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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló J, Rodríguez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Salerno A, Auger C, Alberich M, Río J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI. Neuroimage Clin 2023; 38:103376. [PMID: 36940621 PMCID: PMC10034138 DOI: 10.1016/j.nicl.2023.103376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
The application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Marastoni D, Pisani AI, Schiavi G, Mazziotti V, Castellaro M, Tamanti A, Bosello F, Crescenzo F, Ricciardi GK, Montemezzi S, Pizzini FB, Calabrese M. CSF TNF and osteopontin levels correlate with the response to dimethyl fumarate in early multiple sclerosis. Ther Adv Neurol Disord 2022; 15:17562864221092124. [PMID: 35755969 PMCID: PMC9218430 DOI: 10.1177/17562864221092124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Disease activity in the first years after a diagnosis of relapsing-remitting multiple sclerosis (RRMS) is a negative prognostic factor for long-term disability. Markers of both clinical and radiological responses to disease-modifying therapies (DMTs) are advocated. Objective: The objective of this study is to estimate the value of cerebrospinal fluid (CSF) inflammatory markers at the time of diagnosis in predicting the disease activity in treatment-naïve multiple sclerosis (MS) patients exposed to dimethyl fumarate (DMF). Methods: In total, 48 RRMS patients (31 females/17 males) treated with DMF after the diagnosis were included in this 2-year longitudinal study. All patients underwent a CSF examination, regular clinical and 3T magnetic resonance imaging (MRI) scans that included the assessment of white matter (WM) lesions, cortical lesions (CLs) and global cortical thickness. CSF levels of 10 pro-inflammatory markers – CXCL13 [chemokine (C-X-C motif) ligand 13 or B lymphocyte chemoattractant], CXCL12 (stromal cell-derived factor or C-X-C motif chemokine 12), tumour necrosis factor (TNF), APRIL (a proliferation-inducing ligand, or tumour necrosis factor ligand superfamily member 13), LIGHT (tumour necrosis factor ligand superfamily member 14 or tumour necrosis factor superfamily member 14), interferon (IFN) gamma, interleukin 12 (IL-12), osteopontin, sCD163 [soluble-CD163 (cluster of differentiation 163)] and Chitinase3-like1 – were assessed using immune-assay multiplex techniques. The combined three-domain status of ‘no evidence of disease activity’ (NEDA-3) was defined by no relapses, no disability worsening and no MRI activity, including CLs. Results: Twenty patients (42%) reached the NEDA-3 status; patients with disease activity showed higher CSF TNF (p = 0.009), osteopontin (p = 0.005), CXCL12 (p = 0.037), CXCL13 (p = 0.040) and IFN gamma levels (p = 0.019) compared with NEDA-3 patients. After applying a random forest approach, TNF and osteopontin revealed the most important variables associated with the NEDA-3 status. Six molecules that emerged at the random forest approach were added in a multivariate regression model with demographic, clinical and MRI measures of WM and grey matter damage as independent variables. TNF levels confirmed to be associated with the absence of disease activity: odds ratio (OR) = 0.25, CI% = 0.04–0.77. Conclusion: CSF inflammatory markers may provide prognostic information in predicting disease activity in the first years after DMF initiation. CSF TNF levels are a possible candidate in predicting treatment response, in addition to clinical, demographic and MRI variables.
