1
|
Jiang F, Cai H, Li H, Yin W, Ouyang S, Hu J, Tu E, Fu K, Yin J, Zhao Z, Yang J, Zeng Q, Yang H. Clinical characteristics of double negative atypical inflammatory demyelinating disease: A prospective study. Ann Clin Transl Neurol 2024. [PMID: 39222463 DOI: 10.1002/acn3.52191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/29/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics and predictors of relapse in double negative atypical inflammatory demyelinating disease (IDD) and to explore potential antigenic targets by tissue-based assays (TBA) using rat brain indirect immunofluorescence. METHODS We compared the clinical, laboratory, and MRI data of double negative atypical IDD with other IDD patients. Serum samples were collected for TBA. The predictors of relapse were examined over a minimum of 24 months follow-up. RESULTS In our cohort of 98 patients with double negative atypical IDD, there was no significant female predominance (58.2%, 57/98). The lesions primarily affected the spinal cord and brain stem, with fewer cases of involvement in the area postrema (5.1%, 5/98) and longitudinally extensive transverse myelitis (43.9%, 43/98). A total of 62.5% (50/80) patients tested positive for anti-astrocyte antibodies based on rat brain TBA. Over a median duration of 39.5 months, 80 patients completed the entire follow-up, and 47.5% (38/80) patients exhibited monophasic course. A total of 36% (18/50) patients positively for anti-astrocyte antibodies had a monophasic course, which is significantly lower than patients negatively for anti-astrocyte antibodies (66.7%, 20/30) (p = 0.008). The presence of anti-astrocyte antibodies (hazard ratio (HR), 2.243; 95% CI, 1.087-4.627; p = 0.029) and ≥4 cerebrum lesions at first attack (HR, 2.494; 95% CI, 1.224-5.078; p = 0.012) were risk factors for disease relapse, while maintenance immunotherapy during remission (HR, 0.361; 95% CI, 0.150-0.869; p = 0.023) was protective factor. INTERPRETATION Double negative atypical IDD are unique demyelinating diseases with a high relapse rate. Maintenance immunotherapy is helpful to the prevention of relapse, particularly in patients with anti-astrocyte antibodies or ≥4 cerebrum lesions at first attack.
Collapse
Affiliation(s)
- Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, P.R. China
- Clinical Research Center for Neuroimmune and Neuromuscular disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
| | - Haobing Cai
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, P.R. China
- Clinical Research Center for Neuroimmune and Neuromuscular disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
| | - Hongliang Li
- Department of Acupuncture and Tuina Rehabilitation, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410000, Hunan, P.R. China
| | - Weifan Yin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, P.R. China
- The "Double-First Class" Application Characteristic Discipline of Hunan Province (Clinical Medicine) Changsha Medical University, Changsha, 410000, Hunan, P.R. China
| | - Song Ouyang
- The "Double-First Class" Application Characteristic Discipline of Hunan Province (Clinical Medicine) Changsha Medical University, Changsha, 410000, Hunan, P.R. China
- Department of Neurology, The affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, 410000, Hunan, P.R. China
| | - Jue Hu
- Department of Neurology, Changsha Central Hospital, Changsha, 410000, Hunan, P.R. China
| | - Ewen Tu
- Department of Neurology, Hunan Provincial Brain Hospital (Hunan Second People's Hospital), Changsha, 410000, Hunan, P.R. China
| | - Ke Fu
- Department of Neurology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410000, Hunan, P.R. China
| | - Junjie Yin
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, 418000, Hunan, P.R. China
| | - Zhen Zhao
- Department of Neurology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, 412000, Hunan, P.R. China
| | - Jieyu Yang
- Department of Social Work, Changsha Social Work College, Changsha, 410004, Hunan, P.R. China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, P.R. China
- Clinical Research Center for Neuroimmune and Neuromuscular disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, P.R. China
- Clinical Research Center for Neuroimmune and Neuromuscular disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, P.R. China
| |
Collapse
|
2
|
