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Pressley KR, Schwegman L, Montes De Oca Arena M, Chase Huizar C, Zamvil SS, Forsthuber TG. HLA-transgenic mouse models to study autoimmune central nervous system diseases. Autoimmunity 2024; 57:2387414. [PMID: 39167553 DOI: 10.1080/08916934.2024.2387414] [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: 03/31/2024] [Revised: 07/20/2024] [Accepted: 07/27/2024] [Indexed: 08/23/2024]
Abstract
It is known that certain human leukocyte antigen (HLA) genes are associated with autoimmune central nervous system (CNS) diseases, such as multiple sclerosis (MS), but their exact role in disease susceptibility and etiopathogenesis remains unclear. The best studied HLA-associated autoimmune CNS disease is MS, and thus will be the primary focus of this review. Other HLA-associated autoimmune CNS diseases, such as autoimmune encephalitis and neuromyelitis optica will be discussed. The lack of animal models to accurately capture the complex human autoimmune response remains a major challenge. HLA transgenic (tg) mice provide researchers with powerful tools to investigate the underlying mechanisms promoting susceptibility and progression of HLA-associated autoimmune CNS diseases, as well as for elucidating the myelin epitopes potentially targeted by T cells in autoimmune disease patients. We will discuss the potential role(s) of autoimmune disease-associated HLA alleles in autoimmune CNS diseases and highlight information provided by studies using HLA tg mice to investigate the underlying pathological mechanisms and opportunities to use these models for development of novel therapies.
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Affiliation(s)
- Kyle R Pressley
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX, USA
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Lance Schwegman
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Maria Montes De Oca Arena
- Department of Microbiology, Immunology & Molecular Genetics, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Carol Chase Huizar
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Scott S Zamvil
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Program in Immunology, University of California, San Francisco, CA, USA
| | - Thomas G Forsthuber
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX, USA
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Qiu Y, Shen T, Qiu W, Yang H. Visual improvement in a case of neuromyelitis optica spectrum disorder-related optic neuritis after 18 months of treatment with satralizumab: A case report. Heliyon 2024; 10:e35142. [PMID: 39157378 PMCID: PMC11328017 DOI: 10.1016/j.heliyon.2024.e35142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
Neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) is an autoimmune disease that affects the astrocytes. NMOSD-ON is one of the core clinical phenotypes of neuromyelitis optica spectrum disorder and its most-common initial symptom. NMOSD-ON is characterized by severe vision loss, poor prognosis and high recurrence, mainly affecting young and middle-aged individuals. It is a challenge to know how to improve patients' visual outcomes. In this report, we present a refractory case of NMOSD-ON treated with satralizumab after multiple conventional therapies proved ineffective. Satralizumab was found to effectively control relapses in this patient and visual improvement was found after 18 months of treatment. Given to that, satralizumab may have a potential longitudinal effect on visual improvement in NMOSD-ON.
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Affiliation(s)
- Yao Qiu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangzhou, 510060, China
| | - Ting Shen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangzhou, 510060, China
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Klyscz P, Asseyer S, Alonso R, Bereuter C, Bialer O, Bick A, Carta S, Chen JJ, Cohen L, Cohen-Tayar Y, Contentti EC, Dale RC, Flanagan EP, Gernert JA, Haas J, Havla J, Heesen C, Hellmann M, Levin N, Lopez P, Lotan I, Luis MB, Mariotto S, Mayer C, Vergara AJM, Ocampo C, Ochoa S, Oertel FC, Olszewska M, Uribe JLP, Sastre-Garriga J, Scocco D, Ramanathan S, Rattanathamsakul N, Shi FD, Shifa J, Simantov I, Siritho S, Tiosano A, Tisavipat N, Torres I, Dembinsky AV, Vidal-Jordana A, Wilf-Yarkoni A, Wu T, Zamir S, Zarco LA, Zimmermann HG, Petzold A, Paul F, Stiebel-Kalish H. Application of the international criteria for optic neuritis in the Acute Optic Neuritis Network. Ann Clin Transl Neurol 2024. [PMID: 39099240 DOI: 10.1002/acn3.52166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE The first international consensus criteria for optic neuritis (ICON) were published in 2022. We applied these criteria to a prospective, global observational study of acute optic neuritis (ON). METHODS We included 160 patients with a first-ever acute ON suggestive of a demyelinating CNS disease from the Acute Optic Neuritis Network (ACON). We applied the 2022 ICON to all participants and subsequently adjusted the ICON by replacing a missing relative afferent pupillary defect (RAPD) or dyschromatopsia if magnetic resonance imaging pathology of the optical nerve plus optical coherence tomography abnormalities or certain biomarkers are present. RESULTS According to the 2022 ICON, 80 (50%) patients were classified as definite ON, 12 (7%) patients were classified as possible ON, and 68 (43%) as not ON (NON). The main reasons for classification as NON were absent RAPD (52 patients, 76%) or dyschromatopsia (49 patients, 72%). Distribution of underlying ON etiologies was as follows: 78 (49%) patients had a single isolated ON, 41 (26%) patients were diagnosed with multiple sclerosis, 25 (16%) patients with myelin oligodendrocyte glycoprotein antibody-associated disease, and 15 (9%) with neuromyelitis optica spectrum disorder. The application of the adjusted ON criteria yielded a higher proportion of patients classified as ON (126 patients, 79%). INTERPRETATION According to the 2022 ICON, almost half of the included patients in ACON did not fulfill the requirements for classification of definite or possible ON, particularly due to missing RAPD and dyschromatopsia. Thorough RAPD examination and formal color vision testing are critical to the application of the 2022 ICON.
