyA for the treatment of NMO/NMOSDs.
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Affiliation(s)
- Takashi Kageyama
- Department of Neurology, Tenri Hospital, 200, Mishima-cho, Tenri, Nara 632-8552, Japan.
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Bukhari W, Barnett MH, Prain K, Broadley SA. Molecular pathogenesis of neuromyelitis optica. Int J Mol Sci 2012; 13:12970-93. [PMID: 23202933 PMCID: PMC3497307 DOI: 10.3390/ijms131012970] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/08/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022] Open
Abstract
Neuromyelitis optica (NMO) is a rare autoimmune disorder, distinct from multiple sclerosis, causing inflammatory lesions in the optic nerves and spinal cord. An autoantibody (NMO IgG) against aquaporin-4 (AQP4), a water channel expressed on astrocytes is thought to be causative. Peripheral production of the antibody is triggered by an unknown process in genetically susceptible individuals. Anti-AQP4 antibody enters the central nervous system (CNS) when the blood brain barrier is made permeable and has high affinity for orthogonal array particles of AQP4. Like other autoimmune diseases, Th17 cells and their effector cytokines (such as interleukin 6) have been implicated in pathogenesis. AQP4 expressing peripheral organs are not affected by NMO IgG, but the antibody causes extensive astrocytic loss in specific regions of the CNS through complement mediated cytotoxicity. Demyelination occurs during the inflammatory process and is probably secondary to oligodendrocyte apoptosis subsequent to loss of trophic support from astrocytes. Ultimately, extensive axonal injury leads to severe disability. Despite rapid advances in the understanding of NMO pathogenesis, unanswered questions remain, particularly with regards to disease mechanisms in NMO IgG seronegative cases. Increasing knowledge of the molecular pathology is leading to improved treatment strategies.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Gold Coast Campus, Griffith University, QLD 4222, Australia; E-Mail:
- Department of Neurology, Gold Coast Hospital, Southport, QLD 4215, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, Camperdown, NSW 2050, Australia; E-Mail:
| | - Kerri Prain
- Autoimmune laboratory, Division of Immunology, Pathology Queensland, Herston, QLD 4029, Australia; E-Mail:
| | - Simon A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, QLD 4222, Australia; E-Mail:
- Department of Neurology, Gold Coast Hospital, Southport, QLD 4215, Australia
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Benga I, Benga O. Implications of water channel proteins in selected neurological disorders: Epilepsies, muscular dystrophies, amyotrophic lateral sclerosis, neuromyelitis optica, Parkinson’s disease, and spongiform encephalopathies. Mol Aspects Med 2012; 33:590-604. [DOI: 10.1016/j.mam.2012.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 03/20/2012] [Indexed: 01/17/2023]
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Jones MV, Collongues N, de Seze J, Kinoshita M, Nakatsuji Y, Levy M. Review of Animal Models of Neuromyelitis Optica. Mult Scler Relat Disord 2012; 1:174-179. [PMID: 24555175 DOI: 10.1016/j.msard.2012.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Neuromyelitis optica (NMO) is a recurrent neuroinflammatory disease of the optic nerves and spinal cord associated with the anti-aquaporin-4 (AQP4) antibody biomarker, NMO-IgG. As clinical and scientific research interest in NMO grows, the need for an animal model becomes more urgent. Over the past few years, several groups have developed rodent models that partially represent human NMO disease. Passive transfer of the NMO-IgG is not pathogenic alone, but in certain contexts can recruit granulocytes and lead to increased inflammation. Studies of the cellular immune response against AQP4 have also shed light on the roles of B and T cells in NMO, especially focusing on the role of Th17 T helper cells. This review discusses the contribution of the available NMO animal models to the understanding of NMO disease pathogenesis.
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Affiliation(s)
- Melina V Jones
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Nicolas Collongues
- Department of Neurology, University Hospitals of Strasbourg, Strasbourg, France
| | - Jerome de Seze
- Department of Neurology, University Hospitals of Strasbourg, Strasbourg, France
| | - Makoto Kinoshita
- Department of Neurology, Department of Microbiology and Immunology, Osaka University, Osaka, Japan
| | | | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Cotrina ML, Nedergaard M. Brain connexins in demyelinating diseases: therapeutic potential of glial targets. Brain Res 2012; 1487:61-8. [PMID: 22789906 DOI: 10.1016/j.brainres.2012.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/29/2012] [Accepted: 07/03/2012] [Indexed: 12/23/2022]
Abstract
Several demyelinating syndromes have been linked to mutations in glial gap junction proteins, the connexins. Although mutations in connexins of the myelinating cells, Schwann cells and oligodendrocytes, were initially described, recent data have shown that astrocytes also play a major role in the demyelination process. Alterations in astrocytic proteins directly affect the oligodendrocytes' ability to maintain myelin structure, and associated astrocytic proteins that regulate water and ionic fluxes, including aquaporins, can also regulate myelin integrity. Here, we will review the main evidence from human disorders and transgenic mouse models that implicate glial gap junction proteins in demyelinating diseases and the therapeutic potential of some of these targets. This article is part of a Special Issue entitled Electrical Synapses.
