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Höftberger R, Lassmann H, Berger T, Reindl M. Pathogenic autoantibodies in multiple sclerosis - from a simple idea to a complex concept. Nat Rev Neurol 2022; 18:681-688. [PMID: 35970870 DOI: 10.1038/s41582-022-00700-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/08/2022]
Abstract
The role of autoantibodies in multiple sclerosis (MS) has been enigmatic since the first description, many decades ago, of intrathecal immunoglobulin production in people with this condition. Some studies have indicated that MS pathology is heterogeneous, with an antibody-associated subtype - characterized by B cells (in varying quantities), antibodies and complement - existing alongside other subtypes with different pathologies. However, subsequent evidence suggested that some cases originally diagnosed as MS with autoantibody-mediated demyelination were more likely to be neuromyelitis optica spectrum disorder or myelin oligodendrocyte glycoprotein antibody-associated disease. These findings raise the important question of whether an autoantibody-mediated MS subtype exists and whether pathogenic MS-associated autoantibodies remain to be identified. Potential roles of autoantibodies in MS could range from specific antibodies defining the disease to a non-disease-specific amplification of cellular immune responses and other pathophysiological processes. In this Perspective, we review studies that have attempted to identify MS-associated autoantibodies and provide our opinions on their possible roles in the pathophysiology of MS.
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Affiliation(s)
- Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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2
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Talanki Manjunatha R, Habib S, Sangaraju SL, Yepez D, Grandes XA. Multiple Sclerosis: Therapeutic Strategies on the Horizon. Cureus 2022; 14:e24895. [PMID: 35706718 PMCID: PMC9187186 DOI: 10.7759/cureus.24895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic disease affecting the brain and the spinal cord. It is a chronic inflammatory demyelinating disease of the central nervous system. It is the leading cause of non-traumatic disability in young adults. The clinical course of the disease is quite variable, ranging from stable chronic disease to rapidly evolving debilitating disease. The pathogenesis of MS is not fully understood. Still, there has been a rapid shift in understanding the immune pathology of MS away from pure T cell-mediated disease to B cells and microglia/astrocytes having a vital role in the pathogenesis of MS. This has helped in the emergence of new therapies for management. Effective treatment of MS requires a multidisciplinary approach to manage acute attacks, prevent relapses and disease progression and treat the disabling symptoms associated with the disease. In this review, we discuss the pathogenesis of MS, management of acute relapses, disease-modifying therapies in MS, new drugs and drugs currently in trial for MS and the symptomatic treatment of MS. All language search was conducted on Google Scholar, PubMed, MEDLINE, and Embase till February 2022. The following search strings and medical subheadings (MeSH) were used: "Multiple Sclerosis", "Pathogenesis of MS", and "Disease-modifying therapies in MS". We explored literature on the pathogenic mechanisms behind MS, management of acute relapses, disease-modifying therapies in MS and symptomatic management.
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Affiliation(s)
| | - Salma Habib
- Medicine and Surgery, Institute of Applied Health Science, Chittagong, BGD
| | | | - Daniela Yepez
- Faculty of Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, ECU
| | - Xavier A Grandes
- General Physician, Universidad Catolica Santiago de Guayaquil, Guayaquil, ECU
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Anti-Kir4.1 Antibodies in Multiple Sclerosis: Specificity and Pathogenicity. Int J Mol Sci 2020; 21:ijms21249632. [PMID: 33348803 PMCID: PMC7765826 DOI: 10.3390/ijms21249632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
The glial cells in the central nervous system express diverse inward rectifying potassium channels (Kir). They express multiple Kir channel subtypes that are likely to have distinct functional roles related to their differences in conductance, and sensitivity to intracellular and extracellular factors. Dysfunction in a major astrocyte potassium channel, Kir4.1, appears as an early pathological event underlying neuronal phenotypes in several neurological diseases. The autoimmune effects on the potassium channel have not yet been fully described in the literature. However, several research groups have reported that the potassium channels are an immune target in patients with various neurological disorders. In 2012, Srivastava et al. reported about Kir4.1, a new immune target for autoantibodies in patients with multiple sclerosis (MS). Follow-up studies have been conducted by several research groups, but no clear conclusion has been reached. Most follow-up studies, including ours, have reported that the prevalence of Kir4.1-seropositive patients with MS was lower than that in the initial study. Therefore, we extensively review studies on the method of antibody testing, seroprevalence of MS, and other neurological diseases in patients with MS. Finally, based on the role of Kir4.1 in MS, we consider whether it could be an immune target in this disease.
