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Patitucci E, Lipp I, Stickland RC, Wise RG, Tomassini V. Changes in brain perfusion with training-related visuomotor improvement in MS. Front Mol Neurosci 2023; 16:1270393. [PMID: 38025268 PMCID: PMC10665528 DOI: 10.3389/fnmol.2023.1270393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. A better understanding of the mechanisms supporting brain plasticity in MS would help to develop targeted interventions to promote recovery. A total of 29 MS patients and 19 healthy volunteers underwent clinical assessment and multi-modal MRI acquisition [fMRI during serial reaction time task (SRT), DWI, T1w structural scans and ASL of resting perfusion] at baseline and after 4-weeks of SRT training. Reduction of functional hyperactivation was observed in MS patients following the training, shown by the stronger reduction of the BOLD response during task execution compared to healthy volunteers. The functional reorganization was accompanied by a positive correlation between improvements in task accuracy and the change in resting perfusion after 4 weeks' training in right angular and supramarginal gyri in MS patients. No longitudinal changes in WM and GM measures and no correlation between task performance improvements and brain structure were observed in MS patients. Our results highlight a potential role for CBF as an early marker of plasticity, in terms of functional (cortical reorganization) and behavioral (performance improvement) changes in MS patients that may help to guide future interventions that exploit preserved plasticity mechanisms.
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Affiliation(s)
- Eleonora Patitucci
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, United Kingdom
| | - Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, United Kingdom
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Rachael Cecilia Stickland
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, United Kingdom
| | - Richard G. Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, United Kingdom
- Institute for Advanced Biomedical Technologies, University of Chieti-Pescara “G. d’Annunzio,”Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara “G. d’Annunzio,”Chieti, Italy
| | - Valentina Tomassini
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, United Kingdom
- Institute for Advanced Biomedical Technologies, University of Chieti-Pescara “G. d’Annunzio,”Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara “G. d’Annunzio,”Chieti, Italy
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
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2
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Ma Y, Sannino D, Linden JR, Haigh S, Zhao B, Grigg JB, Zumbo P, Dündar F, Butler D, Profaci CP, Telesford K, Winokur PN, Rumah KR, Gauthier SA, Fischetti VA, McClane BA, Uzal FA, Zexter L, Mazzucco M, Rudick R, Danko D, Balmuth E, Nealon N, Perumal J, Kaunzner U, Brito IL, Chen Z, Xiang JZ, Betel D, Daneman R, Sonnenberg GF, Mason CE, Vartanian T. Epsilon toxin-producing Clostridium perfringens colonize the multiple sclerosis gut microbiome overcoming CNS immune privilege. J Clin Invest 2023; 133:e163239. [PMID: 36853799 PMCID: PMC10145940 DOI: 10.1172/jci163239] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Multiple sclerosis (MS) is a complex disease of the CNS thought to require an environmental trigger. Gut dysbiosis is common in MS, but specific causative species are unknown. To address this knowledge gap, we used sensitive and quantitative PCR detection to show that people with MS were more likely to harbor and show a greater abundance of epsilon toxin-producing (ETX-producing) strains of C. perfringens within their gut microbiomes compared with individuals who are healthy controls (HCs). Isolates derived from patients with MS produced functional ETX and had a genetic architecture typical of highly conjugative plasmids. In the active immunization model of experimental autoimmune encephalomyelitis (EAE), where pertussis toxin (PTX) is used to overcome CNS immune privilege, ETX can substitute for PTX. In contrast to PTX-induced EAE, where inflammatory demyelination is largely restricted to the spinal cord, ETX-induced EAE caused demyelination in the corpus callosum, thalamus, cerebellum, brainstem, and spinal cord, more akin to the neuroanatomical lesion distribution seen in MS. CNS endothelial cell transcriptional profiles revealed ETX-induced genes that are known to play a role in overcoming CNS immune privilege. Together, these findings suggest that ETX-producing C. perfringens strains are biologically plausible pathogens in MS that trigger inflammatory demyelination in the context of circulating myelin autoreactive lymphocytes.
