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Dekeyser C, Hautekeete M, Cambron M, Van Pesch V, Patti F, Kuhle J, Khoury S, Lechner Scott J, Gerlach O, Lugaresi A, Maimone D, Surcinelli A, Grammond P, Kalincik T, Habek M, Willekens B, Macdonell R, Lalive P, Csepany T, Butzkueven H, Boz C, Tomassini V, Foschi M, Sánchez-Menoyo JL, Altintas A, Mrabet S, Iuliano G, Sa MJ, Alroughani R, Karabudak R, Aguera-Morales E, Gray O, de Gans K, van der Walt A, McCombe PA, Deri N, Garber J, Al-Asmi A, Skibina O, Duquette P, Cartechini E, Spitaleri D, Gouider R, Soysal A, Van Hijfte L, Slee M, Amato MP, Buzzard K, Laureys G. Routine CSF parameters as predictors of disease course in multiple sclerosis: an MSBase cohort study. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333307. [PMID: 38569872 DOI: 10.1136/jnnp-2023-333307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND It remains unclear whether routine cerebrospinal fluid (CSF) parameters can serve as predictors of multiple sclerosis (MS) disease course. METHODS This large-scale cohort study included persons with MS with CSF data documented in the MSBase registry. CSF parameters to predict time to reach confirmed Expanded Disability Status Scale (EDSS) scores 4, 6 and 7 and annualised relapse rate in the first 2 years after diagnosis (ARR2) were assessed using (cox) regression analysis. RESULTS In total, 11 245 participants were included of which 93.7% (n=10 533) were persons with relapsing-remitting MS (RRMS). In RRMS, the presence of CSF oligoclonal bands (OCBs) was associated with shorter time to disability milestones EDSS 4 (adjusted HR=1.272 (95% CI, 1.089 to 1.485), p=0.002), EDSS 6 (HR=1.314 (95% CI, 1.062 to 1.626), p=0.012) and EDSS 7 (HR=1.686 (95% CI, 1.111 to 2.558), p=0.014). On the other hand, the presence of CSF pleocytosis (≥5 cells/µL) increased time to moderate disability (EDSS 4) in RRMS (HR=0.774 (95% CI, 0.632 to 0.948), p=0.013). None of the CSF variables were associated with time to disability milestones in persons with primary progressive MS (PPMS). The presence of CSF pleocytosis increased ARR2 in RRMS (adjusted R2=0.036, p=0.015). CONCLUSIONS In RRMS, the presence of CSF OCBs predicts shorter time to disability milestones, whereas CSF pleocytosis could be protective. This could however not be found in PPMS. CSF pleocytosis is associated with short-term inflammatory disease activity in RRMS. CSF analysis provides prognostic information which could aid in clinical and therapeutic decision-making.
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Affiliation(s)
| | | | - Melissa Cambron
- Neurology, Sint-Jan Bruges Hospital, Bruges, Belgium
- University of Ghent, Ghent, Belgium
| | - Vincent Van Pesch
- Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Francesco Patti
- Neuroscience, University of Catania Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', Catania, Italy
- Multiple Sclerosis Unit, AOU Policlinico G Rodolico-San Marco, Catania, Italy
| | - Jens Kuhle
- Neurology, University Hospital Basel, Basel, Switzerland
- Biomedicine and Clinical Research, Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Basel, Switzerland
| | - Samia Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jeanette Lechner Scott
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter New England Health, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Oliver Gerlach
- Neurology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
- Neurology, Universiteit Maastricht School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Andrea Surcinelli
- Department of Neuroscience, MS Center, S Maria delle Croci Hospital, Ravenna, Italy
| | - Pierre Grammond
- CISSS Chaudière-Appalaches Research Center, Levis, Quebec, Canada
| | - Tomas Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mario Habek
- University Hospital Centre Zagreb Department of Neurology, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Zagreb, Croatia
| | - Barbara Willekens
- Neurology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- Laboratory of Experimental Hematology, Universiteit Antwerpen Faculteit geneeskunde en gezondheidswetenschappen, Wilrijk, Belgium
| | | | - Patrice Lalive
- Clinical Neurosciences, Division of Neurology, Unit of Neuroimmunology, Geneva University Hospitals Department of Medicine, Geneve, Switzerland
| | - Tunde Csepany
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Helmut Butzkueven
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Cavit Boz
- Neurology, Karadeniz Technical University, Medical Faculty, Trabzon, Turkey
| | - Valentina Tomassini
- Istituto di Tecnologie Avanzate Biomediche (ITAB), Dipartimento di Neuroscienze e Imaging e Scienze Cliniche; Centro Sclerosi Multipla, Clinica Neurologica, Ospedale SS Annunziata, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
- University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Matteo Foschi
- Department of Neuroscience, MS Center, Neurology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - José Luis Sánchez-Menoyo
- Neurology, Galdakao-Usansolo University Hospital, Osakidetza-Basque Health Service, Galdakao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ayse Altintas
- Neurology, Koc University School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Saloua Mrabet
- Neurology, Razi University Hospital, Clinical Investigation Centre Neurosciences and Mental Health, Tunis, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
| | | | - Maria Jose Sa
- Neurology, Centro Hospitalar de São João, Porto, Portugal
- Fernando Pessoa University Faculty of Health Sciences, Porto, Portugal
| | | | - Rana Karabudak
- Neurological Sciences, Yeditepe Universitesi, Istanbul, Turkey
- Neuroimmunology, Koşuyolu Hospitals, Istanbul, Turkey
| | - Eduardo Aguera-Morales
- Neurology, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC28 Neuroplasticity and Oxidative Stress, IMIBIC, Cordoba, Spain
| | - Orla Gray
- South Eastern HSC Trust, Belfast, UK
| | | | - Anneke van der Walt
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Pamela A McCombe
- UQCCR, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Norma Deri
- Hospital Fernandez, Buenos Aires, Argentina
| | - Justin Garber
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Abdullah Al-Asmi
- Sultan Qaboos University College of Medicine and Health Science, Muscat, Muscat Governorate, Oman
| | - Olga Skibina
- Neurosciences, The Alfred, Melbourne, Victoria, Australia
- Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
| | | | | | - Daniele Spitaleri
- Neurology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità San Giuseppe Moscati Neurologia e Stroke Unit, Avellino, Italy
| | - Riadh Gouider
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Neurology, Razi Hospital, Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia, Manouba, Tunisia
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | - Mark Slee
- Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
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Aleksandravičiūtė E, Stankevičiūtė R, Balnytė R, Šaknys L, Ulozienė I. Oligoclonal Band Status and Features of Radiological and Clinical Findings in Patients with Multiple Sclerosis in Lithuania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1028. [PMID: 37374232 PMCID: PMC10301297 DOI: 10.3390/medicina59061028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Multiple sclerosis (MS) is a widely spread and debilitating disease with 2.8 million people worldwide currently affected. However, the exact pathogenesis of the disease and its progression remains incompletely understood. According to the revised McDonald criteria, cerebrospinal fluid oligoclonal bands (CSF OCBs) magnetic resonance imaging (MRI) results, in conjunction with clinical presentation, remain the gold standard of MS diagnostics. Therefore, this study aims to evaluate the association between CSF OCB status and features of radiological and clinical findings in patients with multiple sclerosis in Lithuania. Materials and Methods: The selection of 200 MS patients was performed in order to find associations between CSF OCB status, MRI data and various disease features. The data were acquired from outpatient records and a retrospective analysis was performed. Results: OCB positive patients were diagnosed with MS earlier and had spinal cord lesions more frequently than OCB negative patients. Patients with lesions in the corpus callosum had a greater increase in the Expanded Disability Status Scale (EDSS) score between their first and last visit. Patients with brainstem lesions had higher EDSS scores during their first and last visit. Even so, the progression of the EDSS score was not greater. The time between the first symptoms and diagnosis was shorter for patients who had juxtacortical lesions than patients who did not. Conclusions: CSF OCBs and MRI data remain irreplaceable tools when diagnosing multiple sclerosis as well as prognosing the development of the disease and disability.
