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Zeineddine M, Al-Hajje A, Salameh P, Massouh J, Saab G, Al-Roughani R, Ahmed SF, Al-Mahdawi A, Shalaby N, Inshasi J, Sahraian MA, Gouider R, Mrabet S, Al-Khabouri J, Shayganneja V, Chentouf A, Boumediene F, Yamout B. Disease-modifying therapies, outcomes, risk factors and severity of COVID-19 in multiple sclerosis: A MENACTRIMS registry based study. Mult Scler Relat Disord 2024; 90:105790. [PMID: 39121598 DOI: 10.1016/j.msard.2024.105790] [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: 05/19/2024] [Revised: 07/04/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND There is a lack information regarding risk factors associated with worse COVID-19 outcomes in patients with multiple sclerosis (MS) in the MENA region. METHODS This is a multicenter, retrospective cohort study that included all MS patients with a suspected or confirmed COVID-19 infection using the MENACTRIMS registry. The association of demographics, disease characteristics, and use of disease-modifying therapies (DMTs) with outcomes and severity of COVID-19 were evaluated by multivariate logistic model. RESULTS A total of 600 MS patients with confirmed (n = 542) or highly suspected (n = 58) COVID-19 were analyzed. Seventy-three patients (12.2 %) had a COVID-19 severity score of ≥3 on a 7-point ordinal scale (ranging from 1 [not hospitalized with no limitations on activities] to 7 [death] with a cutoff at 3 [hospitalized and not requiring supplemental oxygen]), and 15 patients (2.5 %) died. Out of 73 patients with a severity score ≥3, 90.4 % were on DMTs; 50.6 % of them were on anti-CD20, including ocrelizumab and rituximab. Multivariate logistic regression showed that older age (odds ratio per 10 years, 1.4 [95 %CI, 1.0-1.8]), disability (OR for EDSS 3.0-5.5, 2.9 [95 %CI. 1.5-5.7], OR for EDSS ≥6.0, 2.3 [95 %CI. 1.0-5.1]), obesity (OR, 3.0 [95 %CI, 1.5-6.0]), and treatment with rituximab (OR, 9.0 [95 %CI, 3.1-25.3]) or off-label immunosuppressive medications (OR, 5.6 [95 %CI. 1.1-27.8]) were risk factors for moderate or severe COVID-19. CONCLUSION In this registry-based study of MS patients, age, sex, EDSS, obesity, progressive MS were risk factors for severe COVID-19. Moreover, there was an association found between exposure to anti-CD20 DMTs and COVID-19 severity.
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Affiliation(s)
- Maya Zeineddine
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Amal Al-Hajje
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, Lebanon; School of Medicine, Lebanese American University, Byblos, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus
| | - Joelle Massouh
- Harley Street Medical Centre, Neurology Institute, Abu Dhabi, United Arab Emirates
| | - Georges Saab
- American University of Beirut Medical Center, Nehme and Therese Tohme Multiple Sclerosis Center, Beirut, Lebanon
| | | | | | | | - Nevin Shalaby
- Neurology Department, Cairo University, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Jihad Inshasi
- MS Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mohamad Ali Sahraian
- Multiple Sclerosis Research Center of Tehran University of Medical Sciences, Tehran, Iran
| | - Riadh Gouider
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health"- Razi University Hospital- Mannouba, Tunis, Tunisia
| | - Saloua Mrabet
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health"- Razi University Hospital- Mannouba, Tunis, Tunisia
| | | | - Vahid Shayganneja
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amina Chentouf
- Neurology Department, University Hospital Center, Oran, Algeria
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Bassem Yamout
- Harley Street Medical Centre, Neurology Institute, Abu Dhabi, United Arab Emirates.
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Park H, Song J, Jeong HW, Grönloh MLB, Koh BI, Bovay E, Kim KP, Klotz L, Thistlethwaite PA, van Buul JD, Sorokin L, Adams RH. Apelin modulates inflammation and leukocyte recruitment in experimental autoimmune encephalomyelitis. Nat Commun 2024; 15:6282. [PMID: 39060233 PMCID: PMC11282314 DOI: 10.1038/s41467-024-50540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Demyelination due to autoreactive T cells and inflammation in the central nervous system are principal features of multiple sclerosis (MS), a chronic and highly disabling human disease affecting brain and spinal cord. Here, we show that treatment with apelin, a secreted peptide ligand for the G protein-coupled receptor APJ/Aplnr, is protective in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Apelin reduces immune cell entry into the brain, delays the onset and reduces the severity of EAE. Apelin affects the trafficking of leukocytes through the lung by modulating the expression of cell adhesion molecules that mediate leukocyte recruitment. In addition, apelin induces the internalization and desensitization of its receptor in endothelial cells (ECs). Accordingly, protection against EAE major outcomes of apelin treatment are phenocopied by loss of APJ/Aplnr function, achieved by EC-specific gene inactivation in mice or knockdown experiments in cultured primary endothelial cells. Our findings highlight the importance of the lung-brain axis in neuroinflammation and indicate that apelin targets the transendothelial migration of immune cells into the lung during acute inflammation.
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Affiliation(s)
- Hongryeol Park
- Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, Münster, Germany.
| | - Jian Song
- Institute of Physiological Chemistry and Pathobiochemistry and Cells-in-Motion Interfaculty Centre (CIMIC), University of Münster, Münster, Germany
| | - Hyun-Woo Jeong
- Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, Münster, Germany
| | - Max L B Grönloh
- Vascular Cell Biology Lab, Department of Medical Biochemistry, Amsterdam UMC, and Section Molecular Cytology at Swammerdam Institute for Life Sciences, Leeuwenhoek Centre for Advanced Microscopy, University of Amsterdam, Amsterdam, The Netherlands
| | - Bong Ihn Koh
- Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, Münster, Germany
| | - Esther Bovay
- Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, Münster, Germany
| | - Kee-Pyo Kim
- Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Luisa Klotz
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Jaap D van Buul
- Vascular Cell Biology Lab, Department of Medical Biochemistry, Amsterdam UMC, and Section Molecular Cytology at Swammerdam Institute for Life Sciences, Leeuwenhoek Centre for Advanced Microscopy, University of Amsterdam, Amsterdam, The Netherlands
| | - Lydia Sorokin
- Institute of Physiological Chemistry and Pathobiochemistry and Cells-in-Motion Interfaculty Centre (CIMIC), University of Münster, Münster, Germany
| | - Ralf H Adams
- Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, Münster, Germany.
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3
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Schenk A, Popa CO, Cojocaru CM, Marian Ș, Maier S, Bălașa R. The Path from Personality to Anxiety and Depression Is Mediated by Cognition in Multiple Sclerosis. J Pers Med 2024; 14:682. [PMID: 39063936 PMCID: PMC11278007 DOI: 10.3390/jpm14070682] [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: 05/30/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurodegenerative immunological disease causing significant impairment in all life areas. Therefore, personality changes are observed and associated with higher prevalence of depression and anxiety disorders. Considering this relationship, we hypothesized that clinical symptoms and personality disorders are more prevalent in MS and that dysfunctional psychological mechanisms mediate the path from personality disorders to clinical symptoms. METHODS The study sample consisted of 43 patients with MS (age M = 41.9, SD = 11.5) and 31 controls (age M = 39.8, SD = 10.3). Measures of personality, anxiety, depression, fatigue, health status, and dysfunctional psychological mechanisms were conducted. RESULTS The prevalence of clinical symptoms was increased in MS patients as compared to controls. Also, dependent and schizoid personality traits (PTs) were observed in the patient sample. Negative automatic thoughts (NATs) were found to mediate the association between dependent PT and clinical symptoms. Along with schizoid PT, all dysfunctional psychological mechanisms impacted clinical symptoms. DISCUSSION The results of our research are in line with previous studies showing that anxiety, depression, and dysfunctional personality traits are more prevalent in MS as compared to controls. CONCLUSIONS PTs and dysfunctional psychological mechanisms predicted depression, anxiety, fatigue, and health status in MS patients. Cognition acts as a strong mediator between PTs and psychopathology in MS. Hence, integrative personalized psychological treatment is recommended to improve the quality of care in MS.
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Affiliation(s)
- Alina Schenk
- The Doctoral School of George Emil Palade, University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (A.S.); (C.M.C.)
| | - Cosmin Octavian Popa
- Department of Ethics and Social Science, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Cristiana Manuela Cojocaru
- The Doctoral School of George Emil Palade, University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (A.S.); (C.M.C.)
| | - Ștefan Marian
- Department of Psychology, West University of Timişoara, 4 Vasile Pâvan Boulevard, 300223 Timişoara, Romania;
| | - Smaranda Maier
- Neurology Clinic I, Emergency Clinical County Hospital, 40136 Targu Mures, Romania; (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania
| | - Rodica Bălașa
- Neurology Clinic I, Emergency Clinical County Hospital, 40136 Targu Mures, Romania; (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania
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4
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Burian K, Heidler F, Frahm N, Hecker M, Langhorst SE, Mashhadiakbar P, Streckenbach B, Baldt J, Meißner J, Richter J, Zettl UK. Vaccination status and self-reported side effects after SARS-CoV-2 vaccination in relation to psychological and clinical variables in patients with multiple sclerosis. Sci Rep 2024; 14:12248. [PMID: 38806524 PMCID: PMC11133397 DOI: 10.1038/s41598-024-62541-x] [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: 11/14/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
The recent SARS-CoV-2 pandemic and the vaccination campaign posed a challenge to patients with autoimmune disease, such as multiple sclerosis (MS). We aimed for investigating whether psychological/sociodemographic/clinical characteristics of MS patients are associated with SARS-CoV-2 vaccination status and self-reported vaccination side effects (SEs). We have asked patients with MS about their willingness to receive recommended standard vaccinations pre-pandemically since June 2019. Between 10/2021 and 01/2022, we surveyed 193 of these MS patients about their current SARS-CoV-2 vaccination status, their perception of vaccination-related SEs, and reasons for and against SARS-CoV-2 vaccination. 75.6% of the patients declared their willingness to receive standard vaccinations before the pandemic. 84.5%, 78.2%, and 13.0% of the patients had received the first, second, and third SARS-CoV-2 vaccination, respectively, until the follow-up survey. The most common reason for not getting vaccinated against SARS-CoV-2 was concern about possible side effects (82.1%), followed by the belief that the vaccines had not been adequately tested (64.3%). Vaccination-related SEs were reported by 52.8% of the patients. Younger age, higher education, lower degree of disability, relapsing disease course, shorter disease duration, not receiving a disease-modifying therapy and higher anxiety and depression levels were associated with the occurrence of certain vaccination-related SEs. Concerns about novel vaccines are widespread among MS patients and necessitate targeted education of the patients, especially to those with more severe psychopathological symptoms (anxiety or depression) and those who are generally skeptical of vaccination.
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Affiliation(s)
- Katja Burian
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany.
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany.
| | - Felicita Heidler
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Janina Meißner
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Jörg Richter
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
- Faculty of Health Sciences, University of Hull, Cottingham Rd, Hull, HU6 7RX, UK
- Durham Law School, The Palatine Centre, Durham University, Stockton Rd, Durham, DH1 3LE, UK
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
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5
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Campetella M, Filomena GB, Marino F, Fantasia F, Russo P, Gavi F, Rossi F, Gandi C, Ragonese M, Foschi N, Totaro A, Sacco E, Racioppi M, Bientinesi R. Etiology, presentation and management of urinary tract infections in multiple sclerosis patients: A review of the current literature. Urologia 2024; 91:384-393. [PMID: 38279809 DOI: 10.1177/03915603231224511] [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: 01/29/2024]
Abstract
Urinary tract infections (UTIs) present a formidable challenge in the care of individuals affected by multiple sclerosis (MS). Lower urinary tract dysfunction is a prevalent issue among MS patients, predisposing them to an elevated risk of UTIs. When left untreated, UTIs can further exacerbate the already compromised quality of life in individuals with MS. The diagnosis and management of UTIs in MS patients necessitate a careful clinical evaluation. The objective of this review is to delineate preventive strategies and current and developing therapeutic approaches for preventing and treating UTIs associated with urinary dysfunction, catheterization, and upper urinary tract infections in patients with MS. Effectively addressing UTIs and urinary tract dysfunction in individuals with multiple sclerosis calls for a comprehensive, interdisciplinary approach.
