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Pilehvari S, Morgan Y, Peng W. An analytical review on the use of artificial intelligence and machine learning in diagnosis, prediction, and risk factor analysis of multiple sclerosis. Mult Scler Relat Disord 2024; 89:105761. [PMID: 39018642 DOI: 10.1016/j.msard.2024.105761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 06/19/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
Medical research offers potential for disease prediction, like Multiple Sclerosis (MS). This neurological disorder damages nerve cell sheaths, with treatments focusing on symptom relief. Manual MS detection is time-consuming and error prone. Though MS lesion detection has been studied, limited attention has been paid to clinical analysis and computational risk factor prediction. Artificial intelligence (AI) techniques and Machine Learning (ML) methods offer accurate and effective alternatives to mapping MS progression. However, there are challenges in accessing clinical data and interdisciplinary collaboration. By analyzing 103 papers, we recognize the trends, strengths and weaknesses of AI, ML, and statistical methods applied to MS diagnosis. AI/ML-based approaches are suggested to identify MS risk factors, select significant MS features, and improve the diagnostic accuracy, such as Rule-based Fuzzy Logic (RBFL), Adaptive Fuzzy Inference System (ANFIS), Artificial Neural Network methods (ANN), Support Vector Machine (SVM), and Bayesian Networks (BNs). Meanwhile, applications of the Expanded Disability Status Scale (EDSS) and Magnetic Resonance Imaging (MRI) can enhance MS diagnostic accuracy. By examining established risk factors like obesity, smoking, and education, some research tackled the issue of disease progression. The performance metrics varied across different aspects of MS studies: Diagnosis: Sensitivity ranged from 60 % to 98 %, specificity from 60 % to 98 %, and accuracy from 61 % to 97 %. Prediction: Sensitivity ranged from 76 % to 98 %, specificity from 65 % to 98 %, and accuracy from 62 % to 99 %. Segmentation: Accuracy ranged up to 96.7 %. Classification: Sensitivity ranged from 78 % to 97.34 %, specificity from 65 % to 99.32 %, and accuracy from 71 % to 97.94 %. Furthermore, the literature shows that combining techniques can improve efficiency, exploiting their strengths for better overall performance.
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Affiliation(s)
- Shima Pilehvari
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Yasser Morgan
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Wei Peng
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
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Campanioni S, Veiga C, Prieto-González JM, González-Nóvoa JA, Busto L, Martinez C, Alberte-Woodward M, García de Soto J, Pouso-Diz J, Fernández Ceballos MDLÁ, Agis-Balboa RC. Explainable machine learning on baseline MRI predicts multiple sclerosis trajectory descriptors. PLoS One 2024; 19:e0306999. [PMID: 39012871 PMCID: PMC11251627 DOI: 10.1371/journal.pone.0306999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024] Open
Abstract
Multiple sclerosis (MS) is a multifaceted neurological condition characterized by challenges in timely diagnosis and personalized patient management. The application of Artificial Intelligence (AI) to MS holds promises for early detection, accurate diagnosis, and predictive modeling. The objectives of this study are: 1) to propose new MS trajectory descriptors that could be employed in Machine Learning (ML) regressors and classifiers to predict patient evolution; 2) to explore the contribution of ML models in discerning MS trajectory descriptors using only baseline Magnetic Resonance Imaging (MRI) studies. This study involved 446 MS patients who had a baseline MRI, at least two measurements of Expanded Disability Status Scale (EDSS), and a 1-year follow-up. Patients were divided into two groups: 1) for model development and 2) for evaluation. Three descriptors: β1, β2, and EDSS(t), were related to baseline MRI parameters using regression and classification XGBoost models. Shapley Additive Explanations (SHAP) analysis enhanced model transparency by identifying influential features. The results of this study demonstrate the potential of AI in predicting MS progression using the proposed patient trajectories and baseline MRI scans, outperforming classic Multiple Linear Regression (MLR) methods. In conclusion, MS trajectory descriptors are crucial; incorporating AI analysis into MRI assessments presents promising opportunities to advance predictive capabilities. SHAP analysis enhances model interpretation, revealing feature importance for clinical decisions.
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Affiliation(s)
- Silvia Campanioni
- Galicia Sur Health Research Institute (IIS Galicia Sur), Cardiovascular Research Group, Vigo, Spain
| | - César Veiga
- Galicia Sur Health Research Institute (IIS Galicia Sur), Cardiovascular Research Group, Vigo, Spain
| | - José María Prieto-González
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
| | - José A. González-Nóvoa
- Galicia Sur Health Research Institute (IIS Galicia Sur), Cardiovascular Research Group, Vigo, Spain
| | - Laura Busto
- Galicia Sur Health Research Institute (IIS Galicia Sur), Cardiovascular Research Group, Vigo, Spain
| | - Carlos Martinez
- Galicia Sur Health Research Institute (IIS Galicia Sur), Cardiovascular Research Group, Vigo, Spain
| | - Miguel Alberte-Woodward
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
| | - Jesús García de Soto
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
| | - Jessica Pouso-Diz
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
| | - María de los Ángeles Fernández Ceballos
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
| | - Roberto Carlos Agis-Balboa
- Health Research Institute of Santiago de Compostela (IDIS), Translational Research in Neurological Diseases Group, Santiago University Hospital Complex, SERGAS-USC, Santiago de Compostela, Spain
- Neuro Epigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, Santiago de Compostela, Spain
- Neurology Service, Santiago University Hospital Complex, Santiago de Compostela, Spain
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3
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Misicka E, Huang Y, Loomis S, Sadhu N, Fisher E, Gafson A, Runz H, Tsai E, Jia X, Herman A, Bronson PG, Bhangale T, Briggs FB. Adaptive and Innate Immunity Are Key Drivers of Age at Onset of Multiple Sclerosis. Neurol Genet 2024; 10:e200159. [PMID: 38817245 PMCID: PMC11139017 DOI: 10.1212/nxg.0000000000200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 06/01/2024]
Abstract
Background and Objectives Multiple sclerosis (MS) age at onset (AAO) is a clinical predictor of long-term disease outcomes, independent of disease duration. Little is known about the genetic and biological mechanisms underlying age of first symptoms. We conducted a genome-wide association study (GWAS) to investigate associations between individual genetic variation and the MS AAO phenotype. Methods The study population was comprised participants with MS in 6 clinical trials: ADVANCE (N = 655; relapsing-remitting [RR] MS), ASCEND (N = 555; secondary-progressive [SP] MS), DECIDE (N = 1,017; RRMS), OPERA1 (N = 581; RRMS), OPERA2 (N = 577; RRMS), and ORATORIO (N = 529; primary-progressive [PP] MS). Altogether, 3,905 persons with MS of European ancestry were analyzed. GWAS were conducted for MS AAO in each trial using linear additive models controlling for sex and 10 principal components. Resultant summary statistics across the 6 trials were then meta-analyzed, for a total of 8.3 × 10-6 single nucleotide polymorphisms (SNPs) across all trials after quality control and filtering for heterogeneity. Gene-based tests of associations, pathway enrichment analyses, and Mendelian randomization analyses for select exposures were also performed. Results Four lead SNPs within 2 loci were identified (p < 5 × 10-8), including a) 3 SNPs in the major histocompatibility complex and their effects were independent of HLA-DRB1*15:01 and b) a LOC105375167 variant on chromosome 7. At the gene level, the top association was HLA-C (p = 1.2 × 10-7), which plays an important role in antiviral immunity. Functional annotation revealed the enrichment of pathways related to T-cell receptor signaling, autoimmunity, and the complement cascade. Mendelian randomization analyses suggested a link between both earlier age at puberty and shorter telomere length and earlier AAO, while there was no evidence for a role for either body mass index or vitamin D levels. Discussion Two genetic loci associated with MS AAO were identified, and functional annotation demonstrated an enrichment of genes involved in adaptive and complement immunity. There was also evidence supporting a link with age at puberty and telomere length. The findings suggest that AAO in MS is multifactorial, and the factors driving onset of symptoms overlap with those influencing MS risk.
