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Blok KM, van Rosmalen J, Tebayna N, Smolders J, Wokke B, de Beukelaar J. Disease activity in primary progressive multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2023; 14:1277477. [PMID: 38020591 PMCID: PMC10661414 DOI: 10.3389/fneur.2023.1277477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Disease activity in multiple sclerosis (MS) is defined as presence of relapses, gadolinium enhancing lesions and/or new or enlarging lesions on MRI. It is associated with efficacy of immunomodulating therapies (IMTs) in primary progressive MS (PPMS). However, a thorough review on disease activity in PPMS is lacking. In relapsing remitting MS, the prevalence of activity decreases in more contemporary cohorts. For PPMS, this is unknown. Aim To review disease activity in PPMS cohorts and identify its predictors. Methods A systematic search in EMBASE, MEDLINE, Web of science Core Collection, COCHRANE CENTRAL register of trials, and GOOGLE SCHOLAR was performed. Keywords included PPMS, inflammation, and synonyms. We included original studies with predefined available data, extracted cohort characteristics and disease activity outcomes and performed meta-regression analyses. Results We included 34 articles describing 7,109 people with PPMS (pwPPMS). The weighted estimated proportion of pwPPMS with overall disease activity was 26.8% (95% CI 20.6-34.0%). A lower age at inclusion predicted higher disease activity (OR 0.91, p = 0.031). Radiological activity (31.9%) was more frequent than relapses (9.2%), and was predicted by longer follow-up duration (OR 1.27, p = 0.033). Year of publication was not correlated with disease activity. Conclusion Inflammatory disease activity is common in PPMS and has remained stable over the last decades. Age and follow-up duration predict disease activity, advocating prolonged monitoring of young pwPPMS to evaluate potential IMT benefits.
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Affiliation(s)
- Katelijn M. Blok
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nura Tebayna
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Neuroimmunology Researchgroup, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janet de Beukelaar
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
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Ammitzbøll C, Dyrby TB, Börnsen L, Schreiber K, Ratzer R, Romme Christensen J, Iversen P, Magyari M, Lundell H, Jensen PEH, Sørensen PS, Siebner HR, Sellebjerg F. NfL and GFAP in serum are associated with microstructural brain damage in progressive multiple sclerosis. Mult Scler Relat Disord 2023; 77:104854. [PMID: 37418931 DOI: 10.1016/j.msard.2023.104854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The potential of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) as biomarkers of disease activity and severity in progressive forms of multiple sclerosis (MS) is unclear. OBJECTIVE To investigate the relationship between serum concentrations of NfL, GFAP, and magnetic resonance imaging (MRI) in progressive MS. METHODS Serum concentrations of NfL and GFAP were measured in 32 healthy controls and 32 patients with progressive MS from whom clinical and MRI data including diffusion tensor imaging (DTI) were obtained during three years of follow-up. RESULTS Serum concentrations of NfL and GFAP at follow-up were higher in progressive MS patients than in healthy controls and serum NfL correlated with the EDSS score. Decreasing fractional anisotropy (FA) in normal-appearing white matter (NAWM) correlated with worsening EDSS scores and higher serum NfL. Higher serum NfL and increasing T2 lesion volume correlated with worsening paced autitory serial addition test scores. In multivariable regression analyses with serum GFAP and NfL as independent factors and DTI measures of NAWM as dependent factors, we showed that high serum NfL at follow-up was independently associated with decreasing FA and increasing MD in NAWM. Moreover, we found that high serum GFAP was independently associated with decreasing MD in NAWM and with decreasing MD and increasing FA in cortical gray matter. CONCLUSION Serum concentrations of NfL and GFAP are increased in progressive MS and are associated with distinct microstructural changes in NAWM and CGM.
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Affiliation(s)
- C Ammitzbøll
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark.
| | - T B Dyrby
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - L Börnsen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - K Schreiber
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - R Ratzer
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - J Romme Christensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - P Iversen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - M Magyari
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - H Lundell
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - P E H Jensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - P S Sørensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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T Cell Energy Metabolism Is a Target of Glucocorticoids in Mice, Healthy Humans, and MS Patients. Cells 2023; 12:cells12030450. [PMID: 36766792 PMCID: PMC9914408 DOI: 10.3390/cells12030450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Glucocorticoids (GCs) are used to treat inflammatory disorders such as multiple sclerosis (MS) by exerting prominent activities in T cells including apoptosis induction and suppression of cytokine production. However, little is known about their impact on energy metabolism, although it is widely accepted that this process is a critical rheostat of T cell activity. We thus tested the hypothesis that GCs control genes and processes involved in nutrient transport and glycolysis. Our experiments revealed that escalating doses of dexamethasone (Dex) repressed energy metabolism in murine and human primary T cells. This effect was mediated by the GC receptor and unrelated to both apoptosis induction and Stat1 activity. In contrast, treatment of human T cells with rapamycin abolished the repression of metabolic gene expression by Dex, unveiling mTOR as a critical target of GC action. A similar phenomenon was observed in MS patients after intravenous methylprednisolon (IVMP) pulse therapy. The expression of metabolic genes was reduced in the peripheral blood T cells of most patients 24 h after GC treatment, an effect that correlated with disease activity. Collectively, our results establish the regulation of T cell energy metabolism by GCs as a new immunomodulatory principle.
