1
|
Amin M, Martínez-Heras E, Ontaneda D, Prados Carrasco F. Artificial Intelligence and Multiple Sclerosis. Curr Neurol Neurosci Rep 2024; 24:233-243. [PMID: 38940994 PMCID: PMC11258192 DOI: 10.1007/s11910-024-01354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
In this paper, we analyse the different advances in artificial intelligence (AI) approaches in multiple sclerosis (MS). AI applications in MS range across investigation of disease pathogenesis, diagnosis, treatment, and prognosis. A subset of AI, Machine learning (ML) models analyse various data sources, including magnetic resonance imaging (MRI), genetic, and clinical data, to distinguish MS from other conditions, predict disease progression, and personalize treatment strategies. Additionally, AI models have been extensively applied to lesion segmentation, identification of biomarkers, and prediction of outcomes, disease monitoring, and management. Despite the big promises of AI solutions, model interpretability and transparency remain critical for gaining clinician and patient trust in these methods. The future of AI in MS holds potential for open data initiatives that could feed ML models and increasing generalizability, the implementation of federated learning solutions for training the models addressing data sharing issues, and generative AI approaches to address challenges in model interpretability, and transparency. In conclusion, AI presents an opportunity to advance our understanding and management of MS. AI promises to aid clinicians in MS diagnosis and prognosis improving patient outcomes and quality of life, however ensuring the interpretability and transparency of AI-generated results is going to be key for facilitating the integration of AI into clinical practice.
Collapse
Affiliation(s)
- Moein Amin
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Eloy Martínez-Heras
- Neuroimmunology and Multiple Sclerosis Unit, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Ferran Prados Carrasco
- e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain.
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
- Center for Medical Image Computing, University College London, London, UK.
- National Institute for Health Research Biomedical Research Centre at UCL and UCLH, London, UK.
| |
Collapse
|
2
|
Stridh P, Huang J, Kockum I. From discovery to replication: Power and definitions matter for multiple sclerosis severity. Mult Scler 2024:13524585241265021. [PMID: 39054843 DOI: 10.1177/13524585241265021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Pernilla Stridh
- Karolinska Neuroimmunology and Multiple Sclerosis Center, Department of Clinical Neuroscience, Karolinska Insitutet, Stockholm, Sweden
| | - Jesse Huang
- Karolinska Neuroimmunology and Multiple Sclerosis Center, Department of Clinical Neuroscience, Karolinska Insitutet, Stockholm, Sweden
| | - Ingrid Kockum
- Karolinska Neuroimmunology and Multiple Sclerosis Center, Department of Clinical Neuroscience, Karolinska Insitutet, Stockholm, Sweden
| |
Collapse
|
3
|
Scalfari A, Traboulsee A, Oh J, Airas L, Bittner S, Calabrese M, Garcia Dominguez JM, Granziera C, Greenberg B, Hellwig K, Illes Z, Lycke J, Popescu V, Bagnato F, Giovannoni G. Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol 2024. [PMID: 39051525 DOI: 10.1002/ana.27034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Despite therapeutic suppression of relapses, multiple sclerosis (MS) patients often experience subtle deterioration, which extends beyond the definition of "progression independent of relapsing activity." We propose the concept of smouldering-associated-worsening (SAW), encompassing physical and cognitive symptoms, resulting from smouldering pathological processes, which remain unmet therapeutic targets. We provide a consensus-based framework of possible pathological substrates and manifestations of smouldering MS, and we discuss clinical, radiological, and serum/cerebrospinal fluid biomarkers for potentially monitoring SAW. Finally, we share considerations for optimizing disease surveillance and implications for clinical trials to promote the integration of smouldering MS into routine practice and future research efforts. ANN NEUROL 2024.
Collapse
Affiliation(s)
- Antonio Scalfari
- Center of Neuroscience, Department of Medicine, Charing Cross Hospital, Imperial College, London, UK
| | | | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Laura Airas
- University of Turku and Turku University Hospital, Turku, Finland
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Cristina Granziera
- Translational Imaging in Neurology (THiNK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurology and MS Center, University Hospital Basel Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Basel, Switzerland
| | | | | | - Zsolt Illes
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jan Lycke
- Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Popescu
- University MS Centre Pelt-Hasselt, Noorderhart Hospital, Belgium Hasselt University, Pelt, Belgium
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, VA Hospital, TN Valley Healthcare System, Nashville, TN, USA
| | - Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
4
|
Sun D, Wang R, Du Q, Chen H, Shi Z, Zhang Y, Zhang N, Wang X, Zhou H. Integrating genetic and proteomic data to elucidate the association between immune system and blood-brain barrier dysfunction with multiple sclerosis risk and severity. J Affect Disord 2024; 362:652-660. [PMID: 39029667 DOI: 10.1016/j.jad.2024.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Immune system dysfunction and blood-brain barrier (BBB) impairment are implicated in multiple sclerosis (MS) risk and severity. However, the causal relationships and potential therapeutic targets remain unclear. METHODS Leveraging the MRC IEU OpenGWAS data infrastructure, we extracted 1254 peripheral immune systems and 792 BBB biomarkers as genetic instruments for exposure. MS risk data from the International Multiple Sclerosis Genetics Consortium (IMSGC) (47,429 MS cases, 68,374 controls) served as one outcome, replicated in FinnGen (1048 cases, 217,141 controls) and the UK Biobank (1679 cases, 461,254 controls). Genetic associations with MS severity derived from IMSGC and MultipleMS Consortium GWAS data (12,584 cases). Two-sample, bidirectional, and protein drug-target MR analyses were conducted, along with interaction analysis of identified proteins and druggability assessment. RESULTS Causal relationships between 45 immunological markers, 15 BBB markers, and MS risk were strongly supported. In peripheral immunity, the causal associations with MS are predominantly concentrated in CD4+ T cells and CD8+ T cells. Notably, anti-Epstein-Barr virus nuclear antigen (EBNA) IgG levels exhibited the most significant causal effect on MS risk (OR = 225.62, P = 5.63E-208), replicated in the MS severity (OR = 1.11, P = 0.04). Weak causal evidence was found between 62 immunological markers, 35 BBB markers, and MS severity. Reverse MR analysis suggested potential causal effects of MS risk on 8 markers. Drug-targeted MR analysis indicated potential therapeutic benefits in reducing MS risk for CD40 (OR = 0.71, P = 7.24E-13, PPH4 = 97.6 %), AHSG (OR = 0.88, P = 2.91E-05, PPH4 = 94.4 %), and FCRL3 (Sun BB et al.: OR = 0.83, P = 8.93E-09, PPH4 = 94.2 %, Suhre K et al.: OR = 0.88, P = 5.20E-08, PPH4 = 99.2 %). CONCLUSIONS This study provides evidence supporting the causal effects of immune system and BBB dysfunction on MS risk and severity. It emphasizes the significant role of anti-EBNA IgG levels, CD4+ T cells, and CD8+ T cells in MS, and delineates the potential therapeutic benefits of targeting three proteins associated with MS risk: CD40, AHSG, and FCRL3.
Collapse
Affiliation(s)
- Dongren Sun
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Yangyang Zhang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Nana Zhang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China.
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang No. 37, Chengdu 610041, China.
| |
Collapse
|
5
|
Petrovska J, Coynel D, Freytag V, de Quervain DJF, Papassotiropoulos A. Polygenic susceptibility for multiple sclerosis is associated with working memory in low-performing young adults. J Neurol Sci 2024; 463:123138. [PMID: 39059048 DOI: 10.1016/j.jns.2024.123138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex disease with substantial heritability estimates. Besides typical clinical manifestations such as motor and sensory deficits, MS is characterized by structural and functional brain abnormalities, and by cognitive impairment such as decreased working memory (WM) performance. OBJECTIVES We investigated the possible link between the polygenic risk for MS and WM performance in healthy adults (18-35 years). Additionally, we addressed the relationship between polygenic risk for MS and white matter fractional anisotropy (FA). METHODS We generated a polygenic risk score (PRS) of MS susceptibility and investigated its association with WM performance in 3282 healthy adults (two subsamples, N1 = 1803, N2 = 1479). The association between MS-PRS and FA was studied in the second subsample. MS severity PRS associations were also investigated for the WM and FA measurements. RESULTS MS-PRS was significantly associated with WM performance within the 10% lowest WM-performing individuals (p = 0.001; pFDR = 0.018). It was not significantly associated with any of the investigated FA measurements. MS severity PRS was significantly associated with brain-wide mean FA (p = 0.041) and showed suggestive associations with additional FA measurements. CONCLUSIONS By identifying a genetic link between MS and WM performance this study contributes to the understanding of the genetic complexity of MS, and hopefully to the possible identification of molecular pathways linked to cognitive deficits in MS. It also contributes to the understanding of genetic associations with MS severity, as these associations seem to involve distinct biological pathways compared to genetic variants linked to the overall risk of developing MS.