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Affiliation(s)
- Elina Misicka
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Yunfeng Huang
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Stephanie Loomis
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Nilanjana Sadhu
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Elizabeth Fisher
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Arie Gafson
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Heiko Runz
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Ellen Tsai
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Xiaoming Jia
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Ann Herman
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Paola G Bronson
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Tushar Bhangale
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Farren B Briggs
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
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Papetti L, Panella E, Monte G, Ferilli MAN, Tarantino S, Checchi MP, Valeriani M. Pediatric Onset Multiple Sclerosis and Obesity: Defining the Silhouette of Disease Features in Overweight Patients. Nutrients 2023; 15:4880. [PMID: 38068737 PMCID: PMC10707944 DOI: 10.3390/nu15234880] [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: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Obesity has been suggested as an environmental risk factor for multiple sclerosis (MS) and may negatively effect the progression of the disease. The aim of this study is to determine any correlation between overweight/obesity and the clinical and neuroradiological features at the onset of pediatric onset multiple sclerosis (POMS). Were included patients referred to the POMS Unit of the Bambino Gesù Children's Hospital between June 2012 and June 2021. The diagnosis of MS with an onset of less than 18 years was required. For all included subjects, we considered for the analysis the following data at the onset of symptoms: general data (age, sex, functional system compromised by neurological signs, weight and height), brain and spinal magnetic resonance imaging (MRI), cerebrospinal fluid exams. We identified 55 pediatric cases of POMS and divided them into two groups according to the body mass index (BMI): 60% were healthy weight (HW) and 40% were overweight/obese (OW/O). OW/O patients experienced a two-year age difference in disease onset compared to the HW patients (12.7 ± 3.8 years vs. 14.6 ± 4.1 years; p < 0.05). Onset of polyfocal symptoms was seen more frequently in OW/O patients than in HW (72.7% vs. 21.2%; p < 0.05). The pyramidal functions were involved more frequently in the OW/O group than in the HW group (50% vs. 25%; p < 0.005). Black holes were detected more frequently in OW/O patients in onset MRI scans compared to the HW group (50% vs. 15.5%; p < 0.05). Our findings suggest that being overweight/obese affects the risk of developing MS at an earlier age and is associated with an unfavorable clinical-radiological features at onset. Weight control can be considered as a preventive/therapeutic treatment.
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Affiliation(s)
- Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
| | - Elena Panella
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00133 Rome, Italy;
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
| | - Michela Ada Noris Ferilli
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
| | - Samuela Tarantino
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
| | - Martina Proietti Checchi
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.M.); (M.A.N.F.); (S.T.); (M.P.C.); (M.V.)
- Center for Sensory Motor Interaction, Aalborg University, DK-9220 Aalborg, Denmark
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Vázquez-Marrufo M, Sarrias-Arrabal E, García-Torres M, Martín-Clemente R, Izquierdo G. A systematic review of the application of machine-learning algorithms in multiple sclerosis. Neurologia 2023; 38:577-590. [PMID: 35843587 DOI: 10.1016/j.nrleng.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/11/2020] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.
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Affiliation(s)
- M Vázquez-Marrufo
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain.
| | - E Sarrias-Arrabal
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain
| | - M García-Torres
- Escuela Politécnica Superior, Universidad Pablo de Olavide, Sevilla, Spain
| | - R Martín-Clemente
- Departamento de Teoría de la Señal y Comunicaciones, Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Sevilla, Spain
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital VITHAS, Sevilla, Spain
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Hosseini M, Haghighatzadeh M, Hassanpour R, Asadollahzadeh E, Rezaeimanesh N, Eskandarieh S, Navardi S, Ghadiri F, Moghadasi AN, Sahraian MA. The effects of different types of smoking on recovery from attack in hospitalized multiple sclerosis patients. Clin Neurol Neurosurg 2023; 232:107846. [PMID: 37467576 DOI: 10.1016/j.clineuro.2023.107846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/12/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Several studies demonstrated the association between tobacco smoking and higher risk and increased progression of multiple sclerosis (MS). Data about the effect of smoking during the recovery from MS attacks is limited. Furthermore, different types of tobacco exposures such as water pipe and passive smoking are not well assessed separately. So this study evaluated the effect of different types of smokes, cigarette and water pipe as well as passive smoking on the function recovery of relapsing-remitting MS (RRMS) attacks METHODS: This cohort study evaluated the adult patients with RRMS and Expanded Disability Status Scale (EDSS) < 5 in the attack phase. Patients were divided into two groups: smokers and non-smokers. The smokers included those who use cigarette, water pipe as well as passive smokers as subgroups for more analyses later. EDSS was monitored after relapse and two months after relapse. Change of EDSS considered as the criteria for functional recovery. The correlation between the amount of consumption and disability level was assessed among smokers by Pearson's correlation test. While, the difference of EDSS between smoker and non-smoker were assessed by Independent samples T-test. RESULTS 142 patients were evaluated. 79 (55.6%) were smokers (43% male) while 63 (44.4%) were non-smokers (36.5% male). There was a statistically significant difference in change of EDSS between smoker and non-smoker groups, which change of EDSS was higher in non-smoker (-2.62 ± 0.90 non-smoker vs. -1.75 ± 0.76 smoker, P < 0.001). Also, only there was a significantly lesser decline in EDSS after two months in the cigarette smokers in subgroups analyses (P < 0.001). A correlation analysis revealed a significant positive correlation between the number per day of cigarette smoking and EDSS after relapse (r = 0.3, P = 0.03) and a significant positive correlation between minutes per month of smoking of water pipe and EDSS two months after relapse (r = 0.6, P > 0.001). CONCLUSION Tobacco smoking especially cigarette smoking is associated with a negative effect on recovery from the attack in patients with RRMS.
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Affiliation(s)
- Marie Hosseini
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Haghighatzadeh
- Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Hassanpour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Asadollahzadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Navardi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Jiang X, Shen C, Caba B, Arnold DL, Elliott C, Zhu B, Fisher E, Belachew S, Gafson AR. Assessing the utility of magnetic resonance imaging-based "SuStaIn" disease subtyping for precision medicine in relapsing-remitting and secondary progressive multiple sclerosis. Mult Scler Relat Disord 2023; 77:104869. [PMID: 37459715 DOI: 10.1016/j.msard.2023.104869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patient stratification and individualized treatment decisions based on multiple sclerosis (MS) clinical phenotypes are arbitrary. Subtype and Staging Inference (SuStaIn), a published machine learning algorithm, was developed to identify data-driven disease subtypes with distinct temporal progression patterns using brain magnetic resonance imaging; its clinical utility has not been assessed. The objective of this study was to explore the prognostic capability of SuStaIn subtyping and whether it is a useful personalized predictor of treatment effects of natalizumab and dimethyl fumarate. METHODS Subtypes were available from the trained SuStaIn model for 3 phase 3 clinical trials in relapsing-remitting and secondary progressive MS. Regression models were used to determine whether baseline SuStaIn subtypes could predict on-study clinical and radiological disease activity and progression. Differences in treatment responses relative to placebo between subtypes were determined using interaction terms between treatment and subtype. RESULTS Natalizumab and dimethyl fumarate reduced inflammatory disease activity in all SuStaIn subtypes (all p < 0.001). SuStaIn MS subtyping alone did not discriminate responder heterogeneity based on new lesion formation and disease progression (p > 0.05 across subtypes). CONCLUSION SuStaIn subtypes correlated with disease severity and functional impairment at baseline but were not predictive of disability progression and could not discriminate treatment response heterogeneity.
