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Habibi MA, Yazdan Panah M, Vaheb S, Olfatifar M, Shaygannejad A, Mokary Y, Ghasemi M, Thapa S, Shaygannejad V, Mirmosayyeb O. Validity and reliability of the Persian version of Recce stigma scale in people with multiple sclerosis and its impact on quality of life. BMC Neurol 2024; 24:36. [PMID: 38254066 PMCID: PMC10802045 DOI: 10.1186/s12883-024-03544-z] [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: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS. METHOD This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted. RESULTS The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05). CONCLUSION This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.
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Affiliation(s)
- Mohammad Amin Habibi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yazdan Panah
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Ghasemi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sangharsha Thapa
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Bunul SD. Comparing Clinical and Radiological Features in Familial and Sporadic Multiple Sclerosis. Cureus 2023; 15:e44504. [PMID: 37662512 PMCID: PMC10472085 DOI: 10.7759/cureus.44504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To compare the initial presentation, clinical features, disease courses, and radiological parameters between familial multiple sclerosis (fMS) and sporadic multiple sclerosis (sMS) to determine if the two represent distinct clinical entities. Methods This retrospective study was conducted at the Neurology Clinic at Kocaeli University Hospital. Records of 114 fMS and 150 sMS patients, aged 18-65, diagnosed based on either the Poser criteria or the McDonald 2001 criteria were analyzed. Radiological data and Expanded Disability Status Scale (EDSS) evaluations were conducted by a specialist neurologist. Variables included age at MS onset, first symptoms, relapses, EDSS scores at diagnosis and last examination, and MRI findings. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28, Armonk, NY) was utilized for data analysis. Results Both fMS and sMS groups were comparable in age (43.55±12.50 and 42.35±10.61 years, respectively) and gender distribution (females: fMS 71.9%, sMS 71.3%). No significant difference was noted regarding disease onset age (fMS 29.83±10.77, sMS 30.42±9.7). Age of onset, final EDSS, and relapse rate didn't significantly vary among sMS, fMS with first-degree relatives having MS (fMS(1)), and fMS with second or third-degree relatives having MS (fMS(2)). The fMS group showed a significantly higher incidence of initial spinal cord lesions on MRI compared to the sMS group (38.6% vs. 17.3%; p<0.001). Within the fMS group, the presence of spinal cord lesions on initial MRI correlated with a higher relapse rate and elevated initial and final EDSS scores. Conclusion Despite overarching similarities between fMS and sMS, spinal cord lesions' prevalence and implications in fMS may point to a genetic underpinning warranting in-depth exploration.
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Puranik N, Yadav D, Song M. Insight into Early Diagnosis of Multiple Sclerosis by Targeting Prognostic Biomarkers. Curr Pharm Des 2023; 29:2534-2544. [PMID: 37921136 DOI: 10.2174/0113816128247471231018053737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/04/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
Multiple sclerosis (MS) is a central nervous system (CNS) immune-mediated disease that mainly strikes young adults and leaves them disabled. MS is an autoimmune illness that causes the immune system to attack the brain and spinal cord. The myelin sheaths, which insulate the nerve fibers, are harmed by our own immune cells, and this interferes with brain signal transmission. Numbness, tingling, mood swings, memory problems, exhaustion, agony, vision problems, and/or paralysis are just a few of the symptoms. Despite technological advancements and significant research efforts in recent years, diagnosing MS can still be difficult. Each patient's MS is distinct due to a heterogeneous and complex pathophysiology with diverse types of disease courses. There is a pressing need to identify markers that will allow for more rapid and accurate diagnosis and prognosis assessments to choose the best course of treatment for each MS patient. The cerebrospinal fluid (CSF) is an excellent source of particular indicators associated with MS pathology. CSF contains molecules that represent pathological processes such as inflammation, cellular damage, and loss of blood-brain barrier integrity. Oligoclonal bands, neurofilaments, MS-specific miRNA, lncRNA, IgG-index, and anti-aquaporin 4 antibodies are all clinically utilised indicators for CSF in MS diagnosis. In recent years, a slew of new possible biomarkers have been presented. In this review, we look at what we know about CSF molecular markers and how they can aid in the diagnosis and differentiation of different MS forms and treatment options, and monitoring and predicting disease progression, therapy response, and consequences during such opportunistic infections.
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Affiliation(s)
- Nidhi Puranik
- Biological Sciences Department, Bharathiar University, Coimbatore, Tamil Nadu, 641046, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
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4
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Hirata T, Itokazu T, Sasaki A, Sugihara F, Yamashita T. Humanized Anti-RGMa Antibody Treatment Promotes Repair of Blood-Spinal Cord Barrier Under Autoimmune Encephalomyelitis in Mice. Front Immunol 2022; 13:870126. [PMID: 35784362 PMCID: PMC9241446 DOI: 10.3389/fimmu.2022.870126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
The lack of established biomarkers which reflect dynamic neuropathological alterations in multiple sclerosis (MS) makes it difficult to determine the therapeutic response to the tested drugs and to identify the key biological process that mediates the beneficial effect of them. In the present study, we applied high-field MR imaging in locally-induced experimental autoimmune encephalomyelitis (EAE) mice to evaluate dynamic changes following treatment with a humanized anti-repulsive guidance molecule-a (RGMa) antibody, a potential drug for MS. Based on the longitudinal evaluation of various MRI parameters including white matter, axon, and myelin integrity as well as blood-spinal cord barrier (BSCB) disruption, anti-RGMa antibody treatment exhibited a strong and prompt therapeutic effect on the disrupted BSCB, which was paralleled by functional improvement. The antibody’s effect on BSCB repair was also suggested via GeneChip analysis. Moreover, immunohistochemical analysis revealed that EAE-induced vascular pathology which is characterized by aberrant thickening of endothelial cells and perivascular type I/IV collagen deposits were attenuated by anti-RGMa antibody treatment, further supporting the idea that the BSCB is one of the key therapeutic targets of anti-RGMa antibody. Importantly, the extent of BSCB disruption detected by MRI could predict late-phase demyelination, and the predictability of myelin integrity based on the extent of acute-phase BSCB disruption was compromised following anti-RGMa antibody treatment. These results strongly support the concept that longitudinal MRI with simultaneous DCE-MRI and DTI analysis can be used as an imaging biomarker and is useful for unbiased prioritization of the key biological process that mediates the therapeutic effect of tested drugs.
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Affiliation(s)
- Takeshi Hirata
- Department of Neuro-Medical Science, Graduate School of Medicine, Osaka University, Suita, Japan
- Sohyaku, Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - Takahide Itokazu
- Department of Neuro-Medical Science, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Molecular Neuroscience, Graduate School of Medicine, Osaka University, Suita, Japan
- *Correspondence: Toshihide Yamashita, ; Takahide Itokazu,
| | - Atsushi Sasaki
- Department of Neuro-Medical Science, Graduate School of Medicine, Osaka University, Suita, Japan
- Sohyaku, Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - Fuminori Sugihara
- Central Instrumentation Laboratory, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Toshihide Yamashita
- Department of Neuro-Medical Science, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Molecular Neuroscience, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Molecular Neuroscience, World Premier International Research Center Initiative (WPI)-Immunology Frontier Research Center, Osaka University, Suita, Japan
- *Correspondence: Toshihide Yamashita, ; Takahide Itokazu,
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Rival M, Galoppin M, Thouvenot E. Biological Markers in Early Multiple Sclerosis: the Paved Way for Radiologically Isolated Syndrome. Front Immunol 2022; 13:866092. [PMID: 35572543 PMCID: PMC9094445 DOI: 10.3389/fimmu.2022.866092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022] Open
Abstract
Radiologically Isolated Syndrome (RIS) is characterized by MRI-typical brain lesions fulfilling the 2009 Okuda criteria, detected in patients without clinical conditions suggestive of MS. Half of all RIS patients convert to MS within 10 years. The individual course of the disease, however, is highly variable with 12% of RIS converting directly to progressive MS. Demographic and imaging markers have been associated with the risk of clinical MS in RIS: male sex, younger age, infra-tentorial, and spinal cord lesions on the index scan and gadolinium-enhancing lesions on index or follow-up scans. Although not considered as a distinct MS phenotype, RIS certainly shares common pathological features with early active and progressive MS. In this review, we specifically focus on biological markers that may help refine the risk stratification of clinical MS and disability for early treatment. Intrathecal B-cell activation with cerebrospinal fluid (CSF) oligoclonal bands, elevated kappa free light chains, and cytokine production is specific to MS, whereas neurofilament light chain (NfL) levels reflect disease activity associated with neuroaxonal injury. Specific microRNA profiles have been identified in RIS converters in both CSF and blood. CSF levels of chitinases and glial acidic fibrillary protein (GFAP) reflecting astrogliosis might help predict the evolution of RIS to progressive MS. Innovative genomic, proteomic, and metabolomic approaches have provided several new candidate biomarkers to be explored in RIS. Leveraging data from randomized controlled trials and large prospective RIS cohorts with extended follow-up to identify, as early as possible, biomarkers for predicting greater disease severity would be invaluable for counseling patients, managing treatment, and monitoring.
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Affiliation(s)
- Manon Rival
- Department of Neurology, Nîmes University Hospital Center, Univ. Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Manon Galoppin
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital Center, Univ. Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
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El-Emam MA, El Achy S, Abdallah DM, El-Abhar HS, Gowayed MA. Does physical exercise improve or deteriorate treatment of multiple sclerosis with mitoxantrone? Experimental autoimmune encephalomyelitis study in rats. BMC Neurosci 2022; 23:11. [PMID: 35247984 PMCID: PMC8897955 DOI: 10.1186/s12868-022-00692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background Mitoxantrone has proved efficacy in treatment of multiple sclerosis (MS). The fact that physical exercise could slow down the progression of disease and improve performance is still a debatable issue, hence; we aimed at studying whether combining mitoxantrone with exercise is of value in the management of MS. Methods Thirty-six male rats were divided into sedentary and exercised groups. During a 14-day habituation period rats were subjected to exercise training on a rotarod (30 min/day) before Experimental Autoimmune Encephalomyelitis (EAE) induction and thereafter for 17 consecutive days. On day 13 after induction, EAE groups (exercised &sedentary) were divided into untreated and mitoxantrone treated ones. Disease development was evaluated by motor performance and EAE score. Cerebrospinal fluid (CSF) was used for biochemical analysis. Brain stem and cerebellum were examined histopathological and immunohistochemically. Results Exercise training alone did not add a significant value to the studied parameters, except for reducing Foxp3 immunoreactivity in EAE group and caspase-3 in the mitoxantrone treated group. Unexpectedly, exercise worsened the mitoxantrone effect on EAE score, Bcl2 and Bax. Mitoxantrone alone decreased EAE/demyelination/inflammation scores, Foxp3 immunoreactivity, and interleukin-6, while increased the re-myelination marker BDNF without any change in tumor necrosis factor-α. It clearly interrupted the apoptotic pathway in brain stem, but worsened EAE mediated changes of the anti-apoptotic Bcl2 and pro-apoptotic marker Bax in the CSF. Conclusions The neuroprotective effect of mitoxantrone was related with remyelination, immunosuppressive and anti-inflammatory potentials. Exercise training did not show added value to mitoxantrone, in contrast, it disrupts the apoptotic pathway. Supplementary Information The online version contains supplementary material available at 10.1186/s12868-022-00692-1.
