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Zivadinov R, Schweser F, Jakimovski D, Bergsland N, Dwyer MG. Decoding Gray Matter Involvement in Multiple Sclerosis via Imaging. Neuroimaging Clin N Am 2024; 34:453-468. [PMID: 38942527 DOI: 10.1016/j.nic.2024.03.007] [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] [Indexed: 06/30/2024]
Abstract
Multiple sclerosis (MS) is increasingly understood not only as a white matter disease but also involving both the deep and cortical gray matter (GM). GM pathology in people with MS (pwMS) includes the presence of lesions, leptomeningeal inflammation, atrophy, altered iron concentration, and microstructural changes. Studies using 7T and 3T MR imaging with optimized protocols established that GM damage is a principal driver of disease progression in pwMS. Future work is needed to incorporate the assessment of these GM imaging biomarkers into the clinical workup of pwMS and the assessment of treatment efficacy.
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Affiliation(s)
- Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Ferdinand Schweser
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
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2
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Masuda H, Mori M, Hirano S, Uzawa A, Uchida T, Muto M, Ohtani R, Aoki R, Hirano Y, Kuwabara S. Higher longitudinal brain white matter atrophy rate in aquaporin-4 IgG-positive NMOSD compared with healthy controls. Sci Rep 2023; 13:12631. [PMID: 37537208 PMCID: PMC10400628 DOI: 10.1038/s41598-023-38893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
We aimed to compare longitudinal brain atrophy in patients with neuromyelitis optica spectrum disorder (NMOSD) with healthy controls (HCs). The atrophy rate in patients with anti-aquaporin-4 antibody-positive NMOSD (AQP4 + NMOSD) was compared with age-sex-matched HCs recruited from the Japanese Alzheimer's Disease Neuroimaging Initiative study and another study performed at Chiba University. Twenty-nine patients with AQP4 + NMOSD and 29 HCs were enrolled in the study. The time between magnetic resonance imaging (MRI) scans was longer in the AQP4 + NMOSD group compared with the HCs (median; 3.2 vs. 2.9 years, P = 0.009). The annualized normalized white matter volume (NWV) atrophy rate was higher in the AQP4 + NMOSD group compared with the HCs (median; 0.37 vs. - 0.14, P = 0.018). The maximum spinal cord lesion length negatively correlated with NWV at baseline MRI in patients with AQP4 + NMOSD (Spearman's rho = - 0.41, P = 0.027). The annualized NWV atrophy rate negatively correlated with the time between initiation of persistent prednisolone usage and baseline MRI in patients with AQP4 + NMOSD (Spearman's rho = - 0.43, P = 0.019). Patients with AQP4 + NMOSD had a greater annualized NWV atrophy rate than HCs. Suppressing disease activity may prevent brain atrophy in patients with AQP4 + NMOSD.
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Affiliation(s)
- Hiroki Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Tomohiko Uchida
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Mayumi Muto
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Neurology, Chiba Rosai Hospital, 2-16, Tatsumidai-Higashi, Ichihara, 290-0003, Japan
| | - Ryohei Ohtani
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Neurology, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazu-Shi, Chiba, 292-8535, Japan
| | - Reiji Aoki
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
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Yang Y, Li J, Li T, Li Z, Zhuo Z, Han X, Duan Y, Cao G, Zheng F, Tian D, Wang X, Zhang X, Li K, Zhou F, Huang M, Li Y, Li H, Li Y, Zeng C, Zhang N, Sun J, Yu C, Shi F, Asgher U, Muhlert N, Liu Y, Wang J. Cerebellar connectome alterations and associated genetic signatures in multiple sclerosis and neuromyelitis optica spectrum disorder. J Transl Med 2023; 21:352. [PMID: 37245044 DOI: 10.1186/s12967-023-04164-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The cerebellum plays key roles in the pathology of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), but the way in which these conditions affect how the cerebellum communicates with the rest of the brain (its connectome) and associated genetic correlates remains largely unknown. METHODS Combining multimodal MRI data from 208 MS patients, 200 NMOSD patients and 228 healthy controls and brain-wide transcriptional data, this study characterized convergent and divergent alterations in within-cerebellar and cerebello-cerebral morphological and functional connectivity in MS and NMOSD, and further explored the association between the connectivity alterations and gene expression profiles. RESULTS Despite numerous common alterations in the two conditions, diagnosis-specific increases in cerebellar morphological connectivity were found in MS within the cerebellar secondary motor module, and in NMOSD between cerebellar primary motor module and cerebral motor- and sensory-related areas. Both diseases also exhibited decreased functional connectivity between cerebellar motor modules and cerebral association cortices with MS-specific decreases within cerebellar secondary motor module and NMOSD-specific decreases between cerebellar motor modules and cerebral limbic and default-mode regions. Transcriptional data explained > 37.5% variance of the cerebellar functional alterations in MS with the most correlated genes enriched in signaling and ion transport-related processes and preferentially located in excitatory and inhibitory neurons. For NMOSD, similar results were found but with the most correlated genes also preferentially located in astrocytes and microglia. Finally, we showed that cerebellar connectivity can help distinguish the three groups from each other with morphological connectivity as predominant features for differentiating the patients from controls while functional connectivity for discriminating the two diseases. CONCLUSIONS We demonstrate convergent and divergent cerebellar connectome alterations and associated transcriptomic signatures between MS and NMOSD, providing insight into shared and unique neurobiological mechanisms underlying these two diseases.
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Affiliation(s)
- Yuping Yang
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Junle Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Ting Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Zhen Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Xuemei Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, 130031, Jilin, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Fenglian Zheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Decai Tian
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xinli Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinghu Zhang
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, 330006, Jiangxi, China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, Jiangxi, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, 330006, Jiangxi, China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, Jiangxi, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fudong Shi
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Umer Asgher
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Nils Muhlert
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China.
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China.
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, 510631, China.
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.
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Valizadeh A, Fattahi MR, Sadeghi M, Saghab Torbati M, Sahraian MA, Azimi AR. Disease-modifying therapies and T1 hypointense lesions in patients with multiple sclerosis: A systematic review and meta-analysis. CNS Neurosci Ther 2022; 28:648-657. [PMID: 35218155 PMCID: PMC8981477 DOI: 10.1111/cns.13815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous research has shown that cerebral T1 hypointense lesions are positively correlated with the disability of multiple sclerosis (MS) patients. Hence, they could be used as an objective marker for evaluating the progression of the disease. Up to this date, there has not been a systematic evaluation of the effects of disease-modifying therapies (DMTs) on this prognostic marker. OBJECTIVES To evaluate the effects of FDA-approved DMTs on the numbers and volume of T1 hypointense lesions in adult patients with MS. METHODS We included studies with the mentioned desired outcomes. In March 2021, we searched MEDLINE (Ovid), Embase, and CENTRAL to find relevant studies. All included studies were assessed for the risk of bias using the RoB-2 tool. Extracted data were analyzed using a random-effects model. Certainty of evidence was assessed using GRADE. RESULTS Thirteen studies with 7484 participants were included. Meta-analysis revealed the mean difference between the intervention and comparator groups for the number of lesions was -1.3 (95% CI: -2.1, -0.5) and for the mean volume of lesions was -363.1 (95% CI: -611.6, -114.6). Certainty of evidence was judged to be moderate. Heterogeneity was considerable. DISCUSSION DMTs reduce the number and volume of T1 hypointense lesions. Although, these findings must be interpreted cautiously due to the high values of heterogeneity.
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Affiliation(s)
- Amir Valizadeh
- Neuroscience InstituteTehran University of Medical SciencesTehranIran
| | | | - Maryam Sadeghi
- Neuroscience InstituteTehran University of Medical SciencesTehranIran
| | | | - Mohammad Ali Sahraian
- Multiple Sclerosis Research CenterNeuroscience InstituteTehran University of Medical SciencesTehranIran
| | - Amir Reza Azimi
- Multiple Sclerosis Research CenterNeuroscience InstituteTehran University of Medical SciencesTehranIran
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5
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Masuda H, Mori M, Hirano S, Uzawa A, Uchida T, Muto M, Ohtani R, Aoki R, Kuwabara S. Silent progression of brain atrophy in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. J Neurol Neurosurg Psychiatry 2022; 93:32-40. [PMID: 34362853 PMCID: PMC8685614 DOI: 10.1136/jnnp-2021-326386] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate longitudinal brain atrophy in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS We investigated the longitudinal brain atrophy rate in patients with aquaporin-4 antibody-positive NMOSD (AQP4+NMOSD) and those with multiple sclerosis (MS) in a retrospective cohort study. Brain volume was calculated with statistical parametric mapping-12. RESULTS We enrolled 36 patients with AQP4+NMOSD and 60 with MS. Patients with NMOSD were older and had a higher Kurtzke's expanded disability status scale score at baseline MRI compared with those with MS. Disease duration, annual relapse rate and intervals from the last attack and from disease-modifying drugs initiation were not significantly different between the two groups. Lower normalised lesion volume and higher normalised white matter volume were found in patients with NMOSD compared with those with MS at baseline MRI. However, the annualised atrophy rate of normalised brain volume was similar between the NMOSD (median 0.47; IQR 0.75; p=0.49) and MS (median 0.46; IQR 0.84) groups. After adjustment of age and the presence of clinical relapse, no differences of the annualised atrophy rate of normalised brain volume also were found for NMOSD and MS. Patients with AQP4+NMOSD with long cord lesion showed higher annualised atrophy rate of normalised grey matter volume compared with those without long cord lesion. CONCLUSIONS Silent progression of brain atrophy was present in patients with AQP4+NMOSD, as shown in patients with MS, even in the clinically inactive age-matched cases. Subclinical dying back degeneration may explain the brain atrophy in patients with AQP4 +NMOSD.