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Affiliation(s)
| | - Changyu Shen
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
| | - Bastien Caba
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
| | - Douglas L Arnold
- NeuroRx Research, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Bing Zhu
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
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8
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Trends in the environmental risks associated with earlier onset in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104250. [PMID: 36544313 DOI: 10.1016/j.msard.2022.104250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several environmental and lifestyle factors relating to sunlight/vitamin D, body mass index (BMI), and smoking are associated with the risk of developing multiple sclerosis (MS). However, their relation to disease progression, particularly age at symptomatic onset, remains inconsistent, which may be the result of significant changes in human-environment interactions over the last century. This study investigates historical trends in the association between common MS environmental risk factors and age at disease onset. METHODS Using a narrative approach, we evaluated the current literature for published studies assessing the association between vitamin-D, BMI, and tobacco smoking exposures with the risk of early/pediatric-onset MS and direct correlations with age at MS onset using MEDLINE, EMBASE, and Web of Science. Measures were plotted by the average calendar year of disease onset for each cohort to examine trends over time. In total, 25, 9, and 11 articles were identified for vitamin D, BMI, and smoking-related exposures, respectively. RESULTS Higher sun exposure habits and residential solar radiation were associated with older age at onset. On the contrary, two studies observed a negative correlation between age at onset and serum 25-hydroxyvitamin D (25(OH)D) levels. Higher adolescent BMI was generally associated with younger age at onset, although genetic susceptibility for childhood obesity was not significantly associated. Tobacco smoking was associated with later disease onset, despite being a risk factor for MS. Association with age at onset was inflated for more recent studies relating to smoking, while often weaker for serum vitamin D and BMI. CONCLUSION Current findings indicate a likely association between age at onset and environmental risk factors, such as sun exposure, adolescent BMI, and tobacco smoking, in certain populations. However, findings are often inconsistent and assessment of the relationships and potential changes over time require further investigation.
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9
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Romero-Pinel L, Bau L, Matas E, León I, Muñoz-Vendrell A, Arroyo P, Masuet-Aumatell C, Martínez-Yélamos A, Martínez-Yélamos S. The age at onset of relapsing-remitting multiple sclerosis has increased over the last five decades. Mult Scler Relat Disord 2022; 68:104103. [PMID: 36029708 DOI: 10.1016/j.msard.2022.104103] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with relapsing-remitting multiple sclerosis (RRMS) most commonly experience their first symptoms between 20 and 40 years of age. The objective of this study was to investigate how the age at which the first symptoms of RRMS occur has changed over the past decades. METHODS Patients who were followed up in our unit after an initial diagnosis of RRMS using the Poser or McDonald criteria and who experienced their first symptoms between January 1970 and December 2019 were included in the study. The cohort was divided into five groups according to the decade in which the first symptoms appeared. The age at disease onset was compared across decades. Changes in age were also determined after excluding patients with early-onset disease (<18 years of age) and those with late-onset disease (>50 years of age) to avoid bias. RESULTS The cohort included 1,622 patients with RRMS, 67.6% of whom were women. Among them, 5.9% and 4% had early-onset and late-onset disease, respectively. The mean age ± standard deviation at onset was 31.11 ± 9.82 years, with no differences between men and women. The mean ages at onset were 23.79 ± 10.19 years between 1970 and 1979, 27.86 ± 9.22 years between 1980 and 1989, 30.07 ± 9.32 years between 1990 and 1999, 32.12 ± 9.47 between 2000 and 2009, and 34.28 ± 9.83 years between 2010 and 2019. The ages at disease onset were progressively higher in the later decades; this trend was statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.264 and R2 of 0.070 (p < 0.001). The results were similar when analysing men and women separately. We conducted an analysis of 1,460 patients (mean age at onset: 31.10 ± 7.99 years), after excluding patients with early-onset and late-onset disease. In this specific subgroup, the mean ages at disease onset were 28.38 ± 8.17 years between 1970 and 1979, 29.22 ± 7.51 years between 1980 and 1989, 30.06 ± 8.02 years between 1990 and 1999, 31.46 ± 7.77 years between 2000 and 2009, and 33.37 ± 7.97 years between 2010 and 2019. The trend was also statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.193 and R2 of 0.037 (p < 0.001). CONCLUSION Our data showed that the age at RRMS onset has increased over the past decades.
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Affiliation(s)
- Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Laura Bau
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Matas
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel León
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Arroyo
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Epidemiology and Preventive Medicine. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
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10
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Miyazaki Y, Sakushima K, Niino M, Takahashi E, Oiwa K, Naganuma R, Amino I, Akimoto S, Minami N, Yabe I, Kikuchi S. Smoking and younger age at onset in anti-acetylcholine receptor antibody-positive myasthenia gravis. Immunol Med 2022; 46:77-83. [PMID: 36346077 DOI: 10.1080/25785826.2022.2143077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Smoking is a known risk factor for the development and progression of several autoimmune diseases. Previous studies have pointed out the association of smoking with the development and worsening of symptoms in myasthenia gravis (MG), but further investigation is necessary to confirm this association. Smoking history was investigated in a cross-sectional study of 139 patients with anti-acetylcholine receptor antibody-positive MG, and the association of smoking history with the age at the onset of MG was analyzed. Patients who had been smoking at the onset of MG were significantly younger compared with those who had never smoked or had quit before the onset of MG. A linear regression analysis adjusting for sex and the presence/absence of thymoma showed a significant association between smoking at onset and younger age at onset (regression coefficient -9.05; 95% confidence interval, -17.6, -0.51; p = 0.039). Among patients with smoking exposure within 10 years prior to or at the onset of MG, women were significantly younger at the onset of MG compared with men. Our results suggest that smoking is an independent risk factor for the earlier development of anti-acetylcholine receptor antibody-positive MG and further support the putative link between smoking and MG.
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Affiliation(s)
- Yusei Miyazaki
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Eri Takahashi
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Kei Oiwa
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ryoji Naganuma
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Itaru Amino
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Sachiko Akimoto
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Seiji Kikuchi
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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11
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Lee B, Rumrill S, Reyes A, McDaniels B. The association between hope and employment among individuals with multiple sclerosis: A hierarchical logistic regression model. Work 2022; 74:531-538. [PMID: 36278384 DOI: 10.3233/wor-211210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Most people with multiple sclerosis (MS) are employed at the time of their diagnosis; however, due to the unpredictable nature of MS, most exit the workforce shortly thereafter. A plethora of research has examined factors that negatively affect employment outcomes for people with MS. However, little is known about how hope, a modifiable positive psychology factor, affects employment. OBJECTIVE This study examined the role of hope and its association with employment outcomes for people with MS. METHODS Two-hundred and fifty-five adults with MS (mean ± SD age, 45.45 years ± 10.28) completed surveys about their MS, employment, disability-related stress, and hope. A three-step hierarchical logistic regression was conducted to examine the extent to which hope explains the variance in employment, over and above demographic and disability related covariates. RESULTS The final model explained 28% of the variance in employment, suggesting that the model was able to distinguish people with MS who were employed versus those who were unemployed. Higher levels of hope were associated with an increased probability of being employed (OR = 4.65; 95% CI [1.98, 10.92]). CONCLUSION This study supports that hope is associated with favorable employment outcomes for people with MS. Persons with MS may benefit from working with rehabilitation professionals to enhance their hope, and this study provides a foundation for the development of hope-based interventions to improve employment outcomes among this population.