Collapse
Affiliation(s)
- J Petrovska
- Division of Molecular Neuroscience, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland.
| | - D Coynel
- Division of Cognitive Neuroscience, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland
| | - V Freytag
- Division of Molecular Neuroscience, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland
| | - D J-F de Quervain
- Division of Cognitive Neuroscience, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, CH-4055 Basel, Switzerland
| | - A Papassotiropoulos
- Division of Molecular Neuroscience, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, CH-4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, CH-4055 Basel, Switzerland
| |
Collapse
|
6
|
Giordano A, Clarelli F, Pignolet B, Mascia E, Sorosina M, Misra K, Ferrè L, Bucciarelli F, Manouchehrinia A, Moiola L, Martinelli V, Rocca MA, Liblau R, Filippi M, Esposito F. Vitamin D affects the risk of disease activity in multiple sclerosis. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-334062. [PMID: 39004505 DOI: 10.1136/jnnp-2024-334062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Vitamin D (VitD) affects the risk of multiple sclerosis (MS), but the impact on disease activity is controversial. We assessed whether VitD is associated with the No-Evidence of Disease Activity-3 (NEDA-3) status at 2 years from disease-modifying treatment (DMT) start, and whether this association is causal or the result of confounding factors. Furthermore, we explored if a genetic predisposition to higher VitD levels affects the risk of disease activity. METHODS 230 untreated relapsing-remitting MS patients underwent serum 25-OH-vitamin-D measurement, and the association between seasonally adjusted VitD and disease activity was tested. Modelling a Polygenic Risk Score from a Genome-Wide Association Study on ~400 000 individuals, we studied the impact of genetic predisposition to higher VitD on the NEDA-3 status in 1408 independent MS patients. Two-sample Mendelian randomisation (MR) was used to assess causality. RESULTS Lower baseline VitD was associated with decreased probability of NEDA-3 at 2 years (p=0.019). Particularly, VitD levels <20 ng/mL conferred an over twofold risk of disease activity (OR 2.36, 95% CI 1.30 to 3.88, p=0.0037). Genetic predisposition to higher VitD levels was associated with delayed age at MS onset (p=0.018) and with a higher probability of NEDA-3 status (p=0.034). MR confirmed causality between VitD and the risk of disease activity (p=0.041). CONCLUSIONS VitD levels before DMT start affect the risk of disease activity in MS. Genetic predisposition to higher VitD levels confers a lower risk of disease activity and is associated with delayed MS onset. Our work prompts future prospective studies regarding VitD supplementation and lifestyle interventions to hamper disease activity in MS.
Collapse
Affiliation(s)
- Antonino Giordano
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita Salute San Raffaele, Milano, Italy
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ferdinando Clarelli
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Béatrice Pignolet
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, Toulouse, France
- Neurosciences Department, Toulouse University Hospital, Toulouse, France
| | - Elisabetta Mascia
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Melissa Sorosina
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kaalindi Misra
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Ferrè
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Florence Bucciarelli
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, Toulouse, France
| | | | - Lucia Moiola
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vittorio Martinelli
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria A Rocca
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita Salute San Raffaele, Milano, Italy
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roland Liblau
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, Toulouse, France
- Department of Immunology, Toulouse University Hospitals, Toulouse, France
| | - Massimo Filippi
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita Salute San Raffaele, Milano, Italy
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Esposito
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology and MS Center, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
7
|
Zveik O, Rechtman A, Ganz T, Vaknin-Dembinsky A. The interplay of inflammation and remyelination: rethinking MS treatment with a focus on oligodendrocyte progenitor cells. Mol Neurodegener 2024; 19:53. [PMID: 38997755 PMCID: PMC11245841 DOI: 10.1186/s13024-024-00742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) therapeutic goals have traditionally been dichotomized into two distinct avenues: immune-modulatory-centric interventions and pro-regenerative strategies. Oligodendrocyte progenitor cells (OPCs) were regarded for many years solely in concern to their potential to generate oligodendrocytes and myelin in the central nervous system (CNS). However, accumulating data elucidate the multifaceted roles of OPCs, including their immunomodulatory functions, positioning them as cardinal constituents of the CNS's immune landscape. MAIN BODY In this review, we will discuss how the two therapeutic approaches converge. We present a model by which (1) an inflammation is required for the appropriate pro-myelinating immune function of OPCs in the chronically inflamed CNS, and (2) the immune function of OPCs is crucial for their ability to differentiate and promote remyelination. This model highlights the reciprocal interactions between OPCs' pro-myelinating and immune-modulating functions. Additionally, we review the specific effects of anti- and pro-inflammatory interventions on OPCs, suggesting that immunosuppression adversely affects OPCs' differentiation and immune functions. CONCLUSION We suggest a multi-systemic therapeutic approach, which necessitates not a unidimensional focus but a harmonious balance between OPCs' pro-myelinating and immune-modulatory functions.
Collapse
Affiliation(s)
- Omri Zveik
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120, Israel
- The Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem P.O.B. 12000, Jerusalem, 91120, Israel
| | - Ariel Rechtman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120, Israel
- The Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem P.O.B. 12000, Jerusalem, 91120, Israel
| | - Tal Ganz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120, Israel
- The Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem P.O.B. 12000, Jerusalem, 91120, Israel
| | - Adi Vaknin-Dembinsky
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120, Israel.
- The Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem P.O.B. 12000, Jerusalem, 91120, Israel.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Kular L. The lung-brain axis in multiple sclerosis: Mechanistic insights and future directions. Brain Behav Immun Health 2024; 38:100787. [PMID: 38737964 PMCID: PMC11087231 DOI: 10.1016/j.bbih.2024.100787] [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: 11/30/2023] [Revised: 03/23/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system with progressive lifelong disability. Current treatments are particularly effective at the early inflammatory stage of the disease but associate with safety concerns such as increased risk of infection. While clinical and epidemiological evidence strongly support the role of a bidirectional communication between the lung and the brain in MS in influencing disease risk and severity, the exact processes underlying such relationship appear complex and not fully understood. This short review aims to summarize key findings and future perspectives that might provide new insights into the mechanisms underpinning the lung-brain axis in MS.
Collapse
Affiliation(s)
- Lara Kular
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
10
|
Woo MS, Engler JB, Friese MA. The neuropathobiology of multiple sclerosis. Nat Rev Neurosci 2024; 25:493-513. [PMID: 38789516 DOI: 10.1038/s41583-024-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Chronic low-grade inflammation and neuronal deregulation are two components of a smoldering disease activity that drives the progression of disability in people with multiple sclerosis (MS). Although several therapies exist to dampen the acute inflammation that drives MS relapses, therapeutic options to halt chronic disability progression are a major unmet clinical need. The development of such therapies is hindered by our limited understanding of the neuron-intrinsic determinants of resilience or vulnerability to inflammation. In this Review, we provide a neuron-centric overview of recent advances in deciphering neuronal response patterns that drive the pathology of MS. We describe the inflammatory CNS environment that initiates neurotoxicity by imposing ion imbalance, excitotoxicity and oxidative stress, and by direct neuro-immune interactions, which collectively lead to mitochondrial dysfunction and epigenetic dysregulation. The neuronal demise is further amplified by breakdown of neuronal transport, accumulation of cytosolic proteins and activation of cell death pathways. Continuous neuronal damage perpetuates CNS inflammation by activating surrounding glia cells and by directly exerting toxicity on neighbouring neurons. Further, we explore strategies to overcome neuronal deregulation in MS and compile a selection of neuronal actuators shown to impact neurodegeneration in preclinical studies. We conclude by discussing the therapeutic potential of targeting such neuronal actuators in MS, including some that have already been tested in interventional clinical trials.
