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Wei R, Wei P, Yuan H, Yi X, Aschner M, Jiang YM, Li SJ. Inflammation in Metal-Induced Neurological Disorders and Neurodegenerative Diseases. Biol Trace Elem Res 2024; 202:4459-4481. [PMID: 38206494 DOI: 10.1007/s12011-023-04041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
Essential metals play critical roles in maintaining human health as they participate in various physiological activities. Nonetheless, both excessive accumulation and deficiency of these metals may result in neurotoxicity secondary to neuroinflammation and the activation of microglia and astrocytes. Activation of these cells can promote the release of pro-inflammatory cytokines. It is well known that neuroinflammation plays a critical role in metal-induced neurotoxicity as well as the development of neurological disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). Initially seen as a defense mechanism, persistent inflammatory responses are now considered harmful. Astrocytes and microglia are key regulators of neuroinflammation in the central nervous system, and their excessive activation may induce sustained neuroinflammation. Therefore, in this review, we aim to emphasize the important role and molecular mechanisms underlying metal-induced neurotoxicity. Our objective is to raise the awareness on metal-induced neuroinflammation in neurological disorders. However, it is not only just neuroinflammation that different metals could induce; they can also cause harm to the nervous system through oxidative stress, apoptosis, and autophagy, to name a few. The primary pathophysiological mechanism by which these metals induce neurological disorders remains to be determined. In addition, given the various pathways through which individuals are exposed to metals, it is necessary to also consider the effects of co-exposure to multiple metals on neurological disorders.
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Affiliation(s)
- Ruokun Wei
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China
| | - Peiqi Wei
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China
| | - Haiyan Yuan
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China
| | - Xiang Yi
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China
| | - Michael Aschner
- The Department of Molecular Pharmacology at Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Yue-Ming Jiang
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China.
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China.
| | - Shao-Jun Li
- Toxicology Department, School of Public Health, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, China.
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, 22 Shuang-yong Rd., Nanning, 530021, Guangxi, China.
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2
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Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of Progression Independent of Relapses in Multiple Sclerosis. Ann Neurol 2024; 96:1-20. [PMID: 38568026 DOI: 10.1002/ana.26913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 02/15/2024] [Indexed: 06/20/2024]
Abstract
Clinical, pathological, and imaging evidence in multiple sclerosis (MS) suggests that a smoldering inflammatory activity is present from the earliest stages of the disease and underlies the progression of disability, which proceeds relentlessly and independently of clinical and radiological relapses (PIRA). The complex system of pathological events driving "chronic" worsening is likely linked with the early accumulation of compartmentalized inflammation within the central nervous system as well as insufficient repair phenomena and mitochondrial failure. These mechanisms are partially lesion-independent and differ from those causing clinical relapses and the formation of new focal demyelinating lesions; they lead to neuroaxonal dysfunction and death, myelin loss, glia alterations, and finally, a neuronal network dysfunction outweighing central nervous system (CNS) compensatory mechanisms. This review aims to provide an overview of the state of the art of neuropathological, immunological, and imaging knowledge about the mechanisms underlying the smoldering disease activity, focusing on possible early biomarkers and their translation into clinical practice. ANN NEUROL 2024;96:1-20.
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Affiliation(s)
- Massimiliano Calabrese
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College, London, UK
| | - Elisa Colato
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battaglini
- Siena Imaging S.r.l., Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Owain W Howell
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Matilde Inglese
- Dipartimento di neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili - DINOGMI, University of Genova, Genoa, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Martin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Therapeutic Design Unit, Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Cellerys AG, Schlieren, Switzerland
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of Medicine, Burlington Danes, Imperial College London, London, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Agnese Tamanti
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Marco Vercellino
- Multiple Sclerosis Center & Neurologia I U, Department of Neuroscience, University Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Maria Villar
- Department of Immunology, Ramon y Cajal University Hospital. IRYCIS. REI, Madrid, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Magliozzi
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
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3
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Tang C, Yang J, Zhu C, Ding Y, Yang S, Xu B, He D. Iron metabolism disorder and multiple sclerosis: a comprehensive analysis. Front Immunol 2024; 15:1376838. [PMID: 38590521 PMCID: PMC11000231 DOI: 10.3389/fimmu.2024.1376838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system. Currently, the pathological mechanisms of MS are not fully understood, but research has suggested that iron metabolism disorder may be associated with the onset and clinical manifestations of MS. Methods and materials The study utilized publicly available databases and bioinformatics techniques for gene expression data analysis, including differential expression analysis, weighted correlation network analysis, gene enrichment analysis, and construction of logistic regression models. Subsequently, Mendelian randomization was used to assess the causal relationship between different iron metabolism markers and MS. Results This study identified IREB2, LAMP2, ISCU, ATP6V1G1, ATP13A2, and SKP1 as genes associated with multiple sclerosis (MS) and iron metabolism, establishing their multi-gene diagnostic value for MS with an AUC of 0.83. Additionally, Mendelian randomization analysis revealed a potential causal relationship between transferrin saturation and MS (p=2.22E-02; OR 95%CI=0.86 (0.75, 0.98)), as well as serum transferrin and MS (p=2.18E-04; OR 95%CI=1.22 (1.10, 1.36)). Conclusion This study comprehensively explored the relationship between iron metabolism and MS through integrated bioinformatics analysis and Mendelian randomization methods. The findings provide important insights for further research into the role of iron metabolism disorder in the pathogenesis of MS and offer crucial theoretical support for the treatment of MS.
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Affiliation(s)
- Chao Tang
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jiaxin Yang
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Chaomin Zhu
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yaqi Ding
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Sushuang Yang
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Bingyang Xu
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Dian He
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Wang Y, Zhan M, Roebroeck A, De Weerd P, Kashyap S, Roberts MJ. Inconsistencies in atlas-based volumetric measures of the human nucleus basalis of Meynert: A need for high-resolution alternatives. Neuroimage 2022; 259:119421. [PMID: 35779763 DOI: 10.1016/j.neuroimage.2022.119421] [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: 09/23/2021] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
Abstract
The nucleus basalis of Meynert (nbM) is the major source of cortical acetylcholine (ACh) and has been related to cognitive processes and to neurological disorders. However, spatially delineating the human nbM in MRI studies remains challenging. Due to the absence of a functional localiser for the human nbM, studies to date have localised it using nearby neuroanatomical landmarks or using probabilistic atlases. To understand the feasibility of MRI of the nbM we set our four goals; our first goal was to review current human nbM region-of-interest (ROI) selection protocols used in MRI studies, which we found have reported highly variable nbM volume estimates. Our next goal was to quantify and discuss the limitations of existing atlas-based volumetry of nbM. We found that the identified ROI volume depends heavily on the atlas used and on the probabilistic threshold set. In addition, we found large disparities even for data/studies using the same atlas and threshold. To test whether spatial resolution contributes to volume variability, as our third goal, we developed a novel nbM mask based on the normalized BigBrain dataset. We found that as long as the spatial resolution of the target data was 1.3 mm isotropic or above, our novel nbM mask offered realistic and stable volume estimates. Finally, as our last goal we tried to discern nbM using publicly available and novel high resolution structural MRI ex vivo MRI datasets. We find that, using an optimised 9.4T quantitative T2⁎ ex vivo dataset, the nbM can be visualised using MRI. We conclude caution is needed when applying the current methods of mapping nbM, especially for high resolution MRI data. Direct imaging of the nbM appears feasible and would eliminate the problems we identify, although further development is required to allow such imaging using standard (f)MRI scanning.