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Affiliation(s)
- Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ricardo Alonso
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Charlotte Bereuter
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atira Bick
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leila Cohen
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Yamit Cohen-Tayar
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Russell C Dale
- TY Nelson Department of Paediatric Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan A Gernert
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julian Haas
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroimmunology Service, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Belen Luis
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Christina Mayer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | | | - Susana Ochoa
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Frederike C Oertel
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Jaume Sastre-Garriga
- Neurology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dario Scocco
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Ilya Simantov
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
| | - Sasitorn Siritho
- Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Bangkok, Thailand
- Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nanthaya Tisavipat
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabel Torres
- Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Adi Vaknin Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Angela Vidal-Jordana
- Neurology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Adi Wilf-Yarkoni
- Neuroimmunology Service, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ti Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Sol Zamir
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Axel Petzold
- The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Moorfields Eye Hospital, London, UK
- Neuro-ophthalmology Expert Centre, Amsterdam, Netherlands
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
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Sechi E. NMOSD and MOGAD. Continuum (Minneap Minn) 2024; 30:1052-1087. [PMID: 39088288 DOI: 10.1212/con.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article reviews the clinical features, MRI characteristics, diagnosis, and treatment of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The main differences between these disorders and multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS), are also highlighted. LATEST DEVELOPMENTS The past 20 years have seen important advances in understanding rare demyelinating CNS disorders associated with AQP4 IgG and myelin oligodendrocyte glycoprotein (MOG) IgG. The rapidly expanding repertoire of immunosuppressive agents approved for the treatment of AQP4-NMOSD and emerging as potentially beneficial in MOGAD mandates prompt recognition of these diseases. Most of the recent literature has focused on the identification of clinical and MRI features that help distinguish these diseases from each other and MS, simultaneously highlighting major diagnostic pitfalls that may lead to misdiagnosis. An awareness of the limitations of currently available assays for AQP4 IgG and MOG IgG detection is fundamental for identifying rare false antibody positivity and avoiding inappropriate treatments. For this purpose, diagnostic criteria have been created to help the clinician interpret antibody testing results and recognize the clinical and MRI phenotypes associated with AQP4-NMOSD and MOGAD. ESSENTIAL POINTS An awareness of the specific clinical and MRI features associated with AQP4-NMOSD and MOGAD and the limitations of currently available antibody testing assays is crucial for a correct diagnosis and differentiation from MS. The growing availability of effective treatment options will lead to personalized therapies and improved outcomes.
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Chen M, Chu YH, Yu WX, You YF, Tang Y, Pang XW, Zhang H, Shang K, Deng G, Zhou LQ, Yang S, Wang W, Xiao J, Tian DS, Qin C. Serum LDL Promotes Microglial Activation and Exacerbates Demyelinating Injury in Neuromyelitis Optica Spectrum Disorder. Neurosci Bull 2024; 40:1104-1114. [PMID: 38227181 PMCID: PMC11306683 DOI: 10.1007/s12264-023-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/28/2023] [Indexed: 01/17/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) accompanied by blood-brain barrier (BBB) disruption. Dysfunction in microglial lipid metabolism is believed to be closely associated with the neuropathology of NMOSD. However, there is limited evidence on the functional relevance of circulating lipids in CNS demyelination, cellular metabolism, and microglial function. Here, we found that serum low-density lipoprotein (LDL) was positively correlated with markers of neurological damage in NMOSD patients. In addition, we demonstrated in a mouse model of NMOSD that LDL penetrates the CNS through the leaky BBB, directly activating microglia. This activation leads to excessive phagocytosis of myelin debris, inhibition of lipid metabolism, and increased glycolysis, ultimately exacerbating myelin damage. We also found that therapeutic interventions aimed at reducing circulating LDL effectively reversed the lipid metabolic dysfunction in microglia and mitigated the demyelinating injury in NMOSD. These findings shed light on the molecular and cellular mechanisms underlying the positive correlation between serum LDL and neurological damage, highlighting the potential therapeutic target for lowering circulating lipids to alleviate the acute demyelinating injury in NMOSD.
