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Xing X, Liu X, Li X, Li M, Wu X, Huang X, Xu A, Liu Y, Zhang J. Insights into spinal muscular atrophy from molecular biomarkers. Neural Regen Res 2025; 20:1849-1863. [PMID: 38934395 DOI: 10.4103/nrr.nrr-d-24-00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024] Open
Abstract
Spinal muscular atrophy is a devastating motor neuron disease characterized by severe cases of fatal muscle weakness. It is one of the most common genetic causes of mortality among infants aged less than 2 years. Biomarker research is currently receiving more attention, and new candidate biomarkers are constantly being discovered. This review initially discusses the evaluation methods commonly used in clinical practice while briefly outlining their respective pros and cons. We also describe recent advancements in research and the clinical significance of molecular biomarkers for spinal muscular atrophy, which are classified as either specific or non-specific biomarkers. This review provides new insights into the pathogenesis of spinal muscular atrophy, the mechanism of biomarkers in response to drug-modified therapies, the selection of biomarker candidates, and would promote the development of future research. Furthermore, the successful utilization of biomarkers may facilitate the implementation of gene-targeting treatments for patients with spinal muscular atrophy.
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Affiliation(s)
- Xiaodong Xing
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Xinzhu Liu
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiandeng Li
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Mi Li
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Wu
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Xiaohui Huang
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ajing Xu
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Zhang
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fournier AP, Morvan MI, Martinez de Lizarrondo S, Gauberti M. Immuno-MRI for Stroke Diagnosis and Prognosis. Neuroscience 2024; 550:53-61. [PMID: 38141809 DOI: 10.1016/j.neuroscience.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Following a stroke, an inflammatory response occurs, characterized by an increased blood-brain barrier permeability, expression of endothelial trafficking molecules, and infiltration of immune cells. Adhesion molecules expressed on activated brain endothelial cells are potential biomarkers of intraparenchymal inflammation. However, in current clinical practice, it is not possible to measure endothelial activation using clinically available imaging. Using targeted micro-sized particles of iron oxide (MPIO), immuno-MRI enables the detection of endothelial adhesion molecules at high resolution and, consequently, facilitates the detection of stroke-induced brain inflammation. In this review, we highlight the most recent studies that used immuno-MRI in models of neurovascular disorders, including transient ischemic attack, ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage. We also discuss the potential of immuno-MRI in clinical practice and the necessary next steps for its implementation in patients.
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Affiliation(s)
- Antoine Philippe Fournier
- Normandie Université, UNICAEN, INSERM, PhIND (Physiopathology and Imaging of Neurological Disorders), Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - Marion Isabelle Morvan
- Normandie Université, UNICAEN, INSERM, PhIND (Physiopathology and Imaging of Neurological Disorders), Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Sara Martinez de Lizarrondo
- Normandie Université, UNICAEN, INSERM, PhIND (Physiopathology and Imaging of Neurological Disorders), Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Maxime Gauberti
- Normandie Université, UNICAEN, INSERM, PhIND (Physiopathology and Imaging of Neurological Disorders), Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France; CHU Caen, Department of Diagnostic Imaging and Interventional Radiology, CHU de Caen Côte de Nacre, Caen, France
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Barrero Hernández FJ, Romero Villarrubia A, Muñoz Fernández C, Guillén Martinez V, Aguilera Del Moral A, Barrios-López JM, Ramírez Rivas MA, Gálvez Muñoz AJ, Piñar Morales R. Real-World Study of Serum Neurofilament Light Chain Levels in Ocrelizumab-Treated People with Relapsing Multiple Sclerosis. J Pers Med 2024; 14:692. [PMID: 39063946 PMCID: PMC11277843 DOI: 10.3390/jpm14070692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective in improving clinical and radiological outcomes and reducing sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for their short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced ARR in 83% of PwMS and radiological activity in 80%. EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNfL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs.
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Affiliation(s)
- Francisco J. Barrero Hernández
- Neurology Unit, University Hospital Clinic San Cecilio, 18016 Granada, Spain; (M.A.R.R.); (R.P.M.)
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain
- Departament of Medicine, University of Granada, 18016 Granada, Spain
| | - Ana Romero Villarrubia
- Neurology Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (A.R.V.); (V.G.M.); (J.M.B.-L.)
| | - Carmen Muñoz Fernández
- Neurology Unit, University Hospital Torrecárdenas, 04009 Almeria, Spain; (C.M.F.); (A.A.D.M.)
| | - Virginia Guillén Martinez
- Neurology Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (A.R.V.); (V.G.M.); (J.M.B.-L.)
| | | | - José María Barrios-López
- Neurology Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (A.R.V.); (V.G.M.); (J.M.B.-L.)
| | - Maria A. Ramírez Rivas
- Neurology Unit, University Hospital Clinic San Cecilio, 18016 Granada, Spain; (M.A.R.R.); (R.P.M.)
| | - Antonio J. Gálvez Muñoz
- Statistical Advisor and Methodology, Foundation for Biosanitary Research of Eastern Andalusia: FIBAO, 18016 Granada, Spain;
| | - Raquel Piñar Morales
- Neurology Unit, University Hospital Clinic San Cecilio, 18016 Granada, Spain; (M.A.R.R.); (R.P.M.)
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain
- Departament of Medicine, University of Granada, 18016 Granada, Spain
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Kızılay T, Akbayir E, Erol R, Demir AS, Özkan Yaşargün D, Yilmaz V, Tuzun E, Turkoglu R. Altered Cerebrospinal Fluid Neurofilament Light Chain but Not Neurogranin Levels Are Associated with Response to Ocrelizumab Treatment in Relapsing-Remitting Multiple Sclerosis: A Preliminary Study. Eur Neurol 2024:132-139. [PMID: 38754397 DOI: 10.1159/000539376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Ocrelizumab is a CD20-targeting monoclonal antibody used for treatment of multiple sclerosis (MS). Serum and cerebrospinal fluid (CSF) neurofilament light (NFL) chain levels are reduced in MS patients under ocrelizumab treatment indicating a preventive action against neuro-axonal degeneration. Our aim, in this preliminary study, was to explore the impact of ocrelizumab treatment on synaptic integrity through assessment of neurogranin levels. METHODS Thirteen relapsing-remitting multiple sclerosis (RRMS) patients resistant to first-line immunomodulating agents were enrolled and followed up for 24 months under ocrelizumab treatment. Disease activity was monitored by periodic EDSS, MSSS, and cranial-spinal MRI assessments. No evidence of disease activity (NEDA)-3 was determined, and CSF levels of NFL (marker of neuro-axonal integrity) and neurogranin (marker of synaptic integrity) were measured by ELISA at baseline and 12-month ocrelizumab treatment. RESULTS Seven RRMS patients, who preserved NEDA-3 status during 24-month follow-up, showed ≥30% NFL level decrease, whereas 6 patients with stable/increased NFL levels displayed relapse, MRI lesion, or disability progression. Although most RRMS patients exhibited increased CSF levels of neurogranin under ocrelizumab treatment, patients with and without neurogranin level increase did not differ in terms of clinical features and NEDA-3 status. Baseline neurogranin levels negatively correlated with baseline EDSS scores. CONCLUSION Our results confirm that NFL effectively monitors treatment response of RRMS patients under ocrelizumab treatment. Neurogranin does not appear to exhibit a similar benefit in screening of RRMS disease activity. Nevertheless, lower neurogranin levels are associated with increased disability in RRMS indicating a potential disease activity biomarker function.
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Affiliation(s)
- Tuğçe Kızılay
- Neurology Clinic, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ece Akbayir
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ruziye Erol
- Neurology Clinic, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayça Simay Demir
- Neurology Clinic, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Duygu Özkan Yaşargün
- Neurology Clinic, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Recai Turkoglu
- Neurology Clinic, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Schilke ED, Remoli G, Funelli E, Galimberti M, Fusco ML, Cereda D, Balducci C, Frigo M, Cavaletti G. Current use of fluid biomarkers as outcome measures in Multiple Sclerosis (MS): a review of ongoing pharmacological clinical trials. Neurol Sci 2024; 45:1931-1944. [PMID: 38117403 PMCID: PMC11021285 DOI: 10.1007/s10072-023-07228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
The present study aims to describe the state of the art of fluid biomarkers use in ongoing multiple sclerosis (MS) clinical trials.A review of 608 ongoing protocols in the clinicaltrials.gov and EudraCT databases was performed. The trials enrolled patients with a diagnosis of relapsing remitting MS, secondary progressive MS, and/or primary progressive MS according to Revised McDonald criteria or relapsing MS according to Lublin et al. (2014). The presence of fluid biomarkers among the primary and/or secondary study outcomes was assessed.Overall, 5% of ongoing interventional studies on MS adopted fluid biomarkers. They were mostly used as secondary outcomes in phase 3-4 clinical trials to support the potential disease-modifying properties of the intervention. Most studies evaluated neurofilament light chains (NfLs). A small number considered other novel fluid biomarkers of neuroinflammation and neurodegeneration such as glial fibrillary acid protein (GFAP).Considering the numerous ongoing clinical trials in MS, still a small number adopted fluid biomarkers as outcome measures, thus testifying the distance from clinical practice. In most protocols, fluid biomarkers were used to evaluate the effectiveness of approved second-line therapies, but also, new drugs (particularly Bruton kinase inhibitors). NfLs were also adopted to monitor disease progression after natalizumab suspension in stable patients, cladribine efficacy after anti-CD20 discontinuation, and the efficacy of autologous hematopoietic stem cell transplant (AHSCT) compared to medical treatment. Nevertheless, further validation studies are needed for all considered fluid biomarkers to access clinical practice, and cost-effectiveness in the "real word" remains to be clarified.
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Affiliation(s)
- Edoardo Dalmato Schilke
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy.
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy.
| | - Giulia Remoli
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Eugenio Funelli
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Michela Galimberti
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Maria Letizia Fusco
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Diletta Cereda
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Claudia Balducci
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Maura Frigo
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Guido Cavaletti
- Neurology Department, Fondazione IRCCS San Gerardi dei Tintori, Monza, Italy
- School of Medicine and Surgery and Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
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Freedman MS, Gnanapavan S, Booth RA, Calabresi PA, Khalil M, Kuhle J, Lycke J, Olsson T. Guidance for use of neurofilament light chain as a cerebrospinal fluid and blood biomarker in multiple sclerosis management. EBioMedicine 2024; 101:104970. [PMID: 38354532 PMCID: PMC10875256 DOI: 10.1016/j.ebiom.2024.104970] [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: 01/16/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
Neurofilament light chain (NfL) is a long-awaited blood biomarker that can provide clinically useful information about prognosis and therapeutic efficacy in multiple sclerosis (MS). There is now substantial evidence for this biomarker to be used alongside magnetic resonance imaging (MRI) and clinical measures of disease progression as a decision-making tool for the management of patients with MS. Serum NfL (sNfL) has certain advantages over traditional measures of MS disease progression such as MRI because it is relatively noninvasive, inexpensive, and can be repeated frequently to monitor activity and treatment efficacy. sNfL levels can be monitored regularly in patients with MS to determine change from baseline and predict subclinical disease activity, relapse risk, and the development of gadolinium-enhancing (Gd+) lesions. sNfL does not replace MRI, which provides information related to spatial localisation and lesion stage. Laboratory platforms are starting to be made available for clinical application of sNfL in several countries. Further work is needed to resolve issues around comparisons across testing platforms (absolute values) and normalisation (reference ranges) in order to guide interpretation of the results.
