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Oertel FC, Zimmermann HG, Motamedi S, Bereuter C, Manthey LM, Ashtari F, Kafieh R, Dehghani A, Pourazizi M, Pandit L, D'Cunha A, Aktas O, Albrecht P, Ringelstein M, Martinez-Lapiscina EH, Sanchez Dalmau BF, Villoslada P, Asgari N, Marignier R, Cobo-Calvo A, Leocani L, Pisa M, Radaelli M, Palace J, Roca-Fernandez A, Leite MIS, Sharma S, De Seze J, Senger T, Yeaman MR, Smith TJ, Cook LJ, Brandt AU, Paul F. Retinal Changes in Double-Antibody Seronegative Neuromyelitis Optica Spectrum Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200273. [PMID: 38941573 PMCID: PMC11214151 DOI: 10.1212/nxi.0000000000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/29/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES To systematically describe the clinical picture of double-antibody seronegative neuromyelitis optica spectrum disorders (DN-NMOSD) with specific emphasis on retinal involvement. METHODS Cross-sectional data of 25 people with DN-NMOSD (48 eyes) with and without a history of optic neuritis (ON) were included in this study along with data from 25 people with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4-NMOSD, 46 eyes) and from 25 healthy controls (HCs, 49 eyes) for comparison. All groups were matched for age and sex and included from the collaborative retrospective study of retinal optical coherence tomography (OCT) in neuromyelitis optica (CROCTINO). Participants underwent OCT with central postprocessing and local neurologic examination and antibody testing. Retinal neurodegeneration was quantified as peripapillary retinal nerve fiber layer thickness (pRNFL) and combined ganglion cell and inner plexiform layer thickness (GCIPL). RESULTS This DN-NMOSD cohort had a history of [median (inter-quartile range)] 6 (5; 9) attacks within their 5 ± 4 years since onset. Myelitis and ON were the most common attack types. In DN-NMOSD eyes after ON, pRNFL (p < 0.001) and GCIPL (p = 0.023) were thinner compared with eyes of HCs. Even after only one ON episode, DN-NMOSD eyes already had considerable neuroaxonal loss compared with HCs. In DN-NMOSD eyes without a history of ON, pRNFL (p = 0.027) and GCIPL (p = 0.022) were also reduced compared with eyes of HCs. However, there was no difference in pRNFL and GCIPL between DN-NMOSD and AQP4-NMOSD for the whole group and for subsets with a history of ON and without a history of ON-as well as between variances of retinal layer thicknesses. DISCUSSION DN-NMOSD is characterized by severe retinal damage after ON and attack-independent retinal neurodegeneration. Most of the damage occurs during the first ON episode, which highlights the need for better diagnostic markers in DN-NMOSD to facilitate an earlier diagnosis as well as for effective and early treatments. In this study, people with DN-NMOSD presented with homogeneous clinical and imaging findings potentially suggesting a common retinal pathology in these patients.
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Affiliation(s)
- Frederike C Oertel
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Hanna G Zimmermann
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Seyedamirhosein Motamedi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Charlotte Bereuter
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Luca Magdalena Manthey
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Fereshteh Ashtari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Rahele Kafieh
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alireza Dehghani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Mohsen Pourazizi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lekha Pandit
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Anitha D'Cunha
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Orhan Aktas
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Philipp Albrecht
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marius Ringelstein
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Elena H Martinez-Lapiscina
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Bernardo F Sanchez Dalmau
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Pablo Villoslada
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Nasrin Asgari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Romain Marignier
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alvaro Cobo-Calvo
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Letizia Leocani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marco Pisa
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marta Radaelli
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jacqueline Palace
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Adriana Roca-Fernandez
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Maria Isabel S Leite
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Srilakshmi Sharma
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jerome De Seze
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Thomas Senger
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Michael R Yeaman
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Terry J Smith
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lawrence J Cook
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alexander U Brandt
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Friedemann Paul
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
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Lin TY, Motamedi S, Asseyer S, Chien C, Saidha S, Calabresi PA, Fitzgerald KC, Samadzadeh S, Villoslada P, Llufriu S, Green AJ, Preiningerova JL, Petzold A, Leocani L, Garcia-Martin E, Oreja-Guevara C, Outteryck O, Vermersch P, Balcer LJ, Kenney R, Albrecht P, Aktas O, Costello F, Frederiksen J, Uccelli A, Cellerino M, Frohman EM, Frohman TC, Bellmann-Strobl J, Schmitz-Hübsch T, Ruprecht K, Brandt AU, Zimmermann HG, Paul F. Individual Prognostication of Disease Activity and Disability Worsening in Multiple Sclerosis With Retinal Layer Thickness z Scores. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200269. [PMID: 38941572 PMCID: PMC11214150 DOI: 10.1212/nxi.0000000000200269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/06/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Retinal optical coherence tomography (OCT) provides promising prognostic imaging biomarkers for future disease activity in multiple sclerosis (MS). However, raw OCT-derived measures have multiple dependencies, supporting the need for establishing reference values adjusted for possible confounders. The purpose of this study was to investigate the capacity for age-adjusted z scores of OCT-derived measures to prognosticate future disease activity and disability worsening in people with MS (PwMS). METHODS We established age-adjusted OCT reference data using generalized additive models for location, scale, and shape for peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GCIP) thicknesses, involving 910 and 423 healthy eyes, respectively. Next, we transformed the retinal layer thickness of PwMS from 3 published studies into age-adjusted z scores (pRNFL-z and GCIP-z) based on the reference data. Finally, we investigated the association of pRNFL-z or GCIP-z as predictors with future confirmed disability worsening (Expanded Disability Status Scale score increase) or disease activity (failing of the no evidence of disease activity [NEDA-3] criteria) as outcomes. Cox proportional hazards models or logistic regression analyses were applied according to the original studies. Optimal cutoffs were identified using the Akaike information criterion as well as location with the log-rank and likelihood-ratio tests. RESULTS In the first cohort (n = 863), 172 PwMS (24%) had disability worsening over a median observational period of 2.0 (interquartile range [IQR]:1.0-3.0) years. Low pRNFL-z (≤-2.04) were associated with an increased risk of disability worsening (adjusted hazard ratio (aHR) [95% CI] = 2.08 [1.47-2.95], p = 3.82e-5). In the second cohort (n = 170), logistic regression analyses revealed that lower pRNFL-z showed a higher likelihood for disability accumulation at the two-year follow-up (reciprocal odds ratio [95% CI] = 1.51[1.06-2.15], p = 0.03). In the third cohort (n = 78), 46 PwMS (59%) did not maintain the NEDA-3 status over a median follow-up of 2.0 (IQR: 1.9-2.1) years. PwMS with low GCIP-z (≤-1.03) had a higher risk of showing disease activity (aHR [95% CI] = 2.14 [1.03-4.43], p = 0.04). Compared with raw values with arbitrary cutoffs, applying the z score approach with optimal cutoffs showed better performance in discrimination and calibration (higher Harrell's concordance index and lower integrated Brier score). DISCUSSION In conclusion, our work demonstrated reference cohort-based z scores that account for age, a major driver for disease progression in MS, to be a promising approach for creating OCT-derived measures useable across devices and toward individualized prognostication.
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Affiliation(s)
- Ting-Yi Lin
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Seyedamirhosein Motamedi
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Susanna Asseyer
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Claudia Chien
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Shiv Saidha
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Peter A Calabresi
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Kathryn C Fitzgerald
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Sara Samadzadeh
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Pablo Villoslada
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Sara Llufriu
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Ari J Green
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Jana Lizrova Preiningerova
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Axel Petzold
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Letizia Leocani
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Elena Garcia-Martin
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Celia Oreja-Guevara
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Olivier Outteryck
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Patrick Vermersch
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Laura J Balcer
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Rachel Kenney
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Philipp Albrecht
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Orhan Aktas
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Fiona Costello
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Jette Frederiksen
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Antonio Uccelli
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Maria Cellerino
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Elliot M Frohman
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Teresa C Frohman
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Judith Bellmann-Strobl
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Tanja Schmitz-Hübsch
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Klemens Ruprecht
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Alexander U Brandt
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Hanna G Zimmermann
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Friedemann Paul
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
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Großpötzl M, Malle EM, Riedl R, Gran JD, Djavid D, Posch-Pertl L, Glatz WM, Falb T, Lindner E, Wedrich A, Ivastinovic D. Changes of individual retinal layer thickness post-uneventful cataract surgery determined by spectral-domain optical coherence tomography over a 3-months period. Heliyon 2024; 10:e35096. [PMID: 39170147 PMCID: PMC11336489 DOI: 10.1016/j.heliyon.2024.e35096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024] Open
Abstract
Purpose To evaluate retinal thickness changes of individual retinal layers using spectral-domain optical coherence tomography (SD-OCT) after uneventful cataract surgery over a 3-months period. Design Prospective cohort study. Methods 41 patients who underwent uneventful cataract surgery were included. Retinal SD-OCT images of both eyes were acquired preoperatively, 1 day after surgery as well as 1 month and 3 months postoperatively. Changes of retinal layer thickness were estimated after semi-automated segmentation for the following individual layers in the central subfield (CS, 1 mm) and inner ring (IR, 1-3 mm) of the early treatment diabetic retinopathy study (ETDRS) grid: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), RNFL-GCL-IPL complex, inner nuclear layer (INL), outer plexiform layer (OPL), INL-OPL complex, outer nuclear layer (ONL), inner retina layer (IRL) and the total retina (TR). Furthermore, a sub-analysis with exclusion of patients devoid CME and an analysis in regard of patient age, lens status of the fellow eye, best corrected visual acuity and duration of surgery was conducted. Results This study found significant alterations in all analysed retinal layers except for the RNFL (p = 0.33) and the GCL (p = 0.06) in the central subfield and the INL-OPL complex (p = 0.07) in the inner ring over the 3-months period (all p < 0.05). Retinal thickness decreases on the first postoperative day, followed by a significant increase 1 month after surgery and subsequent reduction at 3 months following uneventful cataract surgery could be observed. Conclusion These results assume the hypothesis that the apex of inflammatory response, characterized by an augmentation in the thickness of individual retinal layers, occurs around 1 month after uneventful cataract surgery, and subsequently experience a reduction in activity. Therefore, we suggest that additional therapy for cystoid macular edema does not have to be initiated as early as the first month in mild cases.
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Affiliation(s)
- Manuel Großpötzl
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Eva Maria Malle
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Jakob Daniel Gran
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Daniel Djavid
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Laura Posch-Pertl
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | | | - Thomas Falb
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Ewald Lindner
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
- Department of Ophthalmology, Faculty of Medicine University of Rijeka, Rijeka, Croatia
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Stübiger N, Ruprecht K, Pleyer U. [Uveitis and multiple sclerosis : Clinical aspects, diagnostics, management and treatment]. DIE OPHTHALMOLOGIE 2024; 121:665-678. [PMID: 39037464 DOI: 10.1007/s00347-024-02084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
Approximately 0.5-1% of patients with multiple sclerosis (MS) have co-existing uveitis. Both intraocular inflammation and MS mainly affect women in younger adulthood. The MS in patients is most frequently associated with an often bilateral intermediate uveitis with typical concomitant retinal vasculitis. Both diseases share similar characteristics with chronic inflammatory diseases with a relapsing course and an immune-mediated pathogenesis; however, it is still unclear whether the co-occurrence of uveitis and MS in the same patient represents a coincidence of two separate disease entities or whether uveitis is a rare clinical manifestation of MS. In the differential diagnostics of intermediate uveitis, clinical symptoms and signs of MS should be considered. As both diseases are considered to be immune-mediated, immunotherapy is the main treatment option. In recent years the range of medications has expanded and includes several disease modifying drugs (biologics). When selecting the active substance it must be taken into account that tumor necrosis factor (TNF) alpha blockers are contraindicated in patients with MS.
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Affiliation(s)
- Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Klemens Ruprecht
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland.