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Vazifedoust S, Esmaeili Gouvarchin Ghaleh H, Khafaei M, Azemati F, Jalali Kondori B. Comprehensive Assessment of Multiple Sclerosis: From Immunotherapy and Immunopathogenesis to Predictive Biomarkers. IRANIAN JOURNAL OF PATHOLOGY 2022; 17:241-250. [PMID: 36247502 PMCID: PMC9508536 DOI: 10.30699/ijp.2022.541483.2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND & OBJECTIVE Multiple sclerosis (MS) is an inflammatory neurological disorder that affects the central nervous system (CNS) and causes individuals to experience a variety of cognitive and physical problems. As proven by two decades of clinical experience with immunomodulatory therapies for MS, the disease progresses and relapses through several immunological pathways. New medicines aimed at remyelination and neurodegeneration are being developed; however, they need stronger evidence before being introduced into routine clinical care. The purpose of this study was a thorough assessment of MS immunopathology and predictive biomarkers. METHODS Immunotherapy, immunopathogenesis, and prognostic biomarkers were all parts of the search method. Only publications in English were considered for inclusion in the study. For that purpose, we went through the current state of knowledge around MS immunopathology and related biomarkers. Immunology, as well as the identification of increased inflammation as an important component of neurodegeneration, shaped our understanding of this disease aetiology. The relevant sources examined covered the years 2015-2021. CONCLUSION We found biomarkers in the cerebrospinal fluid and blood that might be used for the prediction and diagnosis of MS, as well as for measuring treatment response and adverse effects. Many variables, including the role of some infectious organisms and the impact of environmental and social factors, might contribute to the immunological dysfunctions seen in MS. Patients with MS may benefit from better therapy options if a better understanding of MS biomarkers and immune response mechanisms would be obtained.
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Affiliation(s)
- Soheil Vazifedoust
- Baqiyatallah Research Center for gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Khafaei
- Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Fateme Azemati
- Department of Biology, School of Basic Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Bahman Jalali Kondori
- Baqiyatallah Research Center for gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran ,Department of Anatomical Sciences, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran ,Corresponding Information: Bahman Jalali Kondori, Department of Anatomical Sciences, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Martinsen V, Kursula P. Multiple sclerosis and myelin basic protein: insights into protein disorder and disease. Amino Acids 2021; 54:99-109. [PMID: 34889995 PMCID: PMC8810476 DOI: 10.1007/s00726-021-03111-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/24/2021] [Indexed: 01/18/2023]
Abstract
Myelin basic protein (MBP) is an abundant protein in central nervous system (CNS) myelin. MBP has long been studied as a factor in the pathogenesis of the autoimmune neurodegenerative disease multiple sclerosis (MS). MS is characterized by CNS inflammation, demyelination, and axonal loss. One of the main theories on the pathogenesis of MS suggests that exposure to foreign antigens causes the activation of cross-reactive T cells in genetically susceptible individuals, with MBP being a possible autoantigen. While a direct role for MBP as a primary antigen in human MS is unclear, it is clear that MBP and its functions in myelin formation and long-term maintenance are linked to MS. This review looks at some key molecular characteristics of MBP and its relevance to MS, as well as the mechanisms of possible molecular mimicry between MBP and some viral antigens. We also discuss the use of serum anti-myelin antibodies as biomarkers for disease. MBP is a prime example of an apparently simple, but in fact biochemically and structurally complex molecule, which is closely linked to both normal nervous system development and neurodegenerative disease.
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Affiliation(s)
- Vebjørn Martinsen
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5020, Bergen, Norway
| | - Petri Kursula
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5020, Bergen, Norway. .,Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Aapistie 7, 90220, Oulu, Finland.
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Huang S, Wu T, Lau AY, Au C, Huang H, Wang X, Kim JY. Attention to time-of-day variability improves the reproducibility of gene expression patterns in multiple sclerosis. iScience 2021; 24:103247. [PMID: 34746708 PMCID: PMC8551071 DOI: 10.1016/j.isci.2021.103247] [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: 01/19/2021] [Revised: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Low reproducibility in gene expression profiles has been observed in transcriptome studies, and this often limits applying findings to clinical practice. Here, we show time-of-day effects on gene expression and analytical schemes to increase the reproducibility in expression patterns. We recruited patients with relapsing-remitting multiple sclerosis (RRMS) and healthy subjects and collected blood from individuals twice a day, day (2 pm) and night (9 pm). RNA sequencing analyses found that gene expression in RRMS in relapse (Relapse) is significantly changed at night compared with either Relapse at day or RRMS in remission (Remission). Gene set overrepresentation analysis demonstrated that gene sets significantly changed in Relapse at night are enriched to immune responses related to MS pathology. In those gene sets, 68 genes are significantly changed expression in Relapse at night compared with Relapse at day and Remission. This supports that times of sample collections should be standardized to obtain reproducible gene expression patterns. Times of day affect gene expression patterns in patients with RRMS in relapse Transcriptome profiles in Relapse are changed from day to night In Relapse, immune response-related genes change the expression at night
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Affiliation(s)
- Suihong Huang
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Tan Wu
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Alexander Y Lau
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheryl Au
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Huang
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Xin Wang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, City University of Hong Kong, Shenzhen, China
| | - Jin Young Kim
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, City University of Hong Kong, Shenzhen, China
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Laboratory biomarkers of Multiple Sclerosis (MS). Clin Biochem 2021; 99:1-8. [PMID: 34673037 DOI: 10.1016/j.clinbiochem.2021.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
Multiple Sclerosis (MS) is a neurological disease that affects the central nervous system (CNS). The diagnosis of the disease is quite challenging due to its variation among patients. As a result, the need to enhance diagnostic procedures, evaluate objective prognostic markers and promote effective monitoring of patients' responses to treatment has prompted the identification of many biomarkers. To present up-to-date knowledge on potential biomarkers for MS used to assess disease activity, progression, and therapeutic responses. The search for articles was conducted in various databases, namely, PubMed, Cochrane Library, and CINAHL, using an identical search strategy and terms that included "Multiple Sclerosis," "MS," "biomarkers," "potential," "magnetic resonance spectroscopy," "progress," "marker," "predict," "disability," "indicator," and "mass spectrometry." Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed when scrutinizing the articles for inclusion in the study. The search process identified 75 articles that were used in this systematic review. MS biomarkers consisted of laboratory biomarkers, imaging biomarkers, and genetic and immunogenetic biomarkers. The efficacy, which leads to their potential classification, relies on numerous factors, such as sensitivity, specificity, clinical rationale, predictability, practicality, biological rationale, reproducibility, and correlations with prognosis and disability. Oligoclonal bands (OCBs) and magnetic resonance imaging (MRI) features are the most established biomarkers so far, although kappa free light chains (kFLCs), the measles-rubella-zoster (MRZ) reaction, and neurofilament light chains (NfLs) might show potential in the near future after more studies are conducted.
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11
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Potential Biomarkers Associated with Multiple Sclerosis Pathology. Int J Mol Sci 2021; 22:ijms221910323. [PMID: 34638664 PMCID: PMC8508638 DOI: 10.3390/ijms221910323] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
Multiple sclerosis (MS) is a complex disease of the central nervous system (CNS) that involves an intricate and aberrant interaction of immune cells leading to inflammation, demyelination, and neurodegeneration. Due to the heterogeneity of clinical subtypes, their diagnosis becomes challenging and the best treatment cannot be easily provided to patients. Biomarkers have been used to simplify the diagnosis and prognosis of MS, as well as to evaluate the results of clinical treatments. In recent years, research on biomarkers has advanced rapidly due to their ability to be easily and promptly measured, their specificity, and their reproducibility. Biomarkers are classified into several categories depending on whether they address personal or predictive susceptibility, diagnosis, prognosis, disease activity, or response to treatment in different clinical courses of MS. The identified members indicate a variety of pathological processes of MS, such as neuroaxonal damage, gliosis, demyelination, progression of disability, and remyelination, among others. The present review analyzes biomarkers in cerebrospinal fluid (CSF) and blood serum, the most promising imaging biomarkers used in clinical practice. Furthermore, it aims to shed light on the criteria and challenges that a biomarker must face to be considered as a standard in daily clinical practice.
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Turner JA, Padgett C, McDonald S, Ahuja KD, Francis HM, Lim CK, Honan CA. Innate immunity impacts social-cognitive functioning in people with multiple sclerosis and healthy individuals: Implications for IL-1ra and urinary immune markers. Brain Behav Immun Health 2021; 14:100254. [PMID: 34589763 PMCID: PMC8474509 DOI: 10.1016/j.bbih.2021.100254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/26/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022] Open
Abstract
Social-cognitive difficulties can negatively impact interpersonal communication, shared social experience, and meaningful relationships. This pilot investigation examined the relationship between social-cognitive functioning and inflammatory markers in people with multiple sclerosis (MS) and demographically-matched healthy individuals. Additionally, we compared the immune marker profile in serum and urine-matched samples. Social cognitive functioning was objectively assessed using The Awareness of Social Inference Test - Short (TASIT-S) and subjectively assessed using self-reports of abilities in emotion recognition, emotional empathy, and cognitive theory of mind. In people with MS and healthy individuals, there were moderate-to-large negative relationships between pro-inflammatory biomarkers (serum IL-1β, IL-17, TNF-α, IP-10, MIP-1α, and urine IP-10, MIP-1β) of the innate immune system and social-cognitive functioning. In MS, a higher serum concentration of the anti-inflammatory marker IL-1ra was associated with better social-cognitive functioning (i.e., self-reported emotional empathy and TASIT-S sarcasm detection performance). However, there were mixed findings for anti-inflammatory serum markers IL-4 and IL-10. Overall, our findings indicate a relationship between pro-inflammatory cytokines and social-cognitive abilities. Future studies may provide greater insight into biologically-derived inflammatory processes, sickness behaviour, and their connection with social cognition.