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Zhao Z, Bao XQ, Zhang Z, Li F, Liu H, Zhang D. Novel phloroglucinol derivative Compound 21 protects experimental autoimmune encephalomyelitis rats via inhibiting Th1/Th17 cell infiltration. Brain Behav Immun 2020; 87:751-764. [PMID: 32173452 DOI: 10.1016/j.bbi.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/27/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory infiltration and demyelination in the central nervous system (CNS). Among the factors involved in the immunological mechanisms of MS, T helper 1 (Th1) cells and T helper 17 (Th17) cells play a critical role. Compound 21, a novel phloroglucinol derivative, significantly protected myelin from damage in our previous study. However, it remains unclear whether this compound affects MS. In this study, the experimental autoimmune encephalomyelitis (EAE) rat model was established to mimic the pathological process of MS and evaluate the neuroprotective effect of Compound 21. The results illustrated that Compound 21 treatment notably attenuates neurological deficits, immune infiltration, and demyelination in EAE rats. Our mechanistic investigation revealed that Compound 21 treatment reduces the population of Th1/Th17 cells and inhibits their infiltration into the CNS. Furthermore, we found that the inhibition of Th1/Th17 cell infiltration is related to the direct suppression of Th1/Th17 cell differentiation and the inhibition of proinflammatory microglial cells. Collectively, these results confirm that Compound 21 suppresses infiltrated Th1/Th17 cells to alleviate demyelination in EAE rats, suggesting its potential role as a novel candidate for MS treatment.
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Affiliation(s)
- Zhe Zhao
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China
| | - Xiu-Qi Bao
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China
| | - Zihong Zhang
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China
| | - Fangyuan Li
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China
| | - Hui Liu
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China
| | - Dan Zhang
- State Key Laboratory of Bioactive Substrate and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian Nong Tan Street, Beijing 100050, China.
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Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of central nervous system (CNS). ADEM is most commonly seen in children, although adults can also be affected. The disease typically starts with an abrupt onset within day to weeks after a viral infection or immunization. Presenting features include an acute encephalopathy with multifocal neurologic signs and fever. ADEM generally has a monophasic course, although recurrent ADEM has also been described and is defined as multiphasic ADEM. MRI shows widespread lesions located in both brain and spinal cord. An involvement of basal ganglia and thalami has also been described. Analysis of cerebrospinal fluid (CSF) may reveal mild lymphocytic pleocytosis and increased proteins, whereas oligoclonal bands are usually negative. In the absence of specific biologic markers, ADEM remains a diagnosis of exclusion and it is still based on clinical manifestations, imaging, and laboratory features. Therapy is based on steroid administration and the prognosis is usually favorable.