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Bsteh G, Hegen H, Krajnc N, Föttinger F, Altmann P, Auer M, Berek K, Kornek B, Leutmezer F, Macher S, Monschein T, Ponleitner M, Rommer P, Schmied C, Zebenholzer K, Zulehner G, Zrzavy T, Deisenhammer F, Di Pauli F, Pemp B, Berger T. Retinal layer thinning for monitoring disease-modifying treatment in relapsing multiple sclerosis-Evidence for applying a rebaselining concept. Mult Scler 2024; 30:1128-1138. [PMID: 39109593 DOI: 10.1177/13524585241267257] [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] [Indexed: 08/30/2024]
Abstract
BACKGROUND Employing a rebaselining concept may reduce noise in retinal layer thinning measured by optical coherence tomography (OCT). METHODS From an ongoing prospective observational study, we included patients with relapsing multiple sclerosis (RMS), who had OCT scans at disease-modifying treatment (DMT) start (baseline), 6-12 months after baseline (rebaseline), and ⩾12 months after rebaseline. Mean annualized percent loss (aL) rates (%/year) were calculated both from baseline and rebaseline for peripapillary-retinal-nerve-fiber-layer (aLpRNFLbaseline/aLpRNFLrebaseline) and macular-ganglion-cell-plus-inner-plexiform-layer (aLGCIPLbaseline/aLGCIPLrebaseline) by mixed-effects linear regression models. RESULTS We included 173 RMS patients (mean age 31.7 years (SD 8.8), 72.8% female, median disease duration 15 months (12-94) median baseline-to-last-follow-up-interval 37 months (18-71); 56.6% moderately effective DMT (M-DMT), 43.4% highly effective DMT (HE-DMT)). Both mean aLpRNFLbaseline and aLGCIPLbaseline significantly increased in association with relapse (0.51% and 0.26% per relapse, p < 0.001, respectively) and disability worsening (1.10% and 0.48%, p < 0.001, respectively) before baseline, but not with DMT class. Contrarily, neither aLpRNFLrebaseline nor aLGCIPLrebaseline was dependent on relapse or disability worsening before baseline, while HE-DMT significantly lowered aLpRNFLrebaseline (by 0.31%, p < 0.001) and aLGCIPLrebaseline (0.25%, p < 0.001) compared with M-DMT. CONCLUSIONS Applying a rebaselining concept significantly improves differentiation of DMT effects on retinal layer thinning by avoiding carry-over confounding from previous disease activity.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Fabian Föttinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Tobias Monschein
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christiane Schmied
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Berthold Pemp
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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6
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Aghababaei A, Arian R, Soltanipour A, Ashtari F, Rabbani H, Kafieh R. Discrimination of multiple sclerosis using scanning laser ophthalmoscopy images with autoencoder-based feature extraction. Mult Scler Relat Disord 2024; 88:105743. [PMID: 38945032 DOI: 10.1016/j.msard.2024.105743] [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: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Optical coherence tomography (OCT) investigations have revealed that the thickness of inner retinal layers becomes decreased in multiple sclerosis (MS) patients, compared to healthy control (HC) individuals. To date, a number of studies have applied machine learning to OCT thickness measurements, aiming to enable accurate and automated diagnosis of the disease. However, there have much less emphasis on other less common retinal imaging modalities, like infrared scanning laser ophthalmoscopy (IR-SLO), for classifying MS. IR-SLO uses laser light to capture high-resolution fundus images, often performed in conjunction with OCT to lock B-scans at a fixed position. METHODS We incorporated two independent datasets of IR-SLO images from the Isfahan and Johns Hopkins centers, consisting of 164 MS and 150 HC images. A subject-wise data splitting approach was employed to ensure that there was no leakage between training and test datasets. Several state-of-the-art convolutional neural networks (CNNs), including VGG-16, VGG-19, ResNet-50, and InceptionV3, and a CNN with a custom architecture were employed. In the next step, we designed a convolutional autoencoder (CAE) to extract semantic features subsequently given as inputs to four conventional ML classifiers, including support vector machine (SVM), k-nearest neighbor (K-NN), random forest (RF), and multi-layer perceptron (MLP). RESULTS The custom CNN (85 % accuracy, 85 % sensitivity, 87 % specificity, 93 % area under the receiver operating characteristics [AUROC], and 94 % area under the precision-recall curve [AUPRC]) outperformed state-of-the-art models (84 % accuracy, 83 % sensitivity, 87 % specificity, 92 % AUROC, and 94 % AUPRC); however, utilizing a combination of the CAE and MLP yields even superior results (88 % accuracy, 86 % sensitivity, 91 % specificity, 94 % AUROC, and 95 % AUPRC). CONCLUSIONS We utilized IR-SLO images to differentiate between MS and HC eyes, with promising results achieved using a combination of CAE and MLP. Future multi-center studies involving more heterogenous data are necessary to assess the feasibility of integrating IR-SLO images into routine clinical practice.
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Affiliation(s)
- Ali Aghababaei
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Arian
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Soltanipour
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Rabbani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Kafieh
- Department of Engineering, Durham University, South Road, Durham, UK.
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7
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Elwood BW, Godwin CR, Anders JJ, Kardon RH, Gramlich OW. Correlation of Visual System Biomarkers With Motor Deficits in Experimental Autoimmune Encephalomyelitis-Optic Neuritis. Transl Vis Sci Technol 2024; 13:1. [PMID: 39087931 PMCID: PMC11305423 DOI: 10.1167/tvst.13.8.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose Experimental autoimmune encephalomyelitis (EAE) scoring, the most commonly used primary outcome metric for an in vivo model of multiple sclerosis (MS), is highly variable and subjective. Here we explored the use of visual biomarkers in EAE as more objective and clinically relevant primary outcomes. Methods Motor impairment in myelin oligodendrocyte glycoprotein-immunized C57BL/6J mice was quantified using a five-point EAE grading scale. Pattern electroretinography (pERG) and retinal ganglion cell/inner plexiform layer (RGC/IPL) complex thickness were measured 60 days after induction. Optic nerve histopathology was analyzed at endpoint. Results EAE mice displayed motor impairments ranging from mild to severe. Significant correlations were seen between pERG amplitude and last EAE score, mean EAE score, and cumulative EAE score. Optical coherence tomography (OCT) analysis demonstrated a significant correlation between thinning of the RGC/IPL complex and both EAE score and pERG amplitude. Optic nerve histopathology showed significant correlations between demyelination and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness, as well as between immune cell infiltration and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness in EAE mice. Conclusions Unlike EAE scoring, pERG and OCT show direct measurement of retinal structure and function. Therefore we conclude that visual outcomes are well suited as a direct assessment of optic nerve involvement in this EAE model of MS while also being indicative of motor impairment. Translational Relevance Standardizing directly translatable measurements as primary outcome parameters in the murine EAE model could lead to more rapid and relevant testing of new therapeutic approaches for mitigating MS.
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Affiliation(s)
- Benjamin W. Elwood
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Cheyanne R. Godwin
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jeffrey J. Anders
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
| | - Randy H. Kardon
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Oliver W. Gramlich
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
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8
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Rovira À, Vidal-Jordana A, Auger C, Sastre-Garriga J. Optic Nerve Imaging in Multiple Sclerosis and Related Disorders. Neuroimaging Clin N Am 2024; 34:399-420. [PMID: 38942524 DOI: 10.1016/j.nic.2024.03.005] [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] [Indexed: 06/30/2024]
Abstract
Optic neuritis is a common feature in multiple sclerosis and in 2 other autoimmune demyelinating disorders such as aquaporin-4 IgG antibody-associated neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Although serologic testing is critical for differentiating these different autoimmune-mediated disorders, MR imaging, which is the preferred imaging modality for assessing the optic nerve, can provide valuable information, suggesting a specific diagnosis and guiding the appropriate serologic testing.
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Affiliation(s)
- Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain.
| | - Angela Vidal-Jordana
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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9
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Hong Y, Lan L, Hu X, Zuo Y, Deng M, Ye K, Xu F, Chen C, Li M. A cross-sectional study on the impact of hemodialysis duration on retinal nerve fiber layer thinning in hemodialysis patients. Sci Rep 2024; 14:17824. [PMID: 39090115 PMCID: PMC11294536 DOI: 10.1038/s41598-024-68589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
This study aimed to investigate the relationship between hemodialysis duration (HDD) and retinal nerve fiber layer (RNFL) thickness. A total of 60 patients receiving maintenance hemodialysis and 67 healthy controls were analyzed. Spectral domain optical coherence tomography (SD-OCT) was employed to measure annular RNFL thicknesses. The hemodialysis group exhibited reduced temporal and inferior RNFL thicknesses relative to the control group. In hemodialysis patients, the inferior RNFL thickness was negatively correlated with HDD and positively correlated with intraocular pressure (IOP). Moreover, IOP was positively correlated with HDD. Mediation analysis showed that the negative correlation between HDD and inferior RNFL thickness was mediated by IOP. In conclusion, hemodialysis leads to temporal and inferior RNFL thinning, and the thickness reduction is proportional to hemodialysis duration. However, such changes are not induced by an increase in IOP.
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Affiliation(s)
- Yiyi Hong
- Eye Center of Renmin Hospital of Wuhan University, Wuhan University, Wuhan, 430060, Hubei, China
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Lin Lan
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiangyu Hu
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Yuan Zuo
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Meiqiu Deng
- Department of Nephrology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Kun Ye
- Department of Nephrology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Fan Xu
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Changzheng Chen
- Eye Center of Renmin Hospital of Wuhan University, Wuhan University, Wuhan, 430060, Hubei, China.
| | - Min Li
- Research Center of Ophthalmology, Guangxi Academy of Medical Sciences and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology and Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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10
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Mulazzani E, Böhm L, Christmann T, Krumbholz M, Kümpfel T, Havla J. Optical coherence tomography assessment of disease activity in cryopyrin-associated periodic syndrome. Eur J Neurol 2024; 31:e16301. [PMID: 38628041 PMCID: PMC11235936 DOI: 10.1111/ene.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND AND PURPOSE Cryopyrin-associated periodic syndrome is a rare autoinflammatory disease caused by gain-of-function mutations or variants in the NLRP3 gene. Clinically, patients suffer from a broad spectrum of both systemic and neurological symptoms. The aim of this study was to determine whether systemic inflammation demonstrated by serum amyloid A (SAA) elevation is associated with neuroinflammation assessed by optical coherence tomography (OCT). METHODS Thirty eyes of 15 patients with NLRP3 low penetrance mutations (PwNLRP3) and 20 eyes of 10 age- and sex-matched healthy controls were examined by spectral-domain OCT as part of routine clinical care. All retinal layers and clinical features were evaluated. RESULTS At baseline no significant retinal neuroaxonal inflammation or degeneration was observed in all measured retinal layers amongst PwNLRP3 compared with healthy controls. In a pooled analysis of all individual OCT time points a significant difference regarding the macular retinal nerve fibre layer was detected. Increased levels of SAA showed a positive association with averaged combined outer plexiform layer and outer nuclear layer volumes (ρ < 0.0001, r2 = 0.35). CONCLUSION In cryopyrin-associated periodic syndrome increased combined outer plexiform layer and outer nuclear layer volumes are mirrored by SAA increase, an acute phase reactant indicating systemic inflammation. Our findings identify OCT as a candidate biomarker to monitor subclinical neuroinflammation and to assess disease activity in PwNLRP3.
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Affiliation(s)
- E. Mulazzani
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - L. Böhm
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - T. Christmann
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - M. Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik RüdersdorfUniversity Hospital of the Brandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Faculty of Health Sciences BrandenburgBrandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
| | - T. Kümpfel
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - J. Havla
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
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11
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Wolf E, Wicklein R, Aly L, Schmaderer C, Afzali AM, Mardin C, Korn T, Hemmer B, Hofauer B, Knier B. Optical coherence tomography angiography suggests different retinal pathologies in multiple sclerosis and Sjögren's syndrome. J Neurol 2024; 271:4610-4619. [PMID: 38743089 PMCID: PMC11233347 DOI: 10.1007/s00415-024-12414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND While retinal vessel changes are evident in the eyes of patients with relapsing-remitting multiple sclerosis (RRMS), changes in the vasculature of possible MS mimics such as primary Sjögren's syndrome (pSS) remain to be determined. We investigated the potential of retinal optical coherence tomography (OCT) angiography (OCTA) as diagnostic tool to differentiate between patients with RRMS and pSS. METHODS This cross-sectional study included patients with RRMS (n = 36), pSS (n = 36) and healthy controls (n = 30). Participants underwent clinical examination, assessment of visual acuity, retinal OCT, OCTA, and serum markers of glial and neuronal damage. We investigated the associations between OCTA parameters, visual functions, and serum markers. Eyes with a history of optic neuritis (ON) were excluded from analysis. RESULTS We observed a significant thinning of the combined ganglion cell and inner plexiform layer in the eyes of patients with RRMS but not with pSS, when compared to healthy controls. Retinal vessel densities of the superficial vascular complex (SVC) were reduced in both patients with RRMS and pSS. However, retinal vessel rarefication of the deep vascular complex (DVC) was only evident in patients with pSS but not RRMS. Using multivariate regression analysis, we found that DVC vessel loss in pSS patients was associated with worse visual acuity. CONCLUSIONS Compared to patients with RRMS, rarefication of deep retinal vessels is a unique characteristic of pSS and associated with worse visual function. Assuming a disease-specific retinal vessel pathology, these data are indicative of a differential affliction of the gliovascular complex in the retina of RRMS and pSS patients.
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Affiliation(s)
- Elisabeth Wolf
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Otorhinolaryngology/Head and Neck Surgery, Tirol Kliniken, Universitätskliniken Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Department of Neurology, Diakonie-Klinkum Schwäbisch Hall, Schwäbisch Hall, Germany.