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Affiliation(s)
- Mark S Freedman
- Department of Medicine (Neurology), University of Ottawa, and the Ottawa Hospital Research Institute, Ontario, Canada.
| | | | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital & Eastern Ontario Regional Laboratory Association, Ontario, Canada
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Switzerland
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
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Sandgren S, Novakova L, Nordin A, Axelsson M, Malmeström C, Zetterberg H, Lycke J. A five-year observational prospective mono-center study of the efficacy of alemtuzumab in a real-world cohort of patients with multiple sclerosis. Front Neurol 2023; 14:1265354. [PMID: 37808497 PMCID: PMC10551138 DOI: 10.3389/fneur.2023.1265354] [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: 07/22/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background Alemtuzumab (ALZ) is a pulsed immune reconstitution therapy for multiple sclerosis (MS). Objective To assess basic characteristics, therapeutic effects, and prognostic biomarkers on clinical and imaging parameters of disease activity for relapsing-remitting MS (RRMS) patients selected for ALZ, in a real-world long-term setting. Methods Fifty-one RRMS patients [female = 31; mean age 36 (standard deviation 7.1) years; median expanded disability status scale (EDSS) 2 (interquartile range (IQR) 1.5)] initiating ALZ treatment, were consecutively included. Patients were assessed at baseline and thereafter annually for 5 years with clinical measures, symbol digit modality test (SDMT), and magnetic resonance imaging (MRI). Concentrations of glial fibrillary acidic protein (GFAP), reflecting astrogliosis, and neurofilament light (NfL), reflecting axonal damage, were measured in cerebrospinal fluid (CSF) and serum samples collected at baseline and after 2 years in CSF, and annually in serum. Control subjects were symptomatic controls (SCs, n = 27), who were examined at baseline and after 5 years without evidence of neurological disease. Results While the mean annualized relapse rate was significantly reduced from baseline at each year of follow-up, disability was essentially maintained at a median EDSS of 1.5 and IQR between 1.13 and 2.25. New MRI activity was recorded in 26 patients (53%) over 5 years. The proportion of patients who achieved no evidence of disease activity (NEDA-3), 6-months confirmed disability worsening (CDW), and 6-months confirmed disability improvement (CDI) at 5 years were 33, 31, and 31%, respectively. The SDMT score was reduced for patients (p < 0.001), but unchanged for SCs. ALZ treatment did not change GFAP levels, whereas there was a significant decrease for RRMS patients in median CSF and serum NfL levels at follow-up [CSF month 24: 456 pg./mL (IQR 285.4) (p = 0.05); serum month 24: 6.7 pg/mL (IQR 4.7) (p < 0.01); serum month 60: 7.2 pg/mL (IQR 4.7) (p < 0.01)], compared to baseline [CSF: 1014 pg/mL (IQR 2832.5); serum 8.6 pg/mL (IQR 17.4)]. Conclusion In this real-world mono-center population, we observed a progression-free survival of 69%, cumulative NEDA-3 of 33%, and reduced NfL levels, over a five-year follow-up. This confirms ALZ as an effective pulsed immune reconstitution therapy that significantly reduces neuro axonal loss, and therefore has the potential to reduce long-term neurological disability. ALZ did not appear to affect astrogliosis.
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Affiliation(s)
- Sofia Sandgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Nordin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clas Malmeström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Laboratory for Clinical Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London (UCL) Queen Square Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at University College London (UCL), London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, Hong Kong SAR, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Talaat F, Abdelatty S, Ragaie C, Dahshan A. Chitinase-3-like 1-protein in CSF: a novel biomarker for progression in patients with multiple sclerosis. Neurol Sci 2023; 44:3243-3252. [PMID: 36988727 PMCID: PMC10415417 DOI: 10.1007/s10072-023-06764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Chitinase -3-like 1-protein (CHI3L1) is a glycoside secreted by monocytes, microglia, and activated astrocytes. Its distribution in inflammatory lesions denotes its role in astrocytic response to modulate CNS inflammation. In multiple sclerosis (MS), CHI3L1 levels have been found to be influenced by disease severity, activity, and progression. We aimed to measure CSF level of CHI3L1 in patients with MS and correlate its level with disability measures for a possible role as a biomarker for disease progression. METHODS Fifty-two MS patients (30 relapsing-remitting MS and 22 progressive MS) and thirty-five age and sex-matched healthy controls were included. They all underwent full clinical assessment (including disability and cognitive scales), radiological assessment, and CSF level of CHI3L1. RESULTS Patients with MS had higher CSF level of CHI3L1 than controls. Patients with progressive forms had higher levels than relapsing forms. There were positive correlations between disease duration, number of attacks, total EDSS, and CSF level of CHI3L1. Patients who had higher level of CSF CHI3L1 showed worse performance in MMSE and BICAMS and more lesions in T2 MRI brain. A cut off value of 154 ng/mL was found between patients with RRMS and PMS patients. CONCLUSION CHI3L1 can be considered as a biomarker of disease progression. CHI3L1 level increases in progressive MS more than RRMS. Also, high CSF level of CHI3L1 was associated with more disability including motor, cognitive, and radiological aspects.
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Affiliation(s)
| | - Sahar Abdelatty
- Clinical Pathology Department, Cairo University, Giza, Egypt
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Gill AJ, Schorr EM, Gadani SP, Calabresi PA. Emerging imaging and liquid biomarkers in multiple sclerosis. Eur J Immunol 2023; 53:e2250228. [PMID: 37194443 PMCID: PMC10524168 DOI: 10.1002/eji.202250228] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023]
Abstract
The advent of highly effective disease modifying therapy has transformed the landscape of multiple sclerosis (MS) care over the last two decades. However, there remains a critical, unmet need for sensitive and specific biomarkers to aid in diagnosis, prognosis, treatment monitoring, and the development of new interventions, particularly for people with progressive disease. This review evaluates the current data for several emerging imaging and liquid biomarkers in people with MS. MRI findings such as the central vein sign and paramagnetic rim lesions may improve MS diagnostic accuracy and evaluation of therapy efficacy in progressive disease. Serum and cerebrospinal fluid levels of several neuroglial proteins, such as neurofilament light chain and glial fibrillary acidic protein, show potential to be sensitive biomarkers of pathologic processes such as neuro-axonal injury or glial-inflammation. Additional promising biomarkers, including optical coherence tomography, cytokines and chemokines, microRNAs, and extracellular vesicles/exosomes, are also reviewed, among others. Beyond their potential integration into MS clinical care and interventional trials, several of these biomarkers may be informative of MS pathogenesis and help elucidate novel targets for treatment strategies.
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Affiliation(s)
- Alexander J. Gill
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, US
| | - Emily M. Schorr
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, US
| | - Sachin P. Gadani
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, US
| | - Peter A. Calabresi
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, US
- Department of Neuroscience, Baltimore, MD, US
- Department of Ophthalmology, Baltimore, MD, US
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Khan Z, Gupta GD, Mehan S. Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges. J Clin Med 2023; 12:4274. [PMID: 37445309 DOI: 10.3390/jcm12134274] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India's treatment techniques vary. In addition, India's population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.
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Affiliation(s)
- Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
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Kim JS. Protein biomarkers in multiple sclerosis. ENCEPHALITIS 2023; 3:54-63. [PMID: 37469674 PMCID: PMC10295828 DOI: 10.47936/encephalitis.2022.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 07/21/2023] Open
Abstract
This review aimed to elucidate protein biomarkers in body fluids, such as blood and cerebrospinal fluid (CSF), to identify those that may be used for early diagnosis of multiple sclerosis (MS), prediction of disease activity, and monitoring of treatment response among MS patients. The potential biomarkers elucidated in this review include neurofilament proteins (NFs), glial fibrillary acidic protein (GFAP), leptin, brain-derived neurotrophic factor (BDNF), chitinase-3-like protein 1 (CHI3L1), C-X-C motif chemokine 13 (CXCL13), and osteopontin (OPN), with each biomarker playing a different role in MS. GFAP, leptin, and CHI3L1 levels were increased in MS patient groups compared to the control group. NFs are the most studied proteins in the MS field, and significant correlations with disease activity, future progression, and treatment outcomes are evident. GFAP CSF level shows a different pattern by MS subtype. Increased concentration of CHI3L1 in the blood/CSF of clinically isolated syndrome (CIS) is an independent predictive factor of conversion to definite MS. BDNF may be affected by chronic progression of MS. CHI3L1 has potential as a biomarker for early diagnosis of MS and prediction of disability progression, while CXCL13 has potential as a biomarker of prognosis of CIS and reflects MS disease activity. OPN was an indicator of disease severity. A periodic detailed patient evaluation should be performed for MS patients, and broadly and easily accessible biomarkers with higher sensitivity and specificity in clinical settings should be identified.
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Affiliation(s)
- Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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Floro S, Carandini T, Pietroboni AM, De Riz MA, Scarpini E, Galimberti D. Role of Chitinase 3-like 1 as a Biomarker in Multiple Sclerosis: A Systematic Review and Meta-analysis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/4/e1164. [PMID: 35534236 PMCID: PMC9128043 DOI: 10.1212/nxi.0000000000001164] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/17/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is an autoimmune disease confined in the CNS, and its course is frequently subtle and variable. Therefore, predictive biomarkers are needed. In this scenario, we conducted a systematic review and meta-analysis to evaluate the reliability of chitinase 3-like 1 as a biomarker of MS. METHODS Research through the main scientific databases (PubMed, Scopus, Web of Science, and Cochrane Library) published from January 2010 to December 2020 was performed using the following keywords: "chitinase 3-like 1 and multiple sclerosis" and "YKL40 and multiple sclerosis." Articles were selected according to the 2020 updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by 2 authors independently, and data were extracted; 20 of the 90 studies screened were included in the meta-analysis. The main efficacy measure was represented by the standardized mean difference of CSF and blood CHI3L1 levels; Review Manager version 5.4 and R software applications were used for analysis. RESULTS Higher levels of CHI3L1 were found in CSF of 673 patients with MS compared with 336 healthy controls (size-weighted mean difference [SMD] 50.88; 95% CI = 44.98-56.79; p < 0.00001) and in 461 patients with MS than 283 patients with clinically isolated syndrome (CIS) (SMD 28.18; 95% CI = 23.59-32.76; p < 0.00001). Mean CSF CHI3L1 levels were significantly higher in 561 converting than 445 nonconverting CIS (SMD 30.6; 95% CI = 28.31-32.93; p < 0.00001). CSF CHI3L1 levels were significantly higher in patients with primary progressive MS (PPMS) than in patients with relapsing-remitting MS (RRMS) (SMD 43.15; 95% CI = 24.41-61.90; p < 0.00001) and in patients with secondary progressive MS (SMD 41.86 with 95% CI = 32.39-51.33; p < 0.00001). CSF CHI3L1 levels in 407 patients with MS during remission phase of disease were significantly higher than those in 395 patients with MS with acute relapse (SMD 10.48; 95% CI = 08.51-12.44; p < 0.00001). The performances of CHI3L1 in blood for differentiating patients with MS from healthy controls were not significant (SMD 0.48; 95% CI = -1.18 to 2.14; p: 0.57). DISCUSSION CSF levels of CHI3L1 have a strong correlation with the MS pathologic course, in particular with the mechanism of progression of the disease; it helps to distinguish the PPMS from the RRMS. The potential role of CHI3L1 in serum needs to be further studied in the future.
