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Gruchot J, Reiche L, Chan A, Hoepner R, Küry P. Human endogenous retrovirus type-W and multiple sclerosis-related smoldering neuroinflammation. Neural Regen Res 2025; 20:813-814. [PMID: 38886951 DOI: 10.4103/nrr.nrr-d-24-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/03/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- Joel Gruchot
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (Gruchot J, Reiche L, Küry P)
| | - Laura Reiche
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (Gruchot J, Reiche L, Küry P)
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (Chan A, Hoepner R, Küry P)
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (Chan A, Hoepner R, Küry P)
| | - Patrick Küry
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (Gruchot J, Reiche L, Küry P)
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (Chan A, Hoepner R, Küry P)
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Ciccarelli O, Barkhof F, Calabrese M, De Stefano N, Eshaghi A, Filippi M, Gasperini C, Granziera C, Kappos L, Rocca MA, Rovira À, Sastre-Garriga J, Sormani MP, Tur C, Toosy AT. Using the Progression Independent of Relapse Activity Framework to Unveil the Pathobiological Foundations of Multiple Sclerosis. Neurology 2024; 103:e209444. [PMID: 38889384 PMCID: PMC11226318 DOI: 10.1212/wnl.0000000000209444] [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: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 06/20/2024] Open
Abstract
Progression independent of relapse activity (PIRA), a recent concept to formalize disability accrual in multiple sclerosis (MS) independent of relapses, has gained popularity as a potential clinical trial outcome. We discuss its shortcomings and appraise the challenges of implementing it in clinical settings, experimental trials, and research. The current definition of PIRA assumes that acute inflammation, which can manifest as a relapse, and neurodegeneration, manifesting as progressive disability accrual, can be disentangled by introducing specific time windows between the onset of relapses and the observed increase in disability. The term PIRMA (progression independent of relapse and MRI activity) was recently introduced to indicate disability accrual in the absence of both clinical relapses and new brain and spinal cord MRI lesions. Assessing PIRMA in clinical practice is highly challenging because it necessitates frequent clinical assessments and brain and spinal cord MRI scans. PIRA is commonly assessed using Expanded Disability Status Scale, a scale heavily weighted toward motor disability, whereas a more granular assessment of disability deterioration, including cognitive decline, using composite measures or other tools, such as digital tools, would possess greater utility. Similarly, using PIRA as an outcome measure in randomized clinical trials is also challenging and requires methodological considerations. The underpinning pathobiology of disability accumulation, that is not associated with relapses, may encompass chronic active lesions (slowly expanding lesions and paramagnetic rim lesions), cortical lesions, brain and spinal cord atrophy, particularly in the gray matter, diffuse and focal microglial activation, persistent leptomeningeal enhancement, and white matter tract damage. We propose to use PIRA to understand the main determinant of disability accrual in observational, cohort studies, where regular MRI scans are not included, and introduce the term of "advanced-PIRMA" to investigate the contributions to disability accrual of the abovementioned processes, using conventional and advanced imaging. This is supported by the knowledge that MRI reflects the MS pathogenic mechanisms better than purely clinical descriptors. Any residual disability accrual, which remains unexplained after considering all these mechanisms with imaging, will highlight future research priorities to help complete our understanding of MS pathogenesis.
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Affiliation(s)
- Olga Ciccarelli
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Frederik Barkhof
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Massimiliano Calabrese
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Nicola De Stefano
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Arman Eshaghi
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Massimo Filippi
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Claudio Gasperini
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Cristina Granziera
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Ludwig Kappos
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Maria A Rocca
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Àlex Rovira
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Jaume Sastre-Garriga
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Maria Pia Sormani
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Carmen Tur
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Ahmed T Toosy
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
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3
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Gruchot J, Reiche L, Werner L, Herrero F, Schira-Heinen J, Meyer U, Küry P. Molecular dissection of HERV-W dependent microglial- and astroglial cell polarization. Microbes Infect 2024:105382. [PMID: 38944109 DOI: 10.1016/j.micinf.2024.105382] [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: 03/07/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
The endogenous retrovirus type W (HERV-W) is a human-specific entity, which was initially discovered in multiple sclerosis (MS) patient derived cells. We initially found that the HERV-W envelope (ENV) protein negatively affects oligodendrogenesis and controls microglial cell polarization towards a myelinated axon associated and damaging phenotype. Such first functional assessments were conducted ex vivo, given the human-specific origin of HERV-W. Recent experimental evidence gathered on a novel transgenic mouse model, mimicking activation and expression of the HERV-W ENV protein, revealed that all glial cell types are impacted and that cellular fates, differentiation, and functions were changed. In order to identify HERV-W-specific signatures in glial cells, the current study analyzed the transcriptome of ENV protein stimulated microglial- and astroglial cells and compared the transcriptomic signatures to lipopolysaccharide (LPS) stimulated cells, owing to the fact that both ligands can activate toll-like receptor-4 (TLR-4). Additionally, a comparison between published disease associated glial signatures and the transcriptome of HERV-W ENV stimulated glial cells was conducted. We, therefore, provide here for the first time a detailed molecular description of specific HERV-W ENV evoked effects on those glial cell populations that are involved in smoldering neuroinflammatory processes relevant for progression of neurodegenerative diseases.
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Affiliation(s)
- Joel Gruchot
- Heinrich-Heine-University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Neurology, D-40225 Düsseldorf, Germany
| | - Laura Reiche
- Heinrich-Heine-University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Neurology, D-40225 Düsseldorf, Germany
| | - Luisa Werner
- Heinrich-Heine-University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Neurology, D-40225 Düsseldorf, Germany
| | - Felisa Herrero
- Institute of Veterinary Pharmacology and Toxicology, University of Zürich, Vetsuisse, Zürich, Switzerland
| | - Jessica Schira-Heinen
- Heinrich-Heine-University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Neurology, D-40225 Düsseldorf, Germany
| | - Urs Meyer
- Institute of Veterinary Pharmacology and Toxicology, University of Zürich, Vetsuisse, Zürich, Switzerland; Neuroscience Center Zürich, University of Zürich and ETH Zürich, Zürich, Switzerland
| | - Patrick Küry
- Heinrich-Heine-University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Neurology, D-40225 Düsseldorf, Germany; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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4
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Fettig NM, Pu A, Osborne LC, Gommerman JL. The influence of aging and the microbiome in multiple sclerosis and other neurologic diseases. Immunol Rev 2024. [PMID: 38890777 DOI: 10.1111/imr.13361] [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: 06/20/2024]
Abstract
The human gut microbiome is well-recognized as a key player in maintaining health. However, it is a dynamic entity that changes across the lifespan. How the microbial changes that occur in later decades of life shape host health or impact age-associated inflammatory neurological diseases such as multiple sclerosis (MS) is still unclear. Current understanding of the aging gut microbiome is largely limited to cross-sectional observational studies. Moreover, studies in humans are limited by confounding host-intrinsic and extrinsic factors that are not easily disentangled from aging. This review provides a comprehensive summary of existing literature on the aging gut microbiome and its known relationships with neurological diseases, with a specific focus on MS. We will also discuss preclinical animal models and human studies that shed light on the complex microbiota-host interactions that have the potential to influence disease pathology and progression in aging individuals. Lastly, we propose potential avenues of investigation to deconvolute features of an aging microbiota that contribute to disease, or alternatively promote health in advanced age.
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Affiliation(s)
- Naomi M Fettig
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lisa C Osborne
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
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5
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Bsteh G, Dal Bianco A, Zrzavy T, Berger T. Novel and Emerging Treatments to Target Pathophysiological Mechanisms in Various Phenotypes of Multiple Sclerosis. Pharmacol Rev 2024; 76:564-578. [PMID: 38719481 DOI: 10.1124/pharmrev.124.001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024] Open
Abstract
The objective is to comprehensively review novel pharmacotherapies used in multiple sclerosis (MS) and the possibilities they may carry for therapeutic improvement. Specifically, we discuss pathophysiological mechanisms worth targeting in MS, ranging from well known targets, such as autoinflammation and demyelination, to more novel and advanced targets, such as neuroaxonal damage and repair. To set the stage, a brief overview of clinical MS phenotypes is provided, followed by a comprehensive recapitulation of both clinical and paraclinical outcomes available to assess the effectiveness of treatments in achieving these targets. Finally, we discuss various promising novel and emerging treatments, including their respective hypothesized modes of action and currently available evidence from clinical trials. SIGNIFICANCE STATEMENT: This comprehensive review discusses pathophysiological mechanisms worth targeting in multiple sclerosis. Various promising novel and emerging treatments, including their respective hypothesized modes of action and currently available evidence from clinical trials, are reviewed.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Assunta Dal Bianco
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology (G.B., A.D.B., T.Z., T.B.) and Comprehensive Center for Clinical Neurosciences & Mental Health (G.B., A.D.B., T.Z., T.B.), Medical University of Vienna, Vienna, Austria
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6
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Gómez-Melero S, Caballero-Villarraso J, Escribano BM, Galvao-Carmona A, Túnez I, Agüera-Morales E. Impact of Cognitive Impairment on Quality of Life in Multiple Sclerosis Patients-A Comprehensive Review. J Clin Med 2024; 13:3321. [PMID: 38893032 PMCID: PMC11172944 DOI: 10.3390/jcm13113321] [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: 05/05/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Multiple sclerosis (MS) is characterized by a variety of symptoms that have a major impact on quality of life (QoL) even in early stages. In addition to individual motor, sensory, visual disturbances, and brainstem and sphincter disorders, which are expressed through the widely used Expanded Disability Status Scale (EDSS), other manifestations of MS have a detrimental effect on overall functioning and quality of life, such as cognitive impairment, depression, anxiety, fatigue, and pain. However, when talking about QoL, categorical definitions cannot be used because although the concept is generally understood, it is highly nuanced. Suffering from MS can significantly reduce QoL. Numerous research studies have focused on trying to identify and assess which are the elements that most affect the loss of QoL in MS people. However, in addition to the fact that the measurement of QoL can be subjective, it is very difficult to consider these elements in isolation, as they are interrelated. One such limiting factor of QoL that has been investigated is cognitive impairment (CI). This has been shown to have an impact on the lives of MS people, although the different approaches that have been taken to assess CI have evident limitations.
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Affiliation(s)
- Sara Gómez-Melero
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
| | - Javier Caballero-Villarraso
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
- Clinical Analyses Service, Reina Sofía University Hospital, 14004 Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Universidad of Córdoba, 14071 Cordoba, Spain
| | - Begoña Mª Escribano
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, University of Cordoba, 14071 Cordoba, Spain
| | - Alejandro Galvao-Carmona
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
- Department of Psychology, Universidad Loyola Andalucía, 41704 Sevilla, Spain
| | - Isaac Túnez
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
- Department of Biochemistry and Molecular Biology, Universidad of Córdoba, 14071 Cordoba, Spain
| | - Eduardo Agüera-Morales
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Cordoba, Spain; (S.G.-M.); (B.M.E.); (A.G.-C.); (I.T.); (E.A.-M.)