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12
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Arian R, Aghababaei A, Soltanipour A, Khodabandeh Z, Rakhshani S, Iyer SB, Ashtari F, Rabbani H, Kafieh R. SLO-Net: Enhancing Multiple Sclerosis Diagnosis Beyond Optical Coherence Tomography Using Infrared Reflectance Scanning Laser Ophthalmoscopy Images. Transl Vis Sci Technol 2024; 13:13. [PMID: 39017629 PMCID: PMC11262482 DOI: 10.1167/tvst.13.7.13] [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: 10/02/2023] [Accepted: 04/27/2024] [Indexed: 07/18/2024] Open
Abstract
Purpose Several machine learning studies have used optical coherence tomography (OCT) for multiple sclerosis (MS) classification with promising outcomes. Infrared reflectance scanning laser ophthalmoscopy (IR-SLO) captures high-resolution fundus images, commonly combined with OCT for fixed B-scan positions. However, no machine learning research has utilized IR-SLO images for automated MS diagnosis. Methods This study utilized a dataset comprised of IR-SLO images and OCT data from Isfahan, Iran, encompassing 32 MS and 70 healthy individuals. A number of convolutional neural networks (CNNs)-namely, VGG-16, VGG-19, ResNet-50, ResNet-101, and a custom architecture-were trained with both IR-SLO images and OCT thickness maps as two separate input datasets. The highest performing models for each modality were then integrated to create a bimodal model that receives the combination of OCT thickness maps and IR-SLO images. Subject-wise data splitting was employed to prevent data leakage among training, validation, and testing sets. Results Overall, images of the 102 patients from the internal dataset were divided into test, validation, and training subsets. Subsequently, we employed a bootstrapping approach on the training data through iterative sampling with replacement. The performance of the proposed bimodal model was evaluated on the internal test dataset, demonstrating an accuracy of 92.40% ± 4.1% (95% confidence interval [CI], 83.61-98.08), sensitivity of 95.43% ± 5.75% (95% CI, 83.71-100.0), specificity of 92.82% ± 3.72% (95% CI, 81.15-96.77), area under the receiver operating characteristic (AUROC) curve of 96.99% ± 2.99% (95% CI, 86.11-99.78), and area under the precision-recall curve (AUPRC) of 97.27% ± 2.94% (95% CI, 86.83-99.83). Furthermore, to assess the model generalization ability, we examined its performance on an external test dataset following the same bootstrap methodology, achieving promising results, with accuracy of 85.43% ± 0.08% (95% CI, 71.43-100.0), sensitivity of 97.33% ± 0.06% (95% CI, 83.33-100.0), specificity of 84.6% ± 0.10% (95% CI, 71.43-100.0), AUROC curve of 99.67% ± 0.02% (95% CI, 95.63-100.0), and AUPRC of 99.65% ± 0.02% (95% CI, 94.90-100.0). Conclusions Incorporating both modalities improves the performance of automated diagnosis of MS, showcasing the potential of utilizing IR-SLO as a complementary tool alongside OCT. Translational Relevance Should the results of our proposed bimodal model be validated in future work with larger and more diverse datasets, diagnosis of MS based on both OCT and IR-SLO can be reliably integrated into routine clinical practice.
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Affiliation(s)
- Roya Arian
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Aghababaei
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Soltanipour
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Khodabandeh
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajed Rakhshani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shwasa B. Iyer
- Department of Engineering, Durham University, Durham, UK
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Rabbani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Kafieh
- Department of Engineering, Durham University, Durham, UK
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13
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Woo MS, Engler JB, Friese MA. The neuropathobiology of multiple sclerosis. Nat Rev Neurosci 2024; 25:493-513. [PMID: 38789516 DOI: 10.1038/s41583-024-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Chronic low-grade inflammation and neuronal deregulation are two components of a smoldering disease activity that drives the progression of disability in people with multiple sclerosis (MS). Although several therapies exist to dampen the acute inflammation that drives MS relapses, therapeutic options to halt chronic disability progression are a major unmet clinical need. The development of such therapies is hindered by our limited understanding of the neuron-intrinsic determinants of resilience or vulnerability to inflammation. In this Review, we provide a neuron-centric overview of recent advances in deciphering neuronal response patterns that drive the pathology of MS. We describe the inflammatory CNS environment that initiates neurotoxicity by imposing ion imbalance, excitotoxicity and oxidative stress, and by direct neuro-immune interactions, which collectively lead to mitochondrial dysfunction and epigenetic dysregulation. The neuronal demise is further amplified by breakdown of neuronal transport, accumulation of cytosolic proteins and activation of cell death pathways. Continuous neuronal damage perpetuates CNS inflammation by activating surrounding glia cells and by directly exerting toxicity on neighbouring neurons. Further, we explore strategies to overcome neuronal deregulation in MS and compile a selection of neuronal actuators shown to impact neurodegeneration in preclinical studies. We conclude by discussing the therapeutic potential of targeting such neuronal actuators in MS, including some that have already been tested in interventional clinical trials.
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Affiliation(s)
- Marcel S Woo
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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14
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Steiner OL, Klostermann F. Central involvement in peripheral disease: melanopsin pathway impairment in chronic inflammatory demyelinating polyneuropathy. Brain Commun 2024; 6:fcae206. [PMID: 39015766 PMCID: PMC11249960 DOI: 10.1093/braincomms/fcae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/26/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) compromises functions of the peripheral nervous system (PNS). Recently, however, symptoms such as cognitive deficits, visual dysfunction and circadian disorders were reported, compatible with additional involvement of the central nervous system (CNS) in CIDP. Against this background, we were interested in the functional state of melanopsin-expressing retinal ganglion cells (mRGCs) as a potential biomarker for sleep-wake abnormalities and CNS involvement in CIDP. Based on a chromatic pupillometry protocol, we examined the integrity of the melanopsin system in a prospective case-control study in 20 persons with CIDP compared to 20 controls without CIDP. The results were referred to clinical measures of disease severity and sleep behaviour. Patients with CIDP had a significantly reduced melanopsin-mediated post-illumination pupil response (PIPR) compared to healthy controls (25% versus 36%; P < 0.01). This reduction correlated with disease severity (r = 0.478, P < 0.05). Further, patients with CIDP reported diminished sleep quality (P < 0.05); however, there was no significant correlation with the melanopsin-mediated PIPR. The results demonstrate an impairment of mRGC function related to CIDP. Since the PIPR reduction correlated with disease severity, it could be an easily available biomarker for CNS affection in CIDP, a condition defined as PNS disorder.
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Affiliation(s)
- Oliver L Steiner
- Department of Neurology, Motor and Cognition Group, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin (CBF), 12203 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
- Institute of Psychology, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Fabian Klostermann
- Department of Neurology, Motor and Cognition Group, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin (CBF), 12203 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
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15
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Reynolds GL, Plant G, Epps S, Sebastian R, Bennetto L. Glaucoma: what the neurologist needs to know. Pract Neurol 2024:pn-2023-003905. [PMID: 38906698 DOI: 10.1136/pn-2023-003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
Glaucoma is a progressive optic neuropathy resulting from pathological changes at the optic disc due to elevated intraocular pressure. Its diagnosis, treatment and follow-up are almost entirely conducted in ophthalmology clinics, with screening conducted by community optometrists. Despite this, neurologists may encounter glaucoma in both its acute presentation (as angle closure, presenting as acute headache) and its chronic forms (often as optic neuropathy of unknown cause). An awareness of the underlying pathological process, and the key distinguishing signs and symptoms, will allow neurologists to identify the glaucomatous process rapidly. Timely referral is essential as glaucoma invariably results in progressive visual loss without treatment. This review therefore condenses the wide field of glaucoma into a practical summary, aimed at practitioners with limited clinical experience of this ophthalmic condition.
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Affiliation(s)
- Gavin L Reynolds
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Gordon Plant
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Epps
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Rani Sebastian
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Luke Bennetto
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
- Department of Neuroscience, North Bristol NHS Trust Southmead Hospital, Bristol, UK
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16
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Buonamassa R, Boscia G, Gaudiomonte M, Guerriero S, Fischetto R, Montepara A, Grassi MO, Pignataro MG, Puzo P, Giancipoli E, D’addario M, Alessio G, Boscia F, Viggiano P. Neurovascular retinal impairment in early-treated adults with phenylketonuria. Front Neurol 2024; 15:1305984. [PMID: 38974690 PMCID: PMC11225547 DOI: 10.3389/fneur.2024.1305984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose To compare radial peripapillary capillary (RPC) vascular plexus parameters and peripapillary retinal nerve fiber layer (pRNFL) thickness between Early-Treated Adults with Phenylketonuria (ETPKU) and controls. Methods This observational study was a monocentric, case control study including 36 eyes of 36 participants. Among these, 18 were early-treated PKU (ETPKU) and 18 were controls. A SD-OCTA (XR Avanti AngioVue OCTA; Optovue Inc., Fremont, CA) was employed to assess the OCT and OCTA parameters of all the participants. The main outcome measures were the RPC vessels density (VD) %, and the pRNFL thickness. Results The average pRNFL thickness was significantly reduced in ETPKU (110.78 ± 12.48 μm) compared to controls (113.22 ± 13.95 μm), p = 0.046. The mean VD% of the small vessels of the RPC plexus was 52.31 ± 2.2 in ETPKU and 50.71 ± 3.2 in controls (p = 0.049), while the VD% of all the radial peripapillary capillary plexus (RPCP) was 58.5 ± 2.2 in ETPKU and 55.08 ± 3.4 in controls (p < 0.001). By contrast, there were no differences in age, sex, and IOP between the two groups. Conclusion Through structural OCT and OCTA, we observed thinning of the nerve fibers accompanied by an increase in perfusion of the RPC plexus. Thus, our conclusions suggest that OCTA may serve as a noninvasive method to identify novel retinal biomarkers in ETPKU.
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Affiliation(s)
- Rosa Buonamassa
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Marida Gaudiomonte
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Silvana Guerriero
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Rita Fischetto
- Metabolic Diseases and Clinical Genetics Unit, Department of Pediatric Medicine, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Alfonso Montepara
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Grazia Pignataro
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Pasquale Puzo
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Marina D’addario
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
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17
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Cujbă L, Banc A, Drugan T, Coadă CA, Cristea AP, Stan C, Nicula C. Homonymous Hemiatrophy of Macular Ganglion Cell Layer as a Marker of Retrograde Neurodegeneration in Multiple Sclerosis-A Narrative Review. Diagnostics (Basel) 2024; 14:1255. [PMID: 38928670 PMCID: PMC11202963 DOI: 10.3390/diagnostics14121255] [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: 04/28/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Retrograde axonal neurodegeneration along the visual pathway-either direct or trans-synaptic-has already been demonstrated in multiple sclerosis (MS), as well as in compressive, vascular, or posttraumatic lesions of the visual pathway. Optical coherence tomography (OCT) can noninvasively track macular and optic nerve changes occurring as a result of this phenomenon. Our paper aimed to review the existing literature regarding hemimacular atrophic changes in the ganglion cell layer identified using OCT examination in MS patients without prior history of optic neuritis. Homonymous hemimacular atrophy has been described in post-chiasmal MS lesions, even in patients with normal visual field results. Temporal and nasal macular OCT evaluation should be performed separately in all MS patients, in addition to an optic nerve OCT evaluation and a visual field exam.
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Affiliation(s)
- Larisa Cujbă
- Medical Doctoral School, University of Oradea, 410087 Oradea, Romania;
| | - Ana Banc
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.B.); (C.S.)