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Pharmacokinetic Study of Intranasal Dexamethasone and Methylprednisolone Compared with Intravenous Administration: Two Open-Label, Single-Dose, Two-Period, Two-Sequence, Cross-Over Study in Healthy Volunteers. Pharmaceutics 2022; 15:pharmaceutics15010105. [PMID: 36678735 PMCID: PMC9861764 DOI: 10.3390/pharmaceutics15010105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022] Open
Abstract
Dexamethasone (DXM) and methylprednisolone (MEP) are potent glucocorticoids used to control several inflammatory conditions. Evidence of delayed DXM reaching the central nervous system (CNS) as well as tachyphylaxis and systemic, undesirable side effects are the main limitations of peripheral delivery. Intranasal administration offers direct access to the brain as it bypasses the blood-brain barrier. The Mucosal Atomization Device is an optimal tool that can achieve rapid absorption into the CNS and the bloodstream across mucosal membranes. This study was designed to evaluate and compare the bioavailability of DXM and MEP after intranasal versus intravenous administration. Two open-label, balanced, randomized, two-treatment, two-period, two-sequence, single-dose, crossover studies were conducted, which involved healthy male and female adult volunteers. After intranasal administration, DXM and MEP were detected in plasma after the first sampling time. Mean peak concentrations of DXM and MEP were 86.61 ng/mL at 60 min and 843.2 ng/mL at 1.5 h post-administration, respectively. DXM and MEP showed high absolute bioavailability, with values of 80% and 95%, respectively. No adverse effects were observed. DXM and MEP systemic bioavailability by intranasal administration was comparable with the intravenous one, suggesting that the intranasal route can be used as a non-invasive and appropriate alternative for systemic drug delivery.
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Allanach JR, Farrell JW, Mésidor M, Karimi-Abdolrezaee S. Current status of neuroprotective and neuroregenerative strategies in multiple sclerosis: A systematic review. Mult Scler 2022; 28:29-48. [PMID: 33870797 PMCID: PMC8688986 DOI: 10.1177/13524585211008760] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Immune-mediated demyelination and consequent degeneration of oligodendrocytes and axons are hallmark features of multiple sclerosis (MS). Remyelination declines in progressive MS, causing permanent axonal loss and irreversible disabilities. Strategies aimed at enhancing remyelination are critical to attenuate disease progression. OBJECTIVE We systematically reviewed recent advances in neuroprotective and regenerative therapies for MS, covering preclinical and clinical studies. METHODS We searched three biomedical databases using defined keywords. Two authors independently reviewed articles for inclusion based on pre-specified criteria. The data were extracted from each study and assessed for risk of bias. RESULTS Our search identified 7351 studies from 2014 to 2020, of which 221 met the defined criteria. These studies reported 262 interventions, wherein 92% were evaluated in animal models. These interventions comprised protein, RNA, lipid and cellular biologics, small molecules, inorganic compounds, and dietary and physiological interventions. Small molecules were the most highly represented strategy, followed by antibody therapies and stem cell transplantation. CONCLUSION While significant strides have been made to develop regenerative treatments for MS, the current evidence illustrates a skewed representation of the types of strategies that advance to clinical trials. Further examination is thus required to address current barriers to implementing experimental treatments in clinical settings.
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Affiliation(s)
- Jessica R Allanach
- Department of Microbiology and Immunology, The University of British Columbia, Vancouver, BC, Canada
| | - John W. Farrell
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Miceline Mésidor
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada/Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
| | - Soheila Karimi-Abdolrezaee
- Department of Physiology and Pathophysiology, Regenerative Medicine Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Højsgaard Chow H, Talbot J, Lundell H, Gøbel Madsen C, Marstrand L, Lange T, Mahler MR, Buhelt S, Holm Hansen R, Blinkenberg M, Romme Christensen J, Soelberg Sørensen P, Rode von Essen M, Siebner HR, Sellebjerg F. Dimethyl Fumarate Treatment in Patients With Primary Progressive Multiple Sclerosis: A Randomized, Controlled Trial. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1037. [PMID: 34429340 PMCID: PMC8407149 DOI: 10.1212/nxi.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
Background and Objective To study whether dimethyl fumarate is superior to placebo in decreasing CSF concentrations of neurofilament light chain (NFL) in patients with primary progressive MS (PPMS). Methods In the double-blind, placebo-controlled phase 2 study dimethyl FUMArate treatment in Progressive Multiple Sclerosis (FUMAPMS), patients with PPMS were randomly assigned to treatment with 240 mg dimethyl fumarate or placebo in a 1:1 ratio for 48 weeks. The primary endpoint was change in concentration of NFL in the CSF. Secondary endpoints included other CSF biomarkers and clinical and MRI measures. Efficacy was evaluated for the full data set by multiple imputations to account for missing data. Safety was assessed for the full data set. Results Fifty-four patients (mean age 54.9 years [SD 6.1], median Expanded Disability Status Scale 4.0 [nterquartile range 4.0–6.0], disease duration 14.1 [SD 9.4], and 21 [39%] female) were randomized to either placebo (n = 27) or dimethyl fumarate (n = 27) therapy. At screening CSF concentrations, adjusted for age and sex, of NFL, myelin basic protein (MBP), soluble CD27, chitinase 3-like 1, and B-cell maturation antigen were higher than in a group of symptomatic controls. Twenty-six patients (96%) in the dimethyl fumarate group and 24 patients (89%) in the placebo group completed the randomized phase. Mean change in CSF concentrations of NFL did not differ between groups (mean difference 99 ng/L; 95% CI −292 to 491 ng/L). MBP in CSF decreased in the treatment group (−182 ng/L, 95% CI −323 to −41 ng/L compared with placebo). The difference observed in the multiple imputation data set was not significant in a per protocol analysis. This was nominally significant in the multiple imputation data set but not in the per protocol analysis This was not found in the per protocol analysis Other secondary and tertiary outcomes were not affected. Various infections, lymphopenia, flushing, and gastrointestinal side effects were more frequent in the dimethyl fumarate group. Serious adverse events were similar between groups. Discussion Dimethyl fumarate treatment for 48 weeks had no effect on any of the investigated efficacy measures in patients with PPMS. We did not observe adverse events not anticipated for dimethyl fumarate treatment. Trial Registration Information Clinicaltrials.gov identifier NCT02959658. Classification of Evidence This study provides Class I evidence that for patients with PPMS, dimethyl fumarate treatment has no effect on CSF NFL levels compared with placebo treatment.