Filippi M, Pagani E, Turrini R, Bartezaghi M, Brescia Morra V, Borriello G, Torri Clerici V, Mirabella M, Pasquali L, Patti F, Totaro R, Gallo P, Rocca MA. Effects of fingolimod on focal and diffuse damage in patients with relapsing-remitting multiple sclerosis - The "EVOLUTION" study. J Neurol 2024; 271:6181-6196. [PMID: 39073436 DOI: 10.1007/s00415-024-12590-z] [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: 03/04/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES In multiple sclerosis (MS), MRI markers can measure the potential neuroprotective effects of fingolimod beyond its anti-inflammatory activity. In this study we aimed to comprehensively explore, in the real-word setting, whether fingolimod not only reduces clinical/MRI inflammatory activity, but also influences the progression of irreversible focal and whole brain damage in relapsing-remitting [RR] MS patients. METHODS The "EVOLUTION" study, a 24-month observational, prospective, single-arm, multicenter study, enrolled 261 RRMS patients who started fingolimod at 32 Italian MS centers and underwent biannual neurological assessments and annual MRI evaluations. Study outcomes included the proportions of evaluable RRMS patients achieving at 24 months: (1) no new/enlarging T2-hyperintense white matter (WM) lesions and/or clinical relapses; (2) a modified classification of "No Evidence of Disease Activity 4" ("modified NEDA-4") defined as no new/enlarging T2-hyperintense WM lesions, clinical relapses, and 6-month confirmed disability progression, and a yearly percentage lateral ventricular volume change on T2-FLAIR images < 2%; (3) less than 40% of active lesions at baseline and month 12 evolving to permanent black holes (PBHs). RESULTS At month 24, 76/160 (47.5%; 95% confidence interval [CI] = 39.8%;55.2%) RRMS patients had no clinical/MRI activity. Thirty-nine of 170 RRMS patients (22.9%; 95% CI = 16.6%;29.3%) achieved "modified NEDA-4" status. Forty-four of 72 RRMS patients (61.1%; 95% CI = 49.8%;72.4%) had less than 40% of active WM lesions evolving to PBHs. The study confirmed the established safety and tolerability profile of fingolimod. DISCUSSION By comparing our results with those from the literature, the EVOLUTION study seems to indicate a neuroprotective effect of fingolimod, limiting inflammatory activity, brain atrophy and PBH development.
Collapse
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | | | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Giovanna Borriello
- Centro Di Riferimento Regionale per la Sclerosi Multipla, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Centro Di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Livia Pasquali
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Centro Sclerosi Multipla, Università Di Catania, Sez. Neuroscienze, Catania, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
3
|
Reinhardt C, Angstwurm K, Freudenstein D, Lee DH, Wendl C, Linker RA. Real-world analysis of brain atrophy in multiple sclerosis patients with an artificial intelligence based software tool. Neurol Res Pract 2024; 6:40. [PMID: 39113151 PMCID: PMC11308334 DOI: 10.1186/s42466-024-00339-y] [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: 12/05/2023] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Atrophy of white and grey matter volumes occurs early in the brains of people with multiple sclerosis (pwMS) and has great clinical relevance. In clinical trials, brain atrophy can be quantified by magnetic resonance imaging (MRI) with automated software tools. METHODS In this study, we analyze volumes of various brain regions with the software "md brain" based on routine MRI scans of 53 pwMS in a real-world setting. We compare brain volumes of pwMS with an EDSS ≥ 3.5 and a disease duration ≥ 10 years to the brain volumes of pwMS with an EDSS < 3.5 and a disease duration < 10 years as well as with or without immunotherapy. RESULTS pwMS with an EDSS ≥ 3.5 and a disease duration ≥ 10 years had significantly lower volumes of the total brain, the grey matter and of the frontal, temporal, parietal and occipital lobe regions as compared to pwMS with an EDSS < 3.5 and a disease duration < 10 years. Regional brain volumes were significantly lower in pwMS without immunotherapy. CONCLUSIONS The study showed that higher EDSS, longer disease duration and absence of immunotherapy was associated with lower volumes in a number of brain regions. Further real-world studies may include larger patient cohorts in longitudinal analyses.