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Affiliation(s)
- Yinghua Ma
- Feil Family Brain and Mind Research Institute
| | | | | | | | - Baohua Zhao
- Feil Family Brain and Mind Research Institute
| | - John B. Grigg
- Jill Roberts Institute for Research in Inflammatory Bowel Disease
- Joan and Sanford I. Weill Department of Medicine, and
- Department of Microbiology and Immunology, Weill Cornell Medical College, Cornell University, New York, New York, USA
- Immunology and Microbial Pathogenesis Program and
| | - Paul Zumbo
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Friederike Dündar
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Daniel Butler
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Caterina P. Profaci
- Departments of Pharmacology and Neurosciences, UCSD, San Diego, California, USA
| | | | - Paige N. Winokur
- Harold and Margaret Milliken Hatch Laboratory of Neuro-endocrinology and
| | - Kareem R. Rumah
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, USA
| | - Susan A. Gauthier
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Vincent A. Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, USA
| | - Bruce A. McClane
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Francisco A. Uzal
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, UCD, Davis, California, USA
| | - Lily Zexter
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | | | | | - David Danko
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | | | - Nancy Nealon
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Jai Perumal
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Ulrike Kaunzner
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Ilana L. Brito
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, USA
| | - Zhengming Chen
- Division of Biostatistics, Department of Population Health Sciences, and
| | - Jenny Z. Xiang
- Genomics Resources Core Facility, Core Laboratories Center, Weill Cornell Medicine, New York, New York, USA
| | - Doron Betel
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Richard Daneman
- Departments of Pharmacology and Neurosciences, UCSD, San Diego, California, USA
| | - Gregory F. Sonnenberg
- Jill Roberts Institute for Research in Inflammatory Bowel Disease
- Joan and Sanford I. Weill Department of Medicine, and
- Department of Microbiology and Immunology, Weill Cornell Medical College, Cornell University, New York, New York, USA
- Immunology and Microbial Pathogenesis Program and
| | - Christopher E. Mason
- Feil Family Brain and Mind Research Institute
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Timothy Vartanian
- Feil Family Brain and Mind Research Institute
- Immunology and Microbial Pathogenesis Program and
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
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3
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Pivovarova-Ramich O, Zimmermann HG, Paul F. Multiple sclerosis and circadian rhythms: Can diet act as a treatment? Acta Physiol (Oxf) 2023; 237:e13939. [PMID: 36700353 DOI: 10.1111/apha.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/15/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory and neurodegenerative disease of the central nervous system (CNS) with increasing incidence and prevalence. MS is associated with inflammatory and metabolic disturbances that, as preliminary human and animal data suggest, might be mediated by disruption of circadian rhythmicity. Nutrition habits can influence the risk for MS, and dietary interventions may be effective in modulating MS disease course. Chronotherapeutic approaches such as time-restricted eating (TRE) may benefit people with MS by stabilizing the circadian clock and restoring immunological and metabolic rhythms, thus potentially counteracting disease progression. This review provides a summary of selected studies on dietary intervention in MS, circadian rhythms, and their disruption in MS, including clock gene variations, circadian hormones, and retino-hypothalamic tract changes. Furthermore, we present studies that reported diurnal variations in MS, which might result from circadian disruption. And lastly, we suggest how chrononutritive approaches like TRE might counteract MS disease activity.
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Affiliation(s)
- Olga Pivovarova-Ramich
- Research Group Molecular Nutritional Medicine, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Hanna Gwendolyn Zimmermann
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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4
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Kolb H, Al-Louzi O, Beck ES, Sati P, Absinta M, Reich DS. From pathology to MRI and back: Clinically relevant biomarkers of multiple sclerosis lesions. Neuroimage Clin 2022; 36:103194. [PMID: 36170753 PMCID: PMC9668624 DOI: 10.1016/j.nicl.2022.103194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
Focal lesions in both white and gray matter are characteristic of multiple sclerosis (MS). Histopathological studies have helped define the main underlying pathological processes involved in lesion formation and evolution, serving as a gold standard for many years. However, histopathology suffers from an intrinsic bias resulting from over-reliance on tissue samples from late stages of the disease or atypical cases and is inadequate for routine patient assessment. Pathological-radiological correlative studies have established advanced MRI's sensitivity to several relevant MS-pathological substrates and its practicality for assessing dynamic changes and following lesions over time. This review focuses on novel imaging techniques that serve as biomarkers of critical pathological substrates of MS lesions: the central vein, chronic inflammation, remyelination and repair, and cortical lesions. For each pathological process, we address the correlative value of MRI to MS pathology, its contribution in elucidating MS pathology in vivo, and the clinical utility of the imaging biomarker.
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Affiliation(s)
- Hadar Kolb
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel,Corresponding author at: Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel.
| | - Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Institute of Experimental Neurology (INSPE), IRCSS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
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5
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Elliott C, Momayyezsiahkal P, Arnold DL, Liu D, Ke J, Zhu L, Zhu B, George IC, Bradley DP, Fisher E, Cahir-McFarland E, Stys PK, Geurts JJG, Franchimont N, Gafson A, Belachew S. Abnormalities in normal-appearing white matter from which multiple sclerosis lesions arise. Brain Commun 2021; 3:fcab176. [PMID: 34557664 PMCID: PMC8453433 DOI: 10.1093/braincomms/fcab176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Normal-appearing white matter is far from normal in multiple sclerosis; little is known about the precise pathology or spatial pattern of this alteration and its relation to subsequent lesion formation. This study was undertaken to evaluate normal-appearing white matter abnormalities in brain areas where multiple sclerosis lesions subsequently form, and to investigate the spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis. Brain MRIs of pre-lesion normal-appearing white matter were analysed in participants with new T2 lesions, pooled from three clinical trials: SYNERGY (NCT01864148; n = 85 with relapsing multiple sclerosis) was the test data set; ASCEND (NCT01416181; n = 154 with secondary progressive multiple sclerosis) and ADVANCE (NCT00906399; n = 261 with relapsing-remitting multiple sclerosis) were used as validation data sets. Focal normal-appearing white matter tissue state was analysed prior to lesion formation in areas where new T2 lesions later formed (pre-lesion normal-appearing white matter) using normalized magnetization transfer ratio and T2-weighted (nT2) intensities, and compared with overall normal-appearing white matter and spatially matched contralateral normal-appearing white matter. Each outcome was analysed using linear mixed-effects models. Follow-up time (as a categorical variable), patient-level characteristics (including treatment group) and other baseline variables were treated as fixed effects. In SYNERGY, nT2 intensity was significantly higher, and normalized magnetization transfer ratio was lower in pre-lesion normal-appearing white matter versus overall and contralateral normal-appearing white matter at all time points up to 24 weeks before new T2 lesion onset. In ASCEND and ADVANCE (for which normalized magnetization transfer ratio was not available), nT2 intensity in pre-lesion normal-appearing white matter was significantly higher compared to both overall and contralateral normal-appearing white matter at all pre-lesion time points extending up to 2 years prior to lesion formation. In all trials, nT2 intensity in the contralateral normal-appearing white matter was also significantly higher at all pre-lesion time points compared to overall normal-appearing white matter. Brain atlases of normal-appearing white matter abnormalities were generated using measures of voxel-wise differences in normalized magnetization transfer ratio of normal-appearing white matter in persons with multiple sclerosis compared to scanner-matched healthy controls. We observed that overall spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis largely recapitulated the anatomical distribution of probabilities of T2 hyperintense lesions. Overall, these findings suggest that intrinsic spatial properties and/or longstanding precursory abnormalities of normal-appearing white matter tissue may contribute to the risk of autoimmune acute demyelination in multiple sclerosis.
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Affiliation(s)
| | - Parya Momayyezsiahkal
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Dawei Liu
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
| | - Jun Ke
- Biogen, Cambridge, MA 02142, USA
| | - Li Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Bing Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Ilena C George
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, 1081 HV Amsterdam, Netherlands
| | | | - Arie Gafson
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
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6
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Januel E, Dessimond B, Colette A, Annesi-Maesano I, Stankoff B. Fine Particulate Matter Related to Multiple Sclerosis Relapse in Young Patients. Front Neurol 2021; 12:651084. [PMID: 34093398 PMCID: PMC8176031 DOI: 10.3389/fneur.2021.651084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Particulate matter (PM) of aerodynamic diameter smaller than 10 μm (PM10) has been associated with multiple sclerosis (MS) relapse. However, the impact of smaller PM with a greater ability to penetrate human organism has never been assessed. We evaluated the impact of PM smaller than 2.5 μm (PM2.5) on the risk of MS relapse. Material and Methods: In a case-crossover study, we included 2,109 consecutive hospitalizations likely due to MS relapse in day hospital in 5 MS centers in the Paris area from January 2009 to December 2013. For each hospitalization, the natural logarithm of the average weekly PM2.5 concentrations (μg/m3) at the patient's residence address during each of the 6 weeks (week[0] to week[−5]) preceding admission was compared with the concentration during the previous week, using a conditional logistic regression adjusted on temperature, flu-like syndrome rate, pollen count, and holiday period. Results: PM2.5 average concentration during week[−3] was significantly associated with the risk of hospitalization for MS relapse [OR = 1.21 (CI 1.01;1.46)]. The association was stronger in patients younger than 30 years [OR=1.77 (CI 1.10; 2.83)]. Conclusion: Our study demonstrates an association between exposure to PM2.5 and MS relapse, particularly in young people.
