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Spelman T, Frisell T, Piehl F, Hillert J. Comparative effectiveness of rituximab relative to IFN-β or glatiramer acetate in relapsing-remitting MS from the Swedish MS registry. Mult Scler 2017. [PMID: 28649912 DOI: 10.1177/1352458517713668] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare treatment effectiveness and persistence in relapsing-remitting multiple sclerosis patients who initiated rituximab versus glatiramer acetate (GA) or interferon-beta (IFN-β). METHODS A total of 461 patients from the Swedish MS registry in the rituximab arm were propensity score matched on a 1:2 basis with 922 patients from the IFN-β/GA comparator, between April 2005 and November 2015. Annualised relapse rate (ARR) was compared using the Poisson method. A marginal Cox model was used to analyse time to first relapse, 3-month confirmed disability progression and treatment discontinuation in the matched sample. A signed-rank test was used to compare Expanded Disability Status Scale (EDSS) change from baseline. RESULTS Rituximab was associated with a reduction in ARR (0.003; 95% confidence interval (CI) = 0.001, 0.009) relative to IFN-β/GA (0.026; 95% CI = 0.020, 0.033) ( p < 0.001). Rituximab was associated with an 87% reduction in the relapse rate (hazard ratio (HR) = 0.13; 95% CI = 0.04, 0.41) and an 85% reduction in the discontinuation rate (HR = 0.15; 95% CI = 0.11, 0.20) relative to IFN-β/GA. EDSS regression from baseline was greater in the rituximab group at 12 and 24 months. CONCLUSION Rituximab appears to be superior to first-generation disease-modifying treatments (DMTs) with respect to relapse control and tolerability, whereas superiority on disability outcomes is less clear.
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Affiliation(s)
- Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Frisell
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Chapouly C, Tadesse Argaw A, Horng S, Castro K, Zhang J, Asp L, Loo H, Laitman BM, Mariani JN, Straus Farber R, Zaslavsky E, Nudelman G, Raine CS, John GR. Astrocytic TYMP and VEGFA drive blood-brain barrier opening in inflammatory central nervous system lesions. Brain 2015; 138:1548-67. [PMID: 25805644 DOI: 10.1093/brain/awv077] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/26/2015] [Indexed: 12/21/2022] Open
Abstract
In inflammatory central nervous system conditions such as multiple sclerosis, breakdown of the blood-brain barrier is a key event in lesion pathogenesis, predisposing to oedema, excitotoxicity, and ingress of plasma proteins and inflammatory cells. Recently, we showed that reactive astrocytes drive blood-brain barrier opening, via production of vascular endothelial growth factor A (VEGFA). Here, we now identify thymidine phosphorylase (TYMP; previously known as endothelial cell growth factor 1, ECGF1) as a second key astrocyte-derived permeability factor, which interacts with VEGFA to induce blood-brain barrier disruption. The two are co-induced NFκB1-dependently in human astrocytes by the cytokine interleukin 1 beta (IL1B), and inactivation of Vegfa in vivo potentiates TYMP induction. In human central nervous system microvascular endothelial cells, VEGFA and the TYMP product 2-deoxy-d-ribose cooperatively repress tight junction proteins, driving permeability. Notably, this response represents part of a wider pattern of endothelial plasticity: 2-deoxy-d-ribose and VEGFA produce transcriptional programs encompassing angiogenic and permeability genes, and together regulate a third unique cohort. Functionally, each promotes proliferation and viability, and they cooperatively drive motility and angiogenesis. Importantly, introduction of either into mouse cortex promotes blood-brain barrier breakdown, and together they induce severe barrier disruption. In the multiple sclerosis model experimental autoimmune encephalitis, TYMP and VEGFA co-localize to reactive astrocytes, and correlate with blood-brain barrier permeability. Critically, blockade of either reduces neurologic deficit, blood-brain barrier disruption and pathology, and inhibiting both in combination enhances tissue preservation. Suggesting importance in human disease, TYMP and VEGFA both localize to reactive astrocytes in multiple sclerosis lesion samples. Collectively, these data identify TYMP as an astrocyte-derived permeability factor, and suggest TYMP and VEGFA together promote blood-brain barrier breakdown.
