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Stefanou MI, Giannopapas V, Kitsos DK, Chondrogianni M, Theodorou A, Kosmidou M, Vlotinou P, Bakirtzis C, Andreadou E, Tzartos JS, Giannopoulos S, Tsivgoulis G. Prevalence and epidemiology of stroke in patients with multiple sclerosis: a systematic review and meta-analysis. J Neurol 2024; 271:4075-4085. [PMID: 38573365 PMCID: PMC11233381 DOI: 10.1007/s00415-024-12331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Epidemiological data are sparse regarding the risk of stroke in patients with multiple sclerosis (MS). OBJECTIVE To estimate the following: (1) the pooled prevalence of all-cause stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) in MS patients; (2) the relative risk for all-cause stroke, AIS and ICH in MS patients compared to the general population; (3) associations between patient characteristics and the risk for AIS and ICH in MS patients. METHODS Systematic review and meta-analysis of registry-based and cohort studies. RESULTS Thirteen observational studies comprising 146,381 MS patients were included. The pooled prevalence of all-cause stroke was 2.7% (95% confidence interval [CI] 1.3-4.6%), with the relative risk of all-cause stroke being higher in MS patients compared to the general population (RR: 2.55; 95% CI 1.97-3.29). Subgroup analyses per stroke subtype revealed a pooled AIS prevalence of 2.1% (95% CI 0.8-4.1%) and a pooled ICH prevalence of 0.6% (95% CI 0.2-1.2%). Compared to the general population, patients with MS were found to harbour an increased risk for AIS (RR: 2.79; 95% CI 2.27-3.41) and ICH (RR: 2.31; 95% CI 1.04-5.11), respectively. The pooled prevalence of cardiovascular risk factors in MS patients was 11.5% (95% CI 2.9-24.7%) for dyslipidaemia, 18.2% (95% CI 5.9-35.3%) for hypertension and 5.4% (95% CI 2.1-10.2%) for diabetes. In meta-regression, age was negatively associated with AIS risk (β = - .03, p = 0.04), with a 1-year increase in age resulting in a significant 3% (95%CI 0-5) attenuation of the risk of AIS. CONCLUSION The findings of the present meta-analysis indicate that MS is associated with an increased risk for ischaemic and haemorrhagic stroke. Future well-designed epidemiological studies are warranted to corroborate the robustness of the present findings in the MS population.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Vasileios Giannopapas
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitrios K Kitsos
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Maria Kosmidou
- Faculty of Medicine, Department of Internal Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, School of Health and Welfare Sciences, University of West Attica, Athens, Greece
| | - Christos Bakirtzis
- Second Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Elizabeth Andreadou
- School of Medicine, First Department of Neurology, National and Kapodistrian University of Athens, "Eginition" University Hospital, Athens, Greece
| | - John S Tzartos
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece.
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
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Marsool MDM, Prajjwal P, John J, Keluskar HS, Sivarajan VV, Kundiri KA, Lam JR, Chavda S, Atew HG, Marsool ADM, Hameed AAZ, Hussin OA. Association of multiple sclerosis with stroke: A comprehensive review. Health Sci Rep 2024; 7:e1837. [PMID: 38264155 PMCID: PMC10804671 DOI: 10.1002/hsr2.1837] [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] [Received: 07/28/2023] [Revised: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
Background Multiple sclerosis (MS) is a chronic immune-mediated disorder characterized by the degradation of the myelin sheath in the central nervous system. Research indicates that individuals with MS exhibit a higher susceptibility to stroke compared to the general population. This association is rooted in shared underlying mechanisms, specifically involving neuroinflammatory processes. Methodology We performed an extensive search on PubMed, MEDLINE, Embase, Scopus, and Google Scholar using specific terms. The search terms included variations of "multiple sclerosis," "stroke," "cerebrovascular disease," "vascular risk factors," "disease-modifying therapies," and "neuroinflammation." The search was limited to articles published from January 1, 2000, up to 31 May, 2023. Results and Discussion Stroke, a global health burden characterized by significant mortality and adult disability, underscores the critical importance of understanding the link between MS and stroke. Despite a growing body of research establishing an elevated risk of stroke in MS patients, notable information gaps persist. Limited prospective multicenter studies on stroke incidence in MS patients contribute to an incomplete understanding of the precise relationship between these two conditions. Conclusion In conclusion, this review underscores the critical need for a thorough understanding of the complex relationship between MS and stroke. The identified risk factors and the influence of MS DMTs on stroke risk necessitate further investigation to inform evidence-based preventive and therapeutic strategies. Bridging the existing information gaps through prospective multicenter studies is imperative for a comprehensive understanding of this association. The development of targeted diagnostic and therapeutic approaches for acute stroke risk in MS patients is paramount to mitigate the impact of these debilitating conditions. Ultimately, this review serves as a foundation for future efforts to enhance preventative measures and therapeutic interventions, thereby improving the overall quality of life for individuals with MS susceptible to strokes.