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Affiliation(s)
- Maria Luisa Cotrina
- Division of Glia Disease and Therapeutics, Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, NY 14640, USA.
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Fujihara K, Misu T, Nakashima I, Takahashi T, Bradl M, Lassmann H, Takano R, Nishiyama S, Takai Y, Suzuki C, Sato D, Kuroda H, Nakamura M, Fujimori J, Narikawa K, Sato S, Itoyama Y, Aoki M. Neuromyelitis optica should be classified as an astrocytopathic disease rather than a demyelinating disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1759-1961.2012.00030.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Ichiro Nakashima
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | | | - Monika Bradl
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Hans Lassmann
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Rina Takano
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Shuhei Nishiyama
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Yoshiki Takai
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Chihiro Suzuki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Douglas Sato
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Hiroshi Kuroda
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Masashi Nakamura
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Juichi Fujimori
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Koichi Narikawa
- Department of Neurology; National Hospital Organization Sendai Medical Center; Sendai; Japan
| | - Shigeru Sato
- Department of Neurology; Kohnan Hospital; Sendai; Japan
| | - Yasuto Itoyama
- National Center Hosptial; National Center of Neurology and Psychiatry; Tokyo; Japan
| | - Masashi Aoki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
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Collongues N, Chanson JB, Blanc F, Steibel J, Lam CD, Shabbir A, Trifilieff E, Honnorat J, Pham-Dinh D, Ghandour MS, de Seze J. The Brown Norway opticospinal model of demyelination: does it mimic multiple sclerosis or neuromyelitis optica? Int J Dev Neurosci 2012; 30:487-97. [PMID: 22634288 DOI: 10.1016/j.ijdevneu.2012.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 05/16/2012] [Accepted: 05/16/2012] [Indexed: 11/25/2022] Open
Abstract
Opticospinal demyelinating diseases in humans are mostly characterized by the opticospinal form of multiple sclerosis (MS) and neuromyelitis optica (NMO). Increasing attention has recently focused on astrocyte markers, aquaporin-4 (AQP4) and glial fibrillary acidic protein (GFAP) in these diseases. We induced opticospinal demyelination in Brown Norway rats with soluble recombinant rat myelin oligodendrocyte glycoprotein (1-116) and incomplete Freund's adjuvant. Clinical, MRI, neuropathological and immunological evaluations were performed, with a focus on AQP4 and GFAP. We confirmed the opticospinal phenotype, including extensive myelitis, but also showed the MRI-characterized involvement of the periventricular area. Expression levels of myelin, AQP4 and GFAP showed the early involvement of astrocytes before demyelination in the optic nerve. The overexpression of AQP4 was particularly pronounced in the spinal cord and was concomitant with demyelination and astrocyte apoptosis. The disability scores were correlated with demyelination and inflammation but not with AQP4/GFAP expression. No antibodies against the linear and conformational epitopes of AQP4 were detected. Whereas a NMO-like phenotype was observed in this model, the AQP4/GFAP expression during the disease process was more closely related to opticospinal MS than NMO. However, this model raises the question of a continuum between opticospinal MS and the seronegative NMO subtype.
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Affiliation(s)
- N Collongues
- Laboratoire d'Imagerie et de Neurosciences Cognitives, UMR 7237 CNRS/UDS, Université de Strasbourg, Faculté de Médecine, 4 Rue Kirschleger, Strasbourg, France.
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Where Do AQP4 Antibodies Fit in the Pathogenesis of NMO? Mult Scler Int 2012; 2012:862169. [PMID: 22530129 PMCID: PMC3316941 DOI: 10.1155/2012/862169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/28/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022] Open
Abstract
Recent advances in the field of neuromyelitis optica (NMO) research provided convincing evidence that anti-AQP4 antibody (AQP4-Ab) not only serves as a highly specific disease marker, but also plays an essential role in the pathogenesis of the disease. Although it is now widely recognized that AQP4-Ab induces astrocytic necrosis in a complement-dependent manner, additional triggers are also suspected as a prerequisite for the development of the disease. Unraveling these unresolved aspects of the disease will provide substantial insight into still controversial issues in the pathogenesis of NMO.
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