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Affiliation(s)
- Man Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Xiang Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yun-Fan You
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yue Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Wei Pang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hang Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ke Shang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Gang Deng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sheng Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Xiao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Téllez-Lara N, Gómez-Ballesteros R, Sepúlveda M, Orviz A, Díaz-Sánchez M, Boyero S, Aguado-Valcarcel M, Cobo-Calvo Á, López-Laiz P, Rebollo P, Maurino J. Preferences for neuromyelitis optica spectrum disorder treatments: A conjoint analysis with neurologists in Spain. Mult Scler Relat Disord 2024; 88:105732. [PMID: 38936324 DOI: 10.1016/j.msard.2024.105732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/02/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The treatment landscape for neuromyelitis optica spectrum disorder (NMOSD) has changed in recent years with the approval of therapies with different efficacy, safety and administration profiles. OBJECTIVE The aim of this study was to assess neurologists' preferences for different NMOSD treatment attributes using conjoint analysis (CA). METHODS We conducted an online, non-interventional, cross-sectional study in collaboration with the Spanish Society of Neurology. Our CA assessed five drugs' attributes: prevention of relapse, prevention of disability accumulation, safety risk, management during pregnancy, and route and frequency of administration. Participants were presented with eight hypothetical treatment scenarios to rank based on their preferences from the most preferred to the least. An ordinary least squares method was selected to estimate weighted preferences. RESULTS A total of 104 neurologists were included. Mean age (standard deviation-SD) was 37.7 (10.3) years, 52.9 % were male, and median time (interquartile range) of experience managing NMOSD was 5.0 (2.9, 10.8) years. Neurologists placed the greatest importance on efficacy attributes, time to relapse (44.1 %) being the most important, followed by preventing disability accumulation (36.8 %). In contrast, route and frequency of administration (4.6 %) was the least important characteristic. Participants who prioritised efficacy attributes felt more comfortable in decision-making, had fewer past experiences of care-related regret and a lower attitude to risk taking than their counterparts. CONCLUSION Neurologists' treatment preferences in NMOSD were mainly driven by efficacy attributes. These results may be useful to design policy decisions and treatment guidelines for this condition.
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Affiliation(s)
- Nieves Téllez-Lara
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Sepúlveda
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Díaz-Sánchez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | | | - Álvaro Cobo-Calvo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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7
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Shi Z, Kong L, Wang R, Wang X, Wang Z, Luo W, Chen H, Du Q, Sun D, Zhou H. Cytomegalovirus and Epstein-Barr virus infections in patients with neuromyelitis optica spectrum disorder. J Neurol 2024:10.1007/s00415-024-12571-2. [PMID: 39046523 DOI: 10.1007/s00415-024-12571-2] [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: 02/22/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections in patients with Neuromyelitis optica spectrum disorder (NMOSD) remain unclear. The objective of this study was to investigate CMV and EBV infections in patients with NMOSD. METHODS Serum immunoglobin (Ig) G antibodies against CMV and EBV were measured in patients with NMOSD and healthy controls (HCs), including anti-CMV, anti-EBV nuclear antigen-1 (EBNA-1), anti-EBV virus capsid antigen (VCA), and anti-EBV early antigen (EA) IgGs. The immune status ratio (ISR) was used to evaluate the serum anti-CMV and anti-EBV IgG levels and ISR ≧1.10 was defined as seropositivity. RESULTS In total, 238 serum samples were collected from 94 patients with NMOSD and 144 HCs, and no significant difference of sex and age between NMOSD and HCs. Comparing to the HCs, patients with NMOSD exhibited significantly higher serum anti-CMV IgG level. In contrast, the serum anti-EBNA1 IgG level was significantly lower in patients with NMOSD than in HCs. The serum anti-VCA and anti-EA IgG levels did not differ between the two groups, but the anti-EA seropositivity was significantly higher in NMOSD group than that in HC group. We did not find associations between serum anti-CMV or anti-EBV IgG levels and NMOSD disease stage, immunotherapy, or disability score. CONCLUSIONS Our findings indicated that increased CMV infection and EBV recent infection, as well as reduced EBV latency infection were associated with the risk of NMOSD. Prospective cohort studies are needed to verify our findings and clarify the correlation between CMV and EBV infections and clinical characteristics of NMOSD.
