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Mascali D, Villani A, Chiarelli AM, Biondetti E, Lipp I, Digiovanni A, Pozzilli V, Caporale AS, Rispoli MG, Ajdinaj P, D'Apolito M, Grasso E, Sensi SL, Murphy K, Tomassini V, Wise RG. Pathophysiology of multiple sclerosis damage and repair: Linking cerebral hypoperfusion to the development of irreversible tissue loss in multiple sclerosis using magnetic resonance imaging. Eur J Neurol 2023; 30:2348-2356. [PMID: 37154298 PMCID: PMC7615142 DOI: 10.1111/ene.15827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/10/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND PURPOSE Reduced cerebral perfusion has been observed in multiple sclerosis (MS) and may contribute to tissue loss both acutely and chronically. Here, we test the hypothesis that hypoperfusion occurs in MS and relates to the presence of irreversible tissue damage. METHODS In 91 patients with relapsing MS and 26 healthy controls (HC), gray matter (GM) cerebral blood flow (CBF) was assessed using pulsed arterial spin labeling. GM volume, T1 hypointense and T2 hyperintense lesion volumes (T1LV and T2LV, respectively), and the proportion of T2-hyperintense lesion volume that appears hypointense on T1-weighted magnetic resonance imaging (T1LV/T2LV) were quantified. GM CBF and GM volume were evaluated globally, as well as regionally, using an atlas-based approach. RESULTS Global GM CBF was lower in patients (56.9 ± 12.3 mL/100 g/min) than in HC (67.7 ± 10.0 mL/100 g/min; p < 0.001), a difference that was widespread across brain regions. Although total GM volume was comparable between groups, significant reductions were observed in a subset of subcortical structures. GM CBF negatively correlated with T1LV (r = -0.43, p = 0.0002) and T1LV/T2LV (r = -0.37, p = 0.0004), but not with T2LV. CONCLUSIONS GM hypoperfusion occurs in MS and is associated with irreversible white matter damage, thus suggesting that cerebral hypoperfusion may actively contribute and possibly precede neurodegeneration by hampering tissue repair abilities in MS.
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Affiliation(s)
- Daniele Mascali
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Alessandro Villani
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Antonio M. Chiarelli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Emma Biondetti
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Ilona Lipp
- Department of NeurophysicsMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Anna Digiovanni
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Valeria Pozzilli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Alessandra S. Caporale
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Marianna G. Rispoli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Paola Ajdinaj
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Maria D'Apolito
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Eleonora Grasso
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Department of PaediatricsSS. Annunziata University HospitalChietiItaly
| | - Stefano L. Sensi
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Centre for Advanced Studies and TechnologyG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre, School of Physics and AstronomyCardiff UniversityCardiffUK
| | - Valentina Tomassini
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Richard G. Wise
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
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Zhao MY, Dahlen A, Ramirez NJ, Moseley M, Van Haren K, Zaharchuk G. Effect of vitamin D supplementation on cerebral blood flow in male patients with adrenoleukodystrophy. J Neurosci Res 2023; 101:1086-1097. [PMID: 36967233 DOI: 10.1002/jnr.25187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
One-third of boys with X-linked adrenoleukodystrophy (ALD) develop inflammatory demyelinating lesions, typically at the splenium. These lesions share similarities with multiple sclerosis, including cerebral hypoperfusion and links to vitamin D insufficiency. We hypothesized that increasing vitamin D levels would increase cerebral blood flow (CBF) in ALD boys. We conducted an exploratory analysis of vitamin D supplementation and CBF using all available data from participants enrolled in a recent single-arm interventional study of vitamin D supplementation in boys with ALD. We measured whole brain and splenium CBF using arterial spin labeling (ASL) from three study time points (baseline, 6 months, and 12 months). We used linear generalized estimating equations to evaluate CBF changes between time points and to test for an association between CBF and vitamin D. ASL data were available for 16 participants, aged 2-22 years. Mean vitamin D levels increased by 72.7% (p < .001) after 6 months and 88.6% (p < .01) after 12 months. Relative to baseline measures, mean CBF of the whole brain (6 months: +2.5%, p = .57; 12 months: +6.1%, p = .18) and splenium (6 months: +1.2%, p = .80; 12 months: +7.4%, p = .058) were not significantly changed. Vitamin D levels were positively correlated with CBF in the splenium (slope = .59, p < .001). In this exploratory analysis, we observed a correlation between vitamin D levels and splenial CBF in ALD boys. We confirm the feasibility of measuring CBF in this brain region and population, but further work is needed to establish a causal role for vitamin D in modulating CBF.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, California, Stanford, USA
| | - Alex Dahlen
- Quantitative Sciences Unit, Stanford University School of Medicine, California, Stanford, USA
| | | | - Michael Moseley
- Department of Radiology, Stanford University, California, Stanford, USA
| | - Keith Van Haren
- Department of Neurology and Neurological Sciences, Stanford University, California, Stanford, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, California, Stanford, USA
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3
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Testud B, Delacour C, El Ahmadi AA, Brun G, Girard N, Duhamel G, Heesen C, Häußler V, Thaler C, Has Silemek AC, Stellmann JP. Brain grey matter perfusion in primary progressive multiple sclerosis: Mild decrease over years and regional associations with cognition and hand function. Eur J Neurol 2022; 29:1741-1752. [PMID: 35167161 DOI: 10.1111/ene.15289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extend and dynamic of neurodegeneration in progressive Multiple Sclerosis (MS) might be reflected by global and regional brain perfusion, an outcome at the intercept between structure and function. Here, we provide a first insight in the evolution of brain perfusion and its association with disability in primary progressive MS (PPMS) over several years. METHODS 77 persons with PPMS were followed over up to 5 years. Visits included a 3T MRI with pulsed Arterial spin labelling (ASL) perfusion, the Timed-25-Foot-Walk, 9-Hole-Peg-Test (NHPT), Symbol-Digit-Modalities-Test (SDMT) and Expanded Disability Status Scale (EDSS). We extracted regional cerebral blood flow surrogates and compared them to 11 controls. Analyses focused in cortical and deep gray matter, the change over time and associations with disability on regional and global level. RESULTS Baseline brain perfusion of patients and controls was comparable for the cortex (p=0.716) and deep grey matter (p=0.095). EDSS disability increased mildly (p=0.023) while brain perfusion decreased during follow up (p<0.001) and with disease duration (p=0.009). Lower global perfusion correlated with higher disability as indicated by EDSS, NHPT and Timed-25-Foot-Walk (p<0.001). The motor task NHPT showed associations with twenty gray matter regions. In contrast, better SDMT performance correlated with lower perfusion (p<0.001) in seven predominantly frontal regions indicating a functional maladaptation. CONCLUSION Decreasing perfusion indicates a putative association with MS disease mechanisms such as neurodegeneration, reduced metabolism, and loss of resilience. A low alteration rate limits its use in clinical practice, but regional association patterns might provide a snapshot of adaptive and maladaptive functional reorganization.