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Affiliation(s)
- Jason A. Turner
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia
| | - Christine Padgett
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kiran D.K. Ahuja
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | | | - Chai K. Lim
- Department of Biomedical Sciences, Macquarie University, Sydney, Australia
| | - Cynthia A. Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia
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Devasahayam AJ, Kelly LP, Williams JB, Moore CS, Ploughman M. Fitness Shifts the Balance of BDNF and IL-6 from Inflammation to Repair among People with Progressive Multiple Sclerosis. Biomolecules 2021; 11:504. [PMID: 33810574 PMCID: PMC8066063 DOI: 10.3390/biom11040504] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022] Open
Abstract
Physical sedentarism is linked to elevated levels of circulating cytokines, whereas exercise upregulates growth-promoting proteins such as brain-derived neurotrophic factor (BDNF). The shift towards a 'repair' phenotype could protect against neurodegeneration, especially in diseases such as multiple sclerosis (MS). We investigated whether having higher fitness or participating in an acute bout of maximal exercise would shift the balance of BDNF and interleukin-6 (IL-6) in serum samples of people with progressive MS (n = 14), compared to matched controls (n = 8). Participants performed a maximal graded exercise test on a recumbent stepper, and blood samples were collected at rest and after the test. We assessed walking speed, fatigue, and maximal oxygen consumption (V·O2max). People with MS achieved about 50% lower V·O2max (p = 0.003) than controls. At rest, there were no differences in BDNF between MS and controls; however, IL-6 was significantly higher in MS. Higher V·O2max was associated with a shift in BDNF/IL-6 ratio from inflammation to repair (R = 0.7, p = 0.001) when considering both groups together. In the MS group, greater ability to upregulate BDNF was associated with faster walking speed and lower vitality. We present evidence that higher fitness indicates a shift in the balance of blood biomarkers towards a repair phenotype in progressive MS.
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Affiliation(s)
- Augustine Joshua Devasahayam
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - Liam Patrick Kelly
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - John Bradley Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Craig Stephen Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
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14
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Brune S, Høgestøl EA, Cengija V, Berg-Hansen P, Sowa P, Nygaard GO, Harbo HF, Beyer MK. LesionQuant for Assessment of MRI in Multiple Sclerosis-A Promising Supplement to the Visual Scan Inspection. Front Neurol 2020; 11:546744. [PMID: 33362682 PMCID: PMC7759639 DOI: 10.3389/fneur.2020.546744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Goals: Multiple sclerosis (MS) is a central nervous system inflammatory disease where magnetic resonance imaging (MRI) is an important tool for diagnosis and disease monitoring. Quantitative measurements of lesion volume, lesion count, distribution of lesions, and brain atrophy have a potentially significant value for evaluating disease progression. We hypothesize that utilizing software designed for evaluating MRI data in MS will provide more accurate and detailed analyses compared to the visual neuro-radiological evaluation. Methods: A group of 56 MS patients (mean age 35 years, 70% females and 96% relapsing-remitting MS) was examined with brain MRI one and 5 years after diagnosis. The T1 and FLAIR brain MRI sequences for all patients were analyzed using the LesionQuant (LQ) software. These data were compared with data from structured visual evaluations of the MRI scans performed by neuro-radiologists, including assessments of atrophy, and lesion count. The data from LQ were also compared with data from other validated research methods for brain segmentation, including assessments of whole brain volume and lesion volume. Correlations with clinical tests like the timed 25-foot walk test (T25FT) were performed to explore additional value of LQ analyses. Results: Lesion count assessments by LQ and by the neuro-radiologist were significantly correlated one year (cor = 0.92, p = 2.2 × 10−16) and 5 years (cor = 0.84, p = 2.7 × 10−16) after diagnosis. Analyzes of the intra- and interrater variability also correlated significantly (cor = 0.96, p < 0.001, cor = 0.97, p < 0.001). Significant positive correlation was found between lesion volume measured by LQ and by the software Cascade (cor = 0.7, p < 0.001. LQ detected a reduction in whole brain percentile >10 in 10 patients across the time-points, whereas the neuro-radiologist assessment identified six of these. The neuro-radiologist additionally identified five patients with increased atrophy in the follow-up period, all of them displayed decreasing low whole brain percentiles (median 11, range 8–28) in the LQ analysis. Significant positive correlation was identified between lesion volume measured by LQ and test performance on the T25FT both at 1 and 5 years after diagnosis. Conclusion: For the number of MS lesions at both time-points, we demonstrated strong correlations between the assessments done by LQ and the neuro-radiologist. Lesion volume evaluated with LQ correlated with T25FT performance. LQ-analyses classified more patients to have brain atrophy than the visual neuro-radiological evaluation. In conclusion, LQ seems like a promising supplement to the evaluation performed by neuro-radiologists, providing an automated tool for evaluating lesions in MS patients and also detecting early signs of atrophy in both a longitudinal and cross-sectional setting.
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Affiliation(s)
- Synne Brune
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Vanja Cengija
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Gro O Nygaard
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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15
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Lee Y, Lee BH, Yip W, Chou P, Yip BS. Neurofilament Proteins as Prognostic Biomarkers in Neurological Disorders. Curr Pharm Des 2020; 25:4560-4569. [PMID: 31820696 DOI: 10.2174/1381612825666191210154535] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/07/2019] [Indexed: 12/13/2022]
Abstract
Neurofilaments: light, medium, and heavy (abbreviated as NF-L, NF-M, and NF-H, respectively), which belong to Type IV intermediate filament family (IF), are neuron-specific cytoskeletal components. Neurofilaments are axonal structural components and integral components of synapses, which are important for neuronal electric signal transmissions along the axons and post-translational modification. Abnormal assembly of neurofilaments is found in several human neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), infantile spinal muscular atrophy (SMA), and hereditary sensory-motor neuropathy (HSMN). In addition, those pathological neurofilament accumulations are known in α-synuclein in Parkinson's disease (PD), Aβ and tau in Alzheimer's disease (AD), polyglutamine in CAG trinucleotide repeat disorders, superoxide dismutase 1 (SOD1), TAR DNA-binding protein 43 (TDP43), neuronal FUS proteins, optineurin (OPTN), ubiquilin 2 (UBQLN2), and dipeptide repeat protein (DRP) in amyotrophic lateral sclerosis (ALS). When axon damage occurs in central nervous disorders, neurofilament proteins are released and delivered into cerebrospinal fluid (CSF), which are then circulated into blood. New quantitative analyses and assay techniques are well-developed for the detection of neurofilament proteins, particularly NF-L and the phosphorylated NF-H (pNF-H) in CSF and serum. This review discusses the potential of using peripheral blood NF quantities and evaluating the severity of damage in the nervous system. Intermediate filaments could be promising biomarkers for evaluating disease progression in different nervous system disorders.
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Affiliation(s)
- Yichen Lee
- Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, China
| | - Bo H Lee
- Department of Geriatrics, Northern Beaches Hospital, Frenchs Forest New South Wales, Australia
| | - William Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vacover, BC V6T1Z4, Canada
| | - Pingchen Chou
- Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, China
| | - Bak-Sau Yip
- Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, China.,Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan, China
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16
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HLA-DPB1*03 as Risk Allele and HLA-DPB1*04 as Protective Allele for Both Early- and Adult-Onset Multiple Sclerosis in a Hellenic Cohort. Brain Sci 2020; 10:brainsci10060374. [PMID: 32560041 PMCID: PMC7349544 DOI: 10.3390/brainsci10060374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Human Leucocyte Antigens (HLA) represent the genetic loci most strongly linked to Multiple Sclerosis (MS). Apart from HLA-DR and HLA–DQ, HLA-DP alleles have been previously studied regarding their role in MS pathogenesis, but to a much lesser extent. Our objective was to investigate the risk/resistance influence of HLA-DPB1 alleles in Hellenic patients with early- and adult-onset MS (EOMS/AOMS), and possible associations with the HLA-DRB1*15:01 risk allele. Methods: One hundred MS-patients (28 EOMS, 72 AOMS) fulfilling the McDonald-2010 criteria were enrolled. HLA genotyping was performed with standard low-resolution Sequence-Specific Oligonucleotide techniques. Demographics, clinical and laboratory data were statistically processed using well-defined parametric and nonparametric methods and the SPSSv22.0 software. Results: No significant HLA-DPB1 differences were found between EOMS and AOMS patients for 23 distinct HLA-DPB1 and 12 HLA-DRB1 alleles. The HLA-DPB1*03 allele frequency was found to be significantly increased, and the HLA-DPB1*02 allele frequency significantly decreased, in AOMS patients compared to controls. The HLA-DPB1*04 allele was to be found significantly decreased in AOMS and EOMS patients compared to controls. Conclusions: Our study supports the previously reported risk susceptibility role of the HLA-DPB1*03 allele in AOMS among Caucasians. Additionally, we report for the first time a protective role of the HLA-DPB1*04 allele among Hellenic patients with both EOMS and AOMS.
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17
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Elechalawar CK, Hossen MN, McNally L, Bhattacharya R, Mukherjee P. Analysing the nanoparticle-protein corona for potential molecular target identification. J Control Release 2020; 322:122-136. [PMID: 32165239 PMCID: PMC7675788 DOI: 10.1016/j.jconrel.2020.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Abstract
When nanoparticles are introduced into biological systems, host proteins tend to associate on the particle surface to form a protein layer termed the "protein corona" (PC). Identifying the proteins that constitute the PC can yield useful information about nanoparticle processing, bio-distribution, toxicity and clearance. Similarly, characterizing and identifying proteins within the PC from patient samples provides opportunities to probe disease proteomes and identify molecules that influence the disease process. Thus, nanoparticles represent unique probing tools for discovery of molecular targets for diseases. Here, we report a first review on target identification using nanoparticles in biological samples based on analysing physico chemical interactions. We also summarize the evolution of the PC surrounding various nano-systems, comment on PC signature, address PC complexity in fluids, and outline challenges associated with analysing the PC. In addition, the influence on PC formation of various nanoparticle parameters is summarized; nanoparticle characteristics considered include size, charge, temperature, and surface modifications for both organic and inorganic nanomaterials. We also discuss the advantages of nanotechnology, over other more invasive and laborious methods, for identifying potential diagnostic and therapeutic targets.
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Affiliation(s)
| | - Md Nazir Hossen
- Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lacey McNally
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Resham Bhattacharya
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Priyabrata Mukherjee
- Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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18
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Bozhenko M, Boichuk M, Bila G, Nehrych T, Bilyy R. Freezing influences, the exposure of IgG glycans in sera from multiple sclerosis patients. UKRAINIAN BIOCHEMICAL JOURNAL 2020. [DOI: 10.15407/ubj92.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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19
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Dziedzic A, Miller E, Saluk-Bijak J, Bijak M. The GPR17 Receptor-A Promising Goal for Therapy and a Potential Marker of the Neurodegenerative Process in Multiple Sclerosis. Int J Mol Sci 2020; 21:ijms21051852. [PMID: 32182666 PMCID: PMC7084627 DOI: 10.3390/ijms21051852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/29/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022] Open
Abstract
One of the most important goals in the treatment of demyelinating diseases such as multiple sclerosis (MS) is, in addition to immunomodulation, reconstruction of the lost myelin sheath. The modulator of the central nervous system myelination is the metabotropic receptor coupled to the G-protein: GPR17. GPR17 receptors are considered to be sensors of local damage to the myelin sheath, and play a role in the reconstruction and repair of demyelinating plaques caused by ongoing inflammatory processes. GPR17 receptors are present on nerve cells and precursor oligodendrocyte cells. Under physiological conditions, they are responsible for the differentiation and subsequent maturation of oligodendrocytes, while under pathological conditions (during damage to nerve cells), their expression increases to become mediators in the demyelinating processes. Moreover, they are essential not only in both the processes of inducing damage and the death of neurons, but also in the local repair of the damaged myelin sheath. Therefore, GPR17 receptors may be recognized as the potential goal in creating innovative therapies for the treatment of the neurodegenerative process in MS, based on the acceleration of the remyelination processes. This review examines the role of GRP17 in pathomechanisms of MS development.
