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Harris L, Hateley S, Baheerathan A, Malik O. A Diagnosis of Multiple Sclerosis Following Whiplash Injury: Is There a True Association? Cureus 2021; 13:e13411. [PMID: 33758706 PMCID: PMC7980313 DOI: 10.7759/cureus.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of a previously well, 25-year-old Caucasian female whose diagnosis of multiple sclerosis (MS) followed significant trauma. Her symptoms and signs developed quickly and satisfied the criteria for rapidly evolving relapsing-remitting MS. She was started on natalizumab (Tysabri) and was stabilized. We discuss the existing literature on traumatic demyelination and possible underlying mechanisms.
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Affiliation(s)
- Lauren Harris
- Neuroscience, Imperial College Healthcare National Health Service Trust, London, GBR
| | - Sofie Hateley
- Neuroscience, Imperial College Healthcare National Health Service Trust, London, GBR
| | | | - Omar Malik
- Neurology, Imperial College Healthcare National Health Service Trust, London, GBR
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Stewart AN, MacLean SM, Stromberg AJ, Whelan JP, Bailey WM, Gensel JC, Wilson ME. Considerations for Studying Sex as a Biological Variable in Spinal Cord Injury. Front Neurol 2020; 11:802. [PMID: 32849242 PMCID: PMC7419700 DOI: 10.3389/fneur.2020.00802] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
In response to NIH initiatives to investigate sex as a biological variable in preclinical animal studies, researchers have increased their focus on male and female differences in neurotrauma. Inclusion of both sexes when modeling neurotrauma is leading to the identification of novel areas for therapeutic and scientific exploitation. Here, we review the organizational and activational effects of sex hormones on recovery from injury and how these changes impact the long-term health of spinal cord injury (SCI) patients. When determining how sex affects SCI it remains imperative to expand outcomes beyond locomotor recovery and consider other complications plaguing the quality of life of patients with SCI. Interestingly, the SCI field predominately utilizes female rodents for basic science research which contrasts most other male-biased research fields. We discuss the unique caveats this creates to the translatability of preclinical research in the SCI field. We also review current clinical and preclinical data examining sex as biological variable in SCI. Further, we report how technical considerations such as housing, size, care management, and age, confound the interpretation of sex-specific effects in animal studies of SCI. We have uncovered novel findings regarding how age differentially affects mortality and injury-induced anemia in males and females after SCI, and further identified estrus cycle dysfunction in mice after injury. Emerging concepts underlying sexually dimorphic responses to therapy are also discussed. Through a combination of literature review and primary research observations we present a practical guide for considering and incorporating sex as biological variable in preclinical neurotrauma studies.
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Affiliation(s)
- Andrew N Stewart
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Steven M MacLean
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Arnold J Stromberg
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, United States
| | - Jessica P Whelan
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - William M Bailey
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - John C Gensel
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Melinda E Wilson
- Department of Physiology, University of Kentucky, Lexington, KY, United States
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Smith KA, Hiyoshi A, Burkill S, Bahmanyar S, Öckinger J, Alfredsson L, Olsson T, Montgomery S. Hospital diagnosed pneumonia before age 20 years and multiple sclerosis risk. BMJ Neurol Open 2020; 2:e000044. [PMID: 33681783 PMCID: PMC7903180 DOI: 10.1136/bmjno-2020-000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Respiratory inflammation has been proposed as a risk factor for MS. This study aims to determine if hospital-diagnosed pneumonia in adolescence (before age 20 years) is associated with subsequent multiple sclerosis (MS). Methods This case-control study included incident MS cases after age 20 years identified using the Swedish national registers. Cases were matched with 10 general population controls by age, sex and region. Pneumonia diagnoses were identified between 0–5, 6–10, 11–15 and 16–20 years of age. Conditional logistic regression models adjusted for infectious mononucleosis (IM) and education calculated ORs with 95% CIs. Urinary tract infections (UTIs), a common complication of MS, before age 20 years were included as a control diagnosis for reverse causation. Results There were 6109 cases and 49 479 controls included. Pneumonia diagnosed between age 11–15 years was associated with subsequent MS (adj OR 2.00, 95% CI 1.22 to 3.27). Although not statistically significant, sensitivity analyses showed similar magnitude associations of pneumonia between age 11–15 years and MS. No statistically significant associations with MS for pneumonia at other age groups were observed. Adjustment for IM had no notable effect on associations, but was statistically significantly associated with MS. UTIs were not associated with MS. Conclusion Pneumonia at 11–15 years of age was associated with MS, suggesting a possible role for inflammation of the respiratory system in the aetiology of MS during a period of susceptibility in adolescence. Further research on respiratory infections prior to MS onset should be conducted to replicate this finding and determine explanatory causal mechanisms.