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Affiliation(s)
- Candice Chapouly
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Azeb Tadesse Argaw
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Sam Horng
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Kamilah Castro
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Jingya Zhang
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Linnea Asp
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Hannah Loo
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Benjamin M Laitman
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - John N Mariani
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Rebecca Straus Farber
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Elena Zaslavsky
- 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 4 Department of Systems Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - German Nudelman
- 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 4 Department of Systems Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Cedric S Raine
- 5 Department of Pathology (Neuropathology), Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gareth R John
- 1 Corinne Goldsmith Dickinson Centre for MS, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 2 Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA 3 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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3
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Positive or negative involvement of heat shock proteins in multiple sclerosis pathogenesis: an overview. J Neuropathol Exp Neurol 2015; 73:1092-106. [PMID: 25383635 DOI: 10.1097/nen.0000000000000136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Multiple sclerosis (MS) is the most diffuse chronic inflammatory disease of the central nervous system. Both immune-mediated and neurodegenerative processes apparently play roles in the pathogenesis of this disease. Heat shock proteins (HSPs) are a family of highly evolutionarily conserved proteins; their expression in the nervous system is induced in a variety of pathologic states, including cerebral ischemia, neurodegenerative diseases, epilepsy, and trauma. To date, investigators have observed protective effects of HSPs in a variety of brain disease models (e.g. of Alzheimer disease and Parkinson disease). In contrast, unequivocal data have been obtained for their roles in MS that depend on the HSP family and particularly on their localization (i.e. intracellular or extracellular). This article reviews our current understanding of the involvement of the principal HSP families in MS.
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Treatment with the antipsychotic agent, risperidone, reduces disease severity in experimental autoimmune encephalomyelitis. PLoS One 2014; 9:e104430. [PMID: 25116424 PMCID: PMC4130540 DOI: 10.1371/journal.pone.0104430] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/09/2014] [Indexed: 01/11/2023] Open
Abstract
Recent studies have demonstrated that atypical antipsychotic agents, which are known to antagonize dopamine D2 and serotonin 5-HT2a receptors, have immunomodulatory properties. Given the potential of these drugs to modulate the immune system both peripherally and within the central nervous system, we investigated the ability of the atypical anti-psychotic agent, risperidone, to modify disease in the animal model of multiple sclerosis (MS)4, experimental autoimune encephalomyelitis (EAE). We found that chronic oral administration of risperidone dose-dependently reduced the severity of disease and decreased both the size and number of spinal cord lesions. Furthermore, risperidone treatment substantially reduced antigen-specific interleukin (IL)-17a, IL-2, and IL-4 but not interferon (IFN)-γ production by splenocytes at peak disease and using an in vitro model, we show that treatment of macrophages with risperidone alters their ability to bias naïve T cells. Another atypical antipsychotic agent, clozapine, showed a similar ability to modify macrophages in vitro and to reduce disease in the EAE model but this effect was not due to antagonism of the type 1 or type 2 dopamine receptors alone. Finally, we found that while risperidone treatment had little effect on the in vivo activation of splenic macrophages during EAE, it significantly reduced the activation of microglia and macrophages in the central nervous system. Together these studies indicate that atypical antipsychotic agents like risperidone are effective immunomodulatory agents with the potential to treat immune-mediated diseases such as MS.