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Affiliation(s)
- Angela Dziedzic
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; (A.D.); (J.S.-B.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; (A.D.); (J.S.-B.)
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
- Correspondence: ; Tel.: +48-42-635-4336
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20
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Gontika M, Skarlis C, Artemiadis A, Pons R, Mastroyianni S, Vartzelis G, Theodorou V, Kilindireas K, Stefanis L, Dalakas M, Chrousos G, Anagnostouli M. HLA-DRB1 allele impact on pediatric multiple sclerosis in a Hellenic cohort. Mult Scler J Exp Transl Clin 2020; 6:2055217320908046. [PMID: 32133149 PMCID: PMC7040929 DOI: 10.1177/2055217320908046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/03/2020] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pediatric-onset multiple sclerosis (POMS) is considered a complex disease entity with many genetic and environmental factors implicated in its pathogenesis. Linkage studies in Caucasian adult populations consistently demonstrate the major histocompatibility complex and its HLA (human leukocyte antigen) polymorphisms as the genetic locus most strongly linked to MS. Objective To investigate the frequencies and possible clinical and imaging correlations of HLA-DRB1 alleles in a Hellenic POMS sample. Methods Fifty POMS patients fulfilling the IPMSSG (International Pediatric Multiple Sclerosis Study Group) criteria were enrolled using 144 adult-onset MS (AOMS) patients and 246 healthy controls for comparisons. HLA genotyping was performed with standard low-resolution sequence-specific oligonucleotide (SSO) techniques. Clinical and imaging correlations with specific HLA-DRB1 alleles were also examined. Results The HLA-DRB1*03 genotype was significantly higher in POMS patients compared to both the AOMS population (26% vs. 12.5%, p = 0.042) and the general population (26% vs. 12.6%, p = 0.004). HLA-DRB1*03-positive POMS patients had significantly more relapses (6.9 ± 4.9 vs. 4.2 ± 4.4, p = 0.005) and more thoracic spinal cord lesions than HLA-DRB1*03-negative patients (61.5% vs. 27%, p = 0.043). Conclusion In our Hellenic population, HLA-DRB1*03 allele confers increased risk for POMS and it is also correlated with possibly increased disease activity, expanding the existing knowledge on HLA associations and POMS.
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Affiliation(s)
- Maria Gontika
- Immunogenetics Laboratory, First Department of Neurology, Medical School,National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Charalampos Skarlis
- Immunogenetics Laboratory, First Department of Neurology, Medical School,National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Artemios Artemiadis
- Immunogenetics Laboratory, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Roser Pons
- First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Sotiria Mastroyianni
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Athens, Greece
| | - George Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Virginia Theodorou
- Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, Greece
| | - Konstantinos Kilindireas
- Demyelinating Diseases Unit, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Marinos Dalakas
- Neuroimmunology Unit, Department of Pathophysiology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Greece
| | - Maria Anagnostouli
- Demyelinating Diseases Unit & Director of Immunogenetics Laboratory, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
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Abstract
The search for an ideal multiple sclerosis biomarker with good diagnostic value, prognostic reference and an impact on clinical outcome has yet to be realized and is still ongoing. The aim of this review is to establish an overview of the frequent biomarkers for multiple sclerosis that exist to date. The review summarizes the results obtained from electronic databases, as well as thorough manual searches. In this review the sources and methods of biomarkers extraction are described; in addition to the description of each biomarker, determination of the prognostic, diagnostic, disease monitoring and treatment response values besides clinical impact they might possess. We divided the biomarkers into three categories according to the achievement method: laboratory markers, genetic-immunogenetic markers and imaging markers. We have found two biomarkers at the time being considered the gold standard for MS diagnostics. Unfortunately, there does not exist a single solitary marker being able to present reliable diagnostic value, prognostic value, high sensitivity and specificity as well as clinical impact. We need more studies to find the best biomarker for MS.
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22
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Skarlis C, Anagnostouli M. The role of melatonin in Multiple Sclerosis. Neurol Sci 2019; 41:769-781. [PMID: 31845043 DOI: 10.1007/s10072-019-04137-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
Melatonin is a neurohormone mainly produced by the pineal gland following a circadian rhythm. It is characterized as a pleiotropic factor because it not only regulates the wake-sleep rhythm but also exerts antinociceptive, antidepressant, anxiolytic, and immunomodulating properties. Recent studies suggest that dysregulation of melatonin secretion is associated with the pathogenesis of various autoimmune diseases, such as, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS). MS is an autoimmune disorder characterized by an abnormal immune response directed against the myelin sheath in the central nervous system, demyelination, oligodendrocyte death, and axonal degeneration. Recent evidence reveals that melatonin secretion is dysregulated in MS patients, suggesting that melatonin could be a potential target for therapeutic intervention. Here, we summarize the available literature regarding the role of melatonin in immune processes relevant for experimental autoimmune encephalomyelitis (EAE), MS, and the current clinical trials of melatonin supplementation in MS patients.
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Affiliation(s)
- Charalampos Skarlis
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas. Sophias, 74, 115 28, Athens, Greece.
| | - Maria Anagnostouli
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas. Sophias, 74, 115 28, Athens, Greece. .,Demyelinating Diseases Clinic, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece.
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23
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Koraysha NA, Kishk N, Hassan A, Samy El Gendy NM, Shehata HS, Al-Azayem SA, Kamal YS. Evaluating optic nerve diameter as a possible biomarker for disability in patients with multiple sclerosis. Neuropsychiatr Dis Treat 2019; 15:2571-2578. [PMID: 31564882 PMCID: PMC6735536 DOI: 10.2147/ndt.s216079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE The development of new biomarkers for multiple sclerosis (MS) is of paramount importance to improve our ability to predict disease progression and disability. The aim of this study was to evaluate the potential role of the optic nerve diameter (OND) measured by ultrasonography as a biomarker of early disability in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Forty-nine RRMS patients, 23 with a history of optic neuritis (MS-ON) and 26 without a history of optic neuritis (MS N-ON), and 50 age- and sex-matched healthy control subjects were included in the study. The OND and optic nerve sheath diameter (ONSD) were measured by transorbital sonography (TOS), and the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT) using the Optovue RTVue™ system (Optovue, Inc., Fremont, CA, USA). RESULTS There was no significant difference between the patient (whether ON or N-ON eyes) and control groups in either the OND (p=0.979) or the ONSD (p=0.911). However, patients with an expanded disability status scale (EDSS) score >2 had a significantly lower OND and RNFL thicknesses (p=0.014, p=0.010 respectively) than patients with an EDSS score ≤2. Statistical logistic regression revealed that OND was an independent predictor of EDSS>2 (p=0.044, OR =0.000, 95% CI=0.000-0.589). CONCLUSION The OND, as measured by ultrasonography, could be potentially used as a biomarker for the detection of early disability in RRMS patients.
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Affiliation(s)
- Noha Abo Koraysha
- Neurology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Nirmeen Kishk
- Neurology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Neurology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | | | - Hatem S Shehata
- Neurology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
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24
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Lotan I, Benninger F, Mendel R, Hellmann MA, Steiner I. Does CSF pleocytosis have a predictive value for disease course in MS? NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e584. [PMID: 31355320 PMCID: PMC6624148 DOI: 10.1212/nxi.0000000000000584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/26/2019] [Indexed: 12/02/2022]
Abstract
Objective MS is a demyelinating CNS disorder with a spectrum of clinical patterns regarding course and prognosis. Although several prognostic factors are considered in the initial evaluation of patients, biological markers defining the disease course and guiding treatments are currently lacking. It is unknown whether patients with CSF pleocytosis differ in regard to symptoms, disease course, and prognosis from those without. The aim of this study was to evaluate whether CSF pleocytosis during the initial presentation has an impact on the clinical course and progression of MS. Methods We retrospectively evaluated patients attending the MS Clinic at Rabin Medical Center between January 1999 and January 2016 who underwent lumbar puncture (LP) at disease presentation, considering CSF cell count, clinical diagnosis (clinically isolated syndrome [CIS] and relapsing-remitting MS [RRMS]), annualized relapse rate (ARR), paraclinical findings (imaging, CSF oligoclonal bands, and evoked potentials), and disease progression, expressed by the Expanded Disability Status Scale (EDSS). Results One hundred fourteen patients (72 females) underwent LP at disease presentation (RRMS: n = 100, CIS: n = 14). Age at diagnosis was 32.4 ± 12.2 years, and the follow-up time was 9.4 ± 3.8 years. Forty-six patients showed a pleocytic CSF (≥5 cells per μL). Compared with patients with <4 cells per μL, patients with pleocytosis had a higher ARR (0.60 ± 0.09 vs 0.48 ± 0.04; p = 0.0267) and a steeper increase (slope) in the EDSS score throughout the follow-up period (correlation coefficient: r2 = 0.04; p = 0.0251). Conclusions CSF pleocytosis may be considered a biological unfavorable predictive factor regarding disease course and progression in MS.
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Affiliation(s)
- Itay Lotan
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Felix Benninger
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Rom Mendel
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Mark A Hellmann
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Israel Steiner
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
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25
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Mojaverrostami S, Bojnordi MN, Ghasemi-Kasman M, Ebrahimzadeh MA, Hamidabadi HG. A Review of Herbal Therapy in Multiple Sclerosis. Adv Pharm Bull 2018; 8:575-590. [PMID: 30607330 PMCID: PMC6311642 DOI: 10.15171/apb.2018.066] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis is a complex autoimmune disorder which characterized by demyelination and axonal loss in the central nervous system (CNS). Several evidences indicate that some new drugs and stem cell therapy have opened a new horizon for multiple sclerosis treatment, but current therapies are partially effective or not safe in the long term. Recently, herbal therapies represent a promising therapeutic approach for multiple sclerosis disease. Here, we consider the potential benefits of some herbal compounds on different aspects of multiple sclerosis disease. The medicinal plants and their derivatives; Ginkgo biloba, Zingiber officinale, Curcuma longa, Hypericum perforatum, Valeriana officinalis, Vaccinium macrocarpon, Nigella sativa,Piper methysticum, Crocus sativus, Panax ginseng, Boswellia papyrifera, Vitis vinifera, Gastrodia elata, Camellia sinensis, Oenothera biennis, MS14 and Cannabis sativa have been informed to have several therapeutic effects in MS patients.
