1
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Andorra M, Freire A, Zubizarreta I, de Rosbo NK, Bos SD, Rinas M, Høgestøl EA, de Rodez Benavent SA, Berge T, Brune-Ingebretse S, Ivaldi F, Cellerino M, Pardini M, Vila G, Pulido-Valdeolivas I, Martinez-Lapiscina EH, Llufriu S, Saiz A, Blanco Y, Martinez-Heras E, Solana E, Bäcker-Koduah P, Behrens J, Kuchling J, Asseyer S, Scheel M, Chien C, Zimmermann H, Motamedi S, Kauer-Bonin J, Brandt A, Saez-Rodriguez J, Alexopoulos LG, Paul F, Harbo HF, Shams H, Oksenberg J, Uccelli A, Baeza-Yates R, Villoslada P. Predicting disease severity in multiple sclerosis using multimodal data and machine learning. J Neurol 2024; 271:1133-1149. [PMID: 38133801 PMCID: PMC10896787 DOI: 10.1007/s00415-023-12132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/28/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Multiple sclerosis patients would benefit from machine learning algorithms that integrates clinical, imaging and multimodal biomarkers to define the risk of disease activity. METHODS We have analysed a prospective multi-centric cohort of 322 MS patients and 98 healthy controls from four MS centres, collecting disability scales at baseline and 2 years later. Imaging data included brain MRI and optical coherence tomography, and omics included genotyping, cytomics and phosphoproteomic data from peripheral blood mononuclear cells. Predictors of clinical outcomes were searched using Random Forest algorithms. Assessment of the algorithm performance was conducted in an independent prospective cohort of 271 MS patients from a single centre. RESULTS We found algorithms for predicting confirmed disability accumulation for the different scales, no evidence of disease activity (NEDA), onset of immunotherapy and the escalation from low- to high-efficacy therapy with intermediate to high-accuracy. This accuracy was achieved for most of the predictors using clinical data alone or in combination with imaging data. Still, in some cases, the addition of omics data slightly increased algorithm performance. Accuracies were comparable in both cohorts. CONCLUSION Combining clinical, imaging and omics data with machine learning helps identify MS patients at risk of disability worsening.
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Affiliation(s)
- Magi Andorra
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Ana Freire
- School of Management, Pompeu Fabra University, Barcelona, Spain
- UPF Barcelona School of Management, Balmes 132, 08008, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Nicole Kerlero de Rosbo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Steffan D Bos
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Melanie Rinas
- Institute for Computational Biomedicine, Heidelberg University Hospital, and Heidelberg University, Heidelberg, Germany
| | - Einar A Høgestøl
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | | | - Tone Berge
- Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
| | | | - Federico Ivaldi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gemma Vila
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Albert Saiz
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Eloy Martinez-Heras
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisabeth Solana
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | | | | | | | - Susanna Asseyer
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | - Claudia Chien
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanna Zimmermann
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | - Alex Brandt
- Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Julio Saez-Rodriguez
- Institute for Computational Biomedicine, Heidelberg University Hospital, and Heidelberg University, Heidelberg, Germany
| | - Leonidas G Alexopoulos
- ProtATonce Ltd, Athens, Greece
- School of Mechanical Engineering, National Technical University of Athens, Zografou, Greece
| | - Friedemann Paul
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanne F Harbo
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Hengameh Shams
- Department of Neurology, University of California, San Francisco, USA
| | - Jorge Oksenberg
- Department of Neurology, University of California, San Francisco, USA
| | - Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Pablo Villoslada
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain.
- Hospital del Mar Research Institute, Barcelona, Spain.