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5
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Yao SQ, Li ZZ, Huang QY, Li F, Wang ZW, Augusto E, He JC, Wang XT, Chen JF, Zheng RY. Genetic inactivation of the adenosine A2Areceptor exacerbates brain damage in mice with experimental autoimmune encephalomyelitis. J Neurochem 2012; 123:100-12. [DOI: 10.1111/j.1471-4159.2012.07807.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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6
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Argaw AT, Asp L, Zhang J, Navrazhina K, Pham T, Mariani JN, Mahase S, Dutta DJ, Seto J, Kramer EG, Ferrara N, Sofroniew MV, John GR. Astrocyte-derived VEGF-A drives blood-brain barrier disruption in CNS inflammatory disease. J Clin Invest 2012; 122:2454-68. [PMID: 22653056 PMCID: PMC3386814 DOI: 10.1172/jci60842] [Citation(s) in RCA: 489] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 04/18/2012] [Indexed: 01/17/2023] Open
Abstract
In inflammatory CNS conditions such as multiple sclerosis (MS), current options to treat clinical relapse are limited, and more selective agents are needed. Disruption of the blood-brain barrier (BBB) is an early feature of lesion formation that correlates with clinical exacerbation, leading to edema, excitotoxicity, and entry of serum proteins and inflammatory cells. Here, we identify astrocytic expression of VEGF-A as a key driver of BBB permeability in mice. Inactivation of astrocytic Vegfa expression reduced BBB breakdown, decreased lymphocyte infiltration and neuropathology in inflammatory and demyelinating lesions, and reduced paralysis in a mouse model of MS. Knockdown studies in CNS endothelium indicated activation of the downstream effector eNOS as the principal mechanism underlying the effects of VEGF-A on the BBB. Systemic administration of the selective eNOS inhibitor cavtratin in mice abrogated VEGF-A-induced BBB disruption and pathology and protected against neurologic deficit in the MS model system. Collectively, these data identify blockade of VEGF-A signaling as a protective strategy to treat inflammatory CNS disease.
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Affiliation(s)
- Azeb Tadesse Argaw
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Linnea Asp
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jingya Zhang
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Kristina Navrazhina
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Trinh Pham
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - John N. Mariani
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sean Mahase
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Dipankar J. Dutta
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jeremy Seto
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Elisabeth G. Kramer
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Napoleone Ferrara
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Michael V. Sofroniew
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Gareth R. John
- Corinne Goldsmith Dickinson Center for MS,
Friedman Brain Institute, and
Department of Neurology, Mount Sinai School of Medicine (MSSM), New York, New York, USA.
Genentech, South San Francisco, California, USA.
Department of Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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7
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Katz Sand IB, Krieger S. Emerging strategies for the treatment of multiple sclerosis. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite extraordinary advances in the field of neuroimmunology, ideal treatment for patients with multiple sclerosis remains an unmet need. Existing treatments are only partially effective in preventing multiple sclerosis relapses, have a limited impact on the accrual of disability, have not been effective in progressive forms of the disease, and treatment remains preventive rather than restorative. This review provides an overview of emerging therapies and targets, and incorporates strategies for two different approaches to multiple sclerosis: prevention, through immune modulation; and repair, through neuroprotection and remyelination. Agents at all stages of development, from late-stage clinical trials of BG-12, teriflunomide, alemtuzumab, daclizumab and anti-CD20 agents, to novel approaches in preclinical testing, are discussed.
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Affiliation(s)
- Ilana B Katz Sand
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, 5 East 98th Street, Box 1138, New York, NY, 10029, USA
| | - Stephen Krieger
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, 5 East 98th Street, Box 1138, New York, NY, 10029, USA
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8
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Zhang J, Zhang Y, Dutta DJ, Argaw AT, Bonnamain V, Seto J, Braun DA, Zameer A, Hayot F, Lòpez CB, Raine CS, John GR. Proapoptotic and antiapoptotic actions of Stat1 versus Stat3 underlie neuroprotective and immunoregulatory functions of IL-11. THE JOURNAL OF IMMUNOLOGY 2011; 187:1129-41. [PMID: 21709156 DOI: 10.4049/jimmunol.1004066] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Current therapies for multiple sclerosis target inflammation but do not directly address oligodendrocyte protection or myelin repair. The gp130 family cytokines ciliary neurotrophic factor, leukemia inhibitory factor, and IL-11 have been identified as oligodendrocyte growth factors, and IL-11 is also strongly immunoregulatory, but their underlying mechanisms of action are incompletely characterized. In this study, we demonstrate that these effects of IL-11 are mediated via differential regulation of apoptosis in oligodendrocytes versus Ag-presenting dendritic cells (DCs), and are dependent on lineage-specific activity of the transcription factors Stat1 versus Stat3. Focal demyelinating lesions induced in cerebral cortices of IL-11Rα(-/-) mice using stereotactic microinjection of lysolecithin were larger than in controls, and remyelination was delayed. In IL-11Rα(-/-) mice, lesions displayed extensive oligodendrocyte loss and axonal transection, and increased infiltration by inflammatory cells including CD11c(+) DCs, CD3(+) lymphocytes, and CD11b(+) phagocytes. In oligodendrocyte progenitor cell (OPC) cultures, IL-11 restricted caspase 9 activation and apoptosis, and it increased myelination in OPC-neuron cocultures. Importantly, siRNA inhibition of Stat1 enhanced the antiapoptotic effects of IL-11 on OPCs, but IL-11 induced apoptosis in the presence of Stat3 silencing. In contrast, IL-11 augmented caspase activation and apoptosis in cultures of CD11c(+) DCs, but not in CD11b(+) or CD3(+) cells. Inhibition of Stat3 exacerbated the proapoptotic effects of IL-11 on DCs, whereas they were ablated in Stat1(-/-) cultures. Collectively, these findings reveal novel mechanisms underlying the actions of a neuroprotective and immunoregulatory member of the gp130 cytokine family, suggesting avenues to enhance oligodendrocyte viability and restrict CNS inflammation in multiple sclerosis.