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Affiliation(s)
- Stefano Floro
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
| | - Tiziana Carandini
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
| | - Anna Margherita Pietroboni
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
| | - Milena Alessandra De Riz
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
| | - Elio Scarpini
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
| | - Daniela Galimberti
- From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy
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Nociti V, Romozzi M, Mirabella M. Update on Multiple Sclerosis Molecular Biomarkers to Monitor Treatment Effects. J Pers Med 2022; 12:549. [PMID: 35455665 PMCID: PMC9024668 DOI: 10.3390/jpm12040549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system characterized by broad inter- and intraindividual heterogeneity. The relapse rate, disability progression, and lesion load assessed through MRI are used to detect disease activity and response to treatment. Although it is possible to standardize these characteristics in larger patient groups, so far, this has been difficult to achieve in individual patients. Easily detectable molecular biomarkers can be powerful tools, permitting a tailored therapy approach for MS patients. However, only a few molecular biomarkers have been routinely used in clinical practice as the validation process, and their transfer into clinical practice takes a long time. This review describes the characteristics of an ideal MS biomarker, the challenges of establishing new biomarkers, and promising molecular biomarkers from blood or CSF samples used to monitor MS treatment effects in clinical practice.
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Affiliation(s)
- Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
| | - Massimiliano Mirabella
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Biernacki T, Kokas Z, Sandi D, Füvesi J, Fricska-Nagy Z, Faragó P, Kincses TZ, Klivényi P, Bencsik K, Vécsei L. Emerging Biomarkers of Multiple Sclerosis in the Blood and the CSF: A Focus on Neurofilaments and Therapeutic Considerations. Int J Mol Sci 2022; 23:ijms23063383. [PMID: 35328802 PMCID: PMC8951485 DOI: 10.3390/ijms23063383] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Multiple Sclerosis (MS) is the most common immune-mediated chronic neurodegenerative disease of the central nervous system (CNS) affecting young people. This is due to the permanent disability, cognitive impairment, and the enormous detrimental impact MS can exert on a patient's health-related quality of life. It is of great importance to recognise it in time and commence adequate treatment at an early stage. The currently used disease-modifying therapies (DMT) aim to reduce disease activity and thus halt disability development, which in current clinical practice are monitored by clinical and imaging parameters but not by biomarkers found in blood and/or the cerebrospinal fluid (CSF). Both clinical and radiological measures routinely used to monitor disease activity lack information on the fundamental pathophysiological features and mechanisms of MS. Furthermore, they lag behind the disease process itself. By the time a clinical relapse becomes evident or a new lesion appears on the MRI scan, potentially irreversible damage has already occurred in the CNS. In recent years, several biomarkers that previously have been linked to other neurological and immunological diseases have received increased attention in MS. Additionally, other novel, potential biomarkers with prognostic and diagnostic properties have been detected in the CSF and blood of MS patients. AREAS COVERED In this review, we summarise the most up-to-date knowledge and research conducted on the already known and most promising new biomarker candidates found in the CSF and blood of MS patients. DISCUSSION the current diagnostic criteria of MS relies on three pillars: MRI imaging, clinical events, and the presence of oligoclonal bands in the CSF (which was reinstated into the diagnostic criteria by the most recent revision). Even though the most recent McDonald criteria made the diagnosis of MS faster than the prior iteration, it is still not an infallible diagnostic toolset, especially at the very early stage of the clinically isolated syndrome. Together with the gold standard MRI and clinical measures, ancillary blood and CSF biomarkers may not just improve diagnostic accuracy and speed but very well may become agents to monitor therapeutic efficacy and make even more personalised treatment in MS a reality in the near future. The major disadvantage of these biomarkers in the past has been the need to obtain CSF to measure them. However, the recent advances in extremely sensitive immunoassays made their measurement possible from peripheral blood even when present only in minuscule concentrations. This should mark the beginning of a new biomarker research and utilisation era in MS.
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Affiliation(s)
- Tamás Biernacki
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Zsófia Kokas
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Dániel Sandi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Judit Füvesi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Zsanett Fricska-Nagy
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Péter Faragó
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Tamás Zsigmond Kincses
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
- Albert Szent-Györgyi Clinical Centre, Department of Radiology, Albert Szent-Györgyi Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Péter Klivényi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Krisztina Bencsik
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - László Vécsei
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
- MTA-SZTE Neuroscience Research Group, University of Szeged, 6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-356; Fax: +36-62-545-597
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Pan Z, Zhu T, Liu Y, Zhang N. Role of the CXCL13/CXCR5 Axis in Autoimmune Diseases. Front Immunol 2022; 13:850998. [PMID: 35309354 PMCID: PMC8931035 DOI: 10.3389/fimmu.2022.850998] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022] Open
Abstract
CXCL13 is a B-cell chemokine produced mainly by mesenchymal lymphoid tissue organizer cells, follicular dendritic cells, and human T follicular helper cells. By binding to its receptor, CXCR5, CXCL13 plays an important role in lymphoid neogenesis, lymphoid organization, and immune responses. Recent studies have found that CXCL13 and its receptor CXCR5 are implicated in the pathogenesis of several autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, primary Sjögren’s syndrome, myasthenia gravis, and inflammatory bowel disease. In this review, we discuss the biological features of CXCL13 and CXCR5 and the recent findings on the pathogenic roles of the CXCL13/CXCR5 axis in autoimmune diseases. Furthermore, we discuss the potential role of CXCL13 as a disease biomarker and therapeutic target in autoimmune diseases.
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Affiliation(s)
- Zijian Pan
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, and State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tong Zhu
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, and State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanjun Liu
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, and State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Nannan Zhang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, and State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- *Correspondence: Nannan Zhang,
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Tang J, Zeng X, Yang J, Zhang L, Li H, Chen R, Tang S, Luo Y, Qin X, Feng J. Expression and Clinical Correlation Analysis Between Repulsive Guidance Molecule a and Neuromyelitis Optica Spectrum Disorders. Front Immunol 2022; 13:766099. [PMID: 35185873 PMCID: PMC8850277 DOI: 10.3389/fimmu.2022.766099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study sought to explore the expression patterns of repulsive guidance molecules a (RGMa) in neuromyelitis optica spectrum disorders (NMOSD) and to explore the correlation between RGMa and the clinical features of NMOSD. Methods A total of 83 NMOSD patients and 22 age-matched healthy controls (HCs) were enrolled in the study from October 2017 to November 2021. Clinical parameters, including Expanded Disability Status Scale (EDSS) score, degree of MRI enhancement, and AQP4 titer were collected. The expression of serum RGMa was measured by enzyme-linked immunosorbent assay (ELISA) and compared across the four patient groups. The correlation between serum RGMa levels and different clinical parameters was also assessed. Results The average serum expression of RGMa in the NMOSD group was significantly higher than that in the HC group (p < 0.001). Among the patient groups, the acute phase group exhibited significantly higher serum RGMa levels than did the remission group (p < 0.001). A multivariate analysis revealed a significant positive correlation between RGMa expression and EDSS score at admission, degree of MRI enhancement, and segmental length of spinal cord lesions. There was a significant negative correlation between the expression of RGMa in NMOSD and the time from attack to sampling or delta EDSS. Conclusions The current study suggests that RGMa may be considered a potential biomarker predicting the severity, disability, and clinical features of NMOSD.
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Affiliation(s)
- Jinhua Tang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, People's Hospital of Chongqing Hechuan, Chongqing, China
| | - Xiaopeng Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shi Tang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Biostatistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lokhande H, Rosso M, Tauhid S, Chu R, Healy BC, Saxena S, Barro C, Paul A, Polgar-Turcsanyi M, Anderson M, Glanz BI, Kropshofer H, Granziera C, Leppert D, Kappos L, Kuhle J, Weiner HL, Bakshi R, Chitnis T. Serum NfL levels in the first five years predict 10-year thalamic fraction in patients with MS. Mult Scler J Exp Transl Clin 2022; 8:20552173211069348. [PMID: 35035990 PMCID: PMC8753083 DOI: 10.1177/20552173211069348] [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] [Received: 02/05/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Serum neurofilament light chain (sNfL) levels are associated with relapses, MRI lesions, and brain volume in multiple sclerosis (MS). Objective To explore the value of early serum neurofilament light (sNfL) measures in prognosticating 10-year regional brain volumes in MS. Methods Patients with MS enrolled in the Comprehensive Longitudinal Investigations in MS at Brigham and Women's Hospital (CLIMB) study within five years of disease onset who had annual blood samples from years 1–10 (n = 91) were studied. sNfL was measured with a single molecule array (SIMOA) assay. We quantified global cortical thickness and normalized deep gray matter (DGM) volumes (fractions of the thalamus, caudate, putamen, and globus pallidus) from high-resolution 3 T MRI at 10 years. Correlations between yearly sNfL levels and 10-year MRI outcomes were assessed using linear regression models. Results sNfL levels from years 1 and 2 were associated with 10-year thalamus fraction. Early sNfL levels were not associated with 10-year putamen, globus pallidus or caudate fractions. At 10 years, cortical thickness was not associated with early sNfL levels, but was weakly correlated with total DGM fraction. Conclusions Early sNfL levels correlate with 10-year thalamic volume, supporting its role as a prognostic biomarker in MS.
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Affiliation(s)
| | - Mattia Rosso
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | - Renxin Chu
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christian Barro
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | | | - Mark Anderson
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Michaličková D, Kübra Ö, Das D, Osama B, Slanař O. Molecular biomarkers in multiple sclerosis. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-36165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Multiple sclerosis (MS) is a highly heterogenous disease regarding radiological, pathological, and clinical characteristics and therapeutic response, including both the efficacy and safety profile of treatments. Accordingly, there is a high demand for biomarkers that sensitively and specifically apprehend the distinctive aspects of the MS heterogeneity, and that can aid in better understanding of the disease diagnosis, prognosis, prediction of the treatment response, and, finally, in the development of new treatments. Currently, clinical characteristics (e.g., relapse rate and disease progression) and magnetic resonance imaging play the most important role in the clinical classification of MS and assessment of its course. Molecular biomarkers (e.g., immunoglobulin G (IgG) oligoclonal bands, IgG index, anti-aquaporin-4 antibodies, neutralizing antibodies against interferon-beta and natalizumab, anti-varicella zoster virus and anti-John Cunningham (JC) virus antibodies) complement these markers excellently. This review provides an overview of exploratory, validated and clinically useful molecular biomarkers in MS which are used for prediction, diagnosis, disease activity and treatment response.
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Zhou R, Li H, Yang H, Jiang F, Cai H, Li J, Chen S, Fang L, Yin J, Zeng Q. Serological markers exploration and real-world effectiveness and safety of teriflunomide in south Chinese patients with multiple sclerosis. Mult Scler Relat Disord 2021; 58:103446. [PMID: 34929454 DOI: 10.1016/j.msard.2021.103446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since September 2012, when teriflunomide was approved as a disease-modifying treatment for relapsing multiple sclerosis, real-world observational studies on teriflunomide in Chinese patients are limited. METHODS We collected demographic characteristics and peripheral blood samples at different time points. Clinical symptoms, magnetic resonance imaging data, and concentrations of neurofilament light chains and multiple cytokines at different time points were compared to assess the efficacy. Moreover, the safety was assessed by blood routine, liver and kidney function, and a questionnaire to report adverse reactions. RESULTS Teriflunomide significantly reduced serum levels of neurofilament light chains and several inflammatory cytokines. After accepting teriflunomide treatment, many clinical symptoms improved, scores of the expanded disability status scale decreased from 2.0 to 1.75, and annualized relapse rates decreased from 1.45 to 0.31. 29 (80.56%) and 15 (78.95%) patients achieved the no evidence of disease activity-3 status after 6 months and 12 months treatment, respectively. Teriflunomide was associated with mild or moderate discomfort, and discontinuation rates due to adverse events were low. CONCLUSION Serum neurofilament light chain protein is sensitive to teriflunomide treatment, suggesting that it has the potential to be used as an indicator to assess the efficacy of teriflunomide. Teriflunomide can significantly reduce the concentrations of inflammatory cytokines, indicating that teriflunomide may regulate neuroinflammation through the inhibitory effect on a variety of immune cells and their cytokines. Teriflunomide can improve clinical symptoms and disease severity in MS patients in southern China, and patients have good compliance.