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Affiliation(s)
- Kelsi A Smith
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, Örebro Universitet-Campus USÖ, Orebro, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Sarah Burkill
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Johan Öckinger
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, Örebro Universitet-Campus USÖ, Orebro, Sweden
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Amanat M, Vaccaro AR, Salehi M, Rahimi-Movaghar V. Neurological conditions associated with spinal cord injury. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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3D Bioprinting Human Induced Pluripotent Stem Cell-Derived Neural Tissues Using a Novel Lab-on-a-Printer Technology. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8122414] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most neurological diseases and disorders lack true cures, including spinal cord injury (SCI). Accordingly, current treatments only alleviate the symptoms of these neurological diseases and disorders. Engineered neural tissues derived from human induced pluripotent stem cells (hiPSCs) can serve as powerful tools to identify drug targets for treating such diseases and disorders. In this work, we demonstrate how hiPSC-derived neural progenitor cells (NPCs) can be bioprinted into defined structures using Aspect Biosystems’ novel RX1 bioprinter in combination with our unique fibrin-based bioink in rapid fashion as it takes under 5 min to print four tissues. This printing process preserves high levels of cell viability (>81%) and their differentiation capacity in comparison to less sophisticated bioprinting methods. These bioprinted neural tissues expressed the neuronal marker, βT-III (45 ± 20.9%), after 15 days of culture and markers associated with spinal cord (SC) motor neurons (MNs), such as Olig2 (68.8 ± 6.9%), and HB9 (99.6 ± 0.4%) as indicated by flow cytometry. The bioprinted neural tissues expressed the mature MN marker, ChaT, after 30 days of culture as indicated by immunocytochemistry. In conclusion, we have presented a novel method for high throughput production of mature hiPSC-derived neural tissues with defined structures that resemble those found in the SC.
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Yeh TS, Ho YC, Hsu CL, Pan SL. Spinal cord injury and Alzheimer's disease risk: a population-based, retrospective cohort study. Spinal Cord 2017; 56:151-157. [PMID: 29057990 DOI: 10.1038/s41393-017-0009-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 01/23/2023]
Abstract
STUDY DESIGN Propensity score-matched, retrospective cohort study. OBJECTIVES To determine the risk of developing Alzheimer's disease (AD) in patients with spinal cord injury (SCI). SETTING The present study used Taiwan's National Health Insurance Research Database. METHODS A total of 9257 patients who had ⩾2 ambulatory visits with a diagnosis of SCI in 2001 were included in the SCI group. The non-SCI group consisted of 37,028 propensity score-matched patients without a diagnosis of SCI. The cumulative incidence of AD was estimated for each of the two patient groups using the Kaplan-Meier method. Stratified Cox proportional hazard regression was then employed to assess the influence of SCI on the risk of AD. RESULTS During the follow-up period, 25 subjects in the SCI group and 57 in the non-SCI group developed AD. The cumulative incidence of AD in the SCI group was higher than in the non-SCI group (P = 0.0168); and the hazard ratio of AD for the SCI group, as compared to the non-SCI group, was 1.71 (95% CI 1.06-2.76, P = 0.0273). CONCLUSIONS This study suggests that patients with SCI have an increased risk of developing AD.
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Affiliation(s)
- Tian-Shin Yeh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yu-Chun Ho
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Cherng-Lan Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan. .,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
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Montgomery S, Hiyoshi A, Burkill S, Alfredsson L, Bahmanyar S, Olsson T. Concussion in adolescence and risk of multiple sclerosis. Ann Neurol 2017; 82:554-561. [DOI: 10.1002/ana.25036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences; Örebro University; Örebro Sweden
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Solna Sweden
- Department of Epidemiology and Public Health; University College London; London United Kingdom
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences; Örebro University; Örebro Sweden
| | - Sarah Burkill
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Solna Sweden
- Center for Pharmacoepidemiology, Department of Medicine; Karolinska Institute; Solna Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine; Karolinska Institute; Stockholm Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council; Stockholm Sweden
| | - Shahram Bahmanyar
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Solna Sweden
- Center for Pharmacoepidemiology, Department of Medicine; Karolinska Institute; Solna Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Center for Molecular Medicine; Karolinska Institute; Stockholm Sweden
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Deczkowska A, Baruch K, Schwartz M. Type I/II Interferon Balance in the Regulation of Brain Physiology and Pathology. Trends Immunol 2016; 37:181-192. [PMID: 26877243 DOI: 10.1016/j.it.2016.01.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 12/11/2022]
Abstract
Recent findings have revealed distinct roles for type I and II interferons (IFN-I and IFN-γ) in the recruitment of immune cells to the central nervous system (CNS) and highlighted the importance of this process for brain maintenance and protection/repair. Furthermore, manipulation of IFN-I and IFN-γ pathways in pathological contexts has yielded conflicting results. We discuss these findings, focusing on two distinct conditions; relapsing remitting multiple sclerosis (RRMS) and brain aging. Using these examples, we propose that regulation of immune cell entry to the CNS is a mechanism through which interaction between IFN-I and -II can affect brain function from its anatomical borders. Deviation from homeostatic IFN-I/-II balance may contribute to distinct brain pathologies, resulting from either insufficient immune surveillance of the CNS and loss of immune-dependent protection, or overwhelming leukocyte entry and immune-mediated destruction.
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Affiliation(s)
| | - Kuti Baruch
- Department of Neurobiology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Michal Schwartz
- Department of Neurobiology, Weizmann Institute of Science, Rehovot 7610001, Israel.
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