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Affiliation(s)
- Edouard Januel
- Assistance Publique des Hôpitaux de Paris, APHP, Hôpital Saint Antoine, Neurology Department, Paris, France
| | - Boris Dessimond
- Sorbonne Université and INSERM, Épidémiologie des maladies Allergiques et Respiratoires, Institut Pierre Louis d'Epidémiologie et Santé Publique, Paris, France
| | - Augustin Colette
- Atmospheric Modelling and Environmental Mapping Unit, INERIS, BP2, Verneuil-en-Halatte, France
| | - Isabella Annesi-Maesano
- Sorbonne Université and INSERM, Épidémiologie des maladies Allergiques et Respiratoires, Institut Pierre Louis d'Epidémiologie et Santé Publique, Paris, France
| | - Bruno Stankoff
- Assistance Publique des Hôpitaux de Paris, APHP, Hôpital Saint Antoine, Neurology Department, Paris, France.,Sorbonne Universités, Brain and Spine Institute, ICM, Hôpital de la Pitié Salpêtrière, Inserm UMR-S 1127, CNRS UMR 7225, Paris, France
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7
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Bruschi N, Boffa G, Inglese M. Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice. Eur Radiol Exp 2020; 4:59. [PMID: 33089380 PMCID: PMC7578213 DOI: 10.1186/s41747-020-00186-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/11/2020] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance imaging (MRI) is essential for the early diagnosis of multiple sclerosis (MS), for investigating the disease pathophysiology, and for discriminating MS from other neurological diseases. Ultra-high-field strength (7-T) MRI provides a new tool for studying MS and other demyelinating diseases both in research and in clinical settings. We present an overview of 7-T MRI application in MS focusing on increased sensitivity and specificity for lesion detection and characterisation in the brain and spinal cord, central vein sign identification, and leptomeningeal enhancement detection. We also discuss the role of 7-T MRI in improving our understanding of MS pathophysiology with the aid of metabolic imaging. In addition, we present 7-T MRI applications in other demyelinating diseases. 7-T MRI allows better detection of the anatomical, pathological, and functional features of MS, thus improving our understanding of MS pathology in vivo. 7-T MRI also represents a potential tool for earlier and more accurate diagnosis.
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Affiliation(s)
- Nicolo' Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
- Ospedale Policlinico San Martino, IRCCS, Largo Daneo 3, 16100, Genoa, Italy.
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8
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Suto DJ, Nair G, Sudarshana DM, Steele SU, Dwyer J, Beck ES, Ohayon J, McFarland H, Koretsky AP, Cortese ICM, Reich DS. Manganese-Enhanced MRI in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1569-1576. [PMID: 32763897 DOI: 10.3174/ajnr.a6665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/31/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Cellular uptake of the manganese ion, when administered as a contrast agent for MR imaging, can noninvasively highlight cellular activity and disease processes in both animals and humans. The purpose of this study was to explore the enhancement profile of manganese in patients with multiple sclerosis. MATERIALS AND METHODS Mangafodipir is a manganese chelate that was clinically approved for MR imaging of liver lesions. We present a case series of 6 adults with multiple sclerosis who were scanned at baseline with gadolinium, then injected with mangafodipir, and followed at variable time points thereafter. RESULTS Fourteen new lesions formed during or shortly before the study, of which 10 demonstrated manganese enhancement of varying intensity, timing, and spatial pattern. One gadolinium-enhancing extra-axial mass, presumably a meningioma, also demonstrated enhancement with manganese. Most interesting, manganese enhancement was detected in lesions that formed in the days after mangafodipir injection, and this enhancement persisted for several weeks, consistent with contrast coming from intracellular uptake of manganese. Some lesions demonstrated a diffuse pattern of manganese enhancement in an area larger than that of both gadolinium enhancement and T2-FLAIR signal abnormality. CONCLUSIONS This work demonstrates the first use of a manganese-based contrast agent to enhance MS lesions on MR imaging. Multiple sclerosis lesions were enhanced with a temporal and spatial profile distinct from that of gadolinium. Further experiments are necessary to uncover the mechanism of manganese contrast enhancement as well as cell-specific uptake.
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Affiliation(s)
- D J Suto
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - G Nair
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D M Sudarshana
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - S U Steele
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - J Dwyer
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - E S Beck
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - J Ohayon
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - H McFarland
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - A P Koretsky
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - I C M Cortese
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
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9
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Koch T, Flemisch B, Helmig R, Wiest R, Obrist D. A multiscale subvoxel perfusion model to estimate diffusive capillary wall conductivity in multiple sclerosis lesions from perfusion MRI data. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3298. [PMID: 31883316 DOI: 10.1002/cnm.3298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
We propose a new mathematical model to learn capillary leakage coefficients from dynamic susceptibility contrast MRI data. To this end, we derive an embedded mixed-dimension flow and transport model for brain tissue perfusion on a subvoxel scale. This model is used to obtain the contrast agent concentration distribution in a single MRI voxel during a perfusion MRI sequence. We further present a magnetic resonance signal model for the considered sequence including a model for local susceptibility effects. This allows modeling MR signal-time curves that can be compared with clinical MRI data. The proposed model can be used as a forward model in the inverse modeling problem of inferring model parameters such as the diffusive capillary wall conductivity. Acute multiple sclerosis lesions are associated with a breach in the integrity of the blood-brain barrier. Applying the model to perfusion MR data of a patient with acute multiple sclerosis lesions, we conclude that diffusive capillary wall conductivity is a good indicator for characterizing activity of lesions, even if other patient-specific model parameters are not well-known.