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Kennedy KE, Kerlero de Rosbo N, Uccelli A, Cellerino M, Ivaldi F, Contini P, De Palma R, Harbo HF, Berge T, Bos SD, Høgestøl EA, Brune-Ingebretsen S, de Rodez Benavent SA, Paul F, Brandt AU, Bäcker-Koduah P, Behrens J, Kuchling J, Asseyer S, Scheel M, Chien C, Zimmermann H, Motamedi S, Kauer-Bonin J, Saez-Rodriguez J, Rinas M, Alexopoulos LG, Andorra M, Llufriu S, Saiz A, Blanco Y, Martinez-Heras E, Solana E, Pulido-Valdeolivas I, Martinez-Lapiscina EH, Garcia-Ojalvo J, Villoslada P. Multiscale networks in multiple sclerosis. PLoS Comput Biol 2024; 20:e1010980. [PMID: 38329927 PMCID: PMC10852301 DOI: 10.1371/journal.pcbi.1010980] [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: 02/25/2023] [Accepted: 12/12/2023] [Indexed: 02/10/2024] Open
Abstract
Complex diseases such as Multiple Sclerosis (MS) cover a wide range of biological scales, from genes and proteins to cells and tissues, up to the full organism. In fact, any phenotype for an organism is dictated by the interplay among these scales. We conducted a multilayer network analysis and deep phenotyping with multi-omics data (genomics, phosphoproteomics and cytomics), brain and retinal imaging, and clinical data, obtained from a multicenter prospective cohort of 328 patients and 90 healthy controls. Multilayer networks were constructed using mutual information for topological analysis, and Boolean simulations were constructed using Pearson correlation to identified paths within and among all layers. The path more commonly found from the Boolean simulations connects protein MK03, with total T cells, the thickness of the retinal nerve fiber layer (RNFL), and the walking speed. This path contains nodes involved in protein phosphorylation, glial cell differentiation, and regulation of stress-activated MAPK cascade, among others. Specific paths identified were subsequently analyzed by flow cytometry at the single-cell level. Combinations of several proteins (GSK3AB, HSBP1 or RS6) and immune cells (Th17, Th1 non-classic, CD8, CD8 Treg, CD56 neg, and B memory) were part of the paths explaining the clinical phenotype. The advantage of the path identified from the Boolean simulations is that it connects information about these known biological pathways with the layers at higher scales (retina damage and disability). Overall, the identified paths provide a means to connect the molecular aspects of MS with the overall phenotype.
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Affiliation(s)
- Keith E. Kennedy
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nicole Kerlero de Rosbo
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
- TomaLab, Institute of Nanotechnology, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Antonio Uccelli
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
| | - Maria Cellerino
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
| | - Federico Ivaldi
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
| | - Paola Contini
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
| | - Raffaele De Palma
- Department of Neurology, Ospedale Policlinico San Martino-IRCCS and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa Italy
| | - Hanne F. Harbo
- Department of Neurology, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Tone Berge
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
| | - Steffan D. Bos
- Department of Neurology, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Einar A. Høgestøl
- Department of Neurology, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Synne Brune-Ingebretsen
- Department of Neurology, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Sigrid A. de Rodez Benavent
- Department of Neurology, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Friedemann Paul
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Alexander U. Brandt
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- Department of Neurology, University of California, Irvine, California, United States of America
| | - Priscilla Bäcker-Koduah
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Janina Behrens
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Joseph Kuchling
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Susanna Asseyer
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Michael Scheel
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Claudia Chien
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanna Zimmermann
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Seyedamirhosein Motamedi
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Josef Kauer-Bonin
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Julio Saez-Rodriguez
- Institute for Computational Biomedicine, University of Heidelberg, Heidelberg, Germany
| | - Melanie Rinas
- Institute for Computational Biomedicine, University of Heidelberg, Heidelberg, Germany
| | - Leonidas G. Alexopoulos
- ProtATonce Ltd, Athens, Greece
- School of Mechanical Engineering, National Technical University of Athens, Zografou, Greece
| | - Magi Andorra
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Eloy Martinez-Heras
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Elisabeth Solana
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Elena H. Martinez-Lapiscina
- Center of Neuroimmunology, Hospital Clinic Barcelona, and Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Jordi Garcia-Ojalvo
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Pablo Villoslada
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Department of Neurology, Hospital del Mar Research Institute, Barcelona, Spain
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3
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Ed‐driouch C, Chéneau F, Simon F, Pasquier G, Combès B, Kerbrat A, Le Page E, Limou S, Vince N, Laplaud D, Mars F, Dumas C, Edan G, Gourraud P. Multiple sclerosis clinical decision support system based on projection to reference datasets. Ann Clin Transl Neurol 2022; 9:1863-1873. [PMID: 36412095 PMCID: PMC9735373 DOI: 10.1002/acn3.51649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is a multifactorial disease with increasingly complicated management. Our objective is to use on-demand computational power to address the challenges of dynamically managing MS. METHODS A phase 3 clinical trial data (NCT00906399) were used to contextualize the medication efficacy of peg-interferon beta-1a vs placebo on patients with relapsing-remitting MS (RRMS). Using a set of reference patients (PORs), selected based on adequate features similar to those of an individual patient, we visualize disease activity by measuring the percentage of relapses, accumulation of new T2 lesions on MRI, and worsening EDSS during the clinical trial. RESULTS We developed MS Vista, a functional prototype of clinical decision support system (CDSS), with a user-centered design and distributed infrastructure. MS Vista shows the medication efficacy of peginterferon beta-1a versus placebo for each individual patient with RRMS. In addition, MS Vista initiated the integration of a longitudinal magnetic resonance imaging (MRI) viewer and interactive dual physician-patient data display to facilitate communication. INTERPRETATION The pioneer use of PORs for each individual patient enables personalized analytics sustaining the dialog between neurologists, patients and caregivers with quantified evidence.