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Affiliation(s)
- Yawen Wang
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Minye Zhan
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands; U992 (Cognitive neuroimaging unit), NeuroSpin, INSERM-CEA, Gif sur Yvette, France
| | - Alard Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Peter De Weerd
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sriranga Kashyap
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mark J Roberts
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
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5
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Dal-Bianco A, Schranzer R, Grabner G, Lanzinger M, Kolbrink S, Pusswald G, Altmann P, Ponleitner M, Weber M, Kornek B, Zebenholzer K, Schmied C, Berger T, Lassmann H, Trattnig S, Hametner S, Leutmezer F, Rommer P. Iron Rims in Patients With Multiple Sclerosis as Neurodegenerative Marker? A 7-Tesla Magnetic Resonance Study. Front Neurol 2022; 12:632749. [PMID: 34992573 PMCID: PMC8724313 DOI: 10.3389/fneur.2021.632749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system, characterized by inflammatory-driven demyelination. Symptoms in MS manifest as both physical and neuropsychological deficits. With time, inflammation is accompanied by neurodegeneration, indicated by brain volume loss on an MRI. Here, we combined clinical, imaging, and serum biomarkers in patients with iron rim lesions (IRLs), which lead to severe tissue destruction and thus contribute to the accumulation of clinical disability. Objectives: Subcortical atrophy and ventricular enlargement using an automatic segmentation pipeline for 7 Tesla (T) MRI, serum neurofilament light chain (sNfL) levels, and neuropsychological performance in patients with MS with IRLs and non-IRLs were assessed. Methods: In total 29 patients with MS [15 women, 24 relapsing-remitting multiple sclerosis (RRMS), and five secondary-progressive multiple sclerosis (SPMS)] aged 38 (22–69) years with an Expanded Disability Status Score of 2 (0–8) and a disease duration of 11 (5–40) years underwent neurological and neuropsychological examinations. Volumes of lesions, subcortical structures, and lateral ventricles on 7-T MRI (SWI, FLAIR, and MP2RAGE, 3D Segmentation Software) and sNfL concentrations using the Simoa SR-X Analyzer in IRL and non-IRL patients were assessed. Results: (1) Iron rim lesions patients had a higher FLAIR lesion count (p = 0.047). Patients with higher MP2Rage lesion volume exhibited more IRLs (p <0.014) and showed poorer performance in the information processing speed tested within 1 year using the Symbol Digit Modalities Test (SDMT) (p <0.047). (2) Within 3 years, patients showed atrophy of the thalamus (p = 0.021) and putamen (p = 0.043) and enlargement of the lateral ventricles (p = 0.012). At baseline and after 3 years, thalamic volumes were lower in IRLs than in non-IRL patients (p = 0.045). (3) At baseline, IRL patients had higher sNfL concentrations (p = 0.028). Higher sNfL concentrations were associated with poorer SDMT (p = 0.004), regardless of IRL presence. (4) IRL and non-IRL patients showed no significant difference in the neuropsychological performance within 1 year. Conclusions: Compared with non-IRL patients, IRL patients had higher FLAIR lesion counts, smaller thalamic volumes, and higher sNfL concentrations. Our pilot study combines IRL and sNfL, two biomarkers considered indicative for neurodegenerative processes. Our preliminary data underscore the reported destructive nature of IRLs.
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Affiliation(s)
| | - R Schranzer
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - G Grabner
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | | | - S Kolbrink
- Department of Neurology, Vienna, Austria
| | - G Pusswald
- Department of Neurology, Vienna, Austria
| | - P Altmann
- Department of Neurology, Vienna, Austria
| | | | - M Weber
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - B Kornek
- Department of Neurology, Vienna, Austria
| | | | - C Schmied
- Department of Neurology, Vienna, Austria
| | - T Berger
- Department of Neurology, Vienna, Austria
| | - H Lassmann
- Department of Neuroimmunology, Center for Brain Research, Vienna, Austria
| | - S Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - S Hametner
- Department of Neurology, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - P Rommer
- Department of Neurology, Vienna, Austria
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6
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Bagnato F, Gauthier SA, Laule C, Moore GRW, Bove R, Cai Z, Cohen-Adad J, Harrison DM, Klawiter EC, Morrow SA, Öz G, Rooney WD, Smith SA, Calabresi PA, Henry RG, Oh J, Ontaneda D, Pelletier D, Reich DS, Shinohara RT, Sicotte NL. Imaging Mechanisms of Disease Progression in Multiple Sclerosis: Beyond Brain Atrophy. J Neuroimaging 2021; 30:251-266. [PMID: 32418324 DOI: 10.1111/jon.12700] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Clinicians involved with different aspects of the care of persons with multiple sclerosis (MS) and scientists with expertise on clinical and imaging techniques convened in Dallas, TX, USA on February 27, 2019 at a North American Imaging in Multiple Sclerosis Cooperative workshop meeting. The aim of the workshop was to discuss cardinal pathobiological mechanisms implicated in the progression of MS and novel imaging techniques, beyond brain atrophy, to unravel these pathologies. Indeed, although brain volume assessment demonstrates changes linked to disease progression, identifying the biological mechanisms leading up to that volume loss are key for understanding disease mechanisms. To this end, the workshop focused on the application of advanced magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging techniques to assess and measure disease progression in both the brain and the spinal cord. Clinical translation of quantitative MRI was recognized as of vital importance, although the need to maintain a relatively short acquisition time mandated by most radiology departments remains the major obstacle toward this effort. Regarding PET, the panel agreed upon its utility to identify ongoing pathological processes. However, due to costs, required expertise, and the use of ionizing radiation, PET was not considered to be a viable option for ongoing care of persons with MS. Collaborative efforts fostering robust study designs and imaging technique standardization across scanners and centers are needed to unravel disease mechanisms leading to progression and discovering medications halting neurodegeneration and/or promoting repair.
