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Fettig NM, Pu A, Osborne LC, Gommerman JL. The influence of aging and the microbiome in multiple sclerosis and other neurologic diseases. Immunol Rev 2024. [PMID: 38890777 DOI: 10.1111/imr.13361] [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: 06/20/2024]
Abstract
The human gut microbiome is well-recognized as a key player in maintaining health. However, it is a dynamic entity that changes across the lifespan. How the microbial changes that occur in later decades of life shape host health or impact age-associated inflammatory neurological diseases such as multiple sclerosis (MS) is still unclear. Current understanding of the aging gut microbiome is largely limited to cross-sectional observational studies. Moreover, studies in humans are limited by confounding host-intrinsic and extrinsic factors that are not easily disentangled from aging. This review provides a comprehensive summary of existing literature on the aging gut microbiome and its known relationships with neurological diseases, with a specific focus on MS. We will also discuss preclinical animal models and human studies that shed light on the complex microbiota-host interactions that have the potential to influence disease pathology and progression in aging individuals. Lastly, we propose potential avenues of investigation to deconvolute features of an aging microbiota that contribute to disease, or alternatively promote health in advanced age.
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Affiliation(s)
- Naomi M Fettig
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lisa C Osborne
- Department of Microbiology & Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
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Hardy TA, Aouad P, Barnett MH, Blum S, Broadley S, Carroll WM, Crimmins D, Griffiths D, Hodgkinson S, Lechner-Scott J, Lee A, Malhotra R, McCombe P, Parratt J, Plummer C, Van der Walt A, Martel K, Walker RA. Onboarding of siponimod in secondary progressive multiple sclerosis patients in Australia: Novel, real-world evidence from the MSGo digital support programme. Mult Scler J Exp Transl Clin 2024; 10:20552173231226106. [PMID: 38222025 PMCID: PMC10787529 DOI: 10.1177/20552173231226106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Siponimod is approved for use in people with secondary progressive multiple sclerosis (pwSPMS). An integrated digital platform, MSGo, was developed for pwSPMS and clinicians to help navigate the multiple steps of the pre-siponimod work-up. Objective To explore real-world onboarding experiences of siponimod amongst pwSPMS in Australia. Methods Retrospective, non-interventional, longitudinal, secondary analysis of data extracted from MSGo (20 April 2022). The primary endpoint was the average time for siponimod onboarding; secondary endpoints were adherence and sub-group analyses of variables influencing onboarding. Results Mixed-cure modelling estimated that 58% of participants (N = 368, females 71%, median age of 59 years) registered in MSGo would ever initiate siponimod. The median time to initiation was 56 days (95% CI [47-59] days). Half of the participants cited 'waiting for vaccination' as the reason for initiation delay. Cox regression analyses found participants with a nominated care partner had faster onboarding (HR 2.1, 95% CI [1.5-3.0]) and were more likely to continue self-reporting daily siponimod dosing than were those without a care partner (HR 2.2, 95% CI [1.3-3.7]). Conclusions Despite the limitations of self-reported data and the challenges of the COVID-19 pandemic, this study provides insights into siponimod onboarding in Australia and demonstrates the positive impact of care partner support.