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Affiliation(s)
- Jingya Zhang
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY 10029, USA
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9
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Cwiklinska H, Mycko MP, Szymanska B, Matysiak M, Selmaj KW. Aberrant stress-induced Hsp70 expression in immune cells in multiple sclerosis. J Neurosci Res 2011; 88:3102-10. [PMID: 20806409 DOI: 10.1002/jnr.22476] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heat shock protein 70 (Hsp70), a prominent member of the heat shock protein family, is a stress-induced chaperone, contributing to the "protein triage" mechanism. However, we and others have previously shown that chaperonin activity of Hsp70 also promotes immune recognition of protein/peptide antigens, including myelin autoantigens. Hsp70 has been strikingly elevated in multiple sclerosis (MS) lesions. In a search for the mechanism of Hsp70 up-regulation in MS, we analyzed Hsp70 expression in peripheral blood mononuclear cells (PBMCs) from MS patients (n = 49), healthy controls (n = 40), and patients with rheumatoid arthritis, (RA; n = 13). Hsp70 was detected by Western blot, and Hsp70 levels were quantified by ELISA. We found that Hsp70 was expressed at low levels in ex vivo PBMCs. However, after heat shock, Hsp70 was up-regulated significantly more (up to sixfold) in MS patients compared with healthy controls. This significant overproduction of Hsp70 was also seen following another stress condition, LPS stimulation. Hsp70 is a product of several independent genes, and we found the HSPA1B gene product to be the major form responsible for Hsp70 protein overexpression in PBMCs. Hsp70 overexpression was preceded by increased nuclear presence of heat shock factor 1 (HSF1). HSF1 activation depends on phosphorylation, and we found that inhibition of the A group of protein kinase C isoenzymes significantly reduced inducible Hsp70 production. These results indicate that immune cells from MS patients are more prone to Hsp70 induction under stress conditions, suggesting a possible link between Hsp70 overexpression and development of autoimmunity.
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Affiliation(s)
- Hanna Cwiklinska
- Department of Neurology, Laboratory of Neuroimmunology, Medical University of Lodz, Lodz, Poland
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10
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Spalice A, Parisi P, Papetti L, Nicita F, Ursitti F, Del Balzo F, Properzi E, Verrotti A, Ruggieri M, Iannetti P. Clinical and pharmacological aspects of inflammatory demyelinating diseases in childhood: an update. Curr Neuropharmacol 2011; 8:135-48. [PMID: 21119885 PMCID: PMC2923368 DOI: 10.2174/157015910791233141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/19/2010] [Accepted: 02/24/2010] [Indexed: 12/21/2022] Open
Abstract
Inflammatory demyelinating diseases comprise a spectrum of disorders affecting the myelin of the central and peripheral nervous system. These diseases can usually be differentiated on the basis of clinical, radiological, laboratory and pathological findings. Recent studies have contributed to current awareness that inflammatory demyelinating diseases are not restricted to the adult age group, but are more common in pediatric age than previously believed. Some of pediatric inflammatory demyelinating diseases carry an unfavorable long-term prognosis but appropriate treatments can improve the outcome. The possibility of physical and cognitive disability resulting from these diseases, highlights the urgent need for therapeutic strategies for neurorehabilitation, neuroregeneration, and neurorepair. This review discusses characteristics of primary demyelinating diseases more frequently observed in childhood, focusing on epidemiology, clinical aspects and treatments.