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Affiliation(s)
- Emilija Aleksandravičiūtė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Radvilė Stankevičiūtė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Renata Balnytė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Laurynas Šaknys
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Ingrida Ulozienė
- Department of Otorhinolaringology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
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Breaching Brain Barriers: B Cell Migration in Multiple Sclerosis. Biomolecules 2022; 12:biom12060800. [PMID: 35740925 PMCID: PMC9221446 DOI: 10.3390/biom12060800] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/25/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) known for the manifestation of demyelinated lesions throughout the CNS, leading to neurodegeneration. To date, not all pathological mechanisms that drive disease progression are known, but the clinical benefits of anti-CD20 therapies have put B cells in the spotlight of MS research. Besides their pathological effects in the periphery in MS, B cells gain access to the CNS where they can contribute to disease pathogenesis. Specifically, B cells accumulate in perivascular infiltrates in the brain parenchyma and the subarachnoid spaces of the meninges, but are virtually absent from the choroid plexus. Hence, the possible migration of B cells over the blood-brain-, blood-meningeal-, and blood-cerebrospinal fluid (CSF) barriers appears to be a crucial step to understanding B cell-mediated pathology. To gain more insight into the molecular mechanisms that regulate B cell trafficking into the brain, we here provide a comprehensive overview of the different CNS barriers in health and in MS and how they translate into different routes for B cell migration. In addition, we review the mechanisms of action of diverse therapies that deplete peripheral B cells and/or block B cell migration into the CNS. Importantly, this review shows that studying the different routes of how B cells enter the inflamed CNS should be the next step to understanding this disease.
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Barakat B, Messina S, Nayak S, Kassa R, Sechi E, Flanagan EP, Kantarci O, Weinshenker BG, Keegan BM. Cerebrospinal fluid evaluation in patients with progressive motor impairment due to critical central nervous system demyelinating lesions. Mult Scler J Exp Transl Clin 2022; 8:20552173211052159. [PMID: 35047187 PMCID: PMC8761886 DOI: 10.1177/20552173211052159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Elevated intrathecal immunoglobulin G (IgG; oligoclonal bands (OCBs)) or IgG in people with progressive motor impairment due to “critical” demyelinating lesions are of uncertain significance. Objective Compare clinical/radiological features of people with “critical” demyelinating lesion-induced progressive motor impairment with/without elevated intrathecal IgG synthesis. Methods A total of 133 people with progressive motor impairment attributable to “critical” demyelinating lesions (corticospinal tract location, consistent with the progressive motor deficit) were compared regarding clinical and radiological presentation with and without ≥2 unique cerebrospinal fluid (CSF) OCB and/or IgG index ≥0.85. Results Ninety-eight (74%) had CSF-elevated OCB and/or IgG index, higher with increased magnetic resonance imaging-lesion burden. No differences were found with/without CSF abnormalities in sex (46 of 98 female (47%) vs. 22 of 35 (63%), p = 0.11), onset-age (median 49 vs. 50 years, p = 0.5), progression from onset (62 of 98 (63%) vs. 25 of 35 (71%)), progression post-relapse (36 of 98 (37%) vs. 10 of 35 (29%), p = 0.4), and duration between demyelinating disease onset and CSF examination (30 (0–359) vs. 48 (0–323) months p = 0.7). “Critical” lesions were radiologically similar, most commonly cervical spine located (72 of 98 (74%) vs. 19 of 35 (54%), p = 0.18) both with/without CSF abnormalities. Conclusions People with “critical” demyelinating lesion-induced progressive motor impairment typically have elevated intrathecal IgG (OCB and/or IgG) and similar clinical and radiological presentation regardless of CSF findings, therefore representing valid presentations of progressive demyelinating disease.
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Affiliation(s)
- Benan Barakat
- Department of Family Medicine, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Steve Messina
- Department of Radiology, Division of Neuroradiology Mayo Clinic Rochester, MN, USA
| | - Shreya Nayak
- St. Elizabeth Physicians, Crestview Hills, KY, USA
| | - Roman Kassa
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Elia Sechi
- Università degli Studi di Sassari, Sassari, Italy
| | | | | | | | - B Mark Keegan
- Department of Neurology Mayo Clinic Rochester, MN, USA
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Zheng Y, Cai MT, Yang F, Zhou JP, Fang W, Shen CH, Zhang YX, Ding MP. IgG Index Revisited: Diagnostic Utility and Prognostic Value in Multiple Sclerosis. Front Immunol 2020; 11:1799. [PMID: 32973754 PMCID: PMC7468492 DOI: 10.3389/fimmu.2020.01799] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: Early and accurate diagnosis of multiple sclerosis (MS) remains a clinical challenge. The main objective is to evaluate the diagnostic and prognostic value of the routinely performed immunoglobulin G (IgG) index for MS patients in the Asian population. Methods: A retrospective study was conducted among a cohort of clinically isolated syndrome (CIS) patients in China with known oligoclonal band (OCB) status and IgG index at baseline. We first evaluated the predictive value of IgG index for OCB status. Secondly, the diagnostic utility and prognostic value of IgG index alone were tested. Lastly, we incorporated IgG index into the 2017 McDonald criteria by replacing OCB with either “IgG index or OCB” (modified criteria 1), “IgG index and OCB” (modified criteria 2), or “IgG index” (modified criteria 3). The diagnostic utility of different criteria was calculated and compared. Results: In a CIS cohort in China (n = 105), IgG index > 0.7 forecasted OCB positivity (X2 = 22.90, P < 0.001). An elevated IgG index was highly prognostic of more clinical relapses [1-year adjusted odds ratio [OR] = 1.32, P = 0.015; 2-years adjusted OR = 1.69, P = 0.013] and Expanded Disability Status Scale worsening (1-year adjusted OR = 1.76, P = 0.040; 2-years adjusted OR = 1.85, P = 0.032). Under the 2017 McDonald criteria (Positive Likelihood Ratio = 1.54, Negative Likelihood Ratio = 0.56), an IgG index > 0.7 in CIS patients increased the likelihood of developing MS within 2 years, either when OCB status was unknown (Positive Likelihood Ratio = 2.11) or with OCB positivity (Positive Likelihood Ratio = 2.11) at baseline; An IgG index ≤ 0.7, along with a negative OCB, helped rule out the MS diagnosis (Negative Likelihood Ratio = 0.53). Conclusions: IgG index > 0.7 predicts OCB positivity at the initial attack of MS and is prognostic of early disease activity. IgG index serves as an easily-obtainable and accurate OCB surrogate for MS diagnosis in the Asian population.