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Affiliation(s)
- Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ziya Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Dongren Sun
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
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Preziosa P, Amato MP, Battistini L, Capobianco M, Centonze D, Cocco E, Conte A, Gasperini C, Gastaldi M, Tortorella C, Filippi M. Moving towards a new era for the treatment of neuromyelitis optica spectrum disorders. J Neurol 2024; 271:3879-3896. [PMID: 38771385 DOI: 10.1007/s00415-024-12426-w] [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: 03/21/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) include a rare group of autoimmune conditions that primarily affect the central nervous system. They are characterized by inflammation and damage to the optic nerves, brain and spinal cord, leading to severe vision impairment, locomotor disability and sphynteric disturbances. In the majority of cases, NMOSD arises due to specific serum immunoglobulin G (IgG) autoantibodies targeting aquaporin 4 (AQP4-IgG), which is the most prevalent water-channel protein of the central nervous system. Early diagnosis and treatment are crucial to manage symptoms and prevent long-term disability in NMOSD patients. NMOSD were previously associated with a poor prognosis. However, recently, a number of randomized controlled trials have demonstrated that biological therapies acting on key elements of NMOSD pathogenesis, such as B cells, interleukin-6 (IL-6) pathway, and complement, have impressive efficacy in preventing the occurrence of clinical relapses. The approval of the initial drugs marks a revolutionary advancement in the treatment of NMOSD patients, significantly transforming therapeutic options and positively impacting their prognosis. In this review, we will provide an updated overview of the key immunopathological, clinical, laboratory, and neuroimaging aspects of NMOSD. Additionally, we will critically examine the latest advancements in NMOSD treatment approaches. Lastly, we will discuss key aspects regarding optimization of treatment strategies and their monitoring.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Amato
- Department Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Luca Battistini
- Neuroimmunology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonella Conte
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Gasperini
- MS Center, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Carla Tortorella
- MS Center, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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9
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Etemadifar M, Mousavi S, Salari M, Hosseinian SA, Mansouri AR. Whole spinal transverse myelitis in neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2024; 87:105666. [PMID: 38749352 DOI: 10.1016/j.msard.2024.105666] [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: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Spinal cord is one of the prominent targets of autoimmune mechanisms in Neuromyelitis Optica Spectrum Disorder (NMOSD). Rarely, NMOSD causes damage to the entire length of the spinal cord, from cervical segments to conus medullaris, which has not been characterized in the existing literature. MATERIAL AND METHOD We reviewed medical records, demographic information, and magnetic resonance imaging (MRI) sequences of 174 NMOSD patients from January 2011 to January 2023 who were admitted to Isfahan Multiple Sclerosis center to find patients with whole spinal transverse myelitis (TM). RESULTS Whole spinal TM was present in five patients (2.9 %). Three patients were seropositive for Aquaporin-4 (AQP4) antibody; Myelin Oligodendrocyte Glycoprotein antibody (MOG IgG) tested negative for all of them. Lower limb weakness was the most frequent clinical complaint. Two patients presented with optic neuritis; One patient reported having episodes of nausea and vomiting. These patients, overall, yielded a higher expanded disability status scale (EDSS) score than the other NMOSD patients. CONCLUSION Whole spinal TM is a rare finding in NMOSD, which is strongly associated with a higher severity and a worse outcome of the disease. The role of anti-AQP4 antibodies in the extent of myelitis in NMOSD has yet to be investigated.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soulmaz Mousavi