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Affiliation(s)
- Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Department of Neurology, Feil Family Brain and Mind Institute, and Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Cornelia Laule
- Department of Radiology, Pathology, and Laboratory Medicine, Department of Physics and Astronomy, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - George R Wayne Moore
- Department of Pathology and Laboratory Medicine, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Zhengxin Cai
- Department of Radiology and Biomedical Imaging, PET Center, Yale University, New Haven, CT
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal and Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Eric C Klawiter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Gülin Öz
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - William D Rooney
- Advanced Imaging Research Center, Departments of Biomedical Engineering, Neurology, and Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Seth A Smith
- Radiology and Radiological Sciences and Vanderbilt University Imaging Institute, Vanderbilt University Medical Center, and Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roland G Henry
- Departments of Neurology, Radiology and Biomedical Imaging, and the UC San Francisco & Berkeley Bioengineering Graduate Group, University of California San Francisco, San Francisco, CA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Pelletier
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
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- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
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7
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Tham M, Frischer JM, Weigand SD, Fitz-Gibbon PD, Webb SM, Guo Y, Adiele RC, Robinson CA, Brück W, Lassmann H, Furber KL, Pushie MJ, Parisi JE, Lucchinetti CF, Popescu BF. Iron Heterogeneity in Early Active Multiple Sclerosis Lesions. Ann Neurol 2020; 89:498-510. [PMID: 33244761 PMCID: PMC7986227 DOI: 10.1002/ana.25974] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a heterogeneous inflammatory demyelinating disease. Iron distribution is altered in MS patients' brains, suggesting iron liberation within active lesions amplifies demyelination and neurodegeneration. Whether the amount and distribution of iron are similar or different among different MS immunopatterns is currently unknown. METHODS We used synchrotron X-ray fluorescence imaging, histology, and immunohistochemistry to compare the iron quantity and distribution between immunopattern II and III early active MS lesions. We analyzed archival autopsy and biopsy tissue from 21 MS patients. RESULTS Immunopattern II early active lesions contain 64% more iron (95% confidence interval [CI] = 17-127%, p = 0.004) than immunopattern III lesions, and 30% more iron than the surrounding periplaque white matter (95% CI = 3-64%, p = 0.03). Iron in immunopattern III lesions is 28% lower than in the periplaque white matter (95% CI = -40 to -14%, p < 0.001). When normalizing the iron content of early active lesions to that of surrounding periplaque white matter, the ratio is significantly higher in immunopattern II (p < 0.001). Microfocused X-ray fluorescence imaging shows that iron in immunopattern II lesions localizes to macrophages, whereas macrophages in immunopattern III lesions contain little iron. INTERPRETATION Iron distribution and content are heterogeneous in early active MS lesions. Iron accumulates in macrophages in immunopattern II, but not immunopattern III lesions. This heterogeneity in the two most common MS immunopatterns may be explained by different macrophage polarization, origin, or different demyelination mechanisms, and paves the way for developing new or using existing iron-sensitive magnetic resonance imaging techniques to differentiate among immunopatterns in the general nonbiopsied MS patient population. ANN NEUROL 2021;89:498-510.
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Affiliation(s)
- Mylyne Tham
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Stephen D Weigand
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Patrick D Fitz-Gibbon
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samuel M Webb
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Yong Guo
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Reginald C Adiele
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christopher A Robinson
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region/College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Kendra L Furber
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M Jake Pushie
- Department of Surgery, Division of Neurosurgery, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Bogdan F Popescu
- Department of Anatomy, Physiology, and Pharmacology/Cameco MS Neuroscience Research Centre, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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8
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Dales JP, Desplat-Jégo S. Metal Imbalance in Neurodegenerative Diseases with a Specific Concern to the Brain of Multiple Sclerosis Patients. Int J Mol Sci 2020; 21:E9105. [PMID: 33266021 PMCID: PMC7730295 DOI: 10.3390/ijms21239105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022] Open
Abstract
There is increasing evidence that deregulation of metals contributes to a vast range of neurodegenerative diseases including multiple sclerosis (MS). MS is a chronic inflammatory disease of the central nervous system (CNS) manifesting disability and neurological symptoms. The precise origin of MS is unknown, but the disease is characterized by focal inflammatory lesions in the CNS associated with an autoimmune reaction against myelin. The treatment of this disease has mainly been based on the prescription of immunosuppressive and immune-modulating agents. However, the rate of progressive disability and early mortality is still worrisome. Metals may represent new diagnostic and predictive markers of severity and disability as well as innovative candidate drug targets for future therapies. In this review, we describe the recent advances in our understanding on the role of metals in brain disorders of neurodegenerative diseases and MS patients.
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Affiliation(s)
- Jean-Philippe Dales
- Institute of Neurophysiopathology, CNRS, INP, Aix-Marseille University, 13005 Marseille, France;
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Pavillon Etoile, Pôle de Biologie, Service d’anatomie-pathologie, CEDEX 20, 13915 Marseille, France
| | - Sophie Desplat-Jégo
- Institute of Neurophysiopathology, CNRS, INP, Aix-Marseille University, 13005 Marseille, France;
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Pôle de Biologie, Service d’Immunologie, 13005 Marseille, France
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9
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Ma YJ, Searleman AC, Jang H, Fan SJ, Wong J, Xue Y, Cai Z, Chang EY, Corey-Bloom J, Du J. Volumetric imaging of myelin in vivo using 3D inversion recovery-prepared ultrashort echo time cones magnetic resonance imaging. NMR IN BIOMEDICINE 2020; 33:e4326. [PMID: 32691472 PMCID: PMC7952008 DOI: 10.1002/nbm.4326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 05/02/2020] [Indexed: 05/28/2023]
Abstract
Direct myelin imaging is promising for characterization of multiple sclerosis (MS) brains at diagnosis and in response to therapy. In this study, a 3D inversion recovery-prepared ultrashort echo time cones (IR-UTE-Cones) sequence was used for both morphological and quantitative imaging of myelin on a clinical 3 T scanner. Myelin powder phantoms with different myelin concentrations were imaged with the 3D UTE-Cones sequence and it showed a strong correlation between concentrations and UTE-Cones signals, demonstrating the ability of the UTE-Cones sequence to directly image myelin in the brain. Quantitative myelin imaging with multi-echo IR-UTE-Cones sequences show similar T2 * values for a D2 O-exchanged myelin phantom (T2 * = 0.33 ± 0.04 ms), ex vivo brain specimens (T2 * = 0.20 ± 0.04 ms) and in vivo healthy volunteers (T2 * = 0.254 ± 0.023 ms), further confirming the feasibility of 3D IR-UTE-Cones sequences for direct myelin imaging in vivo. In ex vivo MS brain study, signal loss is observed in MS lesions, which was confirmed with histology. For the in vivo study, the lesions in MS patients also show myelin signal loss using the proposed direct myelin imaging method, demonstrating the clinical potential for MS diagnosis. Furthermore, the measured IR-UTE-Cones signal intensities show a significant difference between normal-appearing white matter in MS patients and normal white matter in volunteers, which cannot be found in clinical used T2 -FLAIR sequences. Thus, the proposed 3D IR-UTE-Cones sequence showed clinical potential for MS diagnosis with the capability of direct myelin detection of the whole brain.
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Affiliation(s)
- Ya-Jun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Adam C. Searleman
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Shu-Juan Fan
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Jonathan Wong
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Yanping Xue
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Zhenyu Cai
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA, USA
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10
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Erbay MF, Kamışlı Ö, Karatoprak NB. Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients? Br J Radiol 2020; 93:20200552. [DOI: 10.1259/bjr.20200552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective : T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. Methods: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI–ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. Results: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. Conclusions: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. Advances in knowledge: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.