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Affiliation(s)
- Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - G B Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Rossi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Beer E, Chowdhury H, Carroll B, Luintel A, van Tulleken C, Longley N. Advising the immunocompromised traveller: a review of immunocompromise at The London Hospital for Tropical Diseases Travel Clinic between 1st April 2019 and 30th April 2020. Trop Dis Travel Med Vaccines 2024; 10:8. [PMID: 38616263 PMCID: PMC11017494 DOI: 10.1186/s40794-024-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs. METHODS We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice. RESULTS Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections. CONCLUSIONS Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.
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Affiliation(s)
- Ellen Beer
- University College London Hospital, London, NW1 2BU, UK.
| | | | | | - Akish Luintel
- University College London Hospital, London, NW1 2BU, UK
| | | | - Nicky Longley
- Hospital for Tropical Diseases, University College London Hospital, London, NW1 2BU, UK
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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7
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Delgado SR, Faissner S, Linker RA, Rammohan K. Key characteristics of anti-CD20 monoclonal antibodies and clinical implications for multiple sclerosis treatment. J Neurol 2024; 271:1515-1535. [PMID: 37906325 PMCID: PMC10973056 DOI: 10.1007/s00415-023-12007-3] [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: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
The recent success of anti-CD20 monoclonal antibody therapies in the treatment of multiple sclerosis (MS) has highlighted the role of B cells in the pathogenesis of MS. In people with MS, the inflammatory characteristics of B-cell activity are elevated, leading to increased pro-inflammatory cytokine release, diminished anti-inflammatory cytokine production and an accumulation of pathogenic B cells in the cerebrospinal fluid. Rituximab, ocrelizumab, ofatumumab, ublituximab and BCD-132 are anti-CD20 therapies that are either undergoing clinical development, or have been approved, for the treatment of MS. Despite CD20 being a common target for these therapies, differences have been reported in their mechanistic, pharmacological and clinical characteristics, which may have substantial clinical implications. This narrative review explores key characteristics of these therapies. By using clinical trial data and real-world evidence, we discuss their mechanisms of action, routes of administration, efficacy (in relation to B-cell kinetics), safety, tolerability and convenience of use. Clinicians, alongside patients and their families, should consider the aspects discussed in this review as part of shared decision-making discussions to improve outcomes and health-related quality of life for people living with MS.
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Affiliation(s)
- Silvia R Delgado
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simon Faissner
- Department of Neurology, Ruhr-University Bochum, St Josef-Hospital, Bochum, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Kottil Rammohan
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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8
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Fortuny M, Sanduzzi-Zamparelli M, Reig M. Systemic therapies in hepatocellular carcinoma: A revolution? United European Gastroenterol J 2024; 12:252-260. [PMID: 38267015 PMCID: PMC10954433 DOI: 10.1002/ueg2.12510] [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: 09/03/2023] [Accepted: 11/06/2023] [Indexed: 01/26/2024] Open
Abstract
The evolution in systemic therapies in hepatocellular carcinoma (HCC) signifies a strategy of high-cost, high-gain innovation that originated with sorafenib, despite its limited impact on tumor response. This strategic approach paved the way for the emergence of a second wave of the short-lived competitive advantage, exemplified by the incorporation of atezolizumab plus bevacizumab and tremelimumab plus durvalumab. In the context of safety concerns within the liver cancer domain, the IMBRAVE150 and HIMALAYA trials boldly incorporated bevacizumab and tremelimumab, respectively, demonstrating the continuation of the high-risk, high-reward innovation paradigm. This review delves into the strengths, weaknesses, opportunities, and threats analysis of systemic therapies in the field of HCC.
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Affiliation(s)
- Marta Fortuny
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Barcelona University, Barcelona, Spain
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9
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Fneish F, Frahm N, Peters M, Ellenberger D, Haas J, Löbermann M, Pöhlau D, Röper AL, Schilling S, Stahmann A, Temmes H, Paul F, Zettl UK. Occurrence and Risk Factors of Relapse Activity after Vaccination against COVID-19 in People with Multiple Sclerosis: 1-Year Follow-Up Results from a Nationwide Longitudinal Observational Study. Vaccines (Basel) 2023; 11:1859. [PMID: 38140262 PMCID: PMC10747540 DOI: 10.3390/vaccines11121859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Several studies reported post-SARS-CoV-2-vaccination (PV) symptoms. Even people with multiple sclerosis (PwMS) have concerns about disease activity following the SARS-CoV-2 vaccination. We aimed to determine the proportion of PwMS with PV relapses, the PV annualized relapse rate (ARR), the time from vaccination to subsequent relapses, and identify sociodemographic/clinical risk factors for PV relapses. PwMS were surveyed several times at baseline and four follow-ups as part of a longitudinal observational study regarding the safety and tolerability of the SARS-CoV-2 vaccination. The inclusion criteria for this analysis were age ≥18 years, ≥1 SARS-CoV-2 vaccination, and ≥1-year observation period since initial vaccination. Of 2466 PwMS, 13.8% reported PV relapses (mostly after second [N = 147] or booster vaccination [N = 145]) at a median of 8.0 (first/third quantile: 3.55/18.1) weeks PV, with the shortest period following initial vaccination (3.95 weeks). The ARR was 0.153 (95% confidence interval: 0.138-0.168), with a median observation period since initial vaccination of 1.2 years. Risk factors for PV relapses were younger age, female gender, moderate-severe disability levels, concurrent autoimmune diseases, relapsing-remitting MS courses, no DMT, and relapses within the year prior to the first vaccination. Patients' health conditions before/during initial vaccination may play a more important role in PV relapse occurrence than vaccination per se.
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Affiliation(s)
- Firas Fneish
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Niklas Frahm
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
| | - Melanie Peters
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), German MS Registry, 30171 Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University Medical Center of Rostock, 18057 Rostock, Germany;
| | - Dieter Pöhlau
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Anna-Lena Röper
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Sarah Schilling
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Herbert Temmes
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Friedemann Paul
- Experimental and Clinical Research Center, Joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, The Charité Medical Faculty, Campus Berlin-Buch, 13125 Berlin, Germany;
- Department of Neurology, Charité—Universitätsmedizin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin, 10117 Berlin, Germany
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
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10
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Withana M, Castorina A. Potential Crosstalk between the PACAP/VIP Neuropeptide System and Endoplasmic Reticulum Stress-Relevance to Multiple Sclerosis Pathophysiology. Cells 2023; 12:2633. [PMID: 37998368 PMCID: PMC10670126 DOI: 10.3390/cells12222633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disorder characterized by focal demyelination and chronic inflammation of the central nervous system (CNS). Although the exact etiology is unclear, mounting evidence indicates that endoplasmic reticulum (ER) stress represents a key event in disease pathogenesis. Pituitary adenylate cyclase-activating peptide (PACAP) and vasoactive intestinal peptide (VIP) are two structurally related neuropeptides that are abundant in the CNS and are known to exert neuroprotective and immune modulatory roles. Activation of this endogenous neuropeptide system may interfere with ER stress processes to promote glial cell survival and myelin self-repair. However, the potential crosstalk between the PACAP/VIP system and ER stress remains elusive. In this review, we aim to discuss how these peptides ameliorate ER stress in the CNS, with a focus on MS pathology. Our goal is to emphasize the importance of this potential interaction to aid in the identification of novel therapeutic targets for the treatment of MS and other demyelinating disorders.
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Affiliation(s)
| | - Alessandro Castorina
- Laboratory of Cellular and Molecular Neuroscience (LCMN), School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia;
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11
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Sharma P, Kishore A, De I, Negi S, Kumar G, Bhardwaj S, Singh M. Mitigating neuroinflammation in Parkinson's disease: Exploring the role of proinflammatory cytokines and the potential of phytochemicals as natural therapeutics. Neurochem Int 2023; 170:105604. [PMID: 37683836 DOI: 10.1016/j.neuint.2023.105604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
Parkinson's disease (PD) is one of the most prevalent neuroinflammatory illnesses, characterized by the progressive loss of neurons in the brain. Proinflammatory cytokines play a key role in initiating and perpetuating neuroinflammation, which can lead to the activation of glial cells and the deregulation of inflammatory pathways, ultimately leading to permanent brain damage. Currently, available drugs for PD mostly alleviate symptoms but do not target underlying inflammatory processes. There is a growing interest in exploring the potential of phytochemicals to mitigate neuroinflammation. Phytochemicals such as resveratrol, apigenin, catechin, anthocyanins, amentoflavone, quercetin, berberine, and genistein have been studied for their ability to scavenge free radicals and reduce proinflammatory cytokine levels in the brain. These plant-derived compounds offer a natural and potentially safe alternative to conventional drugs for managing neuroinflammation in PD and other neurodegenerative diseases. However, further research is necessary to elucidate their underlying mechanisms of action and clinical effectiveness. So, this review delves into the pathophysiology of PD and its intricate relationship with proinflammatory cytokines, and explores how their insidious contributions fuel the disease's initiation and progression via cytokine-dependent signaling pathways. Additionally, we tried to give an account of PD management using existing drugs along with their limitations. Furthermore, our aim is to provide a thorough overview of the diverse groups of phytochemicals, their plentiful sources, and the current understanding of their anti-neuroinflammatory properties. Through this exploration, we posit the innovative idea that consuming nutrient-rich phytochemicals could be an effective approach to preventing and treating PD.
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Affiliation(s)
- Prashant Sharma
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Abhinoy Kishore
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Indranil De
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Swarnima Negi
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Gulshan Kumar
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Sahil Bhardwaj
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Manish Singh
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India.
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12
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Hoeferlin GF, Bajwa T, Olivares H, Zhang J, Druschel LN, Sturgill BS, Sobota M, Boucher P, Duncan J, Hernandez-Reynoso AG, Cogan SF, Pancrazio JJ, Capadona JR. Antioxidant Dimethyl Fumarate Temporarily but Not Chronically Improves Intracortical Microelectrode Performance. MICROMACHINES 2023; 14:1902. [PMID: 37893339 PMCID: PMC10609067 DOI: 10.3390/mi14101902] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023]
Abstract
Intracortical microelectrode arrays (MEAs) can be used in a range of applications, from basic neuroscience research to providing an intimate interface with the brain as part of a brain-computer interface (BCI) system aimed at restoring function for people living with neurological disorders or injuries. Unfortunately, MEAs tend to fail prematurely, leading to a loss in functionality for many applications. An important contributing factor in MEA failure is oxidative stress resulting from chronically inflammatory-activated microglia and macrophages releasing reactive oxygen species (ROS) around the implant site. Antioxidants offer a means for mitigating oxidative stress and improving tissue health and MEA performance. Here, we investigate using the clinically available antioxidant dimethyl fumarate (DMF) to reduce the neuroinflammatory response and improve MEA performance in a rat MEA model. Daily treatment of DMF for 16 weeks resulted in a significant improvement in the recording capabilities of MEA devices during the sub-chronic (Weeks 5-11) phase (42% active electrode yield vs. 35% for control). However, these sub-chronic improvements were lost in the chronic implantation phase, as a more exacerbated neuroinflammatory response occurs in DMF-treated animals by 16 weeks post-implantation. Yet, neuroinflammation was indiscriminate between treatment and control groups during the sub-chronic phase. Although worse for chronic use, a temporary improvement (<12 weeks) in MEA performance is meaningful. Providing short-term improvement to MEA devices using DMF can allow for improved use for limited-duration studies. Further efforts should be taken to explore the mechanism behind a worsened neuroinflammatory response at the 16-week time point for DMF-treated animals and assess its usefulness for specific applications.
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Affiliation(s)
- George F. Hoeferlin
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Tejas Bajwa
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Hannah Olivares
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Jichu Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Lindsey N. Druschel
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Brandon S. Sturgill
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA (J.J.P.)
| | - Michael Sobota
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Pierce Boucher
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Jonathan Duncan
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Ana G. Hernandez-Reynoso
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA (J.J.P.)
| | - Stuart F. Cogan
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA (J.J.P.)
| | - Joseph J. Pancrazio
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA (J.J.P.)
| | - Jeffrey R. Capadona
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA (H.O.); (J.D.)