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Affiliation(s)
- Helene Højsgaard Chow
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Jacob Talbot
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Henrik Lundell
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Camilla Gøbel Madsen
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Lisbet Marstrand
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Theis Lange
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Mie Reith Mahler
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Sophie Buhelt
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Rikke Holm Hansen
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Morten Blinkenberg
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Jeppe Romme Christensen
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Per Soelberg Sørensen
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Marina Rode von Essen
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Hartwig Roman Siebner
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark
| | - Finn Sellebjerg
- From the Danish Multiple Sclerosis Center (H.H.C., J.T., L.M., M.M., S.B., R.H.H., M.B., J.R.C., P.S.S., M.E., F.S.), Copenhagen University Hospital, Rigshospitalet Glostrup, Glostrup; Danish Research Centre for Magnetic Resonance (H.L., C.G.M., H.R.S.), Copenhagen University Hospital Hvidovre, Hvidovre; Section of Biostatistics (T.L.), Department of Public Health, University of Copenhagen, Copenhagen K; Department of Neurology (H.R.S.), Copenhagen University Hospital Bispebjerg, Copenhagen; and Institute for Clinical Medicine (H.R.S.), University of Copenhagen, Copenhagen N, Denmark.
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7
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Kapoor R, Smith KE, Allegretta M, Arnold DL, Carroll W, Comabella M, Furlan R, Harp C, Kuhle J, Leppert D, Plavina T, Sellebjerg F, Sincock C, Teunissen CE, Topalli I, von Raison F, Walker E, Fox RJ. Serum neurofilament light as a biomarker in progressive multiple sclerosis. Neurology 2020; 95:436-444. [PMID: 32675076 PMCID: PMC7538221 DOI: 10.1212/wnl.0000000000010346] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023] Open
Abstract
There is an unmet need in multiple sclerosis (MS) therapy for treatments to stop progressive disability. The development of treatments may be accelerated if novel biomarkers are developed to overcome the limitations of traditional imaging outcomes revealed in early phase trials. In January 2019, the International Progressive MS Alliance convened a standing expert panel to consider potential tissue fluid biomarkers in MS in general and in progressive MS specifically. The panel focused their attention on neurofilament light chain (NfL) in serum or plasma, examining data from both relapsing and progressive MS. Here, we report the initial conclusions of the panel and its recommendations for further research. Serum NfL (sNfL) is a plausible marker of neurodegeneration that can be measured accurately, sensitively, and reproducibly, but standard procedures for sample processing and analysis should be established. Findings from relapsing and progressive cohorts concur and indicate that sNfL concentrations correlate with imaging and disability measures, predict the future course of the disease, and can predict response to treatment. Importantly, disease activity from active inflammation (i.e., new T2 and gadolinium-enhancing lesions) is a large contributor to sNfL, so teasing apart disease activity from the disease progression that drives insidious disability progression in progressive MS will be challenging. More data are required on the effects of age and comorbidities, as well as the relative contributions of inflammatory activity and other disease processes. The International Progressive MS Alliance is well positioned to advance these initiatives by connecting and supporting relevant stakeholders in progressive MS.
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Affiliation(s)
- Raju Kapoor
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Kathryn E Smith
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Mark Allegretta
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Douglas L Arnold
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - William Carroll
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Manuel Comabella
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Roberto Furlan
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Christopher Harp
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Jens Kuhle
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - David Leppert
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Tatiana Plavina
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Finn Sellebjerg
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Caroline Sincock
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Charlotte E Teunissen
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Ilir Topalli
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Florian von Raison
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Elizabeth Walker
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic
| | - Robert J Fox
- From the University College London (R.K.), United Kingdom; National Multiple Sclerosis Society (K.E.S., M.A.), New York; McGill University (D.L.A.), Montreal, Canada; Perron Institute (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; University Hospital Vall d'Hebron (M.C.), Barcelona, Spain; San Raffaele Scientific Institute (R.F.), Milan, Italy; Genentech/Roche (C.H.), South San Francisco; University Hospital Basel (J.K., D.L.), Switzerland; Biogen (T.P.), Boston; Quanterix Corporation (T.P.), Billerica; Rigshospitalet (F.S.), University of Copenhagen, Denmark; Progressive Multiple Sclerosis Alliance (C.S.), Glasgow, United Kingdom; Amsterdam UMC (C.E.T.), the Netherlands; MedDay Pharma (I.T.), Paris, France; Novartis (F.v.R.), Basel, Switzerland; Elizabeth Walker Consulting (E.W.), Seattle; and Mellen Center for Multiple Sclerosis (R.J.F.), Cleveland Clinic.