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Affiliation(s)
- Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anna I Pisani
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gianmarco Schiavi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valentina Mazziotti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Castellaro
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Bosello
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, Ocular Immunology and Neuroophthalmology Service, AOUI-University of Verona, Verona, Italy
| | - Francesco Crescenzo
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe K Ricciardi
- Neuroradiology & Radiology Units, Integrated University Hospital of Verona, Verona, Italy
| | - Stefania Montemezzi
- Neuroradiology & Radiology Units, Integrated University Hospital of Verona, Verona, Italy
| | - Francesca B Pizzini
- Radiology, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico 'G.B. Rossi' Borgo Roma, Piazzale L. A. Scuro, 10, 37134 Verona, Italy
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Silva BA, Farías MI, Miglietta EA, Leal MC, Ávalos JC, Pitossi FJ, Ferrari CC. Understanding the role of the blood brain barrier and peripheral inflammation on behavior and pathology on ongoing confined cortical lesions. Mult Scler Relat Disord 2021; 57:103346. [DOI: 10.1016/j.msard.2021.103346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
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Magliozzi R, Pezzini F, Pucci M, Rossi S, Facchiano F, Marastoni D, Montagnana M, Lippi G, Reynolds R, Calabrese M. Changes in Cerebrospinal Fluid Balance of TNF and TNF Receptors in Naïve Multiple Sclerosis Patients: Early Involvement in Compartmentalised Intrathecal Inflammation. Cells 2021; 10:cells10071712. [PMID: 34359880 PMCID: PMC8303813 DOI: 10.3390/cells10071712] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
An imbalance of TNF signalling in the inflammatory milieu generated by meningeal immune cell infiltrates in the subarachnoid space in multiple sclerosis (MS), and its animal model may lead to increased cortical pathology. In order to explore whether this feature may be present from the early stages of MS and may be associated with the clinical outcome, the protein levels of TNF, sTNF-R1 and sTNF-R2 were assayed in CSF collected from 122 treatment-naïve MS patients and 36 subjects with other neurological conditions at diagnosis. Potential correlations with other CSF cytokines/chemokines and with clinical and imaging parameters at diagnosis (T0) and after 2 years of follow-up (T24) were evaluated. Significantly increased levels of TNF (fold change: 7.739; p < 0.001), sTNF-R1 (fold change: 1.693; p < 0.001) and sTNF-R2 (fold change: 2.189; p < 0.001) were detected in CSF of MS patients compared to the control group at T0. Increased TNF levels in CSF were significantly (p < 0.01) associated with increased EDSS change (r = 0.43), relapses (r = 0.48) and the appearance of white matter lesions (r = 0.49). CSF levels of TNFR1 were associated with cortical lesion volume (r = 0.41) at T0, as well as with new cortical lesions (r = 0.56), whilst no correlation could be found between TNFR2 levels in CSF and clinical or MRI features. Combined correlation and pathway analysis (ingenuity) of the CSF protein pattern associated with TNF expression (encompassing elevated levels of BAFF, IFN-γ, IL-1β, IL-10, IL-8, IL-16, CCL21, haptoglobin and fibrinogen) showed a particular relationship to the interaction between innate and adaptive immune response. The CSF sTNF-R1-associated pattern (encompassing high levels of CXCL13, TWEAK, LIGHT, IL-35, osteopontin, pentraxin-3, sCD163 and chitinase-3-L1) was mainly related to altered T cell and B cell signalling. Finally, the CSF TNFR2-associated pattern (encompassing high CSF levels of IFN-β, IFN-λ2, sIL-6Rα) was linked to Th cell differentiation and regulatory cytokine signalling. In conclusion, dysregulation of TNF and TNF-R1/2 pathways associates with specific clinical/MRI profiles and can be identified at a very early stage in MS patients, at the time of diagnosis, contributing to the prediction of the disease outcome.
