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Laffont I, Duflos C, Hirtz C, Bakhti K, Gelis A, Palayer C, Macioce V, Soler M, Pradalier F, Galtier F, Jentzer A, Lozano C, Vincent T, Morales RJ. Post-polio syndrome is not a dysimmune condition. Eur J Phys Rehabil Med 2024; 60:270-279. [PMID: 38252127 PMCID: PMC11112507 DOI: 10.23736/s1973-9087.23.08158-3] [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: 07/25/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN Cross-sectional study. SETTING Montpellier University Hospital. POPULATION Forty-seven PPS and 27 healthy controls. METHODS PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1β, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-β, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.
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Affiliation(s)
- Isabelle Laffont
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France -
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France -
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Christophe Hirtz
- Institute for Regenerative Medicine and Biotherapy, INSERM 1183, Montpellier University, Montpellier, France
| | - Karima Bakhti
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France
| | - Anthony Gelis
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Physical and Rehabilitation Medicine, Propara, Montpellier, France
| | - Claire Palayer
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Marion Soler
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Fanny Pradalier
- Department of Physical and Rehabilitation Medicine, Nimes University Hospital, Montpellier University, Nimes, France
| | - Florence Galtier
- Inserm CIC 1411, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Claire Lozano
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Thierry Vincent
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Raul J Morales
- Department of Neurology, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Abstract
Interactions between the immune and nervous systems are of central importance in neuropathic pain, a common and debilitating form of chronic pain caused by a lesion or disease affecting the somatosensory system. Our understanding of neuroimmune interactions in pain research has advanced considerably. Initially considered as passive bystanders, then as culprits in the pathogenesis of neuropathic pain, immune responses in the nervous system are now established to underpin not only the initiation and progression of pain but also its resolution. Indeed, immune cells and their mediators are well-established promoters of neuroinflammation at each level of the neural pain pathway that contributes to pain hypersensitivity. However, emerging evidence indicates that specific subtypes of immune cells (including antinociceptive macrophages, pain-resolving microglia and T regulatory cells) as well as immunoresolvent molecules and modulators of the gut microbiota-immune system axis can reduce the pain experience and contribute to the resolution of neuropathic pain. This Review provides an overview of the immune mechanisms responsible for the resolution of neuropathic pain, including those involved in innate, adaptive and meningeal immunity as well as interactions with the gut microbiome. Specialized pro-resolving mediators and therapeutic approaches that target these neuroimmune mechanisms are also discussed.
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Samaan A, Escalon MX. Joint and Back Pain: Medications and Role of Injection Therapy for Destructive Joint. Phys Med Rehabil Clin N Am 2021; 32:537-546. [PMID: 34175012 DOI: 10.1016/j.pmr.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postpolio syndrome (PPS) is a sequela with symptoms that often occur in patients who previously survived poliomyelitis. Pain is a characteristic feature of PPS. Although poliomyelitis is no longer commonly seen in the western world, there is a significant portion of patients living with PPS. Recognizing the signs of PPS is integral in developing treatment plans. Conservative management is routinely considered first-line therapy; however, alternate treatments, pharmacologic and minimally invasive, are used in more refractory cases. Approaching patients living with pain and PPS requires a holistic approach and an understanding of the efficacy of available treatment modalities.
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Affiliation(s)
- Angela Samaan
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1240, New York, NY 10029, USA.
| | - Miguel X Escalon
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Sixth Floor, Box 1240B, New York, New York 10029, USA
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Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve 2018; 58:760-769. [PMID: 29752826 DOI: 10.1002/mus.26167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760-769, 2018.
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Affiliation(s)
- Julian K Lo
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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