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Affiliation(s)
- Ran Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongliang Li
- The First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Haobing Cai
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Si Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
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Picca A, Guerra F, Calvani R, Romano R, Coelho-Júnior HJ, Bucci C, Marzetti E. Mitochondrial Dysfunction, Protein Misfolding and Neuroinflammation in Parkinson's Disease: Roads to Biomarker Discovery. Biomolecules 2021; 11:biom11101508. [PMID: 34680141 PMCID: PMC8534011 DOI: 10.3390/biom11101508] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/18/2022] Open
Abstract
Parkinson’s Disease (PD) is a highly prevalent neurodegenerative disease among older adults. PD neuropathology is marked by the progressive loss of the dopaminergic neurons of the substantia nigra pars compacta and the widespread accumulation of misfolded intracellular α-synuclein (α-syn). Genetic mutations and post-translational modifications, such as α-syn phosphorylation, have been identified among the multiple factors supporting α-syn accrual during PD. A decline in the clearance capacity of the ubiquitin-proteasome and the autophagy-lysosomal systems, together with mitochondrial dysfunction, have been indicated as major pathophysiological mechanisms of PD neurodegeneration. The accrual of misfolded α-syn aggregates into soluble oligomers, and the generation of insoluble fibrils composing the core of intraneuronal Lewy bodies and Lewy neurites observed during PD neurodegeneration, are ignited by the overproduction of reactive oxygen species (ROS). The ROS activate the α-syn aggregation cascade and, together with the Lewy bodies, promote neurodegeneration. However, the molecular pathways underlying the dynamic evolution of PD remain undeciphered. These gaps in knowledge, together with the clinical heterogeneity of PD, have hampered the identification of the biomarkers that may be used to assist in diagnosis, treatment monitoring, and prognostication. Herein, we illustrate the main pathways involved in PD pathogenesis and discuss their possible exploitation for biomarker discovery.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (E.M.)
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 17165 Stockholm, Sweden
| | - Flora Guerra
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, 73100 Lecce, Italy; (F.G.); (R.R.); (C.B.)
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (E.M.)
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 17165 Stockholm, Sweden
- Correspondence: ; Tel.: +39-(06)-3015-5559; Fax: +39-(06)-3051-911
| | - Roberta Romano
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, 73100 Lecce, Italy; (F.G.); (R.R.); (C.B.)
| | - Hélio José Coelho-Júnior
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Cecilia Bucci
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, 73100 Lecce, Italy; (F.G.); (R.R.); (C.B.)
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (E.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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21
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Kouchaki E, Dashti F, Mirazimi SMA, Alirezaei Z, Jafari SH, Hamblin MR, Mirzaei H. Neurofilament light chain as a biomarker for diagnosis of multiple sclerosis. EXCLI JOURNAL 2021; 20:1308-1325. [PMID: 34602928 PMCID: PMC8481790 DOI: 10.17179/excli2021-3973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
The treatments for multiple sclerosis (MS) have improved over the past 25 years, but now the main question for physicians is deciding who should receive treatment, for how long, and when to switch to other options. These decisions are typically based on treatment tolerance and a reasonable expectation of long-term efficacy. A significant unmet need is the lack of accurate laboratory measurements for diagnosis, and monitoring of treatment response, including deterioration and disease progression. There are few validated biomarkers for MS, and in practice, physicians employ two biomarkers discovered fifty years ago for MS diagnosis, often in combination with MRI scans. These biomarkers are intrathecal IgG and oligoclonal bands in the CSF (cerebrospinal fluid). Neurofilament light chain (NfL) is a relatively new biomarker for MS diagnosis and follow up. Neurofilaments are neuron-specific cytoskeleton proteins that can be measured in various body compartments. NfL is a new biomarker for MS that can be measured in serum samples, but this still needs further study to specify the laboratory cut-off values in clinical practice. In the present review we discuss the evidence for NfL as a reliable biomarker for the early detection and management of MS. Moreover, we highlight the correlation between MRI and NfL, and ask whether they can be combined.
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Affiliation(s)
- Ebrahim Kouchaki
- MS Fellowship, Department of Neurology, School of Medicine, Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Dashti
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mohammad Ali Mirazimi
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Alirezaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Paramedical School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran
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Bellingacci L, Mancini A, Gaetani L, Tozzi A, Parnetti L, Di Filippo M. Synaptic Dysfunction in Multiple Sclerosis: A Red Thread from Inflammation to Network Disconnection. Int J Mol Sci 2021; 22:ijms22189753. [PMID: 34575917 PMCID: PMC8469646 DOI: 10.3390/ijms22189753] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022] Open
Abstract
Multiple sclerosis (MS) has been clinically considered a chronic inflammatory disease of the white matter; however, in the last decade growing evidence supported an important role of gray matter pathology as a major contributor of MS-related disability and the involvement of synaptic structures assumed a key role in the pathophysiology of the disease. Synaptic contacts are considered central units in the information flow, involved in synaptic transmission and plasticity, critical processes for the shaping and functioning of brain networks. During the course of MS, the immune system and its diffusible mediators interact with synaptic structures leading to changes in their structure and function, influencing brain network dynamics. The purpose of this review is to provide an overview of the existing literature on synaptic involvement during experimental and human MS, in order to understand the mechanisms by which synaptic failure eventually leads to brain networks alterations and contributes to disabling MS symptoms and disease progression.
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Affiliation(s)
- Laura Bellingacci
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.B.); (A.M.); (L.G.); (L.P.)
| | - Andrea Mancini
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.B.); (A.M.); (L.G.); (L.P.)
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.B.); (A.M.); (L.G.); (L.P.)
| | - Alessandro Tozzi
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy;
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.B.); (A.M.); (L.G.); (L.P.)
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.B.); (A.M.); (L.G.); (L.P.)
- Correspondence: ; Tel.: +39-075-578-3830
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23
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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: 15] [Impact Index Per Article: 5.0] [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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Harrer C, Otto F, Pilz G, Haschke-Becher E, Trinka E, Hitzl W, Wipfler P, Harrer A. The CXCL13/CXCR5-chemokine axis in neuroinflammation: evidence of CXCR5+CD4 T cell recruitment to CSF. Fluids Barriers CNS 2021; 18:40. [PMID: 34446066 PMCID: PMC8390062 DOI: 10.1186/s12987-021-00272-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background C-X-C chemokine ligand 13 (CXCL13) is frequently elevated in cerebrospinal fluid (CSF) in a variety of inflammatory central nervous system (CNS) diseases, has been detected in meningeal B cell aggregates in brain tissues of multiple sclerosis patients, and proposedly recruits B cells into the inflamed CNS. Besides B cells also follicular helper T (Tfh) cells express the cognate receptor C-X-C chemokine receptor type 5 (CXCR5) and follow CXCL13 gradients in lymphoid tissues. These highly specialized B cell helper T cells are indispensable for B cell responses to infection and vaccination and involved in autoimmune diseases. Phenotypically and functionally related circulating CXCR5+CD4 T cells occur in blood. Their co-recruitment to the inflamed CSF is feasible but unresolved. Methods We approached this question with a retrospective study including data of all patients between 2017 and 2019 of whom immune phenotyping data of CXCR5 expression and CSF CXCL13 concentrations were available. Discharge diagnoses and CSF laboratory parameters were retrieved from records. Patients were categorized as pyogenic/aseptic meningoencephalitis (ME, n = 29), neuroimmunological diseases (NIMM, n = 22), and non-inflammatory neurological diseases (NIND, n = 6). ANOVA models and Spearman’s Rank-Order correlation were used for group comparisons and associations of CXCL13 levels with immune phenotyping data. Results In fact, intrathecal CXCL13 elevations strongly correlated with CXCR5+CD4 T cell frequencies in the total cohort (p < 0.0001, r = 0.59), and ME (p = 0.003, r = 0.54) and NIMM (p = 0.043, r = 0.44) patients. Moreover, the ratio of CSF-to-peripheral blood (CSF/PB) frequencies of CXCR5+CD4 T cells strongly correlated with CXCL13 levels both in the total cohort (p = 0.001, r = 0.45) and ME subgroup (p = 0.005, r = 0.50), indicating selective accumulation. ME, NIMM and NIND groups differed with regard to CSF cell counts, albumin quotient, intrathecal IgG, CXCL13 elevations and CXCR5+CD4 T cells, which were higher in inflammatory subgroups. Conclusion The observed link between intrathecal CXCL13 elevations and CXCR5+CD4 T cell frequencies does not prove but suggests recruitment of possible professional B cell helpers to the inflamed CSF. This highlights CSF CXCR5+CD4 T cells a key target and potential missing link to the poorly understood phenomenon of intrathecal B cell and antibody responses with relevance for infection control, chronic inflammation and CNS autoimmunity. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00272-1.
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Affiliation(s)
- Christine Harrer
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria
| | - Ferdinand Otto
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria
| | - Elisabeth Haschke-Becher
- Department of Laboratory Medicine, Paracelsus Medical University, Landeskrankenhaus, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Peter Wipfler
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria
| | - Andrea Harrer
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str 79, 5020, Salzburg, Austria.
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25
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Rosenstein I, Axelsson M, Novakova L, Blennow K, Zetterberg H, Lycke J. Exploring CSF neurofilament light as a biomarker for MS in clinical practice; a retrospective registry-based study. Mult Scler 2021; 28:872-884. [PMID: 34392718 PMCID: PMC9024026 DOI: 10.1177/13524585211039104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Neurofilament light (NFL) has been increasingly recognized for prognostic and therapeutic decisions. Objective: To validate the utility of cerebrospinal fluid NFL (cNFL) as a biomarker in clinical practice of relapsing-remitting multiple sclerosis (RRMS). Methods: RRMS patients (n = 757) who had cNFL analyzed as part of the diagnostic work-up in a single academic multiple sclerosis (MS) center, 2001–2018, were retrospectively identified. cNFL concentrations were determined with two different immunoassays and the ratio of means between them was used for normalization. Results: RRMS with relapse had 4.4 times higher median cNFL concentration (1134 [interquartile range (IQR) 499–2744] ng/L) than those without relapse (264 [125–537] ng/L, p < 0.001) and patients with gadolinium-enhancing lesions had 3.3 times higher median NFL (1414 [606.8–3210] ng/L) than those without (426 [IQR 221–851] ng/L, p < 0.001). The sensitivity and specificity of cNFL to detect disease activity was 75% and 98.5%, respectively. High cNFL at MS onset predicted progression to Expanded Disability Status Scale (EDSS) ⩾ 3 (p < 0.001, hazard ratios (HR) = 1.89, 95% CI = 1.44–2.65) and conversion to secondary progressive MS (SPMS, p = 0.001, HR = 2.5, 95% CI = 1.4–4.2). Conclusions: cNFL is a robust and reliable biomarker of disease activity, treatment response, and prediction of disability and conversion from RRMS to SPMS. Our data suggest that cNFL should be included in the assessment of patients at MS-onset.