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Affiliation(s)
- Yang Zheng
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fan Yang
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ji-Ping Zhou
- Harvard University School of Public Health, Boston, MA, United States
| | - Wei Fang
- Department of Neurology, School of Medicine, Fourth Affiliated Hospital, Zhejiang University, Yiwu, China
| | - Chun-Hong Shen
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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Ferrazzano G, Crisafulli SG, Baione V, Tartaglia M, Cortese A, Frontoni M, Altieri M, Pauri F, Millefiorini E, Conte A. Early diagnosis of secondary progressive multiple sclerosis: focus on fluid and neurophysiological biomarkers. J Neurol 2020; 268:3626-3645. [PMID: 32504180 DOI: 10.1007/s00415-020-09964-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Most patients with multiple sclerosis presenting with a relapsing-remitting disease course at diagnosis transition to secondary progressive multiple sclerosis (SPMS) 1-2 decades after onset. SPMS is characterized by predominant neurodegeneration and atrophy. These pathogenic hallmarks result in unsatisfactory treatment response in SPMS patients. Therefore, early diagnosis of SPMS is necessary for prompt treatment decisions. The aim of this review was to assess neurophysiological and fluid biomarkers that have the potential to monitor disease progression and support early SPMS diagnosis. METHODS We performed a systematic review of studies that analyzed the role of neurophysiological techniques and fluid biomarkers in supporting SPMS diagnosis using the preferred reporting items for systematic reviews and meta-analyses statement. RESULTS From our initial search, we selected 24 relevant articles on neurophysiological biomarkers and 55 articles on fluid biomarkers. CONCLUSION To date, no neurophysiological or fluid biomarker is sufficiently validated to support the early diagnosis of SPMS. Neurophysiological measurements, including short interval intracortical inhibition and somatosensory temporal discrimination threshold, and the neurofilament light chain fluid biomarker seem to be the most promising. Cross-sectional studies on an adequate number of patients followed by longitudinal studies are needed to confirm the diagnostic and prognostic value of these biomarkers. A combination of neurophysiological and fluid biomarkers may be more sensitive in detecting SPMS conversion.
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Affiliation(s)
- Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Cortese
- Multiple Sclerosis Center, San Filippo Neri Hospital, Rome, Italy
| | - Marco Frontoni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Flavia Pauri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy. .,IRCCS Neuromed, Pozzilli, IS, Italy.
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Abstract
Multiple sclerosis (MS) is a heterogeneous disease. With several disease modifying treatments of different mechanisms of action in use now and in development, it is important to identify reliable biomarkers to identify those higher risk MS patients in whom stronger but riskier treatments might be used, as well as to identify those for whom safer treatments of lower efficacy would be sufficient. Here we review cerebrospinal fluid (CSF) and blood biomarkers that show promise for differentiating people with MS who are at risk for severe disease and disability from those with more benign disease. We reviewed published literature for studies reporting biomarkers with predictive value in MS. Most studies of MS CSF found the presence of oligoclonal bands (both IgG and IgM), high IgG index and high levels of kappa light chains to each be associated with worse prognosis. Neurofilament light chain (NfL) and two markers of glial activation, glial fibrillary acidic protein (GFAP) and YKL-40, were higher in CSF of people with subsequent clinical progression or imaging evidence for neurodegeneration. Few reports have been made yet on the prognostic significance of blood NfL, but in one early report baseline, serum NfL (sNfL) predicted subsequent brain volume loss.
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Affiliation(s)
- Roberta Magliozzi
- Department of Neurosciences, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Simonsen CS, Flemmen HØ, Lauritzen T, Berg-Hansen P, Moen SM, Celius EG. The diagnostic value of IgG index versus oligoclonal bands in cerebrospinal fluid of patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217319901291. [PMID: 32030196 PMCID: PMC6977237 DOI: 10.1177/2055217319901291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/26/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background Diagnostic criteria for multiple sclerosis have been developed to guide the diagnostic process. In the latest revision of the McDonald criteria, the presence of oligoclonal bands may replace the need for dissemination in time. The aim of this study is to investigate if the less time-consuming analysis of immunoglobulin G index in cerebrospinal fluid can safely predict the findings of oligoclonal bands. Methods This is a retrospective study of patients with multiple sclerosis at three hospitals in South-East Norway where lumbar puncture is performed routinely. We included patients diagnosed with multiple sclerosis after 2005 with known oligoclonal band status and an immunoglobulin G index score. Results Of 1295 patients diagnosed during or after 2005, 93.8% were oligoclonal band positive at diagnosis. Of 842 multiple sclerosis patients with known immunoglobulin G index and oligoclonal band status, 93.3% were oligoclonal band positive and 76.7% had an elevated immunoglobulin G index. The positive predictive value of a high immunoglobulin G index when oligoclonal bands are positive was 99.4% (95% confidence interval 98.4–99.8%). The negative predictive value of a normal immunoglobulin G index when oligoclonal bands are negative was 26.5% (95% confidence interval 23.5–29.9%). Conclusion An immunoglobulin G index >0.7 has a positive predictive value >99% for oligoclonal bands. An elevated immunoglobulin G index adds diagnostic value versus oligoclonal bands and saves time in the diagnostic process.
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Affiliation(s)
| | | | | | | | | | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
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Skarlis C, Anagnostouli M. The role of melatonin in Multiple Sclerosis. Neurol Sci 2019; 41:769-781. [PMID: 31845043 DOI: 10.1007/s10072-019-04137-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
Melatonin is a neurohormone mainly produced by the pineal gland following a circadian rhythm. It is characterized as a pleiotropic factor because it not only regulates the wake-sleep rhythm but also exerts antinociceptive, antidepressant, anxiolytic, and immunomodulating properties. Recent studies suggest that dysregulation of melatonin secretion is associated with the pathogenesis of various autoimmune diseases, such as, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS). MS is an autoimmune disorder characterized by an abnormal immune response directed against the myelin sheath in the central nervous system, demyelination, oligodendrocyte death, and axonal degeneration. Recent evidence reveals that melatonin secretion is dysregulated in MS patients, suggesting that melatonin could be a potential target for therapeutic intervention. Here, we summarize the available literature regarding the role of melatonin in immune processes relevant for experimental autoimmune encephalomyelitis (EAE), MS, and the current clinical trials of melatonin supplementation in MS patients.
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Affiliation(s)
- Charalampos Skarlis
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas. Sophias, 74, 115 28, Athens, Greece.
| | - Maria Anagnostouli
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas. Sophias, 74, 115 28, Athens, Greece. .,Demyelinating Diseases Clinic, 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece.
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Oh J, Alikhani K, Bruno T, Devonshire V, Giacomini PS, Giuliani F, Nakhaipour HR, Schecter R, Larochelle C. Diagnosis and management of secondary-progressive multiple sclerosis: time for change. Neurodegener Dis Manag 2019; 9:301-317. [PMID: 31769344 DOI: 10.2217/nmt-2019-0024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Identifying the transition of relapsing-remitting multiple sclerosis (MS) to the secondary-progressive MS form remains a clinical challenge due to the gradual nature of the transition, superimposed relapses, the heterogeneous course of disease among patients and the absence of validated biomarkers and diagnostic tools. The uncertainty associated with the transition makes clinical care challenging for both patients and physicians. The emergence of new disease-modifying treatments for progressive MS and the increasing emphasis of nonpharmacological strategies mark a new era in the treatment of progressive MS. This article summarizes challenges in diagnosis and management, discusses novel treatment strategies and highlights the importance of establishing a clear diagnosis and instituting an interdisciplinary management plan in the care of patients with progressive MS.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tania Bruno
- Division of Physiatry, Department of Medicine, University Health Network - Toronto Rehabilitation Institute, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Virginia Devonshire
- Division of Neurology, Department of Medicine, University of British Columbia MS/NMO Center, Vancouver, BC V6T 1Z3, Canada
| | - Paul S Giacomini
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Fabrizio Giuliani
- Division of Neurology, Neuroscience & Mental Health Institute, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Robyn Schecter
- Novartis Pharmaceuticals Canada, Montreal, QC H9S 1A9, Canada
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Comparison of multiple sclerosis patients with and without oligoclonal IgG bands in South China. J Clin Neurosci 2019; 66:51-55. [DOI: 10.1016/j.jocn.2019.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
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Li R, Bar-Or A. The Multiple Roles of B Cells in Multiple Sclerosis and Their Implications in Multiple Sclerosis Therapies. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a029108. [PMID: 29661809 DOI: 10.1101/cshperspect.a029108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Increasing evidence has suggested that both antibody-dependent and antibody-independent functions of B cells are involved in multiple sclerosis (MS). The contrasting results of distinct B-cell targeting therapies in MS patients underscores the importance of elucidating these multiple B-cell functions. In this review, we discuss the generation of autoreactive B cells, migration of B cells into the central nervous system (CNS), and how different functions of B cells may contribute to MS disease activity and potentially mitigation in both the periphery and CNS compartments. In addition, we propose several future therapeutic strategies that may better target/shape B-cell responses for long-term treatment of MS.