- Neurology Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
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7
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Krieger S, Cook K, Hersh CM. Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold. Curr Opin Neurol 2024; 37:189-201. [PMID: 38535979 PMCID: PMC11064902 DOI: 10.1097/wco.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates the various levels of explanation through which the spectrum of disease is described and investigated both above and below the clinical threshold of detection, as framed by the topographical model of MS, to help advance a cogent mechanistic framework. RECENT FINDINGS Contemporary evidence has amended the view of MS as consisting of sequential disease phases in favor of a spectrum of disease with an admixture of interdependent and dynamic pathobiological axes driving tissue injury and progression. Recent studies have shown the presence of acute and compartmentalized inflammation and mechanisms of neurodegeneration beginning early and evolving throughout the disease continuum. Still, the gap between the understanding of immunopathologic processes in MS and the tools used to measure relevant molecular, laboratory, radiologic, and clinical metrics needs attention to enable better prognostication of disease and monitoring for changes along specific pathologic axes and variable treatment outcomes. SUMMARY Aligning on a consistently-applied mechanistic framework at distinct levels of explanation will enable greater precision across bench and clinical research, and inform discourse on drivers of disability progression and delivery of care for individuals with MS.
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Affiliation(s)
- Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai
| | - Karin Cook
- Medical Education Director, Neurology at Heartbeat/Publicis Health, New York
| | - Carrie M. Hersh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas, Nevada, USA
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8
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Rodrigues P, Frare JM, Peres DS, Viero FT, Ruviaro NA, Dos Santos Stein C, da Silva Brum E, Moresco RN, Oliveira SM, Bochi GV, Trevisan G. Increased levels of advanced oxidation protein products (AOPPs) were associated with nociceptive behavior and clinical scores in an experimental progressive autoimmune encephalomyelitis model (PMS-EAE). J Neurochem 2024; 168:1143-1156. [PMID: 38372436 DOI: 10.1111/jnc.16081] [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: 10/04/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system (CNS) generating neuropathic pain and anxiety. Primary progressive MS (PPMS) is the most disabling clinical form, and the patients present an intense neurodegenerative process. In this context, the advanced oxidation protein products (AOPPs) are oxidized compounds and their accumulation in plasma has been related to clinical disability in MS patients. However, the involvement of AOPPs in neuropathic pain- and anxiety-like symptoms was not previously evaluated. To assess this, female mice C57BL/6J were used to induce progressive experimental autoimmune encephalomyelitis (PMS-EAE). Clinical score, weight, strength of plantar pressure, rotarod test, mechanical allodynia, and cold hypersensitivity were evaluated before induction (baseline) and on days 7th, 10th, and 14th post-immunization. We assessed nest building, open field, and elevated plus-maze tests 13 days post-immunization. Animals were killed at 14 days post-immunization; then, AOPPs levels, NADPH oxidase, and myeloperoxidase (MPO) activity were measured in the prefrontal cortex, hippocampus, and spinal cord samples. The clinical score increased 14th post-immunization without changes in weight and mobility. Reduced paw strength, mechanical allodynia, and cold allodynia increased in the PMS-EAE animals. PMS-EAE mice showed spontaneous nociception and anxiety-like behavior. AOPPs concentration, NADPH oxidase, and MPO activity increase in CNS structures. Multivariate analyses indicated that the rise of AOPPs levels, NADPH oxidase, and MPO activity influenced the clinical score and cold allodynia. Thus, we indicated the association between non-stimuli painful perception, anxiety-like, and CNS oxidative damage in the PMS-EAE model.
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Affiliation(s)
- Patrícia Rodrigues
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Julia Maria Frare
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Diulle Spat Peres
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Fernanda Tibolla Viero
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Náthaly Andrighetto Ruviaro
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Carolina Dos Santos Stein
- Graduate Program in Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Evelyne da Silva Brum
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Rafael Noal Moresco
- Graduate Program in Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Guilherme Vargas Bochi
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Gabriela Trevisan
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
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9
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Campo Garcia J, Bueno RJ, Salla M, Martorell-Serra I, Seeger B, Akbari N, Sperber P, Stachelscheid H, Infante-Duarte C, Paul F, Starossom SC. Establishment of a high-content compatible platform to assess effects of monocyte-derived factors on neural stem cell proliferation and differentiation. Sci Rep 2024; 14:12167. [PMID: 38806485 PMCID: PMC11133477 DOI: 10.1038/s41598-024-57066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/14/2024] [Indexed: 05/30/2024] Open
Abstract
During neuroinflammation, monocytes that infiltrate the central nervous system (CNS) may contribute to regenerative processes depending on their activation status. However, the extent and mechanisms of monocyte-induced CNS repair in patients with neuroinflammatory diseases remain largely unknown, partly due to the lack of a fully human assay platform that can recapitulate monocyte-neural stem cell interactions within the CNS microenvironment. We therefore developed a human model system to assess the impact of monocytic factors on neural stem cells, establishing a high-content compatible assay for screening monocyte-induced neural stem cell proliferation and differentiation. The model combined monocytes isolated from healthy donors and human embryonic stem cell derived neural stem cells and integrated both cell-intrinsic and -extrinsic properties. We identified CNS-mimicking culture media options that induced a monocytic phenotype resembling CNS infiltrating monocytes, while allowing adequate monocyte survival. Monocyte-induced proliferation, gliogenic fate and neurogenic fate of neural stem cells were affected by the conditions of monocytic priming and basal neural stem cell culture as extrinsic factors as well as the neural stem cell passage number as an intrinsic neural stem cell property. We developed a high-content compatible human in vitro assay for the integrated analysis of monocyte-derived factors on CNS repair.
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Affiliation(s)
- Juliana Campo Garcia
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Roemel Jeusep Bueno
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Humboldt-Universität zu Berlin, Faculty of Life Sciences, 10099, Berlin, Germany
| | - Maren Salla
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Ivette Martorell-Serra
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Bibiane Seeger
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Nilufar Akbari
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Pia Sperber
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Harald Stachelscheid
- Stem Cell Core Facility, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany.
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
| | - Sarah C Starossom
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
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10
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Li V, Binder MD, Purcell AW, Kilpatrick TJ. Antigen-specific immunotherapy via delivery of tolerogenic dendritic cells for multiple sclerosis. J Neuroimmunol 2024; 390:578347. [PMID: 38663308 DOI: 10.1016/j.jneuroim.2024.578347] [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: 02/12/2024] [Revised: 03/22/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system resulting from loss of immune tolerance. Many disease-modifying therapies for MS have broad immunosuppressive effects on peripheral immune cells, but this can increase risks of infection and attenuate vaccine-elicited immunity. A more targeted approach is to re-establish immune tolerance in an autoantigen-specific manner. This review discusses methods to achieve this, focusing on tolerogenic dendritic cells. Clinical trials in other autoimmune diseases also provide learnings with regards to clinical translation of this approach, including identification of autoantigen(s), selection of appropriate patients and administration route and frequency.
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Affiliation(s)
- Vivien Li
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3010, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia.
| | - Michele D Binder
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3010, Australia
| | - Anthony W Purcell
- Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3010, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
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11
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Oh J, Giacomini PS, Yong VW, Costello F, Blanchette F, Freedman MS. From progression to progress: The future of multiple sclerosis. J Cent Nerv Syst Dis 2024; 16:11795735241249693. [PMID: 38711957 PMCID: PMC11072059 DOI: 10.1177/11795735241249693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Significant advances have been made in the diagnosis and treatment of multiple sclerosis in recent years yet challenges remain. The current classification of MS phenotypes according to disease activity and progression, for example, does not adequately reflect the underlying pathophysiological mechanisms that may be acting in an individual with MS at different time points. Thus, there is a need for clinicians to transition to a management approach based on the underlying pathophysiological mechanisms that drive disability in MS. A Canadian expert panel convened in January 2023 to discuss priorities for clinical discovery and scientific exploration that would help advance the field. Five key areas of focus included: identifying a mechanism-based disease classification system; developing biomarkers (imaging, fluid, digital) to identify pathologic processes; implementing a data-driven approach to integrate genetic/environmental risk factors, clinical findings, imaging and biomarker data, and patient-reported outcomes to better characterize the many factors associated with disability progression; utilizing precision-based treatment strategies to target different disease processes; and potentially preventing disease through Epstein-Barr virus (EBV) vaccination, counselling about environmental risk factors (e.g. obesity, exercise, vitamin D/sun exposure, smoking) and other measures. Many of the tools needed to meet these needs are currently available. Further work is required to validate emerging biomarkers and tailor treatment strategies to the needs of individual patients. The hope is that a more complete view of the individual's pathobiology will enable clinicians to usher in an era of truly personalized medicine, in which more informed treatment decisions throughout the disease course achieve better long-term outcomes.