Collapse
Affiliation(s)
- Caroline Reinhardt
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - David Freudenstein
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - De-Hyung Lee
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - Christina Wendl
- Department of Neuroradiology, University of Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany.
| |
Collapse
|
4
|
MacKenzie EG, Snow NJ, Chaves AR, Reza SZ, Ploughman M. Weak grip strength among persons with multiple sclerosis having minimal disability is not related to agility or integrity of the corticospinal tract. Mult Scler Relat Disord 2024; 88:105741. [PMID: 38936325 DOI: 10.1016/j.msard.2024.105741] [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: 01/17/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Mobility impairment is common in multiple sclerosis (MS); however, agility has received less attention. Agility requires strength and neuromuscular coordination to elicit controlled propulsive rapid whole-body movement. Grip strength is a common method to assess whole body force production, but also reflects neuromuscular integrity and global brain health. Impaired agility may be linked to loss of neuromuscular integrity (reflected by grip strength or corticospinal excitability). OBJECTIVES We aimed to determine whether grip strength would be associated with agility and transcranial magnetic stimulation (TMS)-based indices of corticospinal excitability and inhibition in persons with MS having low disability. We hypothesized that low grip strength would predict impaired agility and reflect low corticospinal excitability. METHODS We recruited 34 persons with relapsing MS (27 females; median [range] age 45.5 [21.0-65.0] years) and mild disability (median [range] Expanded Disability Status Scale 2.0 [0-3.0]), as well as a convenience sample of age- and sex-matched apparently healthy controls. Agility was tested by measuring hop length during bipedal hopping on an instrumented walkway. Grip strength was measured using a calibrated dynamometer. Corticospinal excitability and inhibition were examined using TMS-based motor evoked potential (MEP) and corticospinal silent period (CSP) recruitment curves, respectively. RESULTS MS participants had significantly lower grip strength than controls independent of sex. Females with and without MS had weaker grip strength than males. There were no statistically significant sex or group differences in agility. After controlling for sex, weaker grip strength was associated with shorter hop length in controls only (r = 0.645, p < .05). Grip strength did not significantly predict agility in persons with MS, nor was grip strength predicted by corticospinal excitability or inhibition. CONCLUSIONS In persons with MS having low disability, grip strength (normalized to body mass) was reduced despite having intact agility and walking performance. Grip strength was not associated with corticospinal excitability or inhibition, suggesting peripheral neuromuscular function, low physical activity or fitness, or other psychosocial factors may be related to weakness. Low grip strength is a putative indicator of early neuromuscular aging in persons with MS having mild disability and normal mobility.
Collapse
Affiliation(s)
- Evan G MacKenzie
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Nicholas J Snow
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Arthur R Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, ON, Canada; Neuromodulation Research Clinic, The Royal's Institute of Mental Health Research, ON, Canada; Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, QC, Canada
| | - Syed Z Reza
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada.
| |
Collapse
|
5
|
Tortosa-Carreres J, Cubas-Núñez L, Quiroga-Varela A, Castillo-Villalba J, Ramió-Torrenta L, Piqueras M, Gasqué-Rubio R, Quintanilla-Bordas C, Sanz MT, Lucas C, Huertas-Pons JM, Miguela A, Casanova B, Laiz-Marro B, Pérez-Miralles FC. Predictive potential of serum and cerebrospinal fluid biomarkers for disease activity in treated multiple sclerosis patients. Mult Scler Relat Disord 2024; 88:105734. [PMID: 38909525 DOI: 10.1016/j.msard.2024.105734] [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: 04/08/2024] [Revised: 06/15/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Our objective was to explore various biomarkers for predicting suboptimal responses to disease-modifying treatments (DMTs) in patients with MS (pwMS). METHODS We conducted a longitudinal, bicentric study with pwMS stratified based on their DMTs responses. Treatment failure (TF) was defined as the onset of a second relapse, presence of two or more T2 new lesions, or disability progression independent of relapse during the follow-up period. We evaluated intrathecal synthesis (ITS) of IgG and IgM using OCB, linear indices, and Reibergrams. Free kappa light chains ITS was assessed using the linear index (FKLCi). NfL and GFAP in serum and CSF, and CHI3L1 in CSF were quantified. Quantitative variables were dichotomized based on the third quartile. Predictive efficacy was assessed through bivariate and multivariate analyses, adjusting for age, sex, EDSS, acute inflammatory activity (AI) -defined as the onset of a relapse or gadolinium-enhancing