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Affiliation(s)
- Rui Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Palace J, Duddy M, Lawton M, Bregenzer T, Zhu F, Boggild M, Piske B, Robertson NP, Oger J, Tremlett H, Tilling K, Ben-Shlomo Y, Lilford R, Dobson C. Assessing the long-term effectiveness of interferon-beta and glatiramer acetate in multiple sclerosis: final 10-year results from the UK multiple sclerosis risk-sharing scheme. J Neurol Neurosurg Psychiatry 2019; 90:251-260. [PMID: 30242090 PMCID: PMC6518464 DOI: 10.1136/jnnp-2018-318360] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/14/2018] [Accepted: 07/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Because multiple sclerosis (MS) is a chronic disease causing disability over decades, it is crucial to know if the short-term effects of disease-modifying therapies reported in randomised controlled trials reduce long-term disability. This 10-year prospective observational study of disability outcomes (Expanded Disability Status Scale (EDSS) and utility) was set up, in conjunction with a risk-sharing agreement between payers and producers, to investigate this issue. METHODS The outcomes of the UK treated patients were compared with a modelled untreated control based on the British Columbia MS data set to assess the long-term effectiveness of these treatments. Two complementary analysis models were used: a multilevel model (MLM) and a continuous Markov model. RESULTS 4862 patients with MS were eligible for the primary analysis (mean and median follow-up times 8.7 and 10 years). EDSS worsening was reduced by 28% (MLM), 7% (Markov) and 24% time-adjusted Markov in the total cohort, and by 31% (MLM) and 14% (Markov) for relapsing remitting patients. The utility worsening was reduced by 23%-24% in the total cohort and by 24%-31% in the RR patients depending on the model used. All sensitivity analyses showed a treatment effect. There was a 4-year (CI 2.7 to 5.3) delay to EDSS 6.0. An apparent waning of treatment effect with time was seen. Subgroup analyses suggested better treatment effects in those treated earlier and with lower EDSS scores. CONCLUSIONS This study supports a beneficial effect on long-term disability with first-line MS disease-modifying treatments, which is clinically meaningful. However the waning effect noted requires further study.
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Affiliation(s)
- Jacqueline Palace
- Clinical Neurology, The Oxford University Hospitals Trust, Oxford, UK
| | - Martin Duddy
- Department of Neurology, The Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, UK
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Feng Zhu
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Boggild
- The Townsville Hospital, Townsville, Queensland, Australia
| | | | - Neil P Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK
| | - Joel Oger
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Oligoclonal bands in multiple sclerosis; Functional significance and therapeutic implications. Does the specificity matter? Mult Scler Relat Disord 2018; 25:131-137. [DOI: 10.1016/j.msard.2018.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 01/24/2023]
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Novakova L, Axelsson M, Malmeström C, Imberg H, Elias O, Zetterberg H, Nerman O, Lycke J. Searching for neurodegeneration in multiple sclerosis at clinical onset: Diagnostic value of biomarkers. PLoS One 2018; 13:e0194828. [PMID: 29614113 PMCID: PMC5882126 DOI: 10.1371/journal.pone.0194828] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neurodegeneration occurs during the early stages of multiple sclerosis. It is an essential, devastating part of the pathophysiology. Tools for measuring the degree of neurodegeneration could improve diagnostics and patient characterization. OBJECTIVE This study aimed to determine the diagnostic value of biomarkers of degeneration in patients with recent clinical onset of suspected multiple sclerosis, and to evaluate these biomarkers for characterizing disease course. METHODS This cross-sectional study included 271 patients with clinical features of suspected multiple sclerosis onset and was the baseline of a prospective study. After diagnostic investigations, the patients were classified into the following disease groups: patients with clinically isolated syndrome (n = 4) or early relapsing remitting multiple sclerosis (early RRMS; n = 93); patients with relapsing remitting multiple sclerosis with disease durations ≥2 years (established RRMS; n = 39); patients without multiple sclerosis, but showing symptoms (symptomatic controls; n = 89); and patients diagnosed with other diseases (n = 46). In addition, we included healthy controls (n = 51) and patients with progressive multiple sclerosis (n = 23). We analyzed six biomarkers of neurodegeneration: cerebrospinal fluid neurofilament light chain levels; cerebral spinal fluid glial fibrillary acidic protein; cerebral spinal fluid tau; retinal nerve fiber layer thickness; macula volume; and the brain parenchymal fraction. RESULTS Except for increased cerebral spinal fluid neurofilament light chain levels, median 670 ng/L (IQR 400-2110), we could not find signs of early degeneration in the early disease group with recent clinical onset. However, the intrathecal immunoglobin G production and cerebral spinal fluid neurofilament light chain levels showed diagnostic value. Moreover, elevated levels of cerebral spinal fluid glial fibrillary acidic protein, thin retinal nerve fiber layers, and low brain parenchymal fractions were associated with progressive disease, but not with the other phenotypes. Thin retinal nerve fiber layers and low brain parenchymal fractions, which indicated neurodegeneration, were associated with longer disease duration. CONCLUSIONS In clinically suspected multiple sclerosis, intrathecal immunoglobin G production and neurofilament light chain levels had diagnostic value. Therefore, these biomarkers could be included in diagnostic work-ups for multiple sclerosis. We found that the thickness of the retinal nerve fiber layer and the brain parenchymal fraction were not different between individuals that were healthy, symptomatic, or newly diagnosed with multiple sclerosis. This finding suggested that neurodegeneration had not reached a significant magnitude in patients with a recent clinical onset of multiple sclerosis.
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Affiliation(s)
- Lenka Novakova
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Markus Axelsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clas Malmeström
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Imberg
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Olle Elias
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Olle Nerman
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Jan Lycke
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abdelhak A, Hottenrott T, Mayer C, Hintereder G, Zettl UK, Stich O, Tumani H. CSF profile in primary progressive multiple sclerosis: Re-exploring the basics. PLoS One 2017; 12:e0182647. [PMID: 28797088 PMCID: PMC5552348 DOI: 10.1371/journal.pone.0182647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this study was to report the basic cerebrospinal fluid (CSF) profile in patients with primary progressive multiple sclerosis (PPMS). Methods The results of CSF analysis from 254 patients with PPMS were collected at four university hospitals in Germany. Routine CSF parameters and different indices of intrathecal immunoglobulin synthesis were evaluated. We assessed possible correlations between the various CSF parameters and the expanded disability status scale (EDSS) both at the time of lumbar puncture and during the course of the disease. Results The median cell count and albumin concentration in the CSF did not deviate from normal values. The CSF-serum albumin-quotient (QALB) was elevated in 29.6% of the patients, while intrathecal immunoglobulin G (IgG) oligoclonal bands (OCBs) were detected in 91.1% of the patients. CSF-lactate levels as well as local IgM- and IgA-synthesis were correlated with the yearly disease progression rate, as assessed by EDSS. Conclusion We present the results of the hitherto largest and most detailed CSF biomarker profile in a cohort of 254 patients with PPMS. As reported previously, OCBs are the most sensitive marker for intrathecal IgG synthesis. CSF-lactate concentrations are positively correlated with the progression rate, which might suggest that mitochondrial dysfunction plays a relevant role in PPMS. The negative correlation between intrathecally produced IgM and IgA and disease progression may indicate their hitherto unexplored protective role.