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Affiliation(s)
| | | | - Jobby John
- Internal MedicineDr. Somervell Memorial CSI Medical College and HospitalNeyyāttinkaraIndia
| | | | | | | | - Justin R. Lam
- Internal MedicineCebu Institute of MedicineCebuPhilippines
| | - Sachi Chavda
- Internal MedicineGMERS Medical College SolaAhmedabadIndia
| | - Hundaol G. Atew
- Internal MedicineSt Paul's Millennium Medical CollegeAddis AbabaEthiopia
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Doskas T, Dardiotis E, Vavougios GD, Ntoskas KT, Sionidou P, Vadikolias K. Stroke risk in multiple sclerosis: a critical appraisal of the literature. Int J Neurosci 2023; 133:1132-1152. [PMID: 35369835 DOI: 10.1080/00207454.2022.2056459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Observational studies suggest that the occurrence of stroke on multiple sclerosis (MS) patients is higher compared to the general population. MS is a heterogeneous disease that involves an interplay of genetic, environmental and immune factors. The occurrence of stroke is subject to a wide range of both modifiable and non-modifiable, short- and long-term risk factors. Both MS and stroke share common risk factors. The immune mechanisms that underlie stroke are similar to neurodegenerative diseases and are attributed to neuroinflammation. The inflammation in autoimmune diseases may, therefore, predispose to an increased risk for stroke or potentiate the effect of conventional stroke risk factors. There are, however, additional determinants that contribute to a higher risk and incidence of stroke in MS. Due to the challenges that are associated with their differential diagnosis, the objective is to present an overview of the factors that may contribute to increased susceptibility or occurrence of stroke in MSpatients by performing a review of the available to date literature. As both MS and stroke can individually detrimentally affect the quality of life of afflicted patients, the identification of factors that contribute to an increased risk for stroke in MS is crucial for the prompt implementation of preventative therapeutic measures to limit the additive burden that stroke imposes.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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4
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Nociti V, Romozzi M. The Importance of Managing Modifiable Comorbidities in People with Multiple Sclerosis: A Narrative Review. J Pers Med 2023; 13:1524. [PMID: 38003839 PMCID: PMC10672087 DOI: 10.3390/jpm13111524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, degenerative demyelinating disease of the central nervous system (CNS) of unknown etiology that affects individuals in their early adulthood. In the last decade, life expectancy for people with MS (PwMS) has almost equaled that of the general population. This demographic shift necessitates a heightened awareness of comorbidities, especially the ones that can be prevented and modified, that can significantly impact disease progression and management. Vascular comorbidities are of particular interest as they are mostly modifiable health states, along with voluntary behaviors, such as smoking and alcohol consumption, commonly observed among individuals with MS. Vascular risk factors have also been implicated in the etiology of cerebral small vessel disease. Furthermore, differentiating between vascular and MS lesion load poses a significant challenge due to overlapping clinical and radiological features. This review describes the current evidence regarding the range of preventable and modifiable comorbidities and risk factors and their implications for PwMS.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
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Prajjwal P, Shree A, Das S, Inban P, Ghosh S, Senthil A, Gurav J, Kundu M, Marsool Marsool MD, Gadam S, Marsool Marsoo AD, Vora N, Amir Hussin O. Vascular multiple sclerosis: addressing the pathogenesis, genetics, pro-angiogenic factors, and vascular abnormalities, along with the role of vascular intervention. Ann Med Surg (Lond) 2023; 85:4928-4938. [PMID: 37811110 PMCID: PMC10553029 DOI: 10.1097/ms9.0000000000001177] [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] [Received: 05/27/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Dysfunction in the epithelium, breakdown of the blood-brain barrier, and consequent leukocyte and T-cell infiltration into the central nervous system define Vascular Multiple Sclerosis. Multiple sclerosis (MS) affects around 2.5 million individuals worldwide, is the leading cause of neurological impairment in young adults, and can have a variety of progressions and consequences. Despite significant discoveries in immunology and molecular biology, the root cause of MS is still not fully understood, as do the immunological triggers and causative pathways. Recent research into vascular anomalies associated with MS suggests that a vascular component may be pivotal to the etiology of MS, and there can be actually a completely new entity in the already available classification of MS, which can be called 'vascular multiple sclerosis'. Unlike the usual other causes of MS, vascular MS is not dependent on autoimmune pathophysiologic mechanisms, instead, it is caused due to the blood vessels pathology. This review aims to thoroughly analyze existing information and updates about the scattered available findings of genetics, pro-angiogenetic factors, and vascular abnormalities in this important spectrum, the vascular facets of MS.