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Affiliation(s)
- Mehmet Fatih Erbay
- Department of Radiology, Inonu UniversityFaculty of Medicine, Malatya, Turkey
| | - Özden Kamışlı
- Department of Neurology, Inonu University Faculty of Medicine, Malatya, Turkey
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11
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Young PNE, Estarellas M, Coomans E, Srikrishna M, Beaumont H, Maass A, Venkataraman AV, Lissaman R, Jiménez D, Betts MJ, McGlinchey E, Berron D, O'Connor A, Fox NC, Pereira JB, Jagust W, Carter SF, Paterson RW, Schöll M. Imaging biomarkers in neurodegeneration: current and future practices. Alzheimers Res Ther 2020; 12:49. [PMID: 32340618 PMCID: PMC7187531 DOI: 10.1186/s13195-020-00612-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
There is an increasing role for biological markers (biomarkers) in the understanding and diagnosis of neurodegenerative disorders. The application of imaging biomarkers specifically for the in vivo investigation of neurodegenerative disorders has increased substantially over the past decades and continues to provide further benefits both to the diagnosis and understanding of these diseases. This review forms part of a series of articles which stem from the University College London/University of Gothenburg course "Biomarkers in neurodegenerative diseases". In this review, we focus on neuroimaging, specifically positron emission tomography (PET) and magnetic resonance imaging (MRI), giving an overview of the current established practices clinically and in research as well as new techniques being developed. We will also discuss the use of machine learning (ML) techniques within these fields to provide additional insights to early diagnosis and multimodal analysis.
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Affiliation(s)
- Peter N E Young
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mar Estarellas
- Centre for Medical Image Computing (CMIC), Department of Computer Science & Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Emma Coomans
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Meera Srikrishna
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helen Beaumont
- Neuroscience and Aphasia Research Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Ashwin V Venkataraman
- Division of Brain Sciences, Imperial College London, London, UK
- United Kingdom Dementia Research Institute, Imperial College London, London, UK
| | - Rikki Lissaman
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, UK
| | - Daniel Jiménez
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Matthew J Betts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - David Berron
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Antoinette O'Connor
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Joana B Pereira
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, MAHSC, University of Manchester, Manchester, UK
| | - Ross W Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK.
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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12
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Taege Y, Hagemeier J, Bergsland N, Dwyer MG, Weinstock-Guttman B, Zivadinov R, Schweser F. Assessment of mesoscopic properties of deep gray matter iron through a model-based simultaneous analysis of magnetic susceptibility and R 2* - A pilot study in patients with multiple sclerosis and normal controls. Neuroimage 2019; 186:308-320. [PMID: 30445148 PMCID: PMC6481304 DOI: 10.1016/j.neuroimage.2018.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/16/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
Most studies of brain iron relied on the effect of the iron on magnetic resonance (MR) relaxation properties, such as R2∗, and bulk tissue magnetic susceptibility, as measured by quantitative susceptibility mapping (QSM). The present study exploited the dependence of R2∗ and magnetic susceptibility on physical interactions at different length-scales to retrieve information about the tissue microenvironment, rather than the iron concentration. We introduce a method for the simultaneous analysis of brain tissue magnetic susceptibility and R2∗ that aims to isolate those biophysical mechanisms of R2∗ -contrast that are associated with the micro- and mesoscopic distribution of iron, referred to as the Iron Microstructure Coefficient (IMC). The present study hypothesized that changes in the deep gray matter (DGM) magnetic microenvironment associated with aging and pathological mechanisms of multiple sclerosis (MS), such as changes of the distribution and chemical form of the iron, manifest in quantifiable contributions to the IMC. To validate this hypothesis, we analyzed the voxel-based association between R2∗ and magnetic susceptibility in different DGM regions of 26 patients with multiple sclerosis and 33 age- and sex-matched normal controls. Values of the IMC varied significantly between anatomical regions, were reduced in the dentate and increased in the caudate of patients compared to controls, and decreased with normal aging, most strongly in caudate, globus pallidus and putamen.
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Affiliation(s)
- Yanis Taege
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute at the University at Buffalo, The State University of New York, 875 Ellicott Street, Buffalo, NY, 14202, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 1010 Main St 2nd Flr, Buffalo, NY, 14202, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute at the University at Buffalo, The State University of New York, 875 Ellicott Street, Buffalo, NY, 14202, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, 100 High Street, Buffalo, NY, 14202, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute at the University at Buffalo, The State University of New York, 875 Ellicott Street, Buffalo, NY, 14202, USA.
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13
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Belova AN, Solovieva VS, Boyko AN. [Anemia and dysregulation of iron metabolism in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:10-17. [PMID: 30160662 DOI: 10.17116/jnevro201811808210] [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: 11/17/2022]
Abstract
Anemia is one of the common diseases comorbid with multiple sclerosis (MS). This article reviews the prevalence and types of anemia in MS patients. It has been shown that anemia is often accompanied by a decrease in serum iron level. The authors present the data on iron metabolism in patients with MS and MRI findings concerning deposits of iron in the gray matter of the brain. The causal relationship between abnormalities in iron metabolism and MS remains unclear; this study allows to approach the understanding of the MS pathogenesis and to increase the efficacy of therapy for this disease.
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Affiliation(s)
- A N Belova
- Privolzskyi Federal Medical Research Center, Nizhny Novgorod, Russia
| | - V S Solovieva
- City Clinical Hospital #3, Regional Center fo Multiple Sclerosis, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia; Center for Demyelination Diseases 'Neuroclinic', Moscow, Russia
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14
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Untangling the R2* contrast in multiple sclerosis: A combined MRI-histology study at 7.0 Tesla. PLoS One 2018; 13:e0193839. [PMID: 29561895 PMCID: PMC5862438 DOI: 10.1371/journal.pone.0193839] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/19/2018] [Indexed: 11/19/2022] Open
Abstract
T2*-weighted multi-echo gradient-echo magnetic resonance imaging and its reciprocal R2* are used in brain imaging due to their sensitivity to iron content. In patients with multiple sclerosis who display pathological alterations in iron and myelin contents, the use of R2* may offer a unique way to untangle mechanisms of disease. Coronal slices from 8 brains of deceased multiple sclerosis patients were imaged using a whole-body 7.0 Tesla MRI scanner. The scanning protocol included three-dimensional (3D) T2*-w multi-echo gradient-echo and 2D T2-w turbo spin echo (TSE) sequences. Histopathological analyses of myelin and iron content were done using Luxol fast blue and proteolipid myelin staining and 3,3′-diaminobenzidine tetrahydrochloride enhanced Turnbull blue staining. Quantification of R2*, myelin and iron intensity were obtained. Variations in R2* were found to be affected differently by myelin and iron content in different regions of multiple sclerosis brains. The data shall inform clinical investigators in addressing the role of T2*/R2* variations as a biomarker of tissue integrity in brains of MS patients, in vivo.
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15
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Gillen KM, Mubarak M, Nguyen TD, Pitt D. Significance and In Vivo Detection of Iron-Laden Microglia in White Matter Multiple Sclerosis Lesions. Front Immunol 2018. [PMID: 29515576 PMCID: PMC5826076 DOI: 10.3389/fimmu.2018.00255] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Microglia are resident immune cells that fulfill protective and homeostatic functions in the central nervous system (CNS) but may also promote neurotoxicity in the aged brain and in chronic disease. In multiple sclerosis (MS), an autoimmune demyelinating disease of the CNS, microglia and macrophages contribute to the development of white matter lesions through myelin phagocytosis, and possibly to disease progression through diffuse activation throughout myelinated white matter. In this review, we discuss an additional compartment of myeloid cell activation in MS, i.e., the rim and normal adjacent white matter of chronic active lesions. In chronic active lesions, microglia and macrophages may contain high amounts of iron, express markers of proinflammatory polarization, are activated for an extended period of time (years), and drive chronic tissue damage. Iron-positive myeloid cells can be visualized and quantified with quantitative susceptibility mapping (QSM), a magnetic resonance imaging technique. Thus, QSM has potential as an in vivo biomarker for chronic inflammatory activity in established white matter MS lesions. Reducing chronic inflammation associated with iron accumulation using existing or novel MS therapies may impact disease severity and progression.
