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Ziccardi S, Tamanti A, Ruggieri C, Guandalini M, Marastoni D, Camera V, Montibeller L, Mazziotti V, Rossi S, Calderone M, Pizzini FB, Montemezzi S, Magliozzi R, Calabrese M. CSF Parvalbumin Levels at Multiple Sclerosis Diagnosis Predict Future Worse Cognition, Physical Disability, Fatigue, and Gray Matter Damage. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200301. [PMID: 39178066 PMCID: PMC11368234 DOI: 10.1212/nxi.0000000000200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/11/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment (CI) in multiple sclerosis (MS) is frequent and determined by a complex interplay between inflammatory and neurodegenerative processes. We aimed to investigate whether CSF parvalbumin (PVALB), measured at the time of diagnosis, may have a prognostic role in patients with MS. METHODS In this cohort study, CSF analysis of PVALB and Nf-L levels was performed on all patients at diagnosis (T0) and combined with physical, cognitive, and MRI assessment after an average of 4 years of follow-up (T4) from diagnosis. Cognitive performance was evaluated with a comprehensive neuropsychologic battery: both global (cognitively normal, CN, mildly CI, mCI, and severely CI, sCI) and domain cognitive status (normal/impaired in memory, attention/information processing speed, and executive functions) were considered. Cortical thickness and gray matter volume data were acquired using 3T MRI scanner. RESULTS A total of 72 patients with MS were included. At diagnosis, PVALB levels were higher in those patients who showed a worsening physical disability after 4 years of follow-up (p = 0.011). CSF PVALB levels were higher in sCI patients than in CN (p = 0.033). Moreover, higher PVALB levels significantly correlated with worse global cognitive (p = 0.024) and memory functioning (p = 0.044). A preliminary clinical threshold for PVALB levels at diagnosis was proposed (2.57 ng/mL), which maximizes the risk of showing CI (in particular, sCI) at follow-up, with a sensitivity of 91% (specificity 30%). No significant results were found for these associations with Nf-L. In addition, patients with higher levels of PVALB at diagnosis showed higher cognitive (p = 0.024) and global fatigue (p = 0.043) at follow-up. Finally, higher PVALB levels also correlated significantly with more pronounced CTh/volume at T4 in the inferior frontal gyrus (p = 0.044), postcentral gyrus (p = 0.025), frontal pole (p = 0.042), transverse temporal gyrus (p = 0.008), and cerebellar cortex (p = 0.041) and higher atrophy (change T0-T4) in the right thalamus (p = 0.038), pericalcarine cortex (p = 0.009), lingual gyrus (p = 0.045), and medial frontal gyrus (p = 0.028). DISCUSSION The significant association found between parvalbumin levels in the CSF at diagnosis and cognitive, clinical, and neuroradiologic worsening after 4 years of follow-up support the idea that parvalbumin, in addition to Nf-L, might represent a new potential prognostic biomarker, reflecting MS neurodegenerative processes occurring since early disease stages.
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Affiliation(s)
- Stefano Ziccardi
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Agnese Tamanti
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Claudia Ruggieri
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Maddalena Guandalini
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Damiano Marastoni
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Valentina Camera
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Luigi Montibeller
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Valentina Mazziotti
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Stefania Rossi
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Milena Calderone
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Francesca Benedetta Pizzini
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Stefania Montemezzi
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Roberta Magliozzi
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
| | - Massimiliano Calabrese
- From the Department of Neurosciences (S.Z., A.T., C.R., M.G., D.M., V.C., L.M., V.M., S.R., R.M., M. Calabrese), Biomedicine and Movement, University of Verona; Department of Oncology and Molecular Medicine (S.R.), Istituto Superiore di Sanità, Rome; Radiology Unit (M. Calderone), Cmsr Veneto Medica s.r.l., Altavilla Vicentina, Vicenza; and Institute of Radiology (F.B.P., S.M.), University of Verona, Italy
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Baraibar AM, Colomer T, Moreno-García A, Bernal-Chico A, Sánchez-Martín E, Utrilla C, Serrat R, Soria-Gómez E, Rodríguez-Antigüedad A, Araque A, Matute C, Marsicano G, Mato S. Autoimmune inflammation triggers aberrant astrocytic calcium signaling to impair synaptic plasticity. Brain Behav Immun 2024; 121:192-210. [PMID: 39032542 DOI: 10.1016/j.bbi.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
Cortical pathology involving inflammatory and neurodegenerative mechanisms is a hallmark of multiple sclerosis and a correlate of disease progression and cognitive decline. Astrocytes play a pivotal role in multiple sclerosis initiation and progression but astrocyte-neuronal network alterations contributing to gray matter pathology remain undefined. Here we unveil deregulation of astrocytic calcium signaling and astrocyte-to-neuron communication as key pathophysiological mechanisms of cortical dysfunction in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis. Using two-photon imaging ex vivo and fiber photometry in freely behaving mice, we found that acute EAE was associated with the emergence of spontaneously hyperactive cortical astrocytes exhibiting dysfunctional responses to cannabinoid, glutamate and purinoreceptor agonists. Abnormal astrocyte signaling by Gi and Gq protein coupled receptors was observed in the inflamed cortex. This was mirrored by treatments with pro-inflammatory factors both in vitro and ex vivo, suggesting cell-autonomous effects of the cortical neuroinflammatory environment. Finally, deregulated astrocyte calcium activity was associated with an enhancement of glutamatergic gliotransmission and a shift of astrocyte-mediated short-term and long-term plasticity mechanisms towards synaptic potentiation. Overall, our data identify astrocyte-neuronal network dysfunctions as key pathological features of gray matter inflammation in multiple sclerosis and potentially additional neuroimmunological disorders.
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Affiliation(s)
- A M Baraibar
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
| | - T Colomer
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - A Moreno-García
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - A Bernal-Chico
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - E Sánchez-Martín
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - C Utrilla
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - R Serrat
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1215 NeuroCentre Magendie, 33077 Bordeaux, France; University of Bordeaux, 33077 Bordeaux, France
| | - E Soria-Gómez
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain
| | - A Rodríguez-Antigüedad
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - A Araque
- Department of Neuroscience, University of Minnesota, Minneapolis, 55455 MN, USA
| | - C Matute
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
| | - G Marsicano
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1215 NeuroCentre Magendie, 33077 Bordeaux, France; University of Bordeaux, 33077 Bordeaux, France.
| | - S Mato
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain; Neuroinmunology Group, Biobizkaia Health Research Institute, 48903 Barakaldo, Spain.
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3
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Müller J, Lu PJ, Cagol A, Ruberte E, Shin HG, Ocampo-Pineda M, Chen X, Tsagkas C, Barakovic M, Galbusera R, Weigel M, Schaedelin SA, Wang Y, Nguyen TD, Spincemaille P, Kappos L, Kuhle J, Lee J, Granziera C. Quantifying Remyelination Using χ-Separation in White Matter and Cortical Multiple Sclerosis Lesions. Neurology 2024; 103:e209604. [PMID: 39213476 PMCID: PMC11362958 DOI: 10.1212/wnl.0000000000209604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Myelin and iron play essential roles in remyelination processes of multiple sclerosis (MS) lesions. χ-separation, a novel biophysical model applied to multiecho T2*-data and T2-data, estimates the contribution of myelin and iron to the obtained susceptibility signal. We used this method to investigate myelin and iron levels in lesion and nonlesion brain areas in patients with MS and healthy individuals. METHODS This prospective MS cohort study included patients with MS fulfilling the McDonald Criteria 2017 and healthy individuals, aged 18 years or older, with no other neurologic comorbidities. Participants underwent MRI at baseline and after 2 years, including multiecho GRE-(T2*) and FAST-(T2) sequences. Using χ-separation, we generated myelin-sensitive and iron-sensitive susceptibility maps. White matter lesions (WMLs), cortical lesions (CLs), surrounding normal-appearing white matter (NAWM), and normal-appearing gray matter were segmented on fluid-attenuated inversion recovery and magnetization-prepared 2 rapid gradient echo images, respectively. Cross-sectional group comparisons used Wilcoxon rank-sum tests, longitudinal analyses applied Wilcoxon signed-rank tests. Associations with clinical outcomes (disease phenotype, age, sex, disease duration, disability measured by Expanded Disability Status Scale [EDSS], neurofilament light chain levels, and T2-lesion number and volume) were assessed using linear regression models. RESULTS Of 168 patients with MS (median [interquartile range (IQR)] age 47.0 [21.7] years; 101 women; 6,898 WMLs, 775 CLs) and 103 healthy individuals (age 33.0 [10.5] years, 57 women), 108 and 62 were followed for a median of 2 years, respectively (IQR 0.1; 5,030 WMLs, 485 CLs). At baseline, WMLs had lower myelin (median 0.025 [IQR 0.015] parts per million [ppm]) and iron (0.017 [0.015] ppm) than the corresponding NAWM (myelin 0.030 [0.012]; iron 0.019 [0.011] ppm; both p < 0.001). After 2 years, both myelin (0.027 [0.014] ppm) and iron had increased (0.018 [0.015] ppm; both p < 0.001). Younger age (p < 0.001, b = -5.111 × 10-5), lower disability (p = 0.04, b = -2.352 × 10-5), and relapsing-remitting phenotype (RRMS, 0.003 [0.01] vs primary progressive 0.002 [IQR 0.01], p < 0.001; vs secondary progressive 0.0004 [IQR 0.01], p < 0.001) at baseline were associated with remyelination. Increment of myelin correlated with clinical improvement measured by EDSS (p = 0.015, b = -6.686 × 10-4). DISCUSSION χ-separation, a novel mathematical model applied to multiecho T2*-images and T2-images shows that young RRMS patients with low disability exhibit higher remyelination capacity, which correlated with clinical disability over a 2-year follow-up.
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Affiliation(s)
- Jannis Müller
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Po-Jui Lu
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Alessandro Cagol
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Esther Ruberte
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Hyeong-Geol Shin
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Mario Ocampo-Pineda
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Xinjie Chen
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Charidimos Tsagkas
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Muhamed Barakovic
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Riccardo Galbusera
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Matthias Weigel
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Sabine A Schaedelin
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Yi Wang
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Thanh D Nguyen
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Pascal Spincemaille
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Ludwig Kappos
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Jens Kuhle
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Jongho Lee
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
| | - Cristina Granziera
- From the Translational Imaging in Neurology (ThINk) Basel (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., S.A.S., L.K., C.G.), Department of Biomedical Engineering, Faculty of Medicine, and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (J.M., P.-J.L., A.C., E.R., M.O.-P., X.C., C.T., M.B., R.G., M.W., L.K., J.K., C.G.), University Hospital Basel and University of Basel, Switzerland; Department of Health Sciences (A.C.), University of Genova, Italy; Laboratory for Imaging Science and Technology (H.-G.S., J.L.), Department of Electrical and Computer Engineering, Seoul National University, South Korea; Division of Radiological Physics (M.W.), Department of Radiology, University Hospital Basel; Department of Clinical Research (S.A.S.), Clinical Trial Unit, University Hospital Basel, Switzerland; and Department of Radiology (Y.W., T.D.N., P.S.), Weill Medical College of Cornell University, New York, NY
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Comi G, Dalla Costa G, Stankoff B, Hartung HP, Soelberg Sørensen P, Vermersch P, Leocani L. Assessing disease progression and treatment response in progressive multiple sclerosis. Nat Rev Neurol 2024:10.1038/s41582-024-01006-1. [PMID: 39251843 DOI: 10.1038/s41582-024-01006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/11/2024]
Abstract
Progressive multiple sclerosis poses a considerable challenge in the evaluation of disease progression and treatment response owing to its multifaceted pathophysiology. Traditional clinical measures such as the Expanded Disability Status Scale are limited in capturing the full scope of disease and treatment effects. Advanced imaging techniques, including MRI and PET scans, have emerged as valuable tools for the assessment of neurodegenerative processes, including the respective role of adaptive and innate immunity, detailed insights into brain and spinal cord atrophy, lesion dynamics and grey matter damage. The potential of cerebrospinal fluid and blood biomarkers is increasingly recognized, with neurofilament light chain levels being a notable indicator of neuro-axonal damage. Moreover, patient-reported outcomes are crucial for reflecting the subjective experience of disease progression and treatment efficacy, covering aspects such as fatigue, cognitive function and overall quality of life. The future incorporation of digital technologies and wearable devices in research and clinical practice promises to enhance our understanding of functional impairments and disease progression. This Review offers a comprehensive examination of these diverse evaluation tools, highlighting their combined use in accurately assessing disease progression and treatment efficacy in progressive multiple sclerosis, thereby guiding more effective therapeutic strategies.
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Affiliation(s)
- Giancarlo Comi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy.
| | | | - Bruno Stankoff
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Centre National de la Recherche Scientifique, Inserm, Paris, France
| | - Hans-Peter Hartung
- Brain and Mind Center, University of Sydney, Sydney, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Per Soelberg Sørensen
- Department of Neurology, Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Vermersch
- University of Lille, Inserm U1172, Lille Neuroscience & Cognition, Centre Hospitalier Universitaire de Lille, Fédération Hospitalo-Universitaire Precision Medicine in Psychiatry, Lille, France
| | - Letizia Leocani
- Vita-Salute San Raffaele University, Milan, Italy
- Multiple Sclerosis Center, Casa di Cura Igea, Milan, Italy
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5
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Marastoni D, Turano E, Tamanti A, Colato E, Pisani AI, Scartezzini A, Carotenuto S, Mazziotti V, Camera V, Anni D, Ziccardi S, Guandalini M, Pizzini FB, Virla F, Mariotti R, Magliozzi R, Bonetti B, Steinman L, Calabrese M. Association of Levels of CSF Osteopontin With Cortical Atrophy and Disability in Early Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200265. [PMID: 38917380 PMCID: PMC11203401 DOI: 10.1212/nxi.0000000000200265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/29/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND OBJECTIVES To evaluate CSF inflammatory markers with accumulation of cortical damage as well as disease activity in patients with early relapsing-remitting MS (RRMS). METHODS CSF levels of osteopontin (OPN) and 66 inflammatory markers were assessed using an immune-assay multiplex technique in 107 patients with RRMS (82 F/25 M, mean age 35.7 ± 11.8 years). All patients underwent regular clinical assessment and yearly 3T MRI scans for 2 years while 39 patients had a 4-year follow-up. White matter lesion number and volume, cortical lesions (CLs) and volume, and global cortical thickness (CTh) were evaluated together with the 'no evidence of disease activity' (NEDA-3) status, defined by no relapses, no disability worsening, and no MRI activity, including CLs. RESULTS The random forest algorithm selected OPN, CXCL13, TWEAK, TNF, IL19, sCD30, sTNFR1, IL35, IL16, and sCD163 as significantly associated with changes in global CTh. OPN and CXCL13 were most related to accumulation of atrophy after 2 and 4 years. In a multivariate linear regression model on CSF markers, OPN (p < 0.001), CXCL13 (p = 0.001), and sTNFR1 (p = 0.024) were increased in those patients with accumulating atrophy (adjusted R-squared 0.615). The 10 markers were added in a model that included all clinical, demographic, and MRI variables: OPN (p = 0.002) and IL19 (p = 0.022) levels were confirmed to be significantly increased in patients developing more CTh change over the follow-up (adjusted R-squared 0.619). CXCL13 and OPN also revealed the best association with NEDA-3 after 2 years, with OPN significantly linked to disability accumulation (OR 2.468 [1.46-5.034], p = 0.004) at the multivariate logistic regression model. DISCUSSION These data confirm and expand our knowledge on the prognostic role of the CSF inflammatory profile in predicting changes in cortical pathology and disease activity in early MS. The data emphasize a crucial role of OPN.