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Affiliation(s)
- Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden/Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden/Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden/Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK/UK Dementia Research Institute, University College London (UCL), London, UK
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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26
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Freigang M, Steinacker P, Wurster CD, Schreiber-Katz O, Osmanovic A, Petri S, Koch JC, Rostásy K, Falkenburger B, Ludolph AC, Otto M, Hermann A, Günther R. Increased chitotriosidase 1 concentration following nusinersen treatment in spinal muscular atrophy. Orphanet J Rare Dis 2021; 16:330. [PMID: 34321067 PMCID: PMC8320162 DOI: 10.1186/s13023-021-01961-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/18/2021] [Indexed: 12/20/2022] Open
Abstract
Background Studies regarding the impact of (neuro)inflammation and inflammatory response following repetitive, intrathecally administered antisense oligonucleotides (ASO) in 5q-associated spinal muscular atrophy (SMA) are sparse. Increased risk of hydrocephalus in untreated SMA patients and a marginal but significant increase of the serum/CSF albumin ratio (Qalb) with rare cases of communicating hydrocephalus during nusinersen treatment were reported, which confirms the unmet need of an inflammatory biomarker in SMA. The aim of this study was to investigate the (neuro)inflammatory marker chitotriosidase 1 (CHIT1) in SMA patients before and following the treatment with the ASO nusinersen.
Methods In this prospective, multicenter observational study, we studied CSF CHIT1 concentrations in 58 adult and 21 pediatric patients with SMA type 1, 2 or 3 before treatment initiation in comparison to age- and sex-matched controls and investigated its dynamics during nusinersen treatment. Concurrently, motor performance and disease severity were assessed. Results CHIT1 concentrations were elevated in treatment-naïve SMA patients as compared to controls, but less pronounced than described for other neurodegenerative diseases such as amyotrophic lateral sclerosis. CHIT1 concentration did not correlate with disease severity and did not distinguish between clinical subtypes. CHIT1 concentration did show a significant increase during nusinersen treatment that was unrelated to the clinical response to nusinersen therapy. Conclusions CHIT1 elevation in treatment-naïve SMA patients indicates the involvement of (neuro)inflammation in SMA. The lacking correlation of CHIT1 concentration with disease severity argues against its use as a marker of disease progression. The observed CHIT1 increase during nusinersen treatment may indicate an immune response-like, off-target reaction. Since antisense oligonucleotides are an establishing approach in the treatment of neurodegenerative diseases, this observation needs to be further evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01961-8.
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Affiliation(s)
- Maren Freigang
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | | | | | | | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Kevin Rostásy
- Department of Pediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Björn Falkenburger
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Albert Christian Ludolph
- Department of Neurology, Ulm University, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE) Ulm, Ulm, Germany
| | - Markus Otto
- Department of Neurology, Ulm University, Ulm, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany. .,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany.
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27
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Harris S, Comi G, Cree BAC, Arnold DL, Steinman L, Sheffield JK, Southworth H, Kappos L, Cohen JA. Plasma neurofilament light chain concentrations as a biomarker of clinical and radiologic outcomes in relapsing multiple sclerosis: Post hoc analysis of Phase 3 ozanimod trials. Eur J Neurol 2021; 28:3722-3730. [PMID: 34292643 PMCID: PMC9291872 DOI: 10.1111/ene.15009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
Background and purpose We investigated plasma neurofilament light chain concentration (pNfL) as a biomarker for neuroaxonal damage and disease activity using data from Phase 3 trials of ozanimod in relapsing multiple sclerosis (RMS). Methods pNfL was measured before and after ozanimod 0.46 mg or 0.92 mg daily or interferon β‐1a 30 µg weekly in the randomized, double‐blind SUNBEAM and RADIANCE trials. In these post hoc analyses, we investigated relationships between pNfL (at baseline and median percentage change from baseline to Month 12 [SUNBEAM] or 24 [RADIANCE]) and clinical and magnetic resonance imaging outcomes. Results Median (Q1, Q3) baseline pNfL, available in 1244 of 1346 SUNBEAM participants, was 14.70 (10.16, 23.26) pg/ml and in 1109 of 1313 RADIANCE participants was 13.35 (9.42, 20.41) pg/ml. Baseline gadolinium‐enhancing (GdE) and T2 lesion counts increased and brain volume decreased with increasing baseline pNfL. Baseline pNfL was higher in those with versus without on‐treatment relapse. Median percentage reduction in pNfL at 12 months in SUNBEAM (n = 1238) and 24 months in RADIANCE (n = 1088) was greater for ozanimod (20%–27%) than interferon β‐1a (13%–16%; p < 0.01). Greater pNfL reduction was associated with fewer GdE lesions, fewer new/enlarging T2 lesions per scan, less loss of brain volume, lower annualized relapse rate (ARR), and no evidence of disease activity. The following models predicted ARR: 0.5111 + 0.0116 × ΔNfL at 12 months (SUNBEAM) and 0.4079 + 0.0088 × ΔNfL at 24 months (RADIANCE). Conclusions pNfL was associated with clinical and radiologic measures of disease and treatment effects in RMS, supporting its use as a biomarker.
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Affiliation(s)
- Sarah Harris
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Douglas L Arnold
- NeuroRx Research and Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Lawrence Steinman
- Department of Neurology and Neurological Sciences, Beckman Center for Molecular Medicine, Stanford University Medical Center, Stanford, California, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
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28
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Callegari I, Derfuss T, Galli E. Update on treatment in multiple sclerosis. Presse Med 2021; 50:104068. [PMID: 34033862 DOI: 10.1016/j.lpm.2021.104068] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. In recent years, many disease-modifying therapies (DMT) have been approved for MS treatment. For this reason, a profound knowledge of the characteristics and indications of the available compounds is required to tailor the therapeutic strategy to the individual patient characteristics. This should include the mechanism of action and pharmacokinetic of the drug, the safety and efficacy profile provided by clinical trials, as well as the understanding of possible side effects. Moreover, the evolving knowledge of the disease is paving the way to new and innovative therapeutic approaches, as well as the development of new biomarkers to monitor the therapeutic response and to guide the clinician's therapeutic choices. In this review we provide a comprehensive overview on currently approved therapies in MS and the emerging evidence-based strategies to adopt for initiating, monitoring, and eventually adapting a therapeutic regimen with DMT.
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Affiliation(s)
- Ilaria Callegari
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Tobias Derfuss
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Edoardo Galli
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
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29
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Repulsive Guidance Molecule-a and Central Nervous System Diseases. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5532116. [PMID: 33997000 PMCID: PMC8112912 DOI: 10.1155/2021/5532116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
Repulsive guidance molecule-a (RGMa) is a member of glycosylphosphatidylinositol- (GPI-) anchored protein family, which has axon guidance function and is widely involved in the development and pathological processes of the central nervous system (CNS). On the one hand, the binding of RGMa and its receptor Neogenin can regulate axonal guidance, differentiation of neural stem cells into neurons, and the survival of these cells; on the other hand, RGMa can inhibit functional recovery of CNS by inhibiting axonal growth. A number of studies have shown that RGMa may be involved in the pathogenesis of CNS diseases, such as multiple sclerosis, neuromyelitis optica spectrum diseases, cerebral infarction, spinal cord injury, Parkinson's disease, and epilepsy. Targeting RGMa can enhance the functional recovery of CNS, so it may become a promising target for the treatment of CNS diseases. This article will comprehensively review the research progression of RGMa in various CNS diseases up to date.
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30
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Ferreira-Atuesta C, Reyes S, Giovanonni G, Gnanapavan S. The Evolution of Neurofilament Light Chain in Multiple Sclerosis. Front Neurosci 2021; 15:642384. [PMID: 33889068 PMCID: PMC8055958 DOI: 10.3389/fnins.2021.642384] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory neurodegenerative disease of the central nervous system characterized by demyelination and axonal damage. Diagnosis and prognosis are mainly assessed through clinical examination and neuroimaging. However, more sensitive biomarkers are needed to measure disease activity and guide treatment decisions in MS. Prompt and individualized management can reduce inflammatory activity and delay disease progression. Neurofilament Light chain (NfL), a neuron-specific cytoskeletal protein that is released into the extracellular fluid following axonal injury, has been identified as a biomarker of disease activity in MS. Measurement of NfL levels can capture the extent of neuroaxonal damage, especially in early stages of the disease. A growing body of evidence has shown that NfL in cerebrospinal fluid (CSF) and serum can be used as reliable indicators of prognosis and treatment response. More recently, NfL has been shown to facilitate individualized treatment decisions for individuals with MS. In this review, we discuss the characteristics that make NfL a highly informative biomarker and depict the available technologies used for its measurement. We further discuss the growing role of serum and CSF NfL in MS research and clinical settings. Finally, we address some of the current topics of debate regarding the use of NfL in clinical practice and examine the possible directions that this biomarker may take in the future.
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Affiliation(s)
- Carolina Ferreira-Atuesta
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Saúl Reyes
- Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Gavin Giovanonni
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sharmilee Gnanapavan
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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31
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Tauil CB, Rocha-Lima AD, Ferrari BB, Silva FMD, Machado LA, Ramari C, Brandão CO, Santos LMBD, Santos-Neto LLD. Depression and anxiety disorders in patients with multiple sclerosis: association with neurodegeneration and neurofilaments. ACTA ACUST UNITED AC 2021; 54:e10428. [PMID: 33470393 PMCID: PMC7812914 DOI: 10.1590/1414-431x202010428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Abstract
There is increasing evidence that neurofilament light chain (NF-L) can be considered as a biomarker for neuro-axonal damage. This polypeptide can be released into the cerebrospinal fluid (CSF) and the blood, where it can be quantified. The concentration of NF-L is elevated in patients with multiple sclerosis (MS) and psychiatric disorders. We aimed to investigate the NF-L levels in the CSF from treated MS patients and the relationship with depression or anxiety. The study involved three groups: control group (individuals without inflammation), the relapse-remitting multiple sclerosis (RRMS)-untreated group, and the RRMS-Fingo group (RRMS patients who were treated with fingolimod). MS disability was assessed by the Expanded Disability Status Scale, and depression and anxiety were evaluated by a neuropsychologist, using the Hospital Anxiety and Depression Scale, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Individual CSF samples were collected to measure NF-L levels. The results of the statistical analysis on levels of NF-L in the CSF of control subjects, RRMS-untreated patients, and RRMS-Fingo patients were significant. The relationship between depression and anxiety in RRMS-Fingo patients and NF-L levels was not statistically significant. In conclusion, MS events such as anxiety and depression appear to contribute to the onset of clinical relapses, subclinical cases, and neurodegeneration.