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Affiliation(s)
| | - Anagha Shree
- SGT Medical College Hospital and Research Institute, Gurgaon
| | - Soumyajit Das
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar
| | - Pugazhendi Inban
- Internal Medicine, Government Medical College, Omandurar, Chennai
| | | | | | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar
| | | | - Srikanth Gadam
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Neel Vora
- Internal Medicine, B.J. Medical College, Ahmedabad, India
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6
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Ghoshouni H, Shafaei B, Farzan M, Hashemi SM, Afshari-Safavi A, Ghaffary EM, Mohammadzamani M, Shaygannejad V, Shamloo AS, Mirmosayyeb O. Multiple sclerosis and the incidence of venous thromboembolism: a systematic review and meta-analysis. J Thromb Thrombolysis 2023; 56:463-473. [PMID: 37394561 DOI: 10.1007/s11239-023-02848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/04/2023]
Abstract
A number of studies have suggested that multiple sclerosis (MS) can be associated with serious vascular complications, for which pulmonary thromboembolism (PTE) is a potentially lethal complication. The purpose of this study is to establish a current literature-based estimate of the incidence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and PTE in patients with MS (pwMS) due to the lack of systematic reviews and meta-analyses on this topic. In this systematic review and meta-analysis, studies were assessed regarding the association between MS and the incidence of VTE. The studies were identified through a systematic search of major electronic databases spanning the period from 1950 to February 2022. A random-effects analysis was conducted to calculate the pooled effect size (ES) and 95% confidence intervals (CI) using STATA software. Nine out of 4605 studies were included in the meta-analysis, with an overall sample size of 158,546 individuals. Meta-analysis revealed that the pooled incidence of VTE was 1.8% (95% CI 1.4-2.3) among pwMS. Also, there was an incidence of 0.9% (95% CI 0.4-1.4) and 1.5% (95% CI 1-2.2) for PTE and DVT, respectively in pwMS. Analysis showed MS would be significantly associated with a twofold increased risk of VTE [risk ratios (RR) = 2.12 (95% CI 1.53-2.93)]. Although MS is not typically considered a major risk factor for VTE, the meta-analysis of cohort studies shows that MS has a relative association with an increased incidence of VTE. Future research should focus on the investigation of the effects of MS and its treatments on VTE risk, and also a full range of confounding adjustments will be needed.
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Affiliation(s)
- Hamed Ghoshouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behnam Shafaei
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahour Farzan
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyedeh Melika Hashemi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahtab Mohammadzamani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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7
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Giannopapas V, Palaiodimou L, Kitsos D, Papagiannopoulou G, Stavrogianni K, Chasiotis A, Kosmidou M, Tzartos JS, Paraskevas GP, Bakalidou D, Tsivgoulis G, Giannopoulos S. The Prevalence of Diabetes Mellitus Type II (DMII) in the Multiple Sclerosis Population: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4948. [PMID: 37568348 PMCID: PMC10420178 DOI: 10.3390/jcm12154948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Introduction: The interactions between Diabetes Mellitus type II (DMII) and Multiple Sclerosis (MS) lead to higher levels of fatigue, higher risk of physical disability, faster cognitive decline, and in general a lower quality of life and a higher frequency of depression compared to the general population. All of the above accelerate the disability progression of patients with MS, reduce the patients' functional capacity, and further increase their psychological and economic burden. Methods: This systematic review and meta-analysis aims to calculate the prevalence of DMII in the MS population. Following PRISMA guidelines, a thorough search of the Medline Pubmed, Cochrane Library, and Scopus databases was performed, focusing on the frequency of DMII in the MS population. Results: A total of 19 studies were included in the synthesis. The results of the main meta-analysis of random effects using R studio 3.3.0 for Windows and the Meta r package showed that the prevalence of DMII in the MS population is 5% (95% CI [0.03, 0.07], 19 studies, I2 = 95%, pQ < 0.001). Additional subgroup analysis based on region showed a difference of 4.4% (I2 = 95.2%, pQ < 0.001), psubgroupdifference = 0.003) between European and non-European participants, while demographic- and MS-specific characteristic (EDSS, Disease Duration) did not seem to affect the prevalence of DMII in the MS population (p = 0.30, p = 0.539, p = 0.19, p = 0.838). No publication bias was discovered (Egger's p test value: 0.896). Conclusions: Even though the prevalence of DMII in the MS population is lower than 10% (the reported prevalence of DMII in the general population) the interactions between the two conditions create significant challenges for MS patients, their caregivers, and physicians. DΜΙΙ should be systematically recorded in the case of MS patients to clearly delineate any potential relationship between the two conditions. Additionally, more structured studies investigating the interactions of MS and DMΙΙ as well as the direction of the causation between those two conditions are necessary in order to gain a deeper insight into the nature of the interaction between MS and DMII.