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Affiliation(s)
- Hiroki Masuda
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Masahiro Mori
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Shigeki Hirano
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Akiyuki Uzawa
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Tomohiko Uchida
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Mayumi Muto
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Ryohei Ohtani
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Reiji Aoki
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Satoshi Kuwabara
- Neurology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
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Masuda H, Mori M, Hirano S, Uzawa A, Uchida T, Ohtani R, Aoki R, Kuwabara S. Comparison of brain atrophy in patients with multiple sclerosis treated with first‐ versus second‐generation disease modifying therapy without clinical relapse. Eur J Neurol 2020; 27:2056-2061. [DOI: 10.1111/ene.14335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H. Masuda
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - M. Mori
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - S. Hirano
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - A. Uzawa
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - T. Uchida
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - R. Ohtani
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - R. Aoki
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
| | - S. Kuwabara
- Department of Neurology Graduate School of Medicine Chiba University Chiba Japan
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Relapse numbers and earlier intervention by disease modifying drugs are related with progression of less brain atrophy in patients with multiple sclerosis. J Neurol Sci 2019; 403:78-84. [DOI: 10.1016/j.jns.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
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8
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Rocca MA, Preziosa P, Filippi M. Application of advanced MRI techniques to monitor pharmacologic and rehabilitative treatment in multiple sclerosis: current status and future perspectives. Expert Rev Neurother 2018; 19:835-866. [PMID: 30500303 DOI: 10.1080/14737175.2019.1555038] [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: 12/21/2022]
Abstract
Introduction: Advances in magnetic resonance imaging (MRI) technology and analyses are improving our understanding of the pathophysiology of multiple sclerosis (MS). Due to their ability to grade the presence of irreversible tissue loss, microstructural tissue abnormalities, metabolic changes and functional plasticity, the application of these techniques is also expanding our knowledge on the efficacy and mechanisms of action of different pharmacological and rehabilitative treatments. Areas covered: This review discusses recent findings derived from the application of advanced MRI techniques to evaluate the structural and functional substrates underlying the effects of pharmacologic and rehabilitative treatments in patients with MS. Current applications as outcome in clinical trials and observational studies, their interpretation and possible pitfalls in their use are discussed. Finally, how these techniques could evolve in the future to improve monitoring of disease progression and treatment response is examined. Expert commentary: The number of treatments currently available for MS is increasing. The application of advanced MRI techniques is providing reliable and specific measures to better understand the targets of different treatments, including neuroprotection, tissue repair, and brain plasticity. This is a fundamental progress to move toward personalized medicine and individual treatment selection.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
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9
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Assessing the cerebral gray matter volume in response to fingolimod therapy in multiple sclerosis: A more analytic view. J Neurol Sci 2017; 383:230-231. [PMID: 29102163 DOI: 10.1016/j.jns.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/09/2017] [Indexed: 11/20/2022]
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10
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Yousuf F, Dupuy SL, Tauhid S, Chu R, Kim G, Tummala S, Khalid F, Weiner HL, Chitnis T, Healy BC, Bakshi R. A two-year study using cerebral gray matter volume to assess the response to fingolimod therapy in multiple sclerosis. J Neurol Sci 2017; 383:221-229. [DOI: 10.1016/j.jns.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/14/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023]
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11
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Kaunzner UW, Al-Kawaz M, Gauthier SA. Defining Disease Activity and Response to Therapy in MS. Curr Treat Options Neurol 2017; 19:20. [PMID: 28451934 DOI: 10.1007/s11940-017-0454-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Disease activity in multiple sclerosis (MS) has classically been defined by the occurrence of new neurological symptoms and the rate of relapses. Definition of disease activity has become more refined with the use of clinical markers, evaluating ambulation, dexterity, and cognition. Magnetic resonance imaging (MRI) has become an important tool in the investigation of disease activity. Number of lesions as well as brain atrophy have been used as surrogate outcome markers in several clinical trials, for which a reduction in these measures is appreciated in most treatment studies. With the increasing availability of new medications, the overall goal is to minimize inflammation to decrease relapse rate and ultimately prevent long-term disability. The aim of this review is to give an overview on commonly used clinical and imaging markers to monitor disease activity in MS, with emphasis on their use in clinical studies, and to give a recommendation on how to utilize these measures in clinical practice for the appropriate assessment of therapeutic response.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York City, NY, 10021, USA
| | - Mais Al-Kawaz
- NewYork Presbyterian, Weill Cornell Medicine, 535 East 68th street, New York City, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York City, NY, 10021, USA.
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12
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Lubina-Dąbrowska N, Stepień A, Sulkowski G, Dąbrowska-Bouta B, Langfort J, Chalimoniuk M. Effects of IFN-β1a and IFN-β1b treatment on the expression of cytokines, inducible NOS (NOS type II), and myelin proteins in animal model of multiple sclerosis. Arch Immunol Ther Exp (Warsz) 2017; 65:325-338. [PMID: 28299403 PMCID: PMC5511332 DOI: 10.1007/s00005-017-0458-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 02/09/2017] [Indexed: 12/28/2022]
Abstract
The aim of this study was to investigate the effects of interferon (IFN)-β1a and IFN-β1b treatment on inflammatory factors and myelin protein levels in the brain cortex of the Lewis rat experimental autoimmune encephalomyelitis (EAE), animal model of multiple sclerosis. To induce EAE, rat were immunized with inoculums containing spinal cord guinea pig homogenized in phosphate-buffered saline and emulsified in Freund's complete adjuvant containing 110 µg of the appropriate antigen in 100 µl of an emulsion and additionally 4-mg/ml Mycobacterium tuberculosis (H37Ra). The rats were treated three times per week with subcutaneous applications of 300,000 units IFN-β1a or IFN-β1b. The treatments were started 8 days prior to immunization and continued until day 14 after immunization. The rats were killed on the 14th day of the experiment. EAE induced dramatic increase in interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-concentrations and inducible nitric oxide synthase (iNOS) expression in the brain, which closely corresponded to the course of neurological symptoms and the loss of weight. Both IFN-β1b and IFN-β1a treatments inhibited the pro-inflammatory cytokines (IL-6, IL-1β, TNF-α and IFN-γ), decreased the activation of astrocytes, increased the myelin protein level in the brain cortex, and improved the neurological status of EAE rats by different mechanisms; IFN-β1a reduced iNOS expression, at least in part, by the enhancement of IL-10, while IFN-β1b diminished IL-10 concentration and did not decrease EAE-induced iNOS expression.
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Affiliation(s)
- Natalia Lubina-Dąbrowska
- Neurology Clinic, Military Institute of Medicine, Warsaw, Poland
- Department of Cellular Signalling, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5, 02-106, Warsaw, Poland
| | - Adam Stepień
- Neurology Clinic, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Sulkowski
- Laboratory of Pathoneurochemistry, Department of Neurochemistry, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Beata Dąbrowska-Bouta
- Laboratory of Pathoneurochemistry, Department of Neurochemistry, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Józef Langfort
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Department of Sports Training, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Małgorzata Chalimoniuk
- Department of Cellular Signalling, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5, 02-106, Warsaw, Poland.
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Dupuy SL, Tauhid S, Hurwitz S, Chu R, Yousuf F, Bakshi R. The Effect of Dimethyl Fumarate on Cerebral Gray Matter Atrophy in Multiple Sclerosis. Neurol Ther 2016; 5:215-229. [PMID: 27744504 PMCID: PMC5130921 DOI: 10.1007/s40120-016-0054-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The objective of this pilot study was to compare cerebral gray matter (GM) atrophy over 1 year in patients starting dimethyl fumarate (DMF) for multiple sclerosis (MS) to that of patients on no disease-modifying treatment (noDMT). DMF is an established therapy for relapsing-remitting (RR) MS. METHODS We retrospectively analyzed 20 patients with RRMS at the start of DMF [age (mean ± SD) 46.1 ± 10.2 years, Expanded Disability Status Scale (EDSS) score 1.1 ± 1.2, timed 25-foot walk (T25FW) 4.6 ± 0.8 s] and eight patients on noDMT (age 42.5 ± 6.6 years, EDSS 1.7 ± 1.1, T25FW 4.4 ± 0.6 s). Baseline and 1-year 3D T1-weighted 3T MRI was processed with automated pipelines (SIENA, FSL-FIRST) to assess percentage whole brain volume change (PBVC) and deep GM (DGM) atrophy. Group differences were assessed by analysis of covariance, with time between MRI scans as a covariate. RESULTS Over 1 year, the DMF group showed a lower rate of whole brain atrophy than the noDMT group (PBVC: -0.37 ± 0.49% vs. -1.04 ± 0.67%, p = 0.005). The DMF group also had less change in putamen volume (-0.06 ± 0.22 vs. -0.32 ± 0.28 ml, p = 0.02). There were no significant on-study differences between groups in caudate, globus pallidus, thalamus, total DGM volume, T2 lesion volume, EDSS, or T25FW (all p > 0.20). CONCLUSIONS These results suggest a treatment effect of DMF on GM atrophy appearing at 1 year after starting therapy. However, due to the retrospective study design and sample size, these findings should be considered preliminary, and require confirmation in future investigations. FUNDING Biogen.