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Affiliation(s)
- Beatrice Lee
- Michigan State University, East Lansing, MI, USA
| | - Stuart Rumrill
- University of Illinois-Urbana Champaign, Champaign, IL, USA
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12
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Hossain MZ, Daskalaki E, Brüstle A, Desborough J, Lueck CJ, Suominen H. The role of machine learning in developing non-magnetic resonance imaging based biomarkers for multiple sclerosis: a systematic review. BMC Med Inform Decis Mak 2022; 22:242. [PMID: 36109726 PMCID: PMC9476596 DOI: 10.1186/s12911-022-01985-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological condition whose symptoms, severity, and progression over time vary enormously among individuals. Ideally, each person living with MS should be provided with an accurate prognosis at the time of diagnosis, precision in initial and subsequent treatment decisions, and improved timeliness in detecting the need to reassess treatment regimens. To manage these three components, discovering an accurate, objective measure of overall disease severity is essential. Machine learning (ML) algorithms can contribute to finding such a clinically useful biomarker of MS through their ability to search and analyze datasets about potential biomarkers at scale. Our aim was to conduct a systematic review to determine how, and in what way, ML has been applied to the study of MS biomarkers on data from sources other than magnetic resonance imaging. METHODS Systematic searches through eight databases were conducted for literature published in 2014-2020 on MS and specified ML algorithms. RESULTS Of the 1, 052 returned papers, 66 met the inclusion criteria. All included papers addressed developing classifiers for MS identification or measuring its progression, typically, using hold-out evaluation on subsets of fewer than 200 participants with MS. These classifiers focused on biomarkers of MS, ranging from those derived from omics and phenotypical data (34.5% clinical, 33.3% biological, 23.0% physiological, and 9.2% drug response). Algorithmic choices were dependent on both the amount of data available for supervised ML (91.5%; 49.2% classification and 42.3% regression) and the requirement to be able to justify the resulting decision-making principles in healthcare settings. Therefore, algorithms based on decision trees and support vector machines were commonly used, and the maximum average performance of 89.9% AUC was found in random forests comparing with other ML algorithms. CONCLUSIONS ML is applicable to determining how candidate biomarkers perform in the assessment of disease severity. However, applying ML research to develop decision aids to help clinicians optimize treatment strategies and analyze treatment responses in individual patients calls for creating appropriate data resources and shared experimental protocols. They should target proceeding from segregated classification of signals or natural language to both holistic analyses across data modalities and clinically-meaningful differentiation of disease.
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Affiliation(s)
- Md Zakir Hossain
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, ACT Australia
| | - Elena Daskalaki
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, ACT Australia
| | - Anne Brüstle
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT Australia
| | - Christian J. Lueck
- Department of Neurology, Canberra Hospital, Canberra, ACT Australia
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, ACT Australia
- Department of Computing, University of Turku, Turku, Finland
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13
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Vandebergh M, Degryse N, Dubois B, Goris A. Environmental risk factors in multiple sclerosis: bridging Mendelian randomization and observational studies. J Neurol 2022; 269:4565-4574. [PMID: 35366084 DOI: 10.1007/s00415-022-11072-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
Multiple sclerosis (MS) is a complex disease with both genetic variants and environmental factors involved in disease susceptibility. The main environmental risk factors associated with MS in observational studies include obesity, vitamin D deficiency, Epstein-Barr virus infection and smoking. As modifying these environmental and lifestyle factors may enable prevention, it is important to pinpoint causal links between these factors and MS. Leveraging genetics through the Mendelian randomization (MR) paradigm is an elegant way to inform prevention strategies in MS. In this review, we summarize MR studies regarding the impact of environmental factors on MS susceptibility, thereby paying attention to quality criteria which will aid readers in interpreting any MR studies. We draw parallels and differences with observational studies and randomized controlled trials and look forward to the challenges that such work presents going forward.
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Affiliation(s)
- Marijne Vandebergh
- Laboratory for Neuroimmunology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49 bus 1022, 3000, Leuven, Belgium
| | - Nicolas Degryse
- Laboratory for Neuroimmunology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49 bus 1022, 3000, Leuven, Belgium
| | - Bénédicte Dubois
- Laboratory for Neuroimmunology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49 bus 1022, 3000, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - An Goris
- Laboratory for Neuroimmunology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49 bus 1022, 3000, Leuven, Belgium.
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14
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Genetics and functional genomics of multiple sclerosis. Semin Immunopathol 2022; 44:63-79. [PMID: 35022889 DOI: 10.1007/s00281-021-00907-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory neurodegenerative disease with genetic predisposition. Over the last decade, genome-wide association studies with increasing sample size led to the discovery of robustly associated genetic variants at an exponential rate. More than 200 genetic loci have been associated with MS susceptibility and almost half of its heritability can be accounted for. However, many challenges and unknowns remain. Definitive studies of disease progression and endophenotypes are yet to be performed, whereas the majority of the identified MS variants are not yet functionally characterized. Despite these shortcomings, the unraveling of MS genetics has opened up a new chapter on our understanding MS causal mechanisms.
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15
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Alifirova V, Kamenskikh E, Koroleva E, Kolokolova E, Petrakovich A. Prognostic markers of multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:22-27. [DOI: 10.17116/jnevro202212202122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Misicka E, Davis MF, Kim W, Brugger SW, Beales J, Loomis S, Bronson PG, Briggs FB. A higher burden of multiple sclerosis genetic risk confers an earlier onset. Mult Scler 2021; 28:1189-1197. [PMID: 34709090 DOI: 10.1177/13524585211053155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Age at onset of multiple sclerosis (MS) is an objective, influential predictor of the evolution of MS independent of disease duration. OBJECTIVES Determine the influence of MS genetic predisposition on age of onset. METHODS We conducted a comprehensive investigation of MS risk variants and age at onset in 3495 non-Latinx white individuals, including for combinations of HLA-DRB1*15:01 alleles and quintiles of an unweighted genetic risk score (GRS) for 198 of 200 autosomal MS risk variants that reside outside the major histocompatibility complex. RESULTS The mean age at onset was 32 years, 29% were male, and 46% were HLA-DRB1*15:01 carriers. For those with the greatest genetic risk burden (the highest GRS quintile with two HLA-DRB1*15:01 alleles) were on average 5 years younger at onset (p = 0.002) than those with the lowest genetic risk burden (the lowest GRS quintile with no HLA-DRB1*15:01 alleles). There was a strong inverse relationship between the MS genetic risk burden and age at onset of MS (p < 5 × 10-8). CONCLUSION We demonstrate a significant gradient between elevated MS genetic risk burden and an earlier onset of MS, suggesting that a higher MS genetic risk burden accelerates onset of the disease.