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA
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13
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Hauser SL, Zielman R, Das Gupta A, Xi J, Stoneman D, Karlsson G, Robertson D, Cohen JA, Kappos L. Efficacy and safety of four-year ofatumumab treatment in relapsing multiple sclerosis: The ALITHIOS open-label extension. Mult Scler 2023; 29:1452-1464. [PMID: 37691530 PMCID: PMC10580679 DOI: 10.1177/13524585231195346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Ofatumumab has demonstrated superior efficacy and favorable safety for up to 2.5 years versus teriflunomide in relapsing multiple sclerosis (RMS). OBJECTIVE Further characterize efficacy and safety of ofatumumab in RMS. METHODS Efficacy set: patients randomized to ofatumumab/teriflunomide in ASCLEPIOS I/II (core). Safety set: patients who received ⩾ 1 dose of ofatumumab in ASCLEPIOS I/II, APLIOS, APOLITOS (all core), or ALITHIOS (umbrella open-label extension). Patients received continuous ofatumumab or were newly switched from teriflunomide. Data cut-off: 25 September 2021. RESULTS In the efficacy set (n = 1882), the continuous ofatumumab group had a low annualized relapse rate (ARR 0.05 (95% confidence interval: 0.04-0.07)), low numbers of gadolinium-enhancing (Gd+) T1 lesions (0.01 lesions/scan) and fewer new/enlarging T2 lesions (annualized rate 0.08). Overall, 78.8% met three-parameter "no evidence of disease activity" criteria through 4 years. Switching from teriflunomide led to reduced ARR, risk of confirmed disability worsening (CDW), new/enlarging T2 lesions, Gd+ T1 lesions, and serum neurofilament light chain. In the continuous and newly switched ofatumumab groups, cumulative 3- and 6-month CDW rates remained low. In the safety set (n = 1969), the most frequently reported adverse events were infections and infestations (58.35%). No new safety signals were identified. CONCLUSION Ofatumumab has a favorable longer-term benefit-risk profile in RMS. TRIAL REGISTRY ALITHIOS (NCT03650114): https://clinicaltrials.gov/ct2/show/NCT03650114.
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Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (UCSF), 1651 4th Street, Box 3126, San Francisco, CA 94143, USA
| | - Ronald Zielman
- Clinical Development, Novartis Pharma B.V., Amsterdam, The Netherlands
| | - Ayan Das Gupta
- Analytics, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Jing Xi
- China Novartis Institutes for Biomedical Research Co. Ltd., Novartis, Shanghai, People’s Republic of China
| | - Dee Stoneman
- Global Medical, Novartis Pharma AG, Basel, Switzerland
| | | | - Derrick Robertson
- Department of Neurology, Multiple Sclerosis Division, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Ludwig Kappos
- MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Head, Spine and Neuromedicine, Biomedical and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Lapucci C, Boccia VD, Sirito T, Cellerino M, Mikulska M, Sticchi L, Inglese M. Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series. Mult Scler 2023; 29:1514-1517. [PMID: 37786976 DOI: 10.1177/13524585231204121] [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: 10/04/2023]
Abstract
The vaccination with live attenuated vaccines is generally not recommended during natalizumab (NTZ), as it is included among immunosuppressive/immunomodulating therapies. Nevertheless, considering the lack of evidence of a non-Central Nervous System (CNS) immunosuppressive effect of NTZ, after a risk/benefit evaluation, we decided to vaccinate four multiple sclerosis (MS) patients (three with an indication to switch to ocrelizumab for high-risk Progressive Multifocal Leukoencephalopathy (PML) and one for pregnancy planning). No vaccine-related adverse events of any type nor varicella zoster virus (VZV) infections were observed. To the best of our knowledge, these case series represent the first description of the good safety profile of anti-VZV vaccination in MS patients during NTZ treatment.
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Affiliation(s)
| | - Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Tommaso Sirito
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Sticchi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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15
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Zhao X, Sun L, Wang J, Xu X, Ni S, Liu M, Hu K. Nose to brain delivery of Astragaloside IV by β-Asarone modified chitosan nanoparticles for multiple sclerosis therapy. Int J Pharm 2023; 644:123351. [PMID: 37640088 DOI: 10.1016/j.ijpharm.2023.123351] [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: 04/29/2023] [Revised: 07/29/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
Multiple sclerosis (MS), an autoimmune disease, has been considered an inflammatory disorder of the central nervous system (CNS) with demyelination and axonal damage. Although there are certain first-line therapies to treat MS, their unsatisfactory efficacy is partly due to the limited CNS access after systemic administration. Besides, there is an urgent need to treat MS by enhancing remyelination or neuroprotection, or dampen the activity of microglia. Astragaloside IV (ASI) bears anti-inflammatory, antioxidant, remyelination and neuroprotective activity. While its poor permeability, relatively high molecular weight and low lipophilicity restrict it to reach the brain. Therefore, β-asarone modified ASI loaded chitosan nanoparticles (ASI-βCS-NP) were prepared to enhance the nose-to-brain delivery and therapeutic effects of ASI on EAE mice. The prepared ASI-βCS-NP showed mean size of about 120 nm, and zeta potential from +19 to +25 mV. DiR-βCS-NP was confirmed with good nose-to-brain targeting ability. After intranasal administration, the ASI-βCS-NP significantly reduced behavioral scores, decreased weight loss, suppressed inflammatory infiltration and astrocyte/microglial activation, reduced demyelination and increased remyelination on a mice EAE model. Our findings indicate that ASI-βCS-NP may be a potent treatment for MS after nose-to-brain drug delivery.
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Affiliation(s)
- Xiao Zhao
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China
| | - Lixue Sun
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China
| | - Jing Wang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China
| | - Xiaolu Xu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China
| | - Shuting Ni
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China
| | - Mei Liu
- Industrial Development Center of Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China.
| | - Kaili Hu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, PR China.
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16
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Winkelmann A, Metze C, Zettl UK, Loebermann M. Side effects following vaccination in multiple sclerosis: a prospective, multi-centre cohort study. Sci Rep 2023; 13:14480. [PMID: 37660223 PMCID: PMC10475060 DOI: 10.1038/s41598-023-41271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
Vaccines play a crucial role in preventing infections in patients with multiple sclerosis (MS), although concerns have been raised about potential worsening of the underlying disease. To investigate this, we conducted a prospective, multicentre, non-randomized observational study assessing changes in disease activity, safety, and clinical tolerability of vaccination in 222 MS patients on disease-modifying drugs. The majority of patients were female (76.6%) and 89.6% had relapsing-remitting MS. The vaccines administered were primarily seasonal influenza (56.3%) or tetanus-based vaccines (33.8%). Disease activity, as measured by annualized relapse rate, decreased significantly from 0.64 the year prior to vaccination to 0.38 in the following year. Moreover, the extended disability status scale remained stable within six months after vaccination in comparison to pre-vaccination values. Side effects were reported in 19.2% of vaccinated subjects, most commonly local side effects (65.2%) or flu-like symptoms (34.8%). Our findings suggest that standard non-live vaccines are safe and well-tolerated in MS patients and do not negatively impact disease activity.
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Affiliation(s)
- Alexander Winkelmann
- Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| | - Christoph Metze
- Neuroimmunological Section, Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
- Kliniken im Theodor-Wenzel-WerkKlinik für Psychiatrie, Potsdamer Chaussee 69, 14129, Berlin, Germany
| | - Uwe K Zettl
- Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
- Neuroimmunological Section, Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| | - Micha Loebermann
- Department of Tropical Medicine and Infectious Diseases, University of Rostock, Ernst Heydemann Strasse 6, 18059, Rostock, Germany.
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17
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Fedeli U, Barbiellini Amidei C, Avossa F, Schievano E, Kingwell E. Association of multiple-sclerosis-related mortality with COVID-19 and other common infections: a multiple causes of death analysis. Eur J Neurol 2023; 30:2870-2873. [PMID: 37306563 DOI: 10.1111/ene.15912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (MS) suffer from higher infection-related mortality compared to the general population; however, sparse data are available on the increased risk of death associated with coronavirus disease 2019 (COVID-19) and other common types of infections. METHODS All mortality records and multiple-cause-of-death data in 2010-2021 of residents in the Veneto region (northeastern Italy) were extracted. Mention of specific infections was compared between death certificates reporting MS or not. Odds ratios (OR) with 95% confidence intervals (95% CI) were estimated by conditional logistic regression matching by age, sex and calendar year. The bimonthly averages of MS-related deaths in 2010-2019 were compared with those registered during the pandemic (2020-2021). RESULTS Of 580,015 deaths through 2010-2021, MS was mentioned in 850 cases (0.15%), 59.3% women. Influenza and pneumonia were reported in 18.4% of MS-related compared to 11.0% non-MS-related deaths (OR 2.72, 95% CI 2.28-3.25). The odds of mention of urinary tract infections was significantly greater in MS-related deaths of men (OR 8.16, 95% CI 5.23-12.7) than women (OR 3.03, 95% CI 1.82-5.02). Aspiration pneumonia, pressure ulcers/skin infections and sepsis were also significantly associated with MS-related deaths. Reporting of COVID-19 as a cause of death did not significantly differ between deaths with and without mention of MS (approximately 11% of both). However, compared to 2010-2019, peaks in MS-related deaths were observed during the pandemic waves. CONCLUSIONS Infections continue to play a significant role in MS-related deaths, underlying the need to improve prevention and management strategies.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Elaine Kingwell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Silva BA, Carnero Contentti E, Becker J, Carranza JI, Correa-Díaz PE, Galleguillos Goiry L, Garcea O, Gracia F, Hamuy F, Macías MA, Navas C, Nuñez S, Rojas JI, Farez MF, Alonso R, López P. Latin American consensus recommendations on the risk of infections in people with multiple sclerosis treated with disease modifying drugs. Mult Scler Relat Disord 2023; 77:104840. [PMID: 37399673 DOI: 10.1016/j.msard.2023.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/14/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION The emergence of several therapeutic options in multiple sclerosis (MS), which significantly modify the immune system functioning, has led to the need for the consideration of additional factors, such as risk of infections, in the decision-making process. The aim of these consensus recommendations was to discuss and perform a practical guide to Latin American neurologists on the risk of infections at diagnosis, follow-up and prior to initiation of DMDs. METHODS A panel of Latin American neurologists, experts in demyelinating diseases and dedicated to management and care of MS patients, gathered during 2021 and 2022 to make consensus recommendations on the risk of infections in PwMS treated with DMDs in Latin America. The RAND/UCLA methodology was developed to synthesize the scientific evidence and expert opinions on health care topics and was used for reaching a formal agreement. RESULTS Recommendations were established based on relevant published evidence and expert opinion, focusing on: 1- baseline infection disease and vaccination status; 2- opportunistic infections; 3- progressive multifocal leukoencephalopathy; 4- genitourinary system infections; 5- respiratory tract infections; 6- digestive system infections, 7-others local infections and 8- COVID-19. CONCLUSION The recommendations of this consensus seek to optimize the care, management and treatment of PwMS in Latin America. The standardized evidence-based care of pwMS infections will allow better outcomes.