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Affiliation(s)
- Vasileios Giannopapas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Dimitrios Kitsos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Konstantina Stavrogianni
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Department of Physiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Athanasios Chasiotis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece;
| | - John S. Tzartos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - George P. Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Daphne Bakalidou
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
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Karathanasis DK, Rapti A, Nezos A, Skarlis C, Kilidireas C, Mavragani CP, Evangelopoulos ME. Differentiating central nervous system demyelinating disorders: The role of clinical, laboratory, imaging characteristics and peripheral blood type I interferon activity. Front Pharmacol 2022; 13:898049. [PMID: 36034800 PMCID: PMC9412761 DOI: 10.3389/fphar.2022.898049] [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: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: While multiple sclerosis (MS) is considered the cornerstone of autoimmune demyelinating CNS disorders, systemic autoimmune diseases (SADs) are important MS mimickers. We sought to explore whether distinct clinical, laboratory, and imaging characteristics along with quantitation of peripheral blood type I interferon (IFN) activity could aid in differentiating between them. Methods: A total of 193 consecutive patients with imaging features suggesting the presence of CNS demyelinating disease with or without relevant clinical manifestations underwent full clinical, laboratory, and imaging evaluation, including testing for specific antibodies against 15 cellular antigens. Expression analysis of type I IFN-inducible genes (MX-1, IFIT-1, and IFI44) was performed by real-time PCR, and a type I IFN score, reflecting type I IFN peripheral activity, was calculated. After joint neurological/rheumatological evaluation and 1 year of follow-up, patients were classified into MS spectrum and CNS autoimmune disorders. Results: While 66.3% (n = 128) of the patients were diagnosed with MS spectrum disorders (predominantly relapsing–remitting MS), 24.9% (n = 48) were included in the CNS autoimmune group, and out of those, one-fourth met the criteria for SAD (6.7% of the cohort, n = 13); the rest (18.1% of the cohort, n = 35), despite showing evidence of systemic autoimmunity, did not fulfill SAD criteria and comprised the “demyelinating disease with autoimmune features” (DAF) subgroup. Compared to the MS spectrum, CNS autoimmune patients were older, more frequently females, with increased rates of hypertension/hyperlipidemia, family history of autoimmunity, cortical dysfunction, anti-nuclear antibody titers ≥1/320, anticardiolipin IgM positivity, and atypical for MS magnetic resonance imaging lesions. Conversely, lower rates of infratentorial and callosal MRI lesions, CSF T2 oligoclonal bands, and IgG-index positivity were observed in CNS autoimmune patients. Patients fulfilling SAD criteria, but not the DAF group, had significantly higher peripheral blood type I IFN scores at baseline compared to MS spectrum [median (IQR)]: 50.18 (152.50) vs. −0.64 (6.75), p-value: 0.0001. Conclusion: Our study suggests that underlying systemic autoimmunity is not uncommon in patients evaluated for possible CNS demyelination. Distinct clinical, imaging and laboratory characteristics can aid in early differentiation between MS and CNS-involving systemic autoimmunity allowing for optimal therapeutic strategies. Activated type I IFN pathway could represent a key mediator among MS-like-presenting SADs and therefore a potential therapeutic target.
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Affiliation(s)
- Dimitris K. Karathanasis
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Rapti
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Adrianos Nezos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Skarlis
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Kilidireas
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P. Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Fourth Department of Internal Medicine, School of Medicine, University Hospital Attikon, National and Kapodistrian University of Athens, Haidari, Greece
- Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Eleftheria Evangelopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Maria Eleftheria Evangelopoulos,
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Sánchez-Soblechero A, Cuello J, Martínez Ginés M, Lozano Ros A, Romero Delgado F, De Andrés C, Goicochea Briceño H, García Domínguez J. Recurrent intracranial hemorrhage in a patient with relapsing multiple sclerosis under interferon-β therapy. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:77-79. [DOI: 10.1016/j.nrleng.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/07/2021] [Indexed: 10/19/2022] Open
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10
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Sánchez-Soblechero A, Cuello JP, Martínez Ginés ML, Lozano Ros A, Romero Delgado F, De Andrés C, Goicochea Briceño H, García Domínguez JM. Recurrent intracranial hemorrhage in a patient with relapsing multiple sclerosis under interferon-β therapy. Neurologia 2022; 37:77-79. [PMID: 33722454 DOI: 10.1016/j.nrl.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/12/2021] [Accepted: 02/07/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- A Sánchez-Soblechero
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J P Cuello
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M L Martínez Ginés
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Lozano Ros
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Romero Delgado
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C De Andrés
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - H Goicochea Briceño
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J M García Domínguez
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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11
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Hauer L, Perneczky J, Sellner J. A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications. J Neurol 2021; 268:4066-4077. [PMID: 32719975 PMCID: PMC8505322 DOI: 10.1007/s00415-020-10107-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Julian Perneczky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria.