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Affiliation(s)
- Elina Misicka
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary F Davis
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT, USA/Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Woori Kim
- Human Target Validation Core, Translational Biology, Biogen, Boston, MA, USA
| | - Steven W Brugger
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT, USA
| | - Jeremy Beales
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT, USA
| | - Stephanie Loomis
- Human Target Validation Core, Translational Biology, Biogen, Boston, MA, USA
| | - Paola G Bronson
- Human Target Validation Core, Translational Biology, Biogen, Boston, MA, USA
| | - Farren Bs Briggs
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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17
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Kahraman T, Ozdogar AT, Abasiyanik Z, Ozakbas S. Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis. Acta Neurol Belg 2021; 121:1199-1206. [PMID: 32222910 DOI: 10.1007/s13760-020-01341-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
Smoking is associated with increased multiple sclerosis (MS) risk. In addition, some studies have reported that smoking is associated with anxiety and depression. However, the associations between smoking, walking, and fatigue are needed to be investigated. The objective was to investigate the associations between cigarette smoking and walking, fatigue, depression symptom severity, and health-related quality of life in persons with MS. Two hundred seventy-nine persons with MS were evaluated in this cross-sectional study. Study outcomes were neurological disability level, walking speed, walking endurance, perceived walking impact of MS, fatigue, depression symptom severity, and health-related quality of life. There were 95 (34.1%) current smokers who had significantly higher fatigue (p = 0.003, pη2 = 0.031) and depression (p = 0.044, pη2 = 0.015), and lower health-related quality of life (p = 0.003, pη2 = 0.031) after adjusting for age, gender, neurological disability level, and disease duration compared to non-smokers (n = 184). There was no significant difference between smokers and non-smokers in walking measures (p > 0.05). Smoking intensity was significantly correlated with age (r = 0.487), neurological disability level (r = 0.227), disease duration (r = 0.30), walking speed (r = 0.574), walking endurance (r = - 0.461), perceived walking impact of MS (r = 0.684), fatigue (r = 0.370), health-related quality of life (r = - 0.259), and depression (r = 0.269) in current smokers. Cigarette smokers with MS had significantly more fatigue and depression symptom severity and less health-related quality of life compared to non-smokers. Increased pack-years of cigarette smoking was associated with worse walking ability and health-related quality of life, and greater depression symptom severity and fatigue.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Asiye Tuba Ozdogar
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Zuhal Abasiyanik
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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18
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Ajdacic-Gross V, Steinemann N, Horváth G, Rodgers S, Kaufmann M, Xu Y, Kamm CP, Kesselring J, Manjaly ZM, Zecca C, Calabrese P, Puhan MA, von Wyl V. Onset Symptom Clusters in Multiple Sclerosis: Characteristics, Comorbidities, and Risk Factors. Front Neurol 2021; 12:693440. [PMID: 34295301 PMCID: PMC8290323 DOI: 10.3389/fneur.2021.693440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Multiple sclerosis (MS) symptoms are expected to aggregate in specific patterns across different stages of the disease. Here, we studied the clustering of onset symptoms and examined their characteristics, comorbidity patterns and associations with potential risk factors. Methods: Data stem from the Swiss Multiple Sclerosis Registry, a prospective study including 2,063 participants by November 2019. MS onset symptoms were clustered using latent class analysis (LCA). The latent classes were further examined using information on socio-demographic characteristics, MS-related features, potential risk factors, and comorbid diseases. Results: The LCA model with six classes (frequencies ranging from 12 to 24%) was selected for further analyses. The latent classes comprised a multiple symptoms class with high probabilities across several symptoms, contrasting with two classes with solitary onset symptoms: vision problems and paresthesia. Two gait classes emerged between these extremes: the gait-balance class and the gait-paralysis class. The last class was the fatigue-weakness-class, also accompanied by depression symptoms, memory, and gastro-intestinal problems. There was a moderate variation by sex and by MS types. The multiple symptoms class yielded increased comorbidity with other autoimmune disorders. Similar to the fatigue-weakness class, the multiple symptoms class showed associations with angina, skin diseases, migraine, and lifetime prevalence of smoking. Mononucleosis was more frequently reported in the fatigue-weakness and the paresthesia class. Familial aggregation did not differ among the classes. Conclusions: Clustering of MS onset symptoms provides new perspectives on the heterogeneity of MS. The clusters comprise different potential risk factors and comorbidities. They point toward different risk mechanisms.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Gábor Horváth
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Yanhua Xu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.,Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Milo A Puhan
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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19
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Ehtesham N, Rafie MZ, Mosallaei M. The global prevalence of familial multiple sclerosis: an updated systematic review and meta-analysis. BMC Neurol 2021; 21:246. [PMID: 34182943 PMCID: PMC8237453 DOI: 10.1186/s12883-021-02267-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Considering that many recent studies have reported the prevalence of familial multiple sclerosis (FMS), we performed an updated meta-analysis of the worldwide prevalence of FMS by the addition of recent publications. METHODS A search in PubMed, Scopus, the ISI Web of Science, and Google Scholar was undertaken up to 20 December 2020. The inclusion criteria were based on the CoCoPop approach (condition, context, and population). Meta-analysis of the qualified studies was conducted by comprehensive meta-analysis ver. 2 software. RESULTS The pooled prevalence of MS in relatives of 16,179 FMS cases was estimated to be 11.8% (95% CI: 10.7-13) based on a random-effects model. The pooled mean age of disease onset in adult probands was calculated to be 28.7 years (95% CI: 27.2 ± 30.2). Regarding 13 studies that reported the data of FMS in pediatrics (n = 877) and adults (n = 6636), the FMS prevalence in pediatrics and adults was 15.5% (95% CI: 13.8-17.4) and 10.8% (95% CI: 8.1-14.2), respectively. The prevalence of FMS in affected males (n = 5243) and females (n = 11,503) was calculated to be 13.7% (95% CI: 10.1-18.2) and 15.4% (95% CI: 10.3-22.4), respectively. The odds ratio of male/female in FMS cases was not statistically significant (OR = 0.9; 95% CI: 0.6-1.2, P = 0.55). Subgroup analysis demonstrated a significant difference in the prevalence of FMS between the geographical areas (P = 0.007). The meta-regression model indicated that the prevalence of FMS is lower with higher latitude and higher MS prevalence (P < 0.001). In contrast, meta-regression based on prevalence day was not statistically significant (P = 0.29). CONCLUSIONS The prevalence of FMS is higher in the pediatric group than that of adults, distinct between geographical areas, and diminishes with the increment of MS prevalence and latitude. Also, the symptoms initiate relatively at younger ages in the FMS cases. Interestingly, our analysis unveiled that FMS is not more prevalent in men than women and the risk of MS development in relatives is not higher when the affected proband is male.
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Affiliation(s)
- Naeim Ehtesham
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Koodakyar Alley, Daneshjoo Blvd., Evin St, Tehran, Iran.
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maryam Zare Rafie
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Meysam Mosallaei
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Berger AA, Sottosanti ER, Winnick A, Izygon J, Berardino K, Cornett EM, Kaye AD, Varrassi G, Viswanath O, Urits I. Monomethyl Fumarate (MMF, Bafiertam) for the Treatment of Relapsing Forms of Multiple Sclerosis (MS). Neurol Int 2021; 13:207-223. [PMID: 34069538 PMCID: PMC8162564 DOI: 10.3390/neurolint13020022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 01/29/2023] Open
Abstract
Multiple sclerosis (MS) is a prevalent neurologic autoimmune disorder affecting two million people worldwide. Symptoms include gait abnormalities, perception and sensory losses, cranial nerve pathologies, pain, cognitive dysfunction, and emotional aberrancies. Traditional therapy includes corticosteroids for the suppression of relapses and injectable interferons. Recently, several modern therapies-including antibody therapy and oral agents-were approved as disease-modifying agents. Monomethyl fumarate (MMF, Bafiertam) is a recent addition to the arsenal available in the fight against MS and appears to be well-tolerated, safe, and effective. In this paper, we review the evidence available regarding the use of monomethyl fumarate (Bafiertam) in the treatment of relapsing-remitting MS.
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Affiliation(s)
- Amnon A. Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence: (A.A.B.); (E.M.C.); Tel.: +1-(617)-667-7000 (A.A.B.); Fax: +1-(617)-667-5050 (A.A.B.)
| | - Emily R. Sottosanti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 8400100, Israel; (A.W.); (J.I.)
- School of Optometry, University of California, Berkeley, CA 94720, USA
| | - Jonathan Izygon
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 8400100, Israel; (A.W.); (J.I.)
| | - Kevin Berardino
- School of Medicine, Georgetown University, Washington, DC 20007, USA;
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Correspondence: (A.A.B.); (E.M.C.); Tel.: +1-(617)-667-7000 (A.A.B.); Fax: +1-(617)-667-5050 (A.A.B.)