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Affiliation(s)
- Berenice A Silva
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital JM Ramos Mejía, Buenos Aires, Argentina; Sección Enfermedades Desmielinizantes, Hospital Italiano de Buenos Aires, Argentina.
| | - Edgar Carnero Contentti
- Unidad de Neuroinmunología, Departamento de Neurociencias, Hospital Alemán de Buenos Aires, Argentina
| | - Jefferson Becker
- Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - José I Carranza
- Sección Zoopatología y Parasitología Médica, Hospital Muñiz, Buenos Aires, Argentina
| | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital JM Ramos Mejía, Buenos Aires, Argentina
| | | | - Fernando Hamuy
- Departamento de Neurología, Hospital IMT, Paraguay; Departamento de Neurología de Diagnostico, Codas Thompson, Paraguay
| | | | - Carlos Navas
- Clínica Enfermedad Desmielinizantes, Clinica Universitaria Colombia, Colombia
| | - Sebastián Nuñez
- Servicio de Infectología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Juan I Rojas
- Service of Neurology, Hospital Universitario CEMIC, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital JM Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Pablo López
- Unidad de Neuroinmunología, Departamento de Neurociencias, Hospital Alemán de Buenos Aires, Argentina
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López-Muguruza E, Matute C. Alterations of Oligodendrocyte and Myelin Energy Metabolism in Multiple Sclerosis. Int J Mol Sci 2023; 24:12912. [PMID: 37629092 PMCID: PMC10454078 DOI: 10.3390/ijms241612912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system (CNS), characterized by demyelination and neurodegeneration. Oligodendrocytes play a vital role in maintaining the integrity of myelin, the protective sheath around nerve fibres essential for efficient signal transmission. However, in MS, oligodendrocytes become dysfunctional, leading to myelin damage and axonal degeneration. Emerging evidence suggests that metabolic changes, including mitochondrial dysfunction and alterations in glucose and lipid metabolism, contribute significantly to the pathogenesis of MS. Mitochondrial dysfunction is observed in both immune cells and oligodendrocytes within the CNS of MS patients. Impaired mitochondrial function leads to energy deficits, affecting crucial processes such as impulse transmission and axonal transport, ultimately contributing to neurodegeneration. Moreover, mitochondrial dysfunction is linked to the generation of reactive oxygen species (ROS), exacerbating myelin damage and inflammation. Altered glucose metabolism affects the energy supply required for oligodendrocyte function and myelin synthesis. Dysregulated lipid metabolism results in changes to the composition of myelin, affecting its stability and integrity. Importantly, low levels of polyunsaturated fatty acids in MS are associated with upregulated lipid metabolism and enhanced glucose catabolism. Understanding the intricate relationship between these mechanisms is crucial for developing targeted therapies to preserve myelin and promote neurological recovery in individuals with MS. Addressing these metabolic aspects may offer new insights into potential therapeutic strategies to halt disease progression and improve the quality of life for MS patients.
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Affiliation(s)
- Eneritz López-Muguruza
- Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain;
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
| | - Carlos Matute
- Achucarro Basque Center for Neuroscience, 48940 Leioa, Spain;
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
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20
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Hecker M, Fitzner B, Boxberger N, Putscher E, Engelmann R, Bergmann W, Müller M, Ludwig-Portugall I, Schwartz M, Meister S, Dudesek A, Winkelmann A, Koczan D, Zettl UK. Transcriptome alterations in peripheral blood B cells of patients with multiple sclerosis receiving immune reconstitution therapy. J Neuroinflammation 2023; 20:181. [PMID: 37533036 PMCID: PMC10394872 DOI: 10.1186/s12974-023-02859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory and neurodegenerative disease that leads to irreversible damage to the brain and spinal cord. The goal of so-called "immune reconstitution therapies" (IRTs) is to achieve long-term disease remission by eliminating a pathogenic immune repertoire through intense short-term immune cell depletion. B cells are major targets for effective immunotherapy in MS. OBJECTIVES The aim of this study was to analyze the gene expression pattern of B cells before and during IRT (i.e., before B-cell depletion and after B-cell repopulation) to better understand the therapeutic effects and to identify biomarker candidates of the clinical response to therapy. METHODS B cells were obtained from blood samples of patients with relapsing-remitting MS (n = 50), patients with primary progressive MS (n = 13) as well as healthy controls (n = 28). The patients with relapsing MS received either monthly infusions of natalizumab (n = 29) or a pulsed IRT with alemtuzumab (n = 15) or cladribine (n = 6). B-cell subpopulation frequencies were determined by flow cytometry, and transcriptome profiling was performed using Clariom D arrays. Differentially expressed genes (DEGs) between the patient groups and controls were examined with regard to their functions and interactions. We also tested for differences in gene expression between patients with and without relapse following alemtuzumab administration. RESULTS Patients treated with alemtuzumab or cladribine showed on average a > 20% lower proportion of memory B cells as compared to before IRT. This was paralleled by profound transcriptome shifts, with > 6000 significant DEGs after adjustment for multiple comparisons. The top DEGs were found to regulate apoptosis, cell adhesion and RNA processing, and the most highly connected nodes in the network of encoded proteins were ESR2, PHB and RC3H1. Higher mRNA levels of BCL2, IL13RA1 and SLC38A11 were seen in patients with relapse despite IRT, though these differences did not pass the false discovery rate correction. CONCLUSIONS We show that B cells circulating in the blood of patients with MS undergoing IRT present a distinct gene expression signature, and we delineated the associated biological processes and gene interactions. Moreover, we identified genes whose expression may be an indicator of relapse risk, but further studies are needed to verify their potential value as biomarkers.
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Affiliation(s)
- Michael Hecker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Brit Fitzner
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Nina Boxberger
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Elena Putscher
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Robby Engelmann
- Clinic III (Hematology, Oncology and Palliative Medicine), Special Hematology Laboratory, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Wendy Bergmann
- Core Facility for Cell Sorting and Cell Analysis, Rostock University Medical Center, Schillingallee 70, 18057, Rostock, Germany
| | - Michael Müller
- Core Facility for Cell Sorting and Cell Analysis, Rostock University Medical Center, Schillingallee 70, 18057, Rostock, Germany
| | | | - Margit Schwartz
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Stefanie Meister
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Ales Dudesek
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Alexander Winkelmann
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Dirk Koczan
- Institute of Immunology, Rostock University Medical Center, Schillingallee 70, 18057, Rostock, Germany
| | - Uwe Klaus Zettl
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany
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Zettl UK, Rommer PS, Aktas O, Wagner T, Richter J, Oschmann P, Cepek L, Elias-Hamp B, Gehring K, Chan A, Hecker M. Interferon beta-1a sc at 25 years: a mainstay in the treatment of multiple sclerosis over the period of one generation. Expert Rev Clin Immunol 2023; 19:1343-1359. [PMID: 37694381 DOI: 10.1080/1744666x.2023.2248391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Interferon beta (IFN beta) preparations are an established group of drugs used for immunomodulation in patients with multiple sclerosis (MS). Subcutaneously (sc) applied interferon beta-1a (IFN beta-1a sc) has been in continuous clinical use for 25 years as a disease-modifying treatment. AREAS COVERED Based on data published since 2018, we discuss recent insights from analyses of the pivotal trial PRISMS and its long-term extension as well as from newer randomized studies with IFN beta-1a sc as the reference treatment, the use of IFN beta-1a sc across the patient life span and as a bridging therapy, recent data regarding the mechanisms of action, and potential benefits of IFN beta-1a sc regarding vaccine responses. EXPERT OPINION IFN beta-1a sc paved the way to effective immunomodulatory treatment of MS, enabled meaningful insights into the disease process, and remains a valid therapeutic option in selected vulnerable MS patient groups.
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Affiliation(s)
- Uwe Klaus Zettl
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Paulus Stefan Rommer
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | | - Andrew Chan
- Department of Neurology, Inselspital Bern, University Hospital Bern, Bern, Switzerland
| | - Michael Hecker
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
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22
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Vacaras V, Nistor C, Schiopu AM, Vacaras C, Marin GE, Muresanu DF. The psychological impact of the COVID-19 pandemic on people with multiple sclerosis. Mult Scler Relat Disord 2023; 76:104825. [PMID: 37320938 PMCID: PMC10257333 DOI: 10.1016/j.msard.2023.104825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that leads to neurological impairment and disability, mostly in young-aged people. Depression and anxiety are important associated mental disorders for people with MS (PwMS), which influence their life quality. During the COVID-19 pandemic, fear and stress levels enhanced dramatically for the general population, but mostly in progressive chronic pathologies such as MS. AIM This study aimed to analyze the dynamic of psychological aspects in PwMS pre-pandemic and during pandemic, their connection with clinical outcomes, and with the coronavirus disease. METHODS We included 95 PwMS with relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS), who were first evaluated 4 years before the pandemic outbreak and the second time 2 years after. They completed a series of psychological tests for depression, anxiety, negative automatic thoughts, and stress: Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Endler Multidimensional Anxiety Scales (EMAS), Automatic Thoughts Questionnaire (ATQ). A neurologist evaluated the Expanded Disability Status Scale (EDSS) and a COVID-19 survey was completed by 78 patients. RESULTS During the pandemic, depression was encountered in 9.47% of PwMS, only 1.05% with a severe form, and 6.3% with suicidal thoughts, while anxiety was more frequent (39% of cases). Compared to the pre-pandemic period, depression levels remained stable over time (p = 0.55), anxiety was reduced (p<0.001), and stress levels significantly increased (p = 0.001). Some social aspects, such as having sufficient income, reduced the risk for psychological comorbidities. There was a mild correlation between emotional well-being and neurological disability. Of all patients who responded to the survey, 53.84% had previous COVID-19 infections, no patient was hospitalized and 69.23% were vaccinated. There was no relationship between the COVID-19 infection and psychological test results. CONCLUSION During the pandemic, in the MS population depression remained stable, anxiety decreased, and stress levels were enhanced compared to the pre-pandemic period. Psychiatric comorbidities were not influenced by the coronavirus infection.
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Affiliation(s)
- Vitalie Vacaras
- Neurology Department, Cluj Emergency County Hospital, Cluj-Napoca 400012, Romania; Department of Neurosciences, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Cristina Nistor
- Neurology Department, Cluj Emergency County Hospital, Cluj-Napoca 400012, Romania; Department of Neurosciences, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Andra Maria Schiopu
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400349, Romania
| | - Cristiana Vacaras
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400349, Romania.
| | - Gheorghe-Eduard Marin
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400349, Romania
| | - Dafin F Muresanu
- Neurology Department, Cluj Emergency County Hospital, Cluj-Napoca 400012, Romania; Department of Neurosciences, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
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23
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Takahashi J, Okamoto T, Lin Y, Saika R, Katsumoto A, Sato W, Yamamura T, Takahashi Y. Ratio of lymphocyte to monocyte area under the curve as a novel predictive factor for severe infection in multiple sclerosis. Front Immunol 2023; 14:1133444. [PMID: 36865535 PMCID: PMC9972680 DOI: 10.3389/fimmu.2023.1133444] [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: 12/29/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023] Open
Abstract
Background Individuals with multiple sclerosis (MS) are vulnerable to all types of infection, because MS itself involves immunodeficiency, in addition to involving treatment with immunosuppressants. Simple predictive variables for infection that are easily assessed in daily examinations are warranted. Lymphocyte area under the curve (L_AUC), defined as the sum of serial absolute lymphocyte counts under the lymphocyte count-time curve, has been established as a predictive factor for several infections after allogenic hematopoietic stem cell transplantation. We assessed whether L_AUC could also be a useful factor for predicting severe infection in MS patients. Methods From October 2010 to January 2022, MS patients, diagnosed based on the 2017 McDonald criteria, were retrospectively reviewed. We extracted patients with infection requiring hospitalization (IRH) from medical records and matched with controls in a 1:2 ratio. Variables including clinical severity and laboratory data were compared between the infection group and controls. L_AUC was calculated along with the AUC of total white blood cells (W_AUC), neutrophils (N_AUC), lymphocytes (L_AUC), and monocytes (M_AUC). To correct for different times of blood examination and extract mean values of AUC per time point, we divided the AUC by follow-up duration. For example, in evaluating lymphocyte counts, we defined the ratio of [L_AUC] to [follow-up duration] as [L_AUC/t]. Multivariate regression analysis was conducted to extract predictive factors associated with IRH. Also, discriminative analysis was conducted using candidate variables from multivariate analysis. Results The total case-control sample included 177 patients of MS with IRH (n=59) and non-IRH (controls) (n=118). Adjusted odds ratios (OR) for the risk of serious infection in patients with MS with higher baseline expanded disability status scale (EDSS) (OR 1.340, 95% confidence interval [CI] 1.070-1.670, p = 0.010) and lower ratio of L_AUC/t to M_AUC/t (OR 0.766, 95%CI 0.591-0.993, p = 0.046) were significant. Notably, the kind of treatment, including glucocorticoids (GCs), disease-modifying drugs (DMDs) and other immunosuppressants agents, and dose of GCs were not significantly associated with serious infection after correlated with EDSS and ratio of L_AUC/t to M_AUC/t. In discriminative analysis, sensitivity was 88.1% (95%CI 76.5-94.7%) and specificity was 35.6% (95%CI 27.1-45.0%), using EDSS ≥ 6.0 or ratio of L_AUC/t to M_AUC/t ≤ 3.699, while sensitivity was 55.9% (95%CI 42.5-68.6%) and specificity was 83.9% (95%CI 75.7-89.8%), using both EDSS ≥ 6.0 and ratio of L_AUC/t to M_AUC/t ≤ 3.699. Conclusion Our study revealed the impact of the ratio L_AUC/t to M_AUC/t as a novel prognostic factor for IRH. Clinicians should pay more attention to laboratory data such as lymphocyte or monocyte counts itself, directly presenting individual immunodeficiency, rather than the kind of drug to prevent infection as a clinical manifestation.