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MESH Headings
- Adaptive Immunity
- Adult
- Antigens, CD/cerebrospinal fluid
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/cerebrospinal fluid
- Antigens, Differentiation, Myelomonocytic/genetics
- Antigens, Differentiation, Myelomonocytic/immunology
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- C-Reactive Protein/cerebrospinal fluid
- C-Reactive Protein/genetics
- C-Reactive Protein/immunology
- Case-Control Studies
- Cerebral Cortex/diagnostic imaging
- Cerebral Cortex/immunology
- Cerebral Cortex/pathology
- Chemokine CXCL13/cerebrospinal fluid
- Chemokine CXCL13/genetics
- Chemokine CXCL13/immunology
- Chitinase-3-Like Protein 1/cerebrospinal fluid
- Chitinase-3-Like Protein 1/genetics
- Chitinase-3-Like Protein 1/immunology
- Cytokine TWEAK/cerebrospinal fluid
- Cytokine TWEAK/genetics
- Cytokine TWEAK/immunology
- Early Diagnosis
- Female
- Gene Expression Regulation
- Humans
- Immunity, Innate
- Interleukins/cerebrospinal fluid
- Interleukins/genetics
- Interleukins/immunology
- Magnetic Resonance Imaging
- Male
- Meninges/diagnostic imaging
- Meninges/immunology
- Meninges/pathology
- Multiple Sclerosis/cerebrospinal fluid
- Multiple Sclerosis/diagnostic imaging
- Multiple Sclerosis/genetics
- Multiple Sclerosis/pathology
- Osteopontin/cerebrospinal fluid
- Osteopontin/genetics
- Osteopontin/immunology
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/immunology
- Receptors, Tumor Necrosis Factor, Type I/cerebrospinal fluid
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type I/immunology
- Receptors, Tumor Necrosis Factor, Type II/cerebrospinal fluid
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Receptors, Tumor Necrosis Factor, Type II/immunology
- Serum Amyloid P-Component/cerebrospinal fluid
- Serum Amyloid P-Component/genetics
- Serum Amyloid P-Component/immunology
- Signal Transduction
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- Tumor Necrosis Factor Ligand Superfamily Member 14/cerebrospinal fluid
- Tumor Necrosis Factor Ligand Superfamily Member 14/genetics
- Tumor Necrosis Factor Ligand Superfamily Member 14/immunology
- Tumor Necrosis Factor-alpha/cerebrospinal fluid
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/immunology
- White Matter/diagnostic imaging
- White Matter/immunology
- White Matter/pathology
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Affiliation(s)
- Roberta Magliozzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
- Department of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK;
- Correspondence:
| | - Francesco Pezzini
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
| | - Mairi Pucci
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
| | - Stefania Rossi
- Department of Oncology and Molecular Medicine, Higher Institute of Health Care, 00161 Rome, Italy; (S.R.); (F.F.)
| | - Francesco Facchiano
- Department of Oncology and Molecular Medicine, Higher Institute of Health Care, 00161 Rome, Italy; (S.R.); (F.F.)
| | - Damiano Marastoni
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
| | - Martina Montagnana
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
| | - Giuseppe Lippi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
| | - Richard Reynolds
- Department of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK;
- Centre for Molecular Neuropathology, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy; (F.P.); (M.P.); (D.M.); (M.M.); (G.L.); (M.C.)
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Silva BA, Miglietta E, Ferrari CC. Insights into the role of B cells in the cortical pathology of Multiple sclerosis: evidence from animal models and patients. Mult Scler Relat Disord 2021; 50:102845. [PMID: 33636613 DOI: 10.1016/j.msard.2021.102845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system (CNS) that affects both white and gray matter. Although it has been traditionally considered as a T cell mediated disease, the role of B cell in MS pathology has become a topic of great research interest. Cortical lesions, key feature of the progressive forms of MS, are involved in cognitive impairment and worsening of the patients' outcome. These lesions present pathognomonic hallmarks, such as: absence of blood-brain barrier (BBB) disruption, limited inflammatory events, reactive microglia, neurodegeneration, demyelination and meningeal inflammation. B cells located in the meninges, either as part of diffuse inflammation or as part of follicle-like structures, are strongly associated with cortical damage. The function of CD20-expressing B cells in MS is further highlighted by the success of specific therapies using anti-CD20 antibodies. The possible roles of B cells in pathology go beyond their ability to produce antibodies, as they also present antigens to T cells, secrete cytokines (both pathogenic and protective) within the CNS to modulate T and myeloid cell functions, and are involved in meningeal inflammation. Here, we will review the contributions of B cells to the pathogenesis of meningeal inflammation and cortical lesions in MS patients as well as in preclinical animal models.