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Mechanisms of activation induced by antiphospholipid antibodies in multiple sclerosis: Potential biomarkers of disease? J Immunol Methods 2019; 474:112663. [DOI: 10.1016/j.jim.2019.112663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
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Contarini G, Franceschini D, Facci L, Barbierato M, Giusti P, Zusso M. A co-ultramicronized palmitoylethanolamide/luteolin composite mitigates clinical score and disease-relevant molecular markers in a mouse model of experimental autoimmune encephalomyelitis. J Neuroinflammation 2019; 16:126. [PMID: 31221190 PMCID: PMC6587257 DOI: 10.1186/s12974-019-1514-4] [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: 01/31/2019] [Accepted: 06/04/2019] [Indexed: 01/31/2023] Open
Abstract
Background Persistent and/or recurrent inflammatory processes are the main factor leading to multiple sclerosis (MS) lesions. The composite ultramicronized palmitoylethanolamide, an endogenous N-acylethanolamine, combined with the flavonoid luteolin, PEALut, have been found to exert neuroprotective activities in experimental models of spinal and brain injury and Alzheimer disease, as well as a clinical improvement in human stroke patients. Furthermore, PEALut enhances the expression of different myelin proteins in oligodendrocyte progenitor cells suggesting that this composite might have protective effects in MS experimental models. Methods The mouse model of experimental autoimmune encephalomyelitis (EAE) based on active immunization with a fragment of myelin oligodendrocyte glycoprotein (MOG35-55) was used. The daily assessment of clinical score and the expression of serum amyloid A (SAA1), proinflammatory cytokines TNF-α, IL-1β, IFN-γ, and NLRP3 inflammasome, as well as TLR2, Fpr2, CD137, CD3-γ, and TCR-ζ chain, heterodimers that form T cell surface glycoprotein (TCR), and cannabinoid receptors CB1, CB2, and MBP, were evaluated in the brainstem and cerebellum at different postimmunization days (PIDs). Results Vehicle-MOG35-55-immunized (MOG35-55) mice developed ascending paralysis which peaked several days later and persisted until the end of the experiment. PEALut, given intraperitoneally daily starting on day 11 post-immunization, dose-dependently improved clinical score over the range 0.1–5 mg/kg. The mRNA expression of SAA1, TNF-α, IL-1β, IFN-γ, and NLRP3 were significantly increased in MOG35-55 mice at 14 PID. In MOG35-55 mice treated with 5 mg /kg PEALut, the increase of SAA1, TNF- α, IL-1β, and IFN-γ transcripts at 14 PID was statistically downregulated as compared to vehicle-MOG35-55 mice (p < 0.05). The expression of TLR2, Fpr2, CD137, CD3-γ, TCR-ζ chain, and CB2 receptors showed a significant upregulation in vehicle-MOG35-55 mice at 14 PID. Instead, CB1 and MBP transcripts have not changed in expression at any time. In MOG/PEALut-treated mice, TLR2, Fpr2, CD137, CD3-γ, TCR-ζ chain, and CB2 mRNAs were significantly downregulated as compared to vehicle MOG35-55 mice. Conclusions The present results demonstrate that the intraperitoneal administration of the composite PEALut significantly reduces the development of clinical signs in the MOG35-55 model of EAE. The dose-dependent improvement of clinical score induced by PEALut was associated with a reduction in transcript expression of the acute-phase protein SAA1, TNF-α, IL-1β, IFN-γ, and NLRP3 proinflammatory proteins and TLR2, Fpr2, CD137, CD3-γ, TCR-ζ chain, and CB2 receptors.
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Affiliation(s)
- Gabriella Contarini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy
| | - Davide Franceschini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy.,Present address: Selvita S.A. Park Life Science ul., Bobrzyńskiego, 14 30-348, Kraków, Poland
| | - Laura Facci
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy
| | - Massimo Barbierato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy
| | - Pietro Giusti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy.
| | - Morena Zusso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo Meneghetti, 2, 35131, Padua, Italy
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Ancau M, Berthele A, Hemmer B. CD20 monoclonal antibodies for the treatment of multiple sclerosis: up-to-date. Expert Opin Biol Ther 2019; 19:829-843. [DOI: 10.1080/14712598.2019.1611778] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mihai Ancau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, München,
Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, München,
Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, München,
Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich,
Germany
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Gan ZS, Stein SC, Swanson R, Guan S, Garcia L, Mehta D, Smith DH. Blood Biomarkers for Traumatic Brain Injury: A Quantitative Assessment of Diagnostic and Prognostic Accuracy. Front Neurol 2019; 10:446. [PMID: 31105646 PMCID: PMC6498532 DOI: 10.3389/fneur.2019.00446] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
Blood biomarkers have been explored for their potential to provide objective measures in the assessment of traumatic brain injury (TBI). However, it is not clear which biomarkers are best for diagnosis and prognosis in different severities of TBI. Here, we compare existing studies on the discriminative abilities of serum biomarkers for four commonly studied clinical situations: detecting concussion, predicting intracranial damage after mild TBI (mTBI), predicting delayed recovery after mTBI, and predicting adverse outcome after severe TBI (sTBI). We conducted a literature search of publications on biomarkers in TBI published up until July 2018. Operating characteristics were pooled for each biomarker for comparison. For detecting concussion, 4 biomarker panels and creatine kinase B type had excellent discriminative ability. For detecting intracranial injury and the need for a head CT scan after mTBI, 2 biomarker panels, and hyperphosphorylated tau had excellent operating characteristics. For predicting delayed recovery after mTBI, top candidates included calpain-derived αII-spectrin N-terminal fragment, tau A, neurofilament light, and ghrelin. For predicting adverse outcome following sTBI, no biomarker had excellent performance, but several had good performance, including markers of coagulation and inflammation, structural proteins in the brain, and proteins involved in homeostasis. The highest-performing biomarkers in each of these categories may provide insight into the pathophysiologies underlying mild and severe TBI. With further study, these biomarkers have the potential to be used alongside clinical and radiological data to improve TBI diagnostics, prognostics, and evidence-based medical management.