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Affiliation(s)
- Damiano Marastoni
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Ermanna Turano
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Agnese Tamanti
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Elisa Colato
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Anna Isabella Pisani
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Arianna Scartezzini
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Silvia Carotenuto
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Valentina Mazziotti
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Valentina Camera
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Daniela Anni
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Stefano Ziccardi
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Maddalena Guandalini
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Francesca B Pizzini
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Federica Virla
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Raffaella Mariotti
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Roberta Magliozzi
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Bruno Bonetti
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Lawrence Steinman
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
| | - Massimiliano Calabrese
- From the Neurology B (D.M., E.T., A.T., E.C., A.I.P., A.S., S.C., V.M., V.C., D.A., S.Z., M.G., F.V., R. Magliozzi, M.C.); Anatomy and Histology section (E.T., F.V., R. Mariotti), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Anatomy and Neurosciences (E.C.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Neuroradiology and Radiology Units (F.B.P.), Department of Engineering for Innovation Medicine, University of Verona, Italy; Department of Brain Sciences (R. Magliozzi), Faculty of Medicine, Imperial College London, United Kingdom; Neurology A (B.B.), Azienda Ospedaliera Universitaria Integrata di Verona, Italy; and Department of Neurology and Neurological Sciences Stanford University (L.S.), CA
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Jakuszyk P, Podlecka-Piętowska A, Kossowski B, Nojszewska M, Zakrzewska-Pniewska B, Juryńczyk M. Patterns of cerebral damage in multiple sclerosis and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders-major differences revealed by non-conventional imaging. Brain Commun 2024; 6:fcae295. [PMID: 39258257 PMCID: PMC11384145 DOI: 10.1093/braincomms/fcae295] [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: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
Multiple sclerosis and aquaporin-4 antibody neuromyelitis optica spectrum disorders are distinct autoimmune CNS disorders with overlapping clinical features but differing pathology. Multiple sclerosis is primarily a demyelinating disease with the presence of widespread axonal damage, while neuromyelitis optica spectrum disorders is characterized by astrocyte injury with secondary demyelination. Diagnosis is typically based on lesion characteristics observed on standard MRI imaging and antibody testing but can be challenging in patients with in-between clinical presentations. Non-conventional MRI techniques can provide valuable diagnostic information by measuring disease processes at the microstructural level. We used non-conventional MRI to measure markers of axonal loss in specific white matter tracts in multiple sclerosis and neuromyelitis optica spectrum disorders, depending on their relationship with focal lesions. Patients with relapsing-remitting multiple sclerosis (n = 20), aquaporin-4 antibody-associated neuromyelitis optica spectrum disorders (n = 20) and healthy controls (n = 20) underwent a 3T brain MRI, including T1-, T2- and diffusion-weighted sequences, quantitative susceptibility mapping and phase-sensitive inversion recovery sequence. Tractometry was used to differentiate tract fibres traversing through white matter lesions from those that did not. Neurite density index was assessed using neurite orientation dispersion and density imaging model. Cortical damage was evaluated using T1 relaxation rates. Cortical lesions and paramagnetic rim lesions were identified using phase-sensitive inversion recovery and quantitative susceptibility mapping. In tracts traversing lesions, only one out of 50 tracts showed a decreased neurite density index in multiple sclerosis compared with neuromyelitis optica spectrum disorders. Among 50 tracts not traversing lesions, six showed reduced neurite density in multiple sclerosis (including three in the cerebellum and brainstem) compared to neuromyelitis optica spectrum disorders. In multiple sclerosis, reduced neurite density was found in the majority of fibres traversing (40/50) and not traversing (37/50) white matter lesions when compared to healthy controls. A negative correlation between neurite density in lesion-free fibres and cortical lesions, but not paramagnetic rim lesions, was observed in multiple sclerosis (39/50 tracts). In neuromyelitis optica spectrum disorders compared to healthy controls, decreased neurite density was observed in a subset of fibres traversing white matter lesions, but not in lesion-free fibres. In conclusion, we identified significant differences between multiple sclerosis and neuromyelitis optica spectrum disorders corresponding to their distinct pathologies. Specifically, in multiple sclerosis, neurite density reduction was widespread across fibres, regardless of their relationship to white matter lesions, while in neuromyelitis optica spectrum disorders, this reduction was limited to fibres passing through white matter lesions. Further studies are needed to evaluate the discriminatory potential of neurite density measures in white matter tracts for differentiating multiple sclerosis from neuromyelitis optica spectrum disorders.
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Affiliation(s)
- Paweł Jakuszyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | | | - Bartosz Kossowski
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | - Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
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7
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Stys PK, Tsutsui S, Gafson AR, ‘t Hart BA, Belachew S, Geurts JJG. New views on the complex interplay between degeneration and autoimmunity in multiple sclerosis. Front Cell Neurosci 2024; 18:1426231. [PMID: 39161786 PMCID: PMC11330826 DOI: 10.3389/fncel.2024.1426231] [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: 05/01/2024] [Accepted: 06/14/2024] [Indexed: 08/21/2024] Open
Abstract
Multiple sclerosis (MS) is a frequently disabling neurological disorder characterized by symptoms, clinical signs and imaging abnormalities that typically fluctuate over time, affecting any level of the CNS. Prominent lymphocytic inflammation, many genetic susceptibility variants involving immune pathways, as well as potent responses of the neuroinflammatory component to immunomodulating drugs, have led to the natural conclusion that this disease is driven by a primary autoimmune process. In this Hypothesis and Theory article, we discuss emerging data that cast doubt on this assumption. After three decades of therapeutic experience, what has become clear is that potent immune modulators are highly effective at suppressing inflammatory relapses, yet exhibit very limited effects on the later progressive phase of MS. Moreover, neuropathological examination of MS tissue indicates that degeneration, CNS atrophy, and myelin loss are most prominent in the progressive stage, when lymphocytic inflammation paradoxically wanes. Finally, emerging clinical observations such as "progression independent of relapse activity" and "silent progression," now thought to take hold very early in the course, together argue that an underlying "cytodegenerative" process, likely targeting the myelinating unit, may in fact represent the most proximal step in a complex pathophysiological cascade exacerbated by an autoimmune inflammatory overlay. Parallels are drawn with more traditional neurodegenerative disorders, where a progressive proteopathy with prion-like propagation of toxic misfolded species is now known to play a key role. A potentially pivotal contribution of the Epstein-Barr virus and B cells in this process is also discussed.
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Affiliation(s)
- Peter K. Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shigeki Tsutsui
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Arie R. Gafson
- Biogen Digital Health, Biogen, Cambridge, MA, United States
| | - Bert A. ‘t Hart
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers (location VUmc), Amsterdam, Netherlands
| | - Shibeshih Belachew
- TheraPanacea, Paris, France
- Indivi (DBA of Healios AG), Basel, Switzerland
| | - Jeroen J. G. Geurts
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers (location VUmc), Amsterdam, Netherlands
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Mistry N, Hobart J, Rog D, Muhlert N, Mathews J, Baker D, Giovannoni G. Reconciling lesions, relapses and smouldering associated worsening: A unifying model for multiple sclerosis pathogenesis. Mult Scler Relat Disord 2024; 88:105706. [PMID: 38880031 DOI: 10.1016/j.msard.2024.105706] [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: 04/02/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
The failure of relapses and white matter lesions to properly explain long-term disability and progression in multiple sclerosis is compounded by its artificial separation into relapsing remitting, secondary progressive, and primary progressive pigeonholes. The well-known epidemiological disconnection between relapses and long-term disability progression has been rediscovered as "progression independent of relapse activity", i.e. smouldering multiple sclerosis. This smouldering associated worsening proceeds despite early and prolonged use of disease modification therapies, even those that are highly effective at preventing relapses and new/enhancing white matter lesions on MRI. We recognise that smouldering associated worsening and relapse/lesion associated worsening coexist, to varying extents. The extent of cortical demyelination has been shown to correlate significantly with the severity of diffuse injury in normal appearing white matter (post mortem histopathologically (r = 0.55; P = 0.001), and in vivo with MRI (r = -0.6874; P = 0.0006)) and does so independently of white matter lesion burden. Axon loss in the normal appearing white matter explains disability in multiple sclerosis better than focal white matter lesions do. Smouldering associated worsening typically manifests as a length-dependent central axonopathy. We propose a unifying model for multiple sclerosis pathogenesis, wherein accumulation of cortical lesion burden predisposes associated normal appearing white matter to diffuse injury, whilst also intensifying damage within white matter lesions. Our novel two-hit hypothesis implicates cortical disease as a culprit for smouldering multiple sclerosis, abetted by active focal inflammation in the white matter (and vice versa). Substantiation of the two-hit hypothesis would advance the importance of specific therapeutic intervention for (and monitoring of) cortical/meningeal inflammation in people with multiple sclerosis.
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Affiliation(s)
- Niraj Mistry
- Department of Clinical Neurosciences, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Jeremy Hobart
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nils Muhlert
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Joela Mathews
- Department of Neurology, The Royal London Hospital, London, UK
| | - David Baker
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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9
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Cortese R, Battaglini M, Prados F, Gentile G, Luchetti L, Bianchi A, Haider L, Jacob A, Palace J, Messina S, Paul F, Marignier R, Durand-Dubief F, de Medeiros Rimkus C, Apostolos Pereira SL, Sato DK, Filippi M, Rocca MA, Cacciaguerra L, Rovira À, Sastre-Garriga J, Arrambide G, Liu Y, Duan Y, Gasperini C, Tortorella C, Ruggieri S, Amato MP, Ulivelli M, Groppa S, Grothe M, Llufriu S, Sepulveda M, Lukas C, Bellenberg B, Schneider R, Sowa P, Celius EG, Pröbstel AK, Granziera C, Yaldizli Ö, Müller J, Stankoff B, Bodini B, Barkhof F, Ciccarelli O, De Stefano N. Grey Matter Atrophy and its Relationship with White Matter Lesions in Patients with Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease, Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder, and Multiple Sclerosis. Ann Neurol 2024; 96:276-288. [PMID: 38780377 DOI: 10.1002/ana.26951] [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: 10/02/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate: (1) the distribution of gray matter (GM) atrophy in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), and relapsing-remitting multiple sclerosis (RRMS); and (2) the relationship between GM volumes and white matter lesions in various brain regions within each disease. METHODS A retrospective, multicenter analysis of magnetic resonance imaging data included patients with MOGAD/AQP4+NMOSD/RRMS in non-acute disease stage. Voxel-wise analyses and general linear models were used to evaluate the relevance of regional GM atrophy. For significant results (p < 0.05), volumes of atrophic areas are reported. RESULTS We studied 135 MOGAD patients, 135 AQP4+NMOSD, 175 RRMS, and 144 healthy controls (HC). Compared with HC, MOGAD showed lower GM volumes in the temporal lobes, deep GM, insula, and cingulate cortex (75.79 cm3); AQP4+NMOSD in the occipital cortex (32.83 cm3); and RRMS diffusely in the GM (260.61 cm3). MOGAD showed more pronounced temporal cortex atrophy than RRMS (6.71 cm3), whereas AQP4+NMOSD displayed greater occipital cortex atrophy than RRMS (19.82 cm3). RRMS demonstrated more pronounced deep GM atrophy in comparison with MOGAD (27.90 cm3) and AQP4+NMOSD (47.04 cm3). In MOGAD, higher periventricular and cortical/juxtacortical lesions were linked to reduced temporal cortex, deep GM, and insula volumes. In RRMS, the diffuse GM atrophy was associated with lesions in all locations. AQP4+NMOSD showed no lesion/GM volume correlation. INTERPRETATION GM atrophy is more widespread in RRMS compared with the other two conditions. MOGAD primarily affects the temporal cortex, whereas AQP4+NMOSD mainly involves the occipital cortex. In MOGAD and RRMS, lesion-related tract degeneration is associated with atrophy, but this link is absent in AQP4+NMOSD. ANN NEUROL 2024;96:276-288.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Queen Square MS Center, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- SIENA imaging SRL, Siena, Italy
| | - Ferran Prados
- Queen Square MS Center, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Center for Medical Imaging Computing, Medical Physics, and Biomedical Engineering, UCL, London, UK
- E-Health Center University Oberta de Catalunya, Barcelona, Spain
| | - Giordano Gentile
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- SIENA imaging SRL, Siena, Italy
| | - Ludovico Luchetti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- SIENA imaging SRL, Siena, Italy
| | - Alessia Bianchi
- Queen Square MS Center, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Lukas Haider
- Queen Square MS Center, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Anu Jacob
- NMO Clinical Service at the Walton Centre, Liverpool, UK
- Department of Neurology, Cleveland Clinic, Abu Dhabi, UAE
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Silvia Messina
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Romain Marignier
- Department of Neurology, Multiple Sclerosis, Myelin Disorders, and Neuro-inflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Françoise Durand-Dubief
- Department of Neurology, Multiple Sclerosis, Myelin Disorders, and Neuro-inflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Carolina de Medeiros Rimkus
- Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | | | - Douglas Kazutoshi Sato
- Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, Brazil
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Claudio Gasperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Pia Amato
- Department Neurofarba, University of Florence, Florence, Italy
- IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sara Llufriu
- Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Katrin Pröbstel
- Department of Neurology, Biomedicine and Clinical Research, and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Department of Neurology, Biomedicine and Clinical Research, and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Department of Neurology, Biomedicine and Clinical Research, and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
| | - Jannis Müller
- Department of Neurology, Biomedicine and Clinical Research, and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Bruno Stankoff
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Paris, France
| | - Benedetta Bodini
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Paris, France
| | - Frederik Barkhof
- Center for Medical Imaging Computing, Medical Physics, and Biomedical Engineering, UCL, London, UK
- Radiology & Nuclear medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Olga Ciccarelli
- Queen Square MS Center, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Center, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Colato E, Stutters J, Narayanan S, Arnold DL, Chataway J, Gandini Wheeler-Kingshott CAM, Barkhof F, Ciccarelli O, Eshaghi A, Chard DT. Longitudinal network-based brain grey matter MRI measures are clinically relevant and sensitive to treatment effects in multiple sclerosis. Brain Commun 2024; 6:fcae234. [PMID: 39077376 PMCID: PMC11285187 DOI: 10.1093/braincomms/fcae234] [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: 07/17/2023] [Revised: 05/24/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
In multiple sclerosis clinical trials, MRI outcome measures are typically extracted at a whole-brain level, but pathology is not homogeneous across the brain and so whole-brain measures may overlook regional treatment effects. Data-driven methods, such as independent component analysis, have shown promise in identifying regional disease effects but can only be computed at a group level and cannot be applied prospectively. The aim of this work was to develop a technique to extract longitudinal independent component analysis network-based measures of co-varying grey matter volumes, derived from T1-weighted volumetric MRI, in individual study participants, and assess their association with disability progression and treatment effects in clinical trials. We used longitudinal MRI and clinical data from 5089 participants (22 045 visits) with multiple sclerosis from eight clinical trials. We included people with relapsing-remitting, primary and secondary progressive multiple sclerosis. We used data from five negative clinical trials (2764 participants, 13 222 visits) to extract the independent component analysis-based measures. We then trained and cross-validated a least absolute shrinkage and selection operator regression model (which can be applied prospectively to previously unseen data) to predict the independent component analysis measures from the same regional MRI volume measures and applied it to data from three positive clinical trials (2325 participants, 8823 visits). We used nested mixed-effect models to determine how networks differ across multiple sclerosis phenotypes are associated with disability progression and to test sensitivity to treatment effects. We found 17 consistent patterns of co-varying regional volumes. In the training cohort, volume loss was faster in four networks in people with secondary progressive compared with relapsing-remitting multiple sclerosis and three networks with primary progressive multiple sclerosis. Volume changes were faster in secondary compared with primary progressive multiple sclerosis in four networks. In the combined positive trials cohort, eight independent component analysis networks and whole-brain grey matter volume measures showed treatment effects, and the magnitude of treatment-placebo differences in the network-based measures was consistently greater than with whole-brain grey matter volume measures. Longitudinal network-based analysis of grey matter volume changes is feasible using clinical trial data, showing differences cross-sectionally and longitudinally between multiple sclerosis phenotypes, associated with disability progression, and treatment effects. Future work is required to understand the pathological mechanisms underlying these regional changes.