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Preziosa P, Rocca MA, Filippi M. Current state-of-art of the application of serum neurofilaments in multiple sclerosis diagnosis and monitoring. Expert Rev Neurother 2020; 20:747-769. [DOI: 10.1080/14737175.2020.1760846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A. Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Saied A, Elsaid N, Azab A. Long term effects of corticosteroids in multiple sclerosis in terms of the "no evidence of disease activity" (NEDA) domains. Steroids 2019; 149:108401. [PMID: 31100292 DOI: 10.1016/j.steroids.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system (CNS) that usually is clinically characterized by multiple subacute relapses and remissions. The established therapeutic strategies include intravenous methylprednisolone (IV-MP) for treatment of relapses and immunomodulatory or immunosuppressive treatment to prevent new relapses and progression of disability. Despite not being one of the recommended immunomodulatory or immunosuppressive treatments, monthly IV-MP is frequently seen in clinical practice especially in the low income developing countries. OBJECTIVES To review the evidences for the possible disease modifying potential of corticosteroids in the treatment of MS in terms of the NEDA 3 domains. MATERIALS & METHODS Available literature from PubMed search and personal experiences on corticosteroid treatment in multiple sclerosis were reviewed. RESULTS There is some evidence that pulsed treatment with methylprednisolone have beneficial long-term effects on relapse rate, MRI findings and disability progression. CONCLUSION More data is needed to determine long-term disease modifying effects of corticosteroids. The findings of this study suggest that, perhaps, regular pulse glucocorticoid treatment may have important long-term consequences (beneficial) for patients with MS and it may achieve the NEDA target. Certainly, the magnitude of the reported effects deserves further investigation in both relapsing and progressive MS populations.
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Affiliation(s)
- Ahmed Saied
- Neurology Department, Faculty of Medicine, Mansoura University, Egypt
| | - Nada Elsaid
- Neurology Department, Faculty of Medicine, Mansoura University, Egypt.
| | - Ahmed Azab
- Neurology Department, Faculty of Medicine, Mansoura University, Egypt
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10
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Christensen JR, Komori M, von Essen MR, Ratzer R, Börnsen L, Bielekova B, Sellebjerg F. CSF inflammatory biomarkers responsive to treatment in progressive multiple sclerosis capture residual inflammation associated with axonal damage. Mult Scler 2019; 25:937-946. [PMID: 29775134 PMCID: PMC6212343 DOI: 10.1177/1352458518774880] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Development of treatments for progressive multiple sclerosis (MS) is challenged by the lack of sensitive and treatment-responsive biomarkers of intrathecal inflammation. OBJECTIVE To validate the responsiveness of cerebrospinal fluid (CSF) inflammatory biomarkers to treatment with natalizumab and methylprednisolone in progressive MS and to examine the relationship between CSF inflammatory and tissue damage biomarkers. METHODS CSF samples from two open-label phase II trials of natalizumab and methylprednisolone in primary and secondary progressive MS. CSF concentrations of 20 inflammatory biomarkers and CSF biomarkers of axonal damage (neurofilament light chain (NFL)) and demyelination were analysed using electrochemiluminescent assay and enzyme-linked immunosorbent assay (ELISA). RESULTS In all, 17 natalizumab- and 23 methylprednisolone-treated patients had paired CSF samples. CSF sCD27 displayed superior standardised response means and highly significant decreases during both natalizumab and methylprednisolone treatment; however, post-treatment levels remained above healthy donor reference levels. Correlation analyses of CSF inflammatory biomarkers and NFL before, during and after treatment demonstrated that CSF sCD27 consistently correlates with NFL. CONCLUSION These findings validate CSF sCD27 as a responsive and sensitive biomarker of intrathecal inflammation in progressive MS, capturing residual inflammation after treatment. Importantly, CSF sCD27 correlates with NFL, consistent with residual inflammation after anti-inflammatory treatment being associated with axonal damage.
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Affiliation(s)
- Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mika Komori
- Neuroimmunological Diseases Unit, National Institute of Neurological Diseases and Stroke, National Institute of Health, Bethesda, USA
| | - Marina Rode von Essen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Ratzer
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Börnsen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Bielekova
- Neuroimmunological Diseases Unit, National Institute of Neurological Diseases and Stroke, National Institute of Health, Bethesda, USA
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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11
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Andreasen AK, Iversen P, Marstrand L, Siersma V, Siebner HR, Sellebjerg F. Structural and cognitive correlates of fatigue in progressive multiple sclerosis. Neurol Res 2018; 41:168-176. [PMID: 30513278 DOI: 10.1080/01616412.2018.1547813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue in multiple sclerosis (MS) is a debilitating symptom and experienced by most patients. In recent studies investigating this phenomenon, the majority of patients had a relapsing-remitting disease course. METHODS Patients with progressive MS participating in one of three treatment trials during a period from 2010 to 2014 were included. Fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions (FSMC) and patients were further examined with a cognitive test battery, including Symbol Digit Modalities Test (SDMT), and 3 T MRI with subsequent quantitative analyses of 13 cortical regions of interest, deep grey matter and lesion volume. RESULTS Twenty-two patients were enrolled. The thickness of the pre-central gyrus correlated significantly with motor fatigue. We found only a non-significant trend towards a correlation between cognitive fatigue and the thickness of the pre-central gyrus, the parietal inferior supra-marginal gyrus and the opercular part of the inferior frontal gyrus. 36% of participants had impaired processing speed and 9% had normal function on all tests. The scores on the FSMC-cognitive scale were related to performance on SDMT. CONCLUSION In this exploratory study of patients with progressive MS, fatigue was related to processing speed. Motor fatigue was also related to the cortical thickness of the primary motor cortex and there was a trend towards a relationship between cognitive fatigue and the thickness of cortical areas involved in attentional processes. Additional studies are needed to further elucidate the relationship between regional cortical atrophy, cognitive functioning and the perception of fatigue. ABBREVIATIONS FSMC: Motor and Cognitive Functions; MS: Multiple Sclerosis; SDMT: Symbol Digit Modalities Test; MRI: Magnetic Resonance Imaging; RRMS: Relapsing-Remitting Disease Course; EDSS: Kurtzke Expanded Disability Status Scale; FLAIR: Fluid Attenuated Inversion Recovery; NAWM: Normal-Appearing White Matter; CGM: Cortical Grey Matter; CTh: Cortical Thickness; ROIs: Regions of Interest; Raven: Raven Progressive Matrices; TM A: Trail Making A; TM B: Trail Making B; Rey: Rey Complex Figure; Similarities: WAIS III Similarities; Stroop: Stroop Colour Naming Test; BDI: Becks Depression Inventory II.