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
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12
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Chen HJ, Tas SW, de Winther MPJ. Type-I interferons in atherosclerosis. J Exp Med 2020; 217:132613. [PMID: 31821440 PMCID: PMC7037237 DOI: 10.1084/jem.20190459] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/05/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
Chen et al. review the effects of type-I IFNs and the potential of anti–type-I IFN therapies in atherosclerosis. The contribution of dyslipidemia and inflammation in atherosclerosis is well established. Along with effective lipid-lowering treatments, the recent success of clinical trials with anti-inflammatory therapies and the accelerated atherosclerosis in many autoimmune diseases suggest that targeting inflammation may open new avenues for the prevention and the treatment for cardiovascular diseases (CVDs). In the past decades, studies have widened the role of type-I interferons (IFNs) in disease, from antivirus defense to autoimmune responses and immuno-metabolic syndromes. While elevated type-I IFN level in serum is associated with CVD incidence in patients with interferonopathies, experimental data have attested that type-I IFNs affect plaque-residing macrophages, potentiate foam cell and extracellular trap formation, induce endothelial dysfunction, alter the phenotypes of dendritic cells and T and B lymphocytes, and lead to exacerbated atherosclerosis outcomes. In this review, we discuss the production and the effects of type-I IFNs in different atherosclerosis-associated cell types from molecular biology studies, animal models, and clinical observations, and the potential of new therapies against type-I IFN signaling for atherosclerosis.
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Affiliation(s)
- Hung-Jen Chen
- Experimental Vascular Biology, Department of Medical Biochemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, and Laboratory for Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands
| | - Menno P J de Winther
- Experimental Vascular Biology, Department of Medical Biochemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany
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13
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Hong Y, Tang HR, Ma M, Chen N, Xie X, He L. Multiple sclerosis and stroke: a systematic review and meta-analysis. BMC Neurol 2019; 19:139. [PMID: 31234793 PMCID: PMC6591845 DOI: 10.1186/s12883-019-1366-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) and stroke are two common causes of death and disability worldwide. The relationship between these two diseases remains unclear. Effective early preventative measures and treatments are available to reduce the morbidity and mortality of acute stroke. The objectives of our systematic review are to estimate the risk of stroke in patients with MS and to collate related studies to draw preliminary conclusions that may improve clinical practice. METHOD Relevant studies were systematically searched in MEDLINE, Embase, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure and the VIP database of Chinese periodicals from January 1983 to May 2017, with no restrictions on language. Patients included in this review were adults who suffered from MS. Review Manager 5.3 software program was used to pool data and calculate the risk ratio (RR) and its 95% confidence interval (CI). We also performed heterogeneity and sensitivity analyses and evaluated bias in the meta-analysis. RESULTS Nine studies including more than 380,000 participants that met our inclusion criteria were incorporated into the meta-analysis. During different follow-up periods, patients with MS had an increased risk of any type of stroke [RR = 3.48, 95% CI (1.59, 7.64), P = 0.002 for 1 year; RR = 2.45, 95% CI (1.90, 3.16), P < 0.00001 for 10-13 years]. The total prevalence of stroke (any type) in patients with MS exceeded expectations compared to different groups [Comparing with general veteran: RR = 2, 95% CI (1.19, 3.38), P = 0.009. Comparing with general population: RR = 2.93, 95% CI (1.13, 7.62), P = 0.03]. Furthermore, ischemic stroke was particularly more common in the MS population than in people without MS [RR = 6.09, 95% CI (3.44, 10.77), P < 0.00001]. CONCLUSION Compared with the general population, people with MS have an increased risk of developing any type of stroke and ischemic stroke in particular. Consistent results were obtained from patients of different sexes and age groups. Preventative measures and treatments should be administered at earlier time points to improve patient outcomes.
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Affiliation(s)
- Ye Hong
- Department of Neurology, West China Hospital of Sichuan University, Wainan Guoxue Xiang #37, 610041, Chengdu, People's Republic of China
| | - Huai Rong Tang
- Department of Health Management Center, West China Hospital of Sichuan University, Chengdu, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital of Sichuan University, Wainan Guoxue Xiang #37, 610041, Chengdu, People's Republic of China
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Wainan Guoxue Xiang #37, 610041, Chengdu, People's Republic of China
| | - Xin Xie
- Department of Neurology, West China Hospital of Sichuan University, Wainan Guoxue Xiang #37, 610041, Chengdu, People's Republic of China.,Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Wainan Guoxue Xiang #37, 610041, Chengdu, People's Republic of China.
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14
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Marrie RA, Garland A, Schaffer SA, Fransoo R, Leung S, Yogendran M, Kingwell E, Tremlett H. Traditional risk factors may not explain increased incidence of myocardial infarction in MS. Neurology 2019; 92:e1624-e1633. [DOI: 10.1212/wnl.0000000000007251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo compare the risk of incident acute myocardial infarction (AMI) in the multiple sclerosis (MS) population and a matched population without MS, controlling for traditional vascular risk factors.MethodsWe conducted a retrospective matched cohort study using population-based administrative (health claims) data in 2 Canadian provinces, British Columbia and Manitoba. We identified incident MS cases using a validated case definition. For each case, we identified up to 5 controls without MS matched on age, sex, and region. We compared the incidence of AMI between cohorts using incidence rate ratios (IRR). We used Cox proportional hazards regression to compare the hazard of AMI between cohorts adjusting for sociodemographic factors, diabetes, hypertension, and hyperlipidemia. We pooled the provincial findings using meta-analysis.ResultsWe identified 14,565 persons with MS and 72,825 matched controls. The crude incidence of AMI per 100,000 population was 146.2 (95% confidence interval [CI] 129.0–163.5) in the MS population and 128.8 (95% CI 121.8–135.8) in the matched population. After age standardization, the incidence of AMI was higher in the MS population than in the matched population (IRR 1.18; 95% CI 1.03–1.36). After adjustment, the hazard of AMI was 60% higher in the MS population than in the matched population (hazard ratio 1.63; 95% CI 1.43–1.87).ConclusionThe risk of AMI is elevated in MS, and this risk may not be accounted for by traditional vascular risk factors.