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Affiliation(s)
- Chadia Ed‐driouch
- Nantes Université, INSERM, CR2TI ‐ Center for Research in Transplantation and Translational ImmunologyF‐44000NantesFrance,Département Automatique, Productique et Informatique, IMT AtlantiqueCNRS, LS2N, UMR CNRS6004NantesFrance
| | - Florent Chéneau
- Département Automatique, Productique et Informatique, IMT AtlantiqueCNRS, LS2N, UMR CNRS6004NantesFrance
| | - Françoise Simon
- Nantes Université, INSERM, CR2TI ‐ Center for Research in Transplantation and Translational ImmunologyF‐44000NantesFrance,Mount Sinai School of Medicine and Columbia UniversityNew YorkNYUSA
| | | | - Benoit Combès
- Université de Rennes, Inria, CNRS, Inserm IRISA UMR 6074, Empenn ERL U 1228F‐35000RennesFrance
| | - Anne Kerbrat
- Université de Rennes, Inria, CNRS, Inserm IRISA UMR 6074, Empenn ERL U 1228F‐35000RennesFrance,CRC‐SEP, CICP 1414 INSERM, CHU Pontchaillou RennesRennesFrance
| | | | - Sophie Limou
- Nantes Université, INSERM, CR2TI ‐ Center for Research in Transplantation and Translational ImmunologyF‐44000NantesFrance,Ecole Centrale Nantes, Department of MathematicsComputer Sciences and BiologyF-44000NantesFrance
| | - Nicolas Vince
- Nantes Université, INSERM, CR2TI ‐ Center for Research in Transplantation and Translational ImmunologyF‐44000NantesFrance
| | - David‐Axel Laplaud
- Nantes Université, CRC‐SEP, CHU Nantes, CIC 1413, Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERMNantesFrance
| | - Franck Mars
- Nantes Université, Centrale NantesCNRS, LS2N, UMR 6004F‐44000NantesFrance
| | - Cédric Dumas
- Département Automatique, Productique et Informatique, IMT AtlantiqueCNRS, LS2N, UMR CNRS6004NantesFrance
| | - Gilles Edan
- Université de Rennes, Inria, CNRS, Inserm IRISA UMR 6074, Empenn ERL U 1228F‐35000RennesFrance,CRC‐SEP, CICP 1414 INSERM, CHU Pontchaillou RennesRennesFrance
| | - Pierre‐Antoine Gourraud
- Nantes Université, CHU Nantes, Pôle Hospitalo‐Universitaire 11: Santé Publique, Clinique des données, INSERM CIC 1413F‐44000NantesFrance
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4
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Villoslada P. Personalized medicine for multiple sclerosis: How to integrate neurofilament light chain levels in the decision? Mult Scler 2021; 27:1967-1969. [PMID: 34612731 DOI: 10.1177/13524585211049552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pablo Villoslada
- Stanford University, Stanford, CA, USA/Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
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5
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Voigt I, Inojosa H, Dillenseger A, Haase R, Akgün K, Ziemssen T. Digital Twins for Multiple Sclerosis. Front Immunol 2021; 12:669811. [PMID: 34012452 PMCID: PMC8128142 DOI: 10.3389/fimmu.2021.669811] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
An individualized innovative disease management is of great importance for people with multiple sclerosis (pwMS) to cope with the complexity of this chronic, multidimensional disease. However, an individual state of the art strategy, with precise adjustment to the patient's characteristics, is still far from being part of the everyday care of pwMS. The development of digital twins could decisively advance the necessary implementation of an individualized innovative management of MS. Through artificial intelligence-based analysis of several disease parameters - including clinical and para-clinical outcomes, multi-omics, biomarkers, patient-related data, information about the patient's life circumstances and plans, and medical procedures - a digital twin paired to the patient's characteristic can be created, enabling healthcare professionals to handle large amounts of patient data. This can contribute to a more personalized and effective care by integrating data from multiple sources in a standardized manner, implementing individualized clinical pathways, supporting physician-patient communication and facilitating a shared decision-making. With a clear display of pre-analyzed patient data on a dashboard, patient participation and individualized clinical decisions as well as the prediction of disease progression and treatment simulation could become possible. In this review, we focus on the advantages, challenges and practical aspects of digital twins in the management of MS. We discuss the use of digital twins for MS as a revolutionary tool to improve diagnosis, monitoring and therapy refining patients' well-being, saving economic costs, and enabling prevention of disease progression. Digital twins will help make precision medicine and patient-centered care a reality in everyday life.