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Affiliation(s)
- Junichiro Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tomoko Okamoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan,*Correspondence: Tomoko Okamoto,
| | - Youwei Lin
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Reiko Saika
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Atsuko Katsumoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Wakiro Sato
- Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takashi Yamamura
- Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Trideva Sastri K, Vishal Gupta N, Kannan A, Balamuralidhara V, Ramkishan A. Potential nanocarrier-mediated miRNA-based therapy approaches for multiple sclerosis. Drug Discov Today 2022; 27:103357. [PMID: 36115632 DOI: 10.1016/j.drudis.2022.103357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune neuroinflammatory disorder attributed to neurodegeneration and demyelination, resulting in neurological impairment. miRNA has a significant role in biological processes in MS. In this review, we focus on the feasibility of delivering miRNAs through nanoformulations for managing MS. We provide a brief discussion of miRNA synthesis and evidence for miRNA dysregulation in MS. We also highlight formulation strategies and resulting technologies for the effective delivery of miRNAs through nanocarrier systems for achieving high therapeutic benefits.
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Affiliation(s)
- K Trideva Sastri
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Shivarathreeshwara Nagara, Bannimantap, Mysuru, India
| | - N Vishal Gupta
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Shivarathreeshwara Nagara, Bannimantap, Mysuru, India.
| | - Anbarasu Kannan
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysuru, India
| | - V Balamuralidhara
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Shivarathreeshwara Nagara, Bannimantap, Mysuru, India
| | - A Ramkishan
- Deputy Drugs Controller (India), Central Drugs Standard Control Organization, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, India
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Pistor M, Hoepner R, Hoepner AG, Lin Y, Jung S, Bassetti CL, Chan A, Salmen A. Multiple Sclerosis immunotherapies and COVID-19 mortality: an analysis of the FDA Adverse Event Reporting System. Ther Adv Neurol Disord 2022; 15:17562864221129383. [PMID: 36237201 PMCID: PMC9551667 DOI: 10.1177/17562864221129383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Evidence on mortality risks associated with MS-immunotherapies during the
SARS-CoV2 pandemic derived thus far mainly from single country
experiences. Objective: In this analysis, we aim to determine the frequency of COVID-19 associated
fatality reports of patients receiving an MS-immunotherapy as reported to
the international Food and Drug Administration (FDA) Adverse Event Reporting
System (FAERS) from February 2020 to March 2021. Methods: In all, 1071 cases for this cross-sectional analysis were retrieved from
FAERS and a multivariable logistic regression was performed. We adjusted for
sex, age, region, month of report to FDA, immunotherapy-class and
additionally for healthcare-system and pandemic-related metrics. Result: Anti-CD20 therapies (60%) followed by sphingosine-1 phosphate modulators
(12%) and dimethylfumarat (10%) were reported most frequently. In 50% of the
cases, MS-phenotype is not reported, relapsing MS in 35% and progressive MS
in 15%. Besides older age (odds ratio [OR]: 1.1; 95% confidence interval
[CI]: 1.07–1.13; p < 0.01), anti-CD20 therapies were
significantly associated with a higher risk of death (OR: 4.1; 95% CI:
1.17–14.46; p = 0.03), whereas female sex was associated
with a reduced mortality risk (OR: 0.4, 95% CI: 0.22–0.72;
p < 0.01). Conclusion: Using international open access data and a multidisciplinary approach for
risk prediction, we identified an increased mortality risk associated with
anti-CD20 therapies, which is in line with national and multi-national
cohort studies.
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Affiliation(s)
| | | | - Andreas G.F. Hoepner
- Department of Banking & Finance, Michael
Smurfit Graduate Business School, University College Dublin, Dublin,
Republic of Ireland,Platform for Sustainable Finance, Department
for Financial Stability and Capital Markets (DG FISMA), European Commission,
European Union (EU), Brussels, Belgium
| | - Yanan Lin
- Department of Banking & Finance, Michael
Smurfit Graduate Business School, University College Dublin, Dublin,
Republic of Ireland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L. Bassetti
- Department of Neurology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
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Association of Disease-Modifying Therapies with COVID-19 Susceptibility and Severity in Patients with Multiple Sclerosis: A Systematic Review and Network Meta-Analysis. Mult Scler Int 2022; 2022:9388813. [PMID: 36187599 PMCID: PMC9519336 DOI: 10.1155/2022/9388813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background We conducted this study to assess the effect of disease-modifying therapies (DMTs) on coronavirus disease (COVID-19) susceptibility and severity in people with multiple sclerosis (MS). Methods Available studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature, including reference lists and conference abstracts, were searched from December 1, 2019, to July 26, 2021. We included cross-sectional, case-control, and cohort studies assessing the association of DMTs with risk of contracting COVID-19 or its outcomes in MS patients on univariate or multivariate regression analyses. We conducted a network meta-analysis (NMA) to compare the risk of COVID-19 and developing severe infection across DMTs. Results Out of the initial 3893 records and 1883 conference abstracts, a total of 10 studies were included. Pairwise comparisons showed that none of the DMTs meaningfully affect the risk of acquiring infection. There was significant total heterogeneity and inconsistency across this NMA. In comparison with no DMT, dimethyl fumarate (0.62 (0.42, 0.93)), fingolimod (0.55 (0.32, 0.94)), natalizumab (0.50 (0.31, 0.81)), and interferon (0.42 (0.22, 0.79)) were associated with a decreased risk of severe COVID-19; but, rituximab was observed to increase the risk (1.94 (1.20, 3.12)). Compared to rituximab or ocrelizumab, all DMTs were associated with a decreased risk. Pairwise comparisons showed no differences across other DMTs. Interferon and rituximab were associated with the lowest and highest risks of severe COVID-19. Conclusion Our study showed an increased risk of severe COVID-19 in patients on rituximab and ocrelizumab. No association with COVID-19 severity across other DMTs was observed.
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Schiavetti I, Carmisciano L, Ponzano M, Cordioli C, Cocco E, Marfia GA, Inglese M, Filippi M, Radaelli M, Bergamaschi R, Immovilli P, Capobianco M, De Rossi N, Brichetto G, Scandellari C, Cavalla P, Pesci I, Confalonieri P, Perini P, Trojano M, Lanzillo R, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M, Sormani MP. Signs and symptoms of Covid‐19 in patients with multiple sclerosis. Eur J Neurol 2022; 29:3728-3736. [PMID: 36086905 PMCID: PMC9538224 DOI: 10.1111/ene.15554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID‐19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID‐19 in MS patients and identify all factors associated with their manifestation. Method Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID‐19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease‐modifying therapies were associated with greater frequencies of certain COVID‐19 symptoms (association between anti‐CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu‐like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID‐19 symptoms.
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Affiliation(s)
| | | | - Marta Ponzano
- Department of Health Sciences University of Genova Genova Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ATS Sardegna Cagliari Italy
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari Cagliari Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine Tor Vergata University Rome Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Massimo Filippi
- Neurology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurophysiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST ‘Papa Giovanni XXIII’ Bergamo Italy
| | | | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto Piacenza Italy
| | - Marco Capobianco
- Regional Referral Multiple Sclerosis Centre, Department of Neurology University Hospital San Luigi Orbassano (Torino) Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | | | - Cinzia Scandellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla Bologna Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience City of Health and Science University Hospital of Turin Turin Italy
| | - Ilaria Pesci
- Centro SM UOC Neurologia, Fidenza, AUSL PR, Fidenza Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Department ‘Carlo Besta’ Neurological Institute Milan Italy
| | - Paola Perini
- Department of Neurology Multiple Sclerosis Center University of Padua Padova Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs University of Bari Bari Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences University of Campania Napoli Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Casa di Cura Privata del Policlinico Milan Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation Genoa Italy
- Department of Life Sciences University of Siena Siena Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia University of Catania Catania Italy
- Centro Sclerosi Multipla, Policlinico Catania University of Catania Catania Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs Sapienza University of Rome Rome Italy
- Unit of Neurology, IRCCS Neuromed Pozzilli Italy
| | - Maria Pia Sormani
- Department of Health Sciences University of Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
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Heidler F, Baldt J, Frahm N, Langhorst SE, Mashhadiakbar P, Streckenbach B, Burian K, Zettl UK, Richter J. Vaccination willingness in association with personality traits in patients with multiple sclerosis in the course of SARS-CoV-2 pandemic. Sci Rep 2022; 12:15147. [PMID: 36071083 PMCID: PMC9449937 DOI: 10.1038/s41598-022-18912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination is a key strategy for controlling the SARS-CoV-2 pandemic. Acceptance of SARS-CoV-2 vaccines by chronically ill patients, such as multiple sclerosis (MS) patients, plays an important role in prevention of complicated disease course. This longitudinal, prospective, multi-centre-study of German MS-patients aimed to detect socio-demographic, clinical, or psychological determinants of attitudes towards standard vaccines, SARS-CoV-2 vaccines, and governmental measures before/during the pandemic. Exactly 404 MS-patients were investigated by standardized questionnaires and structured interviews on socio-demographic, clinical-neurological, and psychological characteristics, vaccination status, and vaccination from June 2019. Data on SARS-CoV-2 vaccination willingness were collected in two follow-up assessments (1st: June to July 2020, before SARS-CoV-2 vaccine availability, N = 200; 2nd: March to May 2021, after SARS-CoV-2 vaccine availability, N = 157). Age, sex, MS course type, depression, and personality characteristics (Extraversion, Novelty seeking, Self-directedness, and Cooperativeness) were significantly associated with vaccination willingness. Although the majority of MS-patients showed SARS-CoV-2 vaccination willingness at both follow-ups (1st: 60%, 2nd: 61%), a substantial proportion had concerns and were undecided or opposed to vaccination. Socio-demographic variables like age and sex, psychopathological status, and various personality characteristics might influence vaccination willingness and should be considered when discussing with MS-patients about SARS-CoV-2 vaccination.
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Affiliation(s)
- Felicita Heidler
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Julia Baldt
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Niklas Frahm
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Silvan Elias Langhorst
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Pegah Mashhadiakbar
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Barbara Streckenbach
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Katja Burian
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunology Section, University Medical Centre of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Jörg Richter
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany.,Faculty of Health Sciences, University of Hull, Hull, UK.,Durham Law School, Durham University, Durham, UK
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29
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Bollo L, Caputo F, Paolicelli D, Trojano M, Iaffaldano P. Interdisciplinary approach to opportunistic infections: staphylococcal meningitis in a patient with multiple sclerosis on treatment with dimethyl fumarate. Intern Emerg Med 2022; 17:1845-1847. [PMID: 35486330 PMCID: PMC9051806 DOI: 10.1007/s11739-022-02989-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Luca Bollo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Francesca Caputo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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30
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Muñoz-Jurado A, Escribano BM, Agüera E, Caballero-Villarraso J, Galván A, Túnez I. SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19. J Neurol 2022; 269:4581-4603. [PMID: 35788744 PMCID: PMC9253265 DOI: 10.1007/s00415-022-11237-1] [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: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022]
Abstract
The SARS-CoV-2 pandemic has raised particular concern for people with Multiple Sclerosis, as these people are believed to be at increased risk of infection, especially those being treated with disease-modifying therapies. Therefore, the objective of this review was to describe how COVID-19 affects people who suffer from Multiple Sclerosis, evaluating the risk they have of suffering an infection by this virus, according to the therapy to which they are subjected as well as the immune response of these patients both to infection and vaccines and the neurological consequences that the virus can have in the long term. The results regarding the increased risk of infection due to treatment are contradictory. B-cell depletion therapies may cause patients to have a lower probability of generating a detectable neutralizing antibody titer. However, more studies are needed to help understand how this virus works, paying special attention to long COVID and the neurological symptoms that it causes.