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Affiliation(s)
- Sheena L Dupuy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Shelley Hurwitz
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Fawad Yousuf
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Departments of Neurology and Radiology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
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Khalid F, Tauhid S, Chua AS, Healy BC, Stankiewicz JM, Weiner HL, Bakshi R. A longitudinal uncontrolled study of cerebral gray matter volume in patients receiving natalizumab for multiple sclerosis. Int J Neurosci 2016; 127:396-403. [PMID: 27143245 DOI: 10.1080/00207454.2016.1185421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Brain atrophy in multiple sclerosis (MS) selectively affects gray matter (GM), which is highly relevant to disability and cognitive impairment. We assessed cerebral GM volume (GMV) during one year of natalizumab therapy. DESIGN/METHODS Patients with relapsing-remitting (n = 18) or progressive (n = 2) MS had MRI ∼1 year apart during natalizumab treatment. At baseline, patients were on natalizumab for (mean ± SD) 16.6 ± 10.9 months with age 38.5 ± 7.4 and disease duration 9.7 ± 4.3 years. RESULTS At baseline, GMV was 664.0 ± 56.4 ml, Expanded Disability Status Scale (EDSS) score was 2.3 ± 2.0, timed 25-foot walk (T25FW) was 6.1±3.4 s; two patients (10%) had gadolinium (Gd)-enhancing lesions. At follow-up, GMV was 663.9 ± 60.2 mL; EDSS was 2.6 ± 2.1 and T25FW was 5.9 ± 2.9 s. One patient had a mild clinical relapse during the observation period (0.052 annualized relapse rate for the entire cohort). No patients had Gd-enhancing lesions at follow-up. Linear mixed-effect models showed no significant change in annualized GMV [estimated mean change per year 0.338 mL, 95% confidence interval -9.66, 10.34, p = 0.94)], GM fraction (p = 0.92), whole brain parenchymal fraction (p = 0.64), T2 lesion load (p = 0.64), EDSS (p = 0.26) or T25FW (p = 0.79). CONCLUSIONS This pilot study shows no GM atrophy during one year of natalizumab MS therapy. We also did not detect any loss of whole brain volume or progression of cerebral T2 hyperintense lesion volume during the observation period. These MRI results paralleled the lack of clinical worsening.
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Affiliation(s)
- Fariha Khalid
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
| | - Shahamat Tauhid
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
| | - Alicia S Chua
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
| | - Brian C Healy
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA.,c c Biostatistics Center, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - James M Stankiewicz
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
| | - Howard L Weiner
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
| | - Rohit Bakshi
- a a Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA.,b b Laboratory for Neuroimaging Research, Department of Radiology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School , Boston, MA , USA
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15
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Roy S, Benedict RHB, Drake AS, Weinstock-Guttman B. Impact of Pharmacotherapy on Cognitive Dysfunction in Patients with Multiple Sclerosis. CNS Drugs 2016; 30:209-25. [PMID: 26884145 DOI: 10.1007/s40263-016-0319-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive impairment is a common symptom of multiple sclerosis (MS), adversely impacting many spheres of daily functioning. Yet the effectiveness of pharmacological interventions for cognitive impairment in MS is unclear. Clinicians and patients alike would benefit from formal guidelines regarding effective management of cognitive symptoms. We reviewed the background on the measurement, pathophysiology and risk factors for cognitive dysfunction in MS, and then examined the published clinical trials of pharmacotherapy, including both disease-modifying treatments (DMTs) and symptom-management therapies (SMTs). Our review of DMTs revealed only a single well-designed, randomized, controlled trial where intramuscular interferon (IFN)-β1a, administered once weekly, was compared with placebo. The results showed significant benefits in terms of cognitive processing speed and memory. Less convincing but promising data have shown the potential benefits of IFN-β1b and natalizumab. The literature on SMTs is replete with placebo-controlled, single-centre studies, with a failure to replicate initially promising results. The results for SMTs such as acetylcholinesterase inhibitors and psychostimulants are mixed. Some encouraging data show promise but not to a threshold of indication for standard clinical use. Numerous methodological factors hamper research in this area. Acknowledging the lack of firm conclusions, we argue that all DMTs are likely to benefit cognition and that, if otherwise safe, SMTs with some empirical support may be attempted at the discretion of the treating clinician. We offer some guidance on the assessment and monitoring of cognitive function to inform off-license treatment of cognitive impairment in MS patients.
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Affiliation(s)
- Shumita Roy
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA.
| | - Allison S Drake
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
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16
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The natural history of brain volume loss among patients with multiple sclerosis: A systematic literature review and meta-analysis. J Neurol Sci 2015; 357:8-18. [DOI: 10.1016/j.jns.2015.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 06/15/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
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17
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Fisher E, Nakamura K, Lee JC, You X, Sperling B, Rudick RA. Effect of intramuscular interferon beta-1a on gray matter atrophy in relapsing-remitting multiple sclerosis: A retrospective analysis. Mult Scler 2015; 22:668-76. [PMID: 26238463 DOI: 10.1177/1352458515599072] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Changes in gray matter (GM) volume may be a useful measure of tissue loss in multiple sclerosis (MS). OBJECTIVES To investigate the rate, patterns, and disability correlates of GM volume change in an MS treatment clinical trial. METHODS Patients (n=140) with relapsing-remitting MS were randomized to intramuscular (IM) interferon (IFN) beta-1a or placebo. Treatment effects on GM fraction (GMF) and white matter (WM) fraction (WMF) changes, differences in rates of GMF and WMF change in year one and two on treatment, and differences in atrophy rates by disease progression status were assessed retrospectively. RESULTS Significantly less GM atrophy (during year two), but not WM atrophy (at any point), was observed with IM IFN beta-1a compared with placebo. Pseudoatrophy effects were more apparent in WM than in GM; in year one, greater WM volume loss was observed with IM IFN beta-1a than with placebo, whereas GM volume loss was similar between groups. Risk of sustained disability progression was significantly associated with GM, but not WM, atrophy. CONCLUSIONS These results suggest that GMF change is more meaningful than WMF as a marker of tissue loss and may be useful to augment whole brain atrophy measurements in MS clinical trials.
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Affiliation(s)
- E Fisher
- Biogen Inc., Cambridge, USA Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, USA
| | - K Nakamura
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, USA
| | - J-C Lee
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, USA
| | - X You
- Biogen Inc., Cambridge, USA
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18
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Pérez-Miralles FC, Sastre-Garriga J, Vidal-Jordana A, Río J, Auger C, Pareto D, Tintoré M, Rovira A, Montalban X. Predictive value of early brain atrophy on response in patients treated with interferon β. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e132. [PMID: 26185778 PMCID: PMC4496631 DOI: 10.1212/nxi.0000000000000132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/20/2015] [Indexed: 01/07/2023]
Abstract
Objective: To investigate the association between brain volume loss during the first year of interferon treatment and clinical outcome at 4 years. Methods: Patients with multiple sclerosis initiating interferon β were clinically evaluated every 6 months for the presence of relapses and assessment of global disability using the Expanded Disability Status Scale (EDSS). MRI scans were performed at baseline and after 12 months, and the percentage of brain volume change (PBVC), brain parenchymal volume change (BPVc%), gray matter volume change (GMVc%), and white matter volume change (WMVc%) were estimated. Patients were divided based on the cutoff values for predicting confirmed EDSS worsening obtained by receiver operating characteristic analysis for all atrophy measurements. Survival curves and Cox proportional hazards regression to predict disability worsening at last observation were applied, adjusting for demographic, clinical, and radiologic variables. Results: Larger PBVC and WMVc% decreases were observed in patients with disability worsening at 4 years of follow-up, whereas no differences were found in BPVc% or GMVc%. Cutoff points were obtained for PBVC (−0.86%; sensitivity 65.5%, specificity 71.4%) and WMVc% (−2.49%; sensitivity 85.3%, specificity 43.8%). Patients with decreases of PBVC and WMVc% below cutoff values were more prone to develop disability worsening (unadjusted hazard ratio [HR] 3.875, p = 0.005; HR 4.246, p = 0.004, respectively). PBVC (HR 4.751, p = 0.008) and the interaction of new T2 lesions with WMVc% (HR 1.086, p = 0.005) were found to be independent predictors of disability worsening in the multivariate analysis. Conclusions: At the patient level, whole-brain and white matter volume changes in the first year of interferon β therapy are predictive of subsequent clinical evolution under treatment.