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Affiliation(s)
- C B Tauil
- Departamento de Ciências Médicas, Universidade de Brasília, Brasília, DF, Brasil
| | - A D Rocha-Lima
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Unidade de Neuroimunologia, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - B B Ferrari
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Unidade de Neuroimunologia, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - F M da Silva
- Departamento de Psicologia, Hospital de Base de Brasília, Brasília, DF, Brasil
| | - L A Machado
- Departamento de Psicologia, Hospital de Base de Brasília, Brasília, DF, Brasil
| | - C Ramari
- Departamento de Ciências Médicas, Universidade de Brasília, Brasília, DF, Brasil
| | - C O Brandão
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Unidade de Neuroimunologia, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - L M B Dos Santos
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Unidade de Neuroimunologia, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - L L Dos Santos-Neto
- Departamento de Ciências Médicas, Universidade de Brasília, Brasília, DF, Brasil
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32
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Negron A, Stüve O, Forsthuber TG. Ectopic Lymphoid Follicles in Multiple Sclerosis: Centers for Disease Control? Front Neurol 2020; 11:607766. [PMID: 33363512 PMCID: PMC7753025 DOI: 10.3389/fneur.2020.607766] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
While the contribution of autoreactive CD4+ T cells to the pathogenesis of Multiple Sclerosis (MS) is widely accepted, the advent of B cell-depleting monoclonal antibody (mAb) therapies has shed new light on the complex cellular mechanisms underlying MS pathogenesis. Evidence supports the involvement of B cells in both antibody-dependent and -independent capacities. T cell-dependent B cell responses originate and take shape in germinal centers (GCs), specialized microenvironments that regulate B cell activation and subsequent differentiation into antibody-secreting cells (ASCs) or memory B cells, a process for which CD4+ T cells, namely follicular T helper (TFH) cells, are indispensable. ASCs carry out their effector function primarily via secreted Ig but also through the secretion of both pro- and anti-inflammatory cytokines. Memory B cells, in addition to being capable of rapidly differentiating into ASCs, can function as potent antigen-presenting cells (APCs) to cognate memory CD4+ T cells. Aberrant B cell responses are prevented, at least in part, by follicular regulatory T (TFR) cells, which are key suppressors of GC-derived autoreactive B cell responses through the expression of inhibitory receptors and cytokines, such as CTLA4 and IL-10, respectively. Therefore, GCs represent a critical site of peripheral B cell tolerance, and their dysregulation has been implicated in the pathogenesis of several autoimmune diseases. In MS patients, the presence of GC-like leptomeningeal ectopic lymphoid follicles (eLFs) has prompted their investigation as potential sources of pathogenic B and T cell responses. This hypothesis is supported by elevated levels of CXCL13 and circulating TFH cells in the cerebrospinal fluid (CSF) of MS patients, both of which are required to initiate and maintain GC reactions. Additionally, eLFs in post-mortem MS patient samples are notably devoid of TFR cells. The ability of GCs to generate and perpetuate, but also regulate autoreactive B and T cell responses driving MS pathology makes them an attractive target for therapeutic intervention. In this review, we will summarize the evidence from both humans and animal models supporting B cells as drivers of MS, the role of GC-like eLFs in the pathogenesis of MS, and mechanisms controlling GC-derived autoreactive B cell responses in MS.
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Affiliation(s)
- Austin Negron
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Olaf Stüve
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Neurology Section, Veterans Affairs North Texas Health Care System, Medical Service, Dallas, TX, United States
| | - Thomas G Forsthuber
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, United States
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33
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Gaetani L, Paolini Paoletti F, Bellomo G, Mancini A, Simoni S, Di Filippo M, Parnetti L. CSF and Blood Biomarkers in Neuroinflammatory and Neurodegenerative Diseases: Implications for Treatment. Trends Pharmacol Sci 2020; 41:1023-1037. [PMID: 33127098 DOI: 10.1016/j.tips.2020.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
Neuroinflammatory and neurodegenerative diseases are characterized by the interplay of a number of molecular pathways that can be assessed through biofluids, especially cerebrospinal fluid and blood. Accordingly, the definition and classification of these disorders will move from clinical and pathological to biological criteria. The consequences of this biomarker-based diagnostic and prognostic approach are highly relevant to the field of drug development. Indeed, in view of the availability of disease-modifying drugs, fluid biomarkers offer a unique opportunity for improving the quality and applicability of results from clinical trials. Herein, we discuss the benefits of using fluid biomarkers for patient stratification, target engagement, and outcome assessment, as well as the most recent developments in neuroinflammatory and neurodegenerative diseases.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Giovanni Bellomo
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Mancini
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Simone Simoni
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Lucilla Parnetti
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy.
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34
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Mahler MR, Søndergaard HB, Buhelt S, von Essen MR, Romme Christensen J, Enevold C, Sellebjerg F. Multiplex assessment of cerebrospinal fluid biomarkers in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102391. [DOI: 10.1016/j.msard.2020.102391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022]
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35
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Jons D, Zetterberg H, Malmeström C, Bergström T, Axelsson M, Blennow K, Thulin M, Sundström P, Andersen O. Intrathecal immunoreactivity in people with or without previous infectious mononucleosis. Acta Neurol Scand 2020; 142:161-168. [PMID: 32415852 DOI: 10.1111/ane.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The risk of developing multiple sclerosis (MS) increases (OR: 3.1) after infectious mononucleosis (IM). However, the nature of this link is obscure. We tested the hypothesis that IM might incur long-term sequelae, including low-key inflammatory activity, with characteristics of an MS endophenotype (or presymptomatic trait) and that assays of MS-relevant cyto-/chemokines in the cerebrospinal fluid (CSF) post-IM may show a trend in this direction. MATERIALS AND METHODS We selected seven CSF cytokines (IL-1b, IL-6, YKL-40, TNF-alpha) or chemokines (IL-8, CCL2, IP-10), representing pro-inflammatory factors previously associated with MS. We assayed the CSF levels of these seven cyto-/chemokines in healthy individuals with a median follow-up time of 10 years after serologically confirmed IM (post-IM group, n = 22), and in healthy controls without a history of IM (n = 19). A group of MS patients (n = 23) were included as reference. RESULTS The CSF levels of IP-10, YKL-40, and CCL-2 were higher in the post-IM group than in our IM unexposed controls (P = .021, .049, .028). Seven of seven cyto-/chemokine assays showed a trend in the predicted direction (P of binomial ratio = .008). However, this trend was non-significant in a multivariate test (P = .22). A power analysis indicated that similar studies including a larger cohort would be numerically realistic. CONCLUSIONS These results do not reject the hypothesis that the established epidemiological association between IM and MS results from a stepwise inflammatory propagation from IM sequelae to an MS endophenotype (or presymptomatic trait) in a proportion of IM patients, pending confirmation with adequate power.
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Affiliation(s)
- Daniel Jons
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- UK Dementia Research Institute at UCL London UK
- Department of Neurodegenerative Diseases UCL Institute of Neurology London UK
| | - Clas Malmeström
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Tomas Bergström
- Department of Clinical Microbiology Sahlgrenska University HospitalVästra Götaland Region Gothenburg Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Måns Thulin
- Department of Statistics Uppsala University Uppsala Sweden
- School of Mathematics and Maxwell Institute for Mathematical Sciences University of Edinburgh Edinburgh UK
| | - Peter Sundström
- Department of Clinical Science, Neurosciences Umeå University Umeå Sweden
| | - Oluf Andersen
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
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Boehnke SE, Robertson EL, Armitage‐Brown B, Wither RG, Lyra e Silva NM, Winterborn A, Levy R, Cook DJ, De Felice FG, Munoz DP. The effect of lumbar puncture on the neurodegeneration biomarker neurofilament light in macaque monkeys. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12069. [PMID: 32695873 PMCID: PMC7366296 DOI: 10.1002/dad2.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Neurofilament light (NFL) in cerebrospinal fluid (CSF) is elevated in neurodegenerative disease patients, and may track disease progression and treatment. Macaque monkeys are emerging as important translational models of neurodegeneration, and NFL may be a useful biomarker. METHODS To determine the influence of a previous lumbar puncture (LP) on NFL, we collected CSF at multiple time points in macaque monkeys via LP or cisterna magna puncture. NFL, amyloid beta (Aβ40, Aβ42), and tau (tTau, pTau) in CSF were measured by standard enzyme-linked immunosorbent assay and multiplex. RESULTS NFL was significantly elevated at 14 to 23 days after an LP (median increase: 162%). Aβ and tau biomarkers remained stable. NFL peaked and decayed over 1 to 2 months after LP. NFL was not elevated after cisterna magna puncture. DISCUSSION Results suggest damage of the cauda equina during LP may increase NFL. Caution should be taken in interpreting NFL concentration in studies in which repeat LPs are performed.
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Affiliation(s)
- Susan E. Boehnke
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada
| | - Emma L. Robertson
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
| | | | - Robert G. Wither
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
| | | | | | - Ron Levy
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
- Department of SurgeryKingston General HospitalKingstonOntarioCanada
| | - Douglas J. Cook
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
- Department of SurgeryKingston General HospitalKingstonOntarioCanada
| | - Fernanda G. De Felice
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
- Department of PsychiatryProvidence Care HospitalKingstonOntarioCanada
- Institute of Medical Biochemistry Leopoldo de MeisFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Douglas P. Munoz
- Centre for Neuroscience StudiesQueen's UniversityKingstonOntarioCanada
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada
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Lycke J, Axelsson M. Can multiple sclerosis be cured? A case of highly active relapsing multiple sclerosis treated with autologous hematopoietic stem-cell transplantation 13 years ago. Mult Scler Relat Disord 2020; 44:102253. [PMID: 32570177 DOI: 10.1016/j.msard.2020.102253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022]
Abstract
A 26-year-old man, with five years of highly active deteriorating relapsing multiple sclerosis (MS), unresponsive to conventional therapy, was treated with autologous hematopoietic stem-cell transplantation (AHSCT) 13 years ago. Since then the patient had no clinical or neuroradiological disease activity and disability progression was halted. Repeated analysis of CSF revealed reduced levels of inflammatory biomarkers and the neurofilament light protein level was normalized indicating no further axonal degeneration. The patient is socio-economic independent, is working full time, and has become a father. Measures of quality of life and cognition did not indicate further deterioration. Long-term follow-up has not shown any signs of active disease suggesting that AHSCT may be a cure for MS.
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Affiliation(s)
- Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Loeffler T, Schilcher I, Flunkert S, Hutter-Paier B. Neurofilament-Light Chain as Biomarker of Neurodegenerative and Rare Diseases With High Translational Value. Front Neurosci 2020; 14:579. [PMID: 32595447 PMCID: PMC7300175 DOI: 10.3389/fnins.2020.00579] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Neurofilament-light chain (NF-L) is a well-known clinical biomarker of many neurodegenerative diseases. By analyzing amyotrophic lateral sclerosis (ALS) patients cerebrospinal fluid (CSF) or plasma, progression of NF-L levels can forecast conversion from the presymptomatic to symptomatic stage and time of survival. The use of plasma for NF-L measurement makes this biomarker exceptionally valuable for clinical studies since sample collection can be performed repeatedly without causing much harm. Detailed analyses of NF-L expression in neurodegenerative disease patient’s samples were already performed, while NF-L levels of preclinical models of ALS, Alzheimer’s and Parkinson’s disease as well as lysosomal storage diseases are still widely unknown. We therefore evaluated NF-L levels in the plasma of the ALS models SOD1-G93A low expressor and TAR6/6 mice, the Alzheimer’s disease (AD) model 5xFAD, the Parkinson’s disease model Line 61 and the Gaucher disease (GD) model 4L/PS-NA and the CSF of selected models. Our results show that NF-L levels are highly increased in the plasma of ALS, Alzheimer’s and GD models, while in the analyzed Parkinson’s disease model NF-L plasma levels barely changed. Most analyzed models show a progressive increase of NF-L levels. NF-L measurements in the plasma of the neurodegenerative disease mouse models of ALS and AD are thus a good tool to evaluate disease progression. Compared to analyses in human tissues, our results suggest a high translation value of murine NF-L levels and their progression. Furthermore, our data indicate that NF-L might also be a good biomarker for disorders with a neuronal component like some lysosomal storage diseases.