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
| | | | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ 85001, USA
- Department of Anesthesiology, School of Medicine, Creighton University, Omaha, NE 68124, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Southcoast Health, Southcoast Health Physician Group Pain Medicine, North Dartmouth, MA 02747, USA
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21
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Briggs FBS, Conway DS, De Nadai AS, Ontaneda D, Gunzler DD. Integrating patient-reported outcomes and quantitative timed tasks to identify relapsing remitting multiple sclerosis patient subgroups: a latent profile analysis. Mult Scler Relat Disord 2021; 51:102912. [PMID: 33773274 DOI: 10.1016/j.msard.2021.102912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients experience wide-ranging symptoms with varied severity, and approaches that integrate patient-reported outcomes and objective quantitative measures will present opportunities for advancing clinical profiling. The primary objective of the current study was to conduct exploratory data analysis using latent variable modeling to empirically identify clusters of relapsing remitting (RR) MS patients with shared impairment patterns across three patient-reported outcomes and two timed task measures. METHODS Latent profile analyses and impairment data for 2,012 RRMS patients identified distinct patient clusters using timed task measures of upper and lower limb performance, and patient-reported outcomes measuring quality of life, depression symptom severity, and perceived global disability. Multinomial logistic regression models were used to characterize associations between socio-demographic attributes and assignment to the patient clusters. RESULTS There were 6 distinct clusters of RRMS patients that differed by symptom patterns, and by their socio-demographic attributes. Most notable were were no differences in age, sex, or disease duration between the least and most impaired classes, representing 14% and 4% of patients, respectively. Patients in the most impaired class were much more likely to be Black American, have a history of smoking, have a higher body mass index, and be of lower socioeconomic status than the least impaired class. There were positive relationships between age and classification to clusters of increasing moderately severe impairment but not the most severe clusters. CONCLUSION We present a framework for discerning phenotypic impairment clusters in RRMS. The results demonstrate opportunities for advancing clinical profiling, which is necessary for optimizing personalized MS care models and clinical research.
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Affiliation(s)
- Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Devon S Conway
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Daniel Ontaneda
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Douglas D Gunzler
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Center for Health Care Research and Policy, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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22
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [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: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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23
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Vázquez-Marrufo M, Sarrias-Arrabal E, García-Torres M, Martín-Clemente R, Izquierdo G. A systematic review of the application of machine-learning algorithms in multiple sclerosis. Neurologia 2021; 38:S0213-4853(20)30431-X. [PMID: 33549371 DOI: 10.1016/j.nrl.2020.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.
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Affiliation(s)
- M Vázquez-Marrufo
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, España.
| | - E Sarrias-Arrabal
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, España
| | - M García-Torres
- Escuela Politécnica Superior, Universidad Pablo de Olavide, Sevilla, España
| | - R Martín-Clemente
- Departamento de Teoría de la Señal y Comunicaciones, Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Sevilla, España
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital VITHAS, Sevilla, España
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24
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Griffin JD, Huayamares SG, Walston TR, Song JY, Shao M, Sedlacek AR, Diaz DL, Chakravarti AR, Berkland CJ. Brain Homogenate Decoys for Antigen-Specific Cell Amplification. ACS APPLIED BIO MATERIALS 2021; 4:387-391. [DOI: 10.1021/acsabm.0c01048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Daniel Griffin
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas 66045, United States
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66047, United States
| | - Sebastian G. Huayamares
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas 66045, United States
| | - Towne R. Walston
- School of Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160, United States
| | - Jimmy Y. Song
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66047, United States
| | - Michael Shao
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States
| | - Alexander R. Sedlacek
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States
| | - Deanna L. Diaz
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States
| | - Aparna R. Chakravarti
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas 66045, United States
| | - Cory J. Berkland
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas 66045, United States
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66047, United States
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States
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25
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Hayashi F, Isobe N, Glanville J, Matsushita T, Maimaitijiang G, Fukumoto S, Watanabe M, Masaki K, Kira JI. A new clustering method identifies multiple sclerosis-specific T-cell receptors. Ann Clin Transl Neurol 2021; 8:163-176. [PMID: 33400858 PMCID: PMC7818280 DOI: 10.1002/acn3.51264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To characterize T-cell receptors (TCRs) and identify target epitopes in multiple sclerosis (MS). METHODS Peripheral blood mononuclear cells were obtained from 39 MS patients and 19 healthy controls (HCs). TCR repertoires for α/β/δ/γ chains, TCR diversity, and V/J usage were determined by next-generation sequencing. TCR β chain repertoires were compared with affectation status using a novel clustering method, Grouping of Lymphocyte Interactions by Paratope Hotspots (GLIPH). Cytomegalovirus (CMV)-IgG was measured in an additional 113 MS patients and 93 HCs. Regulatory T cells (Tregs) were measured by flow cytometry. RESULTS TCR diversity for all four chains decreased with age. TCRα and TCRβ diversity was higher in MS patients (P = 0.0015 and 0.024, respectively), even after age correction. TRAJ56 and TRBV4-3 were more prevalent in MS patients than in HCs (pcorr = 0.027 and 0.040, respectively). GLIPH consolidated 208,674 TCR clones from MS patients into 1,294 clusters, among which two candidate clusters were identified. The TRBV4-3 cluster was shared by HLA-DRB1*04:05-positive patients (87.5%) and predicted to recognize CMV peptides (CMV-TCR). MS Severity Score (MSSS) was lower in patients with CMV-TCR than in those without (P = 0.037). CMV-IgG-positivity was associated with lower MSSS in HLA-DRB1*04:05 carriers (P = 0.0053). HLA-DRB1*04:05-positive individuals demonstrated higher CMV-IgG titers than HLA-DRB1*04:05-negative individuals (P = 0.017). CMV-IgG-positive patients had more Tregs than CMV-IgG-negative patients (P = 0.054). INTERPRETATION High TCRα/TCRβ diversity, regardless of age, is characteristic of MS. Association of a CMV-recognizing TCR with mild disability indicates CMV's protective role in HLA-DRB1*04:05-positive MS.
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Affiliation(s)
- Fumie Hayashi
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jacob Glanville
- Computational and Systems Immunology Program, Stanford University School of Medicine, Stanford, California, USA
| | - Takuya Matsushita
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Shoko Fukumoto
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuhisa Masaki
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Nishanth K, Tariq E, Nzvere FP, Miqdad M, Cancarevic I. Role of Smoking in the Pathogenesis of Multiple Sclerosis: A Review Article. Cureus 2020; 12:e9564. [PMID: 32905534 PMCID: PMC7473606 DOI: 10.7759/cureus.9564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/05/2020] [Indexed: 11/06/2022] Open
Abstract
Multiple sclerosis (MS) is a complex and unpredictable neurological condition. It is the most commonly seen autoimmune disorder. The incidence of disease and its prevalence are growing worldwide. Early identification of the disease and accurate diagnosis is important to prevent further complications and disability. The etiology remains unclear, and it is believed that complex gene-environment interactions play an essential role. Genetic predisposition only describes a portion of the disease risk, whereas lifestyle and environmental factors are significant contributors. Smoking was identified as an important risk factor for MS. The main objectives of this review were to examine the underlying mechanisms of immune dysregulation in the development of MS, explore the association between smoking and MS, and identify other genetic and environmental factors that alter the risk of developing the disease. We searched PubMed for articles relevant to the study topic published between 2000 and 2020 using the search terms "multiple sclerosis," "cigarette smoking," "risk factors," and, "epigenetics." Studies reveal a marked association between smoking and the risk of MS. Unlike genetic risk factors, many lifestyles and environmental factors can be adjusted, with potential for prevention, particularly for people at the highest risk, such as families of individuals with MS.