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Affiliation(s)
- Jiwon Oh
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - V. Wee Yong
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | - Fiona Costello
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | | | - Mark S. Freedman
- Department of Medicine¸ University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, QC, Canada
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12
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Mader MMD, Napole A, Wu D, Atkins M, Scavetti A, Shibuya Y, Foltz A, Hahn O, Yoo Y, Danziger R, Tan C, Wyss-Coray T, Steinman L, Wernig M. Myeloid cell replacement is neuroprotective in chronic experimental autoimmune encephalomyelitis. Nat Neurosci 2024; 27:901-912. [PMID: 38514857 DOI: 10.1038/s41593-024-01609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024]
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination of the central nervous system (CNS). Autologous hematopoietic cell transplantation (HCT) shows promising benefits for relapsing-remitting MS in open-label clinical studies, but the cellular mechanisms underlying its therapeutic effects remain unclear. Using single-nucleus RNA sequencing, we identify a reactive myeloid cell state in chronic experimental autoimmune encephalitis (EAE) associated with neuroprotection and immune suppression. HCT in EAE mice results in an increase of the neuroprotective myeloid state, improvement of neurological deficits, reduced number of demyelinated lesions, decreased number of effector T cells and amelioration of reactive astrogliosis. Enhancing myeloid cell incorporation after a modified HCT further improved these neuroprotective effects. These data suggest that myeloid cell manipulation or replacement may be an effective therapeutic strategy for chronic inflammatory conditions of the CNS.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan Napole
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Danwei Wu
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology and Neurosciences, Division of Neuroimmunology and Multiple Sclerosis Center, Stanford University of Medicine, Stanford, CA, USA
| | - Micaiah Atkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexa Scavetti
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yohei Shibuya
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Aulden Foltz
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Oliver Hahn
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yongjin Yoo
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ron Danziger
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina Tan
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lawrence Steinman
- Department of Neurology and Neurosciences, Division of Neuroimmunology and Multiple Sclerosis Center, Stanford University of Medicine, Stanford, CA, USA
| | - Marius Wernig
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
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13
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Wang W, Pan D, Liu Q, Chen X, Wang S. L-Carnitine in the Treatment of Psychiatric and Neurological Manifestations: A Systematic Review. Nutrients 2024; 16:1232. [PMID: 38674921 PMCID: PMC11055039 DOI: 10.3390/nu16081232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE L-carnitine (LC), a vital nutritional supplement, plays a crucial role in myocardial health and exhibits significant cardioprotective effects. LC, being the principal constituent of clinical-grade supplements, finds extensive application in the recovery and treatment of diverse cardiovascular and cerebrovascular disorders. However, controversies persist regarding the utilization of LC in nervous system diseases, with varying effects observed across numerous mental and neurological disorders. This article primarily aims to gather and analyze database information to comprehensively summarize the therapeutic potential of LC in patients suffering from nervous system diseases while providing valuable references for further research. METHODS A comprehensive search was conducted in PubMed, Web Of Science, Embase, Ovid Medline, Cochrane Library and Clinicaltrials.gov databases. The literature pertaining to the impact of LC supplementation on neurological or psychiatric disorders in patients was reviewed up until November 2023. No language or temporal restrictions were imposed on the search. RESULTS A total of 1479 articles were retrieved, and after the removal of duplicates through both automated and manual exclusion processes, 962 articles remained. Subsequently, a meticulous re-screening led to the identification of 60 relevant articles. Among these, there were 12 publications focusing on hepatic encephalopathy (HE), while neurodegenerative diseases (NDs) and peripheral nervous system diseases (PNSDs) were represented by 9 and 6 articles, respectively. Additionally, stroke was addressed in five publications, whereas Raynaud's syndrome (RS) and cognitive disorder (CD) each had three dedicated studies. Furthermore, migraine, depression, and amyotrophic lateral sclerosis (ALS) each accounted for two publications. Lastly, one article was found for other symptoms under investigation. CONCLUSION In summary, LC has demonstrated favorable therapeutic effects in the management of HE, Alzheimer's disease (AD), carpal tunnel syndrome (CTS), CD, migraine, neurofibromatosis (NF), PNSDs, RS, and stroke. However, its efficacy appears to be relatively limited in conditions such as ALS, ataxia, attention deficit hyperactivity disorder (ADHD), depression, chronic fatigue syndrome (CFS), Down syndrome (DS), and sciatica.
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Affiliation(s)
- Wenbo Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
| | - Qi Liu
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
| | - Xiangjun Chen
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
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14
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Desu HL, Sawicka KM, Wuerch E, Kitchin V, Quandt JA. A rapid review of differences in cerebrospinal neurofilament light levels in clinical subtypes of progressive multiple sclerosis. Front Neurol 2024; 15:1382468. [PMID: 38654736 PMCID: PMC11035744 DOI: 10.3389/fneur.2024.1382468] [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: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Multiple sclerosis (MS) is divided into three clinical phenotypes: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). It is unknown to what extent SPMS and PPMS pathophysiology share inflammatory or neurodegenerative pathological processes. Cerebrospinal (CSF) neurofilament light (NfL) has been broadly studied in different MS phenotypes and is a candidate biomarker for comparing MS subtypes. Research question Are CSF NfL levels different among clinical subtypes of progressive MS? Methods A search strategy identifying original research investigating fluid neurodegenerative biomarkers in progressive forms of MS between 2010 and 2022 was applied to Medline. Identified articles underwent title and abstract screen and full text review against pre-specified criteria. Data abstraction was limited to studies that measured NfL levels in the CSF. Reported statistical comparisons of NfL levels between clinical phenotypes were abstracted qualitatively. Results 18 studies that focused on investigating direct comparisons of CSF NfL from people with MS were included in the final report. We found NfL levels were typically reported to be higher in relapsing and progressive MS compared to healthy controls. Notably, higher NfL levels were not clearly associated with progressive MS subtypes when compared to relapsing MS, and there was no observed difference in NfL levels between PPMS and SPMS in articles that separately assessed these phenotypes. Conclusion CSF NfL levels distinguish individuals with MS from healthy controls but do not differentiate MS subtypes. Broad biological phenotyping is needed to overcome limitations of current clinical phenotyping and improve biomarker translatability to decision-making in the clinic.
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Affiliation(s)
- Haritha L. Desu
- Neuroimmunology Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Katherine M. Sawicka
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Wuerch
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Vanessa Kitchin
- University of British Columbia Library, Vancouver, BC, Canada
| | - Jacqueline A. Quandt
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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15
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Chataway J, Williams T, Li V, Marrie RA, Ontaneda D, Fox RJ. Clinical trials for progressive multiple sclerosis: progress, new lessons learned, and remaining challenges. Lancet Neurol 2024; 23:277-301. [PMID: 38365380 DOI: 10.1016/s1474-4422(24)00027-9] [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: 05/02/2023] [Revised: 10/04/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024]
Abstract
Despite the success of disease-modifying treatments in relapsing multiple sclerosis, for many individuals living with multiple sclerosis, progressive disability continues to accrue. How to interrupt the complex pathological processes underlying progression remains a daunting and ongoing challenge. Since 2014, several immunomodulatory approaches that have modest but clinically meaningful effects have been approved for the management of progressive multiple sclerosis, primarily for people who have active inflammatory disease. The approval of these drugs required large phase 3 trials that were sufficiently powered to detect meaningful effects on disability. New classes of drug, such as Bruton tyrosine-kinase inhibitors, are coming to the end of their trial stages, several candidate neuroprotective compounds have been successful in phase 2 trials, and innovative approaches to remyelination are now also being explored in clinical trials. Work continues to define intermediate outcomes that can provide results in phase 2 trials more quickly than disability measures, and more efficient trial designs, such as multi-arm multi-stage and futility approaches, are increasingly being used. Collaborations between patient organisations, pharmaceutical companies, and academic researchers will be crucial to ensure that future trials maintain this momentum and generate results that are relevant for people living with progressive multiple sclerosis.
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Affiliation(s)
- Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.
| | - Thomas Williams
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Vivien Li
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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16
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Carlson AK, Amin M, Cohen JA. Drugs Targeting CD20 in Multiple Sclerosis: Pharmacology, Efficacy, Safety, and Tolerability. Drugs 2024; 84:285-304. [PMID: 38480630 PMCID: PMC10982103 DOI: 10.1007/s40265-024-02011-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/02/2024]
Abstract
Currently, there are four monoclonal antibodies (mAbs) that target the cluster of differentiation (CD) 20 receptor available to treat multiple sclerosis (MS): rituximab, ocrelizumab, ofatumumab, and ublituximab. B-cell depletion therapy has changed the therapeutic landscape of MS through robust efficacy on clinical manifestations and MRI lesion activity, and the currently available anti-CD20 mAb therapies for use in MS are a cornerstone of highly effective disease-modifying treatment. Ocrelizumab is currently the only therapy with regulatory approval for primary progressive MS. There are currently few data regarding the relative efficacy of these therapies, though several clinical trials are ongoing. Safety concerns applicable to this class of therapeutics relate primarily to immunogenicity and mechanism of action, and include infusion-related or injection-related reactions, development of hypogammaglobulinemia (leading to increased infection and malignancy risk), and decreased vaccine response. Exploration of alternative dose/dosing schedules might be an effective strategy for mitigating these risks. Future development of biosimilar medications might make these therapies more readily available. Although anti-CD20 mAb therapies have led to significant improvements in disease outcomes, CNS-penetrant therapies are still needed to more effectively address the compartmentalized inflammation thought to play an important role in disability progression.
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Affiliation(s)
- Alise K Carlson
- Mellen Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave U10, Cleveland, OH, 44195, USA
| | - Moein Amin
- Mellen Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave U10, Cleveland, OH, 44195, USA
| | - Jeffrey A Cohen
- Mellen Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave U10, Cleveland, OH, 44195, USA.
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17
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Federau C, Hainc N, Edjlali M, Zhu G, Mastilovic M, Nierobisch N, Uhlemann JP, Paganucci S, Granziera C, Heinzlef O, Kipp LB, Wintermark M. Evaluation of the quality and the productivity of neuroradiological reading of multiple sclerosis follow-up MRI scans using an intelligent automation software. Neuroradiology 2024; 66:361-369. [PMID: 38265684 PMCID: PMC10859335 DOI: 10.1007/s00234-024-03293-3] [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: 09/24/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The assessment of multiple sclerosis (MS) lesions on follow-up magnetic resonance imaging (MRI) is tedious, time-consuming, and error-prone. Automation of low-level tasks could enhance the radiologist in this work. We evaluate the intelligent automation software Jazz in a blinded three centers study, for the assessment of new, slowly expanding, and contrast-enhancing MS lesions. METHODS In three separate centers, 117 MS follow-up MRIs were blindly analyzed on fluid attenuated inversion recovery (FLAIR), pre- and post-gadolinium T1-weighted images using Jazz by 2 neuroradiologists in each center. The reading time was recorded. The ground truth was defined in a second reading by side-by-side comparison of both reports from Jazz and the standard clinical report. The number of described new, slowly expanding, and contrast-enhancing lesions described with Jazz was compared to the lesions described in the standard clinical report. RESULTS A total of 96 new lesions from 41 patients and 162 slowly expanding lesions (SELs) from 61 patients were described in the ground truth reading. A significantly larger number of new lesions were described using Jazz compared to the standard clinical report (63 versus 24). No SELs were reported in the standard clinical report, while 95 SELs were reported on average using Jazz. A total of 4 new contrast-enhancing lesions were found in all reports. The reading with Jazz was very time efficient, taking on average 2min33s ± 1min0s per case. Overall inter-reader agreement for new lesions between the readers using Jazz was moderate for new lesions (Cohen kappa = 0.5) and slight for SELs (0.08). CONCLUSION The quality and the productivity of neuroradiological reading of MS follow-up MRI scans can be significantly improved using the dedicated software Jazz.
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Affiliation(s)
- Christian Federau
- AI Medical AG, Goldhaldenstr 22a, 8702, Zollikon, Switzerland.