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Affiliation(s)
- Ana Muñoz-Jurado
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, University of Cordoba, Campus of Rabanales, 14071 Cordoba, Spain
| | - Begoña M. Escribano
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, University of Cordoba, Campus of Rabanales, 14071 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
| | - Eduardo Agüera
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Neurology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Javier Caballero-Villarraso
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
- Clinical Analysis Service, Reina Sofía University Hospital, Cordoba, Spain
| | - Alberto Galván
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
| | - Isaac Túnez
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
- Cooperative Research Thematic Excellent Network on Brain Stimulation (REDESTIM), Madrid, Spain
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31
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Hecker M, Frahm N, Bachmann P, Debus JL, Haker MC, Mashhadiakbar P, Langhorst SE, Baldt J, Streckenbach B, Heidler F, Zettl UK. Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases. Front Pharmacol 2022; 13:946351. [PMID: 36034780 PMCID: PMC9416235 DOI: 10.3389/fphar.2022.946351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with multiple sclerosis (MS) often undergo complex treatment regimens, resulting in an increased risk of polypharmacy and potential drug-drug interactions (pDDIs). Drug interaction databases are useful for identifying pDDIs to support safer medication use. Objective: To compare three different screening tools regarding the detection and classification of pDDIs in a cohort of MS patients. Furthermore, we aimed at ascertaining sociodemographic and clinical factors that are associated with the occurrence of severe pDDIs. Methods: The databases Stockley's, Drugs.com and MediQ were used to identify pDDIs by screening the medication schedules of 627 patients. We determined the overlap of the identified pDDIs and the level of agreement in pDDI severity ratings between the three databases. Logistic regression analyses were conducted to determine patient risk factors of having a severe pDDI. Results: The most different pDDIs were identified using MediQ (n = 1,161), followed by Drugs.com (n = 923) and Stockley's (n = 706). The proportion of pDDIs classified as severe was much higher for Stockley's (37.4%) than for Drugs.com (14.4%) and MediQ (0.9%). Overall, 1,684 different pDDIs were identified by at least one database, of which 318 pDDIs (18.9%) were detected with all three databases. Only 55 pDDIs (3.3%) have been reported with the same severity level across all databases. A total of 336 pDDIs were classified as severe (271 pDDIs by one database, 59 by two databases and 6 by three databases). Stockley's and Drugs.com revealed 47 and 23 severe pDDIs, respectively, that were not included in the other databases. At least one severe pDDI was found for 35.2% of the patients. The most common severe pDDI was the combination of acetylsalicylic acid with enoxaparin, and citalopram was the drug most frequently involved in different severe pDDIs. The strongest predictors of having a severe pDDI were a greater number of drugs taken, an older age, living alone, a higher number of comorbidities and a lower educational level. Conclusions: The information on pDDIs are heterogeneous between the databases examined. More than one resource should be used in clinical practice to evaluate pDDIs. Regular medication reviews and exchange of information between treating physicians can help avoid severe pDDIs.
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Affiliation(s)
- Michael Hecker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Niklas Frahm
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Paula Bachmann
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Jane Louisa Debus
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Marie-Celine Haker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Pegah Mashhadiakbar
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Silvan Elias Langhorst
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Julia Baldt
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.,Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Barbara Streckenbach
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.,Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | | | - Uwe Klaus Zettl
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
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32
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Longinetti E, Bower H, McKay KA, Englund S, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould A, Lycke J, Nilsson P, Salzer J, Svenningsson A, Mellergård J, Olsson T, Piehl F, Frisell T. COVID-19 clinical outcomes and DMT of MS patients and population-based controls. Ann Clin Transl Neurol 2022; 9:1449-1458. [PMID: 35993445 PMCID: PMC9463950 DOI: 10.1002/acn3.51646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate risks for all‐cause mortality and for severe COVID‐19 in multiple sclerosis patients and across relapsing–remitting multiple sclerosis patients exposed to disease‐modifying therapies. Methods We conducted a Swedish nationwide population‐based multi‐register linkage cohort study and followed all multiple sclerosis patients (n = 17,692 in March 2020), individually age‐, sex‐, and region‐matched to five population‐based controls (n = 86,176 in March 2020) during March 2020–June 2021. We compared annual all‐cause mortality within and across cohorts, and assessed incidence rates and relative risks for hospitalization, intensive care admission, and death due to COVID‐19 in relation to disease‐modifying therapy use, using Cox regression. Results Absolute all‐cause mortality among multiple sclerosis patients was higher from March to December 2020 than in previous years, but relative risks versus the population‐based controls were similar to preceding years. Incidence rates of hospitalization, intensive care admission, and death due to COVID‐19 remained in line with those for all‐cause hospitalization, intensive care admission, and mortality. Among relapsing–remitting patients on rituximab, trends for differences in risk of hospitalization due to COVID‐19 remained in the demographics‐, socioeconomic status‐, comorbidity‐, and multiple sclerosis severity‐adjusted model. Interpretation Risks of severe COVID‐19‐related outcomes were increased among multiple sclerosis patients as a whole compared to population controls, but risk increases were also seen for non‐COVID‐19 hospitalization, intensive care admission, and mortality, and did not significantly differ during the pandemic compared to pre‐pandemic years. The risk conveyed by disease‐modifying therapies was smaller than previously assumed, likely as a consequence of the possibility to better control for confounders.
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Affiliation(s)
- Elisa Longinetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annette Langer-Gould
- Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles, USA
| | - Jan Lycke
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mellergård
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Guerra-Amor A, Lopez-Gonzalez A, Bosch-Nicolau P, Rodriguez-Acevedo B, Zabalza A, Sulleiro E, Espinosa-Pereiro J, Aznar ML, Salvador F, Sánchez-Montalvá A, Molina I. Case Report: Leishmaniasis in a 33-Year-Old Man with Multiple Sclerosis. Am J Trop Med Hyg 2022; 107:339-341. [PMID: 35895413 PMCID: PMC9393455 DOI: 10.4269/ajtmh.22-0117] [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: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 08/03/2023] Open
Abstract
Leishmaniasis is a protozoan disease caused by species of genus Leishmania. Immunosuppression increases the risk of severe clinical forms and impairs response to treatment. The expansion of the use of immunomodulatory drugs for different conditions has raised the number of these cases. In this report, we present a case of visceral leishmaniasis in a patient with multiple sclerosis (MS) under fingolimod treatment. He presented with the triad of fever, visceromegaly, and pancytopenia and was diagnosed by the presence of amastigotes in a bone marrow sample. Furthermore, we discuss the previous published cases of MS patients under different immunosuppressant therapies to highlight its risk in endemic areas and suggest a therapeutic approach.
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Affiliation(s)
- Alvaro Guerra-Amor
- Dermatology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | - Ane Lopez-Gonzalez
- Pneumology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Breogan Rodriguez-Acevedo
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, University Hospital Vall d’Hebrón, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Maria Luisa Aznar
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain
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34
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Debus JL, Bachmann P, Frahm N, Mashhadiakbar P, Langhorst SE, Streckenbach B, Baldt J, Heidler F, Hecker M, Zettl UK. Associated factors of potential drug-drug interactions and drug-food interactions in patients with multiple sclerosis. Ther Adv Chronic Dis 2022; 13:20406223221108391. [PMID: 35959503 PMCID: PMC9358348 DOI: 10.1177/20406223221108391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the most common immune-mediated demyelinating
disease in younger adults. Patients with MS (PwMS) are vulnerable to the
presence of potential drug–drug interactions (pDDIs) and potential drug–food
interactions (pDFIs) as they take numerous medications to treat MS,
associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can
increase treatment success and reduce side effects. Objective: We aimed at determining the frequency and severity of pDDIs and pDFIs in
PwMS, with regard to polypharmacy. Methods: In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged
⩾18 years. Data collection was performed through patient record reviews,
clinical examinations and structured patient interviews. pDDIs and pDFIs
were identified using two DDI databases: Drugs.com Interactions Checker and
Stockley’s Interactions Checker. Results: We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%)
had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334
patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a
15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients
without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001).
The most frequently recorded severe pDDI was between citalopram and
fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent
severe pDFI. Conclusion: Pw/P were particularly at risk of severe pDDIs. Age and educational level
were found to be factors associated with the occurrence of pDDIs,
independent of the number of medications taken. Screening for pDDIs/pDFIs
should be routinely done by the clinical physician to increase drug safety
and reduce side effects.
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Affiliation(s)
- Jane Louisa Debus
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Paula Bachmann
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Felicita Heidler
- Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
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Leung MW, Bazelier MT, Souverein PC, Uitdehaag BM, Klungel OH, Leufkens HG, Pajouheshnia R. Mapping the risk of infections in patients with multiple sclerosis: A multi-database study in the United Kingdom Clinical Practice Research Datalink GOLD and Aurum. Mult Scler 2022; 28:1808-1818. [PMID: 35575214 PMCID: PMC9442628 DOI: 10.1177/13524585221094218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: People with multiple sclerosis (pwMS) have an increased risk of infections; risk factors include underlying disease, physical impairment and use of some disease-modifying treatments. Objective: To quantify changes in population-level infection rates among pwMS and compare these to the general population and people with rheumatoid arthritis (pwRA), and identify patient characteristics predictive of infections after MS diagnosis. Methods: We conducted a multi-database study using data on 23,226 people with MS diagnosis from the UK Clinical Practice Research Datalink Aurum and GOLD (January 2000–December 2020). PwMS were matched to MS-free controls and pwRA. We calculated infection rates, and estimated incidence rate ratios (IRR) and 95% confidence intervals (CI) of predictors for infections ⩽ 5 years after MS diagnosis using Poisson regression. Results: Among pwMS, overall infection rates remained stable – 1.51-fold (1.49–1.52) that in MS-free controls and 0.87-fold (0.86–0.88) that in pwRA – although urinary tract infection rate per 1000 person-years increased from 98.7 (96.1–101) (2000–2010) to 136 (134–138) (2011–2020). Recent infection before MS diagnosis was most predictive of infections (1 infection: IRR 1.92 (1.86–1.97); ⩾2 infections: IRR 3.00 (2.89–3.10)). Conclusion: The population-level elevated risk of infection among pwMS has remained stable despite the introduction of disease-modifying treatments.
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Affiliation(s)
- Melissa Wy Leung
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Marloes T Bazelier
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Hubert Gm Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Hatef B, Pirzad Jahromi G, Meftahi GH, Shaygan V, Ghalavand M. Impact of the covid-19 pandemic on the psychological status and cortisol level of multiple sclerosis patients. Neuropsychol Rehabil 2022:1-24. [PMID: 35507425 DOI: 10.1080/09602011.2022.2069825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to compare the changes in psychological status and cortisol level between multiple sclerosis (MS) patients and a healthy control group (HC). One hundred and fifty-five MS patients and 165 HC subjects had completed questionnaires consisting of 36-Item short health survey (SF-36), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory-II (BDI-II), and fatigue severity score (FSS) before and after (one year from onset) COVID-19 pandemic. The salivary cortisol level was also measured again in 26 MS patients and 14 control individuals. MS patients had lower scores of mental and physical components of quality of life (MCS and PCS), but higher HAM-A, FSS, and BDII scores than HC Before and after COVID-19. There were significant changes in scores of MCS, BDI-II, HAM-A, and FSS after the COVID-19 outbreak in MS patients, but not in PCS score. In HC group, we observed significant changes in scores of MCS, BDI-II, and FSS, but not in scores of PCS and HAM-A. Compared to HC, the MS patients reported greater deterioration in the overall mental health component of their health-related quality of life, and their levels of anxiety and fatigue over the study period. The change of cortisol levels was non-significant with a small effect size.