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Affiliation(s)
- Francisco Carlos Pérez-Miralles
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia/Neuroimmunologia (F.C.P.-M., J.S.-G., A.V.-J., J.R., M.T., X.M.) Multiple Sclerosis Centre of Catalonia (Cemcat) and Unitat de Ressonància Magnètica (Servei de Radiologia) (C.A., D.P., A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; and Departament de Medicina (F.C.P.-M.), Universitat Autònoma de Barcelona, Barcelona, Spain
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19
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Chua AS, Egorova S, Anderson MC, Polgar-Turcsanyi M, Chitnis T, Weiner HL, Guttmann CR, Bakshi R, Healy BC. Handling changes in MRI acquisition parameters in modeling whole brain lesion volume and atrophy data in multiple sclerosis subjects: Comparison of linear mixed-effect models. Neuroimage Clin 2015; 8:606-10. [PMID: 26199872 PMCID: PMC4506959 DOI: 10.1016/j.nicl.2015.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/24/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022]
Abstract
Magnetic resonance imaging (MRI) of the brain provides important outcome measures in the longitudinal evaluation of disease activity and progression in MS subjects. Two common measures derived from brain MRI scans are the brain parenchymal fraction (BPF) and T2 hyperintense lesion volume (T2LV), and these measures are routinely assessed longitudinally in clinical trials and observational studies. When measuring each outcome longitudinally, observed changes may be potentially confounded by variability in MRI acquisition parameters between scans. In order to accurately model longitudinal change, the acquisition parameters should thus be considered in statistical models. In this paper, several models for including protocol as well as individual MRI acquisition parameters in linear mixed models were compared using a large dataset of 3453 longitudinal MRI scans from 1341 subjects enrolled in the CLIMB study, and model fit indices were compared across the models. The model that best explained the variance in BPF data was a random intercept and random slope with protocol specific residual variance along with the following fixed-effects: baseline age, baseline disease duration, protocol and study time. The model that best explained the variance in T2LV was a random intercept and random slope along with the following fixed-effects: baseline age, baseline disease duration, protocol and study time. In light of these findings, future studies pertaining to BPF and T2LV outcomes should carefully account for the protocol factors within longitudinal models to ensure that the disease trajectory of MS subjects can be assessed more accurately.
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Affiliation(s)
- Alicia S. Chua
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Svetlana Egorova
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mark C. Anderson
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L. Weiner
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Charles R.G. Guttmann
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C. Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
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Interferon-β1a modulates glutamate neurotransmission in the CNS through CaMKII and GluN2A-containing NMDA receptors. Neuropharmacology 2015; 100:98-105. [PMID: 26116817 DOI: 10.1016/j.neuropharm.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 12/16/2022]
Abstract
Interferons (IFNs) are widely expressed cytokines with antiviral and immune-modulating effects and have been utilised for the treatment of several human pathological conditions. In particular, the immune-modulatory drug IFN-β is utilized in the treatment of multiple sclerosis (MS), a chronic autoimmune and neurodegenerative disorder of the central nervous system (CNS). Although the effects of IFN-β on immune cells functions have been widely investigated, information about the ability of the drug to modulate neuronal transmission in the CNS is still largely lacking. The aim of this study was to investigate the ability of IFN-β1a to modulate excitatory synaptic transmission in the CNS. Whole cell patch-clamp electrophysiological recordings were performed in the nucleus striatum, one of the CNS grey matter structures that is prone to degenerate during the course of MS. We demonstrate that the drug IFN-β1a, independently from its known peripheral immune-modulating action, is able to directly modulate synaptic transmission. In particular, we demonstrated that IFN-β1a reduces the amplitude of striatal excitatory post-synaptic currents, indicating an inhibitory effect on glutamate neurotransmission, and in particular on its NMDA component. The inhibitory effect of IFN-β1a on striatal glutamate neurotransmission was found to be mediated by a novel post-synaptic mechanism requiring Ca(2+), CaMKII and the GluN2A subunit of the NMDA receptor, without the involvement of the classic STAT1 pathway. The evidence of a novel neuro-modulating effect of IFN-β shed light on the mechanisms of action of the drug and on the complex bidirectional interaction occurring between the immune and the nervous system. This article is part of the Special Issue entitled 'Synaptopathy--from Biology to Therapy'.
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21
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Vidal-Jordana A, Sastre-Garriga J, Rovira A, Montalban X. Treating relapsing-remitting multiple sclerosis: therapy effects on brain atrophy. J Neurol 2015; 262:2617-26. [PMID: 26041617 DOI: 10.1007/s00415-015-7798-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system with a complex and heterogeneous pathology that may ultimately lead to neurodegeneration and brain atrophy. Brain volume loss in MS is known to occur early in the disease course and to be clinically relevant, as it has been related to disability progression. Nowadays, brain volume loss is relatively easy to measure with different automated, reproducible and accurate software tools. Therefore, most of (if not all) the newest clinical trials have incorporated brain volume outcomes as a measure of treatment effect. With this review, we aimed to update and summarize all existing data regarding brain volume and RRMS treatment in clinical trials as well as in open-label observational studies of drugs with positive results in its primary outcome in at least one phase III trial as of March 2014.
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Affiliation(s)
- Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Alex Rovira
- Magnetic Resonance Unit, Radiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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22
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Abstract
Magnetic resonance imaging (MRI) has had an enormous impact on multiple sclerosis, enabling early diagnosis and providing surrogate markers for monitoring treatment response in clinical trials. Despite these advantages, conventional MRI is limited by lack of pathological specificity and lack of sensitivity to grey matter lesions and to microscopic damage in normal appearing tissue. Quantitative MRI techniques such as measures of parenchymal volume loss, magnetisation transfer imaging, diffusion tensor imaging, and proton magnetic resonance spectroscopy have enhanced our understanding of the nature and mechanism of tissue injury and repair in multiple sclerosis, and provided more specific correlates of neurological deficits and disability accrual. Some of these techniques may be of potential use in clinical trials as surrogate outcome measures for measuring treatment effects on neurodegenerative injury, which is currently difficult to quantify in clinical trials. In this respect, measures of brain volume, T1 hypointensity and magnetisation transfer ratio, and optical coherence tomography appear to be the most promising in the short term. The evidence for a role of neurodegeneration in the pathogenesis of multiple sclerosis, and particularly in the accumulation of irreversible disability, has become increasingly strong over recent years. This has prompted the search for new treatments that can effectively slow down, halt or even reverse such neurodegenerative processes, and in this way restore nervous system function. For this reason, there has been much interest in the development and validation of surrogate markers of neurodegeneration and neuroprotection for use in clinical trials. Advances in magnetic resonance imaging (MRI) technology have allowed the development and implementation of a number of methods that may be promising in this respect. To assess the utility of these methods and to identify needs for further research, sixty experts in neuropathology, clinical measurement, imaging and statistics participated in a meeting held in Amsterdam in 2008 under the aegis of the National Multiple Sclerosis Society. In the proceedings of the meeting, published in 2009 [1], brain volume changes, T1 hypointensity, magnetisation transfer ratio and optical coherence tomography were deemed the most promising measures for screening the neuroprotective capacity of new agents. Other MRI techniques, such as DTI, (1)H-MRS and functional MRI, although potentially useful, require more observational data to help determine the optimal trial design. This article will review some of the issues that were discussed at this meeting, and present some of the imaging techniques that were considered to be the most promising.
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Affiliation(s)
- Matilde Inglese
- Department of Radiology and Neurology, New York University, New York, USA
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Filipi ML, Beavin J, Brillante RT, Costello K, Hartley GC, Hartley K, Namey M, O'Leary S, Remington G. Nurses' perspective on approaches to limit flu-like symptoms during interferon therapy for multiple sclerosis. Int J MS Care 2014; 16:55-60. [PMID: 24688355 DOI: 10.7224/1537-2073.2013-006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection. Because FLS, which usually occur early in the treatment course and diminish over time, are a primary cause of nonadherence to IFNβ therapy, it is important to employ strategies that can attenuate these side effects. METHODS To identify interventions effective in limiting FLS, a panel of United States-based nurses with expertise in MS patient care was convened and a literature review completed. RESULTS Panel consensus was reached on specific interventions that can attenuate FLS. These prevention and mitigation strategies include dose titration, analgesia, and optimal injection timing, as well as other techniques that panel members have found useful in their clinical practice experience. CONCLUSIONS These measures, in addition to effective patient education, will help to reduce the incidence of FLS secondary to IFNβ therapy, improve patient medication adherence, and positively affect long-term clinical outcomes.