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Affiliation(s)
- Berenice Anabel Silva
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), CONICET, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA, CONICET, Buenos Aires, Argentina; Centro Universitario de Esclerosis Múltiple, División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Esteban Miglietta
- Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA, CONICET, Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), CONICET, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA, CONICET, Buenos Aires, Argentina.
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Silva BA, Miglietta EA, Ferrari CC. Training the brain: could it improve multiple sclerosis treatment? Rev Neurosci 2020; 31:779-792. [PMID: 32712593 DOI: 10.1515/revneuro-2020-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022]
Abstract
Multiple sclerosis (MS) is a neurological disease characterized by neuroinflammation, demyelination and axonal degeneration along with loss of function in the central nervous system. For many years, research in MS has focused on the efficacy of pharmacological treatments. However, during the last years, many publications have been dedicated to the study of the efficacy of non-pharmacological strategies, such as physical exercise and cognitive training. Beneficial effects of the combination of both strategies on cognitive function have been described in both ageing adults and patients with neurodegenerative diseases, such as MS. The analysis of combining both physical and cognitive stimulation can be summarized by the environmental enrichment (EE) experiments, which are more suitable for animal models. EE refers to housing conditions consisting of exercise and cognitive and social stimulation. In this review, we will summarize the available studies that describe the influence of EE in both MS patients and MS animal models.
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Affiliation(s)
- Berenice Anabel Silva
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Esteban Alberto Miglietta
- Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
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Auger C, Rovira À. New concepts about the role of magnetic resonance imaging in the diagnosis and follow-up of multiple sclerosis. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Nuevos conceptos sobre el papel de la resonancia magnética en el diagnóstico y seguimiento de la esclerosis múltiple. RADIOLOGIA 2020; 62:349-359. [DOI: 10.1016/j.rx.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
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Abstract
The etiology and pathogenesis of MS is likely to involve multiple factors interacting with each other, and the role of infectious and viral agents is still under debate, however a consistent amount of studies suggests that some viruses are associated with the disease. The strongest documentation has come from the detection of viral nucleic acid or antigen or of an anti-viral antibody response in MS patients. A further step for the study of the mechanism viruses might be involved in can be made using in vitro and in vivo models. While in vitro models, based on glial and neural cell lines from various sources are widely used, in vivo animal models present challenges. Indeed neurotropic animal viruses are currently used to study demyelination in well-established models, but animal models of demyelination by human virus infection have only recently been developed, using animal gammaherpesviruses closely related to Epstein Barr virus (EBV), or using marmosets expressing the specific viral receptor for Human Herpesvirus 6 (HHV-6). The present review will illustrate the main potential mechanisms of MS pathogenesis possibly associated with viral infections and viruses currently used to study demyelination in animal models. Then the viruses most strongly linked with MS will be discussed, in the perspective that more than one virus might have a role, with varying degrees of interaction, contributing to MS heterogeneity.