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Affiliation(s)
- Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Mayyan Mubarak
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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16
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Popescu BF, Frischer JM, Webb SM, Tham M, Adiele RC, Robinson CA, Fitz-Gibbon PD, Weigand SD, Metz I, Nehzati S, George GN, Pickering IJ, Brück W, Hametner S, Lassmann H, Parisi JE, Yong G, Lucchinetti CF. Pathogenic implications of distinct patterns of iron and zinc in chronic MS lesions. Acta Neuropathol 2017; 134:45-64. [PMID: 28332093 PMCID: PMC5486634 DOI: 10.1007/s00401-017-1696-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) in which oligodendrocytes, the CNS cells that stain most robustly for iron and myelin are the targets of injury. Metals are essential for normal CNS functioning, and metal imbalances have been linked to demyelination and neurodegeneration. Using a multidisciplinary approach involving synchrotron techniques, iron histochemistry and immunohistochemistry, we compared the distribution and quantification of iron and zinc in MS lesions to the surrounding normal appearing and periplaque white matter, and assessed the involvement of these metals in MS lesion pathogenesis. We found that the distribution of iron and zinc is heterogeneous in MS plaques, and with few remarkable exceptions they do not accumulate in chronic MS lesions. We show that brain iron tends to decrease with increasing age and disease duration of MS patients; reactive astrocytes organized in large astrogliotic areas in a subset of smoldering and inactive plaques accumulate iron and safely store it in ferritin; a subset of smoldering lesions do not contain a rim of iron-loaded macrophages/microglia; and the iron content of shadow plaques varies with the stage of remyelination. Zinc in MS lesions was generally decreased, paralleling myelin loss. Iron accumulates concentrically in a subset of chronic inactive lesions suggesting that not all iron rims around MS lesions equate with smoldering plaques. Upon degeneration of iron-loaded microglia/macrophages, astrocytes may form an additional protective barrier that may prevent iron-induced oxidative damage.
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Affiliation(s)
- Bogdan F Popescu
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada.
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada.
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Samuel M Webb
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Mylyne Tham
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada
| | - Reginald C Adiele
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 701 Queen Street, Saskatoon, SK, S7N 5E5, Canada
- Cameco MS Neuroscience Research Center, University of Saskatchewan, 701 Queen Street, Saskatoon City Hospital, Rm 5800, Saskatoon, SK, S7K 0M7, Canada
| | - Christopher A Robinson
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region/College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Patrick D Fitz-Gibbon
- Department of Health Sciences Research, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Imke Metz
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Susan Nehzati
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Graham N George
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
- Toxicology Center, University of Saskatchewan, Saskatoon, Canada
- Department of Chemistry, University of Saskatchewan, Saskatoon, Canada
| | - Ingrid J Pickering
- Molecular and Environmental Science Research Group, Department of Geological Sciences, University of Saskatchewan, Saskatoon, Canada
- Toxicology Center, University of Saskatchewan, Saskatoon, Canada
- Department of Chemistry, University of Saskatchewan, Saskatoon, Canada
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Guo Yong
- Department of Neurology, Mayo Clinic, College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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17
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Sheth VR, Fan S, He Q, Ma Y, Annese J, Switzer R, Corey-Bloom J, Bydder GM, Du J. Inversion recovery ultrashort echo time magnetic resonance imaging: A method for simultaneous direct detection of myelin and high signal demonstration of iron deposition in the brain - A feasibility study. Magn Reson Imaging 2016; 38:87-94. [PMID: 28038965 DOI: 10.1016/j.mri.2016.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 01/05/2023]
Abstract
Multiple sclerosis (MS) causes demyelinating lesions in the white matter and increased iron deposition in the subcortical gray matter. Myelin protons have an extremely short T2* (<1ms) and are not directly detected with conventional clinical magnetic resonance (MR) imaging sequences. Iron deposition also reduces T2*, leading to reduced signal on clinical sequences. In this study we tested the hypothesis that the inversion recovery ultrashort echo time (IR-UTE) pulse sequence can directly and simultaneously image myelin and iron deposition using a clinical 3T scanner. The technique was first validated on a synthetic myelin phantom (myelin powder in D2O) and a Feridex iron phantom. This was followed by studies of cadaveric MS specimens, healthy volunteers and MS patients. UTE imaging of the synthetic myelin phantom showed an excellent bi-component signal decay with two populations of protons, one with a T2* of 1.2ms (residual water protons) and the other with a T2* of 290μs (myelin protons). IR-UTE imaging shows sensitivity to a wide range of iron concentrations from 0.5 to ~30mM. The IR-UTE signal from white matter of the brain of healthy volunteers shows a rapid signal decay with a short T2* of ~300μs, consistent with the T2* values of myelin protons in the synthetic myelin phantom. IR-UTE imaging in MS brain specimens and patients showed multiple white matter lesions as well as areas of high signal in subcortical gray matter. This in specimens corresponded in position to Perl's diaminobenzide staining results, consistent with increased iron deposition. IR-UTE imaging simultaneously detects lesions with myelin loss in the white matter and iron deposition in the gray matter.
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Affiliation(s)
- Vipul R Sheth
- Department of Radiology, University of California, San Diego, CA, United States
| | - Shujuan Fan
- Department of Radiology, University of California, San Diego, CA, United States
| | - Qun He
- Department of Radiology, University of California, San Diego, CA, United States
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, United States
| | - Jacopo Annese
- The Institute for Brain and Society, San Diego, CA, United States
| | - Robert Switzer
- NeuroScience Associates, Inc., Knoxville, TN, United States
| | - Jody Corey-Bloom
- Department of NeuroSciences, University of California, San Diego, United States
| | - Graeme M Bydder
- Department of Radiology, University of California, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, United States.
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18
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Zhang Y, Gauthier SA, Gupta A, Tu L, Comunale J, Chiang GCY, Chen W, Salustri CA, Zhu W, Wang Y. Magnetic Susceptibility from Quantitative Susceptibility Mapping Can Differentiate New Enhancing from Nonenhancing Multiple Sclerosis Lesions without Gadolinium Injection. AJNR Am J Neuroradiol 2016; 37:1794-1799. [PMID: 27365331 DOI: 10.3174/ajnr.a4856] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/15/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Magnetic susceptibility values of multiple sclerosis lesions increase as they change from gadolinium-enhancing to nonenhancing. Can susceptibility values measured on quantitative susceptibility mapping without gadolinium injection be used to identify the status of lesion enhancement in surveillance MR imaging used to monitor patients with MS? MATERIALS AND METHODS In patients who had prior MR imaging and quantitative susceptibility mapping in a current MR imaging, new T2-weighted lesions were evaluated for enhancement on conventional T1-weighted imaging with gadolinium, and their susceptibility values were measured on quantitative susceptibility mapping. Receiver operating characteristic analysis was used to assess the diagnostic accuracy of using quantitative susceptibility mapping in distinguishing new gadolinium-enhancing from new nonenhancing lesions. A generalized estimating equation was used to assess differences in susceptibility values among lesion types. RESULTS In 54 patients, we identified 86 of 133 new lesions that were gadolinium-enhancing and had relative susceptibility values significantly lower than those of nonenhancing lesions (β = -17.2; 95% CI, -20.2 to -14.2; P < .0001). Using susceptibility values to discriminate enhancing from nonenhancing lesions, we performed receiver operating characteristic analysis and found that the area under the curve was 0.95 (95% CI, 0.92-0.99). Sensitivity was measured at 88.4%, and specificity, at 91.5%, with a cutoff value of 11.2 parts per billion for quantitative susceptibility mapping-measured susceptibility. CONCLUSIONS During routine MR imaging monitoring to detect new MS lesion activity, quantitative susceptibility mapping can be used without gadolinium injection for accurate identification of the BBB leakage status in new T2WI lesions.