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Affiliation(s)
- Mary L Filipi
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Jill Beavin
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Raquel T Brillante
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Kathleen Costello
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Gail C Hartley
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Kay Hartley
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Marie Namey
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Shirley O'Leary
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
| | - Gina Remington
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA
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Aharoni R. New findings and old controversies in the research of multiple sclerosis and its model experimental autoimmune encephalomyelitis. Expert Rev Clin Immunol 2014; 9:423-40. [DOI: 10.1586/eci.13.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Interferon-β1a protects neurons against mitochondrial toxicity via modulation of STAT1 signaling: electrophysiological evidence. Neurobiol Dis 2013; 62:387-93. [PMID: 24135008 DOI: 10.1016/j.nbd.2013.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/09/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022] Open
Abstract
Multiple sclerosis, one of the main causes of non-traumatic neurological disability in young adults, is an inflammatory and neurodegenerative disorder of the central nervous system. Although the pathogenesis of neuroaxonal damage occurring during the course of the disease is still largely unknown, there is accumulating evidence highlighting the potential role of mitochondria in multiple sclerosis-associated neuronal degeneration. The aim of the present study was to investigate, by utilizing electrophysiological techniques in brain striatal slices, the potential protective effects of interferon-β1a, one of the most widely used medication for multiple sclerosis, against acute neuronal dysfunction induced by mitochondrial toxins. Interferon-β1a was found to exert a dose-dependent protective effect against the progressive loss of striatal field potential amplitude induced by the mitochondrial complex I inhibitor rotenone. Interferon-β1a also reduced the generation of the rotenone-induced inward current in striatal spiny neurons. Conversely, interferon-β1a did not influence the electrophysiological effects of the mitochondrial complex II inhibitor 3-nitropropionic acid. The protective effect of interferon-β1a against mitochondrial complex I inhibition was found to be dependent on the activation of STAT1 signaling. Conversely, endogenous dopamine depletion and the modulation of the p38 MAPK and mTOR pathways did not influence the effects of interferon-β1a. During experimental autoimmune encephalomyelitis (EAE) striatal rotenone toxicity was enhanced but the protective effect of interferon-β1a was still evident. These results support future studies investigating the role played by specific intracellular signaling pathways in mediating the potential link among inflammation, mitochondrial impairment and neuroaxonal degeneration in multiple sclerosis.
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Müller M, Esser R, Kötter K, Voss J, Müller A, Stellmes P. Third ventricular enlargement in early stages of multiple sclerosis is a predictor of motor and neuropsychological deficits: a cross-sectional study. BMJ Open 2013; 3:e003582. [PMID: 24022394 PMCID: PMC3773637 DOI: 10.1136/bmjopen-2013-003582] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Whether transcranal sonography (TCS) depicted third ventricular enlargement as a sign of brain atrophy is predictive for neuropsychological deficits in mildly affected patients with multiple sclerosis (MS). DESIGN Cross-sectional study of a cohort of mildly diseased patients with MS. SETTING Neurological MS outpatient clinic at a large teaching hospital in central Europe. PARTICIPANTS Fifty-four patients with MS (16 men, 38 women, mean age 40±10 years, mean disease duration 6±5 years; mean Expanded Disability Status Scale 2±1.3) and 33 healthy controls (12 men, 21 women; 38±11 years) underwent clinical examination, an assessment of the third ventricle width by means of TCS and the Brief Repeatable Battery of Neuropsychological tests for MS, the 25-Feet Foot Walk test, the 9-Hole PEG test, the Beck Depression Inventory and a quantitative fatigue assessment. Statistical analysis was performed with univariate correlation and thereafter by stepwise regression analysis. RESULTS Patients' mean third ventricular width (3.9±1.6 mm) was significantly wider compared to controls (3.4±0.8 mm). Using stepwise regression analysis models with age, MS duration, third ventricle width and quantitative fatigue assessment as baseline variables, an increasing third ventricle width significantly correlated with the target variables worsening of motor deficits (p<0.002), worsening of verbal recall (p<0.04) and of visual spatial recall (p<0.005). Severity of depression and of fatigue was unrelated to third ventricular width. CONCLUSIONS In this cohort of patients with MS with mild disease, third ventricular enlargement was indicative for motor deficits and cognitive impairment, even after considering fatigue as a relevant comorbidity. Third ventricular enlargement by means of TCS seems to be a useful, clinically meaningful parameter to stage patients' disease severity. Follow-up studies must show whether an intraindividual future third ventricular increase indeed signals larger cognitive impairment.
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Affiliation(s)
- Martin Müller
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
| | - Regina Esser
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Katharina Kötter
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
| | - Jan Voss
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
| | - Achim Müller
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
| | - Petra Stellmes
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Spitalstrasse, Lucerne, Switzerland
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Gray Matter Pathology in MS: Neuroimaging and Clinical Correlations. Mult Scler Int 2013; 2013:627870. [PMID: 23878736 PMCID: PMC3708448 DOI: 10.1155/2013/627870] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/28/2013] [Indexed: 12/23/2022] Open
Abstract
It is abundantly clear that there is extensive gray matter pathology occurring in multiple sclerosis. While attention to gray matter pathology was initially limited to studies of autopsy specimens and biopsies, the development of new MRI techniques has allowed assessment of gray matter pathology in vivo. Current MRI techniques allow the direct visualization of gray matter demyelinating lesions, the quantification of diffuse damage to normal appearing gray matter, and the direct measurement of gray matter atrophy. Gray matter demyelination (both focal and diffuse) and gray matter atrophy are found in the very earliest stages of multiple sclerosis and are progressive over time. Accumulation of gray matter damage has substantial impact on the lives of multiple sclerosis patients; a growing body of the literature demonstrates correlations between gray matter pathology and various measures of both clinical disability and cognitive impairment. The effect of disease modifying therapies on the rate accumulation of gray matter pathology in MS has been investigated. This review focuses on the neuroimaging of gray matter pathology in MS, the effect of the accumulation of gray matter pathology on clinical and cognitive disability, and the effect of disease-modifying agents on various measures of gray matter damage.
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Müller M, Esser R, Kötter K, Voss J, Müller A, Stellmes P. Width of 3. Ventricle: reference values and clinical relevance in a cohort of patients with relapsing remitting multiple sclerosis. Open Neurol J 2013; 7:11-6. [PMID: 23730365 PMCID: PMC3664451 DOI: 10.2174/1874205x01307010011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/28/2013] [Accepted: 03/12/2013] [Indexed: 11/22/2022] Open
Abstract
Objectives: To estimate the quantity of multiple sclerosis (MS) patients with brain atrophy as indicated by third ventricular enlargement using transcranial colourcoded ultrasound (TCCS). Methods: The width of the 3. ventricle was assessed by TCCS in 70 healthy controls (male 31, female 39, mean age 41 ± 15 years, age range 18 – 79 years), and in a cohort of 54 patients with relapsing remitting MS (male 16, female 38, mean age 40 ± 10 years, median EDSS 2 [1-3]). Results: In the controls, the width of the 3. ventricle increased with age (without any sex differences) from 3.0 ± 0.76 mm in the age group < 40 years to 4.0 ± 0.74 mm in the age group of 60 years or more (ANOVA p=0.0001). Derived from regression analysis, the upper limit of the 95% Confidence Interval for each year provided cutoff points according to which 14 of 54 patients (25%) exhibited an enlarged 3. ventricle. In a multivariate regression analysis, the width of the 3. ventricle over all MS patients was significantly related to EDSS (Spearman rho , r=0.446, p<0.005) and to MS duration (r=0.319, p<0.005). Conclusions: Even in MS patients in good clinical conditions the rate of patients with brain atrophy determined by TCCS is high.
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Affiliation(s)
- Martin Müller
- Department of Neurology, Luzerner Kantonsspital, Spitalstrasse, CH-6000 Luzern, Switzerland ; Department of Internal Medicine, Spital Zollikerberg, Trichtenhauserstr. 20, CH-8125 Zollikerberg, Switzerland
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Zivadinov R, Bergsland N, Dolezal O, Hussein S, Seidl Z, Dwyer MG, Vaneckova M, Krasensky J, Potts JA, Kalincik T, Havrdová E, Horáková D. Evolution of cortical and thalamus atrophy and disability progression in early relapsing-remitting MS during 5 years. AJNR Am J Neuroradiol 2013; 34:1931-9. [PMID: 23578679 DOI: 10.3174/ajnr.a3503] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pathologic changes in GM have an important role in MS. We investigated the association between SDGM and cortical volume changes and disability progression in early RRMS. MATERIALS AND METHODS One hundred eighty patients with RRMS had clinical assessment during 5 years and were divided into those with or without SDP at 5 years by the usual definition in treatment trials. The number of available MR imaging scans at various time points was the following: at baseline, 178; and at 6 months, 172; at 12 months, 175; at 24 months, 155; at 36 months, 160; at 48 months, 158; and at 60 months, 162, respectively. Longitudinal changes in cortical, GM, and WM volume were calculated by using the direct method. RESULTS At 5 years, 90 patients with RRMS experienced SDP and 90 had stable disease. At baseline, patients with SDP had longer disease duration, greater T2-lesion volume, and smaller whole-brain, WM, cortical, and SDGM volume (P < .01). At 5 years, patients with SDP had significantly greater percentage decreases from baseline compared with those without SDP in the volume of the whole brain (P < .0001), cortex (P = .001), GM (P = .003), and thalamus (P = .01). In patients who developed SDP at 5 years and those who did not, mixed-effect models, adjusted for age, disease duration, and change of the treatment status, showed significant interactions between SDP status at 5 years and changes with time in whole-brain, cortical, lateral ventricle (all P < .001), thalamus (P = .006), and total SDGM (P = .0095) volume. CONCLUSIONS SDP is associated with progression of cortical, central, and thalamic atrophy in early RRMS during 5 years.