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Affiliation(s)
- Zoe S Gan
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Sherman C Stein
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Randel Swanson
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Rehabilitation Medicine Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Neurosurgery, Perelman School of Medicine, Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Shaobo Guan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lizette Garcia
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Devanshi Mehta
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Douglas H Smith
- Department of Neurosurgery, Perelman School of Medicine, Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
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Spear ET, Holt EA, Joyce EJ, Haag MM, Mawe SM, Hennig GW, Lavoie B, Applebee AM, Teuscher C, Mawe GM. Altered gastrointestinal motility involving autoantibodies in the experimental autoimmune encephalomyelitis model of multiple sclerosis. Neurogastroenterol Motil 2018; 30:e13349. [PMID: 29644797 PMCID: PMC6153444 DOI: 10.1111/nmo.13349] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that, in addition to motor, sensory, and cognitive symptoms, also causes constipation, which is poorly understood. Here, we characterize gastrointestinal (GI) dysmotility in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS and evaluate whether autoantibodies target the enteric nervous system (ENS) and cause dysmotility. METHODS EAE was induced in male SJL and B6 mice. GI motility was assessed in vivo and ex vivo in wild type (WT) and B cell-deficient mice. MS and EAE serum was used to survey potential targets in the ENS and changes in the ENS structure were characterized using immunohistochemistry. KEY RESULTS EAE mice developed accelerated gastric emptying and delayed whole GI transit with reduced colonic motility. Fecal water content was reduced, and colonic migrating myoelectrical complexes (CMMC) and slow waves were less frequent. Colons from EAE mice exhibited decreased GFAP levels in glia. Sera from MS patients and from EAE mice targeted ENS neurons and glia. B-cell deficiency in EAE protected against colonic dysmotility. CONCLUSIONS & INFERENCES Consistent with symptoms experienced in MS, we demonstrate that EAE mice widely exhibit features of GI dysmotility that persisted in the absence of extrinsic innervation, suggesting direct involvement of ENS neurocircuitry. The absence of GI dysmotility in B cell-deficient mice with EAE together with EAE and MS serum immunoreactivity against ENS targets suggests that MS could be classified among other diseases known to induce autoimmune GI dysmotility.
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Affiliation(s)
- E. T. Spear
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - E. A. Holt
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - E. J. Joyce
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - M. M. Haag
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - S. M. Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - G. W. Hennig
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA,Department of Pharmacology, The University of Vermont, Burlington, VT, USA
| | - B. Lavoie
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - A. M. Applebee
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - C. Teuscher
- Department of Medicine, The University of Vermont, Burlington, VT, USA
| | - G. M. Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA,Department of Pharmacology, The University of Vermont, Burlington, VT, USA,Department of Medicine, The University of Vermont, Burlington, VT, USA
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Olsen I, Singhrao SK, Potempa J. Citrullination as a plausible link to periodontitis, rheumatoid arthritis, atherosclerosis and Alzheimer's disease. J Oral Microbiol 2018; 10:1487742. [PMID: 29963294 PMCID: PMC6022223 DOI: 10.1080/20002297.2018.1487742] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022] Open
Abstract
Periodontitis, rheumatoid arthritis (RA), atherosclerosis (AS), and Alzheimer’s disease (AD) are examples of complex human diseases with chronic inflammatory components in their etiologies. The initial trigger of inflammation that progresses to these diseases remains unresolved. Porphyromonas gingivalis is unique in its ability to secrete the P. gingivalis-derived peptidyl arginine deiminase (PPAD) and consequently offers a plausible and exclusive link to these diseases through enzymatic conversion of arginine to citrulline. Citrullination is a post-translational enzymatic modification of arginine residues in proteins formed as part of normal physiological processes. However, PPAD has the potential to modify self (bacterial) and host proteins by deimination of arginine amino acid residues, preferentially at the C-terminus. Migration of P. gingivalis and/or its secreted PPAD into the bloodstream opens up the possibility that this enzyme will citrullinate proteins at disparate body sites. Citrullination is associated with the pathogenesis of multifactorial diseases such as RA and AD, which have an elusive external perpetrator as they show epidemiological associations with periodontitis. Therefore, PPAD deserves some prominence as an external antigen, in at least, a subset of RA and AD cases, with as yet unidentified, immune/genetic vulnerabilities.