lesions within a 90-day window of lumbar puncture-, treatment modality, study center, and time from disease onset to treatment initiation. In case of collinearity, multiple models were generated or confounding variables were excluded if collinearity existed between them and the biomarker. The same methodology was used to investigate the predictive potential of various combinations of two biomarkers, based on whether any of them tested positive or exceeded the third quartile. RESULTS A total of 137 pwMS were included. FKLCi showed no differences based on AI, no correlation with EDSS and was significantly higher in pwMS with TF (p = 0.008). FKLCi>130 was associated with TF in bivariate analysis (Log-Rank p = 0.004). Due to collinearity between age and EDSS, two different models were generated with each of them and the rest of the confounding variables, in which FKLCi>130 showed a Hazard Ratio (HR) of 2.69 (CI: 1.35-5.4) and 2.67 (CI: 1.32-5.4), respectively. The combination of either FKLC or sNfL exceeding the third quartile was also significant in bivariate (Log-Rank p = 0.04) and multivariate (HR=3.1 (CI: 1.5-6.5)) analyses. However, when analyzed independently, sNfL did not show significance, and FKLCi mirrored the pattern obtained in the previous model (HR: 3.04; CI: 1.51-6.1). Treatment with highefficacy DMTs emerged as a protective factor in all models. DISCUSSION Our analysis and the fact that FKLCi is independent of EDSS and AI suggest that it might be a valuable parameter for discriminating aggressive phenotypes. We propose implementing high-efficacy drugs in pwMS with elevated FKLCi.
Collapse
Affiliation(s)
- Jordi Tortosa-Carreres
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Medicine Department, University of Valencia, Valencia 46010, Spain; Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain.
| | - Laura Cubas-Núñez
- Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain.
| | - Ana Quiroga-Varela
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
| | - Jessica Castillo-Villalba
- Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain; Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
| | - Lluís Ramió-Torrenta
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain; Medical Sciences Department, University of Girona, Girona, Spain
| | - Mónica Piqueras
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Medicine Department, University of Valencia, Valencia 46010, Spain; Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Raquel Gasqué-Rubio
- Medicine Department, University of Valencia, Valencia 46010, Spain; Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Carlos Quintanilla-Bordas
- Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain; Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Maria Teresa Sanz
- Department of Didactic of Mathematics, University of Valencia, Spain
| | - Celia Lucas
- Computer Systems, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Joana María Huertas-Pons
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
| | - Albert Miguela
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain; Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Begoña Laiz-Marro
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Francisco Carlos Pérez-Miralles
- Neuroimmunology Unit, Health Research Institute La Fe (IISLAFE), Valencia, Spain; Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| |
Collapse
|
6
|
Saucier L, Healy BC, Saxena S, Sanon E, Chitnis T. Glial fibrillary acidic protein and neurofilament light chain as biomarkers in pediatric multiple sclerosis. Mult Scler J Exp Transl Clin 2024; 10:20552173241274567. [PMID: 39193071 PMCID: PMC11348348 DOI: 10.1177/20552173241274567] [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: 10/05/2023] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Background Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury, and serum glial fibrillary acidic protein (sGFAP) reflects reactive astrogliosis. In adult multiple sclerosis (MS), sNfL correlates with relapsing disease activity while sGFAP correlates with progressive disease. Objectives We evaluate sNfL and sGFAP as biomarkers in pediatric-onset MS (POMS) compared to pediatric healthy controls (PHC), and correlations with the disease course. Methods In this single-center observational cross-sectional study, we extracted data from a longitudinal database and measured NfL and GFAP from bio-banked serum using single-molecule array technology. Results The analysis included 61 POMS patients and 45 PHC. Controlling for age and BMI, sNfL was 414% higher and sGFAP was 42.3% higher in POMS. Disability (EDSS) is associated with higher sNfL (β = 0.32, p = 0.002) and higher sGFAP (β = 0.11, p = 0.03). sNfL is associated with MRI lesion burden, recent disease activity (β =0.95, p < 0.001), and untreated status (β = 0.5, p = 0.006). Conclusion sNfL and sGFAP are elevated in POMS compared to PHC. Both biomarkers are associated with clinical disability. Elevated sGFAP may reflect early neurodegeneration in POMS, while sNfL reflects disease activity and DMT response. Elevated sNfL among some clinically and radiographically stable POMS patients suggests ongoing neuroaxonal injury with a potential role for sNfL monitoring disease stability.