- University of Zürich, Zürich, Switzerland.
| | - Nicolin Hainc
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Myriam Edjlali
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, Paris, France
- Laboratoire d'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hopsitalier Frédéric Joliot, Orsay, France
| | | | - Milica Mastilovic
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, Paris, France
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nathalie Nierobisch
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Jan-Philipp Uhlemann
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | | | | | - Olivier Heinzlef
- Department of Neurology, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
- CRC SEP IDF Ouest, Poissy-Garches, France
| | - Lucas B Kipp
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Stanford University, Stanford, USA
- MD Anderson Cancer Center, Houston, USA
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18
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Baeva ME, Tottenham I, Koch M, Camara-Lemarroy C. Biomarkers of disability worsening in inactive primary progressive multiple sclerosis. J Neuroimmunol 2024; 387:578268. [PMID: 38157653 DOI: 10.1016/j.jneuroim.2023.578268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To investigate serum biomarkers of progression in inactive primary progressive multiple sclerosis (PPMS). METHODS We measured protein biomarkers (growth differentiation factor-15 (GDF-15), dickkopf-1 (DKK-1), neuron specific enolase (NSE) and cathepsin-D) in serum samples from 39 patients with inactive PPMS included in a clinical trial enrolling people with PPMS (clinicaltrials.gov identifier NCT02913157) and investigated the association of these biomarker levels with clinical disability at baseline and during follow-up. We then performed a meta-analysis of publicly available transcriptomic datasets to investigate the gene expression of these biomarkers in the CNS in progressive MS. RESULTS When compared with healthy controls, people with PPMS had higher serum levels of GDF-15, DKK-1 and cathepsin-D at baseline. These findings match those in our meta-analysis which found increased expression of GDF-15 and cathepsin-D in the CNS in progressive MS. At baseline, elevated serum DKK-1 was associated with worse Expanded Disability Status Scale (EDSS) and nine-hole peg test (9HPT) scores. None of the other biomarkers levels significantly correlated with EDSS, Timed 25-Foot Walk Test (T25FWT), 9HPT, or cognitive measures. However, serum GDF-15 and cathepsin-D were higher at baseline in participants who developed worsening disability. Our receiver operating characteristic curve showed that higher serum GDF-15 and cathepsin-D at baseline significantly discriminated between participants who worsened in T25FWT and 9HPT and those who remained stable. CONCLUSIONS Patients with PPMS have altered levels of GDF-15, DKK-1 and cathepsin-D in serum, and GDF-15 and cathepsin-D may have predictive value in progression free of inflammatory activity in PPMS.
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Affiliation(s)
- Maria-Elizabeth Baeva
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | - Isabelle Tottenham
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | - Marcus Koch
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | - Carlos Camara-Lemarroy
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada.
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19
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Barboza A. It is time to rethink clinical trials on Bruton's tyrosine kinase inhibitors in multiple sclerosis. Mult Scler Relat Disord 2024; 82:105395. [PMID: 38184909 DOI: 10.1016/j.msard.2023.105395] [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: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
The EVOLUTION trials comparing evobrutinib and teriflunomide in multiple sclerosis revealed unexpected negative results, challenging the choice of the annualized relapse rate (ARR) as the primary outcome. While monoclonal antibodies effectively control inflammation, the focus on ARR may not capture the long-term disability progression addressed by Bruton's tyrosine kinase inhibitors (BTKi). This letter questions the suitability of teriflunomide as a comparator due to low relapse rates in the control group, possibly stemming from patient selection bias. The author advocates for a reevaluation of study design, outcomes, and comparators in multiple sclerosis research, emphasizing the need for new approaches to address disease activity and disability progression. It is time to rethink clinical trials on Bruton's tyrosine kinase inhibitors in multiple sclerosis.
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20
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Carlson AK, Fox RJ. Pathophysiology, Diagnosis, Treatment and Emerging Neurotherapeutic Targets for Progressive Multiple Sclerosis: The Age of PIRA. Neurol Clin 2024; 42:39-54. [PMID: 37980122 DOI: 10.1016/j.ncl.2023.07.002] [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: 11/20/2023]
Abstract
More than one million individuals are impacted by progressive forms of multiple sclerosis. The literature examining the management of MS has focused primarily on relapsing forms of disease, and effective therapies targeting progressive mechanisms in MS remains a significant unmet need. Despite this, there are several encouraging potential therapeutics on the horizon. Improved understanding of mechanisms underlying MS progression, identification and validation of biomarkers, identification of novel therapeutic targets, and improved trial design are needed to further propel progress in the management of individuals with progressive forms of MS.
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Affiliation(s)
- Alise K Carlson
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA
| | - Robert J Fox
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA.
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21
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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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22
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Jakimovski D, Bittner S, Zivadinov R, Morrow SA, Benedict RH, Zipp F, Weinstock-Guttman B. Multiple sclerosis. Lancet 2024; 403:183-202. [PMID: 37949093 DOI: 10.1016/s0140-6736(23)01473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 11/12/2023]
Abstract
Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ralph Hb Benedict
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
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23
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Zierfuss B, Larochelle C, Prat A. Blood-brain barrier dysfunction in multiple sclerosis: causes, consequences, and potential effects of therapies. Lancet Neurol 2024; 23:95-109. [PMID: 38101906 DOI: 10.1016/s1474-4422(23)00377-0] [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: 02/06/2023] [Revised: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023]
Abstract
Established by brain endothelial cells, the blood-brain barrier (BBB) regulates the trafficking of molecules, restricts immune cell entry into the CNS, and has an active role in neurovascular coupling (the regulation of cerebral blood flow to support neuronal activity). In the early stages of multiple sclerosis, around the time of symptom onset, inflammatory BBB damage is accompanied by pathogenic immune cell infiltration into the CNS. In the later stages of multiple sclerosis, dysregulation of neurovascular coupling is associated with grey matter atrophy. Genetic and environmental factors associated with multiple sclerosis, including dietary habits, the gut microbiome, and vitamin D concentrations, might contribute directly and indirectly to brain endothelial cell dysfunction. Damage to brain endothelial cells leads to an influx of deleterious molecules into the CNS, accelerating leakage across the BBB. Potential future therapeutic approaches might help to prevent BBB damage (eg, monoclonal antibodies targeting cell adhesion molecules and fibrinogen) and help to repair BBB dysfunction (eg, mesenchymal stromal cells) in people with multiple sclerosis.
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Affiliation(s)
- Bettina Zierfuss
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Catherine Larochelle
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Alexandre Prat
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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24
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Gadhave DG, Sugandhi VV, Kokare CR. Potential biomaterials and experimental animal models for inventing new drug delivery approaches in the neurodegenerative disorder: Multiple sclerosis. Brain Res 2024; 1822:148674. [PMID: 37952871 DOI: 10.1016/j.brainres.2023.148674] [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: 04/25/2023] [Revised: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
The tight junction of endothelial cells in the central nervous system (CNS) has an ideal characteristic, acting as a biological barrier that can securely regulate the movement of molecules in the brain. Tightly closed astrocyte cell junctions on blood capillaries are the blood-brain barrier (BBB). This biological barrier prohibits the entry of polar drugs, cells, and ions, which protect the brain from harmful toxins. However, delivering any therapeutic agent to the brain in neurodegenerative disorders (i.e., schizophrenia, multiple sclerosis, etc.) is extremely difficult. Active immune responses such as microglia, astrocytes, and lymphocytes cross the BBB and attack the nerve cells, which causes the demyelination of neurons. Therefore, there is a hindrance in transmitting electrical signals properly, resulting in blindness, paralysis, and neuropsychiatric problems. The main objective of this article is to shed light on the performance of biomaterials, which will help researchers to create nanocarriers that can cross the blood-brain barrier and achieve a therapeutic concentration of drugs in the CNS of patients with multiple sclerosis (MS). The present review focuses on the importance of biomaterials with diagnostic and therapeutic efficacy that can help enhance multiple sclerosis therapeutic potential. Currently, the development of MS in animal models is limited by immune responses, which prevent MS induction in healthy animals. Therefore, this article also showcases animal models currently used for treating MS. A future advance in developing a novel effective strategy for treating MS is now a potential area of research.
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Affiliation(s)
- Dnyandev G Gadhave
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA; Department of Pharmaceutics, Dattakala Shikshan Sanstha's, Dattakala College of Pharmacy (Affiliated to Savitribai Phule Pune University), Swami Chincholi, Daund, Pune 413130, Maharashtra, India.
| | - Vrashabh V Sugandhi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Chandrakant R Kokare
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
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25
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Husseini L, Geladaris A, Weber MS. Toward identifying key mechanisms of progression in multiple sclerosis. Trends Neurosci 2024; 47:58-70. [PMID: 38102058 DOI: 10.1016/j.tins.2023.11.005] [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: 07/25/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
A major therapeutic goal in the treatment of multiple sclerosis (MS) is to prevent the accumulation of disability over an often decades-long disease course. Disability progression can result from acute relapses as well as from CNS intrinsic parenchymal disintegration without de novo CNS lesion formation. Research focus has shifted to progression not associated with acute inflammation, as it is not sufficiently controlled by currently available treatments. This review outlines how recent advances in the understanding of the pathogenesis of progressive MS have been facilitated by the development of more precise, less static pathogenetic concepts of progressive MS, as well as by new techniques for the analysis of region-specific proteomic and transcriptomic signatures in the human CNS. We highlight key drivers of MS disease progression and potential targets in its treatment.
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Affiliation(s)
- Leila Husseini
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Anastasia Geladaris
- Institute of Neuropathology, University Medical Center, Göttingen, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, 37073 Göttingen, Germany
| | - Martin S Weber
- Department of Neurology, University Medical Center, Göttingen, Germany; Institute of Neuropathology, University Medical Center, Göttingen, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, 37073 Göttingen, Germany.
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26
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Rodrigues P, da Silva B, Trevisan G. A systematic review and meta-analysis of neuropathic pain in multiple sclerosis: Prevalence, clinical types, sex dimorphism, and increased depression and anxiety symptoms. Neurosci Biobehav Rev 2023; 154:105401. [PMID: 37777076 DOI: 10.1016/j.neubiorev.2023.105401] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
Chronic pain is the most disability symptom related to multiple sclerosis (MS) brain lesions and can also generate anxiety and depression. There are no updated reports of the general prevalence of neuropathic pain, MS clinical types, sex dimorphism, and its association with depression and anxiety. The protocol was listed in PROSPERO (CRD42022303571). The article selection resulted in 24 studies with a low risk of bias. The prevalence of neuropathic pain in MS patients was 26.8% with higher levels of depression and anxiety. We also observed that female patients (74.2%) have a higher prevalence of neuropathic pain than males (28.9%). We showed the enhanced prevalence of neuropathic pain using the female and male data (58.9%) compared to the total prevalence (26.8%). In addition, the SPMS (40.3%) presented an increased prevalence of neuropathic pain compared to PPMS (15.6%). Thus, we demonstrated the association between neuropathic pain, depression and anxiety symptoms and the influence of diagnosis, age, disease score, and disease duration in the increased prevalence of neuropathic pain in MS patients.
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Affiliation(s)
- Patrícia Rodrigues
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Brenda da Silva
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Gabriela Trevisan
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil.
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27
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Baeva ME, Camara-Lemarroy C. The role of autophagy protein Atg5 in multiple sclerosis. Mult Scler Relat Disord 2023; 79:105029. [PMID: 37778158 DOI: 10.1016/j.msard.2023.105029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Multiple sclerosis (MS) is a neurological disease which has a strong autoimmune component to its pathology. Although there are currently many approved immunomodulatory treatments that reduce the rate of relapse and slow down the progression of the disease, the cure is still elusive. This may be due to the underlying etiology still being unknown. Autophagy is the potential link between neurodegeneration and autoimmunity. Specifically, this review will focus on the autophagy protein Atg5 and examine the in vitro cell culture, animal and human studies that have examined its expression and effects in the context of MS. The findings of these investigations are summarized, and a model is proposed in which elevated Atg5 levels leads to dysfunctional autophagy, neurodegeneration, inflammation, and eventually clinical disability. While there are currently no drugs that specifically target Atg5, our review recommends that further investigations into the role that Atg5 plays in MS pathophysiology may eventually lead to the development of autophagy-specific treatments of MS.