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Affiliation(s)
- Benoit Testud
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Clara Delacour
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | | | - Gilles Brun
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Nadine Girard
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Guillaume Duhamel
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arzu Ceylan Has Silemek
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - Jan-Patrick Stellmann
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
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Balıkçı A, Parmak Yener N, Seferoğlu M. Optical Coherence Tomography and Optical Coherence Tomography Angiography Findings in Multiple Sclerosis Patients. Neuroophthalmology 2021; 46:19-33. [DOI: 10.1080/01658107.2021.1963787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ayşe Balıkçı
- Department of Ophthalmology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Neslihan Parmak Yener
- Department of Ophthalmology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Meral Seferoğlu
- Department of Neurology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
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5
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Past, present and future role of retinal imaging in neurodegenerative disease. Prog Retin Eye Res 2021; 83:100938. [PMID: 33460813 PMCID: PMC8280255 DOI: 10.1016/j.preteyeres.2020.100938] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.
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6
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Haacke EM, Ge Y, Sethi SK, Buch S, Zamboni P. An Overview of Venous Abnormalities Related to the Development of Lesions in Multiple Sclerosis. Front Neurol 2021; 12:561458. [PMID: 33981281 PMCID: PMC8107266 DOI: 10.3389/fneur.2021.561458] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
The etiology of multiple sclerosis (MS) is currently understood to be autoimmune. However, there is a long history and growing evidence for disrupted vasculature and flow within the disease pathology. A broad review of the literature related to vascular effects in MS revealed a suggestive role for abnormal flow in the medullary vein system. Evidence for venous involvement in multiple sclerosis dates back to the early pathological work by Charcot and Bourneville, in the mid-nineteenth century. Pioneering work by Adams in the 1980s demonstrated vasculitis within the walls of veins and venules proximal to active MS lesions. And more recently, magnetic resonance imaging (MRI) has been used to show manifestations of the central vein as a precursor to the development of new MS lesions, and high-resolution MRI using Ferumoxytol has been used to reveal the microvasculature that has previously only been demonstrated in cadaver brains. Both approaches may shed new light into the structural changes occurring in MS lesions. The material covered in this review shows that multiple pathophysiological events may occur sequentially, in parallel, or in a vicious circle which include: endothelial damage, venous collagenosis and fibrin deposition, loss of vessel compliance, venous hypertension, perfusion reduction followed by ischemia, medullary vein dilation and local vascular remodeling. We come to the conclusion that a potential source of MS lesions is due to locally disrupted flow which in turn leads to remodeling of the medullary veins followed by endothelial damage with the subsequent escape of glial cells, cytokines, etc. These ultimately lead to the cascade of inflammatory and demyelinating events which ensue in the course of the disease.
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Affiliation(s)
- E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Yulin Ge
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
| | - Sean K. Sethi
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Sagar Buch
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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7
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Esmael A, Talaat M, Egila H, Eltoukhy K. Mitochondrial dysfunction and serum lactate as a biomarker for the progression and disability in MS and its correlation with the radiological findings. Neurol Res 2021; 43:582-590. [PMID: 33657991 DOI: 10.1080/01616412.2021.1893567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: To study the serum lactate level in MS and to explore its correlation with the progression and disability in multiple sclerosis (MS), and the important role of mitochondrial dysfunction in the pathogenesis of MS.Methods: This case-control study included 80 participants, involved 50 MS patients and 30 normal healthy controls. Detailed history taking, complete neurological examination, and clinical evaluation of the disability using the Expanded Disability Status Scale (EDSS) were done for all patients. Level of serum lactate was measured in both groups and was correlated with EDSS, MS subtypes, MRI brain, and MRS findings.Results: Serum lactate in MS patients was about three and half times higher than serum lactate levels of healthy controls (22.87 ± 5.92 mg/dl versus 6.39 ± 0.9 6.39 ± 0.91, p < 0.001). Importantly, serum lactate values were increased in MS cases with a progressive course compared with MS cases with RR course. Also, there were linearly correlations linking serum lactate levels and the duration of MS (r = 0.342, P = 0.015), relapses numbers (r = 0.335, P = 0.022), and EDSS (r = 0.483, P < 0.001). Also, there were strong positive correlations between serum lactate and Lipid/Lactate (r = 0.461, P = 0.001), periventricular lesion (r = 0.453, P = 0.005), and moderate positive correlations between serum lactate and juxtacortical lesion (r = 0.351, P = 0.02), and infratentorial lesion (r = 0.355, P = 0.02).Conclusion: Measurement of serum lactate may be helpful in MS and this supports the hypothesis of the critical role of mitochondrial dysfunction and axonal damage in MS.Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04210960.
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Affiliation(s)
- Ahmed Esmael
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Mona Talaat
- Diagnostic Radiology Department, Faculty of Medicine, Kafrelsheikh University, Kafr Ash Shaykh, Egypt
| | - Hosam Egila
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Khaled Eltoukhy
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
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Buch S, Subramanian K, Jella PK, Chen Y, Wu Z, Shah K, Bernitsas E, Ge Y, Haacke EM. Revealing vascular abnormalities and measuring small vessel density in multiple sclerosis lesions using USPIO. Neuroimage Clin 2020; 29:102525. [PMID: 33338965 PMCID: PMC7750444 DOI: 10.1016/j.nicl.2020.102525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Multiple Sclerosis (MS) is a progressive, inflammatory, neuro-degenerative disease of the central nervous system (CNS) characterized by a wide range of histopathological features including vascular abnormalities. In this study, an ultra-small superparamagnetic iron oxide (USPIO) contrast agent, Ferumoxytol, was administered to induce an increase in susceptibility for both arteries and veins to help better reveal the cerebral microvasculature. The purpose of this work was to examine the presence of vascular abnormalities and vascular density in MS lesions using high-resolution susceptibility weighted imaging (SWI). METHODS Six subjects with relapsing remitting MS (RRMS, age = 47.3 ± 11.8 years with 3 females and 3 males) and fourteen age-matched healthy controls were scanned at 3 T with SWI acquired before and after the infusion of Ferumoxytol. Composite data was generated by registering the FLAIR data to the high resolution SWI data in order to highlight the vascular information in MS lesions. Both the central vein sign (CVS) and, a new measure, the multiple vessel sign (MVS) were identified, along with any vascular abnormalities, in the lesions on pre- and post-contrast SWI-FLAIR fusion data. The small vessel density within the periventricular normal-appearing white matter (NAWM) and the periventricular lesions were compared for all subjects. RESULTS Averaged across two independent raters, a total of 530 lesions were identified across all patients. The total number of lesions with vascularity on pre- and post-contrast data were 287 and 488, respectively. The lesions with abnormal vascular behavior were broken up into following categories: small lesions appearing only at the vessel boundary; dilated vessels within the lesions; and developmental venous angiomas. These vessel abnormalities observed within lesions increased from 55 on pre-contrast data to 153 on post-contrast data. Finally, across all the patients, the periventricular lesional vessel density was significantly higher (p < 0.05) than that of the periventricular NAWM. CONCLUSIONS By inducing a super-paramagnetic susceptibility in the blood using Ferumoxytol, the vascular abnormalities in the RRMS patients were revealed and small vessel densities were obtained. This approach has the potential to monitor the venous vasculature present in MS lesions, catalogue their characteristics and compare the vascular structures spatially to the presence of lesions. These enhanced vascular features may provide new insight into the pathophysiology of MS.