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Affiliation(s)
- Katukuri Nishanth
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ezza Tariq
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Nishtar Medical College, Multan, PAK
| | - Farirai P Nzvere
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammed Miqdad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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27
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Watanabe M, Nakamura Y, Isobe N, Tanaka M, Sakoda A, Hayashi F, Kawano Y, Yamasaki R, Matsushita T, Kira JI. Two susceptible HLA-DRB1 alleles for multiple sclerosis differentially regulate anti-JC virus antibody serostatus along with fingolimod. J Neuroinflammation 2020; 17:206. [PMID: 32646493 PMCID: PMC7350631 DOI: 10.1186/s12974-020-01865-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) caused by JC virus (JCV) is a rare but serious complication of some disease-modifying drugs used to treat multiple sclerosis (MS). Japanese MS patients treated with fingolimod were reported to be 10 times more likely to develop PML than equivalent patients in other countries. The strongest susceptibility human leukocyte antigen (HLA) class II alleles for MS are distinct between races (DRB1*15:01 for Caucasians and DRB1*04:05 and DRB1*15:01 for Japanese); therefore, we investigated whether HLA class II alleles modulate anti-JCV antibody serostatus in Japanese MS patients with and without fingolimod. Methods We enrolled 128 Japanese patients with MS, in whom 64 (50%) were under fingolimod treatment at sampling, and examined the relationship between HLA class II alleles and anti-JCV antibody serostatus. Serum anti-JCV antibody positivity and index were measured using a second-generation two-step assay and HLA-DRB1 and -DPB1 alleles were genotyped. Results HLA-DRB1*15 carriers had a lower frequency of anti-JCV antibody positivity (57% vs 78%, p = 0.015), and lower antibody index (median 0.42 vs 1.97, p = 0.037) than non-carriers. Among patients without HLA-DRB1*15, DRB1*04 carriers had a higher seropositivity rate than non-carriers (84% vs 54%, p = 0.030), and DPB1*04:02 carriers had a higher anti-JCV antibody index than non-carriers (3.20 vs 1.34, p = 0.008) although anti-JCV antibody-positivity rates did not differ. Patients treated with fingolimod had a higher antibody index than other patients (1.46 vs 0.64, p = 0.039) and treatment period had a positive correlation with antibody index (p = 0.018). Multivariate logistic regression analysis revealed that age was positively associated, and HLA-DRB1*15 was negatively associated with anti-JCV antibody positivity (odds ratio [OR] = 1.06, p = 0.006, and OR = 0.37, p = 0.028, respectively). Excluding HLA-DRB1*15-carriers, DRB1*04 was an independent risk factor for the presence of anti-JCV antibody (OR = 5.50, p = 0.023). Conclusions HLA-DRB1*15 is associated with low anti-JCV antibody positive rate and low JCV antibody index, and in the absence of DRB1*15, DRB1*04 carriers are associated with a high antibody positive rate in Japanese, suggesting the effects of two susceptible HLA-DRB1 alleles on anti-JCV antibody serostatus differ.
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Affiliation(s)
- Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuri Nakamura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, International University of Health and Welfare, 2-6-11 Yakuin, Chuo-ku, Fukuoka, 810-0022, Japan.,School of Pharmacy at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, 831-8501, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masami Tanaka
- Kyoto MS Center, Kyoto Min-Iren-Chuo Hospital, 2-1 Uzumasatsuchimoto-cho, Ukyo-ku, Kyoto, 616-8147, Japan.,Department of Neurology, Kaikoukai Jyousai Hospital, 1-4 Kitabatake, Nakamura-ku, Nagoya, 453-0815, Japan
| | - Ayako Sakoda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, International University of Health and Welfare, 2-6-11 Yakuin, Chuo-ku, Fukuoka, 810-0022, Japan
| | - Fumie Hayashi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuji Kawano
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Neurology, National Hospital Organization Omuta National Hospital, 1044-1 Oaza, Tachibana, Omuta, 837-0911, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, International University of Health and Welfare, 2-6-11 Yakuin, Chuo-ku, Fukuoka, 810-0022, Japan. .,Translational Neuroscience Center, Graduate School of Medicine, and School of Pharmacy at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, 831-8501, Japan.
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28
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Zahoor I, Giri S. Specialized Pro-Resolving Lipid Mediators: Emerging Therapeutic Candidates for Multiple Sclerosis. Clin Rev Allergy Immunol 2020; 60:147-163. [PMID: 32495237 DOI: 10.1007/s12016-020-08796-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory disease in which unresolved and uncontrolled inflammation disrupts normal cellular homeostasis and leads to a pathological disease state. It has long been recognized that endogenously derived metabolic by-products of omega fatty acids, known as specialized pro-resolving lipid mediators (SPMs), are instrumental in resolving the pathologic inflammation. However, there is minimal data available on the functional status of SPMs in MS, despite the fact that MS presents a classical model of chronic inflammation. Studies to date indicate that dysfunction of the SPM biosynthetic pathway is responsible for their altered levels in patient-derived biofluids, which contributes to heightened inflammation and disease severity. Collectively, current findings suggest the contentious role of SPMs in MS due to variable outcomes in biological matrices across studies conducted so far, which could, in part, also be attributed to differences in population characteristics. It seems that SPMs have neuroprotective action on MS by exerting proresolving effects on brain microglia in its preclinical model; however, there are no reports demonstrating the direct effect of SPMs on oligodendrocytes or neurons. This reveals that "one size does not fit all" notion holds significance for MS in terms of the status of SPMs in other inflammatory conditions. The lack of clarity served as the impetus for this review, which is the first of its kind to summarize the relevant data regarding the role of SPMs in MS and the potential to target them for biomarker development and future alternative therapies for this disease. Understanding the mechanisms behind biological actions of SPMs as resolution mediators may prevent or even cure MS and other neurodegenerative pathologies.
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Affiliation(s)
- Insha Zahoor
- Department of Neurology, Research Division, Education & Research Building, Henry Ford Hospital, Room 4023, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - Shailendra Giri
- Department of Neurology, Research Division, Education & Research Building, Henry Ford Hospital, Room 4051, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
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Fukumoto S, Nakamura Y, Watanabe M, Isobe N, Matsushita T, Sakoda A, Hiwatashi A, Shinoda K, Yamasaki R, Tsujino A, Kira JI. Risk HLA-DRB1 alleles differentially influence brain and lesion volumes in Japanese patients with multiple sclerosis. J Neurol Sci 2020; 413:116768. [DOI: 10.1016/j.jns.2020.116768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/08/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
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Wang FM, Davis MF, Briggs FB. Predicting self-reported depression after the onset of multiple sclerosis using genetic and non-genetic factors. Mult Scler 2020; 27:603-612. [PMID: 32419624 DOI: 10.1177/1352458520921073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) are disproportionately burdened by depression compared to the general population. While several factors associated with depression and depression severity in PwMS have been identified, a prediction model for depression risk has not been developed. In addition, it is unknown if depression-related genetic variants, including Apolipoprotein E (APOE), would be informative for predicting depression in PwMS. OBJECTIVE To develop a depression prediction model for PwMS who did not have a history of depression prior MS onset. METHODS The study population included 917 non-Hispanic white PwMS. An optimized multivariable Cox proportional hazards model for time to depression was generated using non-genetic variables, to which APOE and a depression-related genetic risk score were included. RESULTS Having a mother who had a history of depression, having obstructive pulmonary disease, obesity and other physical disorders at MS onset, and affect-related symptoms at MS onset predicted depression risk (hazards ratios (HRs): 1.6-2.3). Genetic variables improved the prediction model's performance. APOE ε4/ε4 and ε2/x conferred increased (HR = 2.5, p = 0.026) and decreased (HR = 0.65, p = 0.046) depression risk, respectively. CONCLUSION We present a prediction model aligned with The Precision Medicine Initiative, which integrates genetic and non-genetic predictors to inform depression risk stratification after MS onset.