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Affiliation(s)
- Boshra Hatef
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Gila Pirzad Jahromi
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Vahid Shaygan
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majdedin Ghalavand
- Applied Virology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Boyko AN, Sivertseva SA, Chemakina DS, Spirin NN, Bykova OV, Guseva ME. Vaccination and Multiple Sclerosis – Current Situation. NEUROSCIENCE AND BEHAVIORAL PHYSIOLOGY 2022; 52:486-490. [PMID: 35875700 PMCID: PMC9296221 DOI: 10.1007/s11055-022-01265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Active immunization of patients with autoimmune diseases is a current challenge. Vaccination of patients with multiple sclerosis (MS) has been shown not to be associated with increased risk of exacerbation. A personalized approach to immunization of this group of patients is required, taking account of ongoing therapy and the nature of the course of illness. MS is not an absolute contraindication for vaccination against the new coronavirus infection. Vaccination can be with any of the currently authorized immunoformulations.
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Ponzano M, Schiavetti I, Bovis F, Landi D, Carmisciano L, De Rossi N, Cordioli C, Moiola L, Radaelli M, Immovilli P, Capobianco M, Bragadin MM, Cocco E, Scandellari C, Cavalla P, Pesci I, Confalonieri P, Perini P, Bergamaschi R, Inglese M, Petracca M, Trojano M, Tedeschi G, Comi G, Battaglia MA, Patti F, Fragoso YD, Sen S, Siva A, Karabudak R, Efendi H, Furlan R, Salvetti M, Sormani MP. A multiparametric score for assessing the individual risk of severe Covid-19 among patients with Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103909. [PMID: 35675744 PMCID: PMC9130313 DOI: 10.1016/j.msard.2022.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
Background Many risk factors for the development of severe forms of Covid-19 have been identified, some applying to the general population and others specific to Multiple Sclerosis (MS) patients. However, a score for quantifying the individual risk of severe Covid-19 in patients with MS is not available. The aim of this study was to construct such score and to evaluate its performance. Methods Data on patients with MS infected with Covid-19 in Italy, Turkey and South America were extracted from the Musc-19 platform. After imputation of missing values, data were separated into training data set (70%) and validation data set (30%). Univariable logistic regression models were performed in the training dataset to identify the main risk factors to be included in the multivariable logistic regression analyses. To select the most relevant variables we applied three different approaches: (1) multivariable stepwise, (2) Lasso regression, (3) Bayesian model averaging. Three scores were defined as the linear combination of the coefficients estimated in the models multiplied by the corresponding value of the variables and higher scores were associated to higher risk of severe Covid-19 course. The performances of the three scores were compared in the validation dataset based on the area under the ROC curve (AUC) and an optimal cut-off was calculated in the training dataset for the score with the best performance. The probability of showing a severe Covid-19 course was calculated based on the score with the best performance. Results 3852 patients were included in the study (2696 in the training dataset and 1156 in the validation data set). 17% of the patients required hospitalization and risk factors for severe Covid-19 course were older age, male sex, living in Turkey or South America instead of living in Italy, presence of comorbidities, progressive MS, longer disease duration, higher Expanded Disability Status Scale, Methylprednisolone use and anti-CD20 treatment. The score with the best performance was the one derived using the Lasso selection approach (AUC= 0.72) and it was built with the following variables: age, sex, country, BMI, presence of comorbidities, EDSS, methylprednisolone use, treatment. An excel spreadsheet to calculate the score and the probability of severe Covid-19 is available at the following link: https://osf.io/ac47u/?view_only=691814d57b564a34b3596e4fcdcf8580. Conclusions The originality of this study consists in building a useful tool to quantify the individual risk for Covid-19 severity based on patient's characteristics. Due to the modest predictive ability and to the need of external validation, this tool is not ready for being fully used in clinical practice to make important decisions or interventions. However, it can be used as an additional instrument to identify high-risk patients and persuade them to take important measures to prevent Covid-19 infection (i.e. getting vaccinated against Covid-19, adhering to social distancing, and using of personal protection equipment).
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Vaccination Coverage against Tetanus, Diphtheria, Pertussis and Poliomyelitis and Validity of Self-Reported Vaccination Status in Patients with Multiple Sclerosis. J Pers Med 2022; 12:jpm12050677. [PMID: 35629100 PMCID: PMC9146089 DOI: 10.3390/jpm12050677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated disease with a neurodegenerative component of the central nervous system. Immunomodulatory therapy can increase the risk of infection, which is a particular risk for MS patients. Therefore, a complete vaccination status is of utmost importance as protection against vaccine-preventable infectious diseases. Our aim was to investigate the vaccination status, vaccination card knowledge and the vaccination behavior of MS patients with regard to vaccinations against tetanus, diphtheria, pertussis and poliomyelitis. Three hundred twenty-seven patients with MS were evaluated by anamnesis, clinical examination, structured interview and vaccination card control in this two-center study. Based on the recommendations of the Robert Koch Institute, we assessed the completeness of the vaccination status of the examined vaccinations. Furthermore, a comparative analysis of patients with complete/incomplete or correctly/wrongly self-reported vaccination status was performed. In the cohort analyzed, the vaccination coverage was 79.5% for tetanus, 79.2% for diphtheria, 74.8% for pertussis and 84.8% for poliomyelitis. The assumed vaccination status was higher for tetanus (86.5%) and lower for diphtheria (69.4%), pertussis (61.2%) and poliomyelitis (75.9%). Patients who were unvaccinated or only partially vaccinated against tetanus had received vaccination advice from a physician less often in the past year (13.4 vs. 36.9%, p < 0.001) and had no one to check the vaccination card more often (35.8 vs. 12.3%, p < 0.001). High sensitivity (93.7%) and low specificity (30.3%) were determined regarding the validity of self-reported tetanus vaccination status. Patients with a correctly reported tetanus vaccination status were more likely to have their vaccination card checked by a physician than those who overestimated or underestimated their vaccination status (76.7 vs. 63.0/43.8%, p = 0.002). Similar findings were seen with regard to diphtheria, pertussis and poliomyelitis vaccination. Patients without a regular vaccination card control (17.1%) were more likely to be male (44.6 vs. 29.4%, p = 0.037), had fewer siblings on average (1.1 vs. 1.6, p = 0.016), dealt less frequently with the issue of vaccination in the past year (32.1 vs. 69.3%, p < 0.001) and more frequently had the wish to receive vaccination advice (48.2 vs. 34.4%, p = 0.030) than patients in whom the vaccination card was checked regularly by a physician. To minimize the risk of infection in MS patients, treating physicians should provide regular vaccination counseling and perform vaccination card controls, as these factors are associated with a higher vaccination coverage and a higher validity of self-reported vaccination statuses.
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Mirabella M, Annovazzi P, Brownlee W, Cohen JA, Kleinschnitz C, Wolf C. Treatment Challenges in Multiple Sclerosis – A Continued Role for Glatiramer Acetate? Front Neurol 2022; 13:844873. [PMID: 35493825 PMCID: PMC9051342 DOI: 10.3389/fneur.2022.844873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Earlier diagnosis, access to disease-modifying therapies (DMTs), and improved supportive care have favorably altered the disease course of multiple sclerosis (MS), leading to an improvement in long-term outcomes for people with MS (PwMS). This success has changed the medical characteristics of the population seen in MS clinics. Comorbidities and the accompanying polypharmacy, immune senescence, and the growing number of approved DMTs make selecting the optimal agent for an individual patient more challenging. Glatiramer acetate (GA), a moderately effective DMT, interacts only minimally with comorbidities, other medications, or immune senescence. We describe here several populations in which GA may represent a useful treatment option to overcome challenges due to advanced age or comorbidities (e.g., hepatic or renal disease, cancer). Further, we weigh GA's potential merits in other settings where PwMS and their neurologists must base treatment decisions on factors other than selecting the most effective DMT, e.g., family planning, conception and pregnancy, or the need for vaccination.
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Affiliation(s)
- Massimiliano Mirabella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica, Rome, Italy
- *Correspondence: Massimiliano Mirabella ; orcid.org/0000-0002-7783-114X
| | - Pietro Annovazzi
- MS Center, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey A. Cohen
- Department of Neurology, Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States
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Zappulo E, Buonomo AR, Moccia M, Pinchera B, Villari R, Petracca M, Lanzillo R, Scotto R, Carotenuto A, Viceconte G, Moriello NS, Bruno L, Gentile I, Morra VB. Impact of an anti-infective screening and monitoring protocol together with Infectious Disease consultation in preventing infective adverse events in patients treated with anti-CD20/CD52 agents for Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103814. [DOI: 10.1016/j.msard.2022.103814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 01/18/2023]
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Streckenbach B, Baldt J, Heidler F, Frahm N, Langhorst SE, Mashhadiakbar P, Burian K, Zettl UK, Richter J. General vaccination willingness and current vaccination status in relation to clinical and psychological variables in patients with multiple sclerosis. Vaccine 2022; 40:3236-3243. [DOI: 10.1016/j.vaccine.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
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Cross AH, Delgado S, Habek M, Davydovskaya M, Ward BJ, Cree BAC, Totolyan N, Pingili R, Mancione L, Hu X, Sullivan R, Su W, Zielman R, Gupta AD, Montalban X, Winthrop K. COVID-19 Outcomes and Vaccination in People with Relapsing Multiple Sclerosis Treated with Ofatumumab. Neurol Ther 2022; 11:741-758. [PMID: 35284994 PMCID: PMC8918079 DOI: 10.1007/s40120-022-00341-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/28/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction The SARS-CoV-2 pandemic necessitated better understanding of the impact of disease-modifying therapies on COVID-19 outcomes and vaccination. We report characteristics of COVID-19 cases and vaccination status in ofatumumab-treated relapsing multiple sclerosis (RMS) patients. Methods COVID-19 data analyzed were from the ongoing, open-label, long-term extension phase 3b ALITHIOS study from December 2019 (pandemic start) and post-marketing cases from August 2020 (ofatumumab first approval) up to 25 September 2021. COVID-19 cases, severity, seriousness, outcomes, vaccination status, and breakthrough infection were evaluated. Results As of 25 September 2021, 245 of 1703 patients (14.4%) enrolled in ALITHIOS receiving ofatumumab (median exposure: 2.45 years) reported COVID-19 (confirmed: 210; suspected: 35). Most COVID-19 was of mild (44.1%) or moderate (46.5%) severity, but 9% had severe/life-threatening COVID-19. There were 24 serious cases (9.8%) with 23 patients hospitalized; 22 recovered and 2 died. At study cut-off, 241 patients (98.4%) had recovered or were recovering or had recovered with sequelae and 2 (0.8%) had not recovered. Ofatumumab was temporarily interrupted in 39 (15.9%) patients. Before COVID-19 onset, IgG levels were within the normal range in all COVID-19–affected patients, while IgM was < 0.4 g/l in 23 (9.4%) patients. No patient had a reinfection. Overall, 559 patients were vaccinated (full, 476; partial, 74; unspecified, 9). Breakthrough infection was reported in 1.5% (7/476) patients, and 11 reported COVID-19 after partial vaccination. As of 25 September 2021, the Novartis Safety Database (~ 4713 patient-treatment years) recorded 90 confirmed COVID-19 cases receiving ofatumumab. Most cases were non-serious (n = 80), and ten were serious (1 medically significant, 9 hospitalized, 0 deaths). Among 36 of 90 cases with outcomes reported, 30 recovered and 6 did not recover. Conclusion COVID-19 in RMS patients on ofatumumab was primarily of mild/moderate severity and non-serious in these observational data. Most recovered from COVID-19 without treatment interruption. Two people died with COVID-19. Breakthrough COVID-19 despite being fully/partially vaccinated was uncommon. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00341-z.