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Affiliation(s)
- Y Zhang
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York
| | | | - A Gupta
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - L Tu
- School of Applied and Engineering Physics (L.T.)
| | - J Comunale
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - G C-Y Chiang
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - W Chen
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C A Salustri
- Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York.,Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York
| | - W Zhu
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Wang
- Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York .,Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York
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19
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Zhang Y, Gauthier SA, Gupta A, Comunale J, Chia-Yi Chiang G, Zhou D, Chen W, Giambrone AE, Zhu W, Wang Y. Longitudinal change in magnetic susceptibility of new enhanced multiple sclerosis (MS) lesions measured on serial quantitative susceptibility mapping (QSM). J Magn Reson Imaging 2016; 44:426-32. [PMID: 26800367 DOI: 10.1002/jmri.25144] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To measure the longitudinal change in multiple sclerosis (MS) lesion susceptibility using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS The study was approved by our Institutional Review Board. Longitudinal changes in quantitative susceptibility values of new enhanced-with-Gd MS lesions were measured at baseline magnetic resonance imaging (MRI) and on a follow-up MRI in 29 patients within 2 years using a 3D multiple echo gradient echo sequence on a 3T scanner. Paired t-test and the generalized estimating equations (GEE) model was used to analyze the longitudinal change. RESULTS Lesion susceptibility values relative to normal-appearing white matter (NAWM) changed from 3.61 ± 6.11 ppb when enhanced-with-Gd at the baseline MRI to 20.42 ± 10.23 ppb when not-enhanced-with-Gd at the follow-up MRI (P < 0.001). CONCLUSION MS lesion susceptibility value increases significantly as the lesion evolves from enhanced-with-Gd to not-enhanced-with-Gd, serving as a disease biomarker. J. Magn. Reson. Imaging 2016;44:426-432.
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Affiliation(s)
- Yan Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Joseph Comunale
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | | | - Dong Zhou
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ashley E Giambrone
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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20
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016; 17:ijms17010100. [PMID: 26784172 PMCID: PMC4730342 DOI: 10.3390/ijms17010100] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 01/06/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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21
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016. [PMID: 26784172 DOI: 10.3390/ijmsl17010100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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22
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Jonkman LE, Klaver R, Fleysher L, Inglese M, Geurts JJG. Ultra-High-Field MRI Visualization of Cortical Multiple Sclerosis Lesions with T2 and T2*: A Postmortem MRI and Histopathology Study. AJNR Am J Neuroradiol 2015; 36:2062-7. [PMID: 26228878 DOI: 10.3174/ajnr.a4418] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE At 7T MR imaging, T2*-weighted gradient echo has been shown to provide high-resolution anatomic images of gray matter lesions. However, few studies have verified T2*WI lesions histopathologically or compared them with more standard techniques at ultra-high-field strength. This study aimed to determine the sensitivity of T2WI and T2*WI sequences for detecting cortical GM lesions in MS. MATERIALS AND METHODS At 7T, 2D multiecho spin-echo T2WI and 3D gradient-echo T2*WI were acquired from 27 formalin-fixed coronal hemispheric brain sections of 15 patients and 4 healthy controls. Proteolipid-stained tissue sections (8 μm) were matched to the corresponding MR images, and lesions were manually scored on both MR imaging sequences (blinded to histopathology) and tissue sections (blinded to MR imaging). The sensitivity of MR imaging sequences for GM lesion types and white matter lesions was calculated. An unblinded retrospective scoring was also performed. RESULTS If all cortical GM lesions were taken into account, the T2WI sequence detected slightly more lesions than the T2*WI sequence: 28% and 16%, respectively (P = .054). This difference disappeared when only intracortical lesions were considered. When histopathologic information (type, location) was revealed to the reader, the sensitivity went up to 84% (T2WI) and 85% (T2*WI) (not significant). Furthermore, the false-positive rate was 8.6% for the T2WI and 10.5% for the T2*WI sequence. CONCLUSIONS There is no strong advantage of the T2*WI sequence compared with a conventional T2WI sequence in the detection of cortical lesions at 7T. Retrospectively, a high percentage of lesions could be detected with both sequences. However, many lesions are still missed prospectively. This could possibly be minimized with better a priori observer training.
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Affiliation(s)
- L E Jonkman
- From the Department of Anatomy and Neurosciences (L.E.J., R.K., J.J.G.G.), VU University Medical Center, Amsterdam, the Netherlands
| | - R Klaver
- From the Department of Anatomy and Neurosciences (L.E.J., R.K., J.J.G.G.), VU University Medical Center, Amsterdam, the Netherlands
| | | | - M Inglese
- Departments of Radiology (L.F., M.I.) Neurology (M.I.) Neurosciences (M.I.), Mount Sinai School of Medicine, New York, New York Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.I.), University of Genoa, Genoa, Italy
| | - J J G Geurts
- From the Department of Anatomy and Neurosciences (L.E.J., R.K., J.J.G.G.), VU University Medical Center, Amsterdam, the Netherlands
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23
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Eskreis-Winkler S, Deh K, Gupta A, Liu T, Wisnieff C, Jin M, Gauthier SA, Wang Y, Spincemaille P. Multiple sclerosis lesion geometry in quantitative susceptibility mapping (QSM) and phase imaging. J Magn Reson Imaging 2015; 42:224-9. [PMID: 25174493 PMCID: PMC4733654 DOI: 10.1002/jmri.24745] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/14/2014] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To demonstrate the phase and quantitative susceptibility mapping (QSM) patterns created by solid and shell spatial distributions of magnetic susceptibility in multiple sclerosis (MS) lesions. MATERIALS AND METHODS Numerical simulations and experimental phantoms of solid- and shell-shaped magnetic susceptibility sources were used to generate magnitude, phase, and QSM images. Imaging of 20 consecutive MS patients was also reviewed for this Institutional Review Board (IRB)-approved MRI study to identify the appearance of solid and shell lesions on phase and QSM images. RESULTS Solid and shell susceptibility sources were correctly reconstructed in QSM images, while the corresponding phase images depicted both geometries with shell-like patterns, making the underlying susceptibility distribution difficult to determine using phase alone. In MS patients, of the 60 largest lesions identified on T2 , 30 lesions were detected on both QSM and phase, of which 83% were solid and 17% were shells on QSM, and of which 30% were solid and 70% were shell on phase. Of the 21 shell-like lesions on phase, 76% appeared solid on QSM, 24% appeared shell on QSM. Of the five shell-like lesions on QSM, all were shell-like on phase. CONCLUSION QSM accurately depicts both solid and shell patterns of magnetic susceptibility, while phase imaging fails to distinguish them.