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Affiliation(s)
- Frances M Wang
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary F Davis
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT, USA
| | - Farren Bs Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Misicka E, Sept C, Briggs FBS. Predicting onset of secondary-progressive multiple sclerosis using genetic and non-genetic factors. J Neurol 2020; 267:2328-2339. [PMID: 32333165 DOI: 10.1007/s00415-020-09850-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Predicting the transition from relapsing-remitting (RR) to secondary-progressive (SP) multiple sclerosis (MS) from early in the disease course is challenging. OBJECTIVE To construct prediction models for SPMS using sociodemographic and self-reported clinical measures that would be available at/near MS onset, with specific considerations for MS genetic risk factors. METHODS We conducted a retrospective cross-sectional study based on 1295 white, non-Hispanic individuals. Cox proportional hazard prediction models were generated for three censored SPMS outcomes (ever transitioning, transitioning within 10 years, and transitioning within 20 years) using sociodemographic, comorbid health information, symptomatology, and other measures of early disease activity. HLADRB1*15:01 and HLA-A*02:01, as well as a genetic risk score, were iteratively considered in each model. We also explored the relationships for all 200 MS risk variants located outside the major histocompatibility complex. Nomograms were generated for the final prediction models. RESULTS An older age of MS onset and being male predicted a short latency to SPMS, while a longer interval between the first two relapses predicted a much longer latency. Comorbid conditions and onset symptomatology variably predicted the risk for transitioning to SPMS for each censored outcome. The most notable observation was that HLA-A*02:01, which confers decreased risk for MS, also contributed to decreased hazards for SPMS. CONCLUSIONS These results have the potential to advance prognostication for a person with MS using information available at or near onset, potentially improving care and quality of life for those who live with MS.
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Affiliation(s)
- Elina Misicka
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 2103 Cornell Rd, Cleveland, OH, 44106, USA
| | - Corriene Sept
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 2103 Cornell Rd, Cleveland, OH, 44106, USA
| | - Farren B S Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 2103 Cornell Rd, Cleveland, OH, 44106, USA.
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Stafford IS, Kellermann M, Mossotto E, Beattie RM, MacArthur BD, Ennis S. A systematic review of the applications of artificial intelligence and machine learning in autoimmune diseases. NPJ Digit Med 2020; 3:30. [PMID: 32195365 PMCID: PMC7062883 DOI: 10.1038/s41746-020-0229-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/17/2020] [Indexed: 02/07/2023] Open
Abstract
Autoimmune diseases are chronic, multifactorial conditions. Through machine learning (ML), a branch of the wider field of artificial intelligence, it is possible to extract patterns within patient data, and exploit these patterns to predict patient outcomes for improved clinical management. Here, we surveyed the use of ML methods to address clinical problems in autoimmune disease. A systematic review was conducted using MEDLINE, embase and computers and applied sciences complete databases. Relevant papers included "machine learning" or "artificial intelligence" and the autoimmune diseases search term(s) in their title, abstract or key words. Exclusion criteria: studies not written in English, no real human patient data included, publication prior to 2001, studies that were not peer reviewed, non-autoimmune disease comorbidity research and review papers. 169 (of 702) studies met the criteria for inclusion. Support vector machines and random forests were the most popular ML methods used. ML models using data on multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease were most common. A small proportion of studies (7.7% or 13/169) combined different data types in the modelling process. Cross-validation, combined with a separate testing set for more robust model evaluation occurred in 8.3% of papers (14/169). The field may benefit from adopting a best practice of validation, cross-validation and independent testing of ML models. Many models achieved good predictive results in simple scenarios (e.g. classification of cases and controls). Progression to more complex predictive models may be achievable in future through integration of multiple data types.
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Affiliation(s)
- I. S. Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - M. Kellermann
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - E. Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R. M. Beattie
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - B. D. MacArthur
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S. Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Gontika M, Skarlis C, Artemiadis A, Pons R, Mastroyianni S, Vartzelis G, Theodorou V, Kilindireas K, Stefanis L, Dalakas M, Chrousos G, Anagnostouli M. HLA-DRB1 allele impact on pediatric multiple sclerosis in a Hellenic cohort. Mult Scler J Exp Transl Clin 2020; 6:2055217320908046. [PMID: 32133149 PMCID: PMC7040929 DOI: 10.1177/2055217320908046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/03/2020] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pediatric-onset multiple sclerosis (POMS) is considered a complex disease entity with many genetic and environmental factors implicated in its pathogenesis. Linkage studies in Caucasian adult populations consistently demonstrate the major histocompatibility complex and its HLA (human leukocyte antigen) polymorphisms as the genetic locus most strongly linked to MS. Objective To investigate the frequencies and possible clinical and imaging correlations of HLA-DRB1 alleles in a Hellenic POMS sample. Methods Fifty POMS patients fulfilling the IPMSSG (International Pediatric Multiple Sclerosis Study Group) criteria were enrolled using 144 adult-onset MS (AOMS) patients and 246 healthy controls for comparisons. HLA genotyping was performed with standard low-resolution sequence-specific oligonucleotide (SSO) techniques. Clinical and imaging correlations with specific HLA-DRB1 alleles were also examined. Results The HLA-DRB1*03 genotype was significantly higher in POMS patients compared to both the AOMS population (26% vs. 12.5%, p = 0.042) and the general population (26% vs. 12.6%, p = 0.004). HLA-DRB1*03-positive POMS patients had significantly more relapses (6.9 ± 4.9 vs. 4.2 ± 4.4, p = 0.005) and more thoracic spinal cord lesions than HLA-DRB1*03-negative patients (61.5% vs. 27%, p = 0.043). Conclusion In our Hellenic population, HLA-DRB1*03 allele confers increased risk for POMS and it is also correlated with possibly increased disease activity, expanding the existing knowledge on HLA associations and POMS.
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Affiliation(s)
- Maria Gontika
- Immunogenetics Laboratory, First Department of Neurology, Medical School,National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Charalampos Skarlis
- Immunogenetics Laboratory, First Department of Neurology, Medical School,National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Artemios Artemiadis
- Immunogenetics Laboratory, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Roser Pons
- First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Sotiria Mastroyianni
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Athens, Greece
| | - George Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Virginia Theodorou
- Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, Greece
| | - Konstantinos Kilindireas
- Demyelinating Diseases Unit, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Marinos Dalakas
- Neuroimmunology Unit, Department of Pathophysiology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Greece
| | - Maria Anagnostouli
- Demyelinating Diseases Unit & Director of Immunogenetics Laboratory, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
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Tadić D, Đajić V, Grgić S, Miljković S. Association of body mass index with progression and prediction of multiple sclerosis. SCRIPTA MEDICA 2020. [DOI: 10.5937/scriptamed51-24916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Tarlinton RE, Khaibullin T, Granatov E, Martynova E, Rizvanov A, Khaiboullina S. The Interaction between Viral and Environmental Risk Factors in the Pathogenesis of Multiple Sclerosis. Int J Mol Sci 2019; 20:ijms20020303. [PMID: 30646507 PMCID: PMC6359439 DOI: 10.3390/ijms20020303] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic debilitating inflammatory disease of unknown ethology targeting the central nervous system (CNS). MS has a polysymptomatic onset and is usually first diagnosed between the ages of 20–40 years. The pathology of the disease is characterized by immune mediated demyelination in the CNS. Although there is no clinical finding unique to MS, characteristic symptoms include sensory symptoms visual and motor impairment. No definitive trigger for the development of MS has been identified but large-scale population studies have described several epidemiological risk factors for the disease. This list is a confusing one including latitude, vitamin D (vitD) levels, genetics, infection with Epstein Barr Virus (EBV) and endogenous retrovirus (ERV) reactivation. This review will look at the evidence for each of these and the potential links between these disparate risk factors and the known molecular disease pathogenesis to describe potential hypotheses for the triggering of MS pathology.
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Affiliation(s)
| | - Timur Khaibullin
- Republican Clinical Neurological Center, Republic of Tatarstan, Kazan 420021, Russia.
| | - Evgenii Granatov
- Republican Clinical Neurological Center, Republic of Tatarstan, Kazan 420021, Russia.
| | - Ekaterina Martynova
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
| | - Albert Rizvanov
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
| | - Svetlana Khaiboullina
- Department of Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Republic of Tatarstan, Kazan 420021, Russia.
- Department of Microbiology and Immunology, University of Nevada, Reno, NV 89557, USA.
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