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Affiliation(s)
- Timo Koch
- Department of Hydromechanics and Modelling of Hydrosystems, University of Stuttgart, Stuttgart, Germany
| | - Bernd Flemisch
- Department of Hydromechanics and Modelling of Hydrosystems, University of Stuttgart, Stuttgart, Germany
| | - Rainer Helmig
- Department of Hydromechanics and Modelling of Hydrosystems, University of Stuttgart, Stuttgart, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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10
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Zoledziewska M. The gut microbiota perspective for interventions in MS. Autoimmun Rev 2019; 18:814-824. [DOI: 10.1016/j.autrev.2019.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022]
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11
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Boiziau C, Nikolski M, Mordelet E, Aussudre J, Vargas-Sanchez K, Petry KG. A Peptide Targeting Inflammatory CNS Lesions in the EAE Rat Model of Multiple Sclerosis. Inflammation 2018. [PMID: 29516383 DOI: 10.1007/s10753-018-0748-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple sclerosis is characterized by inflammatory lesions dispersed throughout the central nervous system (CNS) leading to severe neurological handicap. Demyelination, axonal damage, and blood brain barrier alterations are hallmarks of this pathology, whose precise processes are not fully understood. In the experimental autoimmune encephalomyelitis (EAE) rat model that mimics many features of human multiple sclerosis, the phage display strategy was applied to select peptide ligands targeting inflammatory sites in CNS. Due to the large diversity of sequences after phage display selection, a bioinformatics procedure called "PepTeam" designed to identify peptides mimicking naturally occurring proteins was used, with the goal to predict peptides that were not background noise. We identified a circular peptide CLSTASNSC called "Ph48" as an efficient binder of inflammatory regions of EAE CNS sections including small inflammatory lesions of both white and gray matter. Tested on human brain endothelial cells hCMEC/D3, Ph48 was able to bind efficiently when these cells were activated with IL1β to mimic inflammatory conditions. The peptide is therefore a candidate for further analyses of the molecular alterations in inflammatory lesions.
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Affiliation(s)
- Claudine Boiziau
- INSERM, UMR 1049, F-33076, Bordeaux, France. .,Univ. Bordeaux, Neuroinflammation Imaging and Therapy of Multiple Sclerosis, F-33076, Bordeaux, France. .,INSERM, UMR 1026, BioTis, F-33 076, Bordeaux, France.
| | - Macha Nikolski
- Univ. Bordeaux, CBiB, F-33076, Bordeaux, France.,CNRS, LaBRI UMR 5800, F-33400, Talence, France
| | - Elodie Mordelet
- INSERM, UMR 1049, F-33076, Bordeaux, France.,Univ. Bordeaux, Neuroinflammation Imaging and Therapy of Multiple Sclerosis, F-33076, Bordeaux, France
| | - Justine Aussudre
- INSERM, UMR 1049, F-33076, Bordeaux, France.,Univ. Bordeaux, Neuroinflammation Imaging and Therapy of Multiple Sclerosis, F-33076, Bordeaux, France
| | - Karina Vargas-Sanchez
- INSERM, UMR 1049, F-33076, Bordeaux, France.,Univ. Bordeaux, Neuroinflammation Imaging and Therapy of Multiple Sclerosis, F-33076, Bordeaux, France.,Biomedical Sciences Research Group, GRINCIBIO, School of Medicine, Universidad Antonio Nariño, Bogotà, Colombia
| | - Klaus G Petry
- INSERM, UMR 1049, F-33076, Bordeaux, France.,Univ. Bordeaux, Neuroinflammation Imaging and Therapy of Multiple Sclerosis, F-33076, Bordeaux, France.,INSERM, UMR1029, F-33076, Bordeaux, France
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12
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Monti L, Morbidelli L, Rossi A. Impaired Cerebral Perfusion in Multiple Sclerosis: Relevance of Endothelial Factors. Biomark Insights 2018; 13:1177271918774800. [PMID: 29795976 PMCID: PMC5960845 DOI: 10.1177/1177271918774800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/07/2018] [Indexed: 12/21/2022] Open
Abstract
Magnetic resonance imaging techniques measuring in vivo brain perfusion and integrity of the blood-brain barrier have developed rapidly in the past decade, resulting in a wide range of available methods. This review first discusses their principles, possible pitfalls, and potential for quantification and outlines clinical application in neurological disorders. Then, we focus on the endothelial cells of the blood-brain barrier, pointing out their contribution in regulating vascular tone by production of vasoactive substances. Finally, the role of these substances in brain hypoperfusion in multiple sclerosis is discussed.