Collapse
Affiliation(s)
- Marcel S Woo
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
11
|
Holt EA, Tyler A, Lakusta-Wong T, Lahue KG, Hankes KC, Teuscher C, Lynch RM, Ferris MT, Mahoney JM, Krementsov DN. Probing the basis of disease heterogeneity in multiple sclerosis using genetically diverse mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.03.597205. [PMID: 38895248 PMCID: PMC11185616 DOI: 10.1101/2024.06.03.597205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Multiple sclerosis (MS) is a complex disease with significant heterogeneity in disease course and progression. Genetic studies have identified numerous loci associated with MS risk, but the genetic basis of disease progression remains elusive. To address this, we leveraged the Collaborative Cross (CC), a genetically diverse mouse strain panel, and experimental autoimmune encephalomyelitis (EAE). The thirty-two CC strains studied captured a wide spectrum of EAE severity, trajectory, and presentation, including severe-progressive, monophasic, relapsing remitting, and axial rotary (AR)-EAE, accompanied by distinct immunopathology. Sex differences in EAE severity were observed in six strains. Quantitative trait locus analysis revealed distinct genetic linkage patterns for different EAE phenotypes, including EAE severity and incidence of AR-EAE. Machine learning-based approaches prioritized candidate genes for loci underlying EAE severity ( Abcc4 and Gpc6 ) and AR-EAE ( Yap1 and Dync2h1 ). This work expands the EAE phenotypic repertoire and identifies novel loci controlling unique EAE phenotypes, supporting the hypothesis that heterogeneity in MS disease course is driven by genetic variation. Summary The genetic basis of disease heterogeneity in multiple sclerosis (MS) remains elusive. We leveraged the Collaborative Cross to expand the phenotypic repertoire of the experimental autoimmune encephalomyelitis (EAE) model of MS and identify loci controlling EAE severity, trajectory, and presentation.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Misicka E, Huang Y, Loomis S, Sadhu N, Fisher E, Gafson A, Runz H, Tsai E, Jia X, Herman A, Bronson PG, Bhangale T, Briggs FB. Adaptive and Innate Immunity Are Key Drivers of Age at Onset of Multiple Sclerosis. Neurol Genet 2024; 10:e200159. [PMID: 38817245 PMCID: PMC11139017 DOI: 10.1212/nxg.0000000000200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 06/01/2024]
Abstract
Background and Objectives Multiple sclerosis (MS) age at onset (AAO) is a clinical predictor of long-term disease outcomes, independent of disease duration. Little is known about the genetic and biological mechanisms underlying age of first symptoms. We conducted a genome-wide association study (GWAS) to investigate associations between individual genetic variation and the MS AAO phenotype. Methods The study population was comprised participants with MS in 6 clinical trials: ADVANCE (N = 655; relapsing-remitting [RR] MS), ASCEND (N = 555; secondary-progressive [SP] MS), DECIDE (N = 1,017; RRMS), OPERA1 (N = 581; RRMS), OPERA2 (N = 577; RRMS), and ORATORIO (N = 529; primary-progressive [PP] MS). Altogether, 3,905 persons with MS of European ancestry were analyzed. GWAS were conducted for MS AAO in each trial using linear additive models controlling for sex and 10 principal components. Resultant summary statistics across the 6 trials were then meta-analyzed, for a total of 8.3 × 10-6 single nucleotide polymorphisms (SNPs) across all trials after quality control and filtering for heterogeneity. Gene-based tests of associations, pathway enrichment analyses, and Mendelian randomization analyses for select exposures were also performed. Results Four lead SNPs within 2 loci were identified (p < 5 × 10-8), including a) 3 SNPs in the major histocompatibility complex and their effects were independent of HLA-DRB1*15:01 and b) a LOC105375167 variant on chromosome 7. At the gene level, the top association was HLA-C (p = 1.2 × 10-7), which plays an important role in antiviral immunity. Functional annotation revealed the enrichment of pathways related to T-cell receptor signaling, autoimmunity, and the complement cascade. Mendelian randomization analyses suggested a link between both earlier age at puberty and shorter telomere length and earlier AAO, while there was no evidence for a role for either body mass index or vitamin D levels. Discussion Two genetic loci associated with MS AAO were identified, and functional annotation demonstrated an enrichment of genes involved in adaptive and complement immunity. There was also evidence supporting a link with age at puberty and telomere length. The findings suggest that AAO in MS is multifactorial, and the factors driving onset of symptoms overlap with those influencing MS risk.
Collapse
Affiliation(s)
- Elina Misicka
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Yunfeng Huang
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Stephanie Loomis
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Nilanjana Sadhu
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Elizabeth Fisher
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Arie Gafson
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Heiko Runz
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Ellen Tsai
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Xiaoming Jia
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Ann Herman
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Paola G Bronson
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Tushar Bhangale
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| | - Farren B Briggs
- From the Department of Population and Quantitative Health Sciences (E.M.), Case Western Reserve University, Cleveland, OH; Biogen (Y.H., S.L., N.S., E.F., A.G., H.R., E.T., P.G.B.), Cambridge, MA; Human Genetics and Bioinformatics (X.J., A.H., T.B.), Genentech, San Francisco, CA; and Department of Public Health Sciences (F.B.B.), University of Miami, FL
| |
Collapse
|
14
|
Tarlinton R, Tanasescu R, Shannon-Lowe C, Gran B. Ocrelizumab B cell depletion has no effect on HERV RNA expression in PBMC in MS patients. Mult Scler Relat Disord 2024; 86:105597. [PMID: 38598954 DOI: 10.1016/j.msard.2024.105597] [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: 11/02/2023] [Revised: 01/29/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Epstein barr virus (EBV) infection of B cells is now understood to be one of the triggering events for the development of Multiple Sclerosis (MS), a progressive immune-mediated disease of the central nervous system. EBV infection is also linked to expression of human endogenous retroviruses (HERVs) of the HERV-W group, a further risk factor for the development of MS. Ocrelizumab is a high-potency disease-modifying treatment (DMT) for MS, which depletes B cells by targeting CD20. OBJECTIVES We studied the effects of ocrelizumab on gene expression in peripheral blood mononuclear cells (PBMC) from paired samples from 20 patients taken prior to and 6 months after beginning ocrelizumab therapy. We hypothesised that EBV and HERV-W loads would be lower in post-treatment samples. METHODS Samples were collected in Paxgene tubes, subject to RNA extraction and Illumina paired end short read mRNA sequencing with mapping of sequence reads to the human genome using Salmon and differential gene expression compared with DeSeq2. Mapping was also performed separately to the HERV-D database of HERV sequences and the EBV reference sequence. RESULTS Patient samples were more strongly clustered by individual rather than disease type (relapsing/remitting or primary progressive), treatment (pre and post), age, or sex. Fourteen genes, all clearly linked to B cell function were significantly down regulated in the post treatment samples. Interestingly only one pre-treatment sample had detectable EBV RNA and there were no significant differences in HERV expression (of any group) between pre- and post-treatment samples. CONCLUSIONS While EBV and HERV expression are clearly linked to triggering MS pathogenesis, it does not appear that high level expression of these viruses is a part of the ongoing disease process or that changes in virus load are associated with ocrelizumab treatment.
Collapse
Affiliation(s)
- Rachael Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom.
| | - Radu Tanasescu
- Department of Neurology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham, United Kingdom; School of Medicine, University of Nottingham, University Park Campus, Nottingham, United Kingdom
| | - Claire Shannon-Lowe
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bruno Gran
- Department of Neurology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham, United Kingdom; School of Medicine, University of Nottingham, University Park Campus, Nottingham, United Kingdom
| |
Collapse
|
15
|
Nan H. Causal effects of dietary composition on multiple sclerosis risk and severity: a Mendelian randomization study. Front Nutr 2024; 11:1410745. [PMID: 38873562 PMCID: PMC11169663 DOI: 10.3389/fnut.2024.1410745] [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: 04/02/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives Observational studies have found potential associations between dietary intake and multiple sclerosis (MS). However, these associations are inconsistent, and the causal relationship remains unclear. In this study, we aim to examine the causal relationship between genetically predicted dietary composition and the risk and severity of MS using two-sample Mendelian randomization. Method Genetic instruments for 30 different dietary compositions were extracted from large-scale genome-wide association studies (GWAS), mainly from the UK Biobank dataset. The GWAS data for MS risk and severity were obtained from the International Multiple Sclerosis Genetics Consortium. The primary analysis employed either the inverse variance weighted method or the Wald ratio method to evaluate the causal association. Several sensitivity analyses were also performed. Results Genetically predicted higher pork intake was causally associated with an increased risk of MS (odds ratio [OR] = 6.76; p = 0.005), while genetically driven higher cereal intake (OR = 0.43, p = 0.016), vitamin C supplement (OR < 0.01; p = 4.34 × 10-5), folic acid supplement (OR < 0.01; p = 4.91 × 10-71), and fish oil supplement (OR = 0.04; p = 0.017) were causally linked to a decreased risk of MS. In addition, genetically predicted higher alcoholic intake (OR = 1.17; p = 0.041) was causally associated with an increase in MS severity, while folic acid supplement (OR < 0.01; p = 0.015) was causally linked to a decrease in MS severity. Interpretation This study found that increased consumption of cereal, vitamin C, folic acid, and fish oil, coupled with reduced pork and alcohol intake, may potentially decrease the risk and severity of MS. These findings inform the development of dietary-based strategies for MS prevention and treatment.
Collapse
Affiliation(s)
- Haitian Nan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
16
|
Peters A, Gerdes LA, Wekerle H. Multiple sclerosis and the intestine: Chasing the microbial offender. Immunol Rev 2024. [PMID: 38809041 DOI: 10.1111/imr.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Multiple sclerosis (MS) affects more than 2.8 million people worldwide but the distribution is not even. Although over 200 gene variants have been associated with susceptibility, studies of genetically identical monozygotic twin pairs suggest that the genetic make-up is responsible for only about 20%-30% of the risk to develop disease, while the rest is contributed by milieu factors. Recently, a new, unexpected player has entered the ranks of MS-triggering or facilitating elements: the human gut microbiota. In this review, we summarize the present knowledge of microbial effects on formation of a pathogenic autoreactive immune response targeting the distant central nervous system and delineate the approaches, both in people with MS and in MS animal models, which have led to this concept. Finally, we propose that a tight combination of investigations of human patients with studies of suitable animal models is the best strategy to functionally characterize disease-associated microbiota and thereby contribute to deciphering pathogenesis of a complex human disease.