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Affiliation(s)
- Anne Katrine Andreasen
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Pernille Iversen
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Lisbet Marstrand
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Volkert Siersma
- c The Research Unit for General Practice and Section of General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Hartwig Roman Siebner
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Finn Sellebjerg
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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Özakbaş S, Çinar BP, Öz D, Kösehasanoğullari G, Kurşun BB, Kahraman T. Monthly Pulse Methylprednisolone Therapy is Effective in Preventing Permanent Disease Progression in Secondary Progressive Multiple Sclerosis. ACTA ACUST UNITED AC 2018; 56:115-118. [PMID: 31223243 DOI: 10.5152/npa.2017.19339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/28/2017] [Indexed: 11/22/2022]
Abstract
Introduction Secondary progressive multiple sclerosis (SPMS) is the phase in which disability continues to worsen with or without accompanying attacks. Monthly methylprednisolone pulse therapy can be used in the secondary progressive phase. The purpose of the present study was to evaluate the effects of methylprednisolone pulse therapy on the basis of clinical and MRI parameters in patients with SPMS. Methods This was a multi-center, examiner-blinded, prospective study. Patients with SPMS with EDSS scores of 3 or more, using one or none of azathioprine, interferon or glatiramer acetate, were evaluated. Patients were given IVMP (1 dose of 1 g IV) once a month for 24 months. EDSS scores, MRI findings, quality of life, and adverse events were evaluated. Results Ninety-seven SPMS patients were included in the study. Significant decreases in new/enlarging, Gd-enhanced, and spinal lesions were observed from baseline to year 2. EDSS scores remained stable at the end of the second year. Monthly high-dose IVMP resulted in a significant decrease in attacks. Conclusion This study is important in terms of emphasizing that this therapeutic option should not be overlooked, since monthly pulse therapy can halt or even reverse progression, regarded as a natural course in SPMS, albeit to a small extent.
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Affiliation(s)
- Serkan Özakbaş
- Department of Neurology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Bilge Piri Çinar
- Samsun Research and Training Hospital, Neurology Clinic, Samsun, Turkey
| | - Didem Öz
- Department of Neurology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | | | - Behice Bircan Kurşun
- Department of Neurology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, İzmir Katip Çelebi University Faculty of Health Sciences, İzmir, Turkey
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De Angelis F, Plantone D, Chataway J. Pharmacotherapy in Secondary Progressive Multiple Sclerosis: An Overview. CNS Drugs 2018; 32:499-526. [PMID: 29968175 DOI: 10.1007/s40263-018-0538-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Multiple sclerosis is an immune-mediated inflammatory disease of the central nervous system characterised by demyelination, neuroaxonal loss and a heterogeneous clinical course. Multiple sclerosis presents with different phenotypes, most commonly a relapsing-remitting course and, less frequently, a progressive accumulation of disability from disease onset (primary progressive multiple sclerosis). The majority of people with relapsing-remitting multiple sclerosis, after a variable time, switch to a stage characterised by gradual neurological worsening known as secondary progressive multiple sclerosis. We have a limited understanding of the mechanisms underlying multiple sclerosis, and it is believed that multiple genetic, environmental and endogenous factors are elements driving inflammation and ultimately neurodegeneration. Axonal loss and grey matter damage have been regarded as amongst the leading causes of irreversible neurological disability in the progressive stages. There are over a dozen disease-modifying therapies currently licenced for relapsing-remitting multiple sclerosis, but none of these has provided evidence of effectiveness in secondary progressive multiple sclerosis. Recently, there has been some early modest success with siponimod in secondary progressive multiple sclerosis and ocrelizumab in primary progressive multiple sclerosis. Finding treatments to delay or prevent the courses of secondary progressive multiple sclerosis is an unmet and essential goal of the research in multiple sclerosis. In this review, we discuss new findings regarding drugs with immunomodulatory, neuroprotective or regenerative properties and possible treatment strategies for secondary progressive multiple sclerosis. We examine the field broadly to include trials where participants have progressive or relapsing phenotypes. We summarise the most relevant results from newer investigations from phase II and III randomised controlled trials over the past decade, with particular attention to the last 5 years.
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Affiliation(s)
- Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.
| | - Domenico Plantone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
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14
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Bonnan M, Gianoli-Guillerme M, Courtade H, Demasles S, Krim E, Marasescu R, Dréau H, Debeugny S, Barroso B. Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation. Ann Clin Transl Neurol 2018; 5:524-537. [PMID: 29761116 PMCID: PMC5945966 DOI: 10.1002/acn3.548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 12/15/2022] Open
Abstract
Objective The low level of passively diffused IgG through the blood–brain barrier is sufficient to blur the estimation of intrathecal IgG synthesis (ITS). Therefore, this estimation requires a mathematical calculation derived from empirical laws, but the range of normal values in healthy controls is wide enough to prevent a precise calculation. This study investigated the precision of various methods of ITS estimations and their application to two clinical situations: plasma exchange and immune suppression targeting ITS. Methods Based on a mathematical model of ITS, we constructed a population of healthy controls and applied a tunable ITS. Results We demonstrate the following results: underestimation of ITS is common at individual level but true ITS is well fitted by cohorts; QIgG increases after plasma exchange; IgGLoc calculation based on Qlim falsely increases when QAlb decreases; the sample size required to demonstrate a decrease in ITS increases exponentially with larger QAlb. Interpretation Studies evaluating changes in ITS level should be adjusted to QAlb. Low amounts of ITS could be largely underestimated.