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Affiliation(s)
- Donatella Donati
- Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese I 53100 Siena, Italy
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Silva BA, Leal MC, Farías MI, Erhardt B, Galeano P, Pitossi FJ, Ferrari CC. Environmental enrichment improves cognitive symptoms and pathological features in a focal model of cortical damage of multiple sclerosis. Brain Res 2020; 1727:146520. [PMID: 31669283 DOI: 10.1016/j.brainres.2019.146520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/27/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
Multiple Sclerosis (MS) is a neuroinflammatory disease affecting white and grey matter, it is characterized by demyelination, axonal degeneration along with loss of motor, sensitive and cognitive functions. MS is a heterogeneous disease that displays different clinical courses: relapsing/remitting MS (RRMS), and MS progressive forms: primary progressive (PPMS) and secondary progressive (SPMS). Cortical damage in the progressive MS forms has considerable clinical relevance due to its association with cognitive impairment and disability progression in patients. One treatment is available for the progressive forms of the disease, but none are specific for cognitive deficits. We developed an animal model that reflects most of the characteristics of the cortical damage, such as cortical neuroinflammation, demyelination, neurodegeneration and meningeal inflammation, which was associated with cognitive impairment. Cognitive rehabilitation, exercise and social support have begun to be evaluated in patients and animal models of neurodegenerative diseases. Environmental enrichment (EE) provides exercise as well as cognitive and social stimulation. EE has been demonstrated to exert positive effects on cognitive domains, such as learning and memory, and improving anxiety-like symptoms. We proposed to study the effect of EE on peripherally stimulated cortical lesion induced by the long term expression of interleukin IL-1β (IL-1β) in adult rats. Here, we demonstrated that EE: 1) reduces the peripheral inflammatory response to the stimulus, 2) ameliorates cognitive deficits and anxiety-like symptoms, 3) modulates neurodegeneration, demyelination and glial activation, 4) regulates neuroinflammation by reducing the expression of pro-inflammatory cytokines and enhancing the expression of anti-inflammatory ones. Our findings correlate with the fact that EE housing could be considered an effective non- pharmacological therapeutic agent that can synergistically aid in the rehabilitation of the disease.
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Affiliation(s)
- Berenice Anabel Silva
- Institute of Translational Medicine and Biomedical Engineering of the Italian Hospital (IMTIB, CONICET), Potosí 4240, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - María Celeste Leal
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - María Isabel Farías
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - Brenda Erhardt
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - Pablo Galeano
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - Fernando Juan Pitossi
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Institute of Translational Medicine and Biomedical Engineering of the Italian Hospital (IMTIB, CONICET), Potosí 4240, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Patricias Argentinas 435, Buenos Aires, Argentina.
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11
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Pitteri M, Dapor C, Pisani AI, Castellaro M, DeLuca J, Chiaravalloti N, Guandalini M, Ziccardi S, Calabrese M. Executive functioning affects verbal learning process in multiple sclerosis patients: Behavioural and imaging results. J Neuropsychol 2019; 14:384-398. [DOI: 10.1111/jnp.12198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Pitteri
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Caterina Dapor
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Anna Isabella Pisani
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Marco Castellaro
- Padova Neuroscience Center University of Padova Italy
- Department of Information Engineering University of Padova Italy
| | - John DeLuca
- Kessler Foundation West Orange New Jersey USA
- Department of Physical Medicine and Rehabilitation Rutgers, New Jersey Medical School Newark New Jersey USA
- Department of Neurology Rutgers, New Jersey Medical School Newark New Jersey USA
| | - Nancy Chiaravalloti
- Department of Physical Medicine and Rehabilitation Rutgers, New Jersey Medical School Newark New Jersey USA
- Neuropsychology and Neuroscience Lab Kessler Foundation East Hanover New Jersey USA
| | - Maddalena Guandalini
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Stefano Ziccardi
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Massimiliano Calabrese
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
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12
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Racial differences in retinal neurodegeneration as a surrogate marker for cortical atrophy in multiple sclerosis. Mult Scler Relat Disord 2019; 31:141-147. [DOI: 10.1016/j.msard.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
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13
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Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A, Stephan KE. Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:642-651. [PMID: 30683707 PMCID: PMC6581095 DOI: 10.1136/jnnp-2018-320050] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
Fatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error with limited success, probably due to the presence of multiple different underlying mechanisms. Recent neuroscientific advances offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. However, development of these tools for differential diagnosis will require guidance by pathophysiological and cognitive theories that propose mechanisms which can be assessed in individual patients. This article provides an overview of contemporary pathophysiological theories of fatigue in MS and discusses how the mechanisms they propose may become measurable with emerging technologies and thus lay a foundation for future personalised treatments.