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Affiliation(s)
- Elisa Colato
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
| | - Jonathan Stutters
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- Brain Connectivity Centre, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, 27100, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, 27100, Italy
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
- Department of Radiology and Nuclear Medicine, Vrije Universiteit (VU) Medical Centre, Amsterdam, 1081 HZ, The Netherlands
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, WC1V 6LJ, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
| | - Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, WC1V 6LJ, UK
| | - Declan T Chard
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
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11
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Scher MS. Interdisciplinary fetal-neonatal neurology training improves brain health across the lifespan. Front Neurol 2024; 15:1411987. [PMID: 39026582 PMCID: PMC11254674 DOI: 10.3389/fneur.2024.1411987] [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: 04/03/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year program. Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene-environment interactions. Maternal-placental-fetal triad, neonatal, or childhood diseases require diagnostic and therapeutic decisions during the first 1,000 days when 80 % of neural connections contribute to life-course phenotypic expression. Pediatric follow-up through 3 years adjusts to gestational ages of preterm survivors. Cumulative reproductive, pregnancy, pediatric and adult exposome effects require educational experiences that emphasize a principle-to-practice approach to a brain capital strategy across the lifespan. More rigorous training during fetal, neonatal, and pediatric rotations will be offered to full time trainees. Adult neurology residents, medical students, and trainees from diverse disciplines will learn essential topics during time-limited rotations. Curriculum content will require periodic re-assessments using educational science standards that maintain competence while promoting creative and collaborative problem-solving. Continued career-long learning by FNN graduates will strengthen shared healthcare decisions by all stakeholders. Recognition of adaptive or maladaptive neuroplasticity mechanisms requires analytic skills that identify phenotypes associated with disease pathways. Developmental origins and life-course concepts emphasize brain health across the developmental-aging continuum, applicable to interdisciplinary research collaborations. Social determinants of health recognize diversity, equity, and inclusion priorities with each neurological intervention, particularly for those challenged with disparities. Diagnostic and therapeutic strategies must address resource challenges particularly throughout the Global South to effectively lower the worldwide burden of neurologic disease. Sustainable development goals proposed by the World Health Organization offer universally applicable guidelines in response to ongoing global and regional polycrises. Gender, race, ethnicity, and socio-economic equality promote effective preventive, rescue and reparative neuroprotective interventions. Global synergistic efforts can be enhanced by establishing leadership within academic teaching hubs in FNN training to assist with structure and guidance for smaller healthcare facilities in each community that will improve practice, education and research objectives. Reduced mortality with an improved quality of life must prioritize maternal-pediatric health and well-being to sustain brain health across each lifespan with transgenerational benefits.
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Affiliation(s)
- Mark S. Scher
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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12
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Yan Z, Shi Z, Zhu Q, Feng J, Liu Y, Li Y, Zhou F, Zhuo Z, Ding S, Wang X, Yin F, Tang Y, Lin B, Li Y. Interpretable and Intuitive Machine Learning Approaches for Predicting Disability Progression in Relapsing-Remitting Multiple Sclerosis Based on Clinical and Gray Matter Atrophy Indicators. Acad Radiol 2024; 31:2910-2921. [PMID: 38429188 DOI: 10.1016/j.acra.2024.01.032] [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: 12/29/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 03/03/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate whether clinical and gray matter (GM) atrophy indicators can predict disability in relapsing-remitting multiple sclerosis (RRMS) and to enhance the interpretability and intuitiveness of a predictive machine learning model. MATERIALS AND METHODS 145 and 50 RRMS patients with structural MRI and at least 1-year follow-up Expanded Disability Status Scale (EDSS) results were retrospectively enrolled and placed in the discovery and external test cohorts, respectively. Six clinical and radiomics feature-based machine learning classifiers were trained and tested to predict disability progression in the discovery cohort and validated in the external test set. Partial dependence plot (PDP) analysis and a Shiny web application were conducted to enhance the interpretability and intuitiveness. RESULTS In the discovery cohort, 98 patients had disability stability, and 47 patients were classified as having disability progression. In the external test set, 35 patients were disability stable, and 15 patients had disability progression. Models trained with both clinical and radiomics features (area under the curve (AUC), 0.725-0.950) outperformed those trained with clinical (AUC, 0.600-0.740) or radiomics features only (AUC, 0.615-0.945). Among clinical+ radiomics feature models, the logistic regression (LR) classifier-based model performed best, with an AUC of 0.950. Only the radiomics feature-only models were applied in the external test set due to the data collection problem and showed fair performance, with AUCs ranging from 0.617 to 0.753. PDP analysis showed that female patients and those with lower volume, surface area, and symbol digit modalities test (SDMT) scores; greater mean curvature and age; and no disease modifying therapy (DMT) had increased probabilities of disease progression. Finally, a Shiny web application (https://lauralin1104.shinyapps.io/LRshiny/) was developed to calculate the risk of disability progression. CONCLUSION Interpretable and intuitive machine learning approaches based on clinical and GM atrophy indicators can help physicians predict disability progression in RRMS patients for clinical decision-making and patient management.
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Affiliation(s)
- Zichun Yan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuowei Shi
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiyuan Zhu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuang Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaohua Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Feiyue Yin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Tang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Lin
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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13
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Ziccardi S, Genova H, Colato E, Guandalini M, Tamanti A, Calabrese M. The neural substrates of social cognition deficits in newly diagnosed multiple sclerosis patients. Ann Clin Transl Neurol 2024; 11:1798-1808. [PMID: 38872257 PMCID: PMC11251485 DOI: 10.1002/acn3.52085] [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: 02/22/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Cognitive and affective symptoms in multiple sclerosis (MS) can be independently impaired and have different pathways of progression. Cognitive alterations have been described since the earliest MS stages; by contrast, the social cognition (SC) domain has never been investigated in the first year from MS diagnosis. We aimed to evaluate SC and unravel its neural bases in newly diagnosed MS patients. METHODS Seventy MS patients underwent at diagnosis a 3 T-MRI and a neuropsychological/SC assessment (median time between diagnosis and MRI/cognitive evaluation = 0 months). We tested two matched reference samples: 31 relapsing-remitting MS patients with longer course (mean ± SD disease duration = 7.0 ± 4.5 years) and 38 healthy controls (HCs). Cortical thicknesses (CTh) and volumes of brain regions were calculated. RESULTS Newly diagnosed MS patients performed significantly lower than HCs in facial emotion recognition (global: p < 0.001; happiness: p = 0.041, anger: p = 0.007; fear: p < 0.001; disgust: p = 0.004) and theory of mind (p = 0.005), while no difference was found between newly diagnosed and longer MS patients. Compared to lower performers, higher performers in facial emotion recognition showed greater volume of amygdala (p = 0.032) and caudate (p = 0.036); higher performers in theory of mind showed greater CTh in lingual gyrus (p = 0.006), cuneus (p = 0.024), isthmus cingulate (p = 0.038), greater volumes of putamen (p = 0.016), pallidum (p = 0.029), and amygdala (p = 0.032); patients with higher empathy showed lower cuneus CTh (p = 0.042) and putamen volume (p = 0.007). INTERPRETATIONS SC deficits are present in MS patients since the time of diagnosis and remain persistent along the disease course. Specific basal, limbic, and occipital areas play a significant role in the pathogenesis of these alterations.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Helen Genova
- Kessler Foundation120 Eagle'Rock Ave, Suite 100East HanoverNew Jersey07936USA
- Department of Physical Medicine and Rehabilitation, New Jersey Medical SchoolRutgers UniversityNewarkNew Jersey07101USA
| | - Elisa Colato
- Neurology Section, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- MS Centre, Department of Anatomy and NeuroscienceAmsterdam UMCAmsterdamthe Netherlands
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Agnese Tamanti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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14
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Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of Progression Independent of Relapses in Multiple Sclerosis. Ann Neurol 2024; 96:1-20. [PMID: 38568026 DOI: 10.1002/ana.26913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 02/15/2024] [Indexed: 06/20/2024]
Abstract
Clinical, pathological, and imaging evidence in multiple sclerosis (MS) suggests that a smoldering inflammatory activity is present from the earliest stages of the disease and underlies the progression of disability, which proceeds relentlessly and independently of clinical and radiological relapses (PIRA). The complex system of pathological events driving "chronic" worsening is likely linked with the early accumulation of compartmentalized inflammation within the central nervous system as well as insufficient repair phenomena and mitochondrial failure. These mechanisms are partially lesion-independent and differ from those causing clinical relapses and the formation of new focal demyelinating lesions; they lead to neuroaxonal dysfunction and death, myelin loss, glia alterations, and finally, a neuronal network dysfunction outweighing central nervous system (CNS) compensatory mechanisms. This review aims to provide an overview of the state of the art of neuropathological, immunological, and imaging knowledge about the mechanisms underlying the smoldering disease activity, focusing on possible early biomarkers and their translation into clinical practice. ANN NEUROL 2024;96:1-20.
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Affiliation(s)
- Massimiliano Calabrese
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College, London, UK
| | - Elisa Colato
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battaglini
- Siena Imaging S.r.l., Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Owain W Howell
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Matilde Inglese
- Dipartimento di neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili - DINOGMI, University of Genova, Genoa, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Martin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Therapeutic Design Unit, Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Cellerys AG, Schlieren, Switzerland
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of Medicine, Burlington Danes, Imperial College London, London, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Agnese Tamanti
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Marco Vercellino
- Multiple Sclerosis Center & Neurologia I U, Department of Neuroscience, University Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Maria Villar
- Department of Immunology, Ramon y Cajal University Hospital. IRYCIS. REI, Madrid, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Magliozzi
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
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15
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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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16
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Young G, Nguyen VS, Howlett-Prieto Q, Abuaf AF, Carroll TJ, Kawaji K, Javed A. T1 mapping from routine 3D T1-weighted inversion recovery sequences in clinical practice: comparison against reference inversion recovery fast field echo T1 scans and feasibility in multiple sclerosis. Neuroradiology 2024:10.1007/s00234-024-03400-4. [PMID: 38880824 DOI: 10.1007/s00234-024-03400-4] [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: 01/21/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND PURPOSE Quantitative T1 mapping can be an essential tool for assessing tissue injury in multiple sclerosis (MS). We introduce T1-REQUIRE, a method that converts a single high-resolution anatomical 3D T1-weighted Turbo Field Echo (3DT1TFE) scan into a parametric T1 map that could be used for quantitative assessment of tissue damage. We present the accuracy and feasibility of this method in MS. METHODS 14 subjects with relapsing-remitting MS and 10 healthy subjects were examined. T1 maps were generated from 3DT1TFE images using T1-REQUIRE, which estimates T1 values using MR signal equations and internal tissue reference T1 values. Estimated T1 of lesions, white, and gray matter regions were compared with reference Inversion-Recovery Fast Field Echo T1 values and analyzed via correlation and Bland-Altman (BA) statistics. RESULTS 159 T1-weighted (T1W) hypointense MS lesions and 288 gray matter regions were examined. T1 values for MS lesions showed a Pearson's correlation of r = 0.81 (p < 0.000), R2 = 0.65, and Bias = 4.18%. BA statistics showed a mean difference of -53.95 ms and limits of agreement (LOA) of -344.20 and 236.30 ms. Non-lesional normal-appearing white matter had a correlation coefficient of r = 0.82 (p < 0.000), R2 = 0.67, Bias = 8.78%, mean difference of 73.87 ms, and LOA of -55.67 and 203.41 ms. CONCLUSIONS We demonstrate the feasibility of retroactively derived high-resolution T1 maps from routinely acquired anatomical images, which could be used to quantify tissue pathology in MS. The results of this study will set the stage for testing this method in larger clinical studies for examining MS disease activity and progression.