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Affiliation(s)
- TA Hardy
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P Aouad
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - MH Barnett
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Blum
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Broadley
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - WM Carroll
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Crimmins
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Griffiths
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Hodgkinson
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Lechner-Scott
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Lee
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - R Malhotra
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P McCombe
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Parratt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - C Plummer
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Van der Walt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - K Martel
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - RA Walker
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
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Houzen H, Kano T, Kondo K, Takahashi T, Niino M. The prevalence and incidence of multiple sclerosis over the past 20 years in northern Japan. Mult Scler Relat Disord 2023; 73:104696. [PMID: 37028125 DOI: 10.1016/j.msard.2023.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES The prevalence of multiple sclerosis (MS) in East Asia is thought to be lower than in Western countries. Globally, there is a trend of increasing MS prevalence. We investigated the changes in the prevalence and clinical phenotype of MS in the Tokachi province of Hokkaido in northern Japan, from 2001 to 2021. METHODS Data processing sheets were sent to all related institutions inside and outside the Tokachi area of Hokkaido island in Japan and were collected from April to May 2021. The prevalence according to the Poser's diagnostic criteria for MS was determined on March 31, 2021. RESULTS In 2021, the crude MS prevalence in northern Japan was 22.4/100,000 (95% confidence interval, 17.6-28.0). The prevalences of MS standardized by the Japanese national population in 2001, 2006, 2011, 2016, and 2021 were 6.9, 11.5, 15.3, 18.5, and 23.3, respectively. The female/male ratio was 4.0 in 2021, increased from 2.6 in 2001. We checked the prevalence using the 2017 revised McDonald criteria, and found only additional male patient who had not fulfilled Poser's criteria. The age- and sex-adjusted incidence of MS per 100,000 individuals increased from 0.09 in 1980-1984 to 0.99 in 2005-2009; since then, it has remained stable. The proportions of primary-progressive, relapsing-remitting, and secondary-progressive MS types in 2021 were 3%, 82%, and 15%, respectively. CONCLUSION Our results demonstrated a consistent increase in the prevalence of MS among the northern Japanese over 20 years, particularly in females, and consistently lower rates of progressive MS in northern Japan than elsewhere in the world.
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Forsberg L, Spelman T, Klyve P, Manouchehrinia A, Ramanujam R, Mouresan E, Drahota J, Horakova D, Joensen H, Pontieri L, Magyari M, Ellenberger D, Stahmann A, Rodgers J, Witts J, Middleton R, Nicholas R, Bezlyak V, Adlard N, Hach T, Lines C, Vukusic S, Soilu-Hänninen M, van der Walt A, Butzkueven H, Iaffaldano P, Trojano M, Glaser A, Hillert J. Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers. Mult Scler J Exp Transl Clin 2023; 9:20552173231153557. [PMID: 36816812 PMCID: PMC9936396 DOI: 10.1177/20552173231153557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
Background To assign a course of secondary progressive multiple sclerosis (MS) (SPMS) may be difficult and the proportion of persons with SPMS varies between reports. An objective method for disease course classification may give a better estimation of the relative proportions of relapsing-remitting MS (RRMS) and SPMS and may identify situations where SPMS is under reported. Materials and methods Data were obtained for 61,900 MS patients from MS registries in the Czech Republic, Denmark, Germany, Sweden, and the United Kingdom (UK), including date of birth, sex, SP conversion year, visits with an Expanded Disability Status Scale (EDSS) score, MS onset and diagnosis date, relapses, and disease-modifying treatment (DMT) use. We included RRMS or SPMS patients with at least one visit between January 2017 and December 2019 if ≥ 18 years of age. We applied three objective methods: A set of SPMS clinical trial inclusion criteria ("EXPAND criteria") modified for a real-world evidence setting, a modified version of the MSBase algorithm, and a decision tree-based algorithm recently published. Results The clinically assigned proportion of SPMS varied from 8.7% (Czechia) to 34.3% (UK). Objective classifiers estimated the proportion of SPMS from 15.1% (Germany by the EXPAND criteria) to 58.0% (UK by the decision tree method). Due to different requirements of number of EDSS scores, classifiers varied in the proportion they were able to classify; from 18% (UK by the MSBase algorithm) to 100% (the decision tree algorithm for all registries). Objectively classified SPMS patients were older, converted to SPMS later, had higher EDSS at index date and higher EDSS at conversion. More objectively classified SPMS were on DMTs compared to the clinically assigned. Conclusion SPMS appears to be systematically underdiagnosed in MS registries. Reclassified patients were more commonly on DMTs.
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Affiliation(s)
- Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Mathematics, Royal Institute of Technology, Stockholm, Sweden
| | - Elena Mouresan
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Drahota
- Czech National Multiple Sclerosis ReMuS, IMPULS Endowment Fund, Prague, Czech Republic
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Dana Horakova
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - James Witts
- Swansea University Medical School, Swansea, UK
| | | | - Richard Nicholas
- Swansea University Medical School, Swansea, UK
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | | | | | | | | | - Sandra Vukusic
- Hôpital Neurologique, Service de Neurologie A, the European Database for Multiple Sclerosis (EDMUS), Coordinating Center and INSERM U 433, Lyon, France
| | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, University Hospital and University of Turku, Turku, Finland
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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