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Affiliation(s)
- Tina Loeffler
- Neuropharmacology, QPS Austria GmbH, Grambach, Austria
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Sugarman MA, Zetterberg H, Blennow K, Tripodis Y, McKee AC, Stein TD, Martin B, Palmisano JN, Steinberg EG, Simkin I, Budson AE, Killiany R, O'Connor MK, Au R, Qiu WWQ, Goldstein LE, Kowall NW, Mez J, Stern RA, Alosco ML. A longitudinal examination of plasma neurofilament light and total tau for the clinical detection and monitoring of Alzheimer's disease. Neurobiol Aging 2020; 94:60-70. [PMID: 32585491 DOI: 10.1016/j.neurobiolaging.2020.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022]
Abstract
We examined baseline and longitudinal associations between plasma neurofilament light (NfL) and total tau (t-tau), and the clinical presentation of Alzheimer's disease (AD). A total of 579 participants (238, normal cognition [NC]; 185, mild cognitive impairment [MCI]; 156, AD dementia) had baseline blood draws; 82% had follow-up evaluations. Plasma samples were analyzed for NfL and t-tau using Simoa technology. Baseline plasma NfL was higher in AD dementia than MCI (standardized mean difference = 0.55, 95% CI: 0.37-0.73) and NC (standardized mean difference = 0.68, 95% CI: 0.49-0.88), corresponded to Clinical Dementia Rating scores (OR = 1.94, 95% CI: 1.35-2.79]), and correlated with all neuropsychological tests (r's = 0.13-0.42). Longitudinally, NfL did not predict diagnostic conversion but predicted decline on 3/10 neuropsychological tests. Baseline plasma t-tau was higher in AD dementia than NC with a small effect (standardized mean difference = 0.33, 95% CI: 0.10-0.57) but not MCI. t-tau did not statistically significant predict any longitudinal outcomes. Plasma NfL may be useful for the detection of AD dementia and monitoring of disease progression. In contrast, there was minimal evidence in support of plasma t-tau.
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Affiliation(s)
- Michael A Sugarman
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neuropsychology, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Eric G Steinberg
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Irene Simkin
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Andrew E Budson
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Ronald Killiany
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Center for Biomedical Imaging, Boston University School of Medicine, Boston, MA, USA
| | - Maureen K O'Connor
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neuropsychology, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Wendy Wei Qiao Qiu
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston, MA, USA; Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
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Manouchehrinia A, Stridh P, Khademi M, Leppert D, Barro C, Michalak Z, Benkert P, Lycke J, Alfredsson L, Kappos L, Piehl F, Olsson T, Kuhle J, Kockum I. Plasma neurofilament light levels are associated with risk of disability in multiple sclerosis. Neurology 2020; 94:e2457-e2467. [PMID: 32434867 PMCID: PMC7455371 DOI: 10.1212/wnl.0000000000009571] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 12/27/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the association between plasma neurofilament light chain (pNfL) levels and the risk of developing sustained disability worsening. Methods Concentrations of pNfL were determined in 4,385 persons with multiple sclerosis (MS) and 1,026 randomly selected population-based sex- and age-matched controls using the highly sensitive Single Molecule Array (SimoaTM) NF-Light Advantage Kit. We assessed the impact of age-stratified pNfL levels above the 80th, 95th, and 99th percentiles among controls on the risk of Expanded Disability Status Scale (EDSS) worsening within the following year and reaching sustained EDSS scores of 3.0, 4.0, and 6.0 and conversion to secondary progressive multiple sclerosis (SPMS). Results The median (interquartile range [IQR]) pNfL was 7.5 (4.1) pg/mL in controls and 11.4 (9.6) pg/mL in MS (p < 0.001). The median (IQR) duration of follow-up was 5 (5.1) years. High pNfL was associated with increased adjusted rates of EDSS worsening ranging between 1.4 (95% confidence intervals [CIs]: 1.1–1.8) and 1.7 (95% CI: 1.4–2.3). High pNfL was also associated with the risk of reaching a sustained EDSS score of 3.0, with adjusted rates ranging between 1.5 (95% CI: 1.2–1.8) and 1.55 (95% CI: 1.3–1.8) over all percentile cutoffs (all p < 0.001). Similar increases were observed for the risk of sustained EDSS score 4.0. In contrast, the risk of reaching sustained EDSS score 6.0 and conversion to SPMS was not consistently significant. Conclusions Elevated pNfL levels at early stages of MS are associated with an increased risk of reaching sustained disability worsening. Hence, pNfL may serve as a prognostic tool to assess the risk of developing permanent disability in MS.
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Affiliation(s)
- Ali Manouchehrinia
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden.
| | - Pernilla Stridh
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Mohsen Khademi
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - David Leppert
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Christian Barro
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Zuzanna Michalak
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Pascal Benkert
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Jan Lycke
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Lars Alfredsson
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Ludwig Kappos
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Fredrik Piehl
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Tomas Olsson
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Jens Kuhle
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
| | - Ingrid Kockum
- From the Department of Clinical Neuroscience (A.M., P.S., M.K., F.P., T.O., I.K.), The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Karolinska Institutet; Centre for Molecular Medicine (A.M., P.S., M.K., F.P., T.O., I.K.), Karolinska University Hospital, Stockholm, Sweden; Departments of Medicine, Biomedicine, and Clinical Research (D.L., C.B., Z.M., L.K., J.K.), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Switzerland; Institution of Neuroscience and Physiology (J.L.), Sahlgrenska Academy, University of Gothenburg, Gothenburg; Institute of Environmental Medicine (L.A.), Karolinska Institutet, Stockholm; and Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Sweden
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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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42
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Alifirova VM, Kamenskikh EM, Koroleva ES. [Evaluation of serum neurofilament light chains levels for diagnosis, treatment monitoring and prognosis in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:7-13. [PMID: 31934983 DOI: 10.17116/jnevro2019119107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pathophysiological processes in multiple sclerosis frequently not diagnosed by clinicians become available for analysis only on the basis of paraclinical data (biomarkers). Nowadays neurofilament light chain can be defined as a promising biomarker for multiple sclerosis (MS). Neurofilaments are a structural part of normal neuronal processes consisting of light, intermediate and heavy chains. However, a damage of neurons such as neurodegeneration or axonal damage causes the escape of neurofilaments into extracellular space. Cutting-edge highly sensitive methods make it possible to detect neurofilament light chains not only in the cerebrospinal fluid but also in the blood serum thus opening the opportunities to utilize them in routine diagnosis in clinical practice. This review comprises existing data on the possible opportunities for research of serum neurofilament light chains in terms of exacerbations, effectiveness of basic therapy, assessment of individual disability, the atrophy of central nervous system structures. Also, there is some information on comparison of two methods: routine MRI of the brain with the contrast agents and detection of serum neurofilament light chains.
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Affiliation(s)
| | | | - E S Koroleva
- Siberian State Medical University, Tomsk, Russia
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43
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Alirezaei Z, Pourhanifeh MH, Borran S, Nejati M, Mirzaei H, Hamblin MR. Neurofilament Light Chain as a Biomarker, and Correlation with Magnetic Resonance Imaging in Diagnosis of CNS-Related Disorders. Mol Neurobiol 2020; 57:469-491. [PMID: 31385229 PMCID: PMC6980520 DOI: 10.1007/s12035-019-01698-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
The search for diagnostic and prognostic biomarkers for neurodegenerative conditions is of high importance, since these disorders may present difficulties in differential diagnosis. Biomarkers with high sensitivity and specificity are required. Neurofilament light chain (NfL) is a unique biomarker related to axonal damage and neural cell death, which is elevated in a number of neurological disorders, and can be detected in cerebrospinal fluid (CSF), as well as blood, serum, or plasma samples. Although the NfL concentration in CSF is higher than that in blood, blood measurement may be easier in practice due to its lesser invasiveness, reproducibility, and convenience. Many studies have investigated NfL in both CSF and serum/plasma as a potential biomarker of neurodegenerative disorders. Neuroimaging biomarkers can also potentially improve detection of CNS-related disorders at an early stage. Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) are sensitive techniques to visualize neuroaxonal loss. Therefore, investigating the combination of NfL levels with indices extracted from MRI and DTI scans could potentially improve diagnosis of CNS-related disorders. This review summarizes the evidence for NfL being a reliable biomarker in the early detection and disease management in several CNS-related disorders. Moreover, we highlight the correlation between MRI and NfL and ask whether they can be combined.
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Affiliation(s)
- Zahra Alirezaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Pourhanifeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Sarina Borran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Nejati
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran.
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Boston, MA, 02114, USA.
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44
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Ziemssen T, Akgün K, Brück W. Molecular biomarkers in multiple sclerosis. J Neuroinflammation 2019; 16:272. [PMID: 31870389 PMCID: PMC6929340 DOI: 10.1186/s12974-019-1674-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/16/2019] [Indexed: 11/30/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory-neurodegenerative disease of the central nervous system presenting with significant inter- and intraindividual heterogeneity. However, the application of clinical and imaging biomarkers is currently not able to allow individual characterization and prediction. Complementary, molecular biomarkers which are easily quantifiable come from the areas of immunology and neurobiology due to the causal pathomechanisms and can excellently complement other disease characteristics. Only a few molecular biomarkers have so far been routinely used in clinical practice as their validation and transfer take a long time. This review describes the characteristics that an ideal MS biomarker should have and the challenges of establishing new biomarkers. In addition, clinically relevant and promising biomarkers from the blood and cerebrospinal fluid are presented which are useful for MS diagnosis and prognosis as well as for the assessment of therapy response and side effects.
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Affiliation(s)
- Tjalf Ziemssen
- MS center, Center of Clinical Neuroscience, University Clinic Carl-Gustav Carus, Dresden University of Technology, Dresden, Germany.
| | - Katja Akgün
- MS center, Center of Clinical Neuroscience, University Clinic Carl-Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
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45
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Sejbaek T, Nielsen HH, Penner N, Plavina T, Mendoza JP, Martin NA, Elkjaer ML, Ravnborg MH, Illes Z. Dimethyl fumarate decreases neurofilament light chain in CSF and blood of treatment naïve relapsing MS patients. J Neurol Neurosurg Psychiatry 2019; 90:1324-1330. [PMID: 31611264 PMCID: PMC6902070 DOI: 10.1136/jnnp-2019-321321] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In a prospective phase IV trial of the first-line oral treatment dimethyl fumarate (DMF), we examined dynamics of neurofilament light (NFL) chain in serum, plasma and cerebrospinal fluid (CSF) samples collected over 12 months from relapsing-remitting multiple sclerosis (RRMS) patients. NFL changes were related to disease activity. METHODS We examined NFL levels by single-molecule array in 88 CSF, 348 plasma and 131 sera from treatment-naïve RRMS patients (n=52), healthy controls (n=23) and a placebo group matched by age, sex and NFL (n=52). Plasma/sera were collected at baseline, and 1, 3, 6 and 12 months after DMF. CSF samples were collected at baseline and 12 months after DMF. RESULTS NFL concentration in CSF, plasma and serum correlated highly (p<0.0001 for all), but plasma levels were only 76.9% of paired serum concentration. After 12 months of DMF treatment, NFL concentration decreased by 73%, 69% and 55% in the CSF, serum and plasma (p<0.0001, respectively). Significant reduction in blood was observed after 6 and 12 months treatment compared with baseline (p<0.01 and p<0.0001, respectively) and to placebo (p<0.0001). Patients with NFL above the 807.5 pg/mL cut-off in CSF had 5.0-times relative risk of disease activity (p<0.001). CONCLUSIONS This study provides Class II evidence that first-line DMF reduces NFL in both blood and CSF after 6 months and normalises CSF levels in 73% of patients. High NFL concentration in CSF after a year reflected disease activity. NFL levels were higher in serum than in plasma, which should be considered when NFL is used as a biomarker.