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Affiliation(s)
- Griffin Young
- Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Vivian S Nguyen
- Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Quentin Howlett-Prieto
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Timothy J Carroll
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Keigo Kawaji
- Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Adil Javed
- Department of Neurology, The University of Chicago, Chicago, IL, 5841 South Maryland Avenue, MC2030, 60637, USA.
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Krieger S, Cook K, Hersh CM. Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold. Curr Opin Neurol 2024; 37:189-201. [PMID: 38535979 PMCID: PMC11064902 DOI: 10.1097/wco.0000000000001262] [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: 04/04/2024]
Abstract
PURPOSE OF REVIEW Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates the various levels of explanation through which the spectrum of disease is described and investigated both above and below the clinical threshold of detection, as framed by the topographical model of MS, to help advance a cogent mechanistic framework. RECENT FINDINGS Contemporary evidence has amended the view of MS as consisting of sequential disease phases in favor of a spectrum of disease with an admixture of interdependent and dynamic pathobiological axes driving tissue injury and progression. Recent studies have shown the presence of acute and compartmentalized inflammation and mechanisms of neurodegeneration beginning early and evolving throughout the disease continuum. Still, the gap between the understanding of immunopathologic processes in MS and the tools used to measure relevant molecular, laboratory, radiologic, and clinical metrics needs attention to enable better prognostication of disease and monitoring for changes along specific pathologic axes and variable treatment outcomes. SUMMARY Aligning on a consistently-applied mechanistic framework at distinct levels of explanation will enable greater precision across bench and clinical research, and inform discourse on drivers of disability progression and delivery of care for individuals with MS.
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Affiliation(s)
- Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai
| | - Karin Cook
- Medical Education Director, Neurology at Heartbeat/Publicis Health, New York
| | - Carrie M. Hersh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas, Nevada, USA
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18
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Singhal T, Cicero S, Rissanen E, Ficke J, Kukreja P, Vaquerano S, Glanz B, Dubey S, Sticka W, Seaver K, Kijewski M, Callen AM, Chu R, Carter K, Silbersweig D, Chitnis T, Bakshi R, Weiner HL. Glial Activity Load on PET Reveals Persistent "Smoldering" Inflammation in MS Despite Disease-Modifying Treatment: 18 F-PBR06 Study. Clin Nucl Med 2024; 49:491-499. [PMID: 38630948 DOI: 10.1097/rlu.0000000000005201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
PURPOSE OF THE REPORT 18 F-PBR06-PET targeting 18-kDa translocator protein can detect abnormal microglial activation (MA) in multiple sclerosis (MS). The objectives of this study are to develop individualized mapping of MA using 18 F-PBR06, to determine the effect of disease-modifying treatment (DMT) efficacy on reducing MA, and to determine its clinical, radiological, and serological correlates in MS patients. PATIENTS AND METHODS Thirty 18 F-PBR06-PET scans were performed in 22 MS patients (mean age, 46 ± 13 years; 16 females) and 8 healthy controls (HCs). Logarithmically transformed "glial activity load on PET" scores (calculated as the sum of voxel-by-voxel z -scores ≥4), "lnGALP," were compared between MS and HC and between MS subjects on high-efficacy DMTs (H-DMT, n = 13) and those on no or lower-efficacy treatment, and correlated with clinical measures, serum biomarkers, and cortical thickness. RESULTS Cortical gray matter (CoGM) and white matter (WM) lnGALP scores were higher in MS versus HC (+33% and +48%, P < 0.001). In H-DMT group, CoGM and WM lnGALP scores were significantly lower than lower-efficacy treatment ( P < 0.01) but remained abnormally higher than in HC group ( P = 0.006). Within H-DMT patients, CoGM lnGALP scores correlated positively with physical disability, fatigue and serum glial fibrillary acid protein levels ( r = 0.65-0.79, all P 's < 0.05), and inversely with cortical thickness ( r = -0.66, P < 0.05). CONCLUSIONS High-efficacy DMTs decrease, but do not normalize, CoGM and WM MA in MS patients. Such "residual" MA in CoGM is associated with clinical disability, serum biomarkers, and cortical degeneration. Individualized mapping of translocator protein PET using 18 F-PBR06 is clinically feasible and can potentially serve as an imaging biomarker for evaluating "smoldering" inflammation in MS patients.
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Affiliation(s)
| | - Steven Cicero
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Eero Rissanen
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - John Ficke
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Preksha Kukreja
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Steven Vaquerano
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Shipra Dubey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - William Sticka
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Kyle Seaver
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Marie Kijewski
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Alexis M Callen
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Renxin Chu
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Kelsey Carter
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - David Silbersweig
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Rohit Bakshi
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Howard L Weiner
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
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19
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Menéndez-Pérez C, Rivas-Santisteban R, del Valle E, Tolivia J, Navarro A, Franco R, Martínez-Pinilla E. Heteromers Formed by GPR55 and Either Cannabinoid CB 1 or CB 2 Receptors Are Upregulated in the Prefrontal Cortex of Multiple Sclerosis Patients. Int J Mol Sci 2024; 25:4176. [PMID: 38673761 PMCID: PMC11050292 DOI: 10.3390/ijms25084176] [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: 03/15/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory, and neurodegenerative disease of the central nervous system for which there is no cure, making it necessary to search for new treatments. The endocannabinoid system (ECS) plays a very important neuromodulatory role in the CNS. In recent years, the formation of heteromers containing cannabinoid receptors and their up/downregulation in some neurodegenerative diseases have been demonstrated. Despite the beneficial effects shown by some phytocannabinoids in MS, the role of the ECS in its pathophysiology is unknown. The main objective of this work was to identify heteromers of cell surface proteins receptive to cannabinoids, namely GPR55, CB1 and CB2 receptors, in brain samples from control subjects and MS patients, as well as determining their cellular localization, using In Situ Proximity Ligation Assays and immunohistochemical techniques. For the first time, CB1R-GPR55 and CB2R-GPR55 heteromers are identified in the prefrontal cortex of the human brain, more in the grey than in the white matter. Remarkably, the number of CB1R-GPR55 and CB2R-GPR55 complexes was found to be increased in MS patient samples. The results obtained open a promising avenue of research on the use of these receptor complexes as potential therapeutic targets for the disease.
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Affiliation(s)
- Carlota Menéndez-Pérez
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Rafael Rivas-Santisteban
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (R.R.-S.); (R.F.)
- CiberNed, Network Center for Neurodegenerative Diseases, National Spanish Health Institute Carlos III, 28031 Madrid, Spain
- Laboratory of Computational Medicine, Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Bellaterra, Spain
| | - Eva del Valle
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Jorge Tolivia
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Ana Navarro
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Rafael Franco
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (R.R.-S.); (R.F.)
- CiberNed, Network Center for Neurodegenerative Diseases, National Spanish Health Institute Carlos III, 28031 Madrid, Spain
| | - Eva Martínez-Pinilla
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
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20
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Cortese R, Testa G, Assogna F, De Stefano N. Magnetic Resonance Imaging Evidence Supporting the Efficacy of Cladribine Tablets in the Treatment of Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2024; 38:267-279. [PMID: 38489020 PMCID: PMC10980660 DOI: 10.1007/s40263-024-01074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
Numerous therapies are currently available to modify the disease course of multiple sclerosis (MS). Magnetic resonance imaging (MRI) plays a pivotal role in assessing treatment response by providing insights into disease activity and clinical progression. Integrating MRI findings with clinical and laboratory data enables a comprehensive assessment of the disease course. Among available MS treatments, cladribine is emerging as a promising option due to its role as a selective immune reconstitution therapy, with a notable impact on B cells and a lesser effect on T cells. This work emphasizes the assessment of MRI's contribution to MS treatment, particularly focusing on the influence of cladribine tablets on imaging outcomes, encompassing data from pivotal and real-world studies. The evidence highlights that cladribine, compared with placebo, not only exhibits a reduction in inflammatory imaging markers, such as T1-Gd+, T2 and combined unique active (CUA) lesions, but also mitigates the effect on brain volume loss, particularly within grey matter. Importantly, cladribine reveals early action by reducing CUA lesions within the first months of treatment, regardless of a patient's initial conditions. The selective mechanism of action, and sustained efficacy beyond year 2, combined with its early onset of action, collectively position cladribine tablets as a pivotal component in the therapeutic paradigm for MS. Overall, MRI, along with clinical measures, has played a substantial role in showcasing the effectiveness of cladribine in addressing both the inflammatory and neurodegenerative aspects of MS.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Giovanna Testa
- Merck Serono S.p.A. Italy, An Affiliate of Merck KGaA, Rome, Italy
| | | | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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21
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Wang AA, Luessi F, Neziraj T, Pössnecker E, Zuo M, Engel S, Hanuscheck N, Florescu A, Bugbee E, Ma XI, Rana F, Lee D, Ward LA, Kuhle J, Himbert J, Schraad M, van Puijenbroek E, Klein C, Urich E, Ramaglia V, Pröbstel AK, Zipp F, Gommerman JL. B cell depletion with anti-CD20 promotes neuroprotection in a BAFF-dependent manner in mice and humans. Sci Transl Med 2024; 16:eadi0295. [PMID: 38446903 DOI: 10.1126/scitranslmed.adi0295] [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: 04/02/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
Anti-CD20 therapy to deplete B cells is highly efficacious in preventing new white matter lesions in patients with relapsing-remitting multiple sclerosis (RRMS), but its protective capacity against gray matter injury and axonal damage is unclear. In a passive experimental autoimmune encephalomyelitis (EAE) model whereby TH17 cells promote brain leptomeningeal immune cell aggregates, we found that anti-CD20 treatment effectively spared myelin content and prevented myeloid cell activation, oxidative damage, and mitochondrial stress in the subpial gray matter. Anti-CD20 treatment increased B cell survival factor (BAFF) in the serum, cerebrospinal fluid, and leptomeninges of mice with EAE. Although anti-CD20 prevented gray matter demyelination, axonal loss, and neuronal atrophy, co-treatment with anti-BAFF abrogated these benefits. Consistent with the murine studies, we observed that elevated BAFF concentrations after anti-CD20 treatment in patients with RRMS were associated with better clinical outcomes. Moreover, BAFF promoted survival of human neurons in vitro. Together, our data demonstrate that BAFF exerts beneficial functions in MS and EAE in the context of anti-CD20 treatment.
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Affiliation(s)
- Angela A Wang
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Tradite Neziraj
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Elisabeth Pössnecker
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Sinah Engel
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Nicholas Hanuscheck
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Alexandra Florescu
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Eryn Bugbee
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Xianjie I Ma
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Fatima Rana
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Dennis Lee
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Lesley A Ward
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Jens Kuhle
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Johannes Himbert
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Muriel Schraad
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | | | - Christian Klein
- Roche Innovation Center Zurich, Roche Glycart AG, 8952 Schlieren, Switzerland
| | - Eduard Urich
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., 4052 Basel, Switzerland
| | - Valeria Ramaglia
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Anne-Katrin Pröbstel
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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22
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Rocca MA, Preziosa P, Filippi M. Juxtacortical Paramagnetic Rim: A New MRI Marker to Characterize Focal Cortical Pathology in Multiple Sclerosis? Neurology 2024; 102:e208085. [PMID: 38165304 DOI: 10.1212/wnl.0000000000208085] [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: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
The accumulation of focal white matter and cortical inflammatory demyelinating lesions represents the pathologic hallmark of multiple sclerosis (MS).1 Typically, acute white matter lesions are characterized by an increased blood-brain barrier (BBB) permeability, an inflammatory infiltrate, and ongoing demyelination and axonal transection.2 In the chronic phase, a substantial proportion of white matter lesions, known as chronic active lesions, exhibit a hypocellular core with a rim of iron-laden activated microglia/macrophages, with no abnormal BBB permeability.2 Some of these lesions can be identified on susceptibility-based MRI as exhibiting a paramagnetic rim, and they are, therefore, referred to as "paramagnetic rim lesions" (PRLs).3.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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23
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Okar SV, Fagiani F, Absinta M, Reich DS. Imaging of brain barrier inflammation and brain fluid drainage in human neurological diseases. Cell Mol Life Sci 2024; 81:31. [PMID: 38212566 PMCID: PMC10838199 DOI: 10.1007/s00018-023-05073-3] [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: 08/20/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
The intricate relationship between the central nervous system (CNS) and the immune system plays a crucial role in the pathogenesis of various neurological diseases. Understanding the interactions among the immunopathological processes at the brain borders is essential for advancing our knowledge of disease mechanisms and developing novel diagnostic and therapeutic approaches. In this review, we explore the emerging role of neuroimaging in providing valuable insights into brain barrier inflammation and brain fluid drainage in human neurological diseases. Neuroimaging techniques have enabled us not only to visualize and assess brain structures, but also to study the dynamics of the CNS in health and disease in vivo. By analyzing imaging findings, we can gain a deeper understanding of the immunopathology observed at the brain-immune interface barriers, which serve as critical gatekeepers that regulate immune cell trafficking, cytokine release, and clearance of waste products from the brain. This review explores the integration of neuroimaging data with immunopathological findings, providing valuable insights into brain barrier integrity and immune responses in neurological diseases. Such integration may lead to the development of novel diagnostic markers and targeted therapeutic approaches that can benefit patients with neurological disorders.
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Affiliation(s)
- Serhat V Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Francesca Fagiani
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy.
- Division of Neuroscience, Vita-Salute San Raffaele University, 20132, Milan, Italy.