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Affiliation(s)
- Sina Mojaverrostami
- Young Researchers and Elite Club, Behshahr Branch, Islamic Azad University, Behshahr, Iran
| | - Maryam Nazm Bojnordi
- Department of Anatomy & Cell Biology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Cellular and Molecular Research Center, Department of Anatomy & Cell Biology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Ghasemi-Kasman
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ali Ebrahimzadeh
- Pharmaceutical Sciences Research Center, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hatef Ghasemi Hamidabadi
- Department of Anatomy & Cell Biology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Immunogenetic Research Center, Department of Anatomy & Cell Biology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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26
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Anti-Myelin Oligodendrocyte Glycoprotein and Human Leukocyte Antigens as Markers in Pediatric and Adolescent Multiple Sclerosis: on Diagnosis, Clinical Phenotypes, and Therapeutic Responses. Mult Scler Int 2018; 2018:8487471. [PMID: 30595920 PMCID: PMC6282147 DOI: 10.1155/2018/8487471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/19/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022] Open
Abstract
Early-onset (pediatric and adolescent) multiple sclerosis (MS) is a well-established demyelinating disease that accounts for approximately 3-5% of all MS cases. Thus, identifying potential biomarkers that can reflect the pathogenic mechanisms, disease course and prognosis, and therapeutic response in such patients is of paramount importance. Myelin oligodendrocyte glycoprotein (MOG) has been regarded as a putative autoantigen and autoantibody target in patients with demyelinating diseases for almost three decades. However, recent studies have suggested that antibodies against MOG represent a distinct clinical entity of dominantly humoral profile, with a range of clinical phenotypes closely related to the age of onset, specific patterns of disease course, and responses to treatment. Furthermore, the major histocompatibility complex (MHC)—which has been regarded as the “gold standard” for attributing genetic burden in adult MS since the early 1970s—has also emerged as the primary genetic locus in early-onset MS, particularly with regard to the human leukocyte antigen (HLA) alleles DRB1⁎1501 and DRB1⁎0401. Recent studies have investigated the potential interactions among HLA, MOG, and environmental factors, demonstrating that early-onset MS is characterized by genetic, immunogenetic, immunological, and familial trait correlations. In this paper, we review recent evidence regarding HLA-genotyping and MOG antibodies—the two most important candidate biomarkers for early-onset MS—as well as their potential application in the diagnosis and treatment of MS.
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27
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Alves C, Batista S, d'Almeida OC, Sousa L, Cunha L, Bernardes R, Castelo‐Branco M. The retinal ganglion cell layer predicts normal-appearing white matter tract integrity in multiple sclerosis: A combined diffusion tensor imaging and optical coherence tomography approach. Hum Brain Mapp 2018; 39:1712-1720. [PMID: 29334156 PMCID: PMC6866258 DOI: 10.1002/hbm.23946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/08/2017] [Accepted: 01/01/2018] [Indexed: 01/06/2023] Open
Abstract
We investigated the relationship between retinal layers and normal-appearing white matter (WM) integrity in the brain of patients with relapsing-remitting multiple sclerosis (MS), using a combined diffusion tensor imaging and high resolution optical coherence tomography approach. Fifty patients and 62 controls were recruited. The patients were divided into two groups according to presence (n = 18) or absence (n = 32) of optic neuritis. Diffusion tensor data were analyzed with a voxel-wise whole brain analysis of diffusion metrics in WM with tract-based spatial statistics. Thickness measurements were obtained for each individual retinal layer. Partial correlation and multivariate regression analyses were performed, assessing the association between individual retinal layers and diffusion metrics across all groups. Region-based analysis was performed, by focusing on tracts associated with the visual system. Receiver operating characteristic (ROC) curves were computed to compare the biomarker potential for the diagnosis of MS, using the thickness of each retinal layer and diffusion metrics. In patients without optic neuritis, both ganglion cell layer (GCL) and inner plexiform layer thickness correlated with the diffusion metrics within and outside the visual system. GCL thickness was a significant predictor of diffusion metrics in the whole WM skeleton, unlike other layers. No association was observed for either controls or patients with a history of optic neuritis. ROC analysis showed that the biomarker potential for the diagnosis of MS based on the GCL was high when compared to other layers. We conclude that GCL integrity is a predictor of whole-brain WM disruption in MS patients without optic neuritis.
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Affiliation(s)
- Carolina Alves
- Visual Neuroscience LaboratoryInstitute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of CoimbraCoimbraPortugal
- Centre for Neuroscience and Cell Biology (CNC).IBILIUniversity of CoimbraCoimbraPortugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of CoimbraCoimbraPortugal
- CIBIT – Coimbra Institute for Biomedical Imaging and Life SciencesCoimbraPortugal
| | - Sónia Batista
- Department of NeurologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Otília C. d'Almeida
- Visual Neuroscience LaboratoryInstitute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of CoimbraCoimbraPortugal
- Centre for Neuroscience and Cell Biology (CNC).IBILIUniversity of CoimbraCoimbraPortugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of CoimbraCoimbraPortugal
- CIBIT – Coimbra Institute for Biomedical Imaging and Life SciencesCoimbraPortugal
| | - Lívia Sousa
- Department of NeurologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Luís Cunha
- Department of NeurologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Rui Bernardes
- Visual Neuroscience LaboratoryInstitute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of CoimbraCoimbraPortugal
- Centre for Neuroscience and Cell Biology (CNC).IBILIUniversity of CoimbraCoimbraPortugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of CoimbraCoimbraPortugal
- CIBIT – Coimbra Institute for Biomedical Imaging and Life SciencesCoimbraPortugal
| | - Miguel Castelo‐Branco
- Visual Neuroscience LaboratoryInstitute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of CoimbraCoimbraPortugal
- Centre for Neuroscience and Cell Biology (CNC).IBILIUniversity of CoimbraCoimbraPortugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of CoimbraCoimbraPortugal
- CIBIT – Coimbra Institute for Biomedical Imaging and Life SciencesCoimbraPortugal
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28
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Jiang D, Ju W, Wu X, Zhan X. Elevated lysophosphatidic acid levels in the serum and cerebrospinal fluid in patients with multiple sclerosis: therapeutic response and clinical implication. Neurol Res 2018; 40:335-339. [PMID: 29557721 DOI: 10.1080/01616412.2018.1446256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND To date, although great effort has been made to identify biomarkers of multiple sclerosis (MS), it remains unclear whether lysophosphatidic acid (LPA) can be used as a biomarker for MS. METHODS This study compared the LPA levels in the serum and cerebrospinal fluid (CSF) in patients with MS in relapse versus in remission and investigated the change in LPA levels in MS patients in relapse after treatment. Forty-one patients with relapsing-remitting MS (RRMS) (21 patients in relapse and 20 patients in remission) and 21 patients with non-inflammatory, non-vascular neurological diseases as controls were included in this study. MS patients in relapse received standard glucocorticoid treatment. LPA concentrations in serum and CSF were measured using an inorganic phosphate quantification assay. RESULTS LPA levels in the serum and CSF were significantly higher in MS patients in relapse than in MS patients in remission and control patients (P < 0.05). The LPA level in MS patients in relapse was significantly reduced after treatment (P < 0.05). CONCLUSION LPA concentrations in the serum and CSF may be used as biomarkers to monitor disease activity and therapeutic response in MS patients.
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Affiliation(s)
- Dongxiao Jiang
- a Department of Neurology , Weihai Central Hospital Affiliated to Medical College of Qingdao University , Weihai , China
| | - Weiping Ju
- a Department of Neurology , Weihai Central Hospital Affiliated to Medical College of Qingdao University , Weihai , China
| | - Xijun Wu
- a Department of Neurology , Weihai Central Hospital Affiliated to Medical College of Qingdao University , Weihai , China
| | - Xia Zhan
- a Department of Neurology , Weihai Central Hospital Affiliated to Medical College of Qingdao University , Weihai , China
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29
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Keane RW, Dietrich WD, de Rivero Vaccari JP. Inflammasome Proteins As Biomarkers of Multiple Sclerosis. Front Neurol 2018; 9:135. [PMID: 29615953 PMCID: PMC5868457 DOI: 10.3389/fneur.2018.00135] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord. The inflammasome is a multiprotein complex that contributes to the innate immune response in animal models of MS as well as in patients with the disease. Important to the care of patients with MS is the need for biomarkers that can predict disease onset, disease exacerbation, as well as response to treatment. In this study, we analyzed serum samples from 32 patients with MS and 120 age-matched controls, and provide receiver operator characteristic (ROC) curves with associated confidence intervals following analyses of serum samples from patients with MS, most of which had the relapsing-remitting form of the disease, and from healthy unaffected donors, and determine the sensitivity and specificity of inflammasome proteins as biomarkers of MS. We report that caspase-1 (1.662 ± 0.6024 difference between means), apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) (407.5 ± 35.79), and interleukin (IL)-18 (78.53 + 17.86) were elevated in the serum of MS patients when compared to controls. Interestingly, the levels of IL-1β (−0.5961 ± 0.265) were lower in the MS cohort. Importantly, the area under the curve (AUC) for ASC and caspase-1 were 0.9448 and 0.848, respectively. Taken together, these data suggest that ASC and caspase-1 could be potential candidate biomarkers for MS onset.