Collapse
Affiliation(s)
- Anneli Peters
- Institute of Clinical Neuroimmunology, University Hospital Ludwig-Maximilians-Universität München, Munich, Germany
- Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Lisa Ann Gerdes
- Institute of Clinical Neuroimmunology, University Hospital Ludwig-Maximilians-Universität München, Munich, Germany
- Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Martinsried, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Hartmut Wekerle
- Institute of Clinical Neuroimmunology, University Hospital Ludwig-Maximilians-Universität München, Munich, Germany
- Max Planck Institute for Biological Intelligence, Martinsried, Germany
| |
Collapse
|
17
|
de Boer A, van den Bosch AMR, Mekkes NJ, Fransen NL, Dagkesamanskaia E, Hoekstra E, Hamann J, Smolders J, Huitinga I, Holtman IR. Disentangling the heterogeneity of multiple sclerosis through identification of independent neuropathological dimensions. Acta Neuropathol 2024; 147:90. [PMID: 38771530 PMCID: PMC11108935 DOI: 10.1007/s00401-024-02742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
Multiple sclerosis (MS) is a heterogeneous neurological disorder with regards to clinical presentation and pathophysiology. Here, we investigated the heterogeneity of MS by performing an exploratory factor analysis on quantitative and qualitative neuropathology data collected for 226 MS donors in the Netherlands Brain Bank autopsy cohort. Three promising dimensions were identified and subsequently validated with clinical, neuropathological, and genetic data. Dimension 1 ranged from a predominance of remyelinated and inactive lesions to extensive pathological changes, higher proportions of active and mixed lesions, and foamy microglia morphology. This pattern was positively correlated with more severe disease, the presence of B and T cells, and neuroaxonal damage. Scoring high on dimension 2 was associated with active lesions, reactive sites, and the presence of nodules. These donors had less severe disease, a specific pattern of cortical lesions, and MS risk variants in the human leukocyte antigen region, the latter indicating a connection between disease onset and this neuropathological dimension. Donors scoring high on dimension 3 showed increased lesional pathology with relatively more mixed and inactive lesions and ramified microglia morphology. This pattern was associated with longer disease duration, subpial cortical lesions, less involvement of the adaptive immune system, and less axonal damage. Taken together, the three dimensions may represent (1) demyelination and immune cell activity associated with pathological and clinical progression, (2) microglia (re)activity and possibly lesion initiation, and (3) loss of lesion activity and scar formation. Our findings highlight that a thorough understanding of the interplay between multiple pathological characteristics is crucial to understand the heterogeneity of MS pathology, as well as its association with genetic predictors and disease outcomes. The scores of donors on the dimensions can serve as an important starting point for further disentanglement of MS heterogeneity and translation into observations and interventions in living cohorts with MS.
Collapse
Affiliation(s)
- Alyse de Boer
- Section Molecular Neurobiology, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Aletta M R van den Bosch
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Nienke J Mekkes
- Section Molecular Neurobiology, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Machine Learning Lab, Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nina L Fransen
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Ekaterina Dagkesamanskaia
- Section Molecular Neurobiology, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Machine Learning Lab, Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric Hoekstra
- Section Molecular Neurobiology, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jörg Hamann
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Department of Experimental Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joost Smolders
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- MS Center ErasMS, Departments of Neurology and Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inge Huitinga
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Inge R Holtman
- Section Molecular Neurobiology, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Machine Learning Lab, Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
| |
Collapse
|
18
|
Winschel I, Willing A, Engler JB, Walkenhorst M, Meurs N, Binkle-Ladisch L, Woo MS, Pfeffer LK, Sonner JK, Borgmeyer U, Hagen SH, Grünhagel B, Claussen JM, Altfeld M, Friese MA. Sex- and species-specific contribution of CD99 to T cell costimulation during multiple sclerosis. Biol Sex Differ 2024; 15:41. [PMID: 38750588 PMCID: PMC11097467 DOI: 10.1186/s13293-024-00618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Differences in immune responses between women and men are leading to a strong sex bias in the incidence of autoimmune diseases that predominantly affect women, such as multiple sclerosis (MS). MS manifests in more than twice as many women, making sex one of the most important risk factor. However, it is incompletely understood which genes contribute to sex differences in autoimmune incidence. To address that, we conducted a gene expression analysis in female and male human spleen and identified the transmembrane protein CD99 as one of the most significantly differentially expressed genes with marked increase in men. CD99 has been reported to participate in immune cell transmigration and T cell regulation, but sex-specific implications have not been comprehensively investigated. METHODS In this study, we conducted a gene expression analysis in female and male human spleen using the Genotype-Tissue Expression (GTEx) project dataset to identify differentially expressed genes between women and men. After successful validation on protein level of human immune cell subsets, we assessed hormonal regulation of CD99 as well as its implication on T cell regulation in primary human T cells and Jurkat T cells. In addition, we performed in vivo assays in wildtype mice and in Cd99-deficient mice to further analyze functional consequences of differential CD99 expression. RESULTS Here, we found higher CD99 gene expression in male human spleens compared to females and confirmed this expression difference on protein level on the surface of T cells and pDCs. Androgens are likely dispensable as the cause shown by in vitro assays and ex vivo analysis of trans men samples. In cerebrospinal fluid, CD99 was higher on T cells compared to blood. Of note, male MS patients had lower CD99 levels on CD4+ T cells in the CSF, unlike controls. By contrast, both sexes had similar CD99 expression in mice and Cd99-deficient mice showed equal susceptibility to experimental autoimmune encephalomyelitis compared to wildtypes. Functionally, CD99 increased upon human T cell activation and inhibited T cell proliferation after blockade. Accordingly, CD99-deficient Jurkat T cells showed decreased cell proliferation and cluster formation, rescued by CD99 reintroduction. CONCLUSIONS Our results demonstrate that CD99 is sex-specifically regulated in healthy individuals and MS patients and that it is involved in T cell costimulation in humans but not in mice. CD99 could potentially contribute to MS incidence and susceptibility in a sex-specific manner.
Collapse
Affiliation(s)
- Ingo Winschel
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Willing
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Walkenhorst
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Meurs
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Binkle-Ladisch
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel S Woo
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Kristina Pfeffer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana K Sonner
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Borgmeyer
- Center of Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Hendrik Hagen
- Research Department Virus Immunology, Leibniz Institute of Virology, Hamburg, Germany
| | - Benjamin Grünhagel
- Research Department Virus Immunology, Leibniz Institute of Virology, Hamburg, Germany
| | - Janna M Claussen
- Research Department Virus Immunology, Leibniz Institute of Virology, Hamburg, Germany
| | - Marcus Altfeld
- Research Department Virus Immunology, Leibniz Institute of Virology, Hamburg, Germany
| | - Manuel A Friese
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Wang W, Huang M, Ge W, Feng J, Zhang X, Li C, Wang L. Identifying serum metabolite biomarkers for autoimmune diseases: a two-sample mendelian randomization and meta-analysis. Front Immunol 2024; 15:1300457. [PMID: 38686387 PMCID: PMC11056515 DOI: 10.3389/fimmu.2024.1300457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Background Extensive evidence suggests a link between alterations in serum metabolite composition and various autoimmune diseases (ADs). Nevertheless, the causal relationship underlying these correlations and their potential utility as dependable biomarkers for early AD detection remain uncertain. Objective The objective of this study was to employ a two-sample Mendelian randomization (MR) approach to ascertain the causal relationship between serum metabolites and ADs. Additionally, a meta-analysis incorporating data from diverse samples was conducted to enhance the validation of this causal effect. Materials and methods A two-sample MR analysis was performed to investigate the association between 486 human serum metabolites and six prevalent autoimmune diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), dermatomyositis (DM), type 1 diabetes (T1D), and celiac disease (CeD). The inverse variance weighted (IVW) model was employed as the primary analytical technique for the two-sample MR analysis, aiming to identify blood metabolites linked with autoimmune diseases. Independent outcome samples were utilized for further validation of significant blood metabolites. Additional sensitivity analyses, including heterogeneity test, horizontal pleiotropy test, and retention rate analysis, were conducted. The results from these analyses were subsequently meta-integrated. Finally, metabolic pathway analysis was performed using the KEGG and Small Molecule Pathway Databases (SMPD). Results Following the discovery and replication phases, eight metabolites were identified as causally associated with various autoimmune diseases, encompassing five lipid metabolism types: 1-oleoylglycerophosphoethanolamine, 1-arachidonoylglycerophosphoethanolamine, 1-myristoylglycerophosphocholine, arachidonate (20:4 n6), and glycerol. The meta-analysis indicated that three out of these eight metabolites exhibited a protective effect, while the remaining five were designated as pathogenic factors. The robustness of these associations was further confirmed through sensitivity analysis. Moreover, an investigation into metabolic pathways revealed a significant correlation between galactose metabolism and autoimmune diseases. Conclusion This study revealed a causal relationship between lipid metabolites and ADs, providing novel insights into the mechanism of AD development mediated by serum metabolites and possible biomarkers for early diagnosis.
Collapse
Affiliation(s)
- Wenwen Wang
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Manli Huang
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Wei Ge
- Department of Field and Disaster Nursing, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Junling Feng
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xihua Zhang
- Department of Neurological Intensive Care Rehabilitation, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Chen Li
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ling Wang
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi’an, Shaanxi, China
| |
Collapse
|
21
|
Menéndez-Pérez C, Rivas-Santisteban R, del Valle E, Tolivia J, Navarro A, Franco R, Martínez-Pinilla E. Heteromers Formed by GPR55 and Either Cannabinoid CB 1 or CB 2 Receptors Are Upregulated in the Prefrontal Cortex of Multiple Sclerosis Patients. Int J Mol Sci 2024; 25:4176. [PMID: 38673761 PMCID: PMC11050292 DOI: 10.3390/ijms25084176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory, and neurodegenerative disease of the central nervous system for which there is no cure, making it necessary to search for new treatments. The endocannabinoid system (ECS) plays a very important neuromodulatory role in the CNS. In recent years, the formation of heteromers containing cannabinoid receptors and their up/downregulation in some neurodegenerative diseases have been demonstrated. Despite the beneficial effects shown by some phytocannabinoids in MS, the role of the ECS in its pathophysiology is unknown. The main objective of this work was to identify heteromers of cell surface proteins receptive to cannabinoids, namely GPR55, CB1 and CB2 receptors, in brain samples from control subjects and MS patients, as well as determining their cellular localization, using In Situ Proximity Ligation Assays and immunohistochemical techniques. For the first time, CB1R-GPR55 and CB2R-GPR55 heteromers are identified in the prefrontal cortex of the human brain, more in the grey than in the white matter. Remarkably, the number of CB1R-GPR55 and CB2R-GPR55 complexes was found to be increased in MS patient samples. The results obtained open a promising avenue of research on the use of these receptor complexes as potential therapeutic targets for the disease.