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Affiliation(s)
- Alberto Spalice
- Child Neurology, Paediatric Department, I Faculty of Medicine, "Sapienza University", c/o Policlinico Umberto I, Rome, Italy.
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11
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Krieger S. Multiple Sclerosis Therapeutic Pipeline: Opportunities and Challenges. ACTA ACUST UNITED AC 2011; 78:192-206. [DOI: 10.1002/msj.20241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Swan DJ, Kirby JA, Ali S. Vascular biology: the role of sphingosine 1-phosphate in both the resting state and inflammation. J Cell Mol Med 2011; 14:2211-22. [PMID: 20716131 PMCID: PMC3822560 DOI: 10.1111/j.1582-4934.2010.01136.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The vascular and immune systems of mammals are closely intertwined: the individual components of the immune system must move between various body compartments to perform their function effectively. Sphingosine 1-phosphate (S1P), a bioactive lipid mediator, exerts effects on the two organ systems and influences the interaction between them. In the resting state, the vascular S1P gradient contributes to control of lymphocyte recirculation through the blood, lymphoid tissue and lymphatic vasculature. The high level of S1P in blood helps maintain endothelial barrier integrity. During the inflammatory process, both the level of S1P in different immune compartments and S1P receptor expression on lymphocytes and endothelial cells are modified, resulting in functionally important changes in endothelial cell and lymphocyte behaviour. These include transient arrest of lymphocytes in secondary lymphoid tissue, crucial for generation of adaptive immunity, and subsequent promotion of lymphocyte recruitment to sites of inflammation. This review begins with an outline of the basic biochemistry of S1P. S1P receptor signalling is then discussed, followed by an exploration of the roles of S1P in the vascular and immune systems, with particular focus on the interface between them. The latter part concerns crosstalk between S1P and other signalling pathways, and concludes with a look at therapies targeting the S1P-S1P receptor axis.
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Affiliation(s)
- David J Swan
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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Bagnato F, Centonze D, Galgani S, Grasso MG, Haggiag S, Strano S. Painful and involuntary multiple sclerosis. Expert Opin Pharmacother 2011; 12:763-77. [PMID: 21323633 DOI: 10.1517/14656566.2011.540239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Pain, dysphagia, respiratory problems, sexual and cardiovascular dysfunctions may occur in patients with MS. AREAS COVERED In the present review, we attempt to summarize the current knowledge on the impact pain, dysphagia, respiratory problems, sexual and cardiovascular dysfunctions have in patients with MS. EXPERT OPINION To effectively manage MS, it is essential that these symptoms are recognized as early as possible and treated by a rehabilitative multidisciplinary approach, based on proven scientific evidence.
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Affiliation(s)
- Francesca Bagnato
- Vanderbilt University Institute of Imaging Science 1161 21st Ave. S. AA1105 MCN Radiology Department, Nashville, TN 37232, USA.
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Losy J, Kalinowska-Łyszczarz A. Emerging disease-modifying oral therapies for multiple sclerosis. J Neuroimmunol 2010; 231:15-22. [PMID: 20947176 DOI: 10.1016/j.jneuroim.2010.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although therapy for multiple sclerosis (MS) has changed substantially over the past few decades, introducing immunomodulatory drugs into everyday clinical practice, it is still not satisfactory enough in halting the disease progression and increasing disability. Moreover, its injection-based administration leads to suboptimal adherence, even further reducing the potential treatment benefits. Emerging disease-modifying oral agents for MS are therefore warranted. In this paper advances in the novel oral therapeutic approaches to MS treatment are reviewed.
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Affiliation(s)
- Jacek Losy
- Department of Clinical Neuroimmunology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznań, Poland.