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Affiliation(s)
- Robert W Keane
- Department of Physiology and Biophysics, Miller School of Medicine, University of Miami, Miami, FL, United States.,InflamaCORE, LLC, Miami, FL, United States
| | - W Dalton Dietrich
- InflamaCORE, LLC, Miami, FL, United States.,Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Juan Pablo de Rivero Vaccari
- InflamaCORE, LLC, Miami, FL, United States.,Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
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30
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Coe S, Collett J, Izadi H, Wade DT, Clegg M, Harrison JM, Buckingham E, Cavey A, DeLuca GC, Palace J, Dawes H. A protocol for a randomised double-blind placebo-controlled feasibility study to determine whether the daily consumption of flavonoid-rich pure cocoa has the potential to reduce fatigue in people with relapsing and remitting multiple sclerosis (RRMS). Pilot Feasibility Stud 2018; 4:35. [PMID: 29403649 PMCID: PMC5778802 DOI: 10.1186/s40814-018-0230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background Dietary interventions including consumption of flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with MS (pwMS) have been performed. The hypothesis is that the consumption of a flavonoid-rich pure cocoa beverage will reduce fatigue in pwMS. The aim of this study is to determine the feasibility and potential outcome of running a trial to evaluate this hypothesis. Methods Using a randomised (1:1) double-blind placebo-controlled feasibility study, 40 men and women (20 in each trial arm) with a recent diagnosis (< 10 years) of relapsing and remitting MS (RRMS) and who are over 18 years of age will be recruited from neurology clinics and throughout the Thames Valley community. During a 6-week nutrition intervention period, participants will consume the cocoa beverage, high flavonoid or low flavonoid content, at breakfast daily. At baseline, demographic factors and disease-related factors will be assessed. Fatigue, activity and quality of life, in addition to other measures, will be taken at three visits (baseline, week 3 and week 6) in a university setting by a researcher blinded to group membership. Feasibility and fidelity will be assessed through recruitment and retention, adherence and a quantitative process evaluation at the end of the trial. We will describe demographic factors (age, gender, level of education) as well as disease-related factors (disease burden scores, length of time diagnosed with MS) and cognitive assessment, depression and quality of life and general physical activity in order to characterise participants and determine possible mediators to identify the processes by which the intervention may bring about change. Feasibility (recruitment, safety, feasibility of implementation of the intervention and evaluation, protocol adherence and data completion) and potential for benefit (estimates of effect size and variability) will be determined to inform future planned studies. Results will be presented using point estimates, 95% confidence intervals and p values. Primary statistical analysis will be on an intention-to-treat basis and will use the complete case data set. Discussion We propose that a flavonoid-enriched cocoa beverage for the management of fatigue will be well received by participants. Further, if it is implemented early in the disease course of people diagnosed with RRMS, it will improve mobility and functioning by modifying fatigue. Trial registration Registered with ISRCTN Registry. Trial registration No: ISRCTN69897291; Date April 2016
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Affiliation(s)
- S Coe
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - J Collett
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - H Izadi
- 3School of Engineering, Computing and Mathematics, Faculty of Technology, Design and Environment, Oxford Brookes University, Wheatley Campus, Room R2.32, Oxford, OX33 1HX UK
| | - D T Wade
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - M Clegg
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - J M Harrison
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - E Buckingham
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK
| | - A Cavey
- 2Department of Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, OX3 9DU UK
| | - G C DeLuca
- 2Department of Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, OX3 9DU UK
| | - J Palace
- 2Department of Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, OX3 9DU UK
| | - H Dawes
- 1Centre for Movement and Occupational Rehabilitation Sciences, Oxford Institute of Midwifery, Nursing and Allied Health Research, and Oxford Brookes Centre for Nutrition and Health, Oxford Brookes University, Oxford, OX30BP UK.,2Department of Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, OX3 9DU UK
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31
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Gjelstrup MC, Stilund M, Petersen T, Møller HJ, Petersen EL, Christensen T. Subsets of activated monocytes and markers of inflammation in incipient and progressed multiple sclerosis. Immunol Cell Biol 2017; 96:160-174. [PMID: 29363161 PMCID: PMC5836924 DOI: 10.1111/imcb.1025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/14/2017] [Accepted: 10/10/2017] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is an immune mediated, inflammatory and demyelinating disease of the central nervous system (CNS). Substantial evidence points toward monocytes and macrophages playing prominent roles early in disease, mediating both pro- and anti-inflammatory responses. Monocytes are subdivided into three subsets depending on the expression of CD14 and CD16, representing different stages of inflammatory activation. To investigate their involvement in MS, peripheral blood mononuclear cells from 40 patients with incipient or progressed MS and 20 healthy controls were characterized ex vivo. In MS samples, we demonstrate a highly significant increase in nonclassical monocytes (CD14+CD16++), with a concomitant significant reduction in classical monocytes (CD14++CD16-) compared with healthy controls. Also, a significant reduction in the surface expression of CD40, CD163, and CD192 was found, attributable to the upregulation of the nonclassical monocytes. In addition, significantly increased levels of human endogenous retrovirus (HERV) envelope (Env) epitopes, encoded by both HERV-H/F and HERV-W, were specifically found on nonclassical monocytes from patients with MS; emphasizing their involvement in MS disease. In parallel, serum and cerebrospinal fluid (CSF) samples were analyzed for soluble biomarkers of inflammation and neurodegeneration. For sCD163 versus CD163, no significant correlations were found, whereas highly significant correlations between levels of soluble neopterine and the intermediate monocyte (CD14++CD16+) population was found, as were correlations between levels of soluble osteopontin and the HERV Env expression on nonclassical monocytes. The results from this study emphasize the relevance of further focus on monocyte subsets, particularly the nonclassical monocytes in monitoring of inflammatory diseases.
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Affiliation(s)
- Mikkel Carstensen Gjelstrup
- Department of Biomedicine, Aarhus University, Bartholin Building, Wilhelm Meyers Allé 4, DK-8000, Aarhus C, Denmark
| | - Morten Stilund
- Department of Biomedicine, Aarhus University, Bartholin Building, Wilhelm Meyers Allé 4, DK-8000, Aarhus C, Denmark.,Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Eva Lykke Petersen
- Department of Biomedicine, Aarhus University, Bartholin Building, Wilhelm Meyers Allé 4, DK-8000, Aarhus C, Denmark
| | - Tove Christensen
- Department of Biomedicine, Aarhus University, Bartholin Building, Wilhelm Meyers Allé 4, DK-8000, Aarhus C, Denmark
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32
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Londoño AC, Mora CA. Evidence of disease control: a realistic concept beyond NEDA in the treatment of multiple sclerosis. F1000Res 2017; 6:566. [PMID: 28588765 PMCID: PMC5446020 DOI: 10.12688/f1000research.11349.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
Although no evidence of disease activity (NEDA) permits evaluation of response to treatment in the systematic follow-up of patients with multiple sclerosis (MS), its ability to accomplish detection of surreptitious activity of disease is limited, thus being unable to prevent patients from falling into a non-reversible progressive phase of disease. A protocol of evaluation based on the use of validated biomarkers that is conducted at an early stage of disease would permit the capture of abnormal neuroimmunological phenomena and lead towards intervention with modifying therapy before tissue damage has been reached.
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Affiliation(s)
- Ana C Londoño
- Instituto Neurológico de Colombia (INDEC), Medellín, Colombia
| | - Carlos A Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
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33
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Londoño AC, Mora CA. Evidence of disease control: a realistic concept beyond NEDA in the treatment of multiple sclerosis. F1000Res 2017; 6:566. [PMID: 28588765 PMCID: PMC5446020 DOI: 10.12688/f1000research.11349.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 10/13/2023] Open
Abstract
Although no evidence of disease activity (NEDA) permits evaluation of response to treatment in the systematic follow-up of patients with multiple sclerosis (MS), its ability to accomplish detection of surreptitious activity of disease is limited, thus being unable to prevent patients from falling into a non-reversible progressive phase of disease. A protocol of evaluation based on the use of validated biomarkers that is conducted at an early stage of disease would permit the capture of abnormal neuroimmunological phenomena and lead towards intervention with modifying therapy before tissue damage has been reached.
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Affiliation(s)
- Ana C. Londoño
- Instituto Neurológico de Colombia (INDEC), Medellín, Colombia
| | - Carlos A. Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
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34
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Nguyen CTO, Hui F, Charng J, Velaedan S, van Koeverden AK, Lim JKH, He Z, Wong VHY, Vingrys AJ, Bui BV, Ivarsson M. Retinal biomarkers provide "insight" into cortical pharmacology and disease. Pharmacol Ther 2017; 175:151-177. [PMID: 28174096 DOI: 10.1016/j.pharmthera.2017.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The retina is an easily accessible out-pouching of the central nervous system (CNS) and thus lends itself to being a biomarker of the brain. More specifically, the presence of neuronal, vascular and blood-neural barrier parallels in the eye and brain coupled with fast and inexpensive methods to quantify retinal changes make ocular biomarkers an attractive option. This includes its utility as a biomarker for a number of cerebrovascular diseases as well as a drug pharmacology and safety biomarker for the CNS. It is a rapidly emerging field, with some areas well established, such as stroke risk and multiple sclerosis, whereas others are still in development (Alzheimer's, Parkinson's, psychological disease and cortical diabetic dysfunction). The current applications and future potential of retinal biomarkers, including potential ways to improve their sensitivity and specificity are discussed. This review summarises the existing literature and provides a perspective on the strength of current retinal biomarkers and their future potential.
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Affiliation(s)
- Christine T O Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia.
| | - Flora Hui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jason Charng
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Shajan Velaedan
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Anna K van Koeverden
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jeremiah K H Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Vickie H Y Wong
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Bang V Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Magnus Ivarsson
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
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35
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Kizlaitienė R, Kaubrys G, Giedraitienė N, Ramanauskas N, Dementavičienė J. Composite Marker of Cognitive Dysfunction and Brain Atrophy is Highly Accurate in Discriminating Between Relapsing-Remitting and Secondary Progressive Multiple Sclerosis. Med Sci Monit 2017; 23:588-597. [PMID: 28145395 PMCID: PMC5301955 DOI: 10.12659/msm.903234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With the advent of numerous new-generation disease-modifying drugs for multiple sclerosis (MS), the discrimination between relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) has become a problem of high importance. The aim of our study was to find a simple way to accurately discriminate between RRMS and SPMS that is applicable in clinical practice as a composite marker, using the linear measures of magnetic resonance imaging (MRI) and the results of cognitive tests. Material/Methods We included 88 MS patients in the study: 43 participants had RRMS and 45 had SPMS. A battery consisting of 11 tests was used to evaluate cognitive function. We used 11 linear MRI measures and 7 indexes to assess brain atrophy. Results Four cognitive tests and 3 linear MRI measures were able to distinguish RRMS from SPMS with the AUC >0.8 based on ROC analysis. Multiple logistic regression models were constructed to identify the best set of cognitive and MRI markers. The model, using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Huckman Index, showed the highest predictive ability: AUC=0.921 (p<0.001). We constructed a simple remission-progression index from the same 3 variables, which discriminated well between RRMS and SPMS: AUC=0.920 (p<0.001), maximal Youden Index=0.702, cut-off=1.68, sensitivity=79.1%, and specificity=91.1%. Conclusions The composite remission-progression index, using the RAVLT test, DSST test, and MRI Huckman Index, is highly accurate in discriminating between RRMS and SPMS.
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Affiliation(s)
- Rasa Kizlaitienė
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | - Nataša Giedraitienė
- Department of Neurology and Neurosurgery, Center of Neurology, Vilnius University, Vilnius, Lithuania
| | | | - Jūratė Dementavičienė
- Department of Radiology, Nuclear Medicine and Physics of Medicine, Center of Radiology and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
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Esmaeil Mousavi S, Heydarpour P, Reis J, Amiri M, Sahraian MA. Multiple sclerosis and air pollution exposure: Mechanisms toward brain autoimmunity. Med Hypotheses 2017; 100:23-30. [PMID: 28236843 DOI: 10.1016/j.mehy.2017.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 01/03/2023]
Abstract
The association between neurodegenerative diseases and environmental exposures, in particular air pollution, has been noticed in the last two decades, but the importance of this environmental factor in multiple sclerosis (MS) pathogenesis has not been considered extensively. However, recent evidence suggests that major mechanisms involved in MS pathogenesis, such as inflammatory factors expression, free radicals overproduction, the blood brain barrier (BBB) breakdown, neuroinflammation, vitamin D deficiency and mitochondrial dysfunction could also occur due to exposure to air pollutants. A prospective hypothesis is suggested here in which exposure to air pollutants may initiate destructive mechanisms inducing inflammatory-oxidative cascades, reduction of immunological self-tolerance and neurodegeneration leading to brain autoimmunity.
