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Villoslada P, Solana E, Alba-Arbalat S, Martinez-Heras E, Vivo F, Lopez-Soley E, Calvi A, Camos-Carreras A, Dotti-Boada M, Bailac RA, Martinez-Lapiscina EH, Blanco Y, Llufriu S, Sanchez Dalmau BF. Retinal Damage and Visual Network Reconfiguration Defines Visual Function Recovery in Optic Neuritis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200288. [PMID: 39213469 DOI: 10.1212/nxi.0000000000200288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Recovery of vision after acute optic neuritis (AON) is critical to improving the quality of life of people with demyelinating diseases. The objective of the study was to prospectively assess the changes in visual acuity, retinal layer thickness, and cortical visual network in patients with AON to identify the predictors of permanent visual disability. METHODS We studied a prospective cohort of 88 consecutive patients with AON with 6-month follow-up using high and low-contrast (2.5%) visual acuity, color vision, retinal thickness from optical coherence tomography, latencies and amplitudes of multifocal visual evoked potentials, mean deviation of visual fields, and diffusion-based structural (n = 53) and functional (n = 19) brain MRI to analyze the cortical visual network. The primary outcome was 2.5% low-contrast vision, and data were analyzed with mixed-effects and multivariate regression models. RESULTS We found that after 6 months, low-contrast vision and quality of vision remained moderately impaired. The thickness of the ganglion cell layer at baseline was a predictor of low-contrast vision 6 months later (ß = 0.49 [CI 0.11-0.88], p = 0.012). The structural cortical visual network at baseline predicted low-contrast vision, the best predictors being the betweenness of the right parahippocampal cortex (ß = -036 [CI -0.66 to 0.06], p = 0.021), the node strength of the right V3 (ß = 1.72 [CI 0.29-3.15], p = 0.02), and the clustering coefficient of the left intraparietal sulcus (ß = 57.8 [CI 12.3-103.4], p = 0.015). The functional cortical visual network at baseline also predicted low-contrast vision, the best predictors being the betweenness of the left ventral occipital cortex (ß = 8.6 [CI: 4.03-13.3], p = 0.009), the node strength of the right intraparietal sulcus (ß = -2.79 [CI: -5.1-0.4], p = 0.03), and the clustering coefficient of the left superior parietal lobule (ß = 501.5 [CI 50.8-952.2], p = 0.03). DISCUSSION The assessment of the visual pathway at baseline predicts permanent vision disability after AON, indicating that damage is produced early after disease onset and that it can be used for defining vision impairment and guiding therapy.
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Affiliation(s)
- Pablo Villoslada
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Elisabeth Solana
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Salut Alba-Arbalat
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Eloy Martinez-Heras
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Francesc Vivo
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Elisabet Lopez-Soley
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Alberto Calvi
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Anna Camos-Carreras
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Marina Dotti-Boada
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Rafel Alcubierre Bailac
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Yolanda Blanco
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Sara Llufriu
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
| | - Bernardo F Sanchez Dalmau
- From the Department of Neurology (P.V.), Hospital Hospital del Mar-Pomepu Fabra University, Barcelona; Neurology Service and Laboratory of Advanced Imaging in Neuroimmunological Diseases (E.S., S.A.-A., E.M.-H., F.V., E.L.-S., A.C., E.H.M.-L., Y.B., S.L.), Hospital Clinic of Barcelona; and Ophthalmology Service (S.A.-A., A.C.-C., M.D.-B., R.A.B., S.L., B.F.S.D.), Hospital Clinic of Barcelona, Spain
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Oh J, Airas L, Harrison D, Järvinen E, Livingston T, Lanker S, Malik RA, Okuda DT, Villoslada P, de Vries HE. Neuroimaging to monitor worsening of multiple sclerosis: advances supported by the grant for multiple sclerosis innovation. Front Neurol 2023; 14:1319869. [PMID: 38107636 PMCID: PMC10722910 DOI: 10.3389/fneur.2023.1319869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Key unmet needs in multiple sclerosis (MS) include detection of early pathology, disability worsening independent of relapses, and accurate monitoring of treatment response. Collaborative approaches to address these unmet needs have been driven in part by industry-academic networks and initiatives such as the Grant for Multiple Sclerosis Innovation (GMSI) and Multiple Sclerosis Leadership and Innovation Network (MS-LINK™) programs. We review the application of recent advances, supported by the GMSI and MS-LINK™ programs, in neuroimaging technology to quantify pathology related to central pathology and disease worsening, and potential for their translation into clinical practice/trials. GMSI-supported advances in neuroimaging methods and biomarkers include developments in magnetic resonance imaging, positron emission tomography, ocular imaging, and machine learning. However, longitudinal studies are required to facilitate translation of these measures to the clinic and to justify their inclusion as endpoints in clinical trials of new therapeutics for MS. Novel neuroimaging measures and other biomarkers, combined with artificial intelligence, may enable accurate prediction and monitoring of MS worsening in the clinic, and may also be used as endpoints in clinical trials of new therapies for MS targeting relapse-independent disease pathology.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Laura Airas
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Daniel Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore VA Medical Center, VA Maryland Healthcare System, Baltimore, MD, United States
| | - Elina Järvinen
- Neurology and Immunology, Medical Unit N&I, Merck OY (an affiliate of Merck KGaA), Espoo, Finland
| | - Terrie Livingston
- Patient Solutions and Center of Excellence Strategic Engagement, EMD Serono, Inc., Rockland, MA, United States
| | - Stefan Lanker
- Neurology & Immunology, US Medical Affairs, EMD Serono Research & Development Institute, Inc., (an affiliate of Merck KGaA), Billerica, MA, United States
| | - Rayaz A. Malik
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Darin T. Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, UT Southwestern Medical Center, Dallas, TX, United States
| | - Pablo Villoslada
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Helga E. de Vries
- MS Center Amsterdam, Department of Molecular Cell Biology and Immunology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers (Amsterdam UMC), Location VUmc, Amsterdam, Netherlands
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Bierhansl L, Hartung HP, Aktas O, Ruck T, Roden M, Meuth SG. Thinking outside the box: non-canonical targets in multiple sclerosis. Nat Rev Drug Discov 2022; 21:578-600. [PMID: 35668103 PMCID: PMC9169033 DOI: 10.1038/s41573-022-00477-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/11/2022]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system that causes demyelination, axonal degeneration and astrogliosis, resulting in progressive neurological disability. Fuelled by an evolving understanding of MS immunopathogenesis, the range of available immunotherapies for clinical use has expanded over the past two decades. However, MS remains an incurable disease and even targeted immunotherapies often fail to control insidious disease progression, indicating the need for new and exceptional therapeutic options beyond the established immunological landscape. In this Review, we highlight such non-canonical targets in preclinical MS research with a focus on five highly promising areas: oligodendrocytes; the blood-brain barrier; metabolites and cellular metabolism; the coagulation system; and tolerance induction. Recent findings in these areas may guide the field towards novel targets for future therapeutic approaches in MS.
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Affiliation(s)
- Laura Bierhansl
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center of Diabetes Research, Partner Düsseldorf, Neuherberg, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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