Collapse
Affiliation(s)
- Laura Saucier
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Mass General Brigham Pediatric MS Center, Massachusetts General Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shrishti Saxena
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eunnindy Sanon
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Mass General Brigham Pediatric MS Center, Massachusetts General Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Hoffmann O, Gold R, Meuth SG, Linker RA, Skripuletz T, Wiendl H, Wattjes MP. Prognostic relevance of MRI in early relapsing multiple sclerosis: ready to guide treatment decision making? Ther Adv Neurol Disord 2024; 17:17562864241229325. [PMID: 38332854 PMCID: PMC10851744 DOI: 10.1177/17562864241229325] [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: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Magnetic resonance imaging (MRI) of the brain and spinal cord plays a crucial role in the diagnosis and monitoring of multiple sclerosis (MS). There is conclusive evidence that brain and spinal cord MRI findings in early disease stages also provide relevant insight into individual prognosis. This includes prediction of disease activity and disease progression, the accumulation of long-term disability and the conversion to secondary progressive MS. The extent to which these MRI findings should influence treatment decisions remains a subject of ongoing discussion. The aim of this review is to present and discuss the current knowledge and scientific evidence regarding the utility of MRI at early MS disease stages for prognostic classification of individual patients. In addition, we discuss the current evidence regarding the use of MRI in order to predict treatment response. Finally, we propose a potential approach as to how MRI data may be categorized and integrated into early clinical decision making.
Collapse
Affiliation(s)
- Olaf Hoffmann
- Department of Neurology, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471 Potsdam, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Ralf A. Linker
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Mike P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
8
|
Bou Rjeily N, Mowry EM, Ontaneda D, Carlson AK. Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis: What Is the Future of Multiple Sclerosis Treatment? Neurol Clin 2024; 42:185-201. [PMID: 37980115 DOI: 10.1016/j.ncl.2023.06.004] [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] [Indexed: 11/20/2023]
Abstract
Treatment options for patients newly diagnosed with multiple sclerosis (MS) are expanding with the continuous development and approval of new disease-modifying therapies (DMTs). The optimal initial treatment strategy, however, remains unclear. The 2 main treatment paradigms currently employed are the escalation (ESC) approach and the early highly effective treatment (EHT) approach. The ESC approach consists of starting a lower- or moderate-efficacy DMT, which offers a potentially safer approach, while the EHT approach favors higher-efficacy treatment early in the disease course, despite a potential increase in risk. Randomized clinical trials aiming to directly compare these approaches in newly diagnosed MS patients are currently underway.
Collapse
Affiliation(s)
- Nicole Bou Rjeily
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA; Department of Epidemiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Daniel Ontaneda
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA
| | - Alise K Carlson
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA.
| |
Collapse
|
9
|
Bazzurri V, Fiore A, Curti E, Tsantes E, Franceschini A, Granella F. Prevalence of 2-year "No evidence of disease activity" (NEDA-3 and NEDA-4) in relapsing-remitting multiple sclerosis. A real-world study. Mult Scler Relat Disord 2023; 79:105015. [PMID: 37769430 DOI: 10.1016/j.msard.2023.105015] [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: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND No evidence of disease activity (NEDA) is becoming a gold standard in the evaluation of disease modifying therapies (DMT) in relapsing-remitting multiple sclerosis (RRMS). NEDA-3 status is the absence of relapses, new activity on brain MRI, and disability progression. NEDA-4 meets all NEDA-3 criteria plus lack of brain atrophy. OBJECTIVE Aim of this study was to investigate the prevalence of two-year NEDA-3, NEDA-4, six-month delayed NEDA-3 (6mdNEDA-3), and six-month delayed NEDA-4 (6mdNEDA-4) in a cohort of patients with RRMS. Six-month delayed measures were introduced to consider latency of action of drugs. METHODS Observational retrospective monocentric study. All the patients with RRMS starting DMT between 2015 and 2018, and with 2-year of follow-up, were included. Annualized brain volume loss (a-BVL) was calculated by SIENA software. RESULTS We included 108 patients, the majority treated with first line DMT. At 2-year follow-up, 35 % of patients were NEDA-3 (50 % 6mdNEDA-3), and 17 % NEDA-4 (28 % 6mdNEDA-4). Loss of NEDA-3 status was mainly driven by MRI activity (70 %), followed by relapses (56 %), and only minimally by disability progression (7 %). CONCLUSION In our cohort 2-year NEDA status, especially including lack of brain atrophy, was hard to achieve. Further studies are needed to establish the prognostic value of NEDA-3 and NEDA4 in the long-term follow-up.