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA.
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24
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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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25
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Thümmler K, Wrzos C, Franz J, McElroy D, Cole JJ, Hayden L, Arseni D, Schwarz F, Junker A, Edgar JM, Kügler S, Neef A, Wolf F, Stadelmann C, Linington C. Fibroblast growth factor 9 (FGF9)-mediated neurodegeneration: Implications for progressive multiple sclerosis? Neuropathol Appl Neurobiol 2023; 49:e12935. [PMID: 37705188 DOI: 10.1111/nan.12935] [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: 02/12/2023] [Revised: 08/22/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023]
Abstract
AIMS Fibroblast growth factor (FGF) signalling is dysregulated in multiple sclerosis (MS) and other neurological and psychiatric conditions, but there is little or no consensus as to how individual FGF family members contribute to disease pathogenesis. Lesion development in MS is associated with increased expression of FGF1, FGF2 and FGF9, all of which modulate remyelination in a variety of experimental settings. However, FGF9 is also selectively upregulated in major depressive disorder (MDD), prompting us to speculate it may also have a direct effect on neuronal function and survival. METHODS Transcriptional profiling of myelinating cultures treated with FGF1, FGF2 or FGF9 was performed, and the effects of FGF9 on cortical neurons investigated using a combination of transcriptional, electrophysiological and immunofluorescence microscopic techniques. The in vivo effects of FGF9 were explored by stereotactic injection of adeno-associated viral (AAV) vectors encoding either FGF9 or EGFP into the rat motor cortex. RESULTS Transcriptional profiling of myelinating cultures after FGF9 treatment revealed a distinct neuronal response with a pronounced downregulation of gene networks associated with axonal transport and synaptic function. In cortical neuronal cultures, FGF9 also rapidly downregulated expression of genes associated with synaptic function. This was associated with a complete block in the development of photo-inducible spiking activity, as demonstrated using multi-electrode recordings of channel rhodopsin-transfected rat cortical neurons in vitro and, ultimately, neuronal cell death. Overexpression of FGF9 in vivo resulted in rapid loss of neurons and subsequent development of chronic grey matter lesions with neuroaxonal reduction and ensuing myelin loss. CONCLUSIONS These observations identify overexpression of FGF9 as a mechanism by which neuroaxonal pathology could develop independently of immune-mediated demyelination in MS. We suggest targeting neuronal FGF9-dependent pathways may provide a novel strategy to slow if not halt neuroaxonal atrophy and loss in MS, MDD and potentially other neurodegenerative diseases.
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Affiliation(s)
- Katja Thümmler
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Claudia Wrzos
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jonas Franz
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Göttingen Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
| | - Daniel McElroy
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - John J Cole
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Lorna Hayden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Diana Arseni
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Friedrich Schwarz
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Junker
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neuropathology, University Hospital Essen, Essen, Germany
| | - Julia M Edgar
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Sebastian Kügler
- Institute for Neurology, University Medical Center Göttingen, Göttingen, Germany
- Center Nanoscale Microscopy and Physiology of the Brain (CNMPB), Göttingen, Germany
| | - Andreas Neef
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Göttingen Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, Göttingen, Germany
| | - Fred Wolf
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Göttingen Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, Göttingen, Germany
- Cluster of Excellence Multiscale Bioimaging: From Molecular Machines to Network of Excitable Cells (MBExC), University of Goettingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence Multiscale Bioimaging: From Molecular Machines to Network of Excitable Cells (MBExC), University of Goettingen, Göttingen, Germany
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26
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Swanson CW, Fling BW. Links between Neuroanatomy and Neurophysiology with Turning Performance in People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2023; 23:7629. [PMID: 37688084 PMCID: PMC10490793 DOI: 10.3390/s23177629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
Multiple sclerosis is accompanied by decreased mobility and various adaptations affecting neural structure and function. Therefore, the purpose of this project was to understand how motor cortex thickness and corticospinal excitation and inhibition contribute to turning performance in healthy controls and people with multiple sclerosis. In total, 49 participants (23 controls, 26 multiple sclerosis) were included in the final analysis of this study. All participants were instructed to complete a series of turns while wearing wireless inertial sensors. Motor cortex gray matter thickness was measured via magnetic resonance imaging. Corticospinal excitation and inhibition were assessed via transcranial magnetic stimulation and electromyography place on the tibialis anterior muscles bilaterally. People with multiple sclerosis demonstrated reduced turning performance for a variety of turning variables. Further, we observed significant cortical thinning of the motor cortex in the multiple sclerosis group. People with multiple sclerosis demonstrated no significant reductions in excitatory neurotransmission, whereas a reduction in inhibitory activity was observed. Significant correlations were primarily observed in the multiple sclerosis group, demonstrating lateralization to the left hemisphere. The results showed that both cortical thickness and inhibitory activity were associated with turning performance in people with multiple sclerosis and may indicate that people with multiple sclerosis rely on different neural resources to perform dynamic movements typically associated with fall risk.
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Affiliation(s)
- Clayton W. Swanson
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA;
- Department of Neurology, University of Florida, Gainesville, FL 32608, USA
| | - Brett W. Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
- Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80521, USA
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27
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Magliozzi R, Howell OW, Calabrese M, Reynolds R. Meningeal inflammation as a driver of cortical grey matter pathology and clinical progression in multiple sclerosis. Nat Rev Neurol 2023:10.1038/s41582-023-00838-7. [PMID: 37400550 DOI: 10.1038/s41582-023-00838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
Growing evidence from cerebrospinal fluid samples and post-mortem brain tissue from individuals with multiple sclerosis (MS) and rodent models indicates that the meninges have a key role in the inflammatory and neurodegenerative mechanisms underlying progressive MS pathology. The subarachnoid space and associated perivascular spaces between the membranes of the meninges are the access points for entry of lymphocytes, monocytes and macrophages into the brain parenchyma, and the main route for diffusion of inflammatory and cytotoxic molecules from the cerebrospinal fluid into the brain tissue. In addition, the meningeal spaces act as an exit route for CNS-derived antigens, immune cells and metabolites. A number of studies have demonstrated an association between chronic meningeal inflammation and a more severe clinical course of MS, suggesting that the build-up of immune cell aggregates in the meninges represents a rational target for therapeutic intervention. Therefore, understanding the precise cell and molecular mechanisms, timing and anatomical features involved in the compartmentalization of inflammation within the meningeal spaces in MS is vital. Here, we present a detailed review and discussion of the cellular, molecular and radiological evidence for a role of meningeal inflammation in MS, alongside the clinical and therapeutic implications.
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Affiliation(s)
- Roberta Magliozzi
- Neurology Section of Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Owain W Howell
- Neurology Section of Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
- Institute of Life Sciences, Swansea University, Swansea, UK
| | - Massimiliano Calabrese
- Neurology Section of Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Richard Reynolds
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Centre for Molecular Neuropathology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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28
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Liang Z, Arefin TM, Lee CH, Zhang J. Using mesoscopic tract-tracing data to guide the estimation of fiber orientation distributions in the mouse brain from diffusion MRI. Neuroimage 2023; 270:119999. [PMID: 36871795 PMCID: PMC10052941 DOI: 10.1016/j.neuroimage.2023.119999] [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: 12/30/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Diffusion MRI (dMRI) tractography is the only tool for non-invasive mapping of macroscopic structural connectivity over the entire brain. Although it has been successfully used to reconstruct large white matter tracts in the human and animal brains, the sensitivity and specificity of dMRI tractography remained limited. In particular, the fiber orientation distributions (FODs) estimated from dMRI signals, key to tractography, may deviate from histologically measured fiber orientation in crossing fibers and gray matter regions. In this study, we demonstrated that a deep learning network, trained using mesoscopic tract-tracing data from the Allen Mouse Brain Connectivity Atlas, was able to improve the estimation of FODs from mouse brain dMRI data. Tractography results based on the network generated FODs showed improved specificity while maintaining sensitivity comparable to results based on FOD estimated using a conventional spherical deconvolution method. Our result is a proof-of-concept of how mesoscale tract-tracing data can guide dMRI tractography and enhance our ability to characterize brain connectivity.
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Affiliation(s)
- Zifei Liang
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Ave, New York, NY 10016, USA
| | - Tanzil Mahmud Arefin
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Ave, New York, NY 10016, USA
| | - Choong H Lee
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Ave, New York, NY 10016, USA
| | - Jiangyang Zhang
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Ave, New York, NY 10016, USA.
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29
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Yilmaz EN, Albrecht S, Groll K, Thomas C, Wallhorn L, Herold M, Hucke S, Klotz L, Kuhlmann T. Influx of T cells into corpus callosum increases axonal injury, but does not change the course of remyelination in toxic demyelination. Glia 2023; 71:991-1001. [PMID: 36511515 DOI: 10.1002/glia.24319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is a focal inflammatory and demyelinating disease. The inflammatory infiltrates consist of macrophages/microglia, T and B cells. Remyelination (RM) is an endogenous repair process which frequently fails in MS patients. In earlier studies, T cells either promoted or impaired RM. Here, we used the combined cuprizone/MOG-EAE model to further dissect the functional role of T cells for RM. The combination of MOG immunization with cuprizone feeding targeted T cells to the corpus callosum and increased the extent of axonal injury. Global gene expression analyses demonstrated significant changes in the inflammatory environment; however, additional MOG immunization did not alter the course of RM. Our results suggest that the inflammatory environment in the combined model affects axons and oligodendrocytes differently and that oligodendroglial lineage cells might be less susceptible to T cell mediated injury.
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Affiliation(s)
- Elif Nur Yilmaz
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Stefanie Albrecht
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Katharina Groll
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Lutz Wallhorn
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Martin Herold
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stephanie Hucke
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
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30
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Gao D, Zheng CC, Hao JP, Yang CC, Hu CY. Icariin ameliorates behavioral deficits and neuropathology in a mouse model of multiple sclerosis. Brain Res 2023; 1804:148267. [PMID: 36731819 DOI: 10.1016/j.brainres.2023.148267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) is a systemic inflammatory illness of the central nervous system that involves demyelinating lesions in the myelin-rich white matter and pathology in the grey matter. Despite significant advancements in drug research for MS, the disease's complex pathophysiology makes it difficult to treat the progressive forms of the disease. In this study, we identified a natural flavonoid compound icariin (ICA) as a potent effective agent for MS in ameliorating the deterioration of symptoms including the neurological deficit score and the body weight in a murine experimental autoimmune encephalomyelitis (EAE) model. These improvements were associated with decreased demyelination in the corpus callosum and neuron loss in the hippocampus and cortex confirmed by immunohistochemistry analysis. Meanwhile, it was observed that the activation of microglia in cerebral cortex and hippocampus were inhibited followed by the neuroinflammatory cytokines downregulation such as IL-1β, IL-6 and TNF-α after ICA treatment, which was probably attributable to the suppression of microglial NLRP3 inflammasome activation. Additionally, molecular docking also revealed the binding force of ICA to NLRP3 inflammasome protein complexes in vitro. Taken together, our findings have demonstrated that ICA, as pleiotropic agent, prevents EAE-induced MS by improving demyelination and neuron loss, which interferes with the neuroinflammation via microglial NLRP3 inflammasome activation.
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Affiliation(s)
- Dan Gao
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing Engineering Research Center for Nervous System Drugs, Beijing 100053, China
| | - Ceng-Ceng Zheng
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing Engineering Research Center for Nervous System Drugs, Beijing 100053, China
| | - Jin-Ping Hao
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing Engineering Research Center for Nervous System Drugs, Beijing 100053, China
| | - Cui-Cui Yang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing Engineering Research Center for Nervous System Drugs, Beijing 100053, China.
| | - Chao-Ying Hu
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing Engineering Research Center for Nervous System Drugs, Beijing 100053, China; Phase I Clinical Trial Unit, Beijing Ditan Hospital Capital Medical University, Beijing 100015, China.
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31
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Straub S, El-Sanosy E, Emmerich J, Sandig FL, Ladd ME, Schlemmer HP. Quantitative magnetic resonance imaging biomarkers for cortical pathology in multiple sclerosis at 7 T. NMR IN BIOMEDICINE 2023; 36:e4847. [PMID: 36259249 DOI: 10.1002/nbm.4847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Substantial cortical gray matter tissue damage, which correlates with clinical disease severity, has been revealed in multiple sclerosis (MS) using advanced magnetic resonance imaging (MRI) methods at 3 T and the use of ultra-high field, as well as in histopathology studies. While clinical assessment mainly focuses on lesions using T 1 - and T 2 -weighted MRI, quantitative MRI (qMRI) methods are capable of uncovering subtle microstructural changes. The aim of this ultra-high field study is to extract possible future MR biomarkers for the quantitative evaluation of regional cortical pathology. Because of their sensitivity to iron, myelin, and in part specifically to cortical demyelination, T 1 , T 2 , R 2 * , and susceptibility mapping were performed including two novel susceptibility markers; in addition, cortical thickness as well as the volumes of 34 cortical regions were computed. Data were acquired in 20 patients and 16 age- and sex-matched healthy controls. In 18 cortical regions, large to very large effect sizes (Cohen's d ≥ 1) and statistically significant differences in qMRI values between patients and controls were revealed compared with only four regions when using more standard MR measures, namely, volume and cortical thickness. Moreover, a decrease in all susceptibility contrasts ( χ , χ + , χ - ) and R 2 * values indicates that the role of cortical demyelination might outweigh inflammatory processes in the form of iron accumulation in cortical MS pathology, and might also indicate iron loss. A significant association between susceptibility contrasts as well as R 2 * of the caudal middle frontal gyrus and disease duration was found (adjusted R2 : 0.602, p = 0.0011). Quantitative MRI parameters might be more sensitive towards regional cortical pathology compared with the use of conventional markers only and therefore may play a role in early detection of tissue damage in MS in the future.