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Affiliation(s)
- Sagar Buch
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | | | - Pavan K Jella
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Zhen Wu
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Kamran Shah
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | | | - Yulin Ge
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, USA; Department of Neurology, Wayne State University, Detroit, MI, USA.
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9
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Hnilicová P, Štrbák O, Kolisek M, Kurča E, Zeleňák K, Sivák Š, Kantorová E. Current Methods of Magnetic Resonance for Noninvasive Assessment of Molecular Aspects of Pathoetiology in Multiple Sclerosis. Int J Mol Sci 2020; 21:E6117. [PMID: 32854318 PMCID: PMC7504207 DOI: 10.3390/ijms21176117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease with expanding axonal and neuronal degeneration in the central nervous system leading to motoric dysfunctions, psychical disability, and cognitive impairment during MS progression. The exact cascade of pathological processes (inflammation, demyelination, excitotoxicity, diffuse neuro-axonal degeneration, oxidative and metabolic stress, etc.) causing MS onset is still not fully understood, although several accompanying biomarkers are particularly suitable for the detection of early subclinical changes. Magnetic resonance (MR) methods are generally considered to be the most sensitive diagnostic tools. Their advantages include their noninvasive nature and their ability to image tissue in vivo. In particular, MR spectroscopy (proton 1H and phosphorus 31P MRS) is a powerful analytical tool for the detection and analysis of biomedically relevant metabolites, amino acids, and bioelements, and thus for providing information about neuro-axonal degradation, demyelination, reactive gliosis, mitochondrial and neurotransmitter failure, cellular energetic and membrane alternation, and the imbalance of magnesium homeostasis in specific tissues. Furthermore, the MR relaxometry-based detection of accumulated biogenic iron in the brain tissue is useful in disease evaluation. The early description and understanding of the developing pathological process might be critical for establishing clinically effective MS-modifying therapies.
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Affiliation(s)
- Petra Hnilicová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Oliver Štrbák
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia;
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Ema Kantorová
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
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10
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Hostenbach S, Raeymaekers H, Van Schuerbeek P, Vanbinst AM, Cools W, De Keyser J, D'Haeseleer M. The Role of Cerebral Hypoperfusion in Multiple Sclerosis (ROCHIMS) Trial in Multiple Sclerosis: Insights From Negative Results. Front Neurol 2020; 11:674. [PMID: 32765401 PMCID: PMC7381129 DOI: 10.3389/fneur.2020.00674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/05/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Accumulating evidence indicates that mitochondrial energy failure is involved in the progressive axonal degeneration in multiple sclerosis (MS). In patients with MS, it has been shown that both levels of N-acetylaspartate (NAA), which is a marker of axonal mitochondrial energy, and cerebral blood flow (CBF) are reduced in cerebral normal appearing white matter (NAWM). The latter is likely due to the vasoconstrictive action of endothelin-1 (ET-1) produced by reactive astrocytes, which is triggered by local proinflammatory cytokines. A preliminary study in patients with MS showed that CBF could be restored to normal values after a single dose of 62.5 mg of the ET-1 antagonist bosentan. Objective: To investigate whether restoring CBF in patients with relapsing remitting MS (RRMS) increases levels of NAA in cerebral NAWM and improves clinical symptoms. Methods: 27 RRMS patients were included in a 4 weeks proof-of-concept, randomized, double-blind placebo-controlled trial (ROCHIMS) to investigate whether bosentan 62.5 mg twice daily could increase the NAA/creatine (NAA/Cr) ratio in NAWM of the centrum semiovale. Magnetic resonance imaging (MRI) assessing CBF and NAA/Cr, and clinical evaluations were performed at baseline and at end of study. Separately from the clinical trial, 10 healthy controls underwent the same baseline multimodal brain MRI protocol as the MS patients. Results: Eleven patients in the bosentan arm and thirteen patients in the placebo arm completed the study. Bosentan did not increase CBF. However, we found that CBF in the patients was not different from that of the healthy controls. There were no effects on NAA levels and clinical symptoms. Conclusions: Our study showed that CBF in RRMS patients is not always decreased and that bosentan has no effect when CBF values are within the normal range. We hypothesize that in our patients there was no significant astrocytic production of ET-1 because they had a mild disease course, with minimal local inflammatory activity. Future studies with bosentan in MS should focus on patients with elevated ET-1 levels in cerebrospinal fluid or blood.
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Affiliation(s)
- Stéphanie Hostenbach
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Medical Physics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Van Schuerbeek
- Department of Radiology and Medical Physics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anne-Marie Vanbinst
- Department of Radiology and Medical Physics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacques De Keyser
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Miguel D'Haeseleer
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,National Multiple Sclerosis Centrum, Melsbroek, Belgium
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11
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Phosphorus magnetic resonance spectroscopy and fatigue in multiple sclerosis. J Neural Transm (Vienna) 2020; 127:1177-1183. [DOI: 10.1007/s00702-020-02221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
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12
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Van Schependom J, Guldolf K, D'hooghe MB, Nagels G, D'haeseleer M. Detecting neurodegenerative pathology in multiple sclerosis before irreversible brain tissue loss sets in. Transl Neurodegener 2019; 8:37. [PMID: 31827784 PMCID: PMC6900860 DOI: 10.1186/s40035-019-0178-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
Background Multiple sclerosis (MS) is a complex chronic inflammatory and degenerative disorder of the central nervous system. Accelerated brain volume loss, or also termed atrophy, is currently emerging as a popular imaging marker of neurodegeneration in affected patients, but, unfortunately, can only be reliably interpreted at the time when irreversible tissue damage likely has already occurred. Timing of treatment decisions based on brain atrophy may therefore be viewed as suboptimal. Main body This Narrative Review focuses on alternative techniques with the potential of detecting neurodegenerative events in the brain of subjects with MS prior to the atrophic stage. First, metabolic and molecular imaging provide the opportunity to identify early subcellular changes associated with energy dysfunction, which is an assumed core mechanism of axonal degeneration in MS. Second, cerebral hypoperfusion has been observed throughout the entire clinical spectrum of the disorder but it remains an open question whether this serves as an alternative marker of reduced metabolic activity, or exists as an independent contributing process, mediated by endothelin-1 hyperexpression. Third, both metabolic and perfusion alterations may lead to repercussions at the level of network performance and structural connectivity, respectively assessable by functional and diffusion tensor imaging. Fourth and finally, elevated body fluid levels of neurofilaments are gaining interest as a biochemical mirror of axonal damage in a wide range of neurological conditions, with early rises in patients with MS appearing to be predictive of future brain atrophy. Conclusions Recent findings from the fields of advanced neuroradiology and neurochemistry provide the promising prospect of demonstrating degenerative brain pathology in patients with MS before atrophy has installed. Although the overall level of evidence on the presented topic is still preliminary, this Review may pave the way for further longitudinal and multimodal studies exploring the relationships between the abovementioned measures, possibly leading to novel insights in early disease mechanisms and therapeutic intervention strategies.