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Affiliation(s)
| | - Tilman Hottenrott
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Christoph Mayer
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Gudrun Hintereder
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University Hospital Rostock, Rostock, Germany
| | - Oliver Stich
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
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Gastaldi M, Zardini E, Franciotta D. An update on the use of cerebrospinal fluid analysis as a diagnostic tool in multiple sclerosis. Expert Rev Mol Diagn 2016; 17:31-46. [DOI: 10.1080/14737159.2017.1262260] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
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Farez MF, Calandri IL, Correale J, Quintana FJ. Anti-inflammatory effects of melatonin in multiple sclerosis. Bioessays 2016; 38:1016-26. [DOI: 10.1002/bies.201600018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mauricio F. Farez
- Center for Research on Neuroimmunological Diseases (CIEN); Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Ismael L. Calandri
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Jorge Correale
- Center for Research on Neuroimmunological Diseases (CIEN); Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Francisco J. Quintana
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- The Broad Institute; Cambridge MA USA
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Pelletier J. [Is it always useful to perform lumbar puncture for the diagnosis of multiple sclerosis? No]. Rev Neurol (Paris) 2015; 171:607-10. [PMID: 26343922 DOI: 10.1016/j.neurol.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
In the absence of a specific test for the diagnosis of multiple sclerosis (MS), cerebrospinal fluid analysis (CSF) remains discussed. There are robust evidences which demonstrated that an early diagnosis of MS must be done, due to the availability of disease-modifying drugs that could influence the natural history of the disease. However, several arguments can be put forward to assert that CSF analysis is not useful for the diagnosis of MS and thus should not be realized in a systematic way. First, MRI remains the most sensitive and specific marker to validate dissemination in space and in time and CSF analysis is not recommended by the 2010 McDonald criteria. The second argument is related to the low sensitivity and specificity of abnormalities detected in CSF analysis to confirm the diagnosis of MS. Moreover, there is currently no evidence that the presence of oligoclonal bands could represent a surrogate marker on an individual prognostic way. Furthermore, lumbar puncture could be traumatic, may entail some infrequent risks and represents unnecessary expense. Thus, there are strong reasons to not recommend systematic CSF examination to diagnose MS.
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Affiliation(s)
- J Pelletier
- Service de neurologie, pôle de neurosciences cliniques, hôpital de la Timone, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Oligoclonal Bands in Cerebrospinal Fluid of Black Patients with Multiple Sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:217961. [PMID: 26295036 PMCID: PMC4532820 DOI: 10.1155/2015/217961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/21/2015] [Accepted: 06/03/2015] [Indexed: 11/18/2022]
Abstract
Genetic susceptibility is a well-recognized factor in the onset of multiple sclerosis (MS). The objective of this study was to determine the frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid, in an ethnically mixed group of MS patients in the city of São Paulo, Brazil. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. OCB were found in 49 (54.4%) out of 90 patients with clinically definite MS; out of the 23 brown/black patients, 17 (73.9%) were OCB+; out of the 66 white patients, 32 (48.5%) were OCB+; and the only patient yellow was OCB+ (p = 0.05). Analysis of the IgG index was also consistent with the findings, but with lower statistical significance. The data presented in our study show that the ethnic differences in MS extend to the immune response.
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Does cerebrospinal fluid analysis add predictive value to magnetic resonance imaging for long term irreversible disability in patients with early multiple sclerosis? J Neurol Sci 2015; 354:51-5. [DOI: 10.1016/j.jns.2015.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/07/2015] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
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Becker M, Latarche C, Roman E, Debouverie M, Malaplate-Armand C, Guillemin F. No prognostic value of routine cerebrospinal fluid biomarkers in a population-based cohort of 407 multiple sclerosis patients. BMC Neurol 2015; 15:79. [PMID: 25966681 PMCID: PMC4430897 DOI: 10.1186/s12883-015-0330-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value. Methods We followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof’s criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m). Results For 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2–7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46–0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis. Conclusion Routine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.
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Affiliation(s)
- Madlyne Becker
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France.
| | - Clotilde Latarche
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France.
| | - Emilie Roman
- Metz-Thionville Hospital, Bel Air Hospital, Departement of Biology, F-57 100, Thionville, France.
| | - Marc Debouverie
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France. .,Department of Neurology, Nancy University Hospital, F-54 000, Nancy, France.
| | | | - Francis Guillemin
- INSERM, CIC-EC, CIC 1433, F-54 000, Nancy, France. .,Departement of Clinical Epidemiology and Evaluation, Nancy University Hospital, F-54 000, Nancy, France. .,Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, F-54 000, Nancy, France. .,Department of Clinical Epidemiology and Evaluation, CHU de Nancy, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre Les, Nancy, France.
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Palace J, Duddy M, Bregenzer T, Lawton M, Zhu F, Boggild M, Piske B, Robertson NP, Oger J, Tremlett H, Tilling K, Ben-Shlomo Y, Dobson C. Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: a clinical cohort study with natural history comparator. Lancet Neurol 2015; 14:497-505. [PMID: 25841667 DOI: 10.1016/s1474-4422(15)00018-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/24/2015] [Accepted: 02/27/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND In 2002, the UK's National Institute for Clinical Excellence (NICE) concluded that interferon beta and glatiramer acetate would be cost effective as disease-modifying therapies (DMTs) for multiple sclerosis only if the short-term disability benefits reported in clinical trials were maintained. The UK Multiple Sclerosis Risk Sharing Scheme (RSS) was established to assess whether disability progression was consistent with a cost-effectiveness target of £36 000 per quality-adjusted life-year projected over 20 years. We aimed to evaluate the long-term effectiveness and cost-effectiveness of these DMTs by comparing a cohort of patients with relapsing-remitting multiple sclerosis enrolled in the UK RSS with a natural history cohort from British Columbia, Canada. METHODS In our clinical cohort we included patients starting a DMT who were enrolled in the UK RSS who had relapsing multiple sclerosis at baseline and had at least one further clinical assessment. In our control cohort we included patients in the British Columbia multiple sclerosis database (BCMS; data collection 1980-96) who met the same eligibility criteria as for the RSS cohort. We compared disability progression at 6 years for RSS patients with untreated progression modelled from BCMS patients using continuous Markov and multilevel models. The primary outcomes were the progression ratio (treated vs untreated) measured both in Expanded Disability Status Scale (EDSS) score and utility. A ratio of less than 100% for EDSS implied slower than expected progression on treatment compared with off treatment; a utility ratio of 62% or less implied that the DMTs were cost effective. FINDINGS 5610 patients starting a DMT were enrolled in the UK RSS between Jan 14, 2002, and July 13, 2005 (72 sites), of whom 4137 were included in our clinical cohort. We included 898 BCMS patients in the control cohort who met the RSS inclusion criteria and had at least one EDSS score after baseline. RSS patients had a mean follow-up of 5·1 years (SD 1·4). Both models showed slower EDSS progression than predicted for untreated controls (Markov model, 75·8% [95% CI 71·4-80·2]; multilevel model, 60·0% [56·6-63·4]). Utility ratios were consistent with cost-effectiveness (Markov model, 58·5% [95% CI 54·2-62·8]; multilevel model, 57·1% [53·0-61·2]). INTERPRETATION Findings from this large observational study of treatment with interferon beta or glatiramer acetate provide evidence that their effects on disability in patients with relapsing-remitting multiple sclerosis are maintained and cost effective over 6 years. Similar modelling approaches could be applied to other chronic diseases for which long-term controlled trials are not feasible. FUNDING Health Departments of England, Wales, Scotland, and Northern Ireland, Biogen Idec, Merck Serono, Bayer Schering Pharmaceuticals, Teva Pharmaceuticals Industries, UK National Institute of Health Research's Health Technology Assessment Programme.