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Affiliation(s)
- Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland .,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Cao Tri Do
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Gabor Stefanics
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research (SNS), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Andreas Lutterotti
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Müller
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Max Planck Institute for Metabolism Research, Cologne, Germany
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14
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O'Muircheartaigh J, Vavasour I, Ljungberg E, Li DKB, Rauscher A, Levesque V, Garren H, Clayton D, Tam R, Traboulsee A, Kolind S. Quantitative neuroimaging measures of myelin in the healthy brain and in multiple sclerosis. Hum Brain Mapp 2019; 40:2104-2116. [PMID: 30648315 PMCID: PMC6590140 DOI: 10.1002/hbm.24510] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
Quantitative magnetic resonance imaging (MRI) techniques have been developed as imaging biomarkers, aiming to improve the specificity of MRI to underlying pathology compared to conventional weighted MRI. For assessing the integrity of white matter (WM), myelin, in particular, several techniques have been proposed and investigated individually. However, comparisons between these methods are lacking. In this study, we compared four established myelin‐sensitive MRI techniques in 56 patients with relapsing–remitting multiple sclerosis (MS) and 38 healthy controls. We used T2‐relaxation with combined GRadient And Spin Echoes (GRASE) to measure myelin water fraction (MWF‐G), multi‐component driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) to measure MWF‐D, magnetization‐transfer imaging to measure magnetization‐transfer ratio (MTR), and T1 relaxation to measure quantitative T1 (qT1). Using voxelwise Spearman correlations, we tested the correspondence of methods throughout the brain. All four methods showed associations that varied across tissue types; the highest correlations were found between MWF‐D and qT1 (median ρ across tissue classes 0.8) and MWF‐G and MWF‐D (median ρ = 0.59). In eight WM tracts, all measures showed differences (p < 0.05) between MS normal‐appearing WM and healthy control WM, with qT1 showing the highest number of different regions (8), followed by MWF‐D and MTR (6), and MWF‐G (n = 4). Comparing the methods in terms of their statistical sensitivity to MS lesions in WM, MWF‐D demonstrated the best accuracy (p < 0.05, after multiple comparison correction). To aid future power analysis, we provide the average and standard deviation volumes of the four techniques, estimated from the healthy control sample.
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Affiliation(s)
- Jonathan O'Muircheartaigh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.,Centre for the Developing Brain, Department of Perinatal Imaging and Health, St. Thomas' Hospital, King's College London, London, United Kingdom.,Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Irene Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Kolind
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Moorman CD, Curtis AD, Bastian AG, Elliott SE, Mannie MD. A GMCSF-Neuroantigen Tolerogenic Vaccine Elicits Systemic Lymphocytosis of CD4 + CD25 high FOXP3 + Regulatory T Cells in Myelin-Specific TCR Transgenic Mice Contingent Upon Low-Efficiency T Cell Antigen Receptor Recognition. Front Immunol 2019; 9:3119. [PMID: 30687323 PMCID: PMC6335336 DOI: 10.3389/fimmu.2018.03119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022] Open
Abstract
Previous studies showed that single-chain fusion proteins comprised of GM-CSF and major encephalitogenic peptides of myelin, when injected subcutaneously in saline, were potent tolerogenic vaccines that suppressed experimental autoimmune encephalomyelitis (EAE) in rats and mice. These tolerogenic vaccines exhibited dominant suppressive activity in inflammatory environments even when emulsified in Complete Freund's Adjuvant (CFA). The current study provides evidence that the mechanism of tolerance was dependent upon vaccine-induced regulatory CD25+ T cells (Tregs), because treatment of mice with the Treg-depleting anti-CD25 mAb PC61 reversed tolerance. To assess tolerogenic mechanisms, we focused on 2D2-FIG mice, which have a transgenic T cell repertoire that recognizes myelin oligodendrocyte glycoprotein peptide MOG35-55 as a low-affinity ligand and the neurofilament medium peptide NFM13-37 as a high-affinity ligand. Notably, a single subcutaneous vaccination of GMCSF-MOG in saline elicited