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Affiliation(s)
- Mickael Bonnan
- Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | | | - Henri Courtade
- Biologie médicale Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Stéphanie Demasles
- Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Elsa Krim
- Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Raluca Marasescu
- Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Hervé Dréau
- Unité de recherche clinique Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Stéphane Debeugny
- Unité de recherche clinique Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
| | - Bruno Barroso
- Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France
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15
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Osteopontin (OPN) as a CSF and blood biomarker for multiple sclerosis: A systematic review and meta-analysis. PLoS One 2018; 13:e0190252. [PMID: 29346446 PMCID: PMC5773083 DOI: 10.1371/journal.pone.0190252] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 12/02/2022] Open
Abstract
Identifying a reliable biomarker may accelerate diagnosis of multiple sclerosis (MS) and lead to early management of the disease. Accumulating evidence suggest that cerebrospinal fluid (CSF) and peripheral blood concentration of osteopontin (OPN) may have diagnostic and prognostic value in MS. We conducted a systematic review and meta-analysis of studies that measured peripheral blood and CSF levels of OPN in MS patients and controls to evaluate the diagnostic potential of this biomarker better. We searched PubMed, Web of Science and Scopus databases to find articles that measured OPN concentration in peripheral blood and CSF samples from MS patients up to October 19, 2016. Q statistic tests and the I2 index were applied for heterogeneity assessment. If the I2 index was less than 40%, the fixed-effects model was used for meta-analysis. Random-effects meta-analysis was chosen if the I2 value was greater than 40%. After removal of duplicates, 918 articles were identified, and 27 of them fulfilled the inclusion criteria. We included 22 eligible studies in the final meta-analysis. MS patients, in general, had considerably higher levels of OPN in their CSF and blood when compared to all types of controls (p<0.05). When the comparisons were made between different subtypes of MS patients and controls, the results pointed to significantly higher levels of OPN in CSF of MS subgroups (p<0.05). All subtypes of MS patients, except CIS patients, had increased blood levels of OPN compared to controls (p<0.05). In the second set of meta-analyses, we compared the peripheral blood and CSF concentrations of OPN between MS patient subtypes. CIS patients had significantly lower levels of OPN both in their peripheral blood and CSF compared to patients with progressive subtypes of MS (p<0.05). CSF concentration of OPN was significantly higher among RRMS patients compared to the CIS patients and SPMS patients (P<0.05). Finally, patients with active MS had significantly higher OPN levels in their CSF compared to patients with stable disease (P = 0.007). The result of this study confirms that increased levels of OPN exist in CSF and peripheral blood of MS patients and strengthens the evidence regarding the clinical utility of OPN as a promising and validated biomarker for MS.
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16
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Lycke J, Zetterberg H. The role of blood and CSF biomarkers in the evaluation of new treatments against multiple sclerosis. Expert Rev Clin Immunol 2017; 13:1143-1153. [PMID: 29090607 DOI: 10.1080/1744666x.2017.1400380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated chronic neurodegenerative disease of the central nervous system (CNS). Therapeutic interventions with immunomodulatory agents reduce disease activity and disability development, which are monitored clinically and by magnetic resonance imaging (MRI). However, these measures largely lack information on the impact from these therapies on inflammation, demyelination and axonal injury, the essential pathophysiological features of MS. Several biomarkers for inflammation and neurodegeneration have been detected in cerebrospinal fluid (CSF). In MS, some of these biomarkers seem to reflect disease activity, disability progression, and therapeutic response. Areas covered: In this review, we describe the most promising CSF biomarkers of inflammation and degeneration for monitoring therapeutic interventions in MS. We also describe the evolution of highly sensitive immunoassays that enable determination of neuron-specific biomarkers in blood. Expert commentary: Together with clinical and MRI measures, CSF biomarkers may improve the assessment of therapeutic efficacy and make personalized treatment possible. One disadvantage has been the need of repetitive lumbar punctures to obtain CSF. However, the technical development of highly sensitive immunoassays allows determination of extremely low quantities of neuron-specific proteins in blood. This will potentially open a new era for monitoring disease activity and treatment response in MS.
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Affiliation(s)
- Jan Lycke
- a Department of Clinical Neuroscience, Institute of Neuroscience and Physiology , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Henrik Zetterberg
- b Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology at Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.,c Clinical Neurochemistry Laboratory , Sahlgrenska University Hospital , Mölndal , Sweden.,d Department of Molecular Neuroscience , UCL Institute of Neurology , London , UK.,e UK Dementia Research Institute , London , UK
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17
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Mahajan KR, Ontaneda D. The Role of Advanced Magnetic Resonance Imaging Techniques in Multiple Sclerosis Clinical Trials. Neurotherapeutics 2017; 14:905-923. [PMID: 28770481 PMCID: PMC5722766 DOI: 10.1007/s13311-017-0561-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging has been crucial in the development of anti-inflammatory disease-modifying treatments. The current landscape of multiple sclerosis clinical trials is currently expanding to include testing not only of anti-inflammatory agents, but also neuroprotective, remyelinating, neuromodulating, and restorative therapies. This is especially true of therapies targeting progressive forms of the disease where neurodegeneration is a prominent feature. Imaging techniques of the brain and spinal cord have rapidly evolved in the last decade to permit in vivo characterization of tissue microstructural changes, connectivity, metabolic changes, neuronal loss, glial activity, and demyelination. Advanced magnetic resonance imaging techniques hold significant promise for accelerating the development of different treatment modalities targeting a variety of pathways in MS.
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Affiliation(s)
- Kedar R Mahajan
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA.