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15
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Sivertseva SA, Prilenskaya AM, Sivertsev MY, Bazhukhin DV, Smirnova NF, Guseva ME, Boyko AN. [The risk of ischemic stroke in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:88-94. [PMID: 30160674 DOI: 10.17116/jnevro201811808288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A brief literature review on risk factors of ischemic stroke in patients with multiple sclerosis (MS) is presented. A case of ischemic stroke in a MS patient was demonstrated, and risk factors were identified.
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Affiliation(s)
- S A Sivertseva
- Tyumen Regional Center of Multiple Sclerosis, Tyumen, Russia
| | - A M Prilenskaya
- Tyumen Regional Center of Multiple Sclerosis, Tyumen, Russia
| | | | - D V Bazhukhin
- Tyumen Regional Center of Multiple Sclerosis, Tyumen, Russia
| | - N F Smirnova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M E Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
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16
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Saroufim P, Zweig SA, Conway DS, Briggs FBS. Cardiovascular conditions in persons with multiple sclerosis, neuromyelitis optica and transverse myelitis. Mult Scler Relat Disord 2018; 25:21-25. [PMID: 30014877 DOI: 10.1016/j.msard.2018.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular conditions are associated with poorer outcomes in multiple sclerosis (MS). Whether the burden of cardiovascular conditions differs between those with demyelinating disease and unaffected controls is not clear. The objective of this study is to investigate the burden and age of onset of cardiovascular conditions in a US population with MS, neuromyelitis optica spectrum disorder (NMOSD), or transverse myelitis (TM) to unaffected controls adjusting for likely confounders. METHODS Using a case-control study design, we compared the burden of self-reported diabetes mellitus type 2, heart disease, hyperlipidemia, and hypertension in cases with MS (N = 1,548), NMOSD (N = 306), and TM (N = 145) to controls (N = 677), adjusting for demographics, smoking history, obesity, family history of individual cardiovascular conditions, and presence of other cardiovascular conditions. The age of onset for individual cardiovascular conditions were also compared between cases and controls. RESULTS MS cases were 48% more likely to have ever had hypertension than controls (p = 0.01). The prevalence of other cardiovascular conditions did not differ across cases and controls. There were also no differences in the age of cardiovascular disease onset between cases and controls. CONCLUSION Cardiovascular conditions are as common in those with demyelinating diseases compared to unaffected individuals, with hypertension being more common among those with MS.
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Affiliation(s)
- Paola Saroufim
- Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States; Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States
| | - Sophia A Zweig
- Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Devon S Conway
- The Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Farren B S Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
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17
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Moccia M, Albero R, Lanzillo R, Saccà F, De Rosa A, Russo CV, Carotenuto A, Palladino R, Brescia Morra V. Cardiovascular profile improvement during Natalizumab treatment. Metab Brain Dis 2018; 33:981-986. [PMID: 29256149 DOI: 10.1007/s11011-017-0169-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 12/11/2017] [Indexed: 01/04/2023]
Abstract
Cardiovascular comorbidities are associated with the risk of MS progression. Thus, we aim to measure variations of cardiovascular risk factors during Natalizumab treatment and their possible clinical associations. Seventy-one relapsing-remitting MS patients treated with Natalizumab were followed-up during a 12.9 ± 6.2 months. Cardiovascular risk factors were recorded on first and last study visits: systolic blood pressure, uric acid, total cholesterol, LDL, HDL, and triglycerides. EDSS progression and relapse occurrence were recorded. At multilevel mixed-effects linear regression models, the population presented with a significant reduction of total cholesterol (Coeff = -7.340; 95%CI = -13.152--1.527; p = 0.013), and of HDL cholesterol (Coeff = -3.473; 95%CI = -6.333--0.613; p = 0.017), and a non-significant reduction of LDL cholesterol (Coeff = -1.872; 95%CI = -8.481-0.736; p = 0.053), and of triglycerides (Coeff = -8.815; 95%CI = -34.011-5.380; p = 0.094). Uric acid levels increased during the study period (Coeff = 0.159; 95%CI = 0.212-0.340; p = 0.038). No significant associations were found with clinical outcomes. Serum lipids decreased and anti-oxidant uric acid increased during Natalizumab treatment. These biomarkers need to be further explored in relation to clinical outcomes on larger cohorts with longer follow-ups.