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Camelia Alexandra Coadă
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andreea-Petra Cristea
- Department of Ophthalmology, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Cristina Stan
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.B.); (C.S.)
| | - Cristina Nicula
- Department of Maxillo-Facial Surgery and Radiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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18
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Bsteh G, Dal Bianco A, Zrzavy T, Berger T. Novel and Emerging Treatments to Target Pathophysiological Mechanisms in Various Phenotypes of Multiple Sclerosis. Pharmacol Rev 2024; 76:564-578. [PMID: 38719481 DOI: 10.1124/pharmrev.124.001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024] Open
Abstract
The objective is to comprehensively review novel pharmacotherapies used in multiple sclerosis (MS) and the possibilities they may carry for therapeutic improvement. Specifically, we discuss pathophysiological mechanisms worth targeting in MS, ranging from well known targets, such as autoinflammation and demyelination, to more novel and advanced targets, such as neuroaxonal damage and repair. To set the stage, a brief overview of clinical MS phenotypes is provided, followed by a comprehensive recapitulation of both clinical and paraclinical outcomes available to assess the effectiveness of treatments in achieving these targets. Finally, we discuss various promising novel and emerging treatments, including their respective hypothesized modes of action and currently available evidence from clinical trials. SIGNIFICANCE STATEMENT: This comprehensive review discusses pathophysiological mechanisms worth targeting in multiple sclerosis. Various promising novel and emerging treatments, including their respective hypothesized modes of action and currently available evidence from clinical trials, are reviewed.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Assunta Dal Bianco
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
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19
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Suh A, Hampel G, Vinjamuri A, Ong J, Kamran SA, Waisberg E, Paladugu P, Zaman N, Sarker P, Tavakkoli A, Lee AG. Oculomics analysis in multiple sclerosis: Current ophthalmic clinical and imaging biomarkers. Eye (Lond) 2024:10.1038/s41433-024-03132-y. [PMID: 38858520 DOI: 10.1038/s41433-024-03132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/18/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Multiple Sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system (CNS) characterized by inflammation, demyelination, and axonal damage. Early recognition and treatment are important for preventing or minimizing the long-term effects of the disease. Current gold standard modalities of diagnosis (e.g., CSF and MRI) are invasive and expensive in nature, warranting alternative methods of detection and screening. Oculomics, the interdisciplinary combination of ophthalmology, genetics, and bioinformatics to study the molecular basis of eye diseases, has seen rapid development through various technologies that detect structural, functional, and visual changes in the eye. Ophthalmic biomarkers (e.g., tear composition, retinal nerve fibre layer thickness, saccadic eye movements) are emerging as promising tools for evaluating MS progression. The eye's structural and embryological similarity to the brain makes it a potentially suitable assessment of neurological and microvascular changes in CNS. In the advent of more powerful machine learning algorithms, oculomics screening modalities such as optical coherence tomography (OCT), eye tracking, and protein analysis become more effective tools aiding in MS diagnosis. Artificial intelligence can analyse larger and more diverse data sets to potentially discover new parameters of pathology for efficiently diagnosing MS before symptom onset. While there is no known cure for MS, the integration of oculomics with current modalities of diagnosis creates a promising future for developing more sensitive, non-invasive, and cost-effective approaches to MS detection and diagnosis.
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Affiliation(s)
- Alex Suh
- Tulane University School of Medicine, New Orleans, LA, USA.
| | - Gilad Hampel
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Galveston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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20
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Cujbă L, Banc A, Stan C, Drugan T, Nicula C. Macular OCT's Proficiency in Identifying Retrochiasmal Visual Pathway Lesions in Multiple Sclerosis-A Pilot Study. Diagnostics (Basel) 2024; 14:1221. [PMID: 38928637 PMCID: PMC11202879 DOI: 10.3390/diagnostics14121221] [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: 04/29/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive imaging technique based on the principle of low-coherence interferometry that captures detailed images of ocular structures. Multiple sclerosis (MS) is a neurodegenerative disease that can lead to damage of the optic nerve and retina, which can be depicted by OCT. The purpose of this pilot study is to determine whether macular OCT can be used as a biomarker in the detection of retrochiasmal lesions of the visual pathway in MS patients. We conducted a prospective study in which we included 52 MS patients and 27 healthy controls. All participants underwent brain MRI, visual field testing, and OCT evaluation of the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer (GCL), and macular inner plexiform layer (IPL). OCT measurements were adjusted for optic neuritis (ON). VF demonstrated poor capability to depict a retrochiasmal lesion identified by brain MRI (PPV 0.50). In conclusion, the OCT analysis of the macula appears to excel in identifying retrochiasmal MS lesions compared to VF changes. The alterations in the GCL and IPL demonstrate the most accurate detection of retrochiasmal visual pathway changes in MS patients.
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Affiliation(s)
- Larisa Cujbă
- Medical Doctoral School, University of Oradea, 410087 Oradea, Romania;
| | - Ana Banc
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Cristina Stan
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Cristina Nicula
- Department of Maxillo-Facial Surgery and Radiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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21
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Dongil-Moreno FJ, Ortiz M, Pueyo A, Boquete L, Sánchez-Morla EM, Jimeno-Huete D, Miguel JM, Barea R, Vilades E, Garcia-Martin E. Diagnosis of multiple sclerosis using optical coherence tomography supported by explainable artificial intelligence. Eye (Lond) 2024; 38:1502-1508. [PMID: 38297153 PMCID: PMC11126721 DOI: 10.1038/s41433-024-02933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/10/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND/OBJECTIVES Study of retinal structure based on optical coherence tomography (OCT) data can facilitate early diagnosis of relapsing-remitting multiple sclerosis (RRMS). Although artificial intelligence can provide highly reliable diagnoses, the results obtained must be explainable. SUBJECTS/METHODS The study included 79 recently diagnosed RRMS patients and 69 age matched healthy control subjects. Thickness (Avg) and inter-eye difference (Diff) features are obtained in 4 retinal layers using the posterior pole protocol. Each layer is divided into six analysis zones. The Support Vector Machine plus Recursive Feature Elimination with Leave-One-Out Cross Validation (SVM-RFE-LOOCV) approach is used to find the subset of features that reduces dimensionality and optimises the performance of the classifier. RESULTS SVM-RFE-LOOCV was used to identify OCT features with greatest capacity for early diagnosis, determining the area of the papillomacular bundle to be the most influential. A correlation was observed between loss of layer thickness and increase in functional disability. There was also greater functional deterioration in patients with greater asymmetry between left and right eyes. The classifier based on the top-ranked features obtained sensitivity = 0.86 and specificity = 0.90. CONCLUSIONS There was consistency between the features identified as relevant by the SVM-RFE-LOOCV approach and the retinotopic distribution of the retinal nerve fibres and the optic nerve head. This simple method contributes to implementation of an assisted diagnosis system and its accuracy exceeds that achieved with magnetic resonance imaging of the central nervous system, the current gold standard. This paper provides novel insights into RRMS affectation of the neuroretina.
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Affiliation(s)
- F J Dongil-Moreno
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - M Ortiz
- School of Physics, University of Melbourne, Melbourne, 3010, VIC, Australia
| | - A Pueyo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Biotech Vision SLP, spin-off Company, University of Zaragoza, Zaragoza, Spain
| | - L Boquete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - E M Sánchez-Morla
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense, 28040, Madrid, Spain
| | - D Jimeno-Huete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - J M Miguel
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - R Barea
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - E Vilades
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Biotech Vision SLP, spin-off Company, University of Zaragoza, Zaragoza, Spain
| | - E Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain.
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Biotech Vision SLP, spin-off Company, University of Zaragoza, Zaragoza, Spain.
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22
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Prathapan V, Eipert P, Wigger N, Kipp M, Appali R, Schmitt O. Modeling and simulation for prediction of multiple sclerosis progression. Comput Biol Med 2024; 175:108416. [PMID: 38657465 DOI: 10.1016/j.compbiomed.2024.108416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In light of extensive work that has created a wide range of techniques for predicting the course of multiple sclerosis (MS) disease, this paper attempts to provide an overview of these approaches and put forth an alternative way to predict the disease progression. For this purpose, the existing methods for estimating and predicting the course of the disease have been categorized into clinical, radiological, biological, and computational or artificial intelligence-based markers. Weighing the weaknesses and strengths of these prognostic groups is a profound method that is yet in need and works directly at the level of diseased connectivity. Therefore, we propose using the computational models in combination with established connectomes as a predictive tool for MS disease trajectories. The fundamental conduction-based Hodgkin-Huxley model emerged as promising from examining these studies. The advantage of the Hodgkin-Huxley model is that certain properties of connectomes, such as neuronal connection weights, spatial distances, and adjustments of signal transmission rates, can be taken into account. It is precisely these properties that are particularly altered in MS and that have strong implications for processing, transmission, and interactions of neuronal signaling patterns. The Hodgkin-Huxley (HH) equations as a point-neuron model are used for signal propagation inside a small network. The objective is to change the conduction parameter of the neuron model, replicate the changes in myelin properties in MS and observe the dynamics of the signal propagation across the network. The model is initially validated for different lengths, conduction values, and connection weights through three nodal connections. Later, these individual factors are incorporated into a small network and simulated to mimic the condition of MS. The signal propagation pattern is observed after inducing changes in conduction parameters at certain nodes in the network and compared against a control model pattern obtained before the changes are applied to the network. The signal propagation pattern varies as expected by adapting to the input conditions. Similarly, when the model is applied to a connectome, the pattern changes could give an insight into disease progression. This approach has opened up a new path to explore the progression of the disease in MS. The work is in its preliminary state, but with a future vision to apply this method in a connectome, providing a better clinical tool.
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Affiliation(s)
- Vishnu Prathapan
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Peter Eipert
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Nicole Wigger
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Markus Kipp
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Revathi Appali
- Institute of General Electrical Engineering, University of Rostock, Albert-Einstein-Straße 2, 18059, Rostock, Germany; Department of Aging of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Universitätsplatz 1, 18055, Rostock, Germany.
| | - Oliver Schmitt
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany; Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
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23
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Zhong W, Yang Q, Wang F, Lin X, Chen Z, Xue J, Zhao W, Liu X, Rao B, Zhang J. Cell-specific localization of β-synuclein in the mouse retina. Brain Struct Funct 2024; 229:1279-1298. [PMID: 38703218 DOI: 10.1007/s00429-024-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
β-synuclein, a member of the synuclein family, is frequently co-expressed with α-synuclein in the neural system, where it serves to inhibit abnormal aggregation of α-synuclein in neurodegenerative diseases. Beyond its role in pathological conditions, β-synuclein plays various functions independently of α-synuclein. In our investigation, we discovered a broader expression of β-synuclein in the mouse retina compared to α-synuclein. This widespread pattern implies its potential significance in the retina. Through detailed examination via light- and electron-microscopic immunocytochemistry, we identified β-synuclein expression from the inner segment (IS) and outer segment (OS) of photoreceptor cells to the ganglion cell layer (GCL). Our findings unveiled unique features, including β-synuclein immunoreactive IS and OS of cones, higher expression in cone pedicles than in rod spherules, absence in horizontal cells, limited expression in cone bipolar dendrites and somas, higher expression in cone bipolar terminals, presence in most amacrine cells, and expression in almost majority of somas in GCL with an absence in intrinsically photosensitive retinal ganglion cell (ipRGCs) processes. Notably, all cholinergic amacrine cells express high β- but not α-synuclein, while dopaminergic amacrine cells express α-synuclein exclusively. These distinctive expression patterns offer valuable insights for further exploration into the functions of β-synuclein and its potential role in synuclein pathology within the retina.
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Affiliation(s)
- Wenhui Zhong
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
| | - Qingwen Yang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Fenglan Wang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xin Lin
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Zhongqun Chen
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Jing Xue
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Wenna Zhao
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xiaoqing Liu
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Bilin Rao
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Jun Zhang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Laboratory of Retinal Physiology and Disease, School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
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24
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Tang WSW, Lau NXM, Krishnan MN, Chin YC, Ho CSH. Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications. J Clin Med 2024; 13:3081. [PMID: 38892791 PMCID: PMC11172702 DOI: 10.3390/jcm13113081] [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: 04/20/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.
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Affiliation(s)
- Wymann Shao Wen Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Nicole Xer Min Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | | | - You Chuen Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Raffles Medical Group, Singapore 188770, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore
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25
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Yao A, Nishitani S, Yamada Y, Oshima H, Sugihara Y, Makita K, Takiguchi S, Kawata NYS, Fujisawa TX, Okazawa H, Inatani M, Tomoda A. Subclinical structural atypicality of retinal thickness and its association with gray matter volume in the visual cortex of maltreated children. Sci Rep 2024; 14:11465. [PMID: 38769421 PMCID: PMC11106279 DOI: 10.1038/s41598-024-62392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 05/16/2024] [Indexed: 05/22/2024] Open
Abstract
Childhood maltreatment is reportedly associated with atypical gray matter structures in the primary visual cortex (V1). This study explores the hypothesis that retinal structures, the sensory organs of vision, are associated with brain atypicality and child maltreatment and examines their interrelation. General ophthalmologic examinations, visual cognitive tasks, retinal imaging, and structural magnetic resonance imaging (MRI) were conducted in children and adolescents aged 9-18 years with maltreatment experiences (CM) and typically developing (TD) children. The retinal nerve fiber layer (RNFL), the most superficial of the ten distinct retinal layers, was found to be significantly thinner in both eyes in CM. While whole-brain analysis using Voxel-based morphometry revealed a significantly larger gray matter volume (GMV) in the thalamus in CM, no significant correlation with RNFL thickness was observed. However, based on region-of-interest analysis, a thinner RNFL was associated with a larger GMV in the right V1. Although it cannot be ruled out that this outcome resulted from maltreatment alone, CM demonstrated subclinical structural atypicality in the retina, which may also correlate with the immaturity of V1 development. Examination of retinal thickness offers a novel clinical approach to capturing characteristics associated with childhood maltreatment.
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Affiliation(s)
- Akiko Yao
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Shota Nishitani
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan.
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan.