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Affiliation(s)
- Jacqueline Palace
- Department of Clinical Neurology, Oxford University Hospitals Trust, Oxford, UK
| | - Martin Duddy
- Department of Neurology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Thomas Bregenzer
- Department of Biostatistics, PAREXEL International, Berlin, Germany
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Feng Zhu
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Mike Boggild
- Department of Neurology, The Townsville Hospital, Townsville, QLD, Australia
| | - Benjamin Piske
- Department of Biostatistics, PAREXEL International, Berlin, Germany
| | - Neil P Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Joel Oger
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Serum proteomics in multiple sclerosis disease progression. J Proteomics 2015; 118:2-11. [PMID: 25753122 DOI: 10.1016/j.jprot.2015.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/30/2015] [Accepted: 02/15/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED Multiple sclerosis (MS) is associated with chronic degeneration of the central nervous system and may cause permanent neurological problems and considerable disability. While its causes remain unclear, its extensive phenotypic variability makes its prognosis and treatment difficult. The identification of serum proteomic biomarkers of MS progression could further our understanding of the molecular mechanisms related to MS disease processes. In the current study, we used isobaric tagging for relative and absolute protein quantification (iTRAQ) methodology and advanced multivariate statistical analysis to quantify and identify potential serum biomarker proteins of MS progression. We identified a panel of 11 proteins and combined them into a classifier that best classified samples into the two disease groups. The estimated area under the receiver operating curve of this classifier was 0.88 (p-value=0.017), with 86% sensitivity and specificity. The identified proteins encompassed processes related to inflammation, opsonization, and complement activation. Results from this study are in particular valuable to design a targeted Multiple Reaction Monitoring mass spectrometry based (MRM-MS) assay to conduct an external validation in an independent and larger cohort of patients. Validated biomarkers may result in the development of a minimally-invasive tool to monitor MS progression and complement current clinical practices. BIOLOGICAL SIGNIFICANCE A hallmark of multiple sclerosis is the unpredictable disease course (progression). There are currently no clinically useful biomarkers of MS disease progression; most work has focused on the analysis of CSF, which requires an invasive procedure. Here, we explore the potential of proteomics to identify panels of serum biomarkers of disease progression in MS. By comparing the protein signatures of two challenging to obtain, but well-defined, MS phenotypic groups at the extremes of progression (benign and aggressive cases of MS), we identified proteins that encompass processes related to inflammation, opsonization, and complement activation. Findings require validation, but are an important step on the pathway to clinically useful biomarker discovery. This article is part of a Special Issue entitled: Protein dynamics in health and disease. Guest Editors: Pierre Thibault and Anne-Claude Gingras.
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Raphael I, Webb J, Stuve O, Haskins W, Forsthuber T. Body fluid biomarkers in multiple sclerosis: how far we have come and how they could affect the clinic now and in the future. Expert Rev Clin Immunol 2014; 11:69-91. [PMID: 25523168 DOI: 10.1586/1744666x.2015.991315] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system, which affects over 2.5 million people worldwide. Although MS has been extensively studied, many challenges still remain in regards to treatment, diagnosis and prognosis. Typically, prognosis and individual responses to treatment are evaluated by clinical tests such as the expanded disability status scale, MRI and presence of oligoclonal bands in the cerebrospinal fluid. However, none of these measures correlates strongly with treatment efficacy or disease progression across heterogeneous patient populations and subtypes of MS. Numerous studies over the past decades have attempted to identify sensitive and specific biomarkers for diagnosis, prognosis and treatment efficacy of MS. The objective of this article is to review and discuss the current literature on body fluid biomarkers in MS, including research on potential biomarker candidates in the areas of miRNA, mRNA, lipids and proteins.
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Affiliation(s)
- Itay Raphael
- University of Texas San Antonio - Biology, San Antonio, TX, USA
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Zeman D, Hradilek P, Kusnierova P, Piza R, Reguliova K, Woznicova I, Zapletalova O. Oligoclonal free light chains in cerebrospinal fluid as markers of intrathecal inflammation. Comparison with oligoclonal IgG. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 159:104-13. [PMID: 25485529 DOI: 10.5507/bp.2014.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022] Open
Abstract
AIMS To compare the sensitivity and specificity of CSF-restricted oligoclonal IgG and free light chains as markers of multiple sclerosis and other inflammatory neurological diseases. METHODS 196 paired CSF and serum samples were examined for oligoclonal IgG and oligoclonal free light chains. The sensitivity and specificity of the tests were calculated and optimal cut-offs for the number of CSF-restricted oligoclonal bands were then determined by analysis of receiver operating characteristic curves. RESULTS Optimal cut-off values were ≥5 IgG bands for multiple sclerosis, ≥4 IgG bands for inflammatory neurological disease, ≥6 free κ, and ≥2 free λ bands for both purposes. Using these cut-off values, sensitivities and specificities for multiple sclerosis were 83.8% and 91.3% for IgG, 83.8% and 81.0% for free κ, and 67.6% and 75.4% for free λ. For inflammatory neurological disease, sensitivities and specificities were 60.8% and 95.7% for IgG, 69.6% and 92.6% for free κ, and 64.8% and 86.2% for free λ. CONCLUSIONS Although exact cut-off values may vary according to method, reporting borderline results as positive, may compromise the specificity of the test and should be avoided.. The detection of intrathecal free light chain synthesis may be of value especially when the oligoclonal IgG test is negative or borderline, even though its specificity is slightly lower.