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Affiliation(s)
- Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy.
| | - Roberto Albero
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Francesco Saccà
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Anna De Rosa
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Cinzia Valeria Russo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College, London, UK
- Department of Public Health, Federico II University, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
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18
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19
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Abstract
This study is one in series determining the potential of RAGE axis (receptor for advanced glycation end products, isoforms, ligands) as a biomarker in multiple sclerosis (MS). We evaluated serum levels of RAGE ligand, the high-mobility group box (HMGB)1 in MS patients, and assessed the correlation between HMGB1 serum levels and the use of disease-modifying drugs (DMDs), and between HMGB1 serum levels and indicators of MS disease severity. HMGB1 serum levels were compared between 96 (23 males) MS patients and 34 age- and gender-matched healthy controls (HCs) using enzyme-linked immunosorbent assays. DMD-naïve MS patients had significantly higher HMGB1 serum levels compared with DMD-treated (P = 0.04) and compared with HCs (P = 0.01). HMGB1 serum levels were not significantly different between total MS patients (DMD-naïve plus DMD-treated) and HCs (P = 0.09). DMD-naïve MS patients in clinical relapse tended to have lower HMGB1 serum levels than clinically stable RRMS patients (P = 0.07). HMGB1 serum levels showed 0.65 area under the curve (95 % CI 0.55-0.95) sensitivity/specificity for MS clinical relapse. The role of HMGB1 in MS disease pathology and DMD modulation of this protein warrant further investigations.
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20
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Impaired Neurovisceral Integration of Cardiovascular Modulation Contributes to Multiple Sclerosis Morbidities. Mol Neurobiol 2016; 54:362-374. [DOI: 10.1007/s12035-015-9599-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/01/2015] [Indexed: 12/16/2022]
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21
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Sternberg Z. Genetic, Epigenetic, and Environmental Factors Influencing Neurovisceral Integration of Cardiovascular Modulation: Focus on Multiple Sclerosis. Neuromolecular Med 2015; 18:16-36. [PMID: 26502224 DOI: 10.1007/s12017-015-8375-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Abstract
Thought to be an autoimmune inflammatory CNS disease, multiple sclerosis (MS) involves multiple pathologies with heterogeneous clinical presentations. An impaired neurovisceral integration of cardiovascular modulation, indicated by sympathetic and parasympathetic autonomic nervous system (ANS) dysfunction, is among common MS clinical presentations. ANS dysfunction could not only enhance MS inflammatory and neurodegenerative processes, but can also lead to clinical symptoms such as depression, fatigue, sleep disorder, migraine, osteoporosis, and cerebral hemodynamic impairments. Therefore, factors influencing ANS functional activities, in one way or another, will have a significant impact on MS disease course. This review describes the genetic and epigenetic factors, and their interactions with a number of environmental factors contributing to the neurovisceral integration of cardiovascular modulation, with a focus on MS. Future studies should investigate the improvement in cardiovascular ANS function, as a strategy for preventing and minimizing MS-related morbidities, and improving patients' quality of life.
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22
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Abstract
Aspirin is widely used to lessen the risks of cardiovascular events. Some studies suggest that patients with multiple sclerosis have an increased risk for some cardiovascular events, for example, venous thromboembolism and perhaps ischemic strokes, raising the possibility that aspirin could lessen these increased risks in this population or subgroups (patients with limited mobility and/or antiphospholipid antibodies). However, aspirin causes a small increased risk of hemorrhagic stroke, which is a concern as it could potentially worsen a compromised blood-brain barrier. Aspirin has the potential to ameliorate the disease process in multiple sclerosis (for example, by limiting some components of inflammation), but aspirin also has the potential to inhibit mitochondrial complex I activity, which is already reduced in multiple sclerosis. In an experimental setting of a cerebral ischemic lesion, aspirin promoted the proliferation and/or differentiation of oligodendrocyte precursors, raising the possibility that aspirin could facilitate remyelination efforts in multiple sclerosis. Other actions by aspirin may lead to small improvements of some symptoms (for example, lessening fatigue). Here we consider potential benefits and risks of aspirin usage by patients with multiple sclerosis.
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Affiliation(s)
- Sheila Tsau
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Mitchell R Emerson
- Department of Pharmaceutical Sciences, College of Pharmacy-Glendale, Midwestern University, Glendale, AZ, USA.