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Affiliation(s)
- Sayed Esmaeil Mousavi
- Social Health Determinants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Pouria Heydarpour
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jacques Reis
- Service de Neurologie, Centre Hospitalier Universitaire, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - Masoud Amiri
- Social Health Determinants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Londoño AC, Mora CA. Autologous Bone Marrow Transplantation in Multiple Sclerosis: Biomarker Relevance for Patient Recruitment and Follow up. JOURNAL OF CLINICAL & CELLULAR IMMUNOLOGY 2016; 7:455. [PMID: 28090375 PMCID: PMC5226132 DOI: 10.4172/2155-9899.1000455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the current availability of disease modifying therapies for the treatment of multiple sclerosis, there are still patients who suffer from severe neurological dysfunction in the relapsing-remitting or early progressive forms of the disease. For these patients autologous hematopoietic stem cell transplant offers an important therapeutic solution to prevent progression to irreversible disability. In spite of multiple studies in the last two decades, patient inclusion criteria, protocols for peripheral blood stem cell mobilization and bone marrow cell conditioning and methodology of follow up for autologous hematopoietic stem cell transplant in multiple sclerosis have not been strictly unified. METHODS We reviewed five recent clinical studies that confirmed the positive outcome of transplant in spite of disclosing significant differences in methodology of enrollment including patient disease subtypes, disease duration range, disability, regimens of peripheral blood stem cell mobilization and bone marrow cell conditioning, scheduling of imaging studies after transplant, and absence of laboratory biomarkers consistently applied to these studies. RESULTS Therapy with autologous hematopoietic stem cell transplant has shown best results among young individuals with severe relapsing-remitting or early progressive disease through its ability to maintain no evidence of disease activity status in a significantly higher proportion of patients after transplant in comparison to patients treated with disease modifying therapies. Important cross-sectional differences in the reviewed studies were found. CONCLUSION A specific and careful selection of biomarkers, based on the current physiopathological mechanisms known to result in multiple sclerosis, will contribute to a better and earlier patient selection for autologous hematopoietic stem cell transplant and follow up process. An objective and measurable response could be obtained with the determination of biomarkers at the onset of treatment and after follow-up on reconstitution of the immune response. The application of such parameters could also help further our understanding of pathogenesis of the disease.
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Affiliation(s)
- Ana C. Londoño
- Instituto Neurológico de Colombia-INDEC (A.C.L.), Medellin, Colombia
| | - Carlos A. Mora
- Department of Neurology (C.A.M.), Georgetown Multiple Sclerosis Center, MedStar Georgetown University Hospital, Washington, DC, USA
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Ludwig MD, Turel AP, Zagon IS, McLaughlin PJ. Long-term treatment with low dose naltrexone maintains stable health in patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2016; 2:2055217316672242. [PMID: 28607740 PMCID: PMC5433405 DOI: 10.1177/2055217316672242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/11/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction A retrospective study was conducted on patients at Penn State Hershey Medical Center diagnosed with relapsing–remitting multiple sclerosis between 2006 and 2015. Methodology Laboratory and clinical data collected over this 10-year period were reviewed. Two cohorts of patients were established based on their relapsing–remitting multiple sclerosis therapy at the time of their first visit to Penn State. One group of patients (n = 23) was initially prescribed low dose naltrexone at the time first seen at Hershey. This group was offered low dose naltrexone because of symptoms of fatigue or refusal to take an available disease-modifying therapy. The second group of patients (n = 31) was treated with the glatiramer acetate (Copaxone) and offered low dose naltrexone as an adjunct therapy to their disease-modifying therapy. Results Patient data from visits after 1–50 months post-diagnosis were evaluated in a retrospective manner. Data obtained from patient charts included clinical laboratory values from standard blood tests, timed 25-foot walking trials, and changes in magnetic resonance imaging reports. Statistical analyses between the groups and for each patient over time indicated no significant differences in clinical laboratory values, timed walking, or changes in magnetic resonance imaging. Conclusion These data suggest that the apparently non-toxic, inexpensive, biotherapeutic is safe and if taken alone did not result in an exacerbation of disease symptoms.
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Affiliation(s)
- Michael D Ludwig
- Department of Neural and Behavioral Sciences, the Pennsylvania State University College of Medicine, USA
| | - Anthony P Turel
- Department of Neurology, The Milton S Hershey Medical Center, USA
| | - Ian S Zagon
- Department of Neural and Behavioral Sciences, the Pennsylvania State University College of Medicine, USA
| | - Patricia J McLaughlin
- Department of Neural and Behavioral Sciences, the Pennsylvania State University College of Medicine, USA
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Anagnostouli M, Katsavos S, Kyrozis A, Gontika M, Voumvourakis KI, Kapaki E. Vertebral hemangiomas in the thoracic spine of multiple sclerosis patients are connected with fewer demyelinating lesions at the same level. Possible impact on pathophysiology and clinical course. Neurol Res 2016; 38:655-62. [PMID: 27625006 DOI: 10.1080/01616412.2016.1219079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mechanisms of angiogenesis regulate multiple sclerosis (MS) lesions' evolution, displaying both neuroprotective and harmful effects. Factors traditionally considered as purely angiogenic, like vascular endothelial growth factor (VEGF), exert complex heterogenous actions on both neural and vascular malformation-derived tissues. Aim of this retrospective study was to examine, for the first time, potential associations between the presence of common vascular malformations, like vertebral hemangiomas (VHs), and several clinico-radiological MS parameters. METHODS 236 MS patients who were followed in our Outpatient Clinic were recruited in this study. Outcome measures concerned demographics, disease-derived variables, and MS-lesions' distribution in VHs - positive and negative patients. All data were collected retrospectively. Potential correlations were assessed with univariate statistical analyses (p = 0.05), followed by multivariate regression models, for purposes of confounder-effects elimination. RESULTS VH presence showed significant negative correlations with presence of MS lesions in the thoracic (p = 0.005 for thoracic VHs), but not the cervical cord. Trends towards negative associations of VH presence with subtentorial MS lesions and positive family history for MS were also observed. DISCUSSION Our observations suggest that VH presence may reduce the risk of thoracic demyelinating lesions in MS patients. They could be explained as part of a multifaceted angiogenic process, concomitantly enhancing neural repair and abnormal hemangioma vascularization.
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Affiliation(s)
- Maria Anagnostouli
- a Immunogenetics Laboratory, 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece.,b 1st Dept of Neurology , Demyelinating Diseases Clinic, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece.,c 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece
| | - Serafeim Katsavos
- a Immunogenetics Laboratory, 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece
| | - Andreas Kyrozis
- c 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece
| | - Maria Gontika
- a Immunogenetics Laboratory, 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece
| | - Konstantinos I Voumvourakis
- d MS Department of the 2nd Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Attikon Hospital, Rimini ave 1 , Athens , 124 62, Greece
| | - Elisabeth Kapaki
- c 1st Dept of Neurology , Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74 , Athens , 115-28, Greece
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Ziemssen T, Kern R, Thomas K. Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol 2016; 16:124. [PMID: 27484848 PMCID: PMC4971685 DOI: 10.1186/s12883-016-0639-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease as it can present inter-individually as well as intra-individually, with different disease phenotypes emerging during different stages in the long-term disease course. In addition to advanced immunological, genetic and magnetic resonance imaging (MRI) profiling of the patient, the clinical profiling of MS patients needs to be widely implemented in clinical practice and improved by including a greater range of relevant parameters as patient-reported outcomes. It is crucial to implement a high standard of clinical characterization of individual patients as this is key to effective long-term observation and evaluation. To generate reliable real-world data, individual clinical data should be collected in specific MS registries and/or using intelligent software instruments as the Multiple Sclerosis Documentation System 3D. Computational analysis of biological processes will play a key role in the transition to personalized MS treatment. Major breakthroughs in the areas of bioinformatics and computational systems biology will be required to process this complex information to enable improved personalization of treatment for MS patients.
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Affiliation(s)
- Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany.
| | - Raimar Kern
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
| | - Katja Thomas
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
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Gold R, Toumi M, Meesen B, Fogarty E. The payer’s perspective: What is the burden of MS and how should the patient’s perspective be integrated in health technology assessment conducted for taking decisions on access to care and treatment? Mult Scler 2016; 22:60-70. [DOI: 10.1177/1352458516650743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/15/2022]
Abstract
Background: In Europe, there exists considerable variability in access to care and treatment for multiple sclerosis (MS). Objectives: To improve this situation, we identified key issues payers should take into account when making decisions on access to care and treatment for MS. We also give an overview of the different dimensions determining total MS burden and discuss why it is key to integrate the patient’s perspective in estimating this burden. Results: The total burden of MS relates to three dimensions: clinical, humanistic and economic. Although the clinical burden is extensively studied, crucial information is still missing about MS pathophysiology, how MS-related symptoms will develop during the disease course and which patients will progress more rapidly. With regard to the humanistic burden, information on patient-reported quality of life systematically collected in clinical trials for registration purposes is still scarce. Early engagement between pharmaceutical companies, the European Medicines Agency and health technology agencies to prospectively identify key evidence needs for the regulatory and reimbursement processes is required as a first step towards more equal access to care and treatment in MS in Europe. Patients’ expectations regarding treatment outcomes should be better researched and integrated into decision-making and patients should be counselled in this process.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Mondher Toumi
- Department of Complex Decision Sciences and Health Policies, University of Lyon, Lyon, France
| | | | - Emer Fogarty
- National Centre for Pharmacoeconomics (NCPE), Dublin, Ireland
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Anagnostouli M, Katsavos S, Artemiadis A, Zacharis M, Argyrou P, Theotoka I, Christidi F, Zalonis I, Liappas I. Determinants of stigma in a cohort of hellenic patients suffering from multiple sclerosis: a cross-sectional study. BMC Neurol 2016; 16:101. [PMID: 27411373 PMCID: PMC4944520 DOI: 10.1186/s12883-016-0621-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Patients suffering from several neurologic disorders may bear the “stigma” of their disease, being disqualified from full social acceptance. Although stigma is considered to be present in Multiple Sclerosis (MS), the factors that influence its levels are ambiguous. Aim of our study was to examine, for the first time in the literature, the basic determinants of stigma in a Hellenic MS-patients cohort, as well as how stigma affects their Quality-of-Life (QoL) profiles. Methods Three hundred forty two patients were recruited in this study. Data collected concerned sociodemographic and disease-related variables, mental illness assessment, Multiple-Sclerosis-QoL-54 (MSQoL-54) and Stigma-Scale-for-Chronic-Illness-24 (SSCI-24) questionnaires. Potential determinants were evaluated with univariate statistical analyses for their contribution to total, internalized (inner-self derived) and externalized (society derived) stigma. Important findings were further evaluated on hierarchical regression models. Results Disability levels were found to be the most powerful predictor in all stigma categories, followed by the presence of mental illness. Working and caregiving status were also ascertained as determinants of internalized stigma. Stigma levels displayed strong negative correlation with all composites of MSQoL-54. Conclusions Stigma is present in the social environment of MS patients and was confirmed as a barrier (according to the International Classification of Functioning, Disability and Health), with detrimental effects on their QoL levels and functioning performances. Disability and mental illness were shown as the principal determinants of stigma, while financial characteristics were not as equally involved. Further validation of these results in other MS populations may provide safer conclusions, towards more efficacious patient-centered care outcomes.