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Affiliation(s)
- Maria-Elizabeth Baeva
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada.
| | - Carlos Camara-Lemarroy
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
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28
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Zierfuss B, Wang Z, Jackson AN, Moezzi D, Yong VW. Iron in multiple sclerosis - Neuropathology, immunology, and real-world considerations. Mult Scler Relat Disord 2023; 78:104934. [PMID: 37579645 DOI: 10.1016/j.msard.2023.104934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/30/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
Iron is an essential element involved in a multitude of bodily processes. It is tightly regulated, as elevated deposition in tissues is associated with diseases such as multiple sclerosis (MS). Iron accumulation in the central nervous system (CNS) of MS patients is linked to neurotoxicity through mechanisms including oxidative stress, glutamate excitotoxicity, misfolding of proteins, and ferroptosis. In the past decade, the combination of MRI and histopathology has enhanced our understanding of iron deposition in MS pathophysiology, including in the pro-inflammatory and neurotoxicity of iron-laden rims of chronic active lesions. In this regard, iron accumulation may not only have an impact on different CNS-resident cells but may also promote the innate and adaptive immune dysfunctions in MS. Although there are discordant results, most studies indicate lower levels of iron but higher amounts of the iron storage molecule ferritin in the circulation of people with MS. Considering the importance of iron, there is a need for evidence-guided recommendation for dietary intake in people living with MS. Potential novel therapeutic approaches include the regulation of iron levels using next generation iron chelators, as well as therapies to interfere with toxic consequences of iron overload including antioxidants in MS.
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Affiliation(s)
- Bettina Zierfuss
- The Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montréal H2X 0A9, Québec, Canada
| | - Zitong Wang
- Department of Psychiatry, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
| | - Alexandra N Jackson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Dorsa Moezzi
- The Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - V Wee Yong
- The Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada.
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29
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Xu W, Yan D, Ning Z. Associations between multiple sclerosis and in-hospital outcomes of patients with hemorrhagic stroke. J Stroke Cerebrovasc Dis 2023; 32:107281. [PMID: 37523878 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To determine the influence of multiple sclerosis (MS) on in-hospital outcomes of patients with hemorrhagic strokes using a large, nationally representative database. MATERIALS AND METHODS This population-based, retrospective study extracted data of adults with hemorrhagic stroke from the US Nationwide Inpatient Sample (NIS) database from 2016 to 2018. Patients with/without MS were then compared. Hemorrhagic stroke and MS were identified by the International Classification of Diseases, Tenth editions (ICD-10) codes. In-hospital outcomes (i.e., in-hospital mortality, discharge destination, length of stay [LOS], total hospital cost, and major complications) were compared between subjects with and without MS using logistic regression analysis. RESULTS Among 107,573 patients with hemorrhagic stroke, 0.3% (n=337) had MS. After 1:10 propensity-score (PS) matching, 3,707 patients remained in the analytic sample. Multivariable analysis revealed that patients with MS had significantly shorter LOS (adjusted β=-1.34 days; 95% CI: -2.41 to -0.26, p=0.015), and lower total hospital costs (adjusted β=-28.82; 95% CI: -43.57 to -14.06, p<0.001) than those without MS. No significant different risks of any major complications, in-hospital mortality, or transfer to nursing homes/long-term care facilities were observed. For major complications, patients with MS had a significantly lower risk of cerebral edema than those without MS (adjusted odds ratio [aOR] = 0.66, 95%CI: 0.51 to 0.86, p =0.002) CONCLUSIONS: In hospitalized patients with hemorrhagic stroke, those with MS have shorter LOS, lower costs, and a lower risk of cerebral edema compared to no MS. More relevant experiments and studies are needed to confirm results of this study.
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Affiliation(s)
- Weiguang Xu
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China.
| | - Dajun Yan
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Zeqian Ning
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
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30
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Xue S, Lozinski BM, Ghorbani S, Ta K, D'Mello C, Yong VW, Dong Y. Elevated Galectin-3 Is Associated with Aging, Multiple Sclerosis, and Oxidized Phosphatidylcholine-Induced Neurodegeneration. J Neurosci 2023; 43:4725-4737. [PMID: 37208177 PMCID: PMC10286945 DOI: 10.1523/jneurosci.2312-22.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Abstract
Aging is a significant risk factor associated with the progression of CNS neurodegenerative diseases including multiple sclerosis (MS). Microglia, the resident macrophages of the CNS parenchyma, are a major population of immune cells that accumulate in MS lesions. While they normally regulate tissue homeostasis and facilitate the clearance of neurotoxic molecules including oxidized phosphatidylcholines (OxPCs), their transcriptome and neuroprotective functions are reprogrammed by aging. Thus, determining the factors that instigate aging associated microglia dysfunction can lead to new insights for promoting CNS repair and for halting MS disease progression. Through single-cell RNA sequencing (scRNAseq), we identified Lgals3, which encodes for galectin-3 (Gal3), as an age upregulated gene by microglia responding to OxPC. Consistently, excess Gal3 accumulated in OxPC and lysolecithin-induced focal spinal cord white matter (SCWM) lesions of middle-aged mice compared with young mice. Gal3 was also elevated in mouse experimental autoimmune encephalomyelitis (EAE) lesions and more importantly in MS brain lesions from two male and one female individuals. While Gal3 delivery alone into the mouse spinal cord did not induce damage, its co-delivery with OxPC increased cleaved caspase 3 and IL-1β within white matter lesions and exacerbated OxPC-induced injury. Conversely, OxPC-mediated neurodegeneration was reduced in Gal3-/- mice compared with Gal3+/+ mice. Thus, Gal3 is associated with increased neuroinflammation and neurodegeneration and its overexpression by microglia/macrophages may be detrimental for lesions within the aging CNS.SIGNIFICANCE STATEMENT Aging accelerates the progression of neurodegenerative diseases such as multiple sclerosis (MS). Understanding the molecular mechanisms of aging that increases the susceptibility of the CNS to damage could lead to new strategies to manage MS progression. Here, we highlight that microglia/macrophage-associated galectin-3 (Gal3) was upregulated with age exacerbated neurodegeneration in the mouse spinal cord white matter (SCWM) and in MS lesions. More importantly, co-injection of Gal3 with oxidized phosphatidylcholines (OxPCs), which are neurotoxic lipids found in MS lesions, caused greater neurodegeneration compared with injection of OxPC alone, whereas genetic loss of Gal3 reduced OxPC damage. These results demonstrate that Gal3 overexpression is detrimental to CNS lesions and suggest its deposition in MS lesions may contribute to neurodegeneration.
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Affiliation(s)
- Sara Xue
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Brian M Lozinski
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Samira Ghorbani
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Khanh Ta
- Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Charlotte D'Mello
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Yifei Dong
- Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
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31
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Zhang X, Chen F, Sun M, Wu N, Liu B, Yi X, Ge R, Fan X. Microglia in the context of multiple sclerosis. Front Neurol 2023; 14:1157287. [PMID: 37360338 PMCID: PMC10287974 DOI: 10.3389/fneur.2023.1157287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease that commonly results in nontraumatic disability in young adults. The characteristic pathological hallmark of MS is damage to myelin, oligodendrocytes, and axons. Microglia provide continuous surveillance in the CNS microenvironment and initiate defensive mechanisms to protect CNS tissue. Additionally, microglia participate in neurogenesis, synaptic refinement, and myelin pruning through the expression and release of different signaling factors. Continuous activation of microglia has been implicated in neurodegenerative disorders. We first review the lifetime of microglia, including the origin, differentiation, development, and function of microglia. We then discuss microglia participate in the whole processes of remyelination and demyelination, microglial phenotypes in MS, and the NF-κB/PI3K-AKT signaling pathway in microglia. The damage to regulatory signaling pathways may change the homeostasis of microglia, which would accelerate the progression of MS.
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Affiliation(s)
- Xue Zhang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Fang Chen
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Mingyue Sun
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Nan Wu
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Bin Liu
- Institute for Metabolic and Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Xiangming Yi
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Ruli Ge
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Xueli Fan
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
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32
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Shi Z, Wang X, Wang J, Chen H, Du Q, Lang Y, Kong L, Luo W, Qiu Y, Zhang Y, Li C, Wen D, Yao J, Cheng X, Cai L, Lin X, Wang R, Mou Z, Li S, Liu D, Zhou H, Zhou H, Yang M. Granzyme B + CD8 + T cells with terminal differentiated effector signature determine multiple sclerosis progression. J Neuroinflammation 2023; 20:138. [PMID: 37268957 DOI: 10.1186/s12974-023-02810-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) leads to demyelination and neurodegeneration with autoimmune responses in central nervous system. Patients begin with a relapsing-remitting (RR) course, and more than 80% of them may advance to secondary progressive MS (SPMS), which is characteristic for the gradual decline of neurological functions without demonstrated treating method to prevent. This study aims to investigate the contribution of peripheral CD8 + T cells during the conversion from RRMS to SPMS, as well as reveal potential diagnostic signature in distinguishing SPMS. METHODS Single-cell RNA sequencing was employed to reveal the heterogeneity of CD8 + T cells between SPMS and RRMS. In addition, flow cytometry was used to further characterized CD8 + T cell dynamic changes in patients. T cell receptor sequencing was performed to detect the clonal expansion of MS. Using Tbx21 siRNA, T-bet was confirmed to manipulate GzmB expression. The correlation between GzmB + CD8 + T cell subsets and clinical characteristics of MS and their potential diagnostic value for SPMS were evaluated by generalized linear regression models and receiver operating characteristic (ROC) curve respectively. RESULTS Other than diminished naïve CD8 + T cell, elevating of activated CD8 + T cell subsets were observed in SPMS patients. Meanwhile, this aberrant amplified peripheral CD8 + T cells not only exhibited terminal differentiated effector (EMRA) phenotype with GzmB expression, but also possessed distinct trajectory from clonal expansion. In addition, T-bet acted as a key transcriptional factor that elicited GzmB expression in CD8 + TEMRA cells of patients with SPMS. Finally, the expression of GzmB in CD8 + T cells was positively correlated with disability and progression of MS, and could effectively distinguish SPMS from RRMS with a high accuracy. CONCLUSIONS Our study mapped peripheral immune cells of RRMS and SPMS patients and provided an evidence for the involvement of GzmB + CD8 + TEMRA cells in the progression of MS, which could be used as a diagnostic biomarker for distinguishing SPMS from RRMS.