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Affiliation(s)
- Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Neurosensory Sciences, "Santa Maria alle Scotte" General Hospital, University Hospital of Siena, Siena, Italy
| | | | - Alessandro Rossi
- Unit of Neurology and Clinical Neurophysiology, Department of Neurological and Neurosensory Sciences, University Hospital of Siena, Siena, Italy
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13
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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14
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Duyn JH. Studying brain microstructure with magnetic susceptibility contrast at high-field. Neuroimage 2018; 168:152-161. [PMID: 28242317 PMCID: PMC5569005 DOI: 10.1016/j.neuroimage.2017.02.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/03/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
A rapidly developing application of high field MRI is the study of brain anatomy and function with contrast based on the magnetic susceptibility of tissues. To study the subtle variations in susceptibility contrast between tissues and with changes in brain activity, dedicated scan techniques such as susceptibility-weighted MRI and blood-oxygen level dependent functional MRI have been developed. Particularly strong susceptibility contrast has been observed with systems that operate at 7T and above, and their recent widespread use has led to an improved understanding of contributing sources and mechanisms. To interpret magnetic susceptibility contrast, analysis approaches have been developed with the goal of extracting measures that report on local tissue magnetic susceptibility, a physical quantity that, under certain conditions, allows estimation of blood oxygenation, local tissue iron content, and quantification of its changes with disease. Interestingly, high field studies have also brought to light that not only the makeup of tissues affects MRI susceptibility contrast, but that also a tissue's sub-voxel structure at scales all the way down to the molecular level plays an important role as well. In this review, various ways will be discussed by which sub-voxel structure can affect the MRI signal in general, and magnetic susceptibility in particular, sometimes in a complex fashion. In the light of this complexity, it appears likely that accurate, brain-wide quantification of iron will require the combination of multiple contrasts that may include diffusion and magnetization transfer information with susceptibility-weighted contrast. On the other hand, this complexity also offers opportunities to use magnetic susceptibility contrast to inform about specific microstructural aspects of brain tissue. Details and several examples will be presented in this review.
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Affiliation(s)
- Jeff H Duyn
- Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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15
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Abstract
PURPOSE OF REVIEW This article focuses on neuroimaging in multiple sclerosis (MS), the most common central nervous system (CNS) demyelinating disorder encountered by practicing neurologists. Less common adult demyelinating disorders and incidental subclinical white matter abnormalities that are often considered in the differential diagnosis of MS are also reviewed. RECENT FINDINGS Advancements in neuroimaging techniques, eg, the application of ultrahigh-field MRI, are rapidly expanding the use of neuroimaging in CNS demyelinating disorders. Probably the most important recent findings include the detection of cortical lesions and CNS atrophy even in early stages of MS. The key development for practicing neurologists is the growing impact of MRI on the diagnostic criteria for MS and neuromyelitis optica (NMO) spectrum disorders. SUMMARY MRI serves as an important component of the diagnostic criteria for MS and other major CNS demyelinating disorders, and it has been established as a reliable and sensitive indicator of disease activity and progression. In addition, rapidly advancing neuroimaging techniques are helping to improve our understanding of disease pathogenesis.
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16
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Affiliation(s)
- Daniel S Reich
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
| | - Claudia F Lucchinetti
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
| | - Peter A Calabresi
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
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17
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Abstract
PURPOSE OF REVIEW Gadolinium-enhancement depicts blood-brain barrier disruption associated with new inflammatory MRI lesions in multiple sclerosis (MS) and is widely used for diagnosis and therapeutic monitoring. However, earlier and more specific markers of inflammation are urgently needed. RECENT FINDINGS Susceptibility-weighted images demonstrate the importance of the central vein in the formation of MS lesions. Perfusion weighted imaging techniques can show focal and diffuse low-grade inflammatory changes not visible on conventional MRI. Leptomeningeal enhancement could be part of the aetiology of subpial cortical MS lesions. Ultrasmall superparamagnetic particles of iron oxide can identify neuroinflammatory changes in addition to gadolinium enhancement and as such identify different types and phases of MS lesions. 18kD-translocator protein PET tracers identify activated microglia and an increase in TSPO uptake in both MS lesions and normal appearing brain tissue is related to disease severity and progression. A range of novel tracers for microglia activation is under development as well as radioligands that can label therapeutic drugs. SUMMARY Novel MRI and PET techniques improve in-vivo visualization and quantification of the pleomorphic aspects of neuroinflammation, providing us with a unique insight in its pathogenesis, clinical relevance, and therapy responsiveness in MS.
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18
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Soluble CD40 ligand disrupts the blood-brain barrier and exacerbates inflammation in experimental autoimmune encephalomyelitis. J Neuroimmunol 2018; 316:117-120. [PMID: 29329699 DOI: 10.1016/j.jneuroim.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022]
Abstract
Serum soluble CD40 ligand (sCD40L) has been reported to positively correlate with the albumin quotient, a marker of blood-brain barrier (BBB) breakdown, in patients with multiple sclerosis (MS). To clarify the mechanisms of sCD40L in MS pathophysiology, sCD40L was administered to experimental autoimmune encephalomyelitis (EAE) mice and a human brain microvascular endothelial cell (HBMEC)-based BBB model. The high-dose sCD40L group showed a worse EAE score than the low-dose and control groups. BBB permeability was increased by administering sCD40L in a HBMEC-based BBB model. Thus, sCD40L induces more severe inflammation in the central nervous system by disrupting the BBB.