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Affiliation(s)
- Jeroen Van Schependom
- 1Neurology Department, Universitair Ziekenhuis Brussel; Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.,2Radiology Department Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaat Guldolf
- 1Neurology Department, Universitair Ziekenhuis Brussel; Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium
| | - Marie Béatrice D'hooghe
- 1Neurology Department, Universitair Ziekenhuis Brussel; Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
| | - Guy Nagels
- 1Neurology Department, Universitair Ziekenhuis Brussel; Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
| | - Miguel D'haeseleer
- 1Neurology Department, Universitair Ziekenhuis Brussel; Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
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13
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Swanberg KM, Landheer K, Pitt D, Juchem C. Quantifying the Metabolic Signature of Multiple Sclerosis by in vivo Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker. Front Neurol 2019; 10:1173. [PMID: 31803127 PMCID: PMC6876616 DOI: 10.3389/fneur.2019.01173] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) offers a growing variety of methods for querying potential diagnostic biomarkers of multiple sclerosis in living central nervous system tissue. For the past three decades, 1H-MRS has enabled the acquisition of a rich dataset suggestive of numerous metabolic alterations in lesions, normal-appearing white matter, gray matter, and spinal cord of individuals with multiple sclerosis, but this body of information is not free of seeming internal contradiction. The use of 1H-MRS signals as diagnostic biomarkers depends on reproducible and generalizable sensitivity and specificity to disease state that can be confounded by a multitude of influences, including experiment group classification and demographics; acquisition sequence; spectral quality and quantifiability; the contribution of macromolecules and lipids to the spectroscopic baseline; spectral quantification pipeline; voxel tissue and lesion composition; T1 and T2 relaxation; B1 field characteristics; and other features of study design, spectral acquisition and processing, and metabolite quantification about which the experimenter may possess imperfect or incomplete information. The direct comparison of 1H-MRS data from individuals with and without multiple sclerosis poses a special challenge in this regard, as several lines of evidence suggest that experimental cohorts may differ significantly in some of these parameters. We review the existing findings of in vivo1H-MRS on central nervous system metabolic abnormalities in multiple sclerosis and its subtypes within the context of study design, spectral acquisition and processing, and metabolite quantification and offer an outlook on technical considerations, including the growing use of machine learning, by future investigations into diagnostic biomarkers of multiple sclerosis measurable by 1H-MRS.
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Affiliation(s)
- Kelley M Swanberg
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - Karl Landheer
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States.,Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, United States
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14
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Quadrelli S, Ribbons K, Arm J, Al-Iedani O, Lechner-Scott J, Lea R, Ramadan S. 2D in-vivo L-COSY spectroscopy identifies neurometabolite alterations in treated multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419877081. [PMID: 31666809 PMCID: PMC6801886 DOI: 10.1177/1756286419877081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 08/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background We have applied in vivo two-dimensional (2D) localized correlation spectroscopy (2D L-COSY), in treated relapsing relapsing-remitting multiple sclerosis (RRMS) to identify novel biomarkers in normal-appearing brain parenchyma. Methods 2D L-COSY magnetic resonance spectroscopy (MRS) spectra were prospectively acquired from the posterior cingulate cortex (PCC) in 45 stable RRMS patients undergoing treatment with Fingolimod, and 40 age and sex-matched healthy control (HC) participants. Average metabolite ratios and clinical symptoms including, disability, cognition, fatigue, and mental health parameters were measured, and compared using parametric and nonparametric tests. Whole brain volume and MRS voxel morphometry were evaluated using SIENAX and the SPM LST toolbox. Results Despite the mean whole brain lesion volume being low in this RRMS group (6.8 ml) a significant reduction in PCC metabolite to tCr ratios were identified for multiple N-acetylaspartate (NAA) signatures, gamma-aminobutyric acid (GABA), glutamine and glutamate (Glx), threonine, and isoleucine/lipid. Of the clinical symptoms measured, visuospatial function, attention, and memory were correlated with NAA signatures, Glx, and isoleucine/lipid in the brain. Conclusions 2D L-COSY has the potential to detect metabolic alterations in the normal-appearing MS brain. Despite examining only a localised region, we could detect metabolic variability associated with symptoms.
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Affiliation(s)
- Scott Quadrelli
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen Ribbons
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Jameen Arm
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Oun Al-Iedani
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | | | - Rodney Lea
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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15
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Liu Y, Delgado S, Jiang H, Lin Y, Hernandez J, Deng Y, Gameiro GR, Wang J. Retinal Tissue Perfusion in Patients with Multiple Sclerosis. Curr Eye Res 2019; 44:1091-1097. [PMID: 31046490 DOI: 10.1080/02713683.2019.1612444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: The goal of this work was to determine whether the retinal tissue perfusion (RTP) is impaired in patients with multiple sclerosis (MS). Methods: Seventy-four patients [66 relapsing-remitting MS (RRMS) and 8 clinically isolated syndrome (CIS)] and 74 age- and gender-matched healthy controls were recruited. RTP was calculated as the retinal blood flow (measured using retinal function imager) supplying the macular area divided by the corresponding tissue volume of the inner retina from the inner limiting membrane to the outer plexiform layer, as measured by ultrahigh-resolution optical coherence tomography. Results: The RTP in the MS group was 2.37 ± 0.59 nl/s/mm3 (mean ± standard deviation), which was significantly lower than the control group (4.06 ± 0.89 nl/s/mm3, P < .001), reflecting a decrease of 42%. The blood flow volume was 2.50 ± 0.50 nl/s in MS, which was 45% lower than in the control group (4.56 ± 0.91 nl/s, P < .001). In addition, the tissue volume of the inner retina was significantly lower than in the control group (P < .05). The RTP in patients with MS was significantly correlated with the retinal blood flow volume (r = 0.84, P < .001) and retinal tissue volume (r = -0.56, P < .001). However, the retinal blood flow in patients with MS was not related to the tissue volume (r = -0.06, P = .59). Conclusions: Impaired retinal tissue perfusion occurred in patients with MS, which could be developed as a possible biomarker in monitoring disease progression in MS.
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Affiliation(s)
- Yi Liu
- Department of Ophthalmology, Third Affiliated Hospital of Nanjing University of Chinese Medicine , Nanjing , China.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Silvia Delgado
- MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Ying Lin
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Jeffrey Hernandez
- MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Yuqing Deng
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Giovana Rosa Gameiro
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
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16
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Jakimovski D, Topolski M, Genovese AV, Weinstock-Guttman B, Zivadinov R. Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities. Expert Rev Neurother 2019; 19:445-458. [PMID: 31003583 DOI: 10.1080/14737175.2019.1610394] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.