Collapse
Affiliation(s)
- Carlota Menéndez-Pérez
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Rafael Rivas-Santisteban
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (R.R.-S.); (R.F.)
- CiberNed, Network Center for Neurodegenerative Diseases, National Spanish Health Institute Carlos III, 28031 Madrid, Spain
- Laboratory of Computational Medicine, Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Bellaterra, Spain
| | - Eva del Valle
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Jorge Tolivia
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Ana Navarro
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Rafael Franco
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (R.R.-S.); (R.F.)
- CiberNed, Network Center for Neurodegenerative Diseases, National Spanish Health Institute Carlos III, 28031 Madrid, Spain
| | - Eva Martínez-Pinilla
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain; (C.M.-P.); (E.d.V.); (J.T.); (A.N.)
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| |
Collapse
|
22
|
Campagna MP, Havrdova EK, Horakova D, Izquierdo G, Matesanz F, Eichau S, Lechner-Scott J, Taylor BV, García-Sanchéz MI, Alcina A, van der Walt A, Butzkueven H, Jokubaitis VG. No evidence for association between rs10191329 severity locus and longitudinal disease severity in 1813 relapse-onset multiple sclerosis patients from the MSBase registry. Mult Scler 2024:13524585241240406. [PMID: 38511853 DOI: 10.1177/13524585241240406] [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: 03/22/2024]
Abstract
BACKGROUND The International Multiple Sclerosis Genetics Consortium and MultipleMS Consortium recently reported a genetic variant associated with multiple sclerosis (MS) severity. However, it remains unclear if these variants remain associated with more robust, longitudinal measures of disease severity. METHODS We examined the top variant, rs10191329, from Harroud et al.'s study in 1813 relapse-onset MS patients from the MSBase Registry to assess association with longitudinal disease severity. RESULTS Our analysis revealed no significant association between rs10191329 genotype and longitudinal binary disease severity (p > 0.05). CONCLUSION These findings highlight the complexity of genetic factors mediating long-term MS outcomes and the need for further research.
Collapse
Affiliation(s)
- Maria Pia Campagna
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Eva Kubala Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Fuencisla Matesanz
- Instituto de Parasitología y Biomedicina López Neyra, CSIC, Granada, Spain
| | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Maria-Isabel García-Sanchéz
- UGC Neurología, Hospital Universitario Virgen Macarena, Nodo Biobanco del Sistema Sanitario Público de Andalucía, Sevilla, Spain
| | - Antonio Alcina
- Instituto de Parasitología y Biomedicina López Neyra, CSIC, Granada, Spain
| | - Anneke van der Walt
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
23
|
Kreft KL, Uzochukwu E, Loveless S, Willis M, Wynford-Thomas R, Harding KE, Holmans P, Lawton M, Tallantyre EC, Robertson NP. Relevance of Multiple Sclerosis Severity Genotype in Predicting Disease Course: A Real-World Cohort. Ann Neurol 2024; 95:459-470. [PMID: 37974536 DOI: 10.1002/ana.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Currently, 233 genetic loci are known to be associated with susceptibility to multiple sclerosis (MS). Two independent pivotal severity genome-wide association studies recently found the first genome-wide significant single-nucleotide variant (SNV; rs10191329A ) and several other suggestive loci associated with overall disability outcomes. It is now important to understand if these findings can influence individual patient management. METHODS We assessed whether these progression SNVs are associated with detailed clinical phenotypes in a well-characterized prospective cohort of 1,455 MS patients. We used logistic regression, survival analysis, and propensity score matching to predict relevant long-term clinical outcomes. RESULTS We were unable to detect any association between rs10191329A and a range of clinically relevant outcomes (eg, time to Expanded Disability Status Scale milestones, age-related MS severity score, anatomical localization at onset or during subsequent relapses, annualized relapse rate). In addition, an extremes of outcome case-control analysis using a propensity score matching for genotype detected no association between disease severity and rs10191329A . However, we were able to replicate the association of two suggestive SNVs (rs7289446G and rs868824C ) with the development of fixed disability, albeit with modest effect sizes, and the association of HLA-DRB1*1501 with age at onset. INTERPRETATION Identification of rs10191329A and other suggestive SNVs are of considerable importance in understanding pathophysiological processes associated with MS severity. However, it is unlikely that individual genotyping can currently be used in a clinical setting to guide disease management. This study shows the importance of independent replication of genome-wide association studies associated with disease progression in neurodegenerative disorders. ANN NEUROL 2024;95:459-470.
Collapse
Affiliation(s)
- Karim L Kreft
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Emeka Uzochukwu
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Sam Loveless
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Mark Willis
- Department of Neurology, University Hospital of Wales, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Ray Wynford-Thomas
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | - Peter Holmans
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Michael Lawton
- Bristol Medical School (PHS), Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Emma C Tallantyre
- Department of Neurology, University Hospital of Wales, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Neil P Robertson
- Department of Neurology, University Hospital of Wales, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| |
Collapse
|
24
|
Gagnon E, Daghlas I, Zagkos L, Sargurupremraj M, Georgakis MK, Anderson CD, Cronje HT, Burgess S, Arsenault BJ, Gill D. Mendelian Randomization Applied to Neurology: Promises and Challenges. Neurology 2024; 102:e209128. [PMID: 38261980 PMCID: PMC7615637 DOI: 10.1212/wnl.0000000000209128] [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: 09/11/2023] [Accepted: 11/16/2023] [Indexed: 01/25/2024] Open
Abstract
The Mendelian randomization (MR) paradigm allows for causal inferences to be drawn using genetic data. In recent years, the expansion of well-powered publicly available genetic association data related to phenotypes such as brain tissue gene expression, brain imaging, and neurologic diseases offers exciting opportunities for the application of MR in the field of neurology. In this review, we discuss the basic principles of MR, its myriad applications to research in neurology, and potential pitfalls of injudicious applications. Throughout, we provide examples where MR-informed findings have shed light on long-standing epidemiologic controversies, provided insights into the pathophysiology of neurologic conditions, prioritized drug targets, and informed drug repurposing opportunities. With the ever-expanding availability of genome-wide association data, we project MR to become a key driver of progress in the field of neurology. It is therefore paramount that academics and clinicians within the field are familiar with the approach.
Collapse
Affiliation(s)
- Eloi Gagnon
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Iyas Daghlas
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Loukas Zagkos
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Muralidharan Sargurupremraj
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Marios K Georgakis
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Christopher D Anderson
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Helene T Cronje
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Stephen Burgess
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Benoit J Arsenault
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| | - Dipender Gill
- From the Quebec Heart and Lung Institute (E.G., B.J.A.), Laval University, Quebec, Canada; Department of Neurology (I.D.), University of California San Francisco; Department of Epidemiology and Biostatistics (L.Z., D.G.), School of Public Health, Imperial College London, United Kingdom; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (M.S.), University of Texas Health Sciences Center, San Antonio; Broad Institute of MIT and Harvard (M.K.G., C.D.A.), Cambridge, MA; Institute for Stroke and Dementia Research (ISD) (M.K.G.), University Hospital, LMU Munich, Germany; Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital; Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA; Department of Public Health (H.T.C.), Section of Epidemiology, University of Copenhagen, Denmark; MRC Biostatistics Unit (S.B.), and Cardiovascular Epidemiology Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, United Kingdom; and Department of Medicine (B.J.A.), Faculty of Medicine, Université Laval, Québec, Canada
| |
Collapse
|
25
|
Chen L, Zhu LF, Zhang LY, Chu YH, Dong MH, Pang XW, Yang S, Zhou LQ, Shang K, Xiao J, Wang W, Qin C, Tian DS. Causal association between the peripheral immunity and the risk and disease severity of multiple sclerosis. Front Immunol 2024; 15:1325938. [PMID: 38390334 PMCID: PMC10881847 DOI: 10.3389/fimmu.2024.1325938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background Growing evidence links immunological responses to Multiple sclerosis (MS), but specific immune factors are still unclear. Methods Mendelian randomization (MR) was performed to investigate the association between peripheral hematological traits, MS risk, and its severity. Then, further subgroup analysis of immune counts and circulating cytokines and growth factors were performed. Results MR revealed higher white blood cell count (OR [95%CI] = 1.26 [1.10,1.44], P = 1.12E-03, P adjust = 3.35E-03) and lymphocyte count (OR [95%CI] = 1.31 [1.15,1.50], P = 5.37E-05, P adjust = 3.22E-04) increased the risk of MS. In further analysis, higher T cell absolute count (OR [95%CI] = 2.04 [1.36,3.08], P = 6.37E-04, P adjust = 2.19E-02) and CD4+ T cell absolute count (OR [95%CI] = 2.11 [1.37,3.24], P = 6.37E-04, P adjust = 2.19E-02), could increase MS risk. While increasing CD25++CD4+ T cell absolute count (OR [95%CI] = 0.75 [0.66,0.86], P = 2.12E-05, P adjust = 1.72E-03), CD25++CD4+ T cell in T cell (OR [95%CI] = 0.79[0.70,0.89], P = 8.54E-05, P adjust = 5.29E-03), CD25++CD4+ T cell in CD4+ T cell (OR [95%CI] = 0.80[0.72,0.89], P = 1.85E-05, P adjust = 1.72E-03), and CD25++CD8+ T cell in T cell (OR [95%CI] = 0.68[0.57,0.81], P = 2.22E-05, P adjust = 1.72E-03), were proved to be causally defensive for MS. For the disease severity, the suggestive association between some traits related to CD4+ T cell, Tregs and MS severity were demonstrated. Moreover, elevated levels of IL-2Ra had a detrimental effect on the risk of MS (OR [95%CI] = 1.22 [1.12,1.32], P = 3.20E-06, P adjust = 1.34E-04). Conclusions This study demonstrated a genetically predicted causal relationship between elevated peripheral immune cell counts and MS. Subgroup analysis revealed a specific contribution of peripheral immune cells, holding potential for further investigations into the underlying mechanisms of MS and its severity.