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Affiliation(s)
- Tobias Sejbaek
- Neurology, Odense Universitetshospital, Odense, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Neurology, Hospital of South West Jutland, Esbjerg, Denmark.,The Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,MS Alliance of Southern Denmark, Esbjerg, Denmark
| | - Helle Hvilsted Nielsen
- Neurology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,MS Alliance of Southern Denmark, Esbjerg, Denmark
| | - Natasha Penner
- Value Based Medicine, Biogen Idec Inc, Cambridge, Massachusetts, USA
| | - Tatiana Plavina
- Value Based Medicine, Biogen Idec Inc, Cambridge, Massachusetts, USA
| | - Jason P Mendoza
- Value Based Medicine, Biogen Idec Inc, Cambridge, Massachusetts, USA
| | - Nellie Anne Martin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Louise Elkjaer
- Neurology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Zsolt Illes
- Neurology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,MS Alliance of Southern Denmark, Esbjerg, Denmark
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46
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Sandelius Å, Sandgren S, Axelsson M, Malmeström C, Novakova L, Kostanjevecki V, Vandijck M, Blennow K, Zetterberg H, Lycke J. Cerebrospinal fluid growth-associated protein 43 in multiple sclerosis. Sci Rep 2019; 9:17309. [PMID: 31754174 PMCID: PMC6872811 DOI: 10.1038/s41598-019-54032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
Neurodegeneration in multiple sclerosis (MS) correlates with disease progression and reparative processes may be triggered. Growth-associated protein 43 (GAP-43) exhibits induced expression during axonal growth and reduced expression during MS progression. We aimed to evaluate if GAP-43 can serve as a biomarker of regeneration in relapsing-remitting MS (RRMS) and whether disease-modifying therapies (DMTs) influence GAP-43 concentration in cerebrospinal fluid (CSF). GAP-43 was measured using an enzyme-linked immunosorbent assay in 105 MS patients (73 RRMS, 12 primary progressive MS, 20 secondary progressive MS) and 23 healthy controls (HCs). In 35 of the patients, lumbar puncture, clinical assessment, and magnetic resonance imaging was performed before initiation of therapeutic intervention, and at follow-up. CSF GAP-43 concentration was significantly lower in progressive MS compared with HCs (p = 0.004) and RRMS (p = < 0.001) and correlated negatively with disability (p = 0.026). However, DMTs did not alter CSF GAP-43. Interestingly, in RRMS CSF GAP-43 levels were higher in patients with signs of active inflammatory disease than in patients in remission (p = 0.042). According to CSF GAP-43 concentrations, regeneration seems reduced in progressive MS, increased during disease activity in RRMS but is unaffected by treatment of highly active DMTs.
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Affiliation(s)
- Åsa Sandelius
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Sofia Sandgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Markus Axelsson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clas Malmeström
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom
| | - Jan Lycke
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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47
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Baldassari LE, Planchon SM, Bermel RA, Nakamura K, Fisher E, Feng J, Sakaie KE, Ontaneda D, Cohen JA. Serum neurofilament light chain concentration in a phase 1/2 trial of autologous mesenchymal stem cell transplantation. Mult Scler J Exp Transl Clin 2019; 5:2055217319887198. [PMID: 31723439 PMCID: PMC6831979 DOI: 10.1177/2055217319887198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 11/15/2022] Open
Abstract
Background Serum neurofilament light chain concentration is a proposed biomarker of axonal injury in multiple sclerosis. Mesenchymal stem cells have anti-inflammatory and repair-promoting activities, making them of interest for potential multiple sclerosis treatment. Objectives The purpose of this study was to assess correlation of serum neurofilament light chain concentration and measures of multiple sclerosis disease activity/severity, longitudinal stability of serum neurofilament light chain concentration, and treatment effect of mesenchymal stem cell transplantation on serum neurofilament light chain concentration. Methods Twenty-four multiple sclerosis patients underwent intravenous infusion of autologous mesenchymal stem cells. Clinical assessments, serum collection, and brain magnetic resonance imaging were performed at months -1, 0 (transplant), 1, 3, and 6. Matched control serum was collected once (n = 10). Serum neurofilament light chain concentration was measured by single-molecule array. Serum neurofilament light chain concentration correlations with disease measures were analyzed by Spearman correlations and linear mixed effect models. Pre-post transplant serum neurofilament light chain concentration was compared by Wilcoxon signed rank testing. Results There were significant (p<0.01) correlations between serum neurofilament light chain concentration and gadolinium-enhancing lesion number (rho = 0.55) and volume (rho = 0.65), and new/enlarging T2 lesions (rho = 0.65). Patients without disease activity had lower fluctuation in serum neurofilament light chain concentration (p = 0.01). Mean pre- versus post-treatment serum neurofilament light chain concentration values were not significantly different. Conclusions Serum neurofilament light chain concentration correlated with magnetic resonance imaging measures of disease activity cross sectionally and longitudinally, and was stable in patients without disease activity. There was no clear treatment effect of mesenchymal stem cell transplantation on serum neurofilament light chain concentration.
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Affiliation(s)
- Laura E Baldassari
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Sarah M Planchon
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | | | | | - Jenny Feng
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | | | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
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48
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Gil-Perotin S, Castillo-Villalba J, Cubas-Nuñez L, Gasque R, Hervas D, Gomez-Mateu J, Alcala C, Perez-Miralles F, Gascon F, Dominguez JA, Casanova B. Combined Cerebrospinal Fluid Neurofilament Light Chain Protein and Chitinase-3 Like-1 Levels in Defining Disease Course and Prognosis in Multiple Sclerosis. Front Neurol 2019; 10:1008. [PMID: 31608004 PMCID: PMC6768010 DOI: 10.3389/fneur.2019.01008] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Neurofilament light chain protein (NFL) and chitinase3-like1 (CHI3L1) have gained importance recently as prognostic biomarkers in multiple sclerosis (MS). Objectives: We aimed to investigate NFL and CHI3L1 cerebrospinal fluid (CSF) profiles in multiple sclerosis and the informative and prognostic potential of the individual and combined measures. Methods: CSF NFL and CHI3L1 levels were measured in a cross-sectional cohort of 157 MS patients [99 relapsing-remitting (RRMS), 35 secondary progressive (SPMS), and 23 primary progressive (PPMS)]. Clinical relapse and/or gadolinium-enhanced lesions (GEL) in MRI within 90 days from CSF collection by lumbar puncture (LP) were registered and considered as indicators of disease activity. Longitudinal treatment and disability data were evaluated during medical visits with a median follow-up of 50 months. Results: CSF levels of NFL and CHI3L1 were higher in MS patients compared to non-MS controls. In RRMS and SPMS patients, increased NFL levels were associated with clinical relapse, and gadolinium-enhanced lesions in MRI (p < 0.001), while high CHI3L1 levels were characteristic of progressive disease (p = 0.01). In RRMS patients, CSF NFL, and CHI3L1 levels correlated with each other (r = 0.58), and with IgM-oligoclonal bands (p = 0.02 and p = 0.004, respectively). In addition, CSF CHI3L1 concentration was a predictor for 1-point EDSS worsening {HR = 2.99 [95% CI (1.27, 7.07)]} and progression during follow-up {HR = 18 [95% CI (2.31, 141.3)]}. The pattern of combined measure of biomarkers was useful to discriminate MS phenotypes and to anticipate clinical progression: RRMS more frequently presented high NFL combined with low CHI3L1 levels, compared to SPMS (HR 0.41 [0.18-0.82]), and PPMS (HR 0.46 [0.19-0.87]), while elevation of both biomarkers preceded diagnosis of clinical progression in RRMS patients (log rank = 0.02). Conclusions: Individual measures of CSF NFL and CHI3L1 are biomarkers of disease activity and progression, respectively. The pattern of combined measure discriminates MS phenotypes. It also predicts the subset of RRMS patients that will progress clinically allowing early intervention.
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Affiliation(s)
- Sara Gil-Perotin
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Jessica Castillo-Villalba
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Laura Cubas-Nuñez
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Raquel Gasque
- Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - David Hervas
- Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain
| | - Josep Gomez-Mateu
- Neurology Department, Hospital Universitari Dr. Peset, Valencia, Spain
| | - Carmen Alcala
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Gascon
- Neuroimmunology Unit, Hospital Clínic de València, Valencia, Spain
| | | | - Bonaventura Casanova
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
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49
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Martin SJ, McGlasson S, Hunt D, Overell J. Cerebrospinal fluid neurofilament light chain in multiple sclerosis and its subtypes: a meta-analysis of case-control studies. J Neurol Neurosurg Psychiatry 2019; 90:1059-1067. [PMID: 31123141 PMCID: PMC6820150 DOI: 10.1136/jnnp-2018-319190] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/13/2019] [Accepted: 04/16/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Neurofilament is a biomarker of axonal injury proposed as a useful adjunct in the monitoring of patients with multiple sclerosis (MS). We conducted a systematic review and meta-analysis of case-control studies that have measured neurofilament light chain (NfL) levels in cerebrospinal fluid (CSF) of people with MS (pwMS), in order to determine whether, and to what degree, CSF NfL levels differentiate MS from controls, or the subtypes or stages of MS from each other. METHODS Guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Electronic databases were searched for published and 'grey' literature, with 151 hits. Of 51 full articles screened, 20 were included in qualitative analysis, and 14 in meta-analysis. RESULTS CSF NfL was higher in 746 pwMS than 435 (healthy and disease) controls, with a moderate effect size of 0.61 (p < 0.00001). Mean CSF NfL levels were significantly higher in 176 pwMS with relapsing disease than 92 with progressive disease (2124.8 ng/L, SD 3348.9 vs 1121.4 ng/L, SD 947.7, p = 0.0108). CSF NfL in 138 pwMS in relapse (irrespective of MS subtype) was double that seen in 268 pwMS in remission (3080.6 ng/L, SD 4715.9 vs 1541.7 ng/L, SD 2406.5, p < 0.0001). CONCLUSIONS CSF NfL correlates with MS activity throughout the course of MS, reflecting the axonal damage in pwMS. Relapse is more strongly associated with elevated CSF NfL levels than the development of progression, and NfL may be most useful as a marker of disease 'activity' rather than as a marker of disability or disease stage.
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Affiliation(s)
- Sarah-Jane Martin
- Anne Rowling Centre for Regenerative Neurology, University of Edinburgh, Edinburgh, UK
- University of Glasgow, Glasgow, UK
| | - Sarah McGlasson
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Overell
- University of Glasgow, Glasgow, UK
- Glasgow Multiple Sclerosis Clinical Research Centre, Queen Elizabeth University Hospital, Glasgow, UK
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50
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Gaetani L, Blennow K, Calabresi P, Di Filippo M, Parnetti L, Zetterberg H. Neurofilament light chain as a biomarker in neurological disorders. J Neurol Neurosurg Psychiatry 2019; 90:870-881. [PMID: 30967444 DOI: 10.1136/jnnp-2018-320106] [Citation(s) in RCA: 618] [Impact Index Per Article: 123.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
In the management of neurological diseases, the identification and quantification of axonal damage could allow for the improvement of diagnostic accuracy and prognostic assessment. Neurofilament light chain (NfL) is a neuronal cytoplasmic protein highly expressed in large calibre myelinated axons. Its levels increase in cerebrospinal fluid (CSF) and blood proportionally to the degree of axonal damage in a variety of neurological disorders, including inflammatory, neurodegenerative, traumatic and cerebrovascular diseases. New immunoassays able to detect biomarkers at ultralow levels have allowed for the measurement of NfL in blood, thus making it possible to easily and repeatedly measure NfL for monitoring diseases' courses. Evidence that both CSF and blood NfL may serve as diagnostic, prognostic and monitoring biomarkers in neurological diseases is progressively increasing, and NfL is one of the most promising biomarkers to be used in clinical and research setting in the next future. Here we review the most important results on CSF and blood NfL and we discuss its potential applications and future directions.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Kaj Blennow
- Institute of Neuroscience and Physiology Department of Psychiatry and Neurochemistry, The Sahlgrenska AcademyUniversity of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Paolo Calabresi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy.,Laboratory of Neurophysiology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Lucilla Parnetti
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology Department of Psychiatry and Neurochemistry, The Sahlgrenska AcademyUniversity of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, United Kingdom
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