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Affiliation(s)
- Sina Straub
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Edris El-Sanosy
- Division Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julian Emmerich
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik L Sandig
- Division Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
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32
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Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:293-311. [PMID: 36803817 DOI: 10.1016/b978-0-323-85555-6.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The improved understanding of multiple sclerosis (MS) neurobiology alongside the development of novel markers of disease will allow precision medicine to be applied to MS patients, bringing the promise of improved care. Combinations of clinical and paraclinical data are currently used for diagnosis and prognosis. The addition of advanced magnetic resonance imaging and biofluid markers has been strongly encouraged, since classifying patients according to the underlying biology will improve monitoring and treatment strategies. For example, silent progression seems to contribute significantly more than relapses to overall disability accumulation, but currently approved treatments for MS act mainly on neuroinflammation and offer only a partial protection against neurodegeneration. Further research, involving traditional and adaptive trial designs, should strive to halt, repair or protect against central nervous system damage. To personalize new treatments, their selectivity, tolerability, ease of administration, and safety must be considered, while to personalize treatment approaches, patient preferences, risk-aversion, and lifestyle must be factored in, and patient feedback used to indicate real-world treatment efficacy. The use of biosensors and machine-learning approaches to integrate biological, anatomical, and physiological parameters will take personalized medicine a step closer toward the patient's virtual twin, in which treatments can be tried before they are applied.
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Affiliation(s)
- Marianna G Rispoli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Maria D'Apolito
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valeria Pozzilli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy.
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33
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Conti A, Treaba CA, Mehndiratta A, Barletta VT, Mainero C, Toschi N. An Interpretable Machine Learning Model to Predict Cortical Atrophy in Multiple Sclerosis. Brain Sci 2023; 13:brainsci13020198. [PMID: 36831740 PMCID: PMC9954500 DOI: 10.3390/brainsci13020198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
To date, the relationship between central hallmarks of multiple sclerosis (MS), such as white matter (WM)/cortical demyelinated lesions and cortical gray matter atrophy, remains unclear. We investigated the interplay between cortical atrophy and individual lesion-type patterns that have recently emerged as new radiological markers of MS disease progression. We employed a machine learning model to predict mean cortical thinning in whole-brain and single hemispheres in 150 cortical regions using demographic and lesion-related characteristics, evaluated via an ultrahigh field (7 Tesla) MRI. We found that (i) volume and rimless (i.e., without a "rim" of iron-laden immune cells) WM lesions, patient age, and volume of intracortical lesions have the most predictive power; (ii) WM lesions are more important for prediction when their load is small, while cortical lesion load becomes more important as it increases; (iii) WM lesions play a greater role in the progression of atrophy during the latest stages of the disease. Our results highlight the intricacy of MS pathology across the whole brain. In turn, this calls for multivariate statistical analyses and mechanistic modeling techniques to understand the etiopathogenesis of lesions.
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Affiliation(s)
- Allegra Conti
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-72596393
| | - Constantina Andrada Treaba
- Massachusetts General Hospital, Boston, MA 02114, USA
- A. A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
| | - Ambica Mehndiratta
- Massachusetts General Hospital, Boston, MA 02114, USA
- A. A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
| | - Valeria Teresa Barletta
- Massachusetts General Hospital, Boston, MA 02114, USA
- A. A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
| | - Caterina Mainero
- Massachusetts General Hospital, Boston, MA 02114, USA
- A. A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy
- Massachusetts General Hospital, Boston, MA 02114, USA
- A. A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
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Schwarz K, Schmitz F. Synapse Dysfunctions in Multiple Sclerosis. Int J Mol Sci 2023; 24:ijms24021639. [PMID: 36675155 PMCID: PMC9862173 DOI: 10.3390/ijms24021639] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system (CNS) affecting nearly three million humans worldwide. In MS, cells of an auto-reactive immune system invade the brain and cause neuroinflammation. Neuroinflammation triggers a complex, multi-faceted harmful process not only in the white matter but also in the grey matter of the brain. In the grey matter, neuroinflammation causes synapse dysfunctions. Synapse dysfunctions in MS occur early and independent from white matter demyelination and are likely correlates of cognitive and mental symptoms in MS. Disturbed synapse/glia interactions and elevated neuroinflammatory signals play a central role. Glutamatergic excitotoxic synapse damage emerges as a major mechanism. We review synapse/glia communication under normal conditions and summarize how this communication becomes malfunctional during neuroinflammation in MS. We discuss mechanisms of how disturbed glia/synapse communication can lead to synapse dysfunctions, signaling dysbalance, and neurodegeneration in MS.
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35
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Adinolfi A, Di Sante G, Rivignani Vaccari L, Tredicine M, Ria F, Bonvissuto D, Corvino V, Sette C, Geloso MC. Regionally restricted modulation of Sam68 expression and Arhgef9 alternative splicing in the hippocampus of a murine model of multiple sclerosis. Front Mol Neurosci 2023; 15:1073627. [PMID: 36710925 PMCID: PMC9878567 DOI: 10.3389/fnmol.2022.1073627] [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: 10/18/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
Multiple sclerosis (MS) and its preclinical models are characterized by marked changes in neuroplasticity, including excitatory/inhibitory imbalance and synaptic dysfunction that are believed to underlie the progressive cognitive impairment (CI), which represents a significant clinical hallmark of the disease. In this study, we investigated several parameters of neuroplasticity in the hippocampus of the experimental autoimmune encephalomyelitis (EAE) SJL/J mouse model, characterized by rostral inflammatory and demyelinating lesions similar to Relapsing-Remitting MS. By combining morphological and molecular analyses, we found that the hippocampus undergoes extensive inflammation in EAE-mice, more pronounced in the CA3 and dentate gyrus (DG) subfields than in the CA1, associated with changes in GABAergic circuitry, as indicated by the increased expression of the interneuron marker Parvalbumin selectively in CA3. By laser-microdissection, we investigated the impact of EAE on the alternative splicing of Arhgef9, a gene encoding a post-synaptic protein playing an essential role in GABAergic synapses and whose mutations have been related to CI and epilepsy. Our results indicate that EAE induces a specific increase in inclusion of the alternative exon 11a only in the CA3 and DG subfields, in line with the higher local levels of inflammation. Consistently, we found a region-specific downregulation of Sam68, a splicing-factor that represses this splicing event. Collectively, our findings confirm a regionalized distribution of inflammation in the hippocampus of EAE-mice. Moreover, since neuronal circuit rearrangement and dynamic remodeling of structural components of the synapse are key processes that contribute to neuroplasticity, our study suggests potential new molecular players involved in EAE-induced hippocampal dysfunction.
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Affiliation(s)
- Annalisa Adinolfi
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Di Sante
- Section of Human, Clinic and Forensic Anatomy, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Rivignani Vaccari
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Tredicine
- Section of General Pathology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ria
- Section of General Pathology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Bonvissuto
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Corvino
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Sette
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy,GSTEP-Organoids Core Facility, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy,*Correspondence: Claudio Sette, ✉
| | - Maria Concetta Geloso
- Section of Human Anatomy, Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy,Maria Concetta Geloso, ✉
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36
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Cortese R, Battaglini M, Sormani MP, Luchetti L, Gentile G, Inderyas M, Alexandri N, De Stefano N. Reduction in grey matter atrophy in patients with relapsing multiple sclerosis following treatment with cladribine tablets. Eur J Neurol 2023; 30:179-186. [PMID: 36168741 PMCID: PMC10091690 DOI: 10.1111/ene.15579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Measures of atrophy in the whole brain can be used to reliably assess treatment effect in clinical trials of patients with multiple sclerosis (MS). Trials assessing the effect of treatment on grey matter (GM) and white matter (WM) atrophy are very informative, but hindered by technical limitations. This study aimed to measure GM and WM volume changes, using a robust longitudinal method, in patients with relapsing MS randomized to cladribine tablets 3.5 mg/kg or placebo in the CLARITY study. METHODS We analysed T1-weighted magnetic resonance sequences using SIENA-XL, from 0 to 6 months (cladribine, n = 267; placebo, n = 265) and 6 to 24 months (cladribine, n = 184; placebo, n = 186). Mean percentage GM and WM volume changes (PGMVC and PWMVC) were compared using a mixed-effect model. RESULTS More GM and WM volume loss was found in patients taking cladribine versus those taking placebo in the first 6 months of treatment (PGMVC: cladribine: -0.53 vs. placebo: -0.25 [p = 0.045]; PWMVC: cladribine: -0.49 vs. placebo: -0.34 [p = 0.137]), probably due to pseudoatrophy. However, over the period 6 to 24 months, GM volume loss was significantly lower in patients on cladribine than in those on placebo (PGMVC: cladribine: -0.90 vs. placebo: -1.27 [p = 0.026]). In this period, volume changes in WM were similar in the two treatment arms (p = 0.52). CONCLUSIONS After a short period of pseudoatrophy, treatment with cladribine 3.5 mg/kg significantly reduced GM atrophy in comparison with placebo. This supports the relevance of GM damage in MS and may have important implications for physical and cognitive disability progression.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Ludovico Luchetti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giordano Gentile
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maira Inderyas
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Nicola De Stefano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Clinical correlates of R1 relaxometry and magnetic susceptibility changes in multiple sclerosis: a multi-parameter quantitative MRI study of brain iron and myelin. Eur Radiol 2023; 33:2185-2194. [PMID: 36241917 PMCID: PMC9935712 DOI: 10.1007/s00330-022-09154-y] [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: 12/04/2021] [Revised: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The clinical impact of brain microstructural abnormalities in multiple sclerosis (MS) remains elusive. We aimed to characterize the topography of longitudinal relaxation rate (R1) and quantitative susceptibility (χ) changes, as indices of iron and myelin, together with brain atrophy, and to clarify their contribution to cognitive and motor disability in MS. METHODS In this cross-sectional study, voxel-based morphometry, and voxel-based quantification analyses of R1 and χ maps were conducted in gray matter (GM) and white matter (WM) of 117 MS patients and 53 healthy controls. Voxel-wise between-group differences were assessed with nonparametric permutation tests, while correlations between MRI metrics and clinical variables (global disability, cognitive and motor performance) were assessed both globally and voxel-wise within clusters emerging from the between-group comparisons. RESULTS MS patients showed widespread R1 decrease associated with more limited modifications of χ, with atrophy mainly involving deep GM, posterior and infratentorial regions (p < 0.02). While R1 and χ showed a parallel reduction in several WM tracts (p < 0.001), reduced GM R1 values (p < 0.001) were associated with decreased thalamic χ (p < 0.001) and small clusters of increased χ in the caudate nucleus and prefrontal cortex (p < 0.02). In addition to the atrophy, χ values in the cingulum and corona radiata correlated with global disability and motor performance, while focal demyelination correlated with cognitive performance (p < 0.04). CONCLUSIONS We confirmed the presence of widespread R1 changes, involving both GM and WM, and atrophy in MS, with less extensive modifications of tissue χ. While atrophy and χ changes are related to global and motor disability, R1 changes are meaningful correlates of cognition. KEY POINTS • Compared to healthy controls, multiple sclerosis patients showed R1 and χ changes suggestive of iron increase within the basal ganglia and reduced iron and myelin content within (subnuclei of) the thalamus. • Thalamic volume and χ changes significantly predicted clinical disability, as well as pulvinar R1 and χ changes, independently from atrophy. • Atrophy-independent R1 and χ changes, suggestive of thalamic iron and myelin depletion, may represent a sensitive marker of subclinical inflammation.
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Evans R, Watkins LM, Hawkins K, Santiago G, Demetriou C, Naughton M, Dittmer M, Rees MI, Fitzgerald D, Morgan BP, Neal JW, Howell OW. Complement activation and increased anaphylatoxin receptor expression are associated with cortical grey matter lesions and the compartmentalised inflammatory response of multiple sclerosis. Front Cell Neurosci 2023; 17:1094106. [PMID: 37032838 PMCID: PMC10073739 DOI: 10.3389/fncel.2023.1094106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background The extent of cortical pathology is an important determinant of multiple sclerosis (MS) severity. Cortical demyelination and neurodegeneration are related to inflammation of the overlying leptomeninges, a more inflammatory CSF milieu and with parenchymal microglia and astroglia activation. These are all components of the compartmentalised inflammatory response. Compartmentalised inflammation is a feature of progressive MS, which is not targeted by disease modifying therapies. Complement is differentially expressed in the MS CSF and complement, and complement receptors, are associated with demyelination and neurodegeneration. Methods To better understand if complement activation in the leptomeninges is associated with underlying cortical demyelination, inflammation, and microglial activation, we performed a neuropathological study of progressive MS (n = 22, 14 females), neuroinflammatory (n = 8), and non-neurological disease controls (n = 10). We then quantified the relative extent of demyelination, connective tissue inflammation, complement, and complement receptor positive microglia/macrophages. Results Complement was elevated at the leptomeninges, subpial, and within and around vessels of the cortical grey matter. The extent of complement C1q immunoreactivity correlated with connective tissue infiltrates, whilst activation products C4d, Bb, and C3b associated with grey matter demyelination, and C3a receptor 1+ and C5a receptor 1+ microglia/macrophages closely apposed C3b labelled cells. The density of C3a receptor 1+ and C5a receptor 1+ cells was increased at the expanding edge of subpial and leukocortical lesions. C5a receptor 1+ cells expressed TNFα, iNOS and contained puncta immunoreactive for proteolipid protein, neurofilament and synaptophysin, suggesting their involvement in grey matter lesion expansion. Interpretation The presence of products of complement activation at the brain surfaces, their association with the extent of underlying pathology and increased complement anaphylatoxin receptor positive microglia/macrophages at expanding cortical grey matter lesions, could represent a target to modify compartmentalised inflammation and cortical demyelination.