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Bendfeldt K, Egger H, Nichols TE, Loetscher P, Denier N, Kuster P, Traud S, Mueller-Lenke N, Naegelin Y, Gass A, Kappos L, Radue EW, Borgwardt SJ. Effect of immunomodulatory medication on regional gray matter loss in relapsing-remitting multiple sclerosis--a longitudinal MRI study. Brain Res 2010; 1325:174-82. [PMID: 20167205 DOI: 10.1016/j.brainres.2010.02.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
Prevention of global gray matter (GM) volume changes in multiple sclerosis (MS) are an objective in clinical trials, but the effect of immunomodulatory medication on regional GM atrophy progression is unclear. MRIs from 86 patients with relapsing-remitting MS (RRMS) followed up for 24 months were analyzed using voxel-based morphometry. An analysis of covariance model (cluster threshold, corrected p<0.05) was used to compare GM volumes between baseline and follow-up while stratified by immunomodulatory medication (IM): Interferone INF-beta-1a (n=34), INF-beta-1b (n=16), glatiramer acetate (GA) (n=15), and no-immunomodulatory treatment (n=21). In the INF-beta-1a/1b group (n=50), significant GM volume reductions were observed during follow-up in fronto-temporal, cingulate and cerebellar cortical brain regions, without significant differences between the INF-beta-1a and INF-beta-1b patients. In the GA group and in unmedicated patients, no significant regional GM volume reductions were observed. In contrast to GA, INF-beta-1a/1b treatment was associated with GM volume reductions in hippocampal/parahippocampal and anterior cingulate cortex. This is the first longitudinal study investigating the effects of IMs on GM in RRMS. Results suggest differences in the dynamics of regional GM volume atrophy in differentially treated or untreated RRMS patients.
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Affiliation(s)
- Kerstin Bendfeldt
- Medical Image Analysis Centre (MIAC), University Hospital Basel, Basel, Switzerland
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Carter PH, Zhao Q. Clinically validated approaches to the treatment of autoimmune diseases. Expert Opin Investig Drugs 2010; 19:195-213. [PMID: 20050823 DOI: 10.1517/13543780903418452] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE OF THE FIELD Autoimmune diseases are pathological conditions in which "self-tolerance" has been broken, and an immune response has been mounted against the body's own tissues. More than seventy autoimmune diseases have been described, some of which are systemic and others of which are organ-specific. Although many of these diseases are rare, the collective prevalence of autoimmune diseases in the United States alone is between 5 and 8%, and is increasing. AREAS COVERED IN THIS REVIEW Herein, we review the exciting advances made during the past decade (1999 - 2009) in the development of clinically-validated agents for the treatment of autoimmune disease. We focus on five of the most prevalent conditions: rheumatoid arthritis, psoriasis, multiple sclerosis, Crohn's disease, and systemic lupus erythematosus. The discussion is largely restricted to agents - both small molecules and macromolecules - that have advanced through randomized, controlled clinical trials. WHAT THE READER WILL GAIN An overview of the pathogenesis of each disease is provided, along with a description of the therapies. Results from pivotal clinical trials are tabulated for four of the disease areas. We also provide summaries of experiences with both failed clinical trials and side effects observed during the course of clinical investigations. We conclude the review with thoughts on current challenges in the field and the prospect for future innovations. TAKE HOME MESSAGE During the past decade, some of the largest advances in the treatment of autoimmune disease have arisen from highly potent and selective macromolecule-based therapies (e.g. antibodies, recombinant proteins and fusion proteins). Together, these clinical experiences have provided insight into the critical mechanisms in autoimmune pathogenesis, including inflammatory cytokine release, T-cell migration and co-stimulation, and B-cell function.
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Affiliation(s)
- Percy H Carter
- Bristol-Myers Squibb Company, Research & Development, Rt. 206 & Province Line Road, Princeton, NJ 08543, USA.