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Borges IT, Shea CD, Ohayon J, Jones BC, Stone RD, Ostuni J, Shiee N, McFarland H, Bielekova B, Reich DS. The effect of daclizumab on brain atrophy in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2013; 2:133-140. [PMID: 23580931 DOI: 10.1016/j.msard.2012.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Daclizumab is a monoclonal antibody that reduces inflammation in multiple sclerosis (MS). Through a retrospective analysis, our objective was to determine whether daclizumab treatment reduces the rate of brain structure atrophy in comparison to a mixture of other disease-modifying therapies (mainly different interferon β preparations). We analyzed MRI examinations (1332 scans from 70 MS cases) obtained between 2000 and 2011 in a single center and processed with an automated brain segmentation method. We used mixed-effects multivariable linear regression models to determine whether a median of 4.3 years of daclizumab therapy in 26 patients altered rates of brain-volume change, controlling for variations in MRI protocol. The control group consisted of 44 patients not treated with daclizumab. We found that supratentorial brain volume declined by 5.17 ml per year (95% confidence limits: 3.58-6.77) off daclizumab therapy. On daclizumab, the annual rate of volume loss decreased to 3.72 ml (p=0.01). The rate of ventricular enlargement decreased from 1.26 to 0.42 ml per year (p<0.001). Focused analysis suggests that reduction in gray matter atrophy rate most likely underlies these results. In summary, in this retrospective analysis, daclizumab therapy substantially decreased the rate of brain atrophy in relapsing-remitting MS in comparison to other disease-modifying therapies, predominantly interferon β.
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Affiliation(s)
- Isabela T Borges
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA
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Bimonthly Evolution of Cortical Atrophy in Early Relapsing-Remitting Multiple Sclerosis over 2 Years: A Longitudinal Study. Mult Scler Int 2013; 2013:231345. [PMID: 23365753 PMCID: PMC3556847 DOI: 10.1155/2013/231345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 12/01/2012] [Accepted: 12/15/2012] [Indexed: 11/18/2022] Open
Abstract
We investigated the evolution of cortical atrophy in patients with early relapsing-remitting (RR) multiple sclerosis (MS) and its association with lesion volume (LV) accumulation and disability progression. 136 of 181 RRMS patients who participated in the Avonex-Steroids-Azathioprine study were assessed bimonthly for clinical and MRI outcomes over 2 years. MS patients with disease duration (DD) at baseline of ≤24 months were classified in the early group (DD of 1.2 years, n = 37), while patients with DD > 24 months were classified in the late group (DD of 7.1 years, n = 99). Mixed effect model analysis was used to investigate the associations. Significant changes in whole brain volume (WBV) (P < 0.001), cortical volume (CV) (P < 0.001), and in T2-LV (P < 0.001) were detected. No significant MRI percent change differences were detected between early and late DD groups over 2 years, except for increased T2-LV accumulation between baseline and year 2 in the early DD group (P < 0.01). No significant associations were found between changes in T2-LV and CV over the followup. Change in CV was related to the disability progression over the 2 years, after adjusting for DD (P = 0.01). Significant cortical atrophy, independent of T2-LV accumulation, occurs in early RRMS over 2 years, and it is associated with the disability progression.
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Vidal-Jordana A, Sastre-Garriga J, Pérez-Miralles F, Tur C, Tintoré M, Horga A, Auger C, Río J, Nos C, Edo MC, Arévalo MJ, Castilló J, Rovira A, Montalban X. Early brain pseudoatrophy while on natalizumab therapy is due to white matter volume changes. Mult Scler 2013; 19:1175-81. [DOI: 10.1177/1352458512473190] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Investigation of atrophy data from a pivotal natalizumab trial has demonstrated an increased rate of volume loss, compared to placebo, after the first year of therapy. It was considered to be probably due to a pseudoatrophy effect. Objective: To assess grey and white matter volume changes and their relation to global brain volume changes and to baseline inflammation, for patients under natalizumab therapy. Methods: We selected 45 patients on natalizumab therapy for at least 24 months, with magnetic resonance imaging (MRI) scans at baseline, 12 and 24 months. We calculated the percentage brain volume change (PBVC) for the first and second year, using SIENA software. Grey and white matter fractions (GMF and WMF, respectively) for the first year were calculated with SPM5, using lesion masks. After quality checks, six patients were excluded. We studied the predictive variables of change in brain volumes. Results: The PBVC decrease was faster during the first year (−1.10% ± 1.43%), as compared to the second (−0.51% ± 0.96%) ( p = 0.037). These differences were more marked in patients with baseline gadolinium-enhancing lesions ( p = 0.005). Mean GMF and WMF changes during the first year of treatment were +1.15% (n.s.) and −1.72% ( p = 0.017), respectively. The presence of active lesions at baseline MRI predicted PBVC ( p = 0.022) and WMF change ( p = 0.026) during the first year of treatment, after adjusting for age and corticosteroid treatment. No predictors were found for GMF volume changes. Conclusion: Early brain volume loss during natalizumab therapy is mainly due to WMF volume loss and it is related to the inflammatory activity present at the onset of therapy. We found that the pseudoatrophy effect is mostly due to white matter volume changes.
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Affiliation(s)
| | | | | | - Carmen Tur
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintoré
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alejandro Horga
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Río
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Nos
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mari C Edo
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - María J Arévalo
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Castilló
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alex Rovira
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
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Stępień A, Chalimoniuk M, Lubina-Dąbrowska N, Chrapusta SJ, Galbo H, Langfort J. Effects of interferon β-1a and interferon β-1b monotherapies on selected serum cytokines and nitrite levels in patients with relapsing-remitting multiple sclerosis: a 3-year longitudinal study. Neuroimmunomodulation 2013; 20:213-22. [PMID: 23711618 DOI: 10.1159/000348701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/06/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Interferon (IFN)β treatment is a mainstay of relapsing-remitting multiple sclerosis (RRMS) immunotherapy. Its efficacy is supposedly a consequence of impaired trafficking of inflammatory cells into the central nervous system and modification of the proinflammatory/antiinflammatory cytokine balance. However, the effects of long-term monotherapy using various IFNβ preparations on cytokine profiles and the relevance of these effects for the therapy outcome have not yet been elucidated. METHODS Changes were compared in serum levels of TNFα, IFNγ, interleukin (IL)-6, IL-10 and nitrite between RRMS patients given 3-year treatment with intramuscular IFNβ-1a (30 μg once a week) or subcutaneous IFNβ-1b (250 μg every other day). Only the data from patients who completed the 3-year study (n = 20 and n = 18, respectively) were analyzed. RESULTS Three-year IFNβ-1a or IFNβ-1b monotherapy reduced serum nitrite levels by 77 and 71%, respectively, lowered multiple sclerosis relapse annual rate by 70 and 71%, respectively, and significantly and similarly lowered Expanded Disability Status Scale scores in both study groups (by 0.9 on average). The two monotherapies showed little if any effect on cytokine levels and cytokine level ratios after the first year, but exerted diverging effects on these indices later on; the only exception was the IFNγ/IL-6 ratio that showed a monotonous rise in both study groups over the entire study period. CONCLUSION During long-term IFNβ monotherapy, the levels of the studied cytokines show no relevance to the course of RRMS and neurological status of patients, whereas there seems to be a link between these clinical indices and the activity of nitric oxide-mediated pathways.
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Affiliation(s)
- Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
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Sühs KW, Hein K, Pehlke JR, Käsmann-Kellner B, Diem R. Retinal nerve fibre layer thinning in patients with clinically isolated optic neuritis and early treatment with interferon-beta. PLoS One 2012; 7:e51645. [PMID: 23272128 PMCID: PMC3521715 DOI: 10.1371/journal.pone.0051645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/02/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Optic neuritis is associated with neurodegeneration leading to chronic impairment of visual functions. OBJECTIVE This study investigated whether early treatment with interferon beta (IFN-β) slows retinal nerve fibre layer (RNFL) thinning in clinically isolated optic neuritis. METHODS Twenty patients with optic neuritis and visual acuity decreased to ≤0.5 (decimal system) were included into this prospective, open-label, parallel group 4-month observation. After methylprednisolone pulse therapy, 10 patients received IFN-β from week 2 onwards. This group was compared to 10 patients free of any disease modifying treatment (DMT). The parameter of interest was change in RNFL thickness assessed at baseline and at weeks 4, 8, and 16. Changes in visual acuity, visual field, and visual evoked potentials (VEPs) served as additional outcome parameters. RESULTS RNFL thinning did not differ between the groups with a mean reduction of 9.80±2.80 µm in IFN-β-treated patients (±SD) vs. 12.44±5.79 µm in patients who did not receive DMT (baseline non-affected eye minus affected eye at week 16; p = 0.67, t-test, 95% confidence interval: -15.77 to 10.48). Parameters of visual function did not show any differences between the groups either. CONCLUSIONS In isolated optic neuritis, early IFN-β treatment did not influence RNFL thinning nor had it any effect on recovery of visual functions.