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19
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Endothelial Wnt/β-catenin signaling reduces immune cell infiltration in multiple sclerosis. Proc Natl Acad Sci U S A 2017; 114:E1168-E1177. [PMID: 28137846 DOI: 10.1073/pnas.1609905114] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Disruption of the blood-brain barrier (BBB) is a defining and early feature of multiple sclerosis (MS) that directly damages the central nervous system (CNS), promotes immune cell infiltration, and influences clinical outcomes. There is an urgent need for new therapies to protect and restore BBB function, either by strengthening endothelial tight junctions or suppressing endothelial vesicular transcytosis. Although wingless integrated MMTV (Wnt)/β-catenin signaling plays an essential role in BBB formation and maintenance in healthy CNS, its role in BBB repair in neurologic diseases such as MS remains unclear. Using a Wnt/β-catenin reporter mouse and several downstream targets, we demonstrate that the Wnt/β-catenin pathway is up-regulated in CNS endothelial cells in both human MS and the mouse model experimental autoimmune encephalomyelitis (EAE). Increased Wnt/β-catenin activity in CNS blood vessels during EAE progression correlates with up-regulation of neuronal Wnt3 expression, as well as breakdown of endothelial cell junctions. Genetic inhibition of the Wnt/β-catenin pathway in CNS endothelium before disease onset exacerbates the clinical presentation of EAE, CD4+ T-cell infiltration into the CNS, and demyelination by increasing expression of vascular cell adhesion molecule-1 and the transcytosis protein Caveolin-1 and promoting endothelial transcytosis. However, Wnt signaling attenuation does not affect the progressive degradation of tight junction proteins or paracellular BBB leakage. These results suggest that reactivation of Wnt/β-catenin signaling in CNS vessels during EAE/MS partially restores functional BBB integrity and limits immune cell infiltration into the CNS.
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20
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Kuhlmann T, Ludwin S, Prat A, Antel J, Brück W, Lassmann H. An updated histological classification system for multiple sclerosis lesions. Acta Neuropathol 2017; 133:13-24. [PMID: 27988845 DOI: 10.1007/s00401-016-1653-y] [Citation(s) in RCA: 388] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis is a complex and heterogeneous, most likely autoimmune, demyelinating disease of the central nervous system (CNS). Although a number of histological classification systems for CNS lesions have been used by different groups in recent years, no uniform classification exists. In this paper, we propose a simple and unifying classification of MS lesions incorporating many elements of earlier histological systems that aims to provide guidelines for neuropathologists and researchers studying MS lesions to allow for better comparison of different studies performed with MS tissue, and to aid in understanding the pathogenesis of the disease. Based on the presence/absence and distribution of macrophages/microglia (inflammatory activity) and the presence/absence of ongoing demyelination (demyelinating activity), we suggest differentiating between active, mixed active/inactive, and inactive lesions with or without ongoing demyelination. Active lesions are characterized by macrophages/microglia throughout the lesion area, whereas mixed active/inactive lesions have a hypocellular lesion center with macrophages/microglia limited to the lesion border. Inactive lesions are almost completely lacking macrophages/microglia. Active and mixed active/inactive lesions can be further subdivided into lesions with ongoing myelin destruction (demyelinating lesions) and lesions in which the destruction of myelin has ceased, but macrophages are still present (post-demyelinating lesions). This distinction is based on the presence or absence of myelin degradation products within the cytoplasm of macrophages/microglia. For this classification of MS lesions, identification of myelin with histological stains [such as luxol fast blue-PAS] or by immunohistochemistry using antibodies against myelin basic-protein (MBP) or proteolipid-protein (PLP), as well as, detection of macrophages/microglia by, e.g., anti-CD68 is sufficient. Active and demyelinating lesions may be further subdivided into the early and late demyelinating lesions. The former is defined by the presence in macrophages of major and small molecular weight myelin proteins, such as cyclic nucleotide diphosphoesterase (CNP), myelin oligodendrocyte glycoprotein (MOG), or myelin-associated protein (MAG), whereas macrophages in the latter demonstrate merely the presence of the major myelin proteins MBP or PLP. We discuss the histological features and staining techniques required to classify MS lesions, and, in addition, describe the histological hallmarks of cortical pathology and diffuse white matter changes, as well as of remyelination.