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Affiliation(s)
- Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sim K Singhrao
- Dementia and Neurodegeneration Research Group, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Jan Potempa
- Faculty of Biochemistry, Biophysics and Biotechnology, Department of Microbiology, Jagiellonian University, Kraków, Poland.,Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
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Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet 2018; 391:1622-1636. [PMID: 29576504 DOI: 10.1016/s0140-6736(18)30481-1] [Citation(s) in RCA: 1144] [Impact Index Per Article: 190.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. Careful consideration is required when choosing the correct treatment, balancing the side-effect profile with efficacy and escalating as clinically appropriate. This move towards more personalised medicine is supported by a clinical guideline published in 2018. Finally, a comprehensive management programme is strongly recommended for all patients with multiple sclerosis, enhancing health-related quality of life through advocating wellness, addressing aggravating factors, and managing comorbidities. The greatest remaining challenge for multiple sclerosis is the development of treatments incorporating neuroprotection and remyelination to treat and ultimately prevent the disabling, progressive forms of the condition.
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Affiliation(s)
- Alan J Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Sergio E Baranzini
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeroen Geurts
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Olga Ciccarelli
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
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14
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Baecher-Allan C, Kaskow BJ, Weiner HL. Multiple Sclerosis: Mechanisms and Immunotherapy. Neuron 2018; 97:742-768. [DOI: 10.1016/j.neuron.2018.01.021] [Citation(s) in RCA: 432] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/25/2017] [Accepted: 01/09/2018] [Indexed: 12/17/2022]
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Abou-Donia MB, Lieberman A, Curtis L. Neural autoantibodies in patients with neurological symptoms and histories of chemical/mold exposures. Toxicol Ind Health 2017; 34:44-53. [PMID: 29069985 DOI: 10.1177/0748233717733852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A number of studies have linked exposures to industrial and household chemicals and biological toxins to increased risk of autoimmunity in general and elevated levels of autoantibodies to neural antigens specifically. Elevated neural autoantibodies are biomarkers for many diseases such as multiple sclerosis and Parkinson's disease. Our study reports levels of six types of neural autoantibodies in a group of 24 toxicant-exposed patients. The patients were exposed to a variety of toxicants including contaminated drinking water (four patients), building water/mold damage (eight patients), pesticides (four patients), and other assorted toxic chemicals (eight patients). Levels of all six neural autoantibodies were significantly elevated in most patients and in the patient group at large, with mean antibody levels for the 24 chemically exposed patients (relative to a healthy control population), in descending order: 475% for tau proteins, 391% for microtubule associated proteins-2, 334% for neurofilament proteins (NFP), 302% for myelin basic protein, 299% for glial fibrillary acidic proteins, and 225% for tubulin. Tau protein autoantibodies were significantly elevated in the patient groups with peripheral neuropathy, muscle and joint pain, asthma, and chemical sensitivity. Autoantibodies to tubulin were significantly higher in the chemical sensitivity and asthma patients, autoantibodies to NFP were significantly higher in the patients with sleep apnea, whereas S-100B autoantibodies were significantly increased in patients with muscle/joint pain, asthma, and apnea/insomnia. In patients exposed to environmental toxicants, measurements of autoantibodies may be useful for prevention, diagnosis, and treatment. This study adds to the scientific literature the ability of a broad spectrum of environmental triggers adversely affecting the nervous system through the process of autoimmunity, which may explain the increasing incidence of neurodegenerative diseases.