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Affiliation(s)
- Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Matthew Topolski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Antonia Valentina Genovese
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,c Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Bianca Weinstock-Guttman
- b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA.,d Center for Biomedical Imaging at Clinical Translational Science Institute , University at Buffalo, State University of New York , Buffalo , NY , USA
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17
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Hostenbach S, Pauwels A, Michiels V, Raeymaekers H, Van Binst AM, Van Merhaeghen-Wieleman A, Van Schuerbeek P, De Keyser J, D'Haeseleer M. Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan. Trials 2019; 20:164. [PMID: 30871594 PMCID: PMC6416892 DOI: 10.1186/s13063-019-3252-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
Background Axonal degeneration is related to long-term disability in patients with multiple sclerosis (MS). The underlying mechanism remains ill understood but appears to involve axonal energetic dysfunction. A globally impaired cerebral blood flow (CBF) has been observed in the normal-appearing white matter (NAWM) of patients with MS, which is probably related to astrocytic overexpression of endothelin-1 (ET-1). Cerebral hypoperfusion has been associated with reduced mitochondrial activity and disabling symptoms (e.g. fatigue and cognitive decline) of MS. Countering this process could therefore be beneficial in the disease course. Short-term CBF restoration with a single 62.5-mg dose of the ET-1 receptor antagonist bosentan has already been demonstrated in patients with MS. Methods The ROCHIMS study is a proof-of-concept double-blind randomized clinical trial in which patients with relapsing-remitting MS will receive either 62.5 mg bosentan or matching placebo twice daily during 28 ± 2 days. Clinical evaluation and brain magnetic resonance imaging (MRI) will be performed at baseline and treatment termination. Based on previous work, we expect a global increase of CBF in the individuals treated with bosentan. The primary outcome measure is the change of N-acetyl aspartate in centrum semiovale NAWM, which is a marker of regional axonal mitochondrial activity. Other parameters of interest include changes in fatigue, cognition, motor function, depression, and brain volume. Discussion We hypothesize that restoring cerebral hypoperfusion in MS patients improves axonal metabolism. Early positive effects on fatigue and cognitive dysfunction related to MS might additionally be detected. There is a medical need for drugs that can slow down the progressive axonal degeneration in MS, making this an important topic of interest. Trial registration Clinical Trials Register, EudraCT 2017-001253-13. Registered on 15 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3252-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Hostenbach
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium. .,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Ayla Pauwels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Veronique Michiels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Medical Physics, UZ Brussel, Brussels, Belgium
| | | | | | | | - Jacques De Keyser
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Miguel D'Haeseleer
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,National Multiple Sclerosis Centrum, Melsbroek, Belgium
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18
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Ho ML. Arterial spin labeling: Clinical applications. J Neuroradiol 2018; 45:276-289. [PMID: 30016705 DOI: 10.1016/j.neurad.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance imaging perfusion technique that enables quantification of cerebral blood flow (CBF) without the use of intravenous gadolinium contrast. An understanding of the technical basis of ASL and physiologic variations in perfusion are important for recognizing normal variants and artifacts. Pathologic variations in perfusion can be seen in a number of disorders including acute and chronic ischemia, vasculopathy, vascular malformations, tumors, trauma, infection/inflammation, epilepsy and dementia.
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Affiliation(s)
- Mai-Lan Ho
- Division of Neuroradiology, Mayo Clinic, 200 First St. SW, 55905 Rochester, MN, United States.
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19
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Zhao PY, Wang YQ, Liu XH, Zhu YJ, Zhao H, Zhang QX, Qi F, Li JL, Zhang N, Fan YP, Li KN, Zhao YY, Lei JF, Wang L. Bu Shen Yi Sui capsule promotes remyelination correlating with Sema3A/NRP-1, LIF/LIFR and Nkx6.2 in mice with experimental autoimmune encephalomyelitis. JOURNAL OF ETHNOPHARMACOLOGY 2018; 217:36-48. [PMID: 29428242 DOI: 10.1016/j.jep.2018.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/19/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bu Shen Yi Sui capsule (BSYSC), based on traditional Chinese formula Liu Wei Di Huang pill, is effective for the treatment of multiple sclerosis (MS) in clinical experience and trials. Our previous studies confirmed that BSYSC had the neuroprotective effect in MS and its animal model, experimental autoimmune encephalomyelitis (EAE); however, its mechanism of action was not clear. Thus, the effect of BSYSC on remyelination and the underlying mechanisms were investigated in the EAE mice. MATERIALS AND METHODS The EAE model was established by injecting subcutaneously myelin oligodendrocyte protein (MOG) 35-55 in mice. Mice were treated with BSYSC (3.02 g/kg) or vehicle daily by oral gavage for 40 days. The body weight and clinical score of mice were evaluated. Brain was observed by magnetic resonance imaging. The inflammation infiltrate of brain and spinal cord was determined by hematoxylin-eosin staining, while the structure of myelin sheath was visualized by transmission electron microscopy on days 23 and 40 post immunization (dpi), respectively. The protein and mRNA levels of platelets-derived growth factor receptor (PDGFR) α and 2', 3'-cyclic nucleotide-3'-phosphodiesterase (CNPase) were measured by immunohistochemistry, western blot and quantitative real-time polymerase chain reaction. The protein expressions of semaphorins (Sema) 3A, Neuropilin (NRP) - 1, leukemia inhibitory factor (LIF), LIF receptor (LIFR) and Nkx6.2 were further investigated by western blot. RESULTS BSYSC treatment improved the body weight and clinical score of EAE mice, alleviated inflammatory infiltration and nerve fiber injuries. It also protected the ultrastructural integrity of myelin sheath. BSYSC significantly increased expressions of PDGFRα and CNPase in mice with EAE on 40 dpi. Furthermore, BSYSC treatment increased the expressions of LIF, LIFR and Nkx6.2 and reduced Sema3A and NRP-1 in EAE mice on 40 dpi. CONCLUSIONS The data demonstrated that BSYSC exhibited the neuroprotective effect against EAE by promoting oligodendrocyte progenitor cells (OPCs) proliferation and differentiation, thus facilitating remyelination. Sema3A/NRP-1, LIF/LIFR and Nkx6.2 are likely contributed to the effects of BSYSC on OPCs.