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Affiliation(s)
- Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, 48149, Münster, Germany.
| | - Samuel Ludwin
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
- Neuroimmunology Unit, Montréal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Alexandre Prat
- Neuroimmunology Research Laboratory, Centre de Recherche DU Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Jack Antel
- Neuroimmunology Unit, Montréal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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21
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Biberacher V, Schmidt P, Keshavan A, Boucard CC, Righart R, Sämann P, Preibisch C, Fröbel D, Aly L, Hemmer B, Zimmer C, Henry RG, Mühlau M. Intra- and interscanner variability of magnetic resonance imaging based volumetry in multiple sclerosis. Neuroimage 2016; 142:188-197. [PMID: 27431758 DOI: 10.1016/j.neuroimage.2016.07.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/05/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022] Open
Abstract
Brain volumetric measurements in multiple sclerosis (MS) reflect not only disease-specific processes but also other sources of variability. The latter has to be considered especially in multicenter and longitudinal studies. Here, we compare data generated by three different 3-Tesla magnetic resonance scanners (Philips Achieva; Siemens Verio; GE Signa MR750). We scanned two patients diagnosed with relapsing remitting MS six times per scanner within three weeks (T1w and FLAIR, 3D). We assessed T2-hyperintense lesions by an automated lesion segmentation tool and determined volumes of grey matter (GM), white matter (WM) and whole brain (GM+WM) from the lesion-filled T1-weighted images using voxel-based morphometry (SPM8/VBM8) and SIENAX (FSL). We measured cortical thickness using FreeSurfer from both, lesion-filled and original T1-weighted images. We quantified brain volume changes with SIENA. In both patients, we found significant differences in total lesion volume, global brain tissue volumes and cortical thickness measures between the scanners. Morphometric measures varied remarkably between repeated scans at each scanner, independent of the brain imaging software tool used. We conclude that for cross-sectional multicenter studies, the effect of different scanners has to be taken into account. For longitudinal monocentric studies, the expected effect size should exceed the size of false positive findings observed in this study. Assuming a physiological loss of brain volume of about 0.3% per year in healthy adult subjects (Good et al., 2001), which may double in MS (De Stefano et al., 2010; De Stefano et al., 2015), with current tools reliable estimation of brain atrophy in individual patients is only possible over periods of several years.
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Affiliation(s)
- Viola Biberacher
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Technische Universität München, Munich, Germany.
| | - Paul Schmidt
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany; Statistics, Ludwig-Maximilians-Universität München, Ludwigstr. 33, 80539 Munich, Germany
| | - Anisha Keshavan
- Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - Christine C Boucard
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Ruthger Righart
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Philipp Sämann
- Neuroimaging Core Unit, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Christine Preibisch
- Neuroradiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel Fröbel
- Neuroradiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lilian Aly
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bernhard Hemmer
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377 Munich, Germany
| | - Claus Zimmer
- Neuroradiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Roland G Henry
- Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - Mark Mühlau
- Neurology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
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22
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Abstract
Over the past few decades, MRI-based visualization of demyelinated CNS lesions has become pivotal to the diagnosis and monitoring of multiple sclerosis (MS). In this Review, we outline current efforts to correlate imaging findings with the pathology of lesion development in MS, and the pitfalls that are being encountered in this research. Multimodal imaging at high and ultra-high magnetic field strengths is yielding biologically relevant insights into the pathophysiology of blood-brain barrier dynamics and both active and chronic inflammation, as well as mechanisms of lesion healing and remyelination. Here, we parallel the results in humans with advances in imaging of a primate model of MS - experimental autoimmune encephalomyelitis (EAE) in the common marmoset - in which demyelinated lesions resemble their human counterparts far more closely than do EAE lesions in the rodent. This approach holds promise for the identification of innovative biological markers, and for next-generation clinical trials that will focus more on tissue protection and repair.
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23
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Ludwin SK, Rao VT, Moore CS, Antel JP. Astrocytes in multiple sclerosis. Mult Scler 2016; 22:1114-24. [PMID: 27207458 DOI: 10.1177/1352458516643396] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
Recent experimental and clinical studies on astrocytes are unraveling the capabilities of these multi-functional cells in normal homeostasis, and in central nervous system (CNS) disease. This review focuses on understanding their behavior in all aspects of the initiation, evolution, and resolution of the multiple sclerosis (MS) lesion. Astrocytes display remarkable flexibility and variability of their physical structure and biochemical output, each aspect finely tuned to the specific stage and location of the disease, participating in both pathogenic and beneficial changes seen in acute and progressive forms. As examples, chemo-attractive or repulsive molecules may facilitate the entry of destructive immune cells but may also aid in the recruitment of oligodendrocyte precursors, essential for repair. Pro-inflammatory cytokines may attack pathogenic cells and also destroy normal oligodendrocytes, myelin, and axons. Protective trophic factors may also open the blood-brain barrier and modulate the extracellular matrix to favor recruitment and persistence of CNS-specific immune cells. A chronic glial scar may confer structural support following tissue loss and inhibit ingress of further noxious insults and also inhibit migration of reparative cells and molecules into the damaged tissue. Continual study into these processes offers the therapeutic opportunities to enhance the beneficial capabilities of these cells while limiting their destructive effects.
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Affiliation(s)
- Samuel K Ludwin
- Neuroimmunology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada/Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Vijayaraghava Ts Rao
- Neuroimmunology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Craig S Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jack P Antel
- Neuroimmunology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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