Collapse
Affiliation(s)
- V Bazzurri
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - A Fiore
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Italy
| | - E Curti
- Multiple Sclerosis Centre, Neurology Unit, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - E Tsantes
- Multiple Sclerosis Centre, Neurology Unit, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - A Franceschini
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - F Granella
- Multiple Sclerosis Centre, Neurology Unit, Department of General Medicine, Parma University Hospital, Parma, Italy; Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
10
|
Gomez-Gaitan EA, Garcia-Ortega YE, Saldaña-Cruz AM, Contreras-Haro B, Gamez-Nava JI, Perez-Guerrero EE, Nava-Valdivia CA, Gallardo-Moya S, Martinez-Hernandez A, Gonzalez Lopez L, Rios-Gonzalez BE, Marquez-Pedroza J, Mendez-del Villar M, Esparza-Guerrero Y, Villagomez-Vega A, Macias Islas MA. Genetic Variant HLA-DRB1*0403 and Therapeutic Response to Disease-Modifying Therapies in Multiple Sclerosis: A Case-Control Study. Int J Mol Sci 2023; 24:14594. [PMID: 37834042 PMCID: PMC10572793 DOI: 10.3390/ijms241914594] [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: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic and demyelinating disease with an autoimmune origin, which leads to neurodegeneration and progressive disability. Approximately 30 to 50% of patients do not respond optimally to disease-modifying therapies (DMTs), and therapeutic response may be influenced by genetic factors such as genetic variants. Therefore, our study aimed to investigate the association of the HLA-DRB1*0403 genetic variant and therapeutic response to DMTs in MS. We included 105 patients with MS diagnosis. No evidence of disease activity based on the absence of clinical relapse, disability progression or radiological activity (NEDA-3) was used to classify the therapeutic response. Patients were classified as follows: (a) controls: patients who achieved NEDA-3; (b) cases: patients who did not achieve NEDA-3. DNA was extracted from peripheral blood leukocytes. HLA-DRB1*0403 genetic variant was analyzed by quantitative polymerase chain reaction (qPCR) using TaqMan probes. NEDA-3 was achieved in 86.7% of MS patients treated with DMTs. Genotype frequencies were GG 50.5%, GA 34.3%, and AA 15.2%. No differences were observed in the genetic variant AA between patients who achieved NEDA-3 versus patients who did not achieve NEDA-3 (48.7% vs. 43.1%, p = 0.6). We concluded that in Mexican patients with MS, HLA-DRB1*0403 was not associated with the therapeutic response to DMTs.
Collapse
Affiliation(s)
- Esteban Alejandro Gomez-Gaitan
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
| | - Yessica Eleanet Garcia-Ortega
- Neurology Department, Western National Medical Center, Mexican Social Security Institute, Guadalajara 44340, Jalisco, Mexico;
| | - Ana Miriam Saldaña-Cruz
- Institute of Experimental and Clinical Therapeutics, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Betsabe Contreras-Haro
- Department of Biomedical Sciences, Tonala University Center, University of Guadalajara, Tonala 45425, Jalisco, Mexico; (B.C.-H.); (M.M.-d.V.); (A.V.-V.)
- Biomedical Research Unit 02, Mexican Social Security Institute, Guadalajara 44340, Jalisco, Mexico
| | - Jorge Ivan Gamez-Nava
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
- Institute of Experimental and Clinical Therapeutics, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Emilio Edsaul Perez-Guerrero
- Institute of Biomedical Sciences, Department of Genetics and Molecular Physiology, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Cesar Arturo Nava-Valdivia
- Department of Microbiology and Pathology, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Sergio Gallardo-Moya
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
| | - Alejandra Martinez-Hernandez
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
| | - Laura Gonzalez Lopez
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
- Institute of Experimental and Clinical Therapeutics, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | | | - Jazmin Marquez-Pedroza
- Neurosciences Division, Western Biomedical Research Center, Mexican Social Security Institute, Guadalajara 44340, Jalisco, Mexico;
| | - Miriam Mendez-del Villar
- Department of Biomedical Sciences, Tonala University Center, University of Guadalajara, Tonala 45425, Jalisco, Mexico; (B.C.-H.); (M.M.-d.V.); (A.V.-V.)