Collapse
Affiliation(s)
- Lian Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Fang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Lu-Yang Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Hao Dong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Wei Pang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Shang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Xiao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
26
|
Ban M, Bredikhin D, Huang Y, Bonder MJ, Katarzyna K, Oliver AJ, Wilson NK, Coupland P, Hadfield J, Göttgens B, Madissoon E, Stegle O, Sawcer S. Expression profiling of cerebrospinal fluid identifies dysregulated antiviral mechanisms in multiple sclerosis. Brain 2024; 147:554-565. [PMID: 38038362 PMCID: PMC10834244 DOI: 10.1093/brain/awad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023] Open
Abstract
Despite the overwhelming evidence that multiple sclerosis is an autoimmune disease, relatively little is known about the precise nature of the immune dysregulation underlying the development of the disease. Reasoning that the CSF from patients might be enriched for cells relevant in pathogenesis, we have completed a high-resolution single-cell analysis of 96 732 CSF cells collected from 33 patients with multiple sclerosis (n = 48 675) and 48 patients with other neurological diseases (n = 48 057). Completing comprehensive cell type annotation, we identified a rare population of CD8+ T cells, characterized by the upregulation of inhibitory receptors, increased in patients with multiple sclerosis. Applying a Multi-Omics Factor Analysis to these single-cell data further revealed that activity in pathways responsible for controlling inflammatory and type 1 interferon responses are altered in multiple sclerosis in both T cells and myeloid cells. We also undertook a systematic search for expression quantitative trait loci in the CSF cells. Of particular interest were two expression quantitative trait loci in CD8+ T cells that were fine mapped to multiple sclerosis susceptibility variants in the viral control genes ZC3HAV1 (rs10271373) and IFITM2 (rs1059091). Further analysis suggests that these associations likely reflect genetic effects on RNA splicing and cell-type specific gene expression respectively. Collectively, our study suggests that alterations in viral control mechanisms might be important in the development of multiple sclerosis.
Collapse
Affiliation(s)
- Maria Ban
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Danila Bredikhin
- European Molecular Biology Laboratory, Genome Biology Unit, 69117 Heidelberg, Germany
- Division of Computational Genomics and Systems Genetics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Yuanhua Huang
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute, Cambridge CB10 1SD, UK
| | - Marc Jan Bonder
- European Molecular Biology Laboratory, Genome Biology Unit, 69117 Heidelberg, Germany
- Division of Computational Genomics and Systems Genetics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Kania Katarzyna
- University of Cambridge, CRUK Cambridge Institute, Cambridge CB2 0RE, UK
| | - Amanda J Oliver
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Nicola K Wilson
- Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
- Wellcome-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Paul Coupland
- University of Cambridge, CRUK Cambridge Institute, Cambridge CB2 0RE, UK
| | - James Hadfield
- University of Cambridge, CRUK Cambridge Institute, Cambridge CB2 0RE, UK
| | - Berthold Göttgens
- Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
- Wellcome-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Elo Madissoon
- European Molecular Biology Laboratory, European Bioinformatics Institute, Cambridge CB10 1SD, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Oliver Stegle
- European Molecular Biology Laboratory, Genome Biology Unit, 69117 Heidelberg, Germany
- Division of Computational Genomics and Systems Genetics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- European Molecular Biology Laboratory, European Bioinformatics Institute, Cambridge CB10 1SD, UK
| | - Stephen Sawcer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| |
Collapse
|
27
|
Alamad B, Elliott K, Knight JC. Cross-population applications of genomics to understand the risk of multifactorial traits involving inflammation and immunity. CAMBRIDGE PRISMS. PRECISION MEDICINE 2024; 2:e3. [PMID: 38549844 PMCID: PMC10953767 DOI: 10.1017/pcm.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 04/26/2024]
Abstract
The interplay between genetic and environmental factors plays a significant role in interindividual variation in immune and inflammatory responses. The availability of high-throughput low-cost genotyping and next-generation sequencing has revolutionized our ability to identify human genetic variation and understand how this varies within and between populations, and the relationship with disease. In this review, we explore the potential of genomics for patient benefit, specifically in the diagnosis, prognosis and treatment of inflammatory and immune-related diseases. We summarize the knowledge arising from genetic and functional genomic approaches, and the opportunity for personalized medicine. The review covers applications in infectious diseases, rare immunodeficiencies and autoimmune diseases, illustrating advances in diagnosis and understanding risk including use of polygenic risk scores. We further explore the application for patient stratification and drug target prioritization. The review highlights a key challenge to the field arising from the lack of sufficient representation of genetically diverse populations in genomic studies. This currently limits the clinical utility of genetic-based diagnostic and risk-based applications in non-Caucasian populations. We highlight current genome projects, initiatives and biobanks from diverse populations and how this is being used to improve healthcare globally by improving our understanding of genetic susceptibility to diseases and regional pathogens such as malaria and tuberculosis. Future directions and opportunities for personalized medicine and wider application of genomics in health care are described, for the benefit of individual patients and populations worldwide.
Collapse
Affiliation(s)
- Bana Alamad
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kate Elliott
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Julian C. Knight
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Science Oxford Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
28
|
Lin X, Wang S, Gao Y. The effects of intermittent fasting for patients with multiple sclerosis (MS): a systematic review. Front Nutr 2024; 10:1328426. [PMID: 38303903 PMCID: PMC10832063 DOI: 10.3389/fnut.2023.1328426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
Some studies have investigated the impact of intermittent fasting (IF) for patients with multiple sclerosis (MS). We aimed to conduct a comprehensive systematic review to analyze and summarize all clinical studies concerning the effects of IF on patients with MS. We conducted an exhaustive review of information available in the Embase, Cochrane, and PubMed databases up until 1 September 2023. All clinical research relating to the impacts of IF for patients with MS were included. In total, this systematic review encompassed 5 studies, which included four RCTs and one pilot study. Each study involved was assessed of high quality. The results from these studies demonstrate that IF protocols could potentially serve as an effective dietary strategy for managing symptoms and improving the quality of life in individuals afflicted with MS. In conclusion, IF might be a potential beneficial dietary intervention for MS. However, the number of trials in this field is relatively limited. The large-scale clinical trials to investigate the effects of IF for MS are urgently needed, which may be helpful to manage this intricate neuroimmune disorder. Systematic review registration https://inplasy.com, identifier INPLASY2023100021.
Collapse
Affiliation(s)
- Xiaoxiao Lin
- Department of Geriatrics, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory of Traditional Chinese Medicine for the Prevention and Treatment of Senile Chronic Diseases, Hangzhou, Zhejiang, China
| | - Shuai Wang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Gao
- Department of Geriatrics, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory of Traditional Chinese Medicine for the Prevention and Treatment of Senile Chronic Diseases, Hangzhou, Zhejiang, China
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
Tur C, Tintoré M. Multiple sclerosis in 2023: beyond the boundaries. Lancet Neurol 2024; 23:22-24. [PMID: 38101890 DOI: 10.1016/s1474-4422(23)00459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia, Neurology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Neurology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
| |
Collapse
|
32
|
Ludwig R, Malla B, Höhrhan M, Infante-Duarte C, Anderhalten L. Investigating the Mitoprotective Effects of S1P Receptor Modulators Ex Vivo Using a Novel Semi-Automated Live Imaging Set-Up. Int J Mol Sci 2023; 25:261. [PMID: 38203434 PMCID: PMC10778583 DOI: 10.3390/ijms25010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
In multiple sclerosis (MS), mitochondrial alterations appear to contribute to disease progression. The sphingosine-1-phosphate receptor modulator siponimod is approved for treating secondary progressive MS. Its preceding compound fingolimod was shown to prevent oxidative stress-induced alterations in mitochondrial morphology. Here, we assessed the effects of siponimod, compared to fingolimod, on neuronal mitochondria in oxidatively stressed hippocampal slices. We have also advanced the model of chronic organotypic hippocampal slices for live imaging, enabling semi-automated monitoring of mitochondrial alterations. The slices were prepared from B6.Cg-Tg(Thy1-CFP/COX8A)S2Lich/J mice that display fluorescent neuronal mitochondria. They were treated with hydrogen peroxide (oxidative stress paradigm) ± 1 nM siponimod or fingolimod for 24 h. Afterwards, mitochondrial dynamics were investigated. Under oxidative stress, the fraction of motile mitochondria decreased and mitochondria were shorter, smaller, and covered smaller distances. Siponimod partly prevented oxidatively induced alterations in mitochondrial morphology; for fingolimod, a similar trend was observed. Siponimod reduced the decrease in mitochondrial track displacement, while both compounds significantly increased track speed and preserved motility. The novel established imaging and analysis tools are suitable for assessing the dynamics of neuronal mitochondria ex vivo. Using these approaches, we showed that siponimod at 1 nM partially prevented oxidatively induced mitochondrial alterations in chronic brain slices.