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Affiliation(s)
- Rhian Evans
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Lewis M. Watkins
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Kristen Hawkins
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Gabriella Santiago
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Constantinos Demetriou
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Michelle Naughton
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Marie Dittmer
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Mark I. Rees
- Faculty of Medicine and Health, The University of Sydney, Darlington, NSW, Australia
| | - Denise Fitzgerald
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - B. Paul Morgan
- School of Medicine, UK Dementia Research Institute Cardiff and Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom
| | - James W. Neal
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Owain W. Howell
- Faculty of Medicine, Health and Life Sciences, Swansea University Medical School, Swansea, United Kingdom
- *Correspondence: Owain W. Howell,
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Zhao P, Liu X, Wang Y, Zhang X, Wang H, Du X, Du Z, Yang L, Hou J. Discovery of grey matter lesion-related immune genes for diagnostic prediction in multiple sclerosis. PeerJ 2023; 11:e15299. [PMID: 37128203 PMCID: PMC10148642 DOI: 10.7717/peerj.15299] [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: 01/17/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic debilitating disease characterized by inflammatory demyelination of the central nervous system. Grey matter (GM) lesions have been shown to be closely related to MS motor deficits and cognitive impairment. In this study, GM lesion-related genes for diagnosis and immune status in MS were investigated. Methods Gene Expression Omnibus (GEO) databases were utilized to analyze RNA-seq data for GM lesions in MS. Differentially expressed genes (DEGs) were identified. Weighted gene co-expression network analysis (WGCNA), least absolute shrinkage and selection operator (LASSO) algorithm and protein-protein interaction (PPI) network were used to screen related gene modules and candidate genes. The abundance of immune cell infiltration was analyzed by the CIBERSORT algorithm. Candidate genes with strong correlation with immune cell types were determined to be hub genes. A diagnosis model of nomogram was constructed based on the hub genes. Gene set enrichment analysis (GSEA) was performed to identify the biological functions of hub genes. Finally, an MS mouse model was induced to verify the expression levels of immune hub genes. Results Nine genes were identified by WGCNA, LASSO regression and PPI network. The infiltration of immune cells was significantly different between the MS and control groups. Four genes were identified as GM lesion-related hub genes. A reliable prediction model was established by nomogram and verified by calibration, decision curve analysis and receiver operating characteristic curves. GSEA indicated that the hub genes were mainly enriched in cell adhesion molecules, cytokine-cytokine receptor interaction and the JAK-STAT signaling pathway, etc. Conclusions TLR9, CCL5, CXCL8 and PDGFRB were identified as potential biomarkers for GM injury in MS. The effectively predicted diagnosis model will provide guidance for therapeutic intervention of MS.
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Affiliation(s)
- Peiyuan Zhao
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xihong Liu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yunqian Wang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xinyan Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Han Wang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaodan Du
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhixin Du
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Liping Yang
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Junlin Hou
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, China
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De Vito F, Balletta S, Caioli S, Musella A, Guadalupi L, Vanni V, Fresegna D, Bassi MS, Gilio L, Sanna K, Gentile A, Bruno A, Dolcetti E, Buttari F, Pavone L, Furlan R, Finardi A, Perlas E, Hornstein E, Centonze D, Mandolesi G. MiR-142-3p is a Critical Modulator of TNF-mediated Neuronal Toxicity in Multiple Sclerosis. Curr Neuropharmacol 2023; 21:2567-2582. [PMID: 37021418 PMCID: PMC10616916 DOI: 10.2174/1570159x21666230404103914] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND TNF-dependent synaptotoxicity contributes to the neuronal damage occurring in patients with Multiple Sclerosis (pwMS) and its mouse model Experimental Autoimmune Encephalomyelitis (EAE). Here, we investigated miR-142-3p, a synaptotoxic microRNA induced by inflammation in EAE and MS, as a potential downstream effector of TNF signalling. METHODS Electrophysiological recordings, supported by molecular, biochemical and histochemical analyses, were performed to explore TNF-synaptotoxicity in the striatum of EAE and healthy mice. MiR-142 heterozygous (miR-142 HE) mice and/or LNA-anti miR-142-3p strategy were used to verify the TNF-miR-142-3p axis hypothesis. The cerebrospinal fluid (CSF) of 151 pwMS was analysed to evaluate possible correlation between TNF and miR-142-3p levels and their impact on clinical parameters (e.g. progression index (PI), age-related clinical severity (gARMSS)) and MRI measurements at diagnosis (T0). RESULTS High levels of TNF and miR-142-3p were detected in both EAE striatum and MS-CSF. The TNF-dependent glutamatergic alterations were prevented in the inflamed striatum of EAE miR-142 HE mice. Accordingly, TNF was ineffective in healthy striatal slices incubated with LNA-anti miR- 142-3p. However, both preclinical and clinical data did not validate the TNF-miR-142-3p axis hypothesis, suggesting a permissive neuronal role of miR-142-3p on TNF-signalling. Clinical data showed a negative impact of each molecule on disease course and/or brain lesions and unveiled that their high levels exert a detrimental synergistic effect on disease activity, PI and white matter lesion volume. CONCLUSION We propose miR-142-3p as a critical modulator of TNF-mediated neuronal toxicity and suggest a detrimental synergistic action of these molecules on MS pathology.
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Affiliation(s)
| | - Sara Balletta
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Silvia Caioli
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion University of Rome San Raffaele, Rome, Italy
| | - Livia Guadalupi
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
| | - Valentina Vanni
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
| | - Diego Fresegna
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Luana Gilio
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Krizia Sanna
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Antonio Bruno
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ettore Dolcetti
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Luigi Pavone
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Roberto Furlan
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Emerald Perlas
- Mouse Biology Unit, European Molecular Biology Laboratory, Monterotondo Scalo, Rome, Italy
| | - Eran Hornstein
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Diego Centonze
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion University of Rome San Raffaele, Rome, Italy
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Hemond CC, Baek J, Ionete C, Reich DS. Paramagnetic rim lesions are associated with pathogenic CSF profiles and worse clinical status in multiple sclerosis: A retrospective cross-sectional study. Mult Scler 2022; 28:2046-2056. [PMID: 35748669 PMCID: PMC9588517 DOI: 10.1177/13524585221102921] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Paramagnetic rims have been observed as a feature of some multiple sclerosis (MS) lesions on susceptibility-sensitive magnetic resonance imaging (MRI) and indicate compartmentalized inflammation. OBJECTIVE To investigate clinical, MRI, and intrathecal (cerebrospinal fluid, CSF) associations of paramagnetic rim lesions (PRLs) using 3T MRI in MS. METHODS This is a retrospective, cross-sectional analysis. All patients underwent 3T MRI using a T2*-weighted sequence with susceptibility postprocessing (susceptibility-weighted angiography (SWAN) protocol, GE). SWAN-derived filtered-phase maps and corresponding T2-FLAIR images were manually reviewed to determine PRL. Descriptive statistics, t-tests, and regression determined demographic, clinical, MRI, and CSF associations with PRL. RESULTS A total of 147 MS patients were included; 79 of whom had available CSF. Forty-three percent had at least one PRL. PRL status (presence/absence) did not vary by sex or Expanded Disability Status Scale (EDSS) but was associated with younger age, shorter disease duration, worse disease severity, high-efficacy therapy use, and poorer dexterity, as well as lower age-adjusted brain volumes and cognitive processing speeds. PRL status was moreover associated with blood-brain barrier disruption as determined by pathologically elevated albumin quotient. Sensitivity analyses remained supportive of these findings. CONCLUSION PRLs, an emerging noninvasive biomarker of chronic neuroinflammation, are confirmed to be associated with greater disease severity and newly shown to be preliminarily associated with blood-brain barrier disruption.
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Affiliation(s)
- Christopher C. Hemond
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jonggyu Baek
- Department of Population and Quantitative Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Carolina Ionete
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Daniel S. Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Pitt D, Lo CH, Gauthier SA, Hickman RA, Longbrake E, Airas LM, Mao-Draayer Y, Riley C, De Jager PL, Wesley S, Boster A, Topalli I, Bagnato F, Mansoor M, Stuve O, Kister I, Pelletier D, Stathopoulos P, Dutta R, Lincoln MR. Toward Precision Phenotyping of Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/6/e200025. [PMID: 36041861 PMCID: PMC9427000 DOI: 10.1212/nxi.0000000000200025] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022]
Abstract
The classification of multiple sclerosis (MS) has been established by Lublin in 1996 and revised in 2013. The revision includes clinically isolated syndrome, relapsing-remitting, primary progressive and secondary progressive MS, and has added activity (i.e., formation of white matter lesions or clinical relapses) as a qualifier. This allows for the distinction between active and nonactive progression, which has been shown to be of clinical importance. We propose that a logical extension of this classification is the incorporation of additional key pathological processes, such as chronic perilesional inflammation, neuroaxonal degeneration, and remyelination. This will distinguish MS phenotypes that may present as clinically identical but are driven by different combinations of pathological processes. A more precise description of MS phenotypes will improve prognostication and personalized care as well as clinical trial design. Thus, our proposal provides an expanded framework for conceptualizing MS and for guiding development of biomarkers for monitoring activity along the main pathological axes in MS.
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Affiliation(s)
- David Pitt
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada.
| | - Chih Hung Lo
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Susan A Gauthier
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Richard A Hickman
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Erin Longbrake
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Laura M Airas
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Yang Mao-Draayer
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Claire Riley
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Philip Lawrence De Jager
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Sarah Wesley
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Aaron Boster
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Ilir Topalli
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Francesca Bagnato
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Mohammad Mansoor
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Olaf Stuve
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Ilya Kister
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Daniel Pelletier
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Panos Stathopoulos
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Ranjan Dutta
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
| | - Matthew R Lincoln
- From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada
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Jayaraman A, Reynolds R. Diverse pathways to neuronal necroptosis in Alzheimer's disease. Eur J Neurosci 2022; 56:5428-5441. [PMID: 35377966 DOI: 10.1111/ejn.15662] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Necroptosis, or programmed necrosis, involves the kinase activity of receptor interacting kinases 1 and 3, the activation of the pseudokinase mixed lineage kinase domain-like and formation of a complex called the necrosome. It is one of the non-apoptotic cell death pathways that has gained interest in the recent years, especially as a neuronal cell death pathway occurring in Alzheimer's disease. In this review, we focus our discussion on the various molecular mechanisms that could trigger neuronal death through necroptosis and have been shown to play a role in Alzheimer's disease pathogenesis and neuroinflammation. We describe how each of these pathways, such as tumour necrosis factor signalling, reactive oxygen species, endosomal sorting complex, post-translational modifications and certain individual molecules, is dysregulated or activated in Alzheimer's disease, and how this dysregulation/activation could trigger necroptosis. At the cellular level, many of these molecular mechanisms and pathways may act in parallel to synergize with each other or inhibit one another, and changes in the balance between them may determine different cellular vulnerabilities at different disease stages. However, from a therapeutic standpoint, it remains unclear how best to target one or more of these pathways, given that such diverse pathways could all contribute to necroptotic cell death in Alzheimer's disease.
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Affiliation(s)
- Anusha Jayaraman
- Centre for Molecular Neuropathology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Richard Reynolds
- Centre for Molecular Neuropathology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Division of Neuroscience, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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The spatio-temporal relationship between white matter lesion volume changes and brain atrophy in clinically isolated syndrome and early multiple sclerosis. Neuroimage Clin 2022; 36:103220. [PMID: 36274376 PMCID: PMC9668617 DOI: 10.1016/j.nicl.2022.103220] [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: 05/27/2022] [Revised: 09/15/2022] [Accepted: 10/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND White matter lesions and brain atrophy are both present early in multiple sclerosis. However, the spatio-temporal relationship between atrophy and lesion processes remains unclear. METHODS Yearly magnetic resonance images were analyzed in 392 patients with clinically isolated syndrome from the 5-year REFLEX/REFLEXION studies. Patients received early treatment (from baseline; N = 262) or delayed treatment (from month-24; N = 130) with subcutaneous interferon beta-1a. Global and central atrophy were assessed using FSL-SIENA to provide yearly percentage volume change of brain and ventricles, respectively. Yearly total lesion volume change was calculated by subtracting the sum of the negative lesion volume change (disappearing + shrinking) from the positive lesion volume change (new + enlarging) for each yearly interval, as determined by an in-house developed semi-automated method. Using linear mixed models, during the period where patients had received ≥1 year of treatment, we investigated whether total lesion volume change was associated with percentage brain volume change or percentage ventricular volume change in the next year, and vice versa. RESULTS Higher total lesion volume change was related to significantly faster global atrophy (percentage brain volume change) in the next year (B = - 0.113, SE = 0.022, p < 0.001). In patients receiving early treatment only, total lesion volume change was also associated with percentage ventricular volume change in the next year (B = 1.348, SE = 0.181, p < 0.001). Voxel-wise analyses showed that in patients receiving early treatment, higher total lesion volume change in years 2, 3, and 4 was related to faster atrophy in the next year, and in year 4 this relationship was stronger in patients receiving delayed treatment. Interestingly, faster atrophy was related to higher total lesion volume change in the next year (percentage brain volume change: B = - 0.136, SE = 0.062, p = 0.028; percentage ventricular volume change: B = 0.028, SE = 0.008, p < 0.001). CONCLUSIONS Higher lesion volume changes were associated with faster atrophy in the next year. Interestingly, there was also an association between faster atrophy and higher lesion volume changes in the next year.