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18
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Sellebjerg F, Börnsen L, Ammitzbøll C, Nielsen JE, Vinther-Jensen T, Hjermind LE, von Essen M, Ratzer RL, Soelberg Sørensen P, Romme Christensen J. Defining active progressive multiple sclerosis. Mult Scler 2017; 23:1727-1735. [DOI: 10.1177/1352458517726592] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: It is unknown whether disease activity according to consensus criteria (magnetic resonance imaging activity or clinical relapses) associate with cerebrospinal fluid (CSF) changes in progressive multiple sclerosis (MS). Objective: To compare CSF biomarkers in active and inactive progressive MS according to consensus criteria. Methods: Neurofilament light chain (NFL), myelin basic protein (MBP), IgG-index, chitinase-3-like-1 (CHI3L1), matrix metalloproteinase-9 (MMP-9), chemokine CXCL13, terminal complement complex, leukocyte counts and nitric oxide metabolites were measured in primary ( n = 26) and secondary progressive MS ( n = 26) and healthy controls ( n = 24). Results: Progressive MS patients had higher CSF cell counts, IgG-index, CHI3L1, MMP-9, CXCL13, NFL and MBP concentrations. Active patients were younger and had higher NFL, CXCL13 and MMP-9 concentrations than inactive patients. Patients with active disease according to consensus criteria or detectable CXCL13 or MMP-9 in CSF were defined as having combined active progressive MS. These patients had increased CSF cell counts, IgG-index and MBP, NFL and CHI3L1 concentrations. Combined inactive patients only had increased IgG-index and MBP concentrations. Conclusion: Patients with combined active progressive MS show evidence of inflammation, demyelination and neuronal/axonal damage, whereas the remaining patients mainly show evidence of active demyelination. This challenges the idea that neurodegeneration independent of inflammation is crucial in disease progression.
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Affiliation(s)
- Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Börnsen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Ammitzbøll
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Neurogenetics Clinic, Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tua Vinther-Jensen
- Neurogenetics Clinic, Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Elisabeth Hjermind
- Neurogenetics Clinic, Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marina von Essen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lenhard Ratzer
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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19
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Brochet B, Deloire MSA, Perez P, Loock T, Baschet L, Debouverie M, Pittion S, Ouallet JC, Clavelou P, de Sèze J, Collongues N, Vermersch P, Zéphir H, Castelnovo G, Labauge P, Lebrun C, Cohen M, Ruet A. Double-Blind Controlled Randomized Trial of Cyclophosphamide versus Methylprednisolone in Secondary Progressive Multiple Sclerosis. PLoS One 2017; 12:e0168834. [PMID: 28045953 PMCID: PMC5207788 DOI: 10.1371/journal.pone.0168834] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Therapeutic options are limited in secondary progressive multiple sclerosis (SPMS). Open-label studies suggested efficacy of monthly IV cyclophosphamide (CPM) without induction for delaying progression but no randomized trial was conducted so far. OBJECTIVE To compare CPM to methylprednisolone (MP) in SPMS. METHODS Randomized, double-blind clinical trial on two parallel groups. Patient with SPMS, with a documented worsening of the Expanded Disability Status Scale (EDSS) score during the last year and an EDSS score between 4·0 and 6·5 were recruited and received one intravenous infusion of treatment (CPM: 750 mg /m2 body surface area-MP: 1g) every four weeks for one year, and every eight weeks for the second year. The primary endpoint was the time to EDSS deterioration, when confirmed sixteen weeks later, analyzed using a Cox model. RESULTS Due to recruitment difficulties, the study was terminated prematurely after 138 patients were included (CPM, n = 72; MP, n = 66). In the CPM group, 33 patients stopped treatment prematurely, mainly due to tolerability, compared with 22 in the MP group. Primary endpoint: the hazard ratio for EDSS deterioration in the CPM in comparison with the MP group was 0.61 [95% CI: 0·31-1·22](p = 0·16). According to the secondary multistate model analysis, patients in the CPM group were 2.2 times more likely ([1·14-4.29]; p = 0.02) to discontinue treatment than those in the MP group and 2.7 times less likely (HR = 0.37, 95% CI: 0.17-0.84; p = 0.02) to experience disability progression when they did not stop treatment prematurely. Safety profile was as expected. CONCLUSION Although the primary end-point was negative, secondary analysis suggested that CPM decreases the risk of progression in SPMS, but its use may be limited by low tolerability. TRIAL REGISTRATION Clinicaltrials.gov NCT00241254.