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MESH Headings
- 2',3'-Cyclic-Nucleotide Phosphodiesterases/metabolism
- Administration, Oral
- Animals
- Brain/drug effects
- Brain/metabolism
- Brain/ultrastructure
- Capsules
- Cell Differentiation/drug effects
- Cell Proliferation/drug effects
- Drugs, Chinese Herbal/administration & dosage
- Drugs, Chinese Herbal/pharmacology
- Encephalomyelitis, Autoimmune, Experimental/chemically induced
- Encephalomyelitis, Autoimmune, Experimental/drug therapy
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Female
- Homeodomain Proteins/metabolism
- Leukemia Inhibitory Factor/metabolism
- Leukemia Inhibitory Factor Receptor alpha Subunit/metabolism
- Mice, Inbred C57BL
- Myelin Sheath/drug effects
- Myelin Sheath/metabolism
- Myelin Sheath/ultrastructure
- Myelin-Oligodendrocyte Glycoprotein
- Neuropilin-1/metabolism
- Neuroprotective Agents/administration & dosage
- Neuroprotective Agents/pharmacology
- Oligodendrocyte Precursor Cells/drug effects
- Oligodendrocyte Precursor Cells/metabolism
- Oligodendrocyte Precursor Cells/pathology
- Peptide Fragments
- Receptor, Platelet-Derived Growth Factor alpha/metabolism
- Semaphorin-3A/metabolism
- Signal Transduction/drug effects
- Spinal Cord/drug effects
- Spinal Cord/metabolism
- Spinal Cord/ultrastructure
- Time Factors
- Transcription Factors/metabolism
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Affiliation(s)
- Pei-Yuan Zhao
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Yong-Qiang Wang
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Xi-Hong Liu
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Ying-Jun Zhu
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Hui Zhao
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Qiu-Xia Zhang
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Fang Qi
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Jun-Ling Li
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Nan Zhang
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China
| | - Yong-Ping Fan
- Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
| | - Kang-Ning Li
- Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
| | - Yuan-Yuan Zhao
- Core Facility Center, Capital Medical University, Beijing 100069, China
| | - Jian-Feng Lei
- Core Facility Center, Capital Medical University, Beijing 100069, China
| | - Lei Wang
- School of Traditional Chinese Medicine, Beijing Key Lab of TCM Collateral Disease Theory Research, Capital Medical University, No.10 Xitoutiao, You An Men, Beijing 100069, China.
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20
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Lapointe E, Li DKB, Traboulsee AL, Rauscher A. What Have We Learned from Perfusion MRI in Multiple Sclerosis? AJNR Am J Neuroradiol 2018; 39:994-1000. [PMID: 29301779 DOI: 10.3174/ajnr.a5504] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
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Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
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21
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Kauv P, Ayache SS, Créange A, Chalah MA, Lefaucheur JP, Hodel J, Brugières P. Adenosine Triphosphate Metabolism Measured by Phosphorus Magnetic Resonance Spectroscopy: A Potential Biomarker for Multiple Sclerosis Severity. Eur Neurol 2017; 77:316-321. [PMID: 28467982 DOI: 10.1159/000475496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/30/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Phosphorus magnetic resonance spectroscopy (31P-MRS) has previously shown abnormal changes in energy metabolites in the brain of multiple sclerosis (MS) patients. However, the relationship between these energy metabolites - particularly adenosine triphosphate (ATP) - and the disease severity remains unclear. The objective of this study was to determine whether measuring ATP metabolites can help to predict disease severity in MS patients. METHODS 31P-MRS at 3 tesla was performed in 9 relapsing remitting (RRMS), 9 secondary progressive MS patients (SPMS), and 10 age-matched healthy controls. ATP metabolites (expressed as %) in normally appearing white matter of the centrum semiovale were compared between patients and healthy controls. The relationship between Expanded Disability Status Scale (EDSS) and ATP metabolites was evaluated. RESULTS RRMS and SPMS patients had higher phosphocreatine (PCr) and lower phosphodiesters than healthy controls. In addition, RRMS patients had higher β-ATP% than SPMS patients. β-ATP% was negatively correlated with EDSS in all patients. CONCLUSION Our findings suggest a defective PCr metabolism in both patient groups, and a higher state of energy production in RRMS that might reflect a compensatory mechanism in face of the increased needs. The correlation of β-ATP with EDSS makes it a candidate biomarker for assessing MS disease severity.
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Affiliation(s)
- Paul Kauv
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
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22
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Ghareghani M, Ghanbari A, Dokoohaki S, Farhadi N, Hosseini SM, Mohammadi R, Sadeghi H. Methylprednisolone improves lactate metabolism through reduction of elevated serum lactate in rat model of multiple sclerosis. Biomed Pharmacother 2016; 84:1504-1509. [PMID: 27884750 DOI: 10.1016/j.biopha.2016.11.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/30/2016] [Accepted: 11/11/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Some studies have demonstrated elevated concentrations of lactate both in the cerebrospinal fluid (CSF) and blood samples of multiple sclerosis (MS) patients as a pathological condition. We designed an experimental study first to investigate the serum level of lactate as a biomarker of MS progression and also to investigate the effect of methylprednisolone on serum lactate. METHODS Experimental autoimmune encephalomyelitis (EAE) was inducted in Lewis rats, and then rats were treated intraperitoneally with methylprednisolone (30mg/kg/d), at the disease onset, and the clinical scores were recorded. After seven days of treatment, the serum levels of lactate were determined using high performance liquid chromatography (HPLC). Moreover, lymphocyte infiltration and the demyelinated area was analysed in spinal cord. RESULTS Compared to the untreated-EAE rats, methylprednisolone remarkably improved the clinical score of EAE and ameliorated the spinal cord inflammation and demyelination. In addition, the marked decline in IFN-γ and the increase in IL-4 confirmed improvement in the rats treated with methylprednisolone. Measurement of lactate using HPLC indicated enhancement in the serum level of lactate in the untreated-EAE rats; the lactate level significantly decreased after methylprednisolone therapy. Moreover, serum lactates and disease severity were correlated positively and significantly. CONCLUSION These data confirmed for the first time, that methylprednisolone can decreases the enhanced level of serum lactate in EAE model. In addition, it was shown that measurement of serum lactate could be an inexpensive and accurate laboratory test to determine the response to treatment and to assess disease severity in MS patients.
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Affiliation(s)
- Majid Ghareghani
- Cellular and Molecular Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran; Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amir Ghanbari
- Cellular and Molecular Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Shima Dokoohaki
- Cellular and Molecular Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Naser Farhadi
- Cellular and Molecular Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Reza Mohammadi
- Medicinal Plants Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Heibatollah Sadeghi
- Cellular and Molecular Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
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23
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Fleischer V, Kolb R, Groppa S, Zipp F, Klose U, Gröger A. Metabolic Patterns in Chronic Multiple Sclerosis Lesions and Normal-appearing White Matter: Intraindividual Comparison by Using 2D MR Spectroscopic Imaging. Radiology 2016; 281:536-543. [PMID: 27243371 DOI: 10.1148/radiol.2016151654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To perform a direct metabolic comparison of chronic lesions and diffusely injured normal-appearing white matter (NAWM) in multiple sclerosis (MS). Materials and Methods In this institutional review board-approved study, with the written informed consent of all patients, two-dimensional magnetic resonance spectroscopic imaging data in 46 patients with relapsing-remitting MS (median disease duration, 0.8 year) were analyzed by using the spectral quantification tool LCModel. Metabolic patterns were evaluated for non-gadolinium-enhancing chronic lesions and the corresponding contralateral NAWM. The sensitivity of the method was assessed by reproducing the known metabolic differences between cortical gray matter (GM) and NAWM. In addition to individual spectra, averaged spectra were calculated by accumulating free induction decays over all subjects to yield an increased signal-to-noise ratio (SNR), and in turn, to allow improved curve fitting as demonstrated by lower error bounds for low-concentration metabolites. Metabolite concentrations were statistically tested for intraindividual differences (paired t tests) to avoid effects resulting from variations in disease severity or treatment. Results Differences between the metabolite concentrations in the NAWM and the cortical GM were highly significant (P < .001), demonstrating the reliability of the spectral analysis used here. The spectral patterns of the individual and averaged spectra of chronic lesions and NAWM were qualitatively very similar at visual inspection. Furthermore, in the quantitative comparison, the estimated metabolite concentrations showed only slight differences (P > .07). Owing to increased SNRs in the averaged spectra compared with individual spectra (eg, for chronic lesions, 63 vs 28.4 ± 4.1), it was possible to reliably (Cramér-Rao lower bound [CRLB], <20%) estimate scyllo-inositol levels with a CRLB of 14%. Conclusion These findings revealed that NAWM exhibits the same metabolic changes as chronic white matter lesions, even very early in the disease course, further supporting the view that such lesions may not be as relevant as widely assumed. © RSNA, 2016.