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Magliozzi R, Fadda G, Brown RA, Bar‐Or A, Howell OW, Hametner S, Marastoni D, Poli A, Nicholas R, Calabrese M, Monaco S, Reynolds R. "Ependymal-in" Gradient of Thalamic Damage in Progressive Multiple Sclerosis. Ann Neurol 2022; 92:670-685. [PMID: 35748636 PMCID: PMC9796378 DOI: 10.1002/ana.26448] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
Leptomeningeal and perivenular infiltrates are important contributors to cortical grey matter damage and disease progression in multiple sclerosis (MS). Whereas perivenular inflammation induces vasculocentric lesions, leptomeningeal involvement follows a subpial "surface-in" gradient. To determine whether similar gradient of damage occurs in deep grey matter nuclei, we examined the dorsomedial thalamic nuclei and cerebrospinal fluid (CSF) samples from 41 postmortem secondary progressive MS cases compared with 5 non-neurological controls and 12 controls with other neurological diseases. CSF/ependyma-oriented gradient of reduction in NeuN+ neuron density was present in MS thalamic lesions compared to controls, greatest (26%) in subventricular locations at the ependyma/CSF boundary and least with increasing distance (12% at 10 mm). Concomitant graded reduction in SMI31+ axon density was observed, greatest (38%) at 2 mm from the ependyma/CSF boundary and least at 10 mm (13%). Conversely, gradient of major histocompatibility complex (MHC)-II+ microglia density increased by over 50% at 2 mm at the ependyma/CSF boundary and only by 15% at 10 mm and this gradient inversely correlated with the neuronal (R = -0.91, p < 0.0001) and axonal (R = -0.79, p < 0.0001) thalamic changes. Observed gradients were also detected in normal-appearing thalamus and were associated with rapid/severe disease progression; presence of leptomeningeal tertiary lymphoid-like structures; large subependymal infiltrates, enriched in CD20+ B cells and occasionally containing CXCL13+ CD35+ follicular dendritic cells; and high CSF protein expression of a complex pattern of soluble inflammatory/neurodegeneration factors, including chitinase-3-like-1, TNFR1, parvalbumin, neurofilament-light-chains and TNF. Substantial "ependymal-in" gradient of pathological cell alterations, accompanied by presence of intrathecal inflammation, compartmentalized either in subependymal lymphoid perivascular infiltrates or in CSF, may play a key role in MS progression. SUMMARY FOR SOCIAL MEDIA: Imaging and neuropathological evidences demonstrated the unique feature of "surface-in" gradient of damage in multiple sclerosis (MS) since early pediatric stages, often associated with more severe brain atrophy and disease progression. In particular, increased inflammation in the cerebral meninges has been shown to be strictly associated with an MS-specific gradient of neuronal, astrocyte, and oligodendrocyte loss accompanied by microglial activation in subpial cortical layers, which is not directly related to demyelination. To determine whether a similar gradient of damage occurs in deep grey matter nuclei, we examined the potential neuronal and microglia alterations in the dorsomedial thalamic nuclei from postmortem secondary progressive MS cases in combination with detailed neuropathological characterization of the inflammatory features and protein profiling of paired CSF samples. We observed a substantial "subependymal-in" gradient of neuro-axonal loss and microglia activation in active thalamic lesions of progressive MS cases, in particular in the presence of increased leptomeningeal and cerebrospinal fluid (CSF) inflammation. This altered graded pathology was found associated with more severe and rapid progressive MS and increased inflammatory degree either in large perivascular subependymal infiltrates, enriched in B cells, or within the paired CSF, in particular with elevated levels of a complex pattern of soluble inflammatory and neurodegeneration factors, including chitinase 3-like-1, TNFR1, parvalbumin, neurofilament light-chains and TNF. These data support a key role for chronic, intrathecally compartmentalized inflammation in specific disease endophenotypes. CSF biomarkers, together with advance imaging tools, may therefore help to improve not only the disease diagnosis but also the early identification of specific MS subgroups that would benefit of more personalized treatments. ANN NEUROL 2022;92:670-685.
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Affiliation(s)
- Roberta Magliozzi
- Neurology Section of Department of Neurological and Movement SciencesUniversity of VeronaVeronaItaly,Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Giulia Fadda
- Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Amit Bar‐Or
- Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Owain W. Howell
- Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK,Institute of Life SciencesSwansea UniversitySwanseaUK
| | - Simon Hametner
- Brain Research CenterMedical University of ViennaViennaAustria
| | - Damiano Marastoni
- Neurology Section of Department of Neurological and Movement SciencesUniversity of VeronaVeronaItaly
| | - Alberto Poli
- Neurology Section of Department of Neurological and Movement SciencesUniversity of VeronaVeronaItaly
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Massimiliano Calabrese
- Neurology Section of Department of Neurological and Movement SciencesUniversity of VeronaVeronaItaly
| | - Salvatore Monaco
- Neurology Section of Department of Neurological and Movement SciencesUniversity of VeronaVeronaItaly
| | - Richard Reynolds
- Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK,Centre for Molecular Neuropathology, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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Zejlon C, Nakhostin D, Winklhofer S, Pangalu A, Kulcsar Z, Lewandowski S, Finnsson J, Piehl F, Ingre C, Granberg T, Ineichen BV. Structural magnetic resonance imaging findings and histopathological correlations in motor neuron diseases—A systematic review and meta-analysis. Front Neurol 2022; 13:947347. [PMID: 36110394 PMCID: PMC9468579 DOI: 10.3389/fneur.2022.947347] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe lack of systematic evidence on neuroimaging findings in motor neuron diseases (MND) hampers the diagnostic utility of magnetic resonance imaging (MRI). Thus, we aimed at performing a systematic review and meta-analysis of MRI features in MND including their histopathological correlation.MethodsIn a comprehensive literature search, out of 5941 unique publications, 223 records assessing brain and spinal cord MRI findings in MND were eligible for a qualitative synthesis. 21 records were included in a random effect model meta-analysis.ResultsOur meta-analysis shows that both T2-hyperintensities along the corticospinal tracts (CST) and motor cortex T2*-hypointensitites, also called “motor band sign”, are more prevalent in ALS patients compared to controls [OR 2.21 (95%-CI: 1.40–3.49) and 10.85 (95%-CI: 3.74–31.44), respectively]. These two imaging findings correlate to focal axonal degeneration/myelin pallor or glial iron deposition on histopathology, respectively. Additionally, certain clinical MND phenotypes such as amyotrophic lateral sclerosis (ALS) seem to present with distinct CNS atrophy patterns.ConclusionsAlthough CST T2-hyperintensities and the “motor band sign” are non-specific imaging features, they can be leveraged for diagnostic workup of suspected MND cases, together with certain brain atrophy patterns. Collectively, this study provides high-grade evidence for the usefulness of MRI in the diagnostic workup of suspected MND cases.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020182682.
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Affiliation(s)
- Charlotte Zejlon
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dominik Nakhostin
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Athina Pangalu
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | | | - Johannes Finnsson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Benjamin Victor Ineichen
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland
- *Correspondence: Benjamin Victor Ineichen
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Misin O, Matilainen M, Nylund M, Honkonen E, Rissanen E, Sucksdorff M, Airas L. Innate Immune Cell–Related Pathology in the Thalamus Signals a Risk for Disability Progression in Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/4/e1182. [PMID: 35581004 PMCID: PMC9128041 DOI: 10.1212/nxi.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives Our aim was to investigate whether 18-kDa translocator protein (TSPO) radioligand binding in gray matter (GM) predicts later disability progression in multiple sclerosis (MS). Methods In this prospective imaging study, innate immune cells were investigated in the MS patient brain using PET imaging. The distribution volume ratio (DVR) of the TSPO-binding radioligand [11C]PK11195 was determined in 5 GM regions: thalamus, caudate, putamen, pallidum, and cortical GM. Volumetric brain MRI parameters were obtained for comparison. The Expanded Disability Status Scale (EDSS) score was assessed at baseline and after follow-up of 3.0 ± 0.3 (mean ± SD) years. Disability progression was defined as an EDSS score increase of 1.0 point or 0.5 point if the baseline EDSS score was ≥6.0. A forward-type stepwise logistic regression model was constructed to compare multiple imaging and clinical variables in their ability to predict later disability progression. Results The cohort consisted of 66 patients with MS and 18 healthy controls. Patients with later disability progression (n = 17) had more advanced atrophy in the thalamus, caudate, and putamen at baseline compared with patients with no subsequent worsening. TSPO binding was significantly higher in the thalamus among the patients with later worsening. The thalamic DVR was the only measured imaging variable that remained a significant predictor of disability progression in the regression model. The final model predicted disability progression with 52.9% sensitivity and 93.9% specificity with an area under the curve value of 0.82 (receiver operating characteristic curve). Discussion Increased TSPO radioligand binding in the thalamus has potential in predicting short-term disability progression in MS and seems to be more sensitive for this than GM atrophy measures.
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James Bates RE, Browne E, Schalks R, Jacobs H, Tan L, Parekh P, Magliozzi R, Calabrese M, Mazarakis ND, Reynolds R. Lymphotoxin-alpha expression in the meninges causes lymphoid tissue formation and neurodegeneration. Brain 2022; 145:4287-4307. [PMID: 35776111 DOI: 10.1093/brain/awac232] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 05/24/2022] [Accepted: 06/17/2022] [Indexed: 11/14/2022] Open
Abstract
Organised meningeal immune cell infiltrates are suggested to play an important role in cortical grey matter pathology in the multiple sclerosis brain, but the mechanisms involved are as yet unresolved. Lymphotoxin-alpha plays a key role in lymphoid organ development and cellular cytotoxicity in the immune system and its expression is increased in the cerebrospinal fluid of naïve and progressive multiple sclerosis patients and post-mortem meningeal tissue. Here we show that persistently increased levels of lymphotoxin alpha in the cerebral meninges can give rise to lymphoid-like structures and underlying multiple sclerosis-like cortical pathology. Stereotaxic injections of recombinant lymphotoxin-alpha into the rat meninges led to acute meningeal inflammation and subpial demyelination that resolved after 28 days, with demyelination being dependent on prior sub-clinical immunisation with myelin oligodendrocyte glycoprotein. Injection of a lymphotoxin-alpha lentiviral vector into the cortical meningeal space, to produce chronic localised over-expression of the cytokine, induced extensive lymphoid-like immune cell aggregates, maintained over 3 months, including T-cell rich zones containing podoplanin+ fibroblastic reticular stromal cells and B-cell rich zones with a network of follicular dendritic cells, together with expression of lymphoid chemokines and their receptors. Extensive microglial and astroglial activation, subpial demyelination and marked neuronal loss occurred in the underlying cortical parenchyma. Whereas subpial demyelination was partially dependent on prior myelin oligodendrocyte glycoprotein immunisation, the neuronal loss was present irrespective of immunisation. Conditioned medium from LTα treated microglia was able to induce a reactive phenotype in astrocytes. Our results show that chronic lymphotoxin-alpha overexpression alone is sufficient to induce formation of meningeal lymphoid-like structures and subsequent neurodegeneration, similar to that seen in the progressive multiple sclerosis brain.
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Affiliation(s)
- Rachel E James Bates
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Eleanor Browne
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Renee Schalks
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Heather Jacobs
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Li Tan
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Puja Parekh
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Roberta Magliozzi
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK.,Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona 37134, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona 37134, Italy
| | - Nicholas D Mazarakis
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, Hammersmith, Hospital Campus, UK.,Centre for Molecular Neuropathology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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49
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Marastoni D, Crescenzo F, Pisani AI, Zuco C, Schiavi G, Benedetti G, Ricciardi GK, Montemezzi S, Pizzini FB, Tamanti A, Calabrese M. Two years' effect of dimethyl fumarate on focal and diffuse gray matter pathology in multiple sclerosis. Mult Scler 2022; 28:2090-2098. [PMID: 35765211 DOI: 10.1177/13524585221104014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data on the effect of dimethyl fumarate (DMF) on focal and diffuse gray matter (GM) damage, a relevant pathological substrate of multiple sclerosis (MS)-related disability are lacking. OBJECTIVE To evaluate the DMF effect on cortical lesions (CLs) accumulation and global and regional GM atrophy in subjects with relapsing-remitting MS. METHODS A total of 148 patients (mean age 38.1 ± 9.7 years) treated with DMF ended a 2-year longitudinal study. All underwent regular Expanded Disability Status Scale (EDSS assessment), and at least two 3T-magnetic resonance imaging (MRI) at 3 and 24 months after DMF initiation. CLs and changes in global and regional atrophy of several brain regions were compared with 47 untreated age and sex-matched patients. RESULTS DMF-treated patients showed lower CLs accumulation (median 0[0-3] vs 2[0-7], p < 0.001) with respect to controls. Global cortical thickness (p < 0.001) and regional thickness and volume were lower in treated group (cerebellum, hippocampus, caudate, and putamen: p < 0.001; thalamus p = 0.03). Lower relapse rate (14% vs 40%, p < 0.001), EDSS change (0.2 ± 0.4 vs 0.4 ± 0.9, p < 0.001), and new WM lesions (median 0[0-5] vs 2[0-6], p < 0.001) were reported. No severe adverse drug reactions occurred. CONCLUSIONS Beyond the well-known effect on disease activity, these results provide evidence of the effect of DMF through reduced progression of focal and diffuse GM damage.
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Affiliation(s)
- Damiano Marastoni
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Anna I Pisani
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carmela Zuco
- Neurology Unit, "Carlo Poma" Hospital, ASST Mantua, Mantua, Italy
| | - Gianmarco Schiavi
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Benedetti
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe K Ricciardi
- Neuroradiology & Radiology Units, Department of Diagnostic and Pathology, Integrated University Hospital of Verona, Verona, Italy
| | - Stefania Montemezzi
- Neuroradiology & Radiology Units, Department of Diagnostic and Pathology, Integrated University Hospital of Verona, Verona, Italy
| | - Francesca B Pizzini
- Radiology Unit, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Regional Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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50
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Zuo M, Fettig NM, Bernier LP, Pössnecker E, Spring S, Pu A, Ma XI, Lee DS, Ward LA, Sharma A, Kuhle J, Sled JG, Pröbstel AK, MacVicar BA, Osborne LC, Gommerman JL, Ramaglia V. Age-dependent gray matter demyelination is associated with leptomeningeal neutrophil accumulation. JCI Insight 2022; 7:e158144. [PMID: 35536649 PMCID: PMC9309059 DOI: 10.1172/jci.insight.158144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
People living with multiple sclerosis (MS) experience episodic CNS white matter lesions instigated by autoreactive T cells. With age, patients with MS show evidence of gray matter demyelination and experience devastating nonremitting symptomology. What drives progression is unclear and studying this has been hampered by the lack of suitable animal models. Here, we show that passive experimental autoimmune encephalomyelitis (EAE) induced by an adoptive transfer of young Th17 cells induced a nonremitting clinical phenotype that was associated with persistent leptomeningeal inflammation and cortical pathology in old, but not young, SJL/J mice. Although the quantity and quality of T cells did not differ in the brains of old versus young EAE mice, an increase in neutrophils and a decrease in B cells were observed in the brains of old mice. Neutrophils were also found in the leptomeninges of a subset of progressive MS patient brains that showed evidence of leptomeningeal inflammation and subpial cortical demyelination. Taken together, our data show that while Th17 cells initiate CNS inflammation, subsequent clinical symptoms and gray matter pathology are dictated by age and associated with other immune cells, such as neutrophils.
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Affiliation(s)
- Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Naomi M. Fettig
- Department of Microbiology and Immunology and Life Sciences Institute, and
| | - Louis-Philippe Bernier
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabeth Pössnecker
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Shoshana Spring
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Xianjie I. Ma
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Dennis S.W. Lee
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Ward
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Anshu Sharma
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Jens Kuhle
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - John G. Sled
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Katrin Pröbstel
- Multiple Sclerosis Center & Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Neurology, Biomedicine, and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Brian A. MacVicar
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa C. Osborne
- Department of Microbiology and Immunology and Life Sciences Institute, and
| | | | - Valeria Ramaglia
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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