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Affiliation(s)
- Mohamed Bahie Abou-Donia
- 1 Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Allan Lieberman
- 2 Center for Occupational and Environmental Medicine, North Charleston, SC, USA
| | - Luke Curtis
- 2 Center for Occupational and Environmental Medicine, North Charleston, SC, USA
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DeMarshall C, Goldwaser EL, Sarkar A, Godsey GA, Acharya NK, Thayasivam U, Belinka BA, Nagele RG. Autoantibodies as diagnostic biomarkers for the detection and subtyping of multiple sclerosis. J Neuroimmunol 2017; 309:51-57. [PMID: 28601288 DOI: 10.1016/j.jneuroim.2017.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/19/2022]
Abstract
The goal of this preliminary proof-of-concept study was to use human protein microarrays to identify blood-based autoantibody biomarkers capable of diagnosing multiple sclerosis (MS). Using sera from 112 subjects, including 51 MS subjects, autoantibody biomarkers effectively differentiated MS subjects from age- and gender-matched normal and breast cancer controls with 95.0% and 100% overall accuracy, but not from subjects with Parkinson's disease. Autoantibody biomarkers were also useful in distinguishing subjects with the relapsing-remitting form of MS from those with the secondary progressive subtype. These results demonstrate that autoantibodies can be used as noninvasive blood-based biomarkers for the detection and subtyping of MS.
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Affiliation(s)
- Cassandra DeMarshall
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Eric L Goldwaser
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Abhirup Sarkar
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA
| | - George A Godsey
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA
| | - Nimish K Acharya
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Robert G Nagele
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA; Durin Technologies, Inc., New Brunswick, NJ, USA.
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Abstract
The complement system is a major component of innate immunity and a potent driver of inflammation. It has key roles in host defense against pathogens but can also contribute to pathology by driving inflammation and cell damage in diverse diseases. Complement has emerged as an important factor in the pathogenesis of numerous diseases of the CNS and PNS, including infectious, autoimmune and degenerative disorders, and is increasingly implicated in neuropsychiatric disease. Establishing the roles and relevance of complement in disease pathogenesis has become ever more important in recent years as new drugs targeting the complement system have reached the clinic, and the potential for using complement analytes as disease biomarkers has been recognized. In this brief review, the author summarizes the evidence implicating complement in these diseases and outlines ways in which this new understanding can be used to aid diagnosis and improve outcome.
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Affiliation(s)
- Bryan Paul Morgan
- a Institute of Infection and Immunity, School of Medicine, Cardiff University, Henry Wellcome Building, Heath Park, Cardiff CF144XN, UK
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Anoctamin 2 identified as an autoimmune target in multiple sclerosis. Proc Natl Acad Sci U S A 2016; 113:2188-93. [PMID: 26862169 DOI: 10.1073/pnas.1518553113] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system and also is regarded as an autoimmune condition. However, the antigenic targets of the autoimmune response in MS have not yet been deciphered. In an effort to mine the autoantibody repertoire within MS, we profiled 2,169 plasma samples from MS cases and population-based controls using bead arrays built with 384 human protein fragments selected from an initial screening with 11,520 antigens. Our data revealed prominently increased autoantibody reactivity against the chloride-channel protein anoctamin 2 (ANO2) in MS cases compared with controls. This finding was corroborated in independent assays with alternative protein constructs and by epitope mapping with peptides covering the identified region of ANO2. Additionally, we found a strong interaction between the presence of ANO2 autoantibodies and the HLA complex MS-associated DRB1*15 allele, reinforcing a potential role for ANO2 autoreactivity in MS etiopathogenesis. Furthermore, immunofluorescence analysis in human MS brain tissue showed ANO2 expression as small cellular aggregates near and inside MS lesions. Thus this study represents one of the largest efforts to characterize the autoantibody repertoire within MS. The findings presented here demonstrate that an ANO2 autoimmune subphenotype may exist in MS and lay the groundwork for further studies focusing on the pathogenic role of ANO2 autoantibodies in MS.