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Affiliation(s)
| | - Kofi Deh
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
| | - Tian Liu
- Medimagemetric, LLC, New York, NY, USA
| | - Cynthia Wisnieff
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
- Bioengineering Department, Cornell University, Ithaca, NY
| | - Moonsoo Jin
- Bioengineering Department, Cornell University, Ithaca, NY
| | - Susan A. Gauthier
- Neurology Department, Weill Cornell Medical College, New York, NY, USA
| | - Yi Wang
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
- Bioengineering Department, Cornell University, Ithaca, NY
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24
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Fjær S, Bø L, Myhr KM, Torkildsen Ø, Wergeland S. Magnetization transfer ratio does not correlate to myelin content in the brain in the MOG-EAE mouse model. Neurochem Int 2015; 83-84:28-40. [PMID: 25744931 DOI: 10.1016/j.neuint.2015.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 01/29/2015] [Accepted: 02/24/2015] [Indexed: 12/27/2022]
Abstract
Magnetization transfer ratio (MTR) is a magnetic resonance imaging (MRI) method which may detect demyelination not detected by conventional MRI in the central nervous system of patients with multiple sclerosis (MS). A decrease in MTR value has previously been shown to correlate to myelin loss in the mouse cuprizone model for demyelination. In this study, we investigated the sensitivity of MTR for demyelination in the myelin oligodendrocyte (MOG) 1-125 induced experimental autoimmune encephalomyelitis (EAE) mouse model. A total of 24 female c57Bl/6 mice were randomized to a control group (N = 6) or EAE (N = 18). MTR images were obtained at a preclinical 7 Tesla Bruker MR-scanner before EAE induction (baseline), 17-19 days (midpoint) and 31-32 days (endpoint) after EAE induction. Mean MTR values were calculated in five regions of the brain and compared to weight, EAE severity score and myelin content assessed by immunostaining for proteolipid protein and luxol fast blue, lymphocyte and monocyte infiltration and iron deposition. Contrary to what was expected, MTR values in the EAE mice were higher than in the control mice at the midpoint and endpoint. No significant difference in myelin content was found according to histo- or immunohistochemistry. Changes in MTR values did not correlate to myelin content, iron content, lymphocyte or monocyte infiltration, weight or EAE severity scores. This suggest that MTR measures of brain tissue can give significant differences between control mice and EAE mice not caused by demyelination, inflammation or iron deposition, and may not be useful surrogate markers for demyelination in the MOG1-125 mouse model.
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Affiliation(s)
- Sveinung Fjær
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
| | - Lars Bø
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stig Wergeland
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
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25
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Raz E, Branson B, Jensen JH, Bester M, Babb JS, Herbert J, Grossman RI, Inglese M. Relationship between iron accumulation and white matter injury in multiple sclerosis: a case-control study. J Neurol 2015; 262:402-9. [PMID: 25416468 PMCID: PMC4452503 DOI: 10.1007/s00415-014-7569-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
Despite the increasing development and applications of iron imaging, the pathophysiology of iron accumulation in multiple sclerosis (MS), and its role in disease progression and development of clinical disability, is poorly understood. The aims of our study were to determine the presence and extent of iron in T2 visible lesions and gray and white matter using magnetic field correlation (MFC) MRI and correlate with microscopic white matter (WM) injury as measured by diffusion tensor imaging (DTI). This is a case-control study including a series of 31 patients with clinically definite MS. The mean age was 39 years [standard deviation (SD) = 9.55], they were 11 males and 20 females, with a disease duration average of 3 years (range 0-13) and a median EDSS of 2 (0-4.5). Seventeen healthy volunteers (6 males and 11 females) with a mean age of 36 years (SD = 11.4) were recruited. All subjects underwent MR imaging on a 3T scanner using T2-weighted sequence, 3D T1 MPRAGE, MFC, single-shot DTI and post-contrast T1. T2-lesion volumes, brain volumetry, DTI parameters and iron quantification were calculated and multiple correlations were exploited. Increased MFC was found in the putamen (p = 0.061), the thalamus (p = 0.123), the centrum semiovale (p = 0.053), globus pallidus (p = 0.008) and gray matter (GM) (p = 0.004) of MS patients compared to controls. The mean lesional MFC was 121 s(-2) (SD = 67), significantly lower compared to the GM MFC (<0.0001). The GM mean diffusivity (MD) was inversely correlated with the MFC in the centrum semiovale (p < 0.001), and in the splenium of the corpus callosum (p < 0.001). Patients with MS have increased iron in the globus pallidus, putamen and centrum with a trend toward increased iron in all the brain structures. Quantitative iron evaluation of WM and GM may improve the understanding of MS pathophysiology, and might serve as a surrogate marker of disease progression.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Brittany Branson
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Jens H. Jensen
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Maxim Bester
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre, Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - James S. Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Joseph Herbert
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Robert I. Grossman
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Matilde Inglese
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY
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Aspli KT, Flaten TP, Roos PM, Holmøy T, Skogholt JH, Aaseth J. Iron and copper in progressive demyelination--New lessons from Skogholt's disease. J Trace Elem Med Biol 2015; 31:183-7. [PMID: 25563774 DOI: 10.1016/j.jtemb.2014.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/03/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
Abstract
The pathophysiological mechanisms of progressive demyelinating disorders including multiple sclerosis are incompletely understood. Increasing evidence indicates a role for trace metals in the progression of several neurodegenerative disorders. The study of Skogholt disease, a recently discovered demyelinating disease affecting both the central and peripheral nervous system, might shed some light on the mechanisms underlying demyelination. Cerebrospinal fluid iron and copper concentrations are about four times higher in Skogholt patients than in controls. The transit into cerebrospinal fluid of these elements from blood probably occurs in protein bound form. We hypothesize that exchangeable fractions of iron and copper are further transferred from cerebrospinal fluid into myelin, thereby contributing to the pathogenesis of demyelination. Free or weakly bound iron and copper ions may exert their toxic action on myelin by catalyzing production of oxygen radicals. Similarities to demyelinating processes in multiple sclerosis and other myelinopathies are discussed.