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Affiliation(s)
- Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Jiancheng Wang
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Yanlin Lang
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Yuhan Qiu
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Chen Li
- Centre for Translational Research in Cancer, Sichuan Cancer Hospital and Institute, No.55 South Renmin Road, Chengdu, 610000, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jie Yao
- Centre for Translational Research in Cancer, Sichuan Cancer Hospital and Institute, No.55 South Renmin Road, Chengdu, 610000, China
| | - Xia Cheng
- Centre for Translational Research in Cancer, Sichuan Cancer Hospital and Institute, No.55 South Renmin Road, Chengdu, 610000, China
| | - Linjun Cai
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Xue Lin
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Zichao Mou
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Shuangjie Li
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China
| | - Duanya Liu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Hong Zhou
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, No.28 Dianxin Nan Street, Chengdu, 610041, China.
| | - Mu Yang
- Centre for Translational Research in Cancer, Sichuan Cancer Hospital and Institute, No.55 South Renmin Road, Chengdu, 610000, China.
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China.
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Krämer J, Bar-Or A, Turner TJ, Wiendl H. Bruton tyrosine kinase inhibitors for multiple sclerosis. Nat Rev Neurol 2023; 19:289-304. [PMID: 37055617 PMCID: PMC10100639 DOI: 10.1038/s41582-023-00800-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/15/2023]
Abstract
Current therapies for multiple sclerosis (MS) reduce both relapses and relapse-associated worsening of disability, which is assumed to be mainly associated with transient infiltration of peripheral immune cells into the central nervous system (CNS). However, approved therapies are less effective at slowing disability accumulation in patients with MS, in part owing to their lack of relevant effects on CNS-compartmentalized inflammation, which has been proposed to drive disability. Bruton tyrosine kinase (BTK) is an intracellular signalling molecule involved in the regulation of maturation, survival, migration and activation of B cells and microglia. As CNS-compartmentalized B cells and microglia are considered central to the immunopathogenesis of progressive MS, treatment with CNS-penetrant BTK inhibitors might curtail disease progression by targeting immune cells on both sides of the blood-brain barrier. Five BTK inhibitors that differ in selectivity, strength of inhibition, binding mechanisms and ability to modulate immune cells within the CNS are currently under investigation in clinical trials as a treatment for MS. This Review describes the role of BTK in various immune cells implicated in MS, provides an overview of preclinical data on BTK inhibitors and discusses the (largely preliminary) data from clinical trials.
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Affiliation(s)
- Julia Krämer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Amit Bar-Or
- Center for Neuroinflammation and Neurotherapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.
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Mader MMD, Napole A, Wu D, Shibuya Y, Scavetti A, Foltz A, Atkins M, Hahn O, Yoo Y, Danziger R, Tan C, Wyss-Coray T, Steinman L, Wernig M. Augmentation of a neuroprotective myeloid state by hematopoietic cell transplantation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.10.532123. [PMID: 36945385 PMCID: PMC10028976 DOI: 10.1101/2023.03.10.532123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease associated with inflammatory demyelination in the central nervous system (CNS). Autologous hematopoietic cell transplantation (HCT) is under investigation as a promising therapy for treatment-refractory MS. Here we identify a reactive myeloid state in chronic experimental autoimmune encephalitis (EAE) mice and MS patients that is surprisingly associated with neuroprotection and immune suppression. HCT in EAE mice leads to an enhancement of this myeloid state, as well as clinical improvement, reduction of demyelinated lesions, suppression of cytotoxic T cells, and amelioration of reactive astrogliosis reflected in reduced expression of EAE-associated gene signatures in oligodendrocytes and astrocytes. Further enhancement of myeloid cell incorporation into the CNS following a modified HCT protocol results in an even more consistent therapeutic effect corroborated by additional amplification of HCT-induced transcriptional changes, underlining myeloid-derived beneficial effects in the chronic phase of EAE. Replacement or manipulation of CNS myeloid cells thus represents an intriguing therapeutic direction for inflammatory demyelinating disease.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Alan Napole
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Danwei Wu
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
- Department of Neurology and Neurosciences, Division of
Neuroimmunology and Multiple Sclerosis Center, Stanford University of Medicine, Stanford, CA
94305, USA
| | - Yohei Shibuya
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Alexa Scavetti
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Aulden Foltz
- Department of Neurology and Neurological Sciences, Stanford
University School of Medicine, Stanford, CA 94305, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto,
CA 94304, USA
| | - Micaiah Atkins
- Department of Neurology and Neurological Sciences, Stanford
University School of Medicine, Stanford, CA 94305, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto,
CA 94304, USA
| | - Oliver Hahn
- Department of Neurology and Neurological Sciences, Stanford
University School of Medicine, Stanford, CA 94305, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto,
CA 94304, USA
| | - Yongjin Yoo
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Ron Danziger
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Christina Tan
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford
University School of Medicine, Stanford, CA 94305, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto,
CA 94304, USA
| | - Lawrence Steinman
- Department of Neurology and Neurosciences, Division of
Neuroimmunology and Multiple Sclerosis Center, Stanford University of Medicine, Stanford, CA
94305, USA
| | - Marius Wernig
- Institute for Stem Cell Biology and Regenerative Medicine and
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Department of Pathology, Stanford University School of Medicine,
Stanford, CA 94305, USA
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Furman MJ, Meuth SG, Albrecht P, Dietrich M, Blum H, Mares J, Milo R, Hartung HP. B cell targeted therapies in inflammatory autoimmune disease of the central nervous system. Front Immunol 2023; 14:1129906. [PMID: 36969208 PMCID: PMC10034856 DOI: 10.3389/fimmu.2023.1129906] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
Cumulative evidence along several lines indicates that B cells play an important role in the pathological course of multiple sclerosis (MS), neuromyelitisoptica spectrum disorders (NMOSD) and related CNS diseases. This has prompted extensive research in exploring the utility of targeting B cells to contain disease activity in these disorders. In this review, we first recapitulate the development of B cells from their origin in the bone marrow to their migration to the periphery, including the expression of therapy-relevant surface immunoglobulin isotypes. Not only the ability of B cells to produce cytokines and immunoglobulins seems to be essential in driving neuroinflammation, but also their regulatory functions strongly impact pathobiology. We then critically assess studies of B cell depleting therapies, including CD20 and CD19 targeting monoclonal antibodies, as well as the new class of B cell modulating substances, Bruton´s tyrosinekinase (BTK) inhibitors, in MS, NMOSD and MOGAD.
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Affiliation(s)
- Moritz J. Furman
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
- Department of Neurology, Maria Hilf Clinic, Moenchengladbach, Germany
| | - Michael Dietrich
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Heike Blum
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Jan Mares
- Department of Neurology, Palacky University in Olomouc, Olomouc, Czechia
| | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
- Department of Neurology, Palacky University in Olomouc, Olomouc, Czechia
- Brain and Mind Center, Medical Faculty, The University of Sydney, Sydney, NSW, Australia
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Harris VK, Bishop D, Wollowitz J, Carling G, Carlson AL, Daviaud N, Sadiq SA. Mesenchymal stem cell-derived neural progenitors attenuate proinflammatory microglial activation via paracrine mechanisms. Regen Med 2023; 18:259-273. [PMID: 36852422 DOI: 10.2217/rme-2023-0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: Mesenchymal stem cell-derived neural progenitor cell (MSC-NP) therapy is an experimental approach to treat multiple sclerosis. The influence of MSC-NPs on microglial activation was investigated. Methods: Microglia were stimulated in the presence of MSC-NP-conditioned media, and proinflammatory or proregenerative marker expression was assessed by quantitative PCR and ELISA. Results: Microglia stimulated in the presence of MSC-NP-conditioned media displayed reduced expression of proinflammatory markers including CCL2, increased expression of proregenerative markers and reduced phagocytic activity. The paracrine effects of MSC-NPs from multiple donors correlated with TGF-β3 gene expression and was reversed by TGF-β signaling inhibition. Conclusion: MSC-NPs promote beneficial microglial polarization through secreted factors. This study suggests that microglia are a potential therapeutic target of MSC-NP cell therapy.
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Affiliation(s)
| | - Derek Bishop
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
| | - Jaina Wollowitz
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
| | - Gillian Carling
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
| | - Alyssa L Carlson
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
| | - Nicolas Daviaud
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
| | - Saud A Sadiq
- Tisch Multiple Sclerosis Research Center of New York, NY 10019, USA
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Wilson DM, Cookson MR, Van Den Bosch L, Zetterberg H, Holtzman DM, Dewachter I. Hallmarks of neurodegenerative diseases. Cell 2023; 186:693-714. [PMID: 36803602 DOI: 10.1016/j.cell.2022.12.032] [Citation(s) in RCA: 235] [Impact Index Per Article: 235.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 02/18/2023]
Abstract
Decades of research have identified genetic factors and biochemical pathways involved in neurodegenerative diseases (NDDs). We present evidence for the following eight hallmarks of NDD: pathological protein aggregation, synaptic and neuronal network dysfunction, aberrant proteostasis, cytoskeletal abnormalities, altered energy homeostasis, DNA and RNA defects, inflammation, and neuronal cell death. We describe the hallmarks, their biomarkers, and their interactions as a framework to study NDDs using a holistic approach. The framework can serve as a basis for defining pathogenic mechanisms, categorizing different NDDs based on their primary hallmarks, stratifying patients within a specific NDD, and designing multi-targeted, personalized therapies to effectively halt NDDs.
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Affiliation(s)
- David M Wilson
- Hasselt University, Biomedical Research Institute, BIOMED, 3500 Hasselt, Belgium.
| | - Mark R Cookson
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ludo Van Den Bosch
- KU Leuven, University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Brain Institute (LBI), 3000 Leuven, Belgium; VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, 3000 Leuven, Belgium
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China; UW Department of Medicine, School of Medicine and Public Health, Madison, WI, USA
| | - David M Holtzman
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilse Dewachter
- Hasselt University, Biomedical Research Institute, BIOMED, 3500 Hasselt, Belgium.