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Metz I, Beißbarth T, Ellenberger D, Pache F, Stork L, Ringelstein M, Aktas O, Jarius S, Wildemann B, Dihazi H, Friede T, Brück W, Ruprecht K, Paul F. Serum peptide reactivities may distinguish neuromyelitis optica subgroups and multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e204. [PMID: 26894206 PMCID: PMC4747481 DOI: 10.1212/nxi.0000000000000204] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess in an observational study whether serum peptide antibody reactivities may distinguish aquaporin-4 (AQP4) antibody (Ab)-positive and -negative neuromyelitis optica spectrum disorders (NMOSD) and relapsing-remitting multiple sclerosis (RRMS). METHODS We screened 8,700 peptides that included human and viral antigens of potential relevance for inflammatory demyelinating diseases and random peptides with pooled sera from different patient groups and healthy controls to set up a customized microarray with 700 peptides. With this microarray, we tested sera from 66 patients with AQP4-Ab-positive (n = 16) and AQP4-Ab-negative (n = 19) NMOSD, RRMS (n = 11), and healthy controls (n = 20). RESULTS Differential peptide reactivities distinguished NMOSD subgroups from RRMS in 80% of patients. However, the 2 NMOSD subgroups were not well-discriminated, although those patients are clearly separated by their antibody reactivities against AQP4 in cell-based assays. Elevated reactivities to myelin and Epstein-Barr virus peptides were present in RRMS and to AQP4 and AQP1 peptides in AQP4-Ab-positive NMOSD. CONCLUSIONS While AQP4-Ab-positive and -negative NMOSD subgroups are not well-discriminated by peptide antibody reactivities, our findings suggest that peptide antibody reactivities may have the potential to distinguish between both NMOSD subgroups and MS. Future studies should thus concentrate on evaluating peptide antibody reactivities for the differentiation of AQP4-Ab-negative NMOSD and MS.
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Affiliation(s)
- Imke Metz
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Tim Beißbarth
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - David Ellenberger
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Florence Pache
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Lidia Stork
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Marius Ringelstein
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Orhan Aktas
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Sven Jarius
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Brigitte Wildemann
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Hassan Dihazi
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Tim Friede
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Wolfgang Brück
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Klemens Ruprecht
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
| | - Friedemann Paul
- Departments of Neuropathology (I.M., L.S., W.B.), Medical Statistics (T.B., D.E., T.F.), and Nephrology and Rheumatology, Internal Medicine (H.D.), University Medical Center Göttingen; Department of Neurology (F. Pache, K.R., F. Paul) and Clinical and Experimental Multiple Sclerosis Research Center (F. Pache, K.R., F. Paul), Charité-Universitätsmedizin Berlin; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F. Pache, F. Paul), Max Delbrueck Center for Molecular Medicine; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf; and Molecular Neuroimmunology Group, Department of Neurology (S.J., B.W.), University of Heidelberg, Germany
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Hohlfeld R, Dornmair K, Meinl E, Wekerle H. The search for the target antigens of multiple sclerosis, part 2: CD8+ T cells, B cells, and antibodies in the focus of reverse-translational research. Lancet Neurol 2015; 15:317-31. [PMID: 26724102 DOI: 10.1016/s1474-4422(15)00313-0] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 01/16/2023]
Abstract
Interest in CD8+ T cells and B cells was initially inspired by observations in multiple sclerosis rather than in animal models: CD8+ T cells predominate in multiple sclerosis lesions, oligoclonal immunoglobulin bands in CSF have long been recognised as diagnostic and prognostic markers, and anti-B-cell therapies showed considerable efficacy in multiple sclerosis. Taking a reverse-translational approach, findings from human T-cell receptor (TCR) and B-cell receptor (BCR) repertoire studies provided strong evidence for antigen-driven clonal expansion in the brain and CSF. New methods allow the reconstruction of human TCRs and antibodies from tissue-infiltrating immune cells, which can be used for the unbiased screening of antigen libraries. Myelin oligodendrocyte glycoprotein (MOG) has received renewed attention as an antibody target in childhood multiple sclerosis and in a small subgroup of adult patients with multiple sclerosis. Furthermore, there is growing evidence that a separate condition in adults exists, tentatively called MOG-antibody-associated encephalomyelitis, which has clinical features that overlap with neuromyelitis optica spectrum disorder and multiple sclerosis. Although CD8+ T cells and B cells are thought to have a pathogenic role in some subgroups of patients, their target antigens have yet to be identified.