Collapse
Affiliation(s)
- Rebecca Ludwig
- Experimental and Clinical Research Center (ECRC), 13125 Berlin, Germany; (R.L.); (L.A.)
- Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany
| | - Bimala Malla
- Experimental and Clinical Research Center (ECRC), 13125 Berlin, Germany; (R.L.); (L.A.)
- Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany
| | - Maria Höhrhan
- Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Institute for Medical Immunology, 13353 Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center (ECRC), 13125 Berlin, Germany; (R.L.); (L.A.)
- Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany
| | - Lina Anderhalten
- Experimental and Clinical Research Center (ECRC), 13125 Berlin, Germany; (R.L.); (L.A.)
- Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany
| |
Collapse
|
33
|
Gasperi C, Wiltgen T, McGinnis J, Cerri S, Moridi T, Ouellette R, Pukaj A, Voon C, Bafligil C, Lauerer M, Andlauer TFM, Held F, Aly L, Shchetynsky K, Stridh P, Harroud A, Wiestler B, Kirschke JS, Zimmer C, Baras A, Piehl F, Berthele A, Granberg T, Kockum I, Hemmer B, Mühlau M. A Genetic Risk Variant for Multiple Sclerosis Severity is Associated with Brain Atrophy. Ann Neurol 2023; 94:1080-1085. [PMID: 37753809 DOI: 10.1002/ana.26807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
The minor allele of the genetic variant rs10191329 in the DYSF-ZNF638 locus is associated with unfavorable long-term clinical outcomes in multiple sclerosis patients. We investigated if rs10191329 is associated with brain atrophy measured by magnetic resonance imaging in a discovery cohort of 748 and a replication cohort of 360 people with relapsing multiple sclerosis. We observed an association with 28% more brain atrophy per rs10191329*A allele. Our results encourage stratification for rs10191329 in clinical trials. Unraveling the underlying mechanisms may enhance our understanding of pathophysiology and identify treatment targets. ANN NEUROL 2023;94:1080-1085.
Collapse
Affiliation(s)
- Christiane Gasperi
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Julian McGinnis
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for AI in Medicine, Technical University of Munich, Munich, Germany
| | - Stefano Cerri
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Moridi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Albert Pukaj
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Cuici Voon
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Cemsel Bafligil
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Markus Lauerer
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Till F M Andlauer
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Friederike Held
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Pernilla Stridh
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Adil Harroud
- Department of Neurology and Neurosurgery and Department of Human Genetics, McGill University, Montréal, Quebec, Canada
- The Neuro (Montreal Neurological Institute and Hospital), McGill University, Montréal, Quebec, Canada
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Aris Baras
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mark Mühlau
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
34
|
Schwab N, Wiendl H. Learning CNS immunopathology from therapeutic interventions. Sci Transl Med 2023; 15:eadg7863. [PMID: 37939164 DOI: 10.1126/scitranslmed.adg7863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Modulation of immune cell trafficking across the blood-brain barrier has not only introduced a therapeutic avenue for multiple sclerosis (MS) but also represents an example of reverse translational medicine. Data from clinical trials of drugs such as natalizumab and fingolimod have revealed the involvement of different compartments in relapsing versus non-relapsing MS immune biology, contributed to our understanding of central nervous system (CNS) immune surveillance, and stimulated new fields of research. Here, we discuss the results of these trials, as well as patient biomaterial-based scientific projects, and how both have informed our understanding of CNS immunopathology.
Collapse
Affiliation(s)
- Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster 48149, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster 48149, Germany
- Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| |
Collapse
|
35
|
Sahi N, Haider L, Chung K, Prados Carrasco F, Kanber B, Samson R, Thompson AJ, Gandini Wheeler-Kingshott CAM, Trip SA, Brownlee W, Ciccarelli O, Barkhof F, Tur C, Houlden H, Chard D. Genetic influences on disease course and severity, 30 years after a clinically isolated syndrome. Brain Commun 2023; 5:fcad255. [PMID: 37841069 PMCID: PMC10576246 DOI: 10.1093/braincomms/fcad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
Multiple sclerosis risk has a well-established polygenic component, yet the genetic contribution to disease course and severity remains unclear and difficult to examine. Accurately measuring disease progression requires long-term study of clinical and radiological outcomes with sufficient follow-up duration to confidently confirm disability accrual and multiple sclerosis phenotypes. In this retrospective study, we explore genetic influences on long-term disease course and severity; in a unique cohort of clinically isolated syndrome patients with homogenous 30-year disease duration, deep clinical phenotyping and advanced MRI metrics. Sixty-one clinically isolated syndrome patients [41 female (67%): 20 male (33%)] underwent clinical and MRI assessment at baseline, 1-, 5-, 10-, 14-, 20- and 30-year follow-up (mean age ± standard deviation: 60.9 ± 6.5 years). After 30 years, 29 patients developed relapsing-remitting multiple sclerosis, 15 developed secondary progressive multiple sclerosis and 17 still had a clinically isolated syndrome. Twenty-seven genes were investigated for associations with clinical outcomes [including disease course and Expanded Disability Status Scale (EDSS)] and brain MRI (including white matter lesions, cortical lesions, and brain tissue volumes) at the 30-year follow-up. Genetic associations with changes in EDSS, relapses, white matter lesions and brain atrophy (third ventricular and medullary measurements) over 30 years were assessed using mixed-effects models. HLA-DRB1*1501-positive (n = 26) patients showed faster white matter lesion accrual [+1.96 lesions/year (0.64-3.29), P = 3.8 × 10-3], greater 30-year white matter lesion volumes [+11.60 ml, (5.49-18.29), P = 1.27 × 10-3] and higher annualized relapse rates [+0.06 relapses/year (0.005-0.11), P = 0.031] compared with HLA-DRB1*1501-negative patients (n = 35). PVRL2-positive patients (n = 41) had more cortical lesions (+0.83 [0.08-1.66], P = 0.042), faster EDSS worsening [+0.06 points/year (0.02-0.11), P = 0.010], greater 30-year EDSS [+1.72 (0.49-2.93), P = 0.013; multiple sclerosis cases: +2.60 (1.30-3.87), P = 2.02 × 10-3], and greater risk of secondary progressive multiple sclerosis [odds ratio (OR) = 12.25 (1.15-23.10), P = 0.031] than PVRL2-negative patients (n = 18). In contrast, IRX1-positive (n = 30) patients had preserved 30-year grey matter fraction [+0.76% (0.28-1.29), P = 8.4 × 10-3], lower risk of cortical lesions [OR = 0.22 (0.05-0.99), P = 0.049] and lower 30-year EDSS [-1.35 (-0.87,-3.44), P = 0.026; multiple sclerosis cases: -2.12 (-0.87, -3.44), P = 5.02 × 10-3] than IRX1-negative patients (n = 30). In multiple sclerosis cases, IRX1-positive patients also had slower EDSS worsening [-0.07 points/year (-0.01,-0.13), P = 0.015] and lower risk of secondary progressive multiple sclerosis [OR = 0.19 (0.04-0.92), P = 0.042]. These exploratory findings support diverse genetic influences on pathological mechanisms associated with multiple sclerosis disease course. HLA-DRB1*1501 influenced white matter inflammation and relapses, while IRX1 (protective) and PVRL2 (adverse) were associated with grey matter pathology (cortical lesions and atrophy), long-term disability worsening and the risk of developing secondary progressive multiple sclerosis.