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17
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Abstract
Multiple sclerosis (MS) is the commonest disabling neurological condition to afflict young adults and therefore has a high social burden. Over several decades, there has been a considerable progress in the understanding of the disease pathogenesis as well as in the clinical management of MS patients. The emphasis in managing MS patients has shifted to multidisciplinary teams working in specialist groups. A review of the literature was conducted using MedLine to identify recent advances in MS. The current consensus is that MS is an autoimmune disease triggered by environmental agents acting in genetically susceptible people. Based on that concept, new methods of immune intervention procedures have been introduced into clinical practice. Licensed first-line disease-modifying therapies reduce the MS attack or relapse rate by a third and delaying short-term disease progression. More effective therapies have emerged; however, these are associated with increased risks. New clinical and pathological insights are making us question the aetiology and pathogenesis of MS. The recognition of pathological heterogeneity has raised the question of whether MS is a single disease entity or a syndrome. Recent evidence suggests that the pathological subtype may predict therapeutic response to specific therapies. A new novel auto-antibody has defined a subset of neuromyelitis optica or Devic's disease as being distinct from MS. This is an attractive concept that is not widely accepted. The observation that MS progresses despite immunosuppressive therapy suggests that MS may be a neurodegenerative disease with overlapping immune activation possibly in response to the release of central nervous system auto-antigens. The development of neuroprotective therapies for MS is required to prevent the devastating effects of long-term disability as a result of progressive disease.
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Affiliation(s)
- Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
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Fischer DJ, Epstein JB, Klasser G. Multiple sclerosis: an update for oral health care providers. ACTA ACUST UNITED AC 2009; 108:318-27. [PMID: 19716502 DOI: 10.1016/j.tripleo.2009.05.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 05/24/2009] [Accepted: 05/28/2009] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system. The disease mostly affects young adults and is increasing in prevalence and incidence. Multiple sclerosis is characterized by periods of activity and remission which, after numerous relapses, cause permanent neurologic deficits. Diagnosis of MS is based on patient history and clinical examination supplemented by the findings of radiologic and laboratory tests. Numerous motor and sensory disturbances occur in MS and may present in the orofacial region. This medical management update highlights issues that are important to the oral health care provider, including orofacial manifestations of MS and dental considerations for patients with MS.
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Affiliation(s)
- Dena J Fischer
- Department of Oral Medicine and Diagnostic Sciences, UIC College of Dentistry, University of Illinois at Chicago, Chicago, Illinois 60612-7213, USA.
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20
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Current World Literature. Curr Opin Neurol 2009; 22:321-9. [DOI: 10.1097/wco.0b013e32832cf9cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Buckley CE, Goldsmith P, Franklin RJM. Zebrafish myelination: a transparent model for remyelination? Dis Model Mech 2009; 1:221-8. [PMID: 19093028 DOI: 10.1242/dmm.001248] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There is currently an unmet need for a therapy that promotes the regenerative process of remyelination in central nervous system diseases, notably multiple sclerosis (MS). A high-throughput model is, therefore, required to screen potential therapeutic drugs and to refine genomic and proteomic data from MS lesions. Here, we review the value of the zebrafish (Danio rerio) larva as a model of the developmental process of myelination, describing the powerful applications of zebrafish for genetic manipulation and genetic screens, as well as some of the exciting imaging capabilities of this model. Finally, we discuss how a model of zebrafish myelination can be used as a high-throughput screening model to predict the effect of compounds on remyelination. We conclude that zebrafish provide a highly versatile myelination model. As more complex transgenic zebrafish lines are developed, it might soon be possible to visualise myelination, or even remyelination, in real time. However, experimental outputs must be designed carefully for such visual and temporal techniques.
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Affiliation(s)
- Clare E Buckley
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
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Abstract
Laquinimod, a quinoline-3-carboxamide derivative, is a new, once-daily oral immunomodulatory therapy in development for the treatment of relapsing–remitting multiple sclerosis (MS). It has demonstrated efficacy in both acute and chronic experimental allergic encephalitis and in animal models of other inflammatory autoimmune diseases. It appears to act, in part, by shifting the immune response from a Th1 to a Th2 response and does not act through nonspecific immunosuppression. In Phase II studies in relapsing forms of MS, laquinimod brought about a 60% decrease in the cumulative number of gadolinium-enhancing lesions and a 33% decrease in relapse rates. In Phase II studies it was safe and well-tolerated. The most common laboratory abnormalities were a transient rise in alanine aminotransferase and C-reactive protein that returned to normal values despite continued therapy. There was no evidence of a proinflammatory effect. Phase III clinical trials for registration are in progress. Laquinimod may find use as a first-line agent in the treatment of relapsing forms of MS.
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Affiliation(s)
- Douglas R Jeffery
- Wake Forest University Health Sciences, Department of Neurology, Medical Center Blvd, Winston-Salem, NC 27157, USA
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