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Yutaka Yamada
- Department of Ophthalmology, University of Fukui, Fukui, Japan
| | - Hideyuki Oshima
- Department of Ophthalmology, University of Fukui, Fukui, Japan
| | - Yuka Sugihara
- Department of Ophthalmology, University of Fukui, Fukui, Japan
| | - Kai Makita
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Shinichiro Takiguchi
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Natasha Y S Kawata
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Takashi X Fujisawa
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidehiko Okazawa
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Ophthalmology, University of Fukui, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan.
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan.
- Life Science Innovation Center, School of Medical Sciences, University of Fukui, Fukui, Japan.
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan.
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26
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Makdoumi K, Ayoub L, Bryngelsson IL, Graff P, Wiebert P, Vihlborg P. The risk for ophthalmological conditions in ulcerative colitis: A population-based case-control study. Is silica dust-exposure associated with inflammatory eye disease? Acta Ophthalmol 2024. [PMID: 38738471 DOI: 10.1111/aos.16708] [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: 01/16/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To study the risk for eye diseases in individuals with Ulcerative Colitis (UC), and to assess whether silica dust-exposure could contribute to the development of inflammatory eye diseases. METHODS A case-control study was conducted using a patient register processed by the National Board of Health and Welfare (NBHW) and Statistics Sweden. Cases were diagnosed with UC between 2007 and 2016. Matching was done with two random controls having the same age, sex and county of residence, without a systemic inflammatory disease. Using a job-exposure matrix, cases and controls were assessed for work-related silica dust exposure. The risk for eye disease was estimated by Cox regression analysis with calculation of Hazard Ratio (HR). RESULTS A total of 58 989 individuals were included, comprising 19 663 cases and 39 326 controls. The sex distribution was similar. Overall, individuals with UC had an increased risk for eye disease, specified in ICD 10 chapter VII (H00-H59) with HR 1.25 (CI 1.20-1.32). The highest HR on block-level for cases was 1.52 (CI 1.36-1.70), (H15-H22), which includes episcleritis, keratitis and anterior uveitis. The risk for ocular disease was higher in silica dust-exposed than non-exposed with a HR of 1.44 (CI 1.16-1.78) and 1.25 (CI 1.19-1.31), respectively. Among cases, the risk for iridocyclitis (H20) was further elevated by silica dust exposure, with HR of 3.84 (CI 1.64-8.97) in exposed compared to 1.94 (1.57-2.41) in non-exposed. CONCLUSION UC is associated with an increased risk for eye diseases, including inflammatory conditions. Our findings highlight that silica dust-exposure may be of importance in the pathogenesis of uveitis.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Lucyn Ayoub
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ing-Liss Bryngelsson
- Department of Ophthalmology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Pål Graff
- National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Pernilla Wiebert
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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27
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Montolío A, Cegoñino J, Garcia-Martin E, Pérez Del Palomar A. The macular retinal ganglion cell layer as a biomarker for diagnosis and prognosis in multiple sclerosis: A deep learning approach. Acta Ophthalmol 2024; 102:e272-e284. [PMID: 37300357 DOI: 10.1111/aos.15722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/12/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The macular ganglion cell layer (mGCL) is a strong potential biomarker of axonal degeneration in multiple sclerosis (MS). For this reason, this study aims to develop a computer-aided method to facilitate diagnosis and prognosis in MS. METHODS This paper combines a cross-sectional study of 72 MS patients and 30 healthy control subjects for diagnosis and a 10-year longitudinal study of the same MS patients for the prediction of disability progression, during which the mGCL was measured using optical coherence tomography (OCT). Deep neural networks were used as an automatic classifier. RESULTS For MS diagnosis, greatest accuracy (90.3%) was achieved using 17 features as inputs. The neural network architecture comprised the input layer, two hidden layers and the output layer with softmax activation. For the prediction of disability progression 8 years later, accuracy of 81.9% was achieved with a neural network comprising two hidden layers and 400 epochs. CONCLUSION We present evidence that by applying deep learning techniques to clinical and mGCL thickness data it is possible to identify MS and predict the course of the disease. This approach potentially constitutes a non-invasive, low-cost, easy-to-implement and effective method.
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Affiliation(s)
- Alberto Montolío
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
| | - José Cegoñino
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- GIMSO Research and Innovation Group, Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
| | - Amaya Pérez Del Palomar
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
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28
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Küchlin S, Ihorst G, Heinrich SP, Márquez Neila P, Albrecht P, Hug MJ, Diem R, Lagrèze WA. Disease Course of Clinically Isolated Optic Neuritis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200223. [PMID: 38588480 PMCID: PMC11010245 DOI: 10.1212/nxi.0000000000200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND OBJECTIVES Optic neuritis is the most common optic neuropathy in young adults and a frequent manifestation of multiple sclerosis. Its clinical course is pertinent to the design of visual pathway neuroprotection trials. METHODS This is a secondary analysis of longitudinal data from the TONE trial, which included 103 patients from 12 German academic tertiary centers with acute unilateral optic neuritis as a clinically isolated syndrome and baseline high-contrast visual acuity <0.5 decimal. Patients were randomized to 1,000 mg methylprednisolone i.v./d plus either erythropoietin (33,000 IU/d) or placebo (saline solution) for 3 days. They were followed up at standardized intervals with a battery of tests including high-contrast visual acuity, low-contrast letter acuity, contrast sensitivity, visual fields, visual evoked potentials, and retinal optical coherence tomography. At 6 months, participants answered a standardized questionnaire on vision-related quality of life (NEI-VFQ 25). We describe the disease course with mixed-effects piecewise linear models and calculate structure-function correlations using Pearson r. Because erythropoietin had no effect on the visual system, we use pooled (treatment-agnostic) data. RESULTS Patients experienced initial rapid and then decelerating improvements of visual function with thinning of inner and thickening of outer retinal layers. At 6 months, visual parameters were positively correlated with inner and negatively correlated with outer retinal thickness changes. Peripapillary retinal nerve fiber layer thinning predominantly occurred in sectors without previous swelling. At 6 months, macular ganglion cell and inner plexiform layer thinning was weakly correlated with the P100 peak time (r = -0.11) and moderately correlated with the amplitude of visual evoked potentials (r = 0.35). Only functional outcomes were at least moderately correlated with vision-related quality of life. DISCUSSION The longitudinal data from this large study cohort may serve as a reference for the clinical course of acute optic neuritis. The pattern of correlation between visual evoked potentials and inner retinal thinning may argue that the latter is mostly due to ganglion cell loss, rather than dysfunction. Visual pathway neuroprotection trials with functional outcomes are needed to confirm that candidate drugs will benefit patients' vision-related quality of life. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov, NCT01962571.
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Affiliation(s)
- Sebastian Küchlin
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Gabriele Ihorst
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Sven P Heinrich
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Pablo Márquez Neila
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Philipp Albrecht
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Martin J Hug
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Ricarda Diem
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Wolf A Lagrèze
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
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29
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Boudriot E, Gabriel V, Popovic D, Pingen P, Yakimov V, Papiol S, Roell L, Hasanaj G, Xu S, Moussiopoulou J, Priglinger S, Kern C, Schulte EC, Hasan A, Pogarell O, Falkai P, Schmitt A, Schworm B, Wagner E, Keeser D, Raabe FJ. Signature of Altered Retinal Microstructures and Electrophysiology in Schizophrenia Spectrum Disorders Is Associated With Disease Severity and Polygenic Risk. Biol Psychiatry 2024:S0006-3223(24)01262-9. [PMID: 38679358 DOI: 10.1016/j.biopsych.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Optical coherence tomography and electroretinography studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSDs). However, it remains unclear which specific retinal layers are affected; how the retina, brain, and clinical symptomatology are connected; and how alterations of the visual system are related to genetic disease risk. METHODS Optical coherence tomography, electroretinography, and brain magnetic resonance imaging were applied to comprehensively investigate the visual system in a cohort of 103 patients with SSDs and 130 healthy control individuals. The sparse partial least squares algorithm was used to identify multivariate associations between clinical disease phenotype and biological alterations of the visual system. The association of the revealed patterns with individual polygenic disease risk for schizophrenia was explored in a post hoc analysis. In addition, covariate-adjusted case-control comparisons were performed for each individual optical coherence tomography and electroretinography parameter. RESULTS The sparse partial least squares analysis yielded a phenotype-eye-brain signature of SSDs in which greater disease severity, longer duration of illness, and impaired cognition were associated with electrophysiological alterations and microstructural thinning of most retinal layers. Higher individual loading onto this disease-relevant signature of the visual system was significantly associated with elevated polygenic risk for schizophrenia. In case-control comparisons, patients with SSDs had lower macular thickness, thinner retinal nerve fiber and inner plexiform layers, less negative a-wave amplitude, and lower b-wave amplitude. CONCLUSIONS This study demonstrates multimodal microstructural and electrophysiological retinal alterations in individuals with SSDs that are associated with disease severity and individual polygenic burden.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Pauline Pingen
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Vladislav Yakimov
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Sergi Papiol
- Max Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Simiao Xu
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany; Institute of Human Genetics, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Benedikt Schworm
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany; Munich Center for Neurosciences, LMU Munich, Planegg-Martinsried, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany.
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30
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Cordano C, Werneburg S, Abdelhak A, Bennett DJ, Beaudry-Richard A, Duncan GJ, Oertel FC, Boscardin WJ, Yiu HH, Jabassini N, Merritt L, Nocera S, Sin JH, Samana IP, Condor Montes SY, Ananth K, Bischof A, Nourbakhsh B, Hauser SL, Cree BAC, Emery B, Schafer DP, Chan JR, Green AJ. Synaptic injury in the inner plexiform layer of the retina is associated with progression in multiple sclerosis. Cell Rep Med 2024; 5:101490. [PMID: 38574736 PMCID: PMC11031420 DOI: 10.1016/j.xcrm.2024.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/01/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
While neurodegeneration underlies the pathological basis for permanent disability in multiple sclerosis (MS), predictive biomarkers for progression are lacking. Using an animal model of chronic MS, we find that synaptic injury precedes neuronal loss and identify thinning of the inner plexiform layer (IPL) as an early feature of inflammatory demyelination-prior to symptom onset. As neuronal domains are anatomically segregated in the retina and can be monitored longitudinally, we hypothesize that thinning of the IPL could represent a biomarker for progression in MS. Leveraging our dataset with over 800 participants enrolled for more than 12 years, we find that IPL atrophy directly precedes progression and propose that synaptic loss is predictive of functional decline. Using a blood proteome-wide analysis, we demonstrate a strong correlation between demyelination, glial activation, and synapse loss independent of neuroaxonal injury. In summary, monitoring synaptic injury is a biologically relevant approach that reflects a potential driver of progression.
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Affiliation(s)
- Christian Cordano
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sebastian Werneburg
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Ophthalmology & Visual Sciences, Michigan Neuroscience Institute, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel J Bennett
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Beaudry-Richard
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Greg J Duncan
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Frederike C Oertel
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Hao H Yiu
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Nora Jabassini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Merritt
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sonia Nocera
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jung H Sin
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isaac P Samana
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Shivany Y Condor Montes
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Antje Bischof
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ben Emery
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy P Schafer
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonah R Chan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Ari J Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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Bollo L, Arrambide G, Cobo-Calvo A, Alvarez JV, Alberich M, Cabello S, Castilló J, Galan I, Midaglia LS, Acevedo BR, Zabalza A, Pappolla A, Mongay Ochoa N, Tintore M, Rio J, Comabella M, Tur C, Auger C, Sastre-Garriga J, Rovira A, Montalban X, Pareto D, Vidal-Jordana A. Trans-Synaptic Degeneration in the Visual Pathway in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Neurology 2024; 102:e209156. [PMID: 38447105 DOI: 10.1212/wnl.0000000000209156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/27/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to assess the presence of retinal neurodegeneration independent of optic neuritis (ON) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to investigate the development of trans-synaptic anterograde degeneration in these patients after ON. METHODS Cross-sectional, retrospective study of 34 adult patients with MOGAD and 23 healthy controls (HC). Clinical, optical coherence tomography (OCT), and MRI data were collected. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GCIPL) were obtained using Heidelberg Spectralis. FreeSurfer7 was used to obtain the lateral geniculate nucleus (LGN), occipital volume fractions (to total estimated intracranial volume), and occipital cortical thickness. For the anterior visual pathway, the analysis was conducted using eyes, classified based on the history of ON (Eye-ON and Eye-NON) and compared with Eye-HC. The analysis of OCT and brain volumetric measures was conducted comparing MOGAD-ON, MOGAD-NON, and HC groups. The analysis of covariance with a Bonferroni-adjusted post hoc test was used to test differences between groups and linear regression analysis to evaluate OCT/MRI associations; age and sex were considered as covariates. RESULTS 24 (70.5%) patients had a prior ON. Median pRNFL and GCIPL thickness (um) was significantly reduced in Eye-ON vs EyeNON and HC (pRNFL: 69.4 (17.3), 89.6 (13.7), 98.2 (11.7), p < 0.001; GCIPL: 55.8 (8.7), 67.39 (8.7), 72.6 (4.5), p < 0.001). pRNFL and GCIPL thickness had a negative correlation with the number of ON episodes (p = 0.025 and p = 0.031, respectively). LGN volume fraction was significantly lower in patients with MOGAD-ON than in HC (0.33 (0.05) vs 0.39 (0.04), p = 0.002). The occipital cortical thickness was lower in MOGAD-ON compared with MOGAD-NON and HC (p = 0.010). In patients with MOGAD-ON, pRNFL correlated with LGN volume (p = 0.006), occipital thickness (p = 0.002), and the medial occipital cortex (p = 0.002), but not the lateral occipital lobe. DISCUSSION Compared with HC, MOGAD-ON exhibits reduced retinal thickness, primarily influenced by the presence and the number of prior ON episodes. Moreover, MOGAD-ON demonstrates significant atrophy in the retinal, subcortical, and cortical regions of the visual pathway, distinguishing them from MOGAD-NON and HC. These findings suggest that in patients with MOGAD neurodegeneration is tightly correlated with damage to the involved pathway.