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Affiliation(s)
- Klaus Thanke Aspli
- Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital Division, Lillehammer, Norway
| | - Trond Peder Flaten
- Department of Chemistry, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per M Roos
- Department of Neurology, Division of Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Jon H Skogholt
- Innlandet Hospital Trust, Kongsvinger Hospital Division, Kongsvinger, Norway
| | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger Hospital Division, Kongsvinger, Norway
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27
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Hasan KM, Lincoln JA, Nelson FM, Wolinsky JS, Narayana PA. Lateral ventricular cerebrospinal fluid diffusivity as a potential neuroimaging marker of brain temperature in multiple sclerosis: a hypothesis and implications. Magn Reson Imaging 2014; 33:262-9. [PMID: 25485790 DOI: 10.1016/j.mri.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/03/2023]
Abstract
In this retrospective study we tested the hypothesis that the net effect of impaired electrical conduction and therefore increased heat dissipation in multiple sclerosis (MS) results in elevated lateral ventricular (LV) cerebrospinal fluid (CSF) diffusivity as a measure of brain temperature estimated in vivo using diffusion tensor imaging (DTI). We used validated DTI-based segmentation methods to obtain normalized LV-CSF volume and its corresponding CSF diffusivity in 108 MS patients and 103 healthy controls in the age range of 21-63 years. The LV CSF diffusivity was ~2% higher in MS compared to controls that correspond to a temperature rise of ~1°C that could not be explained by changes in the CSF viscosity due to altered CSF protein content in MS. The LV diffusivity decreased with age in healthy controls (r=-0.29; p=0.003), but not in MS (r=0.15; p=0.11), possibly related to MS pathology. Age-adjusted LV diffusivity increased with lesion load (r=0.518; p=1×10(-8)). Our data suggest that the total brain lesion load is the primary contributor to the increase in LV CSF diffusivity in MS. These findings suggest that LV diffusivity is a potential in vivo biomarker of the mismatch between heat generation and dissipation in MS. We also discuss limitations and possible confounders.
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Affiliation(s)
- Khader M Hasan
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, Houston, Texas 77030.
| | - John A Lincoln
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Flavia M Nelson
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Jerry S Wolinsky
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Ponnada A Narayana
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, Houston, Texas 77030
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28
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Iron and multiple sclerosis. Neurobiol Aging 2014; 35 Suppl 2:S51-8. [DOI: 10.1016/j.neurobiolaging.2014.03.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022]
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29
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Bamm VV, Harauz G. "Back to the future" or iron in the MS brain - commentary on "perivascular iron deposits are associated with protein nitration in cerebral experimental autoimmune encephalomyelitis". Neurosci Lett 2014; 582:130-2. [PMID: 24942652 DOI: 10.1016/j.neulet.2014.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Vladimir V Bamm
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - George Harauz
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, N1G 2W1, Canada.
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Bamm VV, Harauz G. Hemoglobin as a source of iron overload in multiple sclerosis: does multiple sclerosis share risk factors with vascular disorders? Cell Mol Life Sci 2014; 71:1789-98. [PMID: 24504127 PMCID: PMC11113400 DOI: 10.1007/s00018-014-1570-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/16/2014] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
Although iron is known to be essential for the normal development and health of the central nervous system, abnormal iron deposits are found in and around multiple sclerosis (MS) lesions that themselves are closely associated with the cerebral vasculature. However, the origin of this excess iron is unknown, and it is not clear whether this is one of the primary causative events in the pathogenesis of MS, or simply another consequence of the long-lasting inflammatory conditions. Here, applying a systems biology approach, we propose an additional way for understanding the neurodegenerative component of the disease caused by chronic subclinical extravasation of hemoglobin, in combination with multiple other factors including, but not limited to, dysfunction of different cellular protective mechanisms against extracellular hemoglobin reactivity and oxidative stress. Moreover, such considerations could also shed light on and explain the higher susceptibility of MS patients to a wide range of cardiovascular disorders.
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Affiliation(s)
- Vladimir V. Bamm
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1 Canada
| | - George Harauz
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1 Canada
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Abstract
Histochemical and MRI studies have demonstrated that MS (multiple sclerosis) patients have abnormal deposition of iron in both gray and white matter structures. Data is emerging indicating that this iron could partake in pathogenesis by various mechanisms, e.g., promoting the production of reactive oxygen species and enhancing the production of proinflammatory cytokines. Iron chelation therapy could be a viable strategy to block iron-related pathological events or it can confer cellular protection by stabilizing hypoxia inducible factor 1α, a transcription factor that normally responds to hypoxic conditions. Iron chelation has been shown to protect against disease progression and/or limit iron accumulation in some neurological disorders or their experimental models. Data from studies that administered a chelator to animals with experimental autoimmune encephalomyelitis, a model of MS, support the rationale for examining this treatment approach in MS. Preliminary clinical studies have been performed in MS patients using deferoxamine. Although some side effects were observed, the large majority of patients were able to tolerate the arduous administration regimen, i.e., 6-8 h of subcutaneous infusion, and all side effects resolved upon discontinuation of treatment. Importantly, these preliminary studies did not identify a disqualifying event for this experimental approach. More recently developed chelators, deferasirox and deferiprone, are more desirable for possible use in MS given their oral administration, and importantly, deferiprone can cross the blood-brain barrier. However, experiences from other conditions indicate that the potential for adverse events during chelation therapy necessitates close patient monitoring and a carefully considered administration regimen.
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Simon JH. MRI outcomes in the diagnosis and disease course of multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:405-25. [PMID: 24507528 DOI: 10.1016/b978-0-444-52001-2.00017-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite major advances in MRI, including practical implementations of multiple quantitative MRI methods, the conventional measures of focal, macroscopic disease remain the core MRI outcome measures in clinical trials. MRI enhancing lesion counts are used to assess inflammation, and new T2-lesions provide an index of (interval) activity between scans. These simple MRI measures also have immediate significance for early diagnosis as components of the 2010 revised dissemination in space and time criteria, and they provide a mechanism to monitor the subclinical disease in patients, including after treatment is initiated. The focal macroscopic injury, which includes demyelination and axonal damage, is at least partially linked to the diffuse injury through pathophysiologic mechanisms, such as secondary degeneration, but the diffuse diseases is largely independent. Quantitative measures of the more widespread pathology of the normal appearing white and gray matter currently remain applicable to populations of patients rather than individuals. Gray matter pathology, including focal lesions of the cortical gray matter and diffuse changes in the deep and cortical gray has emerged as both early and clinically relevant, as has atrophy. Major technical improvements in MRI hardware and pulse sequence design allow more specific and potentially more sensitive treatment metrics required for targeting outcomes most relevant to neuronal degeneration, remyelination and repair.
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Affiliation(s)
- Jack H Simon
- Oregon Health and Sciences University and Portland VA Medical Center, Portland, OR, USA.
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Jellinger KA. The relevance of metals in the pathophysiology of neurodegeneration, pathological considerations. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 110:1-47. [PMID: 24209432 DOI: 10.1016/b978-0-12-410502-7.00002-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neurodegenerative disorders are featured by a variety of pathological conditions that share similar critical processes, such as oxidative stress, free radical activity, proteinaceous aggregations, mitochondrial dysfunctions, and energy failure. They are mediated or triggered by an imbalance of metal ions leading to changes of critical biological systems and initiating a cascade of events finally leading to neurodegeneration and cell death. Their causes are multifactorial, and although the source of the shift in oxidative homeostasis is still unclear, current evidence points to changes in the balance of redox transition metals, especially iron, copper, and other trace metals. They are present at elevated levels in Alzheimer disease, Parkinson disease, multisystem atrophy, etc., while in other neurodegenerative disorders, copper, zinc, aluminum, and manganese are involved. This chapter will review the recent advances of the role of metals in the pathogenesis and pathophysiology of major neurodegenerative diseases and discuss the use of chelating agents as potential therapies for metal-related disorders.
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