a major population of FOXP3+ Tregs that appeared within 3 days, was sustained over several weeks, expressed canonical Treg markers, and was present systemically at high frequencies in the blood, spleen, and lymph nodes. Subcutaneous and intravenous injections of GMCSF-MOG were equally effective for induction of FOXP3+ Tregs. Repeated booster vaccinations with GMCSF-MOG elicited FOXP3 expression in over 40% of all circulating T cells. Covalent linkage of GM-CSF with MOG35-55 was required for Treg induction whereas vaccination with GM-CSF and MOG35-55 as separate molecules lacked Treg-inductive activity. GMCSF-MOG elicited high levels of Tregs even when administered in immunogenic adjuvants such as CFA or Alum. Conversely, incorporation of GM-CSF and MOG35-55 as separate molecules in CFA did not support Treg induction. The ability of the vaccine to induce Tregs was dependent upon the efficiency of T cell antigen recognition, because vaccination of 2D2-FIG or OTII-FIG mice with the high-affinity ligands GMCSF-NFM or GMCSF-OVA (Ovalbumin323-339), respectively, did not elicit Tregs. Comparison of 2D2-FIG and 2D2-FIG-Rag1 -/- strains revealed that GMCSF-MOG may predominantly drive Treg expansion because the kinetics of vaccine-induced Treg emergence was a function of pre-existing Treg levels. In conclusion, these findings indicate that the antigenic domain of the GMCSF-NAg tolerogenic vaccine is critical in setting the balance between regulatory and conventional T cell responses in both quiescent and inflammatory environments.
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Affiliation(s)
- Cody D Moorman
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Alan D Curtis
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Alexander G Bastian
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Sarah E Elliott
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mark D Mannie
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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16
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Solomon AJ, Naismith RT, Cross AH. Misdiagnosis of multiple sclerosis: Impact of the 2017 McDonald criteria on clinical practice. Neurology 2018; 92:26-33. [PMID: 30381369 DOI: 10.1212/wnl.0000000000006583] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/30/2018] [Indexed: 11/15/2022] Open
Abstract
Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.
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Affiliation(s)
- Andrew J Solomon
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at The University of Vermont, University Health Center, Burlington; and Department of Neurology (R.T.N., A.H.C.), Washington University in St. Louis, MO.
| | - Robert T Naismith
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at The University of Vermont, University Health Center, Burlington; and Department of Neurology (R.T.N., A.H.C.), Washington University in St. Louis, MO
| | - Anne H Cross
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at The University of Vermont, University Health Center, Burlington; and Department of Neurology (R.T.N., A.H.C.), Washington University in St. Louis, MO
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17
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Bede P, Finegan E, Chipika RH, Li Hi Shing S, Lambe J, Meaney J, Redmond J. Occulomotor Neural Integrator Dysfunction in Multiple Sclerosis: Insights From Neuroimaging. Front Neurol 2018; 9:691. [PMID: 30190700 PMCID: PMC6116658 DOI: 10.3389/fneur.2018.00691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023] Open
Abstract
Background: Magnetic resonance imaging is a key diagnostic and monitoring tool in multiple Sclerosis (MS). While the substrates of motor and neuropsychological symptoms in MS have been extensively investigated, nystagmus-associated imaging signatures are relatively under studied. Accordingly, the objective of this study is the comprehensive characterisation of cortical, subcortical, and brainstem involvement in a cohort of MS patients with gaze-evoked nystagmus. Methods: Patients were recruited from a specialist MS clinic and underwent multimodal neuroimaging including high-resolution structural and diffusion tensor data acquisitions. Morphometric analyses were carried out to evaluate patterns of cortical, subcortical, brainstem, and cerebellar gray matter pathology. Volumetric analyses were also performed to further characterize subcortical gray matter degeneration. White matter integrity was evaluated using axial-, mean-, and radial diffusivity as well as fractional anisotropy. Results: Whole-brain morphometry highlighted considerable brainstem and cerebellar gray matter atrophy, and the tract-wise evaluation of white matter metrics revealed widespread pathology in frontotemporal and parietal regions. Nystagmus-associated gray matter degeneration was identified in medial cerebellar, posterior medullar, central pontine, and superior collicular regions. Volume reductions were identified in the putamen, thalamus and hippocampus. Conclusions: Multiple sclerosis is associated with widespread gray matter pathology which is not limited to cortical regions but involves striatal, thalamic, cerebellar, and hippocampal foci. The imaging signature of gaze-evoked nystagmus in MS confirms the degeneration of key structures of the neural integrator network.