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Affiliation(s)
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Villoslada P, Galetta SL, Toosy A. Seeing the Finish Line: Can Baseline OCT Values Predict Long-term Disability and Therapeutic Management in Multiple Sclerosis? Neurology 2021; 96:731-732. [PMID: 33653903 DOI: 10.1212/wnl.0000000000011793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pablo Villoslada
- From Stanford University (P.V.), CA; Langone Medical Center (S.L.G.), New York University, NY; and Queen Square MS Centre (A.T.), Department of Neuroinflammation, UCL Institute of Neurology, University College London, UK.
| | - Steven L Galetta
- From Stanford University (P.V.), CA; Langone Medical Center (S.L.G.), New York University, NY; and Queen Square MS Centre (A.T.), Department of Neuroinflammation, UCL Institute of Neurology, University College London, UK
| | - Ahmed Toosy
- From Stanford University (P.V.), CA; Langone Medical Center (S.L.G.), New York University, NY; and Queen Square MS Centre (A.T.), Department of Neuroinflammation, UCL Institute of Neurology, University College London, UK
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7
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Roura E, Maclair G, Andorrà M, Juanals F, Pulido-Valdeolivas I, Saiz A, Blanco Y, Sepulveda M, Llufriu S, Martínez-Heras E, Solana E, Martinez-Lapiscina EH, Villoslada P. Cortical fractal dimension predicts disability worsening in Multiple Sclerosis patients. Neuroimage Clin 2021; 30:102653. [PMID: 33838548 PMCID: PMC8045041 DOI: 10.1016/j.nicl.2021.102653] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fractal geometry measures the morphology of the brain and detects CNS damage. We aimed to assess the longitudinal changes on brain's fractal geometry and its predictive value for disease worsening in patients with Multiple Sclerosis (MS). METHODS We prospectively analyzed 146 consecutive patients with relapsing-remitting MS with up to 5 years of clinical and brain MRI (3 T) assessments. The fractal dimension and lacunarity were calculated for brain regions using box-counting methods. Longitudinal changes were analyzed in mixed-effect models and the risk of disability accumulation were assessed using Cox Proportional Hazard regression analysis. RESULTS There was a significant decrease in the fractal dimension and increases of lacunarity in different brain regions over the 5-year follow-up. Lower cortical fractal dimension increased the risk of disability accumulation for the Expanded Disability Status Scale [HR 0.9734, CI 0.8420-0.9125; Harrell C 0.59; Wald p 0.038], 9-hole peg test [HR 0.9734, CI 0.8420-0.9125; Harrell C 0.59; Wald p 0.0083], 2.5% low contrast vision [HR 0.4311, CI 0.2035-0.9133; Harrell C 0.58; Wald p 0.0403], symbol digit modality test [HR 2.215, CI 1.043-4.705; Harrell C 0.65; Wald p 0.0384] and MS Functional Composite-4 [HR 0.55, CI 0.317-0.955; Harrell C 0.59; Wald p 0.0029]. CONCLUSIONS Fractal geometry analysis of brain MRI identified patients at risk of increasing their disability in the next five years.
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Affiliation(s)
| | | | - Magí Andorrà
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | | | - Irene Pulido-Valdeolivas
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Albert Saiz
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Yolanda Blanco
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Maria Sepulveda
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Sara Llufriu
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Eloy Martínez-Heras
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Elisabeth Solana
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Pablo Villoslada
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain; Stanford University, Stanford, CA, USA.