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Affiliation(s)
- David Zeman
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic
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Villar LM, Casanova B, Ouamara N, Comabella M, Jalili F, Leppert D, de Andrés C, Izquierdo G, Arroyo R, Avşar T, Lapin SV, Johnson T, Montalbán X, Fernández O, Álvarez-Lafuente R, Masterman D, García-Sánchez MI, Coret F, Siva A, Evdoshenko E, Álvarez-Cermeño JC, Bar-Or A. Immunoglobulin M oligoclonal bands: Biomarker of targetable inflammation in primary progressive multiple sclerosis. Ann Neurol 2014; 76:231-40. [DOI: 10.1002/ana.24190] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Luisa M. Villar
- Immunology and Neurology Service; Multiple Sclerosis Unit, Ramón y Cajal University Hospital; Madrid Spain
| | - Bonaventura Casanova
- Multiple Sclerosis Unit; La Fe University and Polytechnic Hospital; Valencia Spain
| | - Nadia Ouamara
- Experimental Therapeutics Program, Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | - Manuel Comabella
- Neurological/Neuroimmunological Service; Multiple Sclerosis Center of Catalonia, Vall d'Hebron University Hospital; Barcelona Spain
| | - Farzaneh Jalili
- Neuroimmunology Unit; Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | | | - Clara de Andrés
- Neurology Service; Gregorio Marañón University Hospital; Madrid Spain
| | | | - Rafael Arroyo
- Neurology Service; Health Research Institute of the San Carlos Clinical University Hospital; Madrid Spain
| | - Timuçin Avşar
- Genetics and Biotechnology Program; Department of Molecular Biology; Istanbul Technical University; Istanbul Turkey
| | - Sergey V. Lapin
- Center for Molecular Medicine; Pavlov State Medical University; St Petersburg Russia
| | - Trina Johnson
- Experimental Therapeutics Program, Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | - Xavier Montalbán
- Neurological/Neuroimmunological Service; Multiple Sclerosis Center of Catalonia, Vall d'Hebron University Hospital; Barcelona Spain
| | - Oscar Fernández
- Neurology Service; Regional University Hospital of Málaga; Málaga Spain
| | - Roberto Álvarez-Lafuente
- Neurology Service; Health Research Institute of the San Carlos Clinical University Hospital; Madrid Spain
| | | | | | - Francisco Coret
- Neurology Service; Clinical University Hospital; Valencia Spain
| | - Aksel Siva
- Department of Neurology; Cerrahpaşa School of Medicine, Istanbul University; Istanbul Turkey
| | - Evgeniy Evdoshenko
- St Petersburg Center for Multiple Sclerosis and Autoimmune Diseases; City Hospital; St Petersburg Russia
| | - José C. Álvarez-Cermeño
- Immunology and Neurology Service; Multiple Sclerosis Unit, Ramón y Cajal University Hospital; Madrid Spain
- Department of Medicine; University of Alcalá de Henares; Madrid Spain
| | - Amit Bar-Or
- Experimental Therapeutics Program, Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
- Neuroimmunology Unit; Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
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Ahmed RM, Murphy E, Davagnanam I, Parton M, Schott JM, Mummery CJ, Rohrer JD, Lachmann RH, Houlden H, Fox NC, Chataway J. A practical approach to diagnosing adult onset leukodystrophies. J Neurol Neurosurg Psychiatry 2014; 85:770-81. [PMID: 24357685 DOI: 10.1136/jnnp-2013-305888] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R M Ahmed
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - E Murphy
- The Charles Dent Metabolic Unit, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - I Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery and Brain Repair and Rehabilitation unit UCL Institute of Neurology, London, UK
| | - M Parton
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - C J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - R H Lachmann
- The Charles Dent Metabolic Unit, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - H Houlden
- Department of Molecular Neurosciences, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - N C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
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Scott O, Richer L, Forbes K, Sonnenberg L, Currie A, Eliyashevska M, Goez HR. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis: an unusual cause of autistic regression in a toddler. J Child Neurol 2014; 29:691-4. [PMID: 24092894 DOI: 10.1177/0883073813501875] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Anti N-methyl-d-aspartate (NMDA) receptor encephalitis in children is associated with psychiatric changes, seizures, and dyskinesias. We present the first report of autistic regression in a toddler caused by this entity. A 33-month-old boy presented with decreased appetite, irritability, and insomnia following an upper respiratory tract infection. Over the next few weeks he lost language and social skills, and abnormal movements of his hand developed. Within a month, this patient came to fit the diagnostic criteria for autistic spectrum disorder. Upon investigation, anti-NMDA receptor antibodies were found in the boy's cerebrospinal fluid. He was treated with intravenous immunoglobulins and steroids, resulting in reacquisition of language and social skills and resolution of movements. Our case emphasizes the significance of suspecting anti-NMDA receptor encephalitis as the cause of autistic regression, even in an age group where the diagnosis of autistic spectrum disorder is typically made, and especially when presentation follows a febrile illness.
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Affiliation(s)
- Ori Scott
- 1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Yoshimura S, Isobe N, Matsushita T, Masaki K, Sato S, Kawano Y, Ochi H, Kira JI. Genetic and infectious profiles influence cerebrospinal fluid IgG abnormality in Japanese multiple sclerosis patients. PLoS One 2014; 9:e95367. [PMID: 24736746 PMCID: PMC3988235 DOI: 10.1371/journal.pone.0095367] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/26/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Abnormal intrathecal synthesis of IgG, reflected by cerebrospinal fluid (CSF) oligoclonal IgG bands (OBs) and increased IgG index, is much less frequently observed in Japanese multiple sclerosis (MS) cohorts compared with Western cohorts. We aimed to clarify whether genetic and common infectious backgrounds influence CSF IgG abnormality in Japanese MS patients. METHODOLOGY We analyzed HLA-DRB1 alleles, and IgG antibodies against Chlamydia pneumoniae, Helicobacter pylori, Epstein-Barr virus nuclear antigen (EBNA), and varicella zoster virus (VZV) in 94 patients with MS and 367 unrelated healthy controls (HCs). We defined CSF IgG abnormality as the presence of CSF OBs and/or increased IgG index (>0.658). PRINCIPAL FINDINGS CSF IgG abnormality was found in 59 of 94 (62.8%) MS patients. CSF IgG abnormality-positive patients had a significantly higher frequency of brain MRI lesions meeting the Barkhof criteria compared with abnormality-negative patients. Compared with HCs, CSF IgG abnormality-positive MS patients showed a significantly higher frequency of DRB1 1501, whereas CSF IgG abnormality-negative patients had a significantly higher frequency of DRB1 0405. CSF IgG abnormality-positive MS patients had a significantly higher frequency of anti-C. pneumoniae IgG antibodies compared with CSF IgG abnormality-negative MS patients, although there was no difference in the frequency of anti-C. pneumoniae IgG antibodies between HCs and total MS patients. Compared with HCs, anti-H. pylori IgG antibodies were detected significantly less frequently in the total MS patients, especially in CSF IgG abnormality-negative MS patients. The frequencies of antibodies against EBNA and VZV did not differ significantly among the groups. CONCLUSIONS CSF IgG abnormality is associated with Western MS-like brain MRI features. DRB1 1501 and C. pneumoniae infection confer CSF IgG abnormality, while DRB1 0405 and H. pylori infection are positively and negatively associated with CSF IgG abnormality-negative MS, respectively, suggesting that genetic and environmental factors differentially contribute to MS susceptibility according to the CSF IgG abnormality status.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuhisa Masaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinya Sato
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuji Kawano
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Ochi
- Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Salvisberg C, Tajouri N, Hainard A, Burkhard PR, Lalive PH, Turck N. Exploring the human tear fluid: discovery of new biomarkers in multiple sclerosis. Proteomics Clin Appl 2014; 8:185-94. [PMID: 24488530 DOI: 10.1002/prca.201300053] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/19/2013] [Accepted: 01/22/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE Multiple sclerosis is the first cause of progressive neurological disability among young adults living in Western countries. Its diagnosis is mostly based on clinical evaluation, neuroimaging, and in some cases cerebrospinal fluid (CSF) analysis, but no definitive diagnostic test exists. We proposed here that the exploration of tears from multiple sclerosis patients could lead to the discovery of new biomarkers. EXPERIMENTAL DESIGN Thirty multiple sclerosis patients (20% men) recruited to the Geneva University Hospitals were included in our study (mean age ± SD [years]: 42.4 ± 15.9). Twenty-five control patients (32% men) were also enrolled (mean age ± SD [years]: 42.7±15.1). Tears, CSF or blood was collected for each patient. Three independent quantitative (tandem mass tag) experiments were carried out between tears from multiple sclerosis and control patients. Protein verification was performed by Western blot on tears and CSF and by ELISA on serum samples. RESULTS Combined proteomics analyses provided 185 identified tear proteins. Among the differential proteins, alpha-1 antichymotrypsin was the only one to be significantly increased in the three experiments with similar ratios (ratios 1.6 to 2.5, p < 0.05). Its tear, CSF and serum elevation were further confirmed by Western blot and ELISA, respectively. CONCLUSIONS AND CLINICAL RELEVANCE This study supports the concept that modifications of the tear proteome can reflect biological abnormalities associated with multiple sclerosis and perhaps other inflammatory conditions affecting the CNS. In addition, alpha-1 antichymotrypsin elevation in tear fluid emerges as a promising biomarker for the diagnosis of multiple sclerosis.