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Affiliation(s)
- Luca Bollo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Georgina Arrambide
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alvaro Cobo-Calvo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Javier V Alvarez
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manel Alberich
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Sergio Cabello
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Castilló
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ingrid Galan
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Luciana S Midaglia
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Breogan Rodriguez Acevedo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ana Zabalza
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Agustin Pappolla
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Neus Mongay Ochoa
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Rio
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manuel Comabella
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carmen Tur
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jaume Sastre-Garriga
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alex Rovira
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Deborah Pareto
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Yılmaz Tuğan B, Bünül SD, Kara B, Alikılıç D, Karabaş L, Efendi H, Yüksel N. Retinal and Choroidal Vascularity Evaluation in Pediatric Radiologically Isolated Syndrome and Multiple Sclerosis. Pediatr Neurol 2024; 153:34-43. [PMID: 38320456 DOI: 10.1016/j.pediatrneurol.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND To assess vessel density (VD) and flow of retinal plexuses and peripapillary region related with the pediatric radiologically isolated syndrome (RIS) and multiple sclerosis (MS). METHODS We analyzed 24 eyes of 12 participants with the diagnosis of RIS, 24 eyes of 12 participants with the diagnosis of MS, and 26 eyes of 13 age- and sex-matched healthy controls in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and deep capillary plexus, foveal avascular zone, and the flow of choriocapillaris were investigated using optical coherence tomography angiography. RESULTS Parafoveal VD and all subregion parameters in SCP were significantly decreased in the MS group compared with the controls, whereas only nasal and inferior VD were significantly decreased in the pediatric RIS group compared with the controls. Ganglion cell layer (GCL) thickness of all subregions of the inner ring was significantly decreased in the pediatric MS group compared with the control group. No significant difference was observed between the pediatric RIS group and the control group regarding thickness. CONCLUSIONS We showed lower parafoveal VD in all subregions of SCP in pediatric MS, whereas only parafoveal nasal and inferior VD were decreased in pediatric RIS. GCL thickness of inner ring was significantly decreased in the pediatric MS, whereas GCL thickness did not change in pediatric RIS. Therefore, a decrease of parafoveal nasal and inferior VD without a decrease in thickness implies an early impairment of microvasculature in the RIS before impairment of thickness and that microvascular alterations begin from highly vascular superficial parafovea.
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Affiliation(s)
| | | | - Bülent Kara
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Defne Alikılıç
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
| | - Hüsnü Efendi
- Department of Neurology, Kocaeli University, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
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Lyons HS, Sassani M, Hyder Y, Mitchell JL, Thaller M, Mollan SP, Sinclair AJ, Blanch RJ. A systematic review of optical coherence tomography findings in adults with mild traumatic brain injury. Eye (Lond) 2024; 38:1077-1083. [PMID: 38238577 PMCID: PMC11009235 DOI: 10.1038/s41433-023-02845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 03/21/2024] Open
Abstract
Mild traumatic brain injury (mTBI) is common with many patients suffering disabling long-term sequelae, with visual symptoms frequently reported. There are no objective biomarkers of mTBI that are routinely used in clinical practice. Optical coherence tomography (OCT) has been used in mTBI research, as it enables visualisation of the neuroretina, allowing measurement of the retinal nerve fibre layer and ganglion cell layer. This systematic review aims to appraise the available literature and assess whether there are significant changes within the retinal nerve fibre layer and ganglion cell layer in subjects after mTBI. A systematic review was carried out in accordance with PRISMA guidelines and registered with PROSPERO (Number: CRD42022360498). Four databases were searched for relevant literature published from inception until 1 September 2022. Abstracts and full texts were screened by three independent reviewers. Initial screening of databases yielded 341 publications, of these, three fulfilled all the criteria for inclusion. All three studies showed thinning of the retinal nerve fibre layer, whereas there were no significant changes in the ganglion cell layer. This systematic review demonstrated that thinning of the retinal nerve fibre layer (but not of the ganglion cell layer) is associated with mTBI. It provides preliminary evidence for the use of the retinal nerve fibre layer as a potential biomarker of damage to the visual system in mTBI. Further prospective longitudinal studies ensuring uniform diagnosis and accurate phenotyping of mTBI are needed to understand the effects on the visual system and potential of OCT as a prognostic biomarker.
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Affiliation(s)
- Hannah S Lyons
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Matilde Sassani
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Yousef Hyder
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - James L Mitchell
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
- Academic Department of Medical Rehabilitation, Defence Medical Rehabilitation, Stanford Hall, Loughborough, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Richard J Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK.
- Royal Centre for Defence Medicine, Birmingham, UK.
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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Elmers J, Colzato LS, Ziemssen F, Ziemssen T, Beste C. Optical coherence tomography as a potential surrogate marker of dopaminergic modulation across the life span. Ageing Res Rev 2024; 96:102280. [PMID: 38518921 DOI: 10.1016/j.arr.2024.102280] [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: 09/27/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
The retina has been considered a "window to the brain" and shares similar innervation by the dopaminergic system with the cortex in terms of an unequal distribution of D1 and D2 receptors. Here, we provide a comprehensive overview that Optical Coherence Tomography (OCT), a non-invasive imaging technique, which provides an "in vivo" representation of the retina, shows promise to be used as a surrogate marker of dopaminergic neuromodulation in cognition. Overall, most evidence supports reduced retinal thickness in individuals with dopaminergic dysregulation (e.g., patients with Parkinson's Disease, non-demented older adults) and with poor cognitive functioning. By using the theoretical framework of metacontrol, we derive hypotheses that retinal thinning associated to decreased dopamine (DA) levels affecting D1 families, might lead to a decrease in the signal-to-noise ratio (SNR) affecting cognitive persistence (depending on D1-modulated DA activity) but not cognitive flexibility (depending on D2-modulated DA activity). We argue that the use of OCT parameters might not only be an insightful for cognitive neuroscience research, but also a potentially effective tool for individualized medicine with a focus on cognition. As our society progressively ages in the forthcoming years and decades, the preservation of cognitive abilities and promoting healthy aging will hold of crucial significance. OCT has the potential to function as a swift, non-invasive, and economical method for promptly recognizing individuals with a heightened vulnerability to cognitive deterioration throughout all stages of life.
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Affiliation(s)
- Julia Elmers
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Lorenza S Colzato
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Focke Ziemssen
- Ophthalmological Clinic, University Clinic Leipzig, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China.
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Ugolkov Y, Nikitich A, Leon C, Helmlinger G, Peskov K, Sokolov V, Volkova A. Mathematical modeling in autoimmune diseases: from theory to clinical application. Front Immunol 2024; 15:1371620. [PMID: 38550585 PMCID: PMC10973044 DOI: 10.3389/fimmu.2024.1371620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
The research & development (R&D) of novel therapeutic agents for the treatment of autoimmune diseases is challenged by highly complex pathogenesis and multiple etiologies of these conditions. The number of targeted therapies available on the market is limited, whereas the prevalence of autoimmune conditions in the global population continues to rise. Mathematical modeling of biological systems is an essential tool which may be applied in support of decision-making across R&D drug programs to improve the probability of success in the development of novel medicines. Over the past decades, multiple models of autoimmune diseases have been developed. Models differ in the spectra of quantitative data used in their development and mathematical methods, as well as in the level of "mechanistic granularity" chosen to describe the underlying biology. Yet, all models strive towards the same goal: to quantitatively describe various aspects of the immune response. The aim of this review was to conduct a systematic review and analysis of mathematical models of autoimmune diseases focused on the mechanistic description of the immune system, to consolidate existing quantitative knowledge on autoimmune processes, and to outline potential directions of interest for future model-based analyses. Following a systematic literature review, 38 models describing the onset, progression, and/or the effect of treatment in 13 systemic and organ-specific autoimmune conditions were identified, most models developed for inflammatory bowel disease, multiple sclerosis, and lupus (5 models each). ≥70% of the models were developed as nonlinear systems of ordinary differential equations, others - as partial differential equations, integro-differential equations, Boolean networks, or probabilistic models. Despite covering a relatively wide range of diseases, most models described the same components of the immune system, such as T-cell response, cytokine influence, or the involvement of macrophages in autoimmune processes. All models were thoroughly analyzed with an emphasis on assumptions, limitations, and their potential applications in the development of novel medicines.
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Affiliation(s)
- Yaroslav Ugolkov
- Research Center of Model-Informed Drug Development, Ivan Mikhaylovich (I.M.) Sechenov First Moscow State Medical University, Moscow, Russia
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences (RAS), Moscow, Russia
| | - Antonina Nikitich
- Research Center of Model-Informed Drug Development, Ivan Mikhaylovich (I.M.) Sechenov First Moscow State Medical University, Moscow, Russia
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences (RAS), Moscow, Russia
| | - Cristina Leon
- Modeling and Simulation Decisions FZ - LLC, Dubai, United Arab Emirates
| | | | - Kirill Peskov
- Research Center of Model-Informed Drug Development, Ivan Mikhaylovich (I.M.) Sechenov First Moscow State Medical University, Moscow, Russia
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences (RAS), Moscow, Russia
- Modeling and Simulation Decisions FZ - LLC, Dubai, United Arab Emirates
- Sirius University of Science and Technology, Sirius, Russia
| | - Victor Sokolov
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences (RAS), Moscow, Russia
- Modeling and Simulation Decisions FZ - LLC, Dubai, United Arab Emirates
| | - Alina Volkova
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences (RAS), Moscow, Russia
- Modeling and Simulation Decisions FZ - LLC, Dubai, United Arab Emirates
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Ge JY, Teo ZL, Loo JL. Recent advances in the use of optical coherence tomography in neuro-ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:220-233. [PMID: 38214066 DOI: 10.1111/ceo.14341] [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: 08/31/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Optical coherence tomography (OCT) is an in vivo imaging modality that provides non-invasive, high resolution and fast cross-sectional images of the optic nerve head, retina and choroid. OCT angiography (OCTA) is an emerging tool. It is a non-invasive, dye-free imaging approach of visualising the microvasculature of the retina and choroid by employing motion contrast imaging for blood flow detection and is gradually receiving attention for its potential roles in various neuro-ophthalmic and retinal conditions. We will review the clinical utility of the OCT in the management of various common neuro-ophthalmic and neurological disorders. We also review some of the OCTA research findings in these conditions. Finally, we will discuss the limitations of OCT as well as introduce other emerging technologies.
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Affiliation(s)
- Jasmine Yaowei Ge
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Zhen Ling Teo
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jing Liang Loo
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Varmpompiti K, Chow G, Foster M, Kodali S, Prados F, Yiannakas MC, Kanber B, Burke A, Ogunbowale L, Davagnanam I, Toosy AT, Collorone S. Associations between cortical lesions, optic nerve damage, and disability at the onset of multiple sclerosis: insights into neurodegenerative processes. Mult Scler Relat Disord 2024; 83:105413. [PMID: 38215633 DOI: 10.1016/j.msard.2023.105413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Multiple sclerosis cortical lesions are areas of demyelination and neuroaxonal loss. Retinal layer thickness, measured with optical coherence tomography (OCT), is an emerging biomarker of neuroaxonal loss. Studies have reported correlations between cortical lesions and retinal layer thinning in established multiple sclerosis, suggesting a shared pathophysiological process. Here, we assessed the correlation between cortical lesions and OCT metrics at the onset of multiple sclerosis, examining, for the first time, associations with physical or cognitive disability. OBJECTIVE To examine the relationship between cortical lesions, optic nerve and retinal layer thicknesses, and physical and cognitive disability at the first demyelinating event. METHODS Thirty-nine patients and 22 controls underwent 3T-MRI, optical coherence tomography, and clinical tests. We identified cortical lesions on phase-sensitive inversion recovery sequences, including occipital cortex lesions. We measured the estimated total intracranial volume and the white matter lesion volume. OCT metrics included peripapillary retinal nerve fibre layer (pRNFL), ganglion cell and inner plexiform layer (GCIPL) and inner nuclear layer (INL) thicknesses. RESULTS Higher total cortical and leukocortical lesion volumes correlated with thinner pRNFL (B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01; B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01, respectively). Leukocortical lesion number correlated with colour vision deficits (B = 0.58, 95 %CI 0.039 to 1,11, p = 0.036). Thinner GCIPL correlated with a higher Expanded Disability Status Scale (B = -0.06, 95 % CI -1.1 to -0.008, p = 0.026). MS diagnosis (n = 18) correlated with higher cortical and leukocortical lesion numbers (p = 0.004 and p = 0.003), thinner GCIPL (p = 0.029) and INL (p = 0.041). CONCLUSION The association between cortical lesions and axonal damage in the optic nerve reinforces the role of neurodegenerative processes in MS pathogenesis at onset.