Collapse
Affiliation(s)
- Nitin Sahi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Lukas Haider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, 1090 Vienna, Austria
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Ferran Prados Carrasco
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Department of Clinical and Experimental Epilepsy, University College London, London WC1N 3BG, UK
| | - Rebecca Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - S Anand Trip
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Wallace Brownlee
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
| | - Frederik Barkhof
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Carmen Tur
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- MS Centre of Catalonia (Cemcat), Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen’s Square House, Queen’s Square, London, WC1N 3BG, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
| |
Collapse
|
36
|
Jokubaitis VG, Butzkueven H. A genetic basis for the severity of multiple sclerosis. Lancet Neurol 2023; 22:879-881. [PMID: 37739566 DOI: 10.1016/s1474-4422(23)00319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Vilija G Jokubaitis
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia.
| | - Helmut Butzkueven
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
37
|
He A, Manouchehrinia A, Glaser A, Ciccarelli O, Butzkueven H, Hillert J, McKay KA. Premorbid Sociodemographic Status and Multiple Sclerosis Outcomes in a Universal Health Care Context. JAMA Netw Open 2023; 6:e2334675. [PMID: 37751208 PMCID: PMC10523174 DOI: 10.1001/jamanetworkopen.2023.34675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/11/2023] [Indexed: 09/27/2023] Open
Abstract
Importance Multiple sclerosis (MS) severity may be informed by premorbid sociodemographic factors. Objective To determine whether premorbid education, income, and marital status are associated with future MS disability and symptom severity, independent of treatment, in a universal health care context. Design, Setting, and Participants This nationwide observational cohort study examined data from the Swedish MS Registry linked to national population registries from 2000 to 2020. Participants included people with MS onset from 2005 to 2015 and of working age (aged 23 to 59 years) 1 year and 5 years preceding disease onset. Exposures Income quartile, educational attainment, and marital status measured at 1 and 5 years preceding disease onset. Main Outcome and Measures Repeated measures of Expanded Disability Status Scale (EDSS) scores and patient-reported Multiple Sclerosis Impact Scale (MSIS-29) scores. Models were adjusted for age, sex, relapses, disease duration, and treatment exposure. Secondary analyses further adjusted for comorbidity. All analyses were stratified by disease course (relapse onset and progressive onset). Results There were 4557 patients (mean [SD] age, 37.5 [9.3] years; 3136 [68.8%] female, 4195 [92.1%] relapse-onset MS) with sociodemographic data from 1-year preonset of MS. In relapse-onset MS, higher premorbid income and education correlated with lower disability (EDSS, -0.16 [95% CI, -0.12 to -0.20] points) per income quartile; EDSS, -0.47 [95% CI, -0.59 to -0.35] points if tertiary educated), physical symptoms (MSIS-29 physical subscore, -14% [95% CI, -11% to -18%] per income quartile; MSIS-29 physical subscore, -43% [95% CI, -35% to -50%] if tertiary educated), and psychological symptoms (MSIS-29 psychological subscore, -12% [95% CI, -9% to -16%] per income quartile; MSIS-29 psychological subscore, -25% [95% CI, -17% to -33%] if tertiary educated). Marital separation was associated with adverse outcomes (EDSS, 0.34 [95% CI, 0.18 to 0.51]; MSIS-29 physical subscore, 35% [95% CI, 12% to 62%]; MSIS-29 psychological subscore, 25% [95% CI, 8% to 46%]). In progressive-onset MS, higher income correlated with lower EDSS (-0.30 [95% CI, -0.48 to -0.11] points per income quartile) whereas education correlated with lower physical (-34% [95% CI, -53% to -7%]) and psychological symptoms (-33% [95% CI, -54% to -1%]). Estimates for 5-years preonset were comparable with 1-year preonset, as were the comorbidity-adjusted findings. Conclusions and relevance In this cohort study of working-age adults with MS, premorbid income, education, and marital status correlated with disability and symptom severity in relapse-onset and progressive-onset MS, independent of treatment. These findings suggest that socioeconomic status may reflect both structural and individual determinants of health in MS.
Collapse
Affiliation(s)
- Anna He
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Kyla A. McKay
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
38
|
Giovannoni G, Hawkes CH, Lechner-Scott J, Levy M, Ann Yeh E. CNS resilience in the progression of MS. Mult Scler Relat Disord 2023; 77:104937. [PMID: 37634271 DOI: 10.1016/j.msard.2023.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Resilience; Progressive multiple sclerosis; Genomics.
Collapse
Affiliation(s)
- Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Christopher H Hawkes
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, MA, United States
| | - E Ann Yeh
- Department of Paediatrics (Neurology), Hospital for Sick Children, Division of Neuroscience and Mental Health, The Hospital for Sick Children Research Institute University of Toronto, Canada
| |
Collapse
|
39
|
Loomis SJ, Sadhu N, Fisher E, Gafson AR, Huang Y, Yang C, Hughes EE, Marshall E, Herman A, John S, Runz H, Jia X, Bhangale T, Bronson PG. Genome-wide study of longitudinal brain imaging measures of multiple sclerosis progression across six clinical trials. Sci Rep 2023; 13:14313. [PMID: 37652990 PMCID: PMC10471679 DOI: 10.1038/s41598-023-41099-0] [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: 03/07/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
While the genetics of MS risk susceptibility are well-described, and recent progress has been made on the genetics of disease severity, the genetics of disease progression remain elusive. We therefore investigated the genetic determinants of MS progression on longitudinal brain MRI: change in brain volume (BV) and change in T2 lesion volume (T2LV), reflecting progressive tissue loss and increasing disease burden, respectively. We performed genome-wide association studies of change in BV (N = 3401) and change in T2LV (N = 3513) across six randomized clinical trials from Biogen and Roche/Genentech: ADVANCE, ASCEND, DECIDE, OPERA I & II, and ORATORIO. Analyses were adjusted for randomized treatment arm, age, sex, and ancestry. Results were pooled in a meta-analysis, and were evaluated for enrichment of MS risk variants. Variant colocalization and cell-specific expression analyses were performed using published cohorts. The strongest peaks were in PTPRD (rs77321193-C/A, p = 3.9 × 10-7) for BV change, and NEDD4L (rs11398377-GC/G, p = 9.3 × 10-8) for T2LV change. Evidence of colocalization was observed for NEDD4L, and both genes showed increased expression in neuronal and/or glial populations. No association between MS risk variants and MRI outcomes was observed. In this unique, precompetitive industry partnership, we report putative regions of interest in the neurodevelopmental gene PTPRD, and the ubiquitin ligase gene NEDD4L. These findings are distinct from known MS risk genetics, indicating an added role for genetic progression analyses and informing drug discovery.
Collapse
|
40
|
Clayton BL, Barbar L, Sapar M, Rusielewicz T, Kalpana K, Migliori B, Paull D, Brenner K, Moroziewicz D, Sand IK, Casaccia P, Tesar PJ, Fossati V. Patient iPSC models reveal glia-intrinsic phenotypes in multiple sclerosis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.01.551553. [PMID: 37577713 PMCID: PMC10418164 DOI: 10.1101/2023.08.01.551553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Multiple sclerosis (MS) is considered an inflammatory and neurodegenerative disease of the central nervous system, typically resulting in significant neurological disability that worsens over time. While considerable progress has been made in defining the immune system's role in MS pathophysiology, the contribution of intrinsic CNS-cell dysfunction remains unclear. Here, we generated the largest reported collection of iPSC lines from people with MS spanning diverse clinical subtypes and differentiated them into glia-enriched cultures. Using single-cell transcriptomic profiling, we observed several distinguishing characteristics of MS cultures pointing to glia-intrinsic disease mechanisms. We found that iPSC-derived cultures from people with primary progressive MS contained fewer oligodendrocytes. Moreover, iPSC-oligodendrocyte lineage cells and astrocytes from people with MS showed increased expression of immune and inflammatory genes that match those of glial cells from MS postmortem brains. Thus, iPSC-derived MS models provide a unique platform for dissecting glial contributions to disease phenotypes independent of the peripheral immune system and identify potential glia-specific targets for therapeutic intervention.
Collapse
Affiliation(s)
- Benjamin L.L. Clayton
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- These authors contributed equally
| | - Lilianne Barbar
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
- Current affiliation: Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, 63105, USA
- These authors contributed equally
| | - Maria Sapar
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Tomasz Rusielewicz
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Kriti Kalpana
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Bianca Migliori
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | | | - Daniel Paull
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Katie Brenner
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Dorota Moroziewicz
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| | - Ilana Katz Sand
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | | | - Paul J. Tesar
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Valentina Fossati
- The New York Stem Cell Foundation Research Institute, New York, NY 10019, USA
| |
Collapse
|
41
|
Puranik N, Yadav D, Song M. Insight into Early Diagnosis of Multiple Sclerosis by Targeting Prognostic Biomarkers. Curr Pharm Des 2023; 29:2534-2544. [PMID: 37921136 DOI: 10.2174/0113816128247471231018053737] [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: 03/09/2023] [Revised: 08/04/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
Multiple sclerosis (MS) is a central nervous system (CNS) immune-mediated disease that mainly strikes young adults and leaves them disabled. MS is an autoimmune illness that causes the immune system to attack the brain and spinal cord. The myelin sheaths, which insulate the nerve fibers, are harmed by our own immune cells, and this interferes with brain signal transmission. Numbness, tingling, mood swings, memory problems, exhaustion, agony, vision problems, and/or paralysis are just a few of the symptoms. Despite technological advancements and significant research efforts in recent years, diagnosing MS can still be difficult. Each patient's MS is distinct due to a heterogeneous and complex pathophysiology with diverse types of disease courses. There is a pressing need to identify markers that will allow for more rapid and accurate diagnosis and prognosis assessments to choose the best course of treatment for each MS patient. The cerebrospinal fluid (CSF) is an excellent source of particular indicators associated with MS pathology. CSF contains molecules that represent pathological processes such as inflammation, cellular damage, and loss of blood-brain barrier integrity. Oligoclonal bands, neurofilaments, MS-specific miRNA, lncRNA, IgG-index, and anti-aquaporin 4 antibodies are all clinically utilised indicators for CSF in MS diagnosis. In recent years, a slew of new possible biomarkers have been presented. In this review, we look at what we know about CSF molecular markers and how they can aid in the diagnosis and differentiation of different MS forms and treatment options, and monitoring and predicting disease progression, therapy response, and consequences during such opportunistic infections.
Collapse
Affiliation(s)
- Nidhi Puranik
- Biological Sciences Department, Bharathiar University, Coimbatore, Tamil Nadu, 641046, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
| |
Collapse
|