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Affiliation(s)
- Vinzenz Fleischer
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
| | - Rupert Kolb
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
| | - Sergiu Groppa
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
| | - Frauke Zipp
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
| | - Uwe Klose
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
| | - Adriane Gröger
- From the Department of Neurology and Neuroimaging Center of Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany (V.F., S.G., F.Z., A.G.); and Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany (R.K., U.K.)
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Jiang H, Delgado S, Tan J, Liu C, Rammohan KW, DeBuc DC, Lam BL, Feuer WJ, Wang J. Impaired retinal microcirculation in multiple sclerosis. Mult Scler 2016; 22:1812-1820. [PMID: 26903007 DOI: 10.1177/1352458516631035] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/02/2015] [Accepted: 01/14/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The transparent ocular structure enables quantitative analysis of microvasculature of retina, a neuronal tissue affected by multiple sclerosis (MS). OBJECTIVE The aim of this study was to determine whether the retinal blood flow velocity and flow volume at the macula are impaired in patients with relapsing remitting multiple sclerosis (RRMS). METHODS A total of 17 RRMS patients and 17 age- and gender-matched healthy subjects were assessed. A retinal function imager was used to measure the blood flow velocity of retinal arterioles and venules and to calculate the total perifoveal blood flow volume. RESULTS The blood flow velocities of the retinal arterioles (3.34 ± 0.89 mm/s) and venules (2.61 ± 0.6 mm/s) were significantly lower in MS patients than normal subjects (arteriole: 4.10 ± 0.87 mm/s; venule: 3.22 ± 0.65 mm/s, both p = 0.01). In addition, the total perifoveal blood flow volume in arterioles (3.74 ± 1.64 nL/s) and venules (3.81 ± 1.60 nL/s) were significantly lower in MS patients than in normal subjects (arteriole: 4.87 ± 1.41 nL/s, p = 0.02; venule: 4.71 ± 1.64 nL/s, p = 0.04). CONCLUSION The impaired retinal microcirculation in RRMS patients indicates microvascular dysfunction in MS.
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Affiliation(s)
- Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA/Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jia Tan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA/Department of Ophthalmology, The Second Xiangya Hospital, Central-South University, Changsha, China
| | - Che Liu
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kottil W Rammohan
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William J Feuer
- Statistic Division, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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Amorini AM, Lazzarino G, Di Pietro V, Signoretti S, Lazzarino G, Belli A, Tavazzi B. Metabolic, enzymatic and gene involvement in cerebral glucose dysmetabolism after traumatic brain injury. Biochim Biophys Acta Mol Basis Dis 2016; 1862:679-687. [PMID: 26844378 DOI: 10.1016/j.bbadis.2016.01.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/29/2016] [Indexed: 12/16/2022]
Abstract
In this study, the metabolic, enzymatic and gene changes causing cerebral glucose dysmetabolism following graded diffuse traumatic brain injury (TBI) were evaluated. TBI was induced in rats by dropping 450g from 1 (mild TBI; mTBI) or 2m height (severe TBI; sTBI). After 6, 12, 24, 48, and 120h gene expressions and enzymatic activities of glycolysis and pentose phosphate pathway (PPP) enzymes, and levels of lactate, ATP, ADP, ATP/ADP (indexing mitochondrial phosphorylating capacity), NADP(+), NADPH and GSH were determined in whole brain extracts (n=9 rats at each time for both TBI levels). Sham-operated animals (n=9) were used as controls. Results demonstrated that mTBI caused a late increase (48-120h post injury) of glycolytic gene expression and enzymatic activities, concomitantly with mitochondrial functional recovery (ATP and ATP/ADP normalization). No changes in lactate and PPP genes and enzymes, were accompanied by transient decrease in GSH, NADP(+), NADPH and NADPH/NADP(+). Animals following sTBI showed early increase (6-24h post injury) of glycolytic gene expression and enzymatic activities, occurring during mitochondrial malfunctioning (50% decrease in ATP and ATP/ADP). Higher lactate and lower GSH, NADP(+), NADPH, NADPH/NADP(+) than controls were recorded at anytime post injury (p<0.01). Both TBI levels caused metabolic and gene changes affecting glucose metabolism. Following mTBI, increased glucose flux through glycolysis is coupled to mitochondrial glucose oxidation. "True" hyperglycolysis occurs only after sTBI, where metabolic changes, caused by depressed mitochondrial phosphorylating capacity, act on genes causing net glycolytic flux increase uncoupled from mitochondrial glucose oxidation.
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Affiliation(s)
- Angela Maria Amorini
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy.
| | - Giacomo Lazzarino
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy.
| | - Valentina Di Pietro
- Neurobiology, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK.
| | - Stefano Signoretti
- Division of Neurosurgery, Department of Neurosciences Head and Neck Surgery, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
| | - Giuseppe Lazzarino
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Viale A. Doria 6, 95125 Catania, Italy.
| | - Antonio Belli
- Neurobiology, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, B15 2TH Birmingham, UK.
| | - Barbara Tavazzi
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy.
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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27
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Sowa P, Bjørnerud A, Nygaard GO, Damangir S, Spulber G, Celius EG, Due-Tønnessen P, Harbo HF, Beyer MK. Reduced perfusion in white matter lesions in multiple sclerosis. Eur J Radiol 2015; 84:2605-12. [PMID: 26391230 DOI: 10.1016/j.ejrad.2015.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/14/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate dynamic susceptibility contrast (DSC) perfusion weighted imaging (PWI) in white matter lesions (WML) in patients with multiple sclerosis (MS), using automatically generated binary masks of brain tissue. BACKGROUND WML in MS have in some studies demonstrated perfusion abnormalities compared to normal appearing white matter (NAWM), however perfusion changes in WML in MS have in general not been well documented. METHODS DSC PWI was performed at 1.5 Tesla in 69 newly diagnosed MS patients. Parametric perfusion maps representing cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) were obtained. Binary masks of WML, white matter (WM) and grey matter (GM) were automatically generated and co-registered to the perfusion maps. The WML mask was manually edited and modified to correct for errors in the automatic lesion detection. Perfusion parameters were derived both from WML and NAWM using the manually modified WML mask, and using the original non-modified WML mask (with and without GM exclusion mask). Differences in perfusion measures between WML and NAWM were analyzed. RESULTS CBF was significantly lower (p<0.001) and MTT significantly higher (p<0.001) in WML compared to NAWM. CBV did not show significant difference between WML and NAWM. The non-modified WML mask gave similar results as manually modified WML mask if the GM exclusion mask was used in the analysis. CONCLUSIONS DSC PWI revealed lower CBF and higher MTT, consistent with reduced perfusion, in WML compared to NAWM in patients with early MS. Automatically generated binary masks are a promising tool in perfusion analysis of WML.