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Affiliation(s)
- Kyriakoula Varmpompiti
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Geoffrey Chow
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Michael Foster
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Srikirti Kodali
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK; eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Baris Kanber
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | | | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Ahmed T Toosy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Sara Collorone
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
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Riboni-Verri G, Chen BS, McMurran CE, Halliwell GJ, Brown JWL, Coles AJ, Cunniffe NG. Visual outcome measures in clinical trials of remyelinating drugs. BMJ Neurol Open 2024; 6:e000560. [PMID: 38389586 PMCID: PMC10882304 DOI: 10.1136/bmjno-2023-000560] [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: 10/16/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
One of the most promising approaches to delay, prevent or reverse disability progression in multiple sclerosis (MS) is to enhance endogenous remyelination and limit axonal degeneration. In clinical trials of remyelinating drugs, there is a need for reliable, sensitive and clinically relevant outcome measures. The visual pathway, which is frequently affected by MS, provides a unique model system to evaluate remyelination of acute and chronic MS lesions in vivo and non-invasively. In this review, we discuss the different measures that have been used and scrutinise visual outcome measure selection in current and future remyelination trials.
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Affiliation(s)
- Gioia Riboni-Verri
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Benson S Chen
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Christopher E McMurran
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gregory J Halliwell
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Clinical Outcomes Research Unit (CORe), University of Melbourne, Melborune, Melborune, Australia
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Nick G Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
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Raghib MF, Bao F, Elkhooly M, Bernitsas E. Choroid plexus volume as a marker of retinal atrophy in relapsing remitting multiple sclerosis. J Neurol Sci 2024; 457:122884. [PMID: 38237367 DOI: 10.1016/j.jns.2024.122884] [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: 05/30/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate choroid plexus (CP) volume as a biomarker for predicting clinical disability and retinal layer atrophy in relapsing remitting multiple sclerosis (RRMS). METHODS Ninety-five RRMS patients and 26 healthy controls (HCs) underwent 3 T whole brain MRI, expanded disability status scale (EDSS) and optical coherence tomography (OCT). Fully automated intra-retinal segmentation was performed to obtain the volumes of the retinal nerve fiber layer (RNFL), combined ganglion cell layer -inner plexiform layer (GCIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), total macular volume (TMV) and papillomacular bundle (PMB). Automated segmentation of the CP within the lateral ventricles was performed and the choroid plexus volume (CPV) was normalized by total intracranial volume (TIV). Linear regression analysis and generalized estimating equation (GEE) models were applied to evaluate relationships between nCPV and EDSS, T2 lesion volume, disease duration, and retinal layer volumes, followed by Bonferroni correction analysis for multiple comparisons. RESULTS RRMS patients had larger tChPV compared to HCs (p < 0.001). After Bonferroni correction, there was a significant positive correlation between tChPV and EDSS (r2 = 0.25, p = 0.0002), disease duration (r2 = 0.30, p = 0.01), and T2 lesion volume (r2 = 0.39, p = 0.0000). A robust negative correlation was found between tChPV and RNFL (p < 0.001), GCIPL (p = 0.003), TMV (p = 0.0185), PMB (p < 0.0001), G (p = 0.04), T(p = 0.0001). CONCLUSIONS Our findings support the association of tChPV with disability and altered retinal integrity in RRMS.
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Affiliation(s)
- Muhammad F Raghib
- Department of Neurology, Wayne State University School of Medicine, United States of America
| | - Fen Bao
- Department of Neurology, Wayne State University School of Medicine, United States of America
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne State University School of Medicine, United States of America; Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, United States of America; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, United States of America; Detroit Medical Center, Detroit, MI, United States of America.
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40
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Jiang B, Hong N, Zhao F, Dong F. Visualization and analysis of mapping knowledge domains for optic neuritis: a bibliometric research from 2013 to 2022. Int Ophthalmol 2024; 44:57. [PMID: 38342798 PMCID: PMC10859331 DOI: 10.1007/s10792-024-02948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/04/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To explore the global research trends, hotspots and frontiers of optic neuritis (ON) over the past decade through qualitative and quantitative analysis of bibliometrics. METHODS Publications on ON from 2013 to 2022 were retrieved from Web of Science Core Collection (WoSCC). VOSviewer and CiteSpace were mainly used to facilitate bibliometric analysis and visualization. RESULTS A total of 3027 papers were retrieved from peer-reviewed publications and the annual research output increased over time. Neurosciences neurology was the most published area. The USA was the most productive and influential country, and in the focus of international cooperation. University College London was the most productive organization and Charite Medical University of Berlin had the largest number of cooperating partners. Paul F contributed the largest number of publications and Wingerchuk DM ranked first among the co-cited authors. Multiple Sclerosis and Related Disorders was the most prolific journal publishing ON research. The most co-cited references mainly focused on the diagnostic criteria for neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). The keywords formed the following four clusters: the pathophysiology of MS-ON; the autoantibody markers and diagnostic criteria of NMOSD-ON and myelin oligodendrocyte glycoprotein associated disorder-ON (MOGAD-ON); the epidemiology and clinical characteristics of ON; and the treatment of ON. CONCLUSION This bibliometrics analysis showed a systematic view of the evolutionary process, research hotspots, and future directions of ON research. It can provide insights for ON research and valuable information for neuro-ophthalmologic specialists to evaluate research policies and promote international cooperation.
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Affiliation(s)
- Bo Jiang
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Nan Hong
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Fangkun Zhao
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
| | - Feng Dong
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Hopf S, Tüscher O, Schuster AK. [Retinal OCT biomarkers and neurodegenerative diseases of the central nervous system beyond Alzheimer's disease]. DIE OPHTHALMOLOGIE 2024; 121:93-104. [PMID: 38263475 DOI: 10.1007/s00347-023-01974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Optical coherence tomography (OCT) biomarkers are increasingly used by neurologists, psychiatrists, and ophthalmologists for the diagnosis, prognosis, and follow-up of neurodegenerative diseases. Long-term data on OCT biomarkers of selected primary and secondary neurodegenerative diseases of the central nervous system (CNS), such as multiple sclerosis (MS) or Parkinson's disease, are already available in part. In addition, there are rare neurodegenerative diseases with early disease onset that may show OCT abnormalities. METHODS A literature review on the association of OCT biomarkers with neurodegenerative diseases of the CNS beyond Alzheimer's disease is presented. Parkinson's disease, MS, Friedreich's ataxia, Huntington's disease, spinocerebellar ataxia, and lysosomal storage diseases are addressed. RESULTS Relevant OCT biomarkers of neurodegenerative diseases are the macular ganglion cell inner plexiform layer (GCIPL) and the peripapillary retinal nerve fiber layer (pRNFL) thickness. Different sectors may be affected depending on the disease entity in addition to global pRFNL reduction. OCT‑angiography (OCT-A) is also increasingly used as a biomarker in neurodegenerative diseases. CONCLUSION Optical coherence tomography biomarkers are used in an interdisciplinary context. Retinal pathologies should be excluded by an ophthalmologist. While OCT biomarkers are increasingly used clinically in MS, the benefit in other neurodegenerative diseases, especially the rare ones, is less well documented. Further longitudinal studies are required.
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Affiliation(s)
- Susanne Hopf
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - Oliver Tüscher
- Zentrum für seltene Erkrankungen des Nervensystems (ZSEN) Mainz und Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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Arda H, Sonmez HK, Sener H, Buyukpatır Deneme E, Polat OA, Unlu M, Evereklioglu C, Horozoglu F. Parapapillary choroidal microvasculature in retrobulbar optic neuritis: An optical coherence tomography angiography study. Mult Scler Relat Disord 2024; 82:105343. [PMID: 38134608 DOI: 10.1016/j.msard.2023.105343] [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: 06/14/2023] [Revised: 07/06/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To compare superficial and deep vascular characteristics of the optic disc in retrobulbar optic neuritis using optical coherence tomography angiography (OCT-A). METHODS Nineteen patients with unilateral non-infectious retrobulbar neuritis were included in the study. The contralateral eyes of each patient were served as controls. OCT-A scans of the optic discs were performed in a 4.5 × 4.5 mm rectangular area, while macular OCT-A scans were performed in a 6 × 6 mm rectangular area. Various parameters, including radial peripapillary capillary (RPC) density, peripapillary retinal nerve fibre layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical and horizontal c/d ratios were automatically obtained using the instrument software. The density for superficial capillary plexus (SCP) and deep capillary plexus (DCP) were assessed using macular OCT-A. Parapapillary choroidal microvascular (PPCMv) density was calculated using MATLAB software. RESULTS Parafoveal inferior, perifoveal total and inferior SCP densities were significantly decreased in eyes with optic neuritis when compared with contralateral control eyes in OCT-A measurements (respectively, p = 0.027, p = 0.041, p = 0.045). The axial lengths, (p = 0.72), vertical and horizontal cup-disc ratios, and disc area, cup-disc areas, cup volumes, and pRNFL thicknesses between the groups were similar (for each, p>0.05). CONCLUSIONS This study demonstrated for the first time that patients with retrobulbar optic neuritis had decreased SCP densities, though it did not cause any changes in PPCMv density.
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Affiliation(s)
- Hatice Arda
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye.
| | - Hatice Kubra Sonmez
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Hidayet Sener
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Erinç Buyukpatır Deneme
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Osman Ahmet Polat
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Metin Unlu
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Cem Evereklioglu
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Fatih Horozoglu
- Department of Ophthalmology, Division of Neuro-ophthalmology, Erciyes University Medical Faculty, Kayseri, Türkiye
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Etebar F, Harkin DG, White AR, Dando SJ. Non-invasive in vivo imaging of brain and retinal microglia in neurodegenerative diseases. Front Cell Neurosci 2024; 18:1355557. [PMID: 38348116 PMCID: PMC10859418 DOI: 10.3389/fncel.2024.1355557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Microglia play crucial roles in immune responses and contribute to fundamental biological processes within the central nervous system (CNS). In neurodegenerative diseases, microglia undergo functional changes and can have both protective and pathogenic roles. Microglia in the retina, as an extension of the CNS, have also been shown to be affected in many neurological diseases. While our understanding of how microglia contribute to pathological conditions is incomplete, non-invasive in vivo imaging of brain and retinal microglia in living subjects could provide valuable insights into their role in the neurodegenerative diseases and open new avenues for diagnostic biomarkers. This mini-review provides an overview of the current brain and retinal imaging tools for studying microglia in vivo. We focus on microglia targets, the advantages and limitations of in vivo microglia imaging approaches, and applications for evaluating the pathogenesis of neurological conditions, such as Alzheimer's disease and multiple sclerosis.
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Affiliation(s)
- Fazeleh Etebar
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Damien G. Harkin
- Centre for Vision and Eye Research, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Anthony R. White
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Samantha J. Dando
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Centre for Vision and Eye Research, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Shew W, Zhang DJ, Menkes DB, Danesh-Meyer HV. Optical Coherence Tomography in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:19-30. [PMID: 38021252 PMCID: PMC10654004 DOI: 10.1016/j.bpsgos.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background Inner retinal atrophy has been demonstrated in schizophrenia spectrum disorder (SSD) using optical coherence tomography (OCT). This systematic review and meta-analysis investigated the role of contemporary Fourier domain OCT devices in SSD. Methods MEDLINE, PubMed, Scopus, Embase, PsycInfo, PYSNDEX, World Health Organization, and Cochrane databases were searched from inception until May 2022. All peer-reviewed adult SSD case-control studies using Fourier domain OCT were included. Ocular pathologies known to affect retinal OCT scans were excluded. Search, data appraisal, and summary data extraction were independently performed by 2 authors. Results The review criteria was met by k = 36 studies, with k = 24 studies (1074 cases, 854 controls) suitable for meta-analysis. The SSD group exhibited a thinner global peripapillary retinal nerve fiber layer (-3.26 μm, 95% CI, -5.07 to -1.45, I2 = 64%, k = 21), thinner average macular layer (-7.88 μm, 95% CI, -12.73 to -3.04, I2 = 65%, k = 11), and thinner macular ganglion cell-inner plexiform sublayer (-2.44 μm, 95% CI, -4.13 to -0.76, I2 = 30%, k = 8) compared with the control group. Retinal nerve fiber layer findings remained significant after exclusion of metabolic disease, low quality, outlier, and influential studies. Studies involving eye examinations to exclude eye disease were associated with greater atrophy in SSD. Except for cardiometabolic disease, most studies did not report clinically significant covariate data known to influence retinal thickness. Conclusions Individuals with SSD generally exhibited retinal atrophy, possibly paralleling reduced brain volumes documented in clinical imaging. Prospective longitudinal studies that collect clinical data, including various illness phases, and control for confounders will be necessary to evaluate retinal atrophy as a biomarker in SSD.