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Carmena Moratalla A, Carpentier Solorio Y, Lemaître F, Farzam-Kia N, Da Cal S, Guimond JV, Haddad E, Duquette P, Girard JM, Prat A, Larochelle C, Arbour N. Specific alterations in NKG2D + T lymphocytes in relapsing-remitting and progressive multiple sclerosis patients. Mult Scler Relat Disord 2023; 71:104542. [PMID: 36716577 DOI: 10.1016/j.msard.2023.104542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND T lymphocytes exhibit numerous alterations in relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive multiple sclerosis (PPMS). The NKG2D pathway has been involved in MS pathology. NKG2D is a co-activating receptor on subsets of CD4+ and most CD8+ T lymphocytes. The ligands of NKG2D are expressed at low levels in normal tissues but are elevated in MS postmortem brain tissues compared with controls. Whether the NKG2D pathway shows specific changes in different forms of MS remains unclear. METHODS We performed unsupervised and supervised flow cytometry analysis to characterize peripheral blood T lymphocytes from RRMS, SPMS, and PPMS patients and healthy controls (HC). We used an in vitro microscopy approach to assess the role of NKG2D in the interactions between human CD8+T lymphocytes and human astrocytes. RESULTS Specific CD8+, CD4+, and CD4-CD8- T cell populations exhibited altered frequency in MS patients' subgroups. The proportion of NKG2D+ T lymphocytes declined with age in PPMS patients but not in RRMS and HC. This reduced percentage of NKG2D+ cells was due to lower abundance of γδ and αβ CD4-CD8- T lymphocytes in PPMS patients. NKG2D+ T lymphocytes were significantly less abundant in RRMS than in HC; this was caused by a decreased frequency of CD4-CD8- and CD8+ T lymphocytes and was not linked to age. Blocking NKG2D increased the motility of CD8+ T lymphocytes co-cultured with astrocytes expressing NKG2D ligand. Moreover, preventing NKG2D from interacting with its ligands increased the proportion of CD8+ T lymphocytes exhibiting a kinapse-like behavior characterized by short-term interaction while reducing those displaying a long-lasting synapse-like behavior. These results support that NKG2D participates in the establishment of long-term interactions between activated CD8+ T lymphocytes and astrocytes. CONCLUSION Our data demonstrate specific alterations in NKG2D+ T lymphocytes in MS patients' subgroups and suggest that NKG2D contributes to the interactions between human CD8+ T lymphocytes and human astrocytes.
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Affiliation(s)
- Ana Carmena Moratalla
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9
| | - Yves Carpentier Solorio
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9
| | - Florent Lemaître
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9
| | - Negar Farzam-Kia
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9
| | - Sandra Da Cal
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9
| | - Jean Victor Guimond
- CLSC des Faubourgs, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Elie Haddad
- Department of Microbiology, Infectious Diseases, and Immunology and Department of Pediatrics, Université de Montréal, Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine (CHU Sainte-Justine), Montreal, Quebec, Canada
| | - Pierre Duquette
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9; MS-CHUM Clinic 900 St-Denis Street, Montreal, QC, Canada, H2X0A9
| | - J Marc Girard
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9; MS-CHUM Clinic 900 St-Denis Street, Montreal, QC, Canada, H2X0A9
| | - Alexandre Prat
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9; MS-CHUM Clinic 900 St-Denis Street, Montreal, QC, Canada, H2X0A9
| | - Catherine Larochelle
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9; MS-CHUM Clinic 900 St-Denis Street, Montreal, QC, Canada, H2X0A9
| | - Nathalie Arbour
- Department of Neurosciences, Université de Montréal and Centre de Recherche du CHUM (CRCHUM) 900 St-Denis Street Montreal, QC, Canada, H2X0A9.
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Potentially toxic elements in the brains of people with multiple sclerosis. Sci Rep 2023; 13:655. [PMID: 36635465 PMCID: PMC9837144 DOI: 10.1038/s41598-022-27169-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023] Open
Abstract
Potentially toxic elements such as lead and aluminium have been proposed to play a role in the pathogenesis of multiple sclerosis (MS), since their neurotoxic mechanisms mimic many of the pathogenetic processes in MS. We therefore examined the distribution of several potentially toxic elements in the autopsied brains of people with and without MS, using two methods of elemental bio-imaging. Toxicants detected in the locus ceruleus were used as indicators of past exposures. Autometallography of paraffin sections from multiple brain regions of 21 MS patients and 109 controls detected inorganic mercury, silver, or bismuth in many locus ceruleus neurons of both groups, and in widespread blood vessels, oligodendrocytes, astrocytes, and neurons of four MS patients and one control. Laser ablation-inductively coupled plasma-mass spectrometry imaging of pons paraffin sections from all MS patients and 12 controls showed that combinations of iron, silver, lead, aluminium, mercury, nickel, and bismuth were present more often in the locus ceruleus of MS patients and were located predominantly in white matter tracts. Based on these results, we propose that metal toxicants in locus ceruleus neurons weaken the blood-brain barrier, enabling multiple interacting toxicants to pass through blood vessels and enter astrocytes and oligodendroglia, leading to demyelination.
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Kuhlmann T, Moccia M, Coetzee T, Cohen JA, Correale J, Graves J, Marrie RA, Montalban X, Yong VW, Thompson AJ, Reich DS. Multiple sclerosis progression: time for a new mechanism-driven framework. Lancet Neurol 2023; 22:78-88. [PMID: 36410373 PMCID: PMC10463558 DOI: 10.1016/s1474-4422(22)00289-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
Abstract
Traditionally, multiple sclerosis has been categorised by distinct clinical descriptors-relapsing-remitting, secondary progressive, and primary progressive-for patient care, research, and regulatory approval of medications. Accumulating evidence suggests that the clinical course of multiple sclerosis is better considered as a continuum, with contributions from concurrent pathophysiological processes that vary across individuals and over time. The apparent evolution to a progressive course reflects a partial shift from predominantly localised acute injury to widespread inflammation and neurodegeneration, coupled with failure of compensatory mechanisms, such as neuroplasticity and remyelination. Ageing increases neural susceptibility to injury and decreases resilience. These observations encourage a new consideration of the course of multiple sclerosis as a spectrum defined by the relative contributions of overlapping pathological and reparative or compensatory processes. New understanding of key mechanisms underlying progression and measures to quantify progressive pathology will potentially have important and beneficial implications for clinical care, treatment targets, and regulatory decision-making.
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Affiliation(s)
- Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany; Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Timothy Coetzee
- National Multiple Sclerosis Society (USA), New York, NY, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jorge Correale
- Fleni, Department of Neurology, Buenos Aires, Argentina; Institute of Biological Chemistry and Biophysics (IQUIFIB), CONICET/UBA, Buenos Aires, Argentina
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Ruth Ann Marrie
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia and Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Faculty of Brain Sciences, University College London, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Barro C, Healy BC, Liu Y, Saxena S, Paul A, Polgar-Turcsanyi M, Guttmann CR, Bakshi R, Kropshofer H, Weiner HL, Chitnis T. Serum GFAP and NfL Levels Differentiate Subsequent Progression and Disease Activity in Patients With Progressive Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200052. [DOI: 10.1212/nxi.0000000000200052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
Background and ObjectivesNeurodegeneration and astrocytic activation are pathologic hallmarks of progressive multiple sclerosis (MS) and can be quantified by serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP). We investigated sNfL and sGFAP as tools for stratifying patients with progressive MS based on progression and disease activity status.MethodsWe leveraged our Comprehensive Longitudinal Investigation of MS at the Brigham and Women's Hospital (CLIMB) natural history study, which includes clinical, MRI data and serum samples collected over more than 20 years. We included patients with MS with a confirmed Expanded Disability Status Scale (EDSS) score ≥3 that corresponds with our classifier for patients at high risk of underlying progressive pathology. We analyzed sNfL and sGFAP within 6 months from the confirmed EDSS score ≥3 corresponding with our baseline visit. Patients who further developed 6-month confirmed disability progression (6mCDP) were classified as progressors. We further stratified our patients into active/nonactive based on new brain/spinal cord lesions or relapses in the 2 years before baseline or during follow-up. Statistical analysis on log-transformed sGFAP/sNfL assessed the baseline association with demographic, clinical, and MRI features and associations with future disability.ResultsWe included 257 patients with MS who had an average EDSS score of 4.0 and a median follow-up after baseline of 7.6 years. sNfL was higher in patients with disease activity in the 2 years before baseline (adjusted β = 1.21; 95% CI 1.04–1.42;p= 0.016), during the first 2 years of follow-up (adjusted β = 1.17; 95% CI = 1.01–1.36;p= 0.042). sGFAP was not increased in the presence of disease activity. Higher sGFAP levels, but not sNfL levels, were associated with higher risk of 6mCDP (adjusted hazard ratio [HR] = 1.71; 95% CI = 1.19–2.45;p= 0.004). The association was stronger in patients with low sNfL (adjusted HR = 2.44; 95% CI 1.32–4.52;p= 0.005) and patients who were nonactive in the 2 years prior or after the sample.DiscussionHigher levels of sGFAP correlated with subsequent progression, particularly in nonactive patients, whereas sNfL reflected acute disease activity in patients with MS at high risk of underlying progressive pathology. Thus, sGFAP and sNfL levels may be used to stratify patients with progressive MS for clinical research studies and clinical trials and may inform clinical care.
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Camara-Lemarroy C, Silva C, Gohill J, Yong VW, Koch M. Serum neurofilament-light and glial fibrillary acidic protein levels in hydroxychloroquine-treated primary progressive multiple sclerosis. Eur J Neurol 2023; 30:187-194. [PMID: 36214614 DOI: 10.1111/ene.15588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a recent trial, hydroxychloroquine (HCQ) treatment reduced the expected rate of disability worsening at 18 months in primary progressive multiple sclerosis (PPMS). Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are emerging biomarkers in multiple sclerosis. METHODS We measured NfL and GFAP levels in serum samples from 39 patients with inactive PPMS included in a phase II clinical trial of HCQ treatment in PPMS at multiple time points over 18 months, and investigated the association of these biomarkers with clinical disability at screening and during follow-up. Screening and 12-month retinal nerve fiber layer (RNFL) thickness was also recorded and analyzed. RESULTS NfL and GFAP levels increased over time, but only significantly from screening to month 6. NfL and GFAP levels did not significantly increase from month 6 up to month 18. At screening, NfL and GFAP levels did not correlate with the Expanded Disability Status Scale (EDSS), and GFAP but not NfL modestly correlated with Timed 25-Foot Walk test (T25FW). Screening NfL and GFAP levels did not predict disability worsening (≥20% worsening on the T25FW) at month 18. RNFL thickness decreased significantly from screening to month 12 and independently predicted disability worsening. CONCLUSIONS In this cohort of people with inactive PPMS, HCQ treatment attenuated the increase of NfL and GFAP after 6 months of treatment and up to 18 months of follow-up, suggesting a treatment effect of HCQ over these biomarkers. RNFL thickness, a marker of neuroaxonal atrophy, was associated with disability worsening, and should be explored further as a prognostic marker in this population.
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Affiliation(s)
- Carlos Camara-Lemarroy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,UANL School of Medicine, Monterrey, Mexico
| | - Claudia Silva
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jit Gohill
- Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - V Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marcus Koch
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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43
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Ziemssen T, Bhan V, Chataway J, Chitnis T, Campbell Cree BA, Havrdova EK, Kappos L, Labauge P, Miller A, Nakahara J, Oreja-Guevara C, Palace J, Singer B, Trojano M, Patil A, Rauser B, Hach T. Secondary Progressive Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200064. [DOI: 10.1212/nxi.0000000000200064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022]
Abstract
Many challenges exist in the precise diagnosis and clinical management of secondary progressive multiple sclerosis (SPMS) because of the lack of definitive clinical, imaging, immunologic, or pathologic criteria that demarcate the transition from relapsing-remitting MS to SPMS. This review provides an overview of the diagnostic criteria/definition and the heterogeneity associated with different SPMS patient populations; it also emphasizes the importance of available prospective/retrospective tools to identify patients with SPMS earlier in the disease course so that approved disease-modifying therapies and nonpharmacological strategies will translate into better outcomes. Delivery of such interventions necessitates an evolving patient-clinician dialog within the context of a multidisciplinary team.