| | - Yussef Esparza-Guerrero
- Pharmacology Doctoral Program, Physiology Department, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.A.G.-G.); (J.I.G.-N.); (S.G.-M.); (A.M.-H.); (L.G.L.); (Y.E.-G.)
| | - Alejandra Villagomez-Vega
- Department of Biomedical Sciences, Tonala University Center, University of Guadalajara, Tonala 45425, Jalisco, Mexico; (B.C.-H.); (M.M.-d.V.); (A.V.-V.)
| | - Miguel Angel Macias Islas
- Neurosciences Departament, University Center for Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| |
Collapse
|
11
|
Centonze D, Amato MP, Brescia Morra V, Cocco E, De Stefano N, Gasperini C, Gallo P, Pozzilli C, Trojano M, Filippi M. Multiple sclerosis patients treated with cladribine tablets: expert opinion on practical management after year 4. Ther Adv Neurol Disord 2023; 16:17562864231183221. [PMID: 37434878 PMCID: PMC10331342 DOI: 10.1177/17562864231183221] [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: 03/06/2023] [Accepted: 06/04/2023] [Indexed: 07/13/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive neurological disease involving neuroinflammation, neurodegeneration, and demyelination. Cladribine tablets are approved for immune reconstitution therapy in patients with highly active relapsing-remitting MS based on favorable efficacy and tolerability results from the CLARITY study that have been confirmed in long-term extension studies. The approved 4-year dosing regimen foresees a cumulative dose of 3.5 mg/kg administered in two cycles administered 1 year apart, followed by 2 years of observation. Evidence on managing patients beyond year 4 is scarce; therefore, a group of 10 neurologists has assessed the available evidence and formulated an expert opinion on management of the growing population of patients now completing the approved 4-year regimen. We propose five patient categories based on response to treatment during the first 4-year regimen, and corresponding management pathways that envision close monitoring with clinical visits, magnetic resonance imaging (MRI) and/or biomarkers. At the first sign of clinical or radiological disease activity, patients should receive a highly effective disease-modifying therapy, comprising either a full cladribine regimen as described in regulatory documents (cumulative dose 7.0 mg/kg) or a comparably effective treatment. Re-treatment decisions should be based on the intensity and timing of onset of disease activity, clinical and radiological assessments, as well as patient eligibility for treatment and treatment preference.
Collapse
Affiliation(s)
- Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133 Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center and Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health and Centro Sclerosi Multipla, University of Cagliari, Cagliari, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital Rome, Rome, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
12
|
Coutinho Costa VG, Araújo SES, Alves-Leon SV, Gomes FCA. Central nervous system demyelinating diseases: glial cells at the hub of pathology. Front Immunol 2023; 14:1135540. [PMID: 37261349 PMCID: PMC10227605 DOI: 10.3389/fimmu.2023.1135540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Inflammatory demyelinating diseases (IDDs) are among the main causes of inflammatory and neurodegenerative injury of the central nervous system (CNS) in young adult patients. Of these, multiple sclerosis (MS) is the most frequent and studied, as it affects about a million people in the USA alone. The understanding of the mechanisms underlying their pathology has been advancing, although there are still no highly effective disease-modifying treatments for the progressive symptoms and disability in the late stages of disease. Among these mechanisms, the action of glial cells upon lesion and regeneration has become a prominent research topic, helped not only by the discovery of glia as targets of autoantibodies, but also by their role on CNS homeostasis and neuroinflammation. In the present article, we discuss the participation of glial cells in IDDs, as well as their association with demyelination and synaptic dysfunction throughout the course of the disease and in experimental models, with a focus on MS phenotypes. Further, we discuss the involvement of microglia and astrocytes in lesion formation and organization, remyelination, synaptic induction and pruning through different signaling pathways. We argue that evidence of the several glia-mediated mechanisms in the course of CNS demyelinating diseases supports glial cells as viable targets for therapy development.
Collapse
Affiliation(s)
| | - Sheila Espírito-Santo Araújo
- Laboratório de Biologia Celular e Tecidual, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil
| | - Soniza Vieira Alves-Leon
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|