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Affiliation(s)
- William Shew
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Daniel J. Zhang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David B. Menkes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Helen V. Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Lin T, Chien C, Kuchling J, Asseyer S, Motamedi S, Bellmann‐Strobl J, Schmitz‐Hübsch T, Ruprecht K, Brandt AU, Zimmermann HG, Paul F. Interactions of optic radiation lesions with retinal and brain atrophy in early multiple sclerosis. Ann Clin Transl Neurol 2024; 11:45-56. [PMID: 37903651 PMCID: PMC10791029 DOI: 10.1002/acn3.51931] [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: 07/06/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Retrograde trans-synaptic neuroaxonal degeneration is considered a key pathological factor of subclinical retinal neuroaxonal damage in multiple sclerosis (MS). We aim to evaluate the longitudinal association of optic radiation (OR) lesion activity with retinal neuroaxonal damage and its role in correlations between retinal and brain atrophy in people with clinically isolated syndrome and early MS (pweMS). METHODS Eighty-five pweMS were retrospectively screened from a prospective cohort (Berlin CIS cohort). Participants underwent 3T magnetic resonance imaging (MRI) for OR lesion volume and brain atrophy measurements and optical coherence tomography (OCT) for retinal layer thickness measurements. All pweMS were followed with serial OCT and MRI over a median follow-up of 2.9 (interquartile range: 2.6-3.4) years. Eyes with a history of optic neuritis prior to study enrollment were excluded. Linear mixed models were used to analyze the association of retinal layer thinning with changes in OR lesion volume and brain atrophy. RESULTS Macular ganglion cell-inner plexiform layer (GCIPL) thinning was more pronounced in pweMS with OR lesion volume increase during follow-up compared to those without (Difference: -0.82 μm [95% CI:-1.49 to -0.15], p = 0.018). Furthermore, GCIPL thinning correlated with both OR lesion volume increase (β [95% CI] = -0.27 [-0.50 to -0.03], p = 0.028) and brain atrophy (β [95% CI] = 0.47 [0.25 to 0.70], p < 0.001). Correlations of GCIPL changes with brain atrophy did not differ between pweMS with or without OR lesion increase (η p 2 = 5.92e-7 , p = 0.762). INTERPRETATION Faster GCIPL thinning rate is associated with increased OR lesion load. Our results support the value of GCIPL as a sensitive biomarker reflecting both posterior visual pathway pathology and global brain neurodegeneration.
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Affiliation(s)
- Ting‐Yi Lin
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
| | - Claudia Chien
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Department of Psychiatry and PsychotherapyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu BerlinBerlinGermany
| | - Joseph Kuchling
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Department of NeurologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Seyedamirhosein Motamedi
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Judith Bellmann‐Strobl
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Tanja Schmitz‐Hübsch
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Klemens Ruprecht
- Department of NeurologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Alexander U. Brandt
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
| | - Hanna G. Zimmermann
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Einstein Center Digital FutureBerlinGermany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité – Universitätsmedizin BerlinBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
- Department of NeurologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Neuroscience Clinical Research CenterCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
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Kaçar S, Coric D, Ometto G, Montesano G, Denniston AK, Keane PA, Uitdehaag BMJ, Crabb DP, Schoonheim MM, Petzold A, Strijbis EMM. Exploring Vitreous Haze as a Potential Biomarker for Accelerated Glymphatic Outflow and Neurodegeneration in Multiple Sclerosis: A Cross-Sectional Study. Brain Sci 2023; 14:36. [PMID: 38248251 PMCID: PMC10813039 DOI: 10.3390/brainsci14010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/08/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The glymphatic system removes neurodegenerative debris. The ocular glymphatic outflow is from the eye to the proximal optic nerve. In multiple sclerosis (MS), atrophy of the optic nerve increases the glymphatic outflow space. Here, we tested whether vitreous haze (VH) can provide novel insights into the relationship between neurodegeneration and the ocular glymphatic system in MS. METHODS This cross-sectional study comprised 315 persons with MS and 87 healthy controls (HCs). VH was quantified from optical coherence tomography (OCT) volume scans. Neurodegeneration was determined on three-dimensional T1 (3DT1) MRI, lesion detection on fluid-attenuated inversion (FLAIR), and layer thickness on OCT. Generalized estimating equations, corrected for age, were used to analyze associations between VH and metrics for neurodegeneration, demographics, and clinical scales. Group differences were determined between mild, moderate, and severe disability. RESULTS On the group level, VH scores were comparable between MS and control (p = 0.629). In MS, VH scores declined with disease duration (β = -0.009, p = 0.004) and age (β = -0.007, p = 0.001). There was no relation between VH scores and higher age in HCs. In MS patients, VH was related to normalized gray (NGMV, β = 0.001, p = 0.011) and white matter volume (NWMV, β = 0.001, p = 0.003), macular ganglion cell-inner plexiform layer thickness (mGCIPL, β = 0.006, p < 0.001), and peripapillary retinal nerve fiber layer thickness (pRNFL, β = 0.004, p = 0.008). VH was significantly lower in severe compared to mild disability (mean difference -28.86%, p = 0.058). CONCLUSIONS There is a correlation between VH on OCT and disease duration, more severe disability and lower brain volumes in MS. Biologically, these relationships suggest accelerated glymphatic clearance with disease-related atrophy.
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Affiliation(s)
- Sezgi Kaçar
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Danko Coric
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Giovanni Ometto
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Giovanni Montesano
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Alastair K. Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK;
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London EC1V 9LF, UK;
| | - Pearse A. Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London EC1V 9LF, UK;
| | - Bernard M. J. Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
| | - David P. Crabb
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Menno M. Schoonheim
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Axel Petzold
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
- Department of Neurology and Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 9LF, UK
- The National Hospital for Neurology and Neurosurgery, University College London, London WC1E 7HU, UK
| | - Eva M. M. Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
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Filippatou AG, Calabresi PA, Saidha S, Murphy OC. Spotlight on Trans-Synaptic Degeneration in the Visual Pathway in Multiple Sclerosis. Eye Brain 2023; 15:153-160. [PMID: 38169913 PMCID: PMC10759909 DOI: 10.2147/eb.s389632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
A putative mechanism of neurodegeneration in multiple sclerosis (MS) is trans-synaptic degeneration (TSD), whereby injury to a neuron leads to degeneration of synaptically connected neurons. The visual system is commonly involved in MS and provides an ideal model to study TSD given its well-defined structure. TSD may occur in an anterograde direction (optic neuropathy causing degeneration in the posterior visual pathway including the optic radiations and occipital gray matter) and/or retrograde direction (posterior visual pathway lesions causing retinal degeneration). In the current review, we discuss evidence supporting the presence of anterograde and retrograde TSD in the visual system in MS.
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Affiliation(s)
- Angeliki G Filippatou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Olwen C Murphy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Palazon-Cabanes A, Palazon-Cabanes B, Garcia-Medina JJ, Alvarez-Sarrion A, del-Rio-Vellosillo M. Normative Database of the Superior-Inferior Thickness Asymmetry for All Inner and Outer Macular Layers of Adults for the Posterior Pole Algorithm of the Spectralis SD-OCT. J Clin Med 2023; 12:7609. [PMID: 38137678 PMCID: PMC10743748 DOI: 10.3390/jcm12247609] [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: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study aims to establish a reference for the superior-inferior hemisphere asymmetry in thickness values for all macular layers for the posterior pole algorithm (PPA) available for the Spectralis SD-OCT device. METHODS We examined 300 eyes of 300 healthy Caucasian volunteers aged 18-84 years using the PPA, composed of a grid of 64 (8 × 8) cells, to analyze the thickness asymmetries of the following automatically segmented macular layers: retinal nerve fiber layer (RNFL); ganglion cell layer (GCL); inner plexiform layer (IPL); inner nuclear layer (INL); outer plexiform layer (OPL); outer nuclear layer (ONL); retinal pigment epithelium (RPE); inner retina; outer retina; complete retina. Mean ± standard deviation and the 2.5th and 97.5th percentiles of the thickness asymmetry values were obtained for all the corresponding cells. RESULTS All the macular layers had significant superior-inferior thickness asymmetries. GCL, IPL, INL, ONL and RPE showed significantly greater thicknesses in the superior than the inferior hemisphere, whereas RNFL and OPL were thicker in the inferior hemisphere. The largest differences between hemispheres were for RNFL and ONL. CONCLUSIONS This is the first normative database of macular thickness asymmetries for the PPA and should be considered to distinguish normal from pathological values when interpreting superior-inferior macular asymmetries.
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Affiliation(s)
- Ana Palazon-Cabanes
- Department of Ophthalmology, Hospital Virgen del Castillo, 30510 Murcia, Spain;
| | | | - Jose Javier Garcia-Medina
- Department of Ophthalmology, General University Hospital Morales Meseguer, 30008 Murcia, Spain
- Department of Ophthalmology and Optometry, University of Murcia, 30120 Murcia, Spain;
- Ophthalmic Research Unit “Santiago Grisolia”, 46010 Valencia, Spain
- Spanish Net of Inflammatory Diseases RICORS, Institute of Health Carlos III, 28029 Madrid, Spain
| | | | - Monica del-Rio-Vellosillo
- Department of Anesthesiology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain;
- Department of Surgery, Obstetrics and Gynecology and Pediatrics, University of Murcia, 30120 Murcia, Spain
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Oertel FC, Hastermann M, Paul F. Delimiting MOGAD as a disease entity using translational imaging. Front Neurol 2023; 14:1216477. [PMID: 38333186 PMCID: PMC10851159 DOI: 10.3389/fneur.2023.1216477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/23/2023] [Indexed: 02/10/2024] Open
Abstract
The first formal consensus diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) were recently proposed. Yet, the distinction of MOGAD-defining characteristics from characteristics of its important differential diagnoses such as multiple sclerosis (MS) and aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (NMOSD) is still obstructed. In preclinical research, MOG antibody-based animal models were used for decades to derive knowledge about MS. In clinical research, people with MOGAD have been combined into cohorts with other diagnoses. Thus, it remains unclear to which extent the generated knowledge is specifically applicable to MOGAD. Translational research can contribute to identifying MOGAD characteristic features by establishing imaging methods and outcome parameters on proven pathophysiological grounds. This article reviews suitable animal models for translational MOGAD research and the current state and prospect of translational imaging in MOGAD.
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Affiliation(s)
- Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Hastermann
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Coskun C, Coskun Y. Evaluation of optic coherence tomography findings in patients with inflammatory bowel disease. Photodiagnosis Photodyn Ther 2023; 44:103788. [PMID: 37666381 DOI: 10.1016/j.pdpdt.2023.103788] [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: 05/06/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Ocular complications are known to appear in inflammatory bowel disease (IBD). Among these, posterior segment complications can lead to substantial morbidity. The aim of the study is to evaluate the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and macula thickness measurement in patients with IBD. METHODS A total of 118 patients with IBD (42 Crohn's disease (CD), 76 ulcerative colitis (UC)) and 52 healthy subjects were included in the study. RNFL, GCIPL, and macula thickness were measured using spectral-domain optical coherence tomography (SD-OCT). RESULTS The central macular thickness was increased, mean and all superior quadrants of GCIPL thickness measurements were significantly decreased, but RNFL thickness wasn't changed in CD compared to healthy subjects. Although the central macular thickness increased, no change was observed in mean RNFL and GCIPL in UC compared to healthy subjects. Mean RNFL, GCIPL, and macular thickness did not differ during the remission and active phases of the disease in IBD. There was no difference in RNFL, GCIPL, and macular thicknesses in CD patients in terms of the location and behavior of the disease. A significant thickness increase was found in extensive type UC for inferior RNFL value compared to the left side and proctitis. CONCLUSIONS IBD may cause an increase in macular thickness. This finding may be related to the inflammation or ischemia of the retina. The use of SD-OCT in ophthalmologic examination in patients with IBD may enable early detection of retinal changes and alert the clinician to complications of IBD.
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Affiliation(s)
- Cigdem Coskun
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Yusuf Coskun
- Department of Gastroenterology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
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