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44
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Rommer PS, Bsteh G, Zrzavy T, Hoeftberger R, Berger T. Immunosenescence in Neurological Diseases-Is There Enough Evidence? Biomedicines 2022; 10:2864. [PMID: 36359383 PMCID: PMC9687682 DOI: 10.3390/biomedicines10112864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2023] Open
Abstract
The aging of the immune system has recently attracted a lot of attention. Immune senescence describes changes that the immune system undergoes over time. The importance of immune senescence in neurological diseases is increasingly discussed. For this review, we considered studies that investigated cellular changes in the aging immune system and in neurological disease. Twenty-six studies were included in our analysis (for the following diseases: multiple sclerosis, stroke, Parkinson's disease, and dementia). The studies differed considerably in terms of the patient groups included and the cell types studied. Evidence for immunosenescence in neurological diseases is currently very limited. Prospective studies in well-defined patient groups with appropriate control groups, as well as comprehensive methodology and reporting, are essential prerequisites to generate clear insights into immunosenescence in neurological diseases.
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Affiliation(s)
- Paulus S Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Romana Hoeftberger
- Department of Neurology, Division of Neuropathology and Neurochemistry, Comprohensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
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45
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Franklin RJM, Simons M. CNS remyelination and inflammation: From basic mechanisms to therapeutic opportunities. Neuron 2022; 110:3549-3565. [PMID: 36228613 DOI: 10.1016/j.neuron.2022.09.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
Remyelination, the myelin regenerative response that follows demyelination, restores saltatory conduction and function and sustains axon health. Its declining efficiency with disease progression in the chronic autoimmune disease multiple sclerosis (MS) contributes to the currently untreatable progressive phase of the disease. Although some of the bona fide myelin regenerative medicine clinical trials have succeeded in demonstrating proof-of-principle, none of these compounds have yet proceeded toward approval. There therefore remains a need to increase our understanding of the fundamental biology of remyelination so that existing targets can be refined and new ones discovered. Here, we review the role of inflammation, in particular innate immunity, in remyelination, describing its many and complex facets and discussing how our evolving understanding can be harnessed to translational goals.
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Affiliation(s)
- Robin J M Franklin
- Altos Labs - Cambridge Institute of Science, Granta Park, Cambridge CB21 6GP, UK.
| | - Mikael Simons
- Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; Cluster of Systems Neurology (SyNergy), Munich, Germany; Institute for Stroke and Dementia Research, Munich, Germany.
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46
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Yong VW. Microglia in multiple sclerosis: Protectors turn destroyers. Neuron 2022; 110:3534-3548. [PMID: 35882229 DOI: 10.1016/j.neuron.2022.06.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
Microglia are implicated in all stages of multiple sclerosis (MS). Microglia alterations are detected by positron emission tomography in people living with MS prior to the formation of structural lesions determined through magnetic resonance imaging. In histological specimens, clusters of microglia form in normal-appearing tissue likely predating the development of lesions. Features of degeneration-associated/pro-inflammatory states of microglia increase with chronicity of MS. However, microglia play many beneficial roles including the removal of neurotoxins and in fostering repair. The protector-gone-rogue microglia in MS is featured herein. We consider mechanisms of microglia neurotoxicity and discuss factors, including aging, osteopontin, and iron metabolism, that cause microglia to lose their protective states and become injurious. We evaluate medications to affect microglia in MS, such as the emerging class of Bruton's tyrosine kinase inhibitors. The framework of microglia-turned-destroyers may instigate new approaches to counter microglia-driven neurodegeneration in MS.
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Affiliation(s)
- V Wee Yong
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
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47
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Yang K, He X, Wu Z, Yin Y, Pan H, Zhao X, Sun T. The emerging roles of piezo1 channels in animal models of multiple sclerosis. Front Immunol 2022; 13:976522. [PMID: 36177027 PMCID: PMC9513475 DOI: 10.3389/fimmu.2022.976522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease in the central nervous system (CNS). Its pathogenesis is quite complex: Accumulated evidence suggests that biochemical signals as well as mechanical stimuli play important roles in MS. In both patients and animal models of MS, brain viscoelasticity is reduced during disease progression. Piezo mechanosensitive channels are recently discovered, and their three-dimensional structure has been solved. Both the membrane dome mechanism and the membrane footprint hypothesis have been proposed to explain their mechanosensitivity. While membrane-mediated forces alone appear to be sufficient to induce Piezo gating, tethers attached to the membrane or to the channel itself also seem to play a role. Current research indicates that Piezo1 channels play a key role in multiple aspects of MS pathogenesis. Activation of Piezo1 channels in axon negatively regulates CNS myelination. in addition, the inhibition of Piezo1 in CD4+ T cells and/or T regulatory cells (Treg) attenuates experimental autoimmune encephalitis (EAE) symptoms. Although more work has to be done to clarify the roles of Piezo1 channels in MS, they might be a promising future drug target for MS treatment.
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Affiliation(s)
- Kai Yang
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
- *Correspondence: Kai Yang, ; Taolei Sun,
| | - Xueai He
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
| | - Zhengqi Wu
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
| | - Yimeng Yin
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
| | - Hanyu Pan
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
| | - Xinyue Zhao
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, China
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
- *Correspondence: Kai Yang, ; Taolei Sun,
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Mabrouk M, El Ayed M, Démosthènes A, Aissouni Y, Aouani E, Daulhac-Terrail L, Mokni M, Bégou M. Antioxidant effect of grape seed extract corrects experimental autoimmune encephalomyelitis behavioral dysfunctions, demyelination, and glial activation. Front Immunol 2022; 13:960355. [PMID: 36059517 PMCID: PMC9428676 DOI: 10.3389/fimmu.2022.960355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background and purpose Multiple sclerosis (MS), a multifactorial autoimmune disease of the central nervous system (CNS), is characterized by demyelination and chronic inflammation, as well as axonal and neuronal loss. There is no cure for MS, and despite a significant improvement in the therapeutic management of patients during the last 20 years, some symptoms are still resistant to treatment, and the evolution of the disease to progressive form seems still ineluctable. The etiology of MS is complex and still not fully understood. However, inflammation is a major driver of physiopathology and oxidative stress contributes to CNS lesions and promotes existing inflammatory response. Plant polyphenols are endowed with many therapeutic benefits through alleviating oxidative stress and inflammation, thus providing neuroprotection in MS. We presently evaluated the curative effect of grape seed extract (GSE) in an experimental autoimmune encephalomyelitis (EAE) mouse model of MS. Experimental approach Six-week-old C57Bl/6J females were subjected to the EAE paradigm (using myelin oligodendrocyte glycoprotein peptide fragment (35-55), complete Freund’s adjuvant, and pertussis toxin) and then chronically treated with GSE from day 10 to day 30 post-induction. Clinical score and body weight were monitored daily, while evaluation of sensitive, motor, cognitive, and anxiety-related behaviors was performed weekly. Then, the GSE effect was evaluated on whole brain and spinal cord samples through the evaluation of oxidative stress damage, antioxidant capacities, myelin alteration, astroglial and microglial proliferation, and sirtuin expression. Key results Grape seed extract curative chronic treatment corrected the clinical course of EAE, as well as the mechanical hypersensitivity, and avoided the development of EAE mouse thermal cold allodynia. The neuropathological evaluation showed that GSE reduced oxidative stress in the brain and spinal cord by decreasing the lipid and protein oxidation through correction of the three main antioxidant enzyme activities, namely, superoxide dismutase, catalase, and glutathione peroxidase, as well as restoring normal myelin protein expression and correcting microglial and astroglial protein overexpression and sirtuin downregulation. Conclusion and implications These data strongly support GSE as an effective therapeutic approach in MS treatment.
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Affiliation(s)
- Maha Mabrouk
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Mohamed El Ayed
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Amélie Démosthènes
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Youssef Aissouni
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Ezzedine Aouani
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Laurence Daulhac-Terrail
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Meherzia Mokni
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Mélina Bégou
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
- *Correspondence: Mélina Bégou,
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49
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Curcumin Regulates Anti-Inflammatory Responses by AXL/JAK2/STAT3 Signaling Pathway in experimental autoimmune encephalomyelitis. Neurosci Lett 2022; 787:136821. [PMID: 35908626 DOI: 10.1016/j.neulet.2022.136821] [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: 02/13/2022] [Revised: 07/09/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Microglia-mediated neuroinflammation plays an important role in multiple sclerosis (MS). This study explored whether curcumin has a protective effect on experimental autoimmune encephalomyelitis (EAE), and the specific mechanism was investigated. We found that curcumin attenuates the severity of EAE mice. It inhibits the activation of microglia in the spinal cord of EAE mice and LPS-stimulated BV-2 cells. The findings clarify that curcumin may inhibit the inflammatory response mediated by microglia by inactivating the AXL/JAK2/STAT3 signaling pathway, which laid a theoretical foundation for the clinical management of MS.
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50
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Moezzi D, Dong Y, Jain RW, Lozinski BM, Ghorbani S, D'Mello C, Wee Yong V. Expression of antioxidant enzymes in lesions of multiple sclerosis and its models. Sci Rep 2022; 12:12761. [PMID: 35882921 PMCID: PMC9325863 DOI: 10.1038/s41598-022-16840-w] [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: 02/21/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Oxidative stress promotes tissue injury in the central nervous system in neurological disorders such as multiple sclerosis (MS). To protect against this, antioxidant enzymes including superoxide dismutase-1 (SOD1), heme oxygenase-1 (HO-1), peroxiredoxin-5 (PRDX5) and glutathione peroxidase-4 (GPX4) may be upregulated. However, whether antioxidant enzyme elevation in mouse models of neurodegeneration corresponds to their expression in human diseases such as MS requires investigation. Here, we analyzed and compared the expression of SOD1, HO-1, PRDX5 and GPX4 in the murine spinal cord of three models of MS: focal lesions induced by (1) oxidized phosphatidylcholine or (2) lysophosphatidylcholine (lysolecithin), and (3) diffuse lesions of experimental autoimmune encephalomyelitis. Notably, CD68+ microglia/macrophages were the predominant cellular populations that expressed the highest levels of the detected antioxidant enzymes. Overall, the expression patterns of antioxidant enzymes across the models were similar. The increase of these antioxidant enzymes was corroborated in MS brain tissue using spatial RNA sequencing. Collectively, these results show that antioxidant capacity is relatively conserved between mouse models and MS lesions, and suggest a need to investigate whether the antioxidant elevation in microglia/macrophages is a protective response during oxidative injury, neurodegeneration, and MS.
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Affiliation(s)
- Dorsa Moezzi
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Yifei Dong
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Rajiv W Jain
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Brian M Lozinski
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Samira Ghorbani
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Charlotte D'Mello
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - V Wee Yong
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
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