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Affiliation(s)
- Kurt-Wolfram Sühs
- Department of Neurology, Saarland University, Homburg, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katharina Hein
- Department of Neurology, Georg-August University, Göttingen, Germany
| | - Jens R. Pehlke
- Department of Neurology, Saarland University, Homburg, Germany
- Department of Addiction Disorders, LWL Clinic Münster, Münster, Germany
| | | | - Ricarda Diem
- Department of Neurology, Saarland University, Homburg, Germany
- Department of Neuro-oncology, University Clinic Heidelberg, Heidelberg, Germany
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Zivadinov R, Ramanathan M, Ambrus J, Hussein S, Ramasamy DP, Dwyer MG, Bergsland N, Minagar A, Weinstock-Guttman B. Anti-phospholipid antibodies are associated with response to interferon-beta1a treatment in MS: results from a 3-year longitudinal study. Neurol Res 2012; 34:761-769. [DOI: 10.1179/1743132812y.0000000076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis CenterState University of New York, USA
- The Jacobs Neurological InstituteDepartment of Neurology, University at Buffalo, State University of New York, USA
| | - Murali Ramanathan
- Department of Pharmaceutical SciencesState University of New York, USA
| | - Julian Ambrus
- Department of MedicineDivision of Allergy, Immunology and Rheumatology, State University of New York, USA
| | - Sara Hussein
- Buffalo Neuroimaging Analysis CenterState University of New York, USA
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis CenterState University of New York, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis CenterState University of New York, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis CenterState University of New York, USA
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Bianca Weinstock-Guttman
- The Jacobs Neurological InstituteDepartment of Neurology, University at Buffalo, State University of New York, USA
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Horakova D, Kalincik T, Dusankova JB, Dolezal O. Clinical correlates of grey matter pathology in multiple sclerosis. BMC Neurol 2012; 12:10. [PMID: 22397707 PMCID: PMC3311149 DOI: 10.1186/1471-2377-12-10] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 03/07/2012] [Indexed: 12/26/2022] Open
Abstract
Traditionally, multiple sclerosis has been viewed as a disease predominantly affecting white matter. However, this view has lately been subject to numerous changes, as new evidence of anatomical and histological changes as well as of molecular targets within the grey matter has arisen. This advance was driven mainly by novel imaging techniques, however, these have not yet been implemented in routine clinical practice. The changes in the grey matter are related to physical and cognitive disability seen in individuals with multiple sclerosis. Furthermore, damage to several grey matter structures can be associated with impairment of specific functions. Therefore, we conclude that grey matter damage - global and regional - has the potential to become a marker of disease activity, complementary to the currently used magnetic resonance markers (global brain atrophy and T2 hyperintense lesions). Furthermore, it may improve the prediction of the future disease course and response to therapy in individual patients and may also become a reliable additional surrogate marker of treatment effect.
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Affiliation(s)
- Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
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Ziemann U, Wahl M, Hattingen E, Tumani H. Development of biomarkers for multiple sclerosis as a neurodegenerative disorder. Prog Neurobiol 2011; 95:670-85. [DOI: 10.1016/j.pneurobio.2011.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/07/2011] [Accepted: 04/10/2011] [Indexed: 01/24/2023]
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Abstract
Multiple sclerosis (MS) is characterized by autoimmune inflammation and subsequent neurodegeneration. It is believed that early in the disease course, proinflammatory T cells that are activated in the periphery by antigen presentation cross the blood-brain barrier (BBB) into the CNS directed by various chemotaxic agents. However, to date, there has been no formal demonstration of a specific precipitating antigen. Once inside the CNS, activated T cells including T helper-1 (T(h)1), T(h)17, γδ and CD8+ types are believed to secrete proinflammatory cytokines. Decreased levels of T(h)2 cells also correlate with relapses and disease progression in MS, since T(h)2-derived cytokines are predominantly anti-inflammatory. In healthy tissue, inflammatory effects are opposed by specific subsets of regulatory T cells (T(regs)) including CD4+, CD25+ and FoxP3+ cells that have the ability to downregulate the activity of proinflammatory T cells, allowing repair and recovery to generally follow inflammatory insult. Given their function, the pathogenesis of MS most likely involves deficits of T(reg) function, which allow autoimmune inflammation and resultant neurodegeneration to proceed relatively unchecked. Interferons (IFNs) are naturally occurring cytokines possessing a wide range of anti-inflammatory properties. Recombinant forms of IFNβ are widely used as first-line treatment in relapsing forms of MS. The mechanism of action of IFNβ is complex, involving effects at multiple levels of cellular function. IFNβ appears to directly increase expression and concentration of anti-inflammatory agents while downregulating the expression of proinflammatory cytokines. IFNβ treatment may reduce the trafficking of inflammatory cells across the BBB and increase nerve growth factor production, leading to a potential increase in neuronal survival and repair. IFNβ can also increase the number of CD56bright natural killer cells in the peripheral blood. These cells are efficient producers of anti-inflammatory mediators, and may have the ability to curb neuron inflammation. The mechanistic effects of IFNβ manifest clinically as reduced MRI lesion activity, reduced brain atrophy, increased time to reach clinically definite MS after the onset of neurological symptoms, decreased relapse rate and reduced risk of sustained disability progression. The mechanism of action of IFNβ in MS is multifactorial and incompletely understood. Ongoing and future studies will increase our understanding of the actions of IFNβ on the immune system and the CNS, which will in turn aid advances in the management of MS.
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Affiliation(s)
- Bernd C Kieseier
- Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany.
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When to initiate disease-modifying drugs for relapsing remitting multiple sclerosis in adults? Mult Scler Int 2011; 2011:724871. [PMID: 22096641 PMCID: PMC3195775 DOI: 10.1155/2011/724871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/27/2011] [Indexed: 12/23/2022] Open
Abstract
For patients with Relapsing Remitting Multiple Scierosis Beta Interfaerons and Glatiramer Acetate were the first to be licensed for treatment. This review deals with one major question: when to initiate therapy? Through exploring the unique characteristics of the disease and treatement we suggest an approach that should be helpful in the process of decision-making.
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Magraner MJ, Bosca I, Simó-Castelló M, García-Martí G, Alberich-Bayarri A, Coret F, Álvarez-Cermeño JC, Martí-Bonmatí L, Villar LM, Casanova B. Brain atrophy and lesion load are related to CSF lipid-specific IgM oligoclonal bands in clinically isolated syndromes. Neuroradiology 2011; 54:5-12. [DOI: 10.1007/s00234-011-0841-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 01/27/2011] [Indexed: 11/30/2022]
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Abstract
Imaging techniques, in particular magnetic resonance imaging (MRI), play an important role in the diagnosis and management of multiple sclerosis (MS) and related demyelinating diseases. Findings on MRI studies of the brain and spinal cord are critical for MS diagnosis, are used to monitor treatment response and may aid in predicting disease progression in individual patients. In addition, results of imaging studies serve as essential biomarkers in clinical trials of putative MS therapies and have led to important insights into disease pathophysiology. Although they are useful tools and provide in vivo measures of disease-related activity, there are some important limitations of MRI findings in MS, including the non-specific nature of detectable white matter changes, the poor correlation with clinical disability, the limited sensitivity and ability of standard measures of gadolinium enhancing lesions and T2 lesions to predict future clinical course, and the lack of validated biomarkers of long term outcomes. Advancements that hold promise for the future include new techniques that are sensitive to diffuse changes, the increased use of higher field scanners, measures that capture disease related changes in gray matter, and the use of combined structural and functional imaging approaches to assess the complex and evolving disease process that occurs during the course of MS.
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Affiliation(s)
- Nancy L Sicotte
- Division of Brain Mapping, Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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Nakamura K, Fox R, Fisher E. CLADA: cortical longitudinal atrophy detection algorithm. Neuroimage 2010; 54:278-89. [PMID: 20674750 DOI: 10.1016/j.neuroimage.2010.07.052] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 07/22/2010] [Accepted: 07/23/2010] [Indexed: 11/17/2022] Open
Abstract
Measurement of changes in brain cortical thickness is useful for the assessment of regional gray matter atrophy in neurodegenerative conditions. A new longitudinal method, called CLADA (cortical longitudinal atrophy detection algorithm), has been developed for the measurement of changes in cortical thickness in magnetic resonance images (MRI) acquired over time. CLADA creates a subject-specific cortical model which is longitudinally deformed to match images from individual time points. The algorithm was designed to work reliably for lower resolution images, such as the MRIs with 1×1×5 mm(3) voxels previously acquired for many clinical trials in multiple sclerosis (MS). CLADA was evaluated to determine reproducibility, accuracy, and sensitivity. Scan-rescan variability was 0.45% for images with 1mm(3) isotropic voxels and 0.77% for images with 1×1×5 mm(3) voxels. The mean absolute accuracy error was 0.43 mm, as determined by comparison of CLADA measurements to cortical thickness measured directly in post-mortem tissue. CLADA's sensitivity for correctly detecting at least 0.1mm change was 86% in a simulation study. A comparison to FreeSurfer showed good agreement (Pearson correlation=0.73 for global mean thickness). CLADA was also applied to MRIs acquired over 18 months in secondary progressive MS patients who were imaged at two different resolutions. Cortical thinning was detected in this group in both the lower and higher resolution images. CLADA detected a higher rate of cortical thinning in MS patients compared to healthy controls over 2 years. These results show that CLADA can be used for reliable measurement of cortical atrophy in longitudinal studies, even in lower resolution images.