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Affiliation(s)
- Anne H Cross
- Department of Neurology, Washington University, St. Louis, MO, USA.
| | - Silvia Delgado
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mario Habek
- University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Maria Davydovskaya
- Moscow State Public Healthcare InsCity Clinical Hospital 24, Moscow, Russia
| | - Brian J Ward
- Infectious Diseases Division, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Natalia Totolyan
- First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | - Linda Mancione
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Xixi Hu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Kevin Winthrop
- School of Public Health at Oregon Health and Science University, Portland, OR, USA
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Iaffaldano P, Lucisano G, Manni A, Paolicelli D, Patti F, Capobianco M, Brescia Morra V, Sola P, Pesci I, Lus G, De Luca G, Lugaresi A, Cavalla P, Montepietra S, Maniscalco GT, Granella F, Ragonese P, Vianello M, Brambilla L, Totaro R, Toscano S, Malucchi S, Petracca M, Moiola L, Ferraro D, Lepore V, Mosconi P, Ponzio M, Tedeschi G, Comi G, Battaglia MA, Filippi M, Amato MP, Trojano M. Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1141. [PMID: 35046084 PMCID: PMC8771668 DOI: 10.1212/nxi.0000000000001141] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods A case-control (1:2) study was set up. Cases included PwMS with a confirmed diagnosis of COVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administered DMT, previous DMT sequences, or the place where the last treatment was administered. Results A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p < 0.02) with a higher risk of contracting COVID-19. Patients receiving natalizumab as last DMT (OR [95% CI]: 2.38 [1.66–3.42], p < 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34–2.04], p < 0.0001) showed a significant higher risk than those taking self-administered DMTs at home. Discussion This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS. Classification of Evidence This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective.
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Affiliation(s)
- Pietro Iaffaldano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giuseppe Lucisano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessia Manni
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Damiano Paolicelli
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Francesco Patti
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marco Capobianco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vincenzo Brescia Morra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Patrizia Sola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Ilaria Pesci
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giacomo Lus
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giovanna De Luca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessandra Lugaresi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Cavalla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Sara Montepietra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giorgia Teresa Maniscalco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Franco Granella
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paolo Ragonese
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marika Vianello
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Laura Brambilla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Rocco Totaro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Toscano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Malucchi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Petracca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Lucia Moiola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Diana Ferraro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vito Lepore
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Mosconi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Michela Ponzio
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Gioacchino Tedeschi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giancarlo Comi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Mario Alberto Battaglia
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Massimo Filippi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Pia Amato
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Trojano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy.
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Ruggieri S, Quartuccio ME, Prosperini L. Ponesimod in the Treatment of Relapsing Forms of Multiple Sclerosis: An Update on the Emerging Clinical Data. Degener Neurol Neuromuscul Dis 2022; 12:61-73. [PMID: 35356493 PMCID: PMC8958267 DOI: 10.2147/dnnd.s313825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
Sphingosine 1-phosphate (S1P) receptors are bioactive lipid metabolites that bind five different types of receptors expressed ubiquitously in human body and mediate a broad range of biological functions. Targeting S1P receptors is nowadays a well-established pharmacological strategy to treat multiple sclerosis (MS). However, the adverse events associated with the ancestor (fingolimod), especially in terms of heart conduction and slow reversibility of its pharmacodynamics effect on lymphocytes, have stimulated a search for a S1P modulator with greater selectivity for S1P1 (the most important immune mechanism to prevent MS-related neuroinflammation). Ponesimod is a second-generation, orally active, directly bioavailable, highly selective, and rapidly reversible modulator of the S1P1 receptor. Gradual 14-day up-titration of ponesimod mitigates its first-dose effects on heart rate and facilitates its use over fingolimod, as it does not require first-dose cardiac monitoring. Ponesimod is rapidly eliminated within 1 week of discontinuation, thereby representing a more manageable approach in case of vaccination, pregnancy, or adverse events. However, the fast reversibility of ponesimod may also raise concerns about the possibility of a rapid reactivation of disease activity following its discontinuation. Ponesimod was recently approved for the treatment of relapsing MS forms on the basis of a Phase III, double-blind, double-dummy, randomized clinical trial (OPTIMUM) that demonstrated the superiority of ponesimod over teriflunomide on disease activity markers, without unexpected safety concerns. This review summarizes the pharmacodynamic and pharmacokinetic characteristics of ponesimod, and the main Phase II and III studies that led to its approval. Comparisons of ponesimod with other S1P receptor modulators currently available for MS (fingolimod, ozanimod, siponimod) are also provided.
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Affiliation(s)
- Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Rome, 00185, Italy
- Neuroimmunology Unit, Santa Lucia Foundation, Rome, 00143, Italy
| | | | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, 00152, Italy
- Correspondence: Luca Prosperini, Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, Rome, 00152, Italy, Tel +39-6-58704349, Fax +39-6-58704206, Email
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Perdaens O, van Pesch V. Molecular Mechanisms of Immunosenescene and Inflammaging: Relevance to the Immunopathogenesis and Treatment of Multiple Sclerosis. Front Neurol 2022; 12:811518. [PMID: 35281989 PMCID: PMC8913495 DOI: 10.3389/fneur.2021.811518] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aging is characterized, amongst other features, by a complex process of cellular senescence involving both innate and adaptive immunity, called immunosenescence and associated to inflammaging, a low-grade chronic inflammation. Both processes fuel each other and partially explain increasing incidence of cancers, infections, age-related autoimmunity, and vascular disease as well as a reduced response to vaccination. Multiple sclerosis (MS) is a lifelong disease, for which considerable progress in disease-modifying therapies (DMTs) and management has improved long-term survival. However, disability progression, increasing with age and disease duration, remains. Neurologists are now involved in caring for elderly MS patients, with increasing comorbidities. Aging of the immune system therefore has relevant implications for MS pathogenesis, response to DMTs and the risks mediated by these treatments. We propose to review current evidence regarding markers and molecular mechanisms of immunosenescence and their relevance to understanding MS pathogenesis. We will focus on age-related changes in the innate and adaptive immune system in MS and other auto-immune diseases, such as systemic lupus erythematosus and rheumatoid arthritis. The consequences of these immune changes on MS pathology, in interaction with the intrinsic aging process of central nervous system resident cells will be discussed. Finally, the impact of immunosenescence on disease evolution and on the safety and efficacy of current DMTs will be presented.
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Affiliation(s)
- Océane Perdaens
- Laboratory of Neurochemistry, Institute of Neuroscience, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Laboratory of Neurochemistry, Institute of Neuroscience, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- *Correspondence: Vincent van Pesch
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Cannabinoid and endocannabinoid system: a promising therapeutic intervention for multiple sclerosis. Mol Biol Rep 2022; 49:5117-5131. [PMID: 35182322 DOI: 10.1007/s11033-022-07223-5] [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: 09/14/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
Multiple sclerosis (MS) is a chronic and complex neurodegenerative disease, distinguished by the presence of lesions in the central nervous system (CNS) due to exacerbated immunological responses that inflict oligodendrocytes and the myelin sheath of axons. In recent years, studies have focused on targeted therapeutics for MS that emphasize the role of G protein-coupled receptors (GPCRs), specifically cannabinoids receptors. Clinical studies have suggested the therapeutic potential of cannabinoids derived from Cannabis sativa in relieving pain, tremors and spasticity. Cannabinoids also appear to prevent exaggerated immune responses in CNS due to compromised blood-brain barrier. Both, endocannabinoid system (ECS) modulators and cannabinoid ligands actively promote oligodendrocyte survival by regulating signaling, migration and myelination of nerve cells. The cannabinoid receptors 1 (CB1) and 2 (CB2) of ECS are the main ones in focus for therapeutic intervention of MS. Various CB1/CB2 receptors agonists have been experimentally studied which showed anti-inflammatory properties and are considered to be effective as potential therapeutics for MS. In this review, we focused on the exacerbated immune attack on nerve cells and the role of the cannabinoids and its interaction with the ECS in CNS during MS pathology.
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Schiavetti I, Ponzano M, Signori A, Bovis F, Carmisciano L, Sormani MP. Severe outcomes of COVID-19 among patients with multiple sclerosis under anti-CD-20 therapies: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 57:103358. [PMID: 35158467 PMCID: PMC8570399 DOI: 10.1016/j.msard.2021.103358] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023]
Abstract
Background COVID-19 may spread through various ways ranging from asymptomatic to severe forms, until respiratory failure, critical conditions and death occurs. There is a particular concern for patients affected by multiple sclerosis, especially for those under disease-modifying treatments. Some studies have found an association between anti-CD20 therapies (especially rituximab) and severe COVID-19. However, results were not always clear and thus a systematic review was helpful. Methods A systematic literature search was performed independently by two authors on the main search tools considering as key inclusion criterion the presence of data on patients under ocrelizumab or rituximab positive to COVID-19. The quality of the included studies was evaluated based on a modified version of the Dutch Cochrane center critical review checklist proposed by MOOSE and in case of missing data an email was sent to the corresponding authors asking for missing information. After excluding case-reports, a random effects meta-analysis of proportions was conducted using the continuity correction and the I2statistic was calculated to measure heterogeneity. Results 29 articles were included in the analysis and the median quality of the articles reached 4/5 after having integrated the additional details provided by the authors. The articles included 5173 patients, of whom 770 (14.8%) and 455 (8.8%) were, respectively, under ocrelizumab and rituximab. Pooled estimates of hospitalization, pneumonia and intensive care unit admission were 18.1%, 14.8% and 3.3%, respectively, while pooled estimate for death was 1.8% overall and 1.6% and 4.5%, respectively, for patients under ocrelizumab and rituximab. Conclusion Patients treated with rituximab seem to be at higher risk of severe COVID-19 outcomes compared to patients under other treatments.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy.
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Patti F, Chisari CG, Toscano S, Arena S, Finocchiaro C, Cimino V, Milone G. Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Patients: Monocentric Case Series and Systematic Review of the Literature. J Clin Med 2022; 11:jcm11040942. [PMID: 35207216 PMCID: PMC8875789 DOI: 10.3390/jcm11040942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory and immune-mediated disease of the central nervous system (CNS), commonly affecting young adults and potentially associated with life-long disability. About 14 disease-modifying treatments (DMTs) are currently approved for the treatment of MS. However, despite the use of highly effective therapies, some patients exhibit a highly active disease with an aggressive course from onset and a higher risk of long-term disability accrual. In the last few years, several retrospective studies, clinical trials, meta-analyses and systematic reviews have investigated autologous hematopoietic stem cell transplantation (AHSCT) as a possible therapeutic option in order to address this unmet clinical need. These studies demonstrated that AHSCT is a highly efficacious and relatively safe therapeutic option for the treatment of highly active MS. Particularly, over recent years, the amount of evidence has grown, with significant improvements in the development of patient selection criteria, choice of the most suitable transplant technique and clinical experience. In this paper, we present six patients who received AHSCT in our MS center and we systematically reviewed recent evidence about the long-term efficacy and safety of AHSCT and the placement of AHSCT in the rapidly evolving therapeutic armamentarium for MS.
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Affiliation(s)
- Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
- Correspondence: (F.P.); (C.G.C.); Tel.: +39-09-5378-2620 (F.P.)
| | - Clara Grazia Chisari
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
- Correspondence: (F.P.); (C.G.C.); Tel.: +39-09-5378-2620 (F.P.)
| | - Simona Toscano
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Sebastiano Arena
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Chiara Finocchiaro
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Vincenzo Cimino
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy;
| | - Giuseppe Milone
- Hematology and Bone Marrow Transplant Unit, Azienda Policlinico-Vittorio Emanuele, 95124 Catania, Italy;
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Golshani M, Hrdý J. Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination. Vaccines (Basel) 2022; 10:vaccines10020279. [PMID: 35214735 PMCID: PMC8876554 DOI: 10.3390/vaccines10020279] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
This article reviews the literature on SARS-CoV-2 pandemic and multiple sclerosis (MS). The first part of the paper focuses on the current data on immunopathology of SARS-CoV-2 and leading vaccines produced against COVID-19 infection. In the second part of the article, we discuss the effect of Disease Modifying Therapies (DMTs) on COVID-19 infection severity or SARS-CoV-2 vaccination in MS patients plus safety profile of different vaccine platforms in MS patients.
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Affiliation(s)
| | - Jiří Hrdý
- Correspondence: ; Tel.: +420-224968509
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