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Affiliation(s)
- Piotr Sowa
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Atle Bjørnerud
- Intervention Center, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway.
| | - Gro O Nygaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Soheil Damangir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Gabriela Spulber
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Elisabeth G Celius
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Paulina Due-Tønnessen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Cerebral hypoperfusion: a new pathophysiologic concept in multiple sclerosis? J Cereb Blood Flow Metab 2015; 35:1406-10. [PMID: 26104292 PMCID: PMC4640326 DOI: 10.1038/jcbfm.2015.131] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/08/2015] [Accepted: 05/04/2015] [Indexed: 01/28/2023]
Abstract
The exact pathogenesis of multiple sclerosis (MS) is incompletely understood. Although auto-immune responses have an important role in the development of hallmark focal demyelinating lesions, the underlying mechanism of axonal degeneration, the other key player in MS pathology and main determinant of long-term disability, remains unclear and corresponds poorly with inflammatory disease activity. Perfusion-weighted imaging studies have demonstrated that there is a widespread cerebral hypoperfusion in patients with MS, which is present from the early beginning to more advanced disease stages. This reduced cerebral blood flow (CBF) does not seems to be secondary to loss of axonal integrity with decreased metabolic demands but appears to be mediated by elevated levels of the potent vasospastic peptide endothelin-1 in the cerebral circulation. Evidence is evolving that cerebral hypoperfusion in MS is associated with chronic hypoxia, focal lesion formation, diffuse axonal degeneration, cognitive dysfunction, and fatigue. Restoring CBF may therefore emerge as a new therapeutic target in MS.
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29
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Koudriavtseva T, Plantone D, Renna R, Inglese M. Brain perfusion by arterial spin labeling MRI in multiple sclerosis. J Neurol 2015; 262:1769-71. [PMID: 26016686 DOI: 10.1007/s00415-015-7792-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Tatiana Koudriavtseva
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO, Rome, Italy,
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30
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Nathoo N, Rogers JA, Yong VW, Dunn JF. Detecting deoxyhemoglobin in spinal cord vasculature of the experimental autoimmune encephalomyelitis mouse model of multiple sclerosis using susceptibility MRI and hyperoxygenation. PLoS One 2015; 10:e0127033. [PMID: 25992667 PMCID: PMC4436315 DOI: 10.1371/journal.pone.0127033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/10/2015] [Indexed: 11/23/2022] Open
Abstract
Susceptibility-weighted imaging (SWI) detects hypointensities due to iron deposition and deoxyhemoglobin. Previously it was shown that SWI detects hypointensities in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis (MS), most of which are due to intravascular deoxyhemoglobin, with a small proportion being due to iron deposition in the central nervous system parenchyma and demyelination. However, animals had to be sacrificed to differentiate these two types of lesions which is impractical for time course studies or for human application. Here, we proposed altering the inspired oxygen concentration during imaging to identify deoxyhemoglobin-based hypointensities in vivo. SWI was performed on lumbar spinal cords of naive control and EAE mice using 30% O2 then 100% O2. Some mice were imaged using 30% O2, 100% O2 and after perfusion. Most SWI-visible hypointensities seen with 30% O2 changed in appearance upon administration of 100% O2, and were not visible after perfusion. That hypointensities changed with hyperoxygenation indicates that they were caused by deoxyhemoglobin. We show that increasing the inspired oxygen concentration identifies deoxyhemoglobin-based hypointensities in vivo. This could be applied in future studies to investigate the contribution of vascular-based hypointensities with SWI in EAE and MS over time.
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Affiliation(s)
- Nabeela Nathoo
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - James A. Rogers
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - V. Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F. Dunn
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Experimental Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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31
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Koudriavtseva T, Sbardella E, Mainero C. Brain perfusion and vasoreactivity in multiple sclerosis. AJNR Am J Neuroradiol 2015; 36:E27-8. [PMID: 25593205 DOI: 10.3174/ajnr.a4249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Koudriavtseva
- Neurology Unit, Multiple Sclerosis Center Regina Elena National Cancer Institute Istituti Fisioterapici Ospitalieri Rome, Italy
| | - E Sbardella
- Neurology Unit, Multiple Sclerosis Center Regina Elena National Cancer Institute Istituti Fisioterapici Ospitalieri Rome, Italy
| | - C Mainero
- Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital Boston, Massachusetts Harvard Medical School Boston, Massachusetts
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Viola S, Viola P, Fiorelli L, Buongarzone MP, Litterio P. Transcranial brain photoplethysmography to study the venules of cerebral cortex in patients with multiple sclerosis. Phlebology 2015; 30:119-26. [DOI: 10.1177/0268355513515650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the utility of a transcranial brain photoplethysmography parameter as a potential marker for patients with multiple sclerosis. Methods We investigated 38 patients affected by multiple sclerosis, according to the revised McDonald criteria (12 males and 26 females, mean age 41.1 ± 8.5 years, Expanded Disability Status Scale mean value 2.6 ± 2.1) and compared them with 20 age- and sex-matched healthy controls. By means of transcranial brain photoplethysmography, a safe and non-invasive technology, we measured the increase in cerebral blood volume during compression for 10 s of the internal jugular veins of both sides in sitting position. Results The cerebral blood volume increase was significantly smaller in the multiple sclerosis patients (left frontal cortex: −58%, p < 0.0001; right frontal cortex: −59%, p < 0.0001) compared with the controls. Conclusions Our study reveals that a minor increase in cerebral blood volume on the frontal cortex of both sides in sitting position is associated with a diagnosis of multiple sclerosis and might be a new marker.
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Affiliation(s)
- S Viola
- Department of Neurology, S. Pio Hospital, Vasto (CH), Italy
| | - P Viola
- Emergency Medical Service, S.C. De Lellis Hospital, Atessa (CH), Italy
| | - L Fiorelli
- Department of Neurology, S. Pio Hospital, Vasto (CH), Italy
| | - MP Buongarzone
- Department of Neurology, S. Pio Hospital, Vasto (CH), Italy
| | - P Litterio
- Department of Neurology, S. Pio Hospital, Vasto (CH), Italy
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Amorini AM, Nociti V, Petzold A, Gasperini C, Quartuccio E, Lazzarino G, Di Pietro V, Belli A, Signoretti S, Vagnozzi R, Lazzarino G, Tavazzi B. Serum lactate as a novel potential biomarker in multiple sclerosis. Biochim Biophys Acta Mol Basis Dis 2014; 1842:1137-43. [DOI: 10.1016/j.bbadis.2014.04.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/13/2014] [Accepted: 04/04/2014] [Indexed: 12/26/2022]
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