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Affiliation(s)
- Maria Anagnostouli
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
| | - Serafeim Katsavos
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Artemios Artemiadis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Markos Zacharis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Paraskevi Argyrou
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ilia Theotoka
- 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Fotini Christidi
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ioannis Liappas
- 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
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D’Amico E, Leone C, Graziano G, Amato MP, Bergamaschi R, Cavalla P, Coniglio G, Di Battista G, Ferrò MT, Granella F, Granieri E, Lugaresi A, Lus G, Millefiorini E, Pozzilli C, Tedeschi G, Zappia M, Comi G, Trojano M, Lepore V, Patti F. The Use of Immunosuppressant Therapy for Multiple Sclerosis in Italy: A Multicenter Retroprospective Study. PLoS One 2016; 11:e0157721. [PMID: 27348606 PMCID: PMC4922668 DOI: 10.1371/journal.pone.0157721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/05/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Immunosuppressive agents (ISA) have been used in multiple sclerosis (MS) for decades, frequently as off label licensed therapies. Given the new MS treatment landscape, what place do ISA have in combating MS? Methods We conducted a retrospective multicentre study to investigate the frequency of ISA prescription in 17 Italian MS centres, and to describe the clinical factors related to ISA use. Results Out of 6,447 MS patients, 2,034 (31.6%) were treated with ISA, with Azathioprine being the most frequently used ISA overall. MS patients treated with ISA alone were more frequently affected by the progressive course (both primary and secondary) of the disease (RRR 5.82, 95% CI 4.14–8.16, p<0.0001), had higher EDSS (RRR 3.69, 95% CI 2.61–5.21, p<0.0001), higher assignment age (RRR 1.04, 95% CI 1.03–1.06, p<0.0001) than patients treated with only disease modifying drugs (DMDs). Conclusions Progressive course, higher EDSS, higher assignment age were the strongest predictors of ISA prescription and use in our population.
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Affiliation(s)
| | | | - Giusi Graziano
- Scientific Direction, National Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Maria Pia Amato
- Department NEUROFARBA- University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Roberto Bergamaschi
- CRISM, Istituto Neurologico Nazionale ‘C. Mondino’, Via Mondino 2, 27100, Pavia, Italy
| | - Paola Cavalla
- MS center, University of Turin, Via Cherasco, 15, Turin, Italy
| | | | | | | | | | | | | | - Giacomo Lus
- Clinica Neurologica I, Seconda Università di Napoli Ed.10 Policlinico Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy
| | | | | | | | - Mario Zappia
- MS center, Via S. Sofia, 78 95123, Catania, Italy
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D’Amico E, Zanghì A, Patti F. Personalized therapy in multiple sclerosis: state of art and future perspectives. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1199950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Emanuele D’Amico
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
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Abstract
Secondary progressive multiple sclerosis (SPMS) is diagnosed retrospectively and involves a clinical course characterized by a progressive accumulation of neurological disability, independent of relapses, following an initial relapsing-remitting (RR) phase. Our incomplete understanding of the pathological mechanisms underlying neurodegeneration in multiple sclerosis (MS) may explain why, to date, there is no definitive imaging or laboratory test that is able to inform us when the disease is clearly entering into a progressive phase and why the vast majority of clinical trials testing immunosuppressant and immunomodulating drugs in SPMS patients has so far yielded disappointing or mixed results. Here we discuss the definition(s) of SPMS and how it may vary, outcome measurements (current and emerging) and modern trial design.
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Affiliation(s)
- Domenico Plantone
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, WC1N 3BG, UK.
| | - Floriana De Angelis
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Anisha Doshi
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jeremy Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, WC1N 3BG, UK
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MR Spectroscopy evaluation of white matter signal abnormalities of different non-neoplastic brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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D'Amico E, Patti F, Leone C, Lo Fermo S, Zappia M. Negative prognostic impact of MRI spinal lesions in the early stages of relapsing-remitting multiple sclerosis. Mult Scler J Exp Transl Clin 2016; 2:2055217316631565. [PMID: 28607716 PMCID: PMC5408896 DOI: 10.1177/2055217316631565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The presence of spinal cord (SC) magnetic resonance imaging (MRI) lesions can be expected to affect the mobility of people with relapsing-remitting MS (pwRRMS), but reports are ambiguous. OBJECTIVE The objective of this paper is to determine whether the presence of SC MRI lesions in early diagnosed pwRRMS could be considered a predictor of long-term disability. METHODS pwRRMS with an SC MRI performed within two years from the onset of symptoms and followed up for at least seven years were included. Patients were grouped into: (a) pwRRMs with at least one SC T2 MRI lesion, and (b) pwRRMs without SC T2 MRI lesions. The primary end point was to evaluate the effects of independent factors on reaching an Expanded Disability Status Score (EDSS) of 4.0. RESULTS A total of 239 pwRRMS matched the required criteria: 116 in the group with SC lesions and 123 in the group without SC lesions. At baseline, there were no statistical differences between the two groups. The presence of SC lesions (Exp(b) 4.4, CI 2.1-9.0, p < 0.001) and higher basal EDSS (Exp(b) 3.3, CI 2.3-4.8, p < 0.001) proved to be the best predictors of reaching EDSS 4.0. CONCLUSION The presence of T2 SC MRI lesions detected early from MS onset of RRMS predicts a worse prognosis.
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Affiliation(s)
| | - F Patti
- University of Catania, Italy
| | - C Leone
- University of Catania, Italy
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Mehr SR, Zimmerman MP. Reviewing the Unmet Needs of Patients with Multiple Sclerosis. AMERICAN HEALTH & DRUG BENEFITS 2015; 8:426-431. [PMID: 26702334 PMCID: PMC4684633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence.
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Stilund M, Gjelstrup MC, Petersen T, Møller HJ, Rasmussen PV, Christensen T. Biomarkers of inflammation and axonal degeneration/damage in patients with newly diagnosed multiple sclerosis: contributions of the soluble CD163 CSF/serum ratio to a biomarker panel. PLoS One 2015; 10:e0119681. [PMID: 25860354 PMCID: PMC4393241 DOI: 10.1371/journal.pone.0119681] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expression of soluble CD163 (sCD163), a macrophage/microglia biomarker, is increased in inflammatory conditions, and sCD163 levels in the cerebrospinal fluid (CSF) have recently been shown to be elevated in patients with multiple sclerosis (MS): the sCD163 CSF/serum ratio was elevated in patients with relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and clinically isolated syndrome (CIS) compared with symptomatic controls. OBJECTIVE To investigate the contributions of the sCD163 CSF/serum ratio to a biomarker panel focusing on inflammation and axonal degeneration in newly diagnosed MS; thus optimising a diagnostic biomarker panel for MS. METHODS After a full MS diagnostic work-up, including collection of paired samples of CSF and serum, 125 patients were included in this study. Patients were divided into groups based on their diagnosis, and patients with normal clinical and paraclinical findings were defined as symptomatic controls. Serum and CSF levels, ratios, and indices of sCD163, CXCL13, osteopontin, neopterin, and CSF levels of neurofilament light polypeptide were determined by enzyme-linked immunosorbent assays (ELISAs). For sCD163 the results constitute a post-hoc analysis of already published data. RESULTS All tested biomarkers, notably the sCD163 ratio, the CXCL13 ratio, the NEO ratio, the CSF level of NfL, the IgG index, and the serum level of OPN, were significantly correlated to RRMS, PPMS, and/or CIS. The individual biomarkers in single tests had a lower performance than the IgG index, however, their combined receiver operating characteristic (ROC) curve demonstrated excellent diagnostic discriminatory power. CONCLUSION The biomarker panel showed distinct profiles for each patient group and could be a valuable tool for clinical differentiation of MS subgroups. The combined ROC analysis showed that sCD163 contributes positively as a diagnostic marker to a panel of established MS biomarkers. Patients with PPMS were demonstrated to have significantly elevated levels of both inflammatory and degenerative markers.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antigens, CD/analysis
- Antigens, CD/blood
- Antigens, CD/cerebrospinal fluid
- Antigens, Differentiation, Myelomonocytic/analysis
- Antigens, Differentiation, Myelomonocytic/blood
- Antigens, Differentiation, Myelomonocytic/cerebrospinal fluid
- Area Under Curve
- Axons/metabolism
- Biomarkers/analysis
- Biomarkers/blood
- Biomarkers/cerebrospinal fluid
- Chemokine CXCL13/blood
- Chemokine CXCL13/cerebrospinal fluid
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Inflammation/metabolism
- Linear Models
- Macrophages/immunology
- Macrophages/metabolism
- Male
- Microglia/metabolism
- Middle Aged
- Multiple Sclerosis/cerebrospinal fluid
- Multiple Sclerosis/diagnosis
- Multiple Sclerosis, Chronic Progressive/cerebrospinal fluid
- Multiple Sclerosis, Chronic Progressive/diagnosis
- Multiple Sclerosis, Relapsing-Remitting/cerebrospinal fluid
- Multiple Sclerosis, Relapsing-Remitting/diagnosis
- Neopterin/blood
- Neopterin/cerebrospinal fluid
- Osteopontin/blood
- Osteopontin/cerebrospinal fluid
- ROC Curve
- Receptors, Cell Surface/analysis
- Receptors, Cell Surface/blood
- Young Adult
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Affiliation(s)
- Morten Stilund
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
- Department of Biomedicine, Bartholin Building, Wilhelm Meyers Allé 4, Aarhus University, DK-8000 Aarhus C, Denmark
- * E-mail:
| | - Mikkel Carstensen Gjelstrup
- Department of Biomedicine, Bartholin Building, Wilhelm Meyers Allé 4, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | | | - Tove Christensen
- Department of Biomedicine, Bartholin Building, Wilhelm Meyers Allé 4, Aarhus University, DK-8000 Aarhus C, Denmark
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Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol 2014; 72:132-41. [PMID: 25095894 DOI: 10.1159/000360528] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by demyelination and axonal loss. The etiology of MS is unknown; however, environmental and genetic factors play a key role in the development of MS. Diagnostic criteria have been adapted to facilitate earlier diagnosis with increased sensitivity and specificity. Our understanding of the pathophysiology of MS has deepened considerably in recent years, resulting in different therapies to modify the disease course. Furthermore, several drugs have lately shown efficacy in phase III studies and their approval is expected in the near future. As treatment options expand, a future challenge will be to find the optimal treatment for the individual patient. SUMMARY This mini-review gives an overview of the current knowledge of MS with emphasis on the latest diagnostic criteria and both current and upcoming treatment options. Key Messages: Treatment of MS changes rapidly as the knowledge and therapeutic options in MS expand. Clinical Impact: Diagnosis of MS is based on McDonald criteria. MS therapy can be divided into relapse, disease-modifying and symptomatic treatment. Relapses are commonly treated with intravenous methylprednisolone. First-line therapy consists of either interferon-β, glatiramer acetate or teriflunomide. In general, agents used as escalation therapies (natalizumab, fingolimod and mitoxantrone) are more potent than the agents used for first-line therapy; however, these have potentially serious side effects and should be used with care.
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Affiliation(s)
- Christian P Kamm
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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