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Affiliation(s)
- Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Sahraian MA, Radue EW, Haller S, Kappos L. Black holes in multiple sclerosis: definition, evolution, and clinical correlations. Acta Neurol Scand 2010; 122:1-8. [PMID: 20003089 DOI: 10.1111/j.1600-0404.2009.01221.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) is a sensitive paraclinical test for diagnosis and assessment of disease progression in multiple sclerosis (MS) and is often used to evaluate therapeutic efficacy. The formation of new T2-hyperintense MRI lesions is commonly used to measure disease activity, but lacks specificity because edema, inflammation, gliosis, and axonal loss all contribute to T2 lesion formation. As the role of neurodegeneration in the pathophysiology of MS has become more prominent, the formation and evolution of chronic or persistent Tl-hypointense lesions (black holes) have been used as markers of axonal loss and neuronal destruction to measure disease activity. Despite the use of various detection methods, including advanced imaging techniques such as magnetization transfer imaging and magnetic resonance spectroscopy, correlation of persistent black holes with clinical outcomes in patients with MS remains uncertain. Furthermore, although axonal loss and neuronal tissue destruction are known to contribute to irreversible disability in patients with MS, there are limited data on the effect of therapy on longitudinal change in Tl-hypointense lesion volume. Measurement of black holes in clinical studies may elucidate the underlying pathophysiology of MS and may be an additional method of evaluating therapeutic efficacy.
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Bendfeldt K, Egger H, Nichols TE, Loetscher P, Denier N, Kuster P, Traud S, Mueller-Lenke N, Naegelin Y, Gass A, Kappos L, Radue EW, Borgwardt SJ. Effect of immunomodulatory medication on regional gray matter loss in relapsing-remitting multiple sclerosis--a longitudinal MRI study. Brain Res 2010; 1325:174-82. [PMID: 20167205 DOI: 10.1016/j.brainres.2010.02.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
Prevention of global gray matter (GM) volume changes in multiple sclerosis (MS) are an objective in clinical trials, but the effect of immunomodulatory medication on regional GM atrophy progression is unclear. MRIs from 86 patients with relapsing-remitting MS (RRMS) followed up for 24 months were analyzed using voxel-based morphometry. An analysis of covariance model (cluster threshold, corrected p<0.05) was used to compare GM volumes between baseline and follow-up while stratified by immunomodulatory medication (IM): Interferone INF-beta-1a (n=34), INF-beta-1b (n=16), glatiramer acetate (GA) (n=15), and no-immunomodulatory treatment (n=21). In the INF-beta-1a/1b group (n=50), significant GM volume reductions were observed during follow-up in fronto-temporal, cingulate and cerebellar cortical brain regions, without significant differences between the INF-beta-1a and INF-beta-1b patients. In the GA group and in unmedicated patients, no significant regional GM volume reductions were observed. In contrast to GA, INF-beta-1a/1b treatment was associated with GM volume reductions in hippocampal/parahippocampal and anterior cingulate cortex. This is the first longitudinal study investigating the effects of IMs on GM in RRMS. Results suggest differences in the dynamics of regional GM volume atrophy in differentially treated or untreated RRMS patients.
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Affiliation(s)
- Kerstin Bendfeldt
- Medical Image Analysis Centre (MIAC), University Hospital Basel, Basel, Switzerland
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Antulov R, Carone DA, Bruce J, Yella V, Dwyer MG, Tjoa CW, Benedict RHB, Zivadinov R. Regionally Distinct White Matter Lesions Do Not Contribute to Regional Gray Matter Atrophy in Patients with Multiple Sclerosis. J Neuroimaging 2010; 21:210-8. [DOI: 10.1111/j.1552-6569.2010.00482.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Healy B, Valsasina P, Filippi M, Bakshi R. Sample size requirements for treatment effects using gray matter, white matter and whole brain volume in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:1218-23. [PMID: 19204021 PMCID: PMC2846617 DOI: 10.1136/jnnp.2008.154732] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the sample size requirements for a neuroprotection trial with change in cerebral gray matter volume (GMV), white matter volume (WMV) or whole brain parenchymal volume (BPV) as outcome measures in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Two datasets with longitudinal MRI measures of untreated patients with RRMS (n = 116 and n = 26) and one dataset of treated patients with RRMS (n = 109) were investigated. In each dataset, normalised GMV, normalised WMV and normalised BPV were analysed using a random intercepts and slopes model to estimate the variance components and per cent change. The required sample size to observe a 33%, 50% and 90% reduction in the per cent change was calculated for each dataset using both a constant per cent change for each measurement and the estimated per cent change for each dataset. RESULTS The per cent change was greatest in GMV but all variance components were smallest in BPV. Using the estimated per cent change, the sample size required in the untreated cohorts was similar for GMV and BPV, and both were lower than WMV. In the treated cohort, the sample size for GMV was the smallest of all measures. Including additional scans reduced the sample size but increasing the length of the trial and clustering scans led to greater reductions. CONCLUSIONS Cerebral GMV may be a viable outcome measure for clinical trials investigating neuroprotection in RRMS patients, especially considering that the treatment effect may be larger on GMV compared with BPV. However, GMV was somewhat limited by increased variability versus BPV.
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Affiliation(s)
- B Healy
- Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School, Boston, Massachusetts, USA
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Shijie J, Takeuchi H, Yawata I, Harada Y, Sonobe Y, Doi Y, Liang J, Hua L, Yasuoka S, Zhou Y, Noda M, Kawanokuchi J, Mizuno T, Suzumura A. Blockade of glutamate release from microglia attenuates experimental autoimmune encephalomyelitis in mice. TOHOKU J EXP MED 2009; 217:87-92. [PMID: 19212100 DOI: 10.1620/tjem.217.87] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system. Despite a variety of anti-inflammatory or immunomodulation drugs including interferon-beta are effective to reduce relapse risk, most patients have progressive neurological deterioration due to axonal degeneration. Accumulation of activated microglia is a pathological hallmark of active MS lesion. Microglia can act as not only antigen-presenting cells but also effector cells to damage other cells in the central nervous system. Especially, glutamate released by activated microglia induces excito-neurotoxicity and may contribute to neurodegeneration in MS. Gap junction is a major cell-to-cell channel and is composed of paired hemichannels on coupled cells. Recent studies showed that cells release various small molecules (including ions, ATP, and amino acids) from unpaired hemichannel of gap junction that is openly exposed to the extracellular space. We have previously revealed that activated microglia produce glutamate via glutaminase and release it through hemichannels of gap junctions. Thus, in this study, we examined whether the glutaminase inhibitor and the gap junction blocker relieved experimental autoimmune encephalomyelitis (EAE) that is an animal model of MS. Here we show that the gap junction blocker carbenoxolone (CBX) and the glutaminase inhibitor 6-diazo-5-oxo-L-norleucine (DON) decreased glutamate release from activated microglia and rescued neuronal death in a dose-dependent manner in vitro. In EAE mice, treatment with CBX or DON also attenuated EAE clinical symptoms. Thus, blockade of glutamate release from activated microglia with CBX or DON may be an effective therapeutic strategy against neurodegeneration in MS.
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Affiliation(s)
- Jin Shijie
- Department of Neuroimmunology, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
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A pilot test of pioglitazone as an add-on in patients with relapsing remitting multiple sclerosis. J Neuroimmunol 2009; 211:124-30. [DOI: 10.1016/j.jneuroim.2009.04.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/15/2009] [Accepted: 04/20/2009] [Indexed: 11/23/2022]
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Anderson VM, Fisniku LK, Altmann DR, Thompson AJ, Miller DH. MRI measures show significant cerebellar gray matter volume loss in multiple sclerosis and are associated with cerebellar dysfunction. Mult Scler 2009; 15:811-7. [PMID: 19465449 DOI: 10.1177/1352458508101934] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Regional atrophy measures may offer useful information about the causes of specific clinical deficits in multiple sclerosis (MS). OBJECTIVE To determine the magnitude of cerebellar gray and white matter (GM and WM) atrophy in patients with clinically isolated syndromes (CIS) and MS, and their role in clinical manifestations of cerebellar damage. METHODS T1-weighted volumetric magnetic resonance imaging (MRI) of 73 patients [29 CIS, 33 relapsing-remitting MS (RRMS), 11 secondary progressive MS (SPMS)] was compared with 25 controls. GM and WM regions were generated using SPM5 and cerebellar regions delineated. Linear regression was used to investigate differences in tissue-specific cerebellar volumes between groups and the association with clinical measures. RESULTS Mean cerebellar GM volume (CGMV) was 100.1 cm(3) in controls, 96.4 cm(3) in CIS patients, 91.8 cm(3) in RRMS patients, and 88.8 cm(3) in SPMS patients. Mean cerebellar WM volumes (CWMV) were 21.3 cm(3), 20.4 cm(3), 19.9 cm(3), and 18.8 cm(3), respectively. CGMV was reduced by 4.8 cm(3) (P = 0.054) in RRMS patients, and 8.5 cm(3) (P = 0.012) in SPMS patients, relative to controls. Only patients with SPMS showed a borderline significant reduction in CWMV compared with controls (mean 2.1 cm(3), P = 0.053). CGMV was significantly smaller in patients assessed as having cerebellar dysfunction compared with patients who had normal cerebellar function. Significant associations of CGMV and CWMV with performance on the nine-hole peg test were also observed. CONCLUSION Clinically relevant GM atrophy occurs in the cerebellum of MS patients and is more prominent than WM atrophy. As such, it may provide complementary data to other regional atrophy and intrinsic tissue measures.
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Affiliation(s)
- V M Anderson
- Nuclear Magnetic Resonance Research Unit, Institute of Neurology, University College London, Queen Square, London, UK.
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