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Affiliation(s)
- Cindy Salvisberg
- Translational Biomarker Group, Department of Human Protein Sciences, Medical University Center, Geneva, Switzerland
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Palace J, Bregenzer T, Tremlett H, Oger J, Zhu F, Boggild M, Duddy M, Dobson C. UK multiple sclerosis risk-sharing scheme: a new natural history dataset and an improved Markov model. BMJ Open 2014; 4:e004073. [PMID: 24441054 PMCID: PMC3902459 DOI: 10.1136/bmjopen-2013-004073] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES In 2002, the UK's National Institute for Health and Care Excellence concluded that the multiple sclerosis (MS) disease modifying therapies; interferon-β and glatiramer acetate, were not cost effective over the short term but recognised that reducing disability over the longer term might dramatically improve the cost effectiveness. The UK Risk-sharing Scheme (RSS) was established to ensure cost-effective provision by prospectively collecting disability-related data from UK-treated patients with MS and comparing findings to a natural history (untreated) cohort. However, deficiencies were found in the originally selected untreated cohort and the resulting analytical approach. This study aims to identify a more suitable natural history cohort and to develop a robust analytical approach using the new cohort. DESIGN The Scientific Advisory Group, recommended the British Columbia Multiple Sclerosis (BCMS) database, Canada, as providing a more suitable natural history comparator cohort. Transition probabilities were derived and different Markov models (discrete and continuous) with and without baseline covariates were applied. SETTING MS clinics in Canada and the UK. PARTICIPANTS From the BCMS database, 898 'untreated' patients with MS considered eligible for drug treatment based on the UK's Association of British Neurologists criteria. OUTCOME MEASURE The predicted Expanded Disability Status Scale (EDSS) score was collected and assessed for goodness of fit when compared with actual outcome. RESULTS The BCMS untreated cohort contributed 7335 EDSS scores over a median 6.4 years (6357 EDSS 'transitions' recorded at consecutive visits) during the period 1980-1995. A continuous Markov model with 'onset age' as a binary covariate was deemed the most suitable model for future RSS analysis. CONCLUSIONS A new untreated MS cohort from British Columbia has been selected and will be modelled using a continuous Markov model with onset age as a baseline covariate. This approach will now be applied to the treated UK RSS MS cohort for future price adjustment calculations.
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Affiliation(s)
- Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | | | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Oger
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fheng Zhu
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Boggild
- Neurology Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Martin Duddy
- Neurology Department, The Newcastle upon Tyne Hospitals, Newcastle, UK
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Axelsson M, Mattsson N, Malmeström C, Zetterberg H, Lycke J. The influence of disease duration, clinical course, and immunosuppressive therapy on the synthesis of intrathecal oligoclonal IgG bands in multiple sclerosis. J Neuroimmunol 2013; 264:100-5. [PMID: 24125567 DOI: 10.1016/j.jneuroim.2013.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 01/06/2023]
Abstract
We investigated the impact of disease duration, clinical course and immunosuppressive therapy on intrathecal IgG synthesis in multiple sclerosis (MS). Cerebrospinal fluid (CSF) was obtained twice, 8-10 years apart, from 20 MS patients and 26 healthy controls, and from 22 MS patients before and after two years of mitoxantrone treatment. The oligoclonal IgG band patterns changed in 15 patients at long-term follow-up, but were only influenced in 4 patients by mitoxantrone therapy. The CSF B-cell-regulating chemokine CXCL13 correlated with intrathecal IgG production suggesting a B-cell-dependence of intrathecal IgG synthesis in MS.
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Affiliation(s)
- Markus Axelsson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Mero IL, Gustavsen MW, Sæther HS, Flåm ST, Berg-Hansen P, Søndergaard HB, Jensen PEH, Berge T, Bjølgerud A, Muggerud A, Aarseth JH, Myhr KM, Celius EG, Sellebjerg F, Hillert J, Alfredsson L, Olsson T, Oturai AB, Kockum I, Lie BA, Andreassen BK, Harbo HF. Oligoclonal band status in Scandinavian multiple sclerosis patients is associated with specific genetic risk alleles. PLoS One 2013; 8:e58352. [PMID: 23472185 PMCID: PMC3589422 DOI: 10.1371/journal.pone.0058352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/03/2013] [Indexed: 12/24/2022] Open
Abstract
The presence of oligoclonal bands (OCB) in cerebrospinal fluid (CSF) is a typical finding in multiple sclerosis (MS). We applied data from Norwegian, Swedish and Danish (i.e. Scandinavian) MS patients from a genome-wide association study (GWAS) to search for genetic differences in MS relating to OCB status. GWAS data was compared in 1367 OCB positive and 161 OCB negative Scandinavian MS patients, and nine of the most associated SNPs were genotyped for replication in 3403 Scandinavian MS patients. HLA-DRB1 genotypes were analyzed in a subset of the OCB positive (n = 2781) and OCB negative (n = 292) MS patients and compared to 890 healthy controls. Results from the genome-wide analyses showed that single nucleotide polymorphisms (SNPs) from the HLA complex and six other loci were associated to OCB status. In SNPs selected for replication, combined analyses showed genome-wide significant association for two SNPs in the HLA complex; rs3129871 (p = 5.7×10(-15)) and rs3817963 (p = 5.7×10(-10)) correlating with the HLA-DRB1*15 and the HLA-DRB1*04 alleles, respectively. We also found suggestive association to one SNP in the Calsyntenin-2 gene (p = 8.83×10(-7)). In HLA-DRB1 analyses HLA-DRB1*15∶01 was a stronger risk factor for OCB positive than OCB negative MS, whereas HLA-DRB1*04∶04 was associated with increased risk of OCB negative MS and reduced risk of OCB positive MS. Protective effects of HLA-DRB1*01∶01 and HLA-DRB1*07∶01 were detected in both groups. The groups were different with regard to age at onset (AAO), MS outcome measures and gender. This study confirms both shared and distinct genetic risk for MS subtypes in the Scandinavian population defined by OCB status and indicates different clinical characteristics between the groups. This suggests differences in disease mechanisms between OCB negative and OCB positive MS with implications for patient management, which need to be further studied.
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Affiliation(s)
- Inger-Lise Mero
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Marte W. Gustavsen
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hanne S. Sæther
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Siri T. Flåm
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helle B. Søndergaard
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Poul Erik H. Jensen
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tone Berge
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anja Bjølgerud
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aslaug Muggerud
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan H. Aarseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Kjell-Morten Myhr
- The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Centre for MS-research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Finn Sellebjerg
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, The Multiple Sclerosis Research Group, Center for Molecular Medicine, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, The Neuroimmunology Research Group, Stockholm, Sweden
| | - Annette Bang Oturai
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, The Neuroimmunology Research Group, Stockholm, Sweden
| | - Benedicte A. Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Bettina Kulle Andreassen
- Department of Clinical Molecular Biology and Laboratory Sciences (EpiGen), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Biostiatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hanne F. Harbo
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
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