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Affiliation(s)
- Bruno Brochet
- Service de Neurologie et INSERM-CHU CIC-P 0005, CHU de Bordeaux, Bordeaux, France
- INSERM U 1215, Université de Bordeaux, Bordeaux, France
- * E-mail:
| | | | - Paul Perez
- Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux France
| | - Timothé Loock
- Service de Neurologie et INSERM-CHU CIC-P 0005, CHU de Bordeaux, Bordeaux, France
| | - Louise Baschet
- Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux France
| | | | | | | | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme de Sèze
- Service de Neurologie et CIC INSERM 1434, CHU de Strasbourg, Strasbourg, France
| | - Nicolas Collongues
- Service de Neurologie et CIC INSERM 1434, CHU de Strasbourg, Strasbourg, France
| | - Patrick Vermersch
- Univ. Lille, CHU Lille, LIRIC-INSERM U995, FHU Imminent, Lille, France
| | - Hélène Zéphir
- Univ. Lille, CHU Lille, LIRIC-INSERM U995, FHU Imminent, Lille, France
| | | | - Pierre Labauge
- Service de Neurologie, CHU de Montpellier, Montpellier, France
| | | | - Mikael Cohen
- Service de Neurologie, CHU de Nice, Nice, France
| | - Aurélie Ruet
- Service de Neurologie et INSERM-CHU CIC-P 0005, CHU de Bordeaux, Bordeaux, France
- INSERM U 1215, Université de Bordeaux, Bordeaux, France
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20
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Bloom J, Metz C, Nalawade S, Casabar J, Cheng KF, He M, Sherry B, Coleman T, Forsthuber T, Al-Abed Y. Identification of Iguratimod as an Inhibitor of Macrophage Migration Inhibitory Factor (MIF) with Steroid-sparing Potential. J Biol Chem 2016; 291:26502-26514. [PMID: 27793992 DOI: 10.1074/jbc.m116.743328] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/27/2016] [Indexed: 12/11/2022] Open
Abstract
Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that has been implicated in a broad range of inflammatory and oncologic diseases. MIF is unique among cytokines in terms of its release profile and inflammatory role, notably as an endogenous counter-regulator of the anti-inflammatory effects of glucocorticoids. In addition, it exhibits a catalytic tautomerase activity amenable to the design of high affinity small molecule inhibitors. Although several classes of these compounds have been identified, biologic characterization of these molecules remains a topic of active investigation. In this study, we used in vitro LPS-driven assays to characterize representative molecules from several classes of MIF inhibitors. We determined that MIF inhibitors exhibit distinct profiles of anti-inflammatory activity, especially with regard to TNFα. We further investigated a molecule with relatively low anti-inflammatory activity, compound T-614 (also known as the anti-rheumatic drug iguratimod), and found that, in addition to exhibiting selective MIF inhibition in vitro and in vivo, iguratimod also has additive effects with glucocorticoids. Furthermore, we found that iguratimod synergizes with glucocorticoids in attenuating experimental autoimmune encephalitis, a model of multiple sclerosis. Our work identifies iguratimod as a valuable new candidate for drug repurposing to MIF-relevant diseases, including multiple sclerosis.
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Affiliation(s)
- Joshua Bloom
- From the Hofstra-Northwell School of Medicine, Hempstead, New York 11549, .,the Centers for Molecular Innovation
| | - Christine Metz
- From the Hofstra-Northwell School of Medicine, Hempstead, New York 11549.,Biomedical Sciences, and
| | - Saisha Nalawade
- the Department of Biology, University of Texas at San Antonio, San Antonio, Texas 78249
| | - Julian Casabar
- the Department of Biology, University of Texas at San Antonio, San Antonio, Texas 78249
| | | | | | - Barbara Sherry
- From the Hofstra-Northwell School of Medicine, Hempstead, New York 11549.,Immunology and Inflammation, and
| | - Thomas Coleman
- the Office of Technology Transfer, The Feinstein Institute for Medical Research, Manhasset, New York 11030, and
| | - Thomas Forsthuber
- the Department of Biology, University of Texas at San Antonio, San Antonio, Texas 78249
| | - Yousef Al-Abed
- From the Hofstra-Northwell School of Medicine, Hempstead, New York 11549, .,the Centers for Molecular Innovation
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21
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Lam MA, Maghzal GJ, Khademi M, Piehl F, Ratzer R, Romme Christensen J, Sellebjerg FT, Olsson T, Stocker R. Absence of systemic oxidative stress and increased CSF prostaglandin F2α in progressive MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e256. [PMID: 27386506 PMCID: PMC4929888 DOI: 10.1212/nxi.0000000000000256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/17/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to investigate the role of oxidative stress in the progression of multiple sclerosis (MS). METHODS We determined by liquid chromatography-tandem mass spectrometry nonenzymatic (F2-isoprostanes) and enzymatic oxidation products of arachidonic acid (prostaglandin F2α [PGF2α]) in plasma and CSF of 45 controls (other neurologic disease [OND] with no signs of inflammation) and 62 patients with MS. Oxidation products were correlated with disease severity and validated biomarkers of inflammation (chemokine ligand 13; matrix metalloproteinase-9; osteopontin) and axonal damage (neurofilament light protein). RESULTS Compared with OND controls, plasma concentrations of F2-isoprostanes and PGF2α were significantly lower in patients with progressive disease, and decreased with increasing disability score (Expanded Disability Status Scale). In contrast, CSF concentrations of PGF2α, but not F2-isoprostanes, were significantly higher in patients with progressive disease than OND controls (p < 0.01). The content of PGF2α in CSF increased with disease severity (p = 0.044) and patient age (p = 0.022), although this increase could not be explained by age. CSF PGF2α decreased with natalizumab and methylprednisolone treatment and was unaffected by the use of nonsteroidal anti-inflammatory drug in secondary progressive MS. CSF PGF2α did not associate with validated CSF markers of inflammation and axonal damage that themselves did not associate with the Expanded Disability Status Scale. CONCLUSIONS Our data suggest that MS progression is associated with low systemic oxidative activity. This may contribute to immune dysregulation with CNS inflammation accompanied by increased local cyclooxygenase-dependent lipid oxidation.
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Affiliation(s)
- Magda A Lam
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Ghassan J Maghzal
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Mohsen Khademi
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Fredik Piehl
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Ratzer
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe Romme Christensen
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Thorup Sellebjerg
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Tomas Olsson
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
| | - Roland Stocker
- Vascular Biology Division (M.A.L., G.J.M., R.S.), Victor Chang Cardiac Research Institute, Sydney; School of Medical Sciences (G.J.M., R.S.), University of New South Wales, Sydney, Australia; Neuroimmunology Unit (M.K., F.P., T.O.), Department of Clinical Neurosciences, Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden; and Department of Neurology (R.R., J.R.C., F.T.S.), Copenhagen University Hospital, Copenhagen, Denmark
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