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Affiliation(s)
- Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Campus Martinsried-Grosshadern, Ludwig-Maximilians University, Munich, Germany; Munich Cluster of Systems Neurology (SyNergy), Munich, Germany.
| | - Klaus Dornmair
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Campus Martinsried-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Campus Martinsried-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Hartmut Wekerle
- HERTIE Senior Professor Group Neuroimmunology, Max Planck Institute of Neurobiology, Martinsried, Germany
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Abstract
While over the past decades T cells have been considered key players in the pathogenesis of multiple sclerosis (MS), it has only recently become evident that B cells have a major contributing role. Our understanding of the role of B cells has evolved substantially following the clinical success of B cell-targeting therapies and increasing experimental evidence for significant B cell involvement. Rather than mere antibody-producing cells, it is becoming clear that they are team players with the capacity to prime and regulate T cells, and function both as pro- and anti-inflammatory mediators. However, despite tremendous efforts, the target antigen(s) of B cells in MS have yet to be identified. The first part of this review summarizes the clinical evidence and results from animal studies pointing to the relevance of B cells in the pathogenesis of MS. The second part gives an overview of the currently known potential autoantigen targets. The third part recapitulates and critically appraises the currently available B cell-directed therapies.
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23
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Stathopoulos P, Alexopoulos H, Dalakas MC. Autoimmune antigenic targets at the node of Ranvier in demyelinating disorders. Nat Rev Neurol 2015; 11:143-56. [DOI: 10.1038/nrneurol.2014.260] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hemmer B. Antibodies to the inward rectifying potassium channel 4.1 in multiple sclerosis: different methodologies—conflicting results? Mult Scler 2015; 21:537-9. [DOI: 10.1177/1352458514564493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany
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25
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Utility of Autoantibodies as Biomarkers for Diagnosis and Staging of Neurodegenerative Diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 122:1-51. [DOI: 10.1016/bs.irn.2015.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Schirmer L, Srivastava R, Kalluri SR, Böttinger S, Herwerth M, Carassiti D, Srivastava B, Gempt J, Schlegel J, Kuhlmann T, Korn T, Reynolds R, Hemmer B. Differential loss of KIR4.1 immunoreactivity in multiple sclerosis lesions. Ann Neurol 2014; 75:810-28. [DOI: 10.1002/ana.24168] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Lucas Schirmer
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Rajneesh Srivastava
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Sudhakar Reddy Kalluri
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Susanne Böttinger
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Marina Herwerth
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Daniele Carassiti
- Wolfson Neuroscience Laboratories, Division of Brain Sciences, Imperial College Faculty of Medicine, Hammersmith Hospital; London United Kingdom
| | - Barkha Srivastava
- Comprehensive Pneumology Center, Ludwig Maximilians University Munich and Helmholtz Center Munich; Munich Germany
| | - Jens Gempt
- Department of Neurosurgery; Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Jürgen Schlegel
- Division of Neuropathology, Institute of Pathology, Klinikum rechts der Isar, Technische Universität München; Munich Germany
| | - Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster; Münster Germany
| | - Thomas Korn
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
- Munich Cluster for Systems Neurology (SyNergy); Munich Germany
| | - Richard Reynolds
- Wolfson Neuroscience Laboratories, Division of Brain Sciences, Imperial College Faculty of Medicine, Hammersmith Hospital; London United Kingdom
| | - Bernhard Hemmer
- Department of Neurology; Klinikum rechts der Isar, Technische Universität München; Munich Germany
- Munich Cluster for Systems Neurology (SyNergy); Munich Germany
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Lindner M, Linington C. Myelinating Cultures: An In Vitro Tool to Identify Demyelinating and Axopathic Autoantibodies. Methods Mol Biol 2014; 1304:105-14. [PMID: 25417062 DOI: 10.1007/7651_2014_129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Myelinating cultures derived from embryonic spinal cord provide an invaluable tool to detect demyelinating and axopathic autoantibodies in clinical samples. A single preparation will provide a minimum of 200 individual cultures allowing 60 or more samples to be assayed in triplicate.
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Affiliation(s)
- Maren Lindner
- Institute of Infection, Immunity and Inflammation, University of Glasgow, 120 University Place, Glasgow, UK
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