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Reza Mansouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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Lapucci C, Boccia VD, Clementi TD, Schiavi S, Benedetti L, Uccelli A, Novi G, Cellerino M, Inglese M. Brain lesion microstructure in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein disease. J Neuroimaging 2024; 34:459-465. [PMID: 38831519 DOI: 10.1111/jon.13218] [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: 04/17/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) diagnosis are based on the presence of serological and magnetic resonance imaging (MRI) biomarkers. Diffusion tensor imaging (DTI), neurites orientation dispersion and density imaging (NODDI), and the Spherical Mean Technique (SMT) may be helpful to provide a microstructural characterization of the different types of white matter lesions and give an insight about their different pathological mechanisms. The aim of the study was to characterize microstructural differences between brain typical lesions (TLs) and nontypical lesions (nTLs). METHODS A total of 17 NMOSD and MOGAD patients [9 Aquaporin4 (AQP4) + NMO, 2 seronegative-NMO, 6 MOGAD] underwent MRI scans on a 3 Tesla MAGNETON PRISMA. Diffusion parameters (fractional anisotropy; mean diffusivity [MD]; intracellular volume fraction [ICVF]; extra-neurite transverse diffusivity; and extra-neurite MD; neurite signal fraction) were obtained using DTI, NODDI, and SMT. Microstructural parameters within lesions were compared through a generalized linear model using age, sex, and total lesion volume as covariates. RESULTS In NMOSD/MOGAD whole cohort (total lesions = 477), TLs showed increased MD and decreased ICVF compared to nTLs (p < .05), indicating higher inflammation and axonal loss. Similar results were found also in the AQP4 + NMO subgroup (decreased ICVF, p < .05). Furthermore, in NMOSD/MOGAD whole cohort and in AQP4 + NMO subgroup, TLs showed a trend toward higher EXRATRANS than nTLs, suggesting a more severe degree of demyelination within TLs. CONCLUSIONS TLs and nTLs in NMOSD/MOGAD showed different diffusion MRI-derived microstructural features, with TLs showing a more severe degree of inflammation and fiber disruption with respect to nTLs.
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Affiliation(s)
| | - Vincenzo Daniele Boccia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Thoma Dario Clementi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanni Novi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Shaygannejad A, Rafiei N, Vaheb S, Yazdan Panah M, Shaygannejad V, Mirmosayyeb O. The Role of Glial Fibrillary Acidic Protein as a Biomarker in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1050. [PMID: 39064479 PMCID: PMC11279275 DOI: 10.3390/medicina60071050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
There is debate on the role of glial fibrillary acidic protein (GFAP) as a reliable biomarker in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), and its potential to reflect disease progression. This review aimed to investigate the role of GFAP in MS and NMOSD. A systematic search of electronic databases, including PubMed, Embase, Scopus, and Web of Sciences, was conducted up to 20 December 2023 to identify studies that measured GFAP levels in people with MS (PwMS) and people with NMOSD (PwNMOSD). R software version 4.3.3. with the random-effect model was used to pool the effect size with its 95% confidence interval (CI). Of 4109 studies, 49 studies met our inclusion criteria encompassing 3491 PwMS, 849 PwNMOSD, and 1046 healthy controls (HCs). The analyses indicated that the cerebrospinal fluid level of GFAP (cGFAP) and serum level of GFAP (sGFAP) were significantly higher in PwMS than HCs (SMD = 0.7, 95% CI: 0.54 to 0.86, p < 0.001, I2 = 29%, and SMD = 0.54, 95% CI: 0.1 to 0.99, p = 0.02, I2 = 90%, respectively). The sGFAP was significantly higher in PwNMOSD than in HCs (SMD = 0.9, 95% CI: 0.73 to 1.07, p < 0.001, I2 = 10%). Among PwMS, the Expanded Disability Status Scale (EDSS) exhibited significant correlations with cGFAP (r = 0.43, 95% CI: 0.26 to 0.59, p < 0.001, I2 = 91%) and sGFAP (r = 0.36, 95% CI: 0.23 to 0.49, p < 0.001, I2 = 78%). Regarding that GFAP is increased in MS and NMOSD and has correlations with disease features, it can be a potential biomarker in MS and NMOSD and indicate the disease progression and disability in these disorders.
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Affiliation(s)
- Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
| | - Nazanin Rafiei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran;
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
| | - Mohammad Yazdan Panah
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord 88157-13471, Iran;
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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Rashidi M, Naghavi S, Ramezani N, Ashtari F, Shaygannejad V, Hosseini SM, Adibi I. Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases. J Cent Nerv Syst Dis 2024; 16:11795735241262738. [PMID: 38903856 PMCID: PMC11188695 DOI: 10.1177/11795735241262738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. Objectives This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. Design This prospective observational study was designed in a tertiary center during one year. Methods All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Results Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively). Conclusion The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.
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Affiliation(s)
- Mehran Rashidi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Naghavi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Biostatistics & Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Xiao L, Huang Y, Sun H, Gao