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8
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Villoslada P, Steinman L. New targets and therapeutics for neuroprotection, remyelination and repair in multiple sclerosis. Expert Opin Investig Drugs 2020; 29:443-459. [DOI: 10.1080/13543784.2020.1757647] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Pablo Villoslada
- Department of Psychiatry and Behavioural Sciences & Department of Neurology and Neurological Sciences, Stanford University, California, CA, USA
| | - Lawrence Steinman
- Department of Psychiatry and Behavioural Sciences & Department of Neurology and Neurological Sciences, Stanford University, California, CA, USA
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Knox KB, Saini A, Levin MC. The Dilemma of When to Stop Disease-Modifying Therapy in Multiple Sclerosis: A Narrative Review and Canadian Regional Reimbursement Policies. Int J MS Care 2020; 22:75-84. [PMID: 32410902 PMCID: PMC7204360 DOI: 10.7224/1537-2073.2018-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disease-modifying therapy (DMT) has changed the landscape of multiple sclerosis (MS) care. However, there is lack of consensus on the duration of treatment and the selection of individuals most likely to benefit from continued treatment. Current evidence, practice guidelines, health policy, and ethical considerations presented together may further inform challenging clinical decision making and future directions. The objectives of this study were to conduct a narrative review of original research and practice guideline recommendations on discontinuation of DMTs in MS; to collect information regarding Canadian regional reimbursement policies for DMT coverage in MS; and to present ethical considerations applicable to such decision making. METHODS A literature review was conducted of the MEDLINE/PubMed, OneFile (GALE), Scopus (Elsevier), and ProQuest Biological Science Collection databases. Data regarding Canadian regional reimbursement policies for DMT coverage in MS were collected from the ministry/government websites. Ethical considerations were reviewed in the context of the identified evidence, guidelines, and policies. RESULTS The literature lacks evidence from prospective randomized controlled trials that directly addresses the issue of discontinuation of DMTs in MS. Current practice guidelines advocate the vital role of patient choice in decision making. There are regional variations in Expanded Disability Status Scale criteria scores for continuing MS DMT coverage among Canadian provinces/territories. CONCLUSIONS In the absence of strong evidence on discontinuation of DMTs, shared decision making and consideration of the ethical complexities could help in the decision-making process.
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Villoslada P, Green AJ, Galetta S. Personalizing medical care for patients with MS. Neurology 2019; 92:929-930. [DOI: 10.1212/wnl.0000000000007493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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de Santiago L, Sánchez Morla EM, Ortiz M, López E, Amo Usanos C, Alonso-Rodríguez MC, Barea R, Cavaliere-Ballesta C, Fernández A, Boquete L. A computer-aided diagnosis of multiple sclerosis based on mfVEP recordings. PLoS One 2019; 14:e0214662. [PMID: 30947273 PMCID: PMC6449069 DOI: 10.1371/journal.pone.0214662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction The aim of this study is to develop a computer-aided diagnosis system to identify subjects at differing stages of development of multiple sclerosis (MS) using multifocal visual-evoked potentials (mfVEPs). Using an automatic classifier, diagnosis is performed first on the eyes and then on the subjects. Patients MfVEP signals were obtained from patients with Radiologically Isolated Syndrome (RIS) (n = 30 eyes), patients with Clinically Isolated Syndrome (CIS) (n = 62 eyes), patients with definite MS (n = 56 eyes) and 22 control subjects (n = 44 eyes). The CIS and MS groups were divided into two subgroups: those with eyes affected by optic neuritis (ON) and those without (non-ON). Methods For individual eye diagnosis, a feature vector was formed with information about the intensity, latency and singular values of the mfVEP signals. A flat multiclass classifier (FMC) and a hierarchical classifier (HC) were tested and both were implemented using the k-Nearest Neighbour (k-NN) algorithm. The output of the best eye classifier was used to classify the subjects. In the event of divergence, the eye with the best mfVEP recording was selected. Results In the eye classifier, the HC performed better than the FMC (accuracy = 0.74 and extended Matthew Correlation Coefficient (MCC) = 0.68). In the subject classification, accuracy = 0.95 and MCC = 0.93, confirming that it may be a promising tool for MS diagnosis. Conclusion In addition to amplitude (axonal loss) and latency (demyelination), it has shown that the singular values of the mfVEP signals provide discriminatory information that may be used to identify subjects with differing degrees of the disease.
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Affiliation(s)
- Luis de Santiago
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - E. M. Sánchez Morla
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Ortiz
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Elena López
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Carlos Amo Usanos
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - R. Barea
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Carlo Cavaliere-Ballesta
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Alfredo Fernández
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Luciano Boquete
- Grupo de Ingeniería Biomédica, Departamento de Electrónica, Universidad de Alcalá, Alcalá de Henares, Spain
- RETICS: Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares Oftared, Madrid, Spain
- * E-mail:
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