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Steven M LeVine
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
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23
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Moccia M, Lanzillo R, Palladino R, Maniscalco GT, De Rosa A, Russo C, Massarelli M, Carotenuto A, Postiglione E, Caporale O, Triassi M, Brescia Morra V. The Framingham cardiovascular risk score in multiple sclerosis. Eur J Neurol 2015; 22:1176-83. [PMID: 25912468 DOI: 10.1111/ene.12720] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Cardiovascular risk factors can increase the risk of multiple sclerosis (MS) and modify its course. However, such factors possibly interact, determining a global cardiovascular risk. Our aim was to compare the global cardiovascular risk of subjects with and without MS with the simplified 10-year Framingham General Cardiovascular Disease Risk Score (FR) and to evaluate its importance on MS-related outcomes. METHODS Age, gender, smoking status, body mass index, systolic blood pressure, type II diabetes and use of antihypertensive medications were recorded in subjects with and without MS to estimate the FR, an individualized percentage risk score estimating the 10-year likelihood of cardiovascular events. RESULTS In total, 265 MS subjects were identified with 530 matched controls. A t test showed similar FR in cases and controls (P = 0.212). Secondary progressive MS presented significantly higher FR compared to relapsing-remitting MS (P < 0.001). Linear regression analysis showed a direct relationship between FR and Expanded Disability Status Scale (P < 0.001) and MS Severity Scale (P < 0.001). CONCLUSION The FR, evaluating the global cardiovascular health by the interaction amongst different risk factors, relates to MS disability, severity and course.
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Affiliation(s)
- M Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - R Lanzillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - R Palladino
- Department of Public Health, Federico II University, Naples, Italy.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - G T Maniscalco
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Neurology Clinic, AORN 'Antonio Cardarelli', Naples, Italy
| | - A De Rosa
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - C Russo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - M Massarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Carotenuto
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - E Postiglione
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - O Caporale
- Department of Public Health, Federico II University, Naples, Italy
| | - M Triassi
- Department of Public Health, Federico II University, Naples, Italy
| | - V Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
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24
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Tettey P, Simpson S, Taylor BV, van der Mei IAF. Vascular comorbidities in the onset and progression of multiple sclerosis. J Neurol Sci 2014; 347:23-33. [PMID: 25454639 DOI: 10.1016/j.jns.2014.10.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/29/2014] [Accepted: 10/09/2014] [Indexed: 02/02/2023]
Abstract
Vascular comorbidities are common in the general population and are associated with adverse health outcomes. In people with multiple sclerosis (MS), an increasing amount of evidence suggests that vascular comorbidities are also common, but an association with MS risk and disability has not been conclusively established. This review aims to critically examine published data on the relationship between vascular comorbidities (including vascular risk factors) and MS. The evidence suggests an increased risk of MS in people with a high BMI during childhood or adolescence but not adulthood. People with established MS appear to have a slightly increased risk of cardiovascular disease and a greater proportion of people with MS die from cardiovascular disease, which has important implications for clinicians trying to identify risk factors for cardiovascular disease and reviewing treatment options. In relation to whether vascular comorbidities influence MS clinical disability or other aspects of the disease course, the key finding was that having type-2-diabetes, hypertension, dyslipidaemia or peripheral vascular disease at any point in the disease course may be associated with a greater progression in disability. Additionally, a negative effect of high cholesterol and triglycerides and a positive effect of higher HDL (high density lipoprotein) levels on acute inflammatory activity were observed on magnetic resonance imaging. The results of the published clinical trials of statins as an intervention in MS were however conflicting and care needs to be taken when treating people with MS with statins. Taken together, the literature seems to indicate a potential association of vascular comorbidities with MS risk and disability, but the number of prospective studies was sparse, thus precluding ascription of causality. We therefore recommend that future studies of the frequency and effects of vascular comorbidities on MS risk and disability should be prospective and objective where relevant.
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Affiliation(s)
- Prudence Tettey
- Menzies Research Institute Tasmania, University of Tasmania, Australia
| | - Steve Simpson
- Menzies Research Institute Tasmania, University of Tasmania, Australia
| | - Bruce V Taylor
- Menzies Research Institute Tasmania, University of Tasmania, Australia
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Sternberg Z, Sternberg D, Drake A, Chichelli T, Yu J, Hojnacki D. Disease modifying drugs modulate endogenous secretory receptor for advanced glycation end-products, a new biomarker of clinical relapse in multiple sclerosis. J Neuroimmunol 2014; 274:197-201. [DOI: 10.1016/j.jneuroim.2014.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/04/2014] [Accepted: 07/08/2014] [Indexed: 12/20/2022]
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Wens I, Dalgas U, Deckx N, Cools N, Eijnde BO. Does multiple sclerosis affect glucose tolerance? Mult Scler 2013; 20:1273-6. [DOI: 10.1177/1352458513515957] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 11/28/2011] [Indexed: 11/16/2022]
Abstract
Based on current literature, it is not clear if multiple sclerosis (MS) patients are at increased risk to develop impaired glucose tolerance (IGT). Eighty-one MS patients and 45 healthy controls (HC) performed an oral glucose tolerance test. IGT was defined as a fasting glucose concentration of 6.1–6.9 mmol/l and two-hour post-load glucose of 7.8–11.1 mmol/l. The prevalence of impaired fasting glucose concentrations (17% vs 2%) and IGT (11% vs 0%) was higher in MS patients than HC. Accordingly, the areas under the glucose and insulin curves were higher in MS patients. The current study demonstrates an elevated IGT-prevalence in MS.
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Affiliation(s)
- I Wens
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - U Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Denmark
| | - N Deckx
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Belgium
| | - N Cools
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Belgium
| | - BO Eijnde
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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