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Laboratoire d'Imagerie Biomédicale, Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, St James's Hospital, Dublin, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, St James's Hospital, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Jeffrey Lambe
- Department of Neurology, St James's Hospital, Dublin, Ireland
| | - James Meaney
- Centre for Advanced Medical Imaging (CAMI), St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Janice Redmond
- Department of Neurology, St James's Hospital, Dublin, Ireland
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18
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Silva BA, Leal MC, Farías MI, Avalos JC, Besada CH, Pitossi FJ, Ferrari CC. A new focal model resembling features of cortical pathology of the progressive forms of multiple sclerosis: Influence of innate immunity. Brain Behav Immun 2018; 69:515-531. [PMID: 29378262 DOI: 10.1016/j.bbi.2018.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/10/2018] [Accepted: 01/19/2018] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and demyelinating disease of unknown aetiology that causes neurological disabilities in young adults. MS displays different clinical patterns, including recurrent episodes with remission periods ("relapsing-remitting MS" (RRMS)), which can progress over several years to a secondary progressive form (SPMS). However, 10% of patients display persistent progression at the onset of disease ("primary progressive MS" (PPMS)). Currently, no specific therapeutic agents are available for the progressive forms, mainly because the underlying pathogenic mechanisms are not clear and because no animal models have been specifically developed for these forms. The development of MS animal models is required to clarify the pathological mechanisms and to test novel therapeutic agents. In the present work, we overexpressed interleukin 1 beta (IL-1β) in the cortex to develop an animal model reflecting the main pathological hallmarks of MS. The treated animals presented with neuroinflammation, demyelination, glial activation, and neurodegeneration along with cognitive symptoms and MRI images consistent with MS pathology. We also demonstrated the presence of meningeal inflammation close to cortical lesions, with characteristics similar to those described in MS patients. Systemic pro-inflammatory stimulation caused a flare-up of the cortical lesions and behavioural symptoms, including impairment of working memory and the appearance of anxiety-like symptoms. Our work demonstrated induced cortical lesions, reflecting the main histopathological hallmarks and cognitive impairments characterizing the cortical pathology described in MS patients with progressive forms of the disease.
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Affiliation(s)
- Berenice Anabel Silva
- Institute of Basic Science and Experimental Medicine (ICBME), University Institute, Italian Hospital, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Buenos Aires, Argentina
| | - María Celeste Leal
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Buenos Aires, Argentina
| | - María Isabel Farías
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Buenos Aires, Argentina
| | | | | | - Fernando Juan Pitossi
- Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Institute of Basic Science and Experimental Medicine (ICBME), University Institute, Italian Hospital, Buenos Aires, Argentina; Leloir Institute Foundation, Institute for Biochemical Investigations of Buenos Aires, (IIBBA, CONICET), Buenos Aires, Argentina.
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19
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MRI and multiple sclerosis––the evolving role of MRI in the diagnosis and management of MS: the radiologist’s perspective. Ir J Med Sci 2017; 187:781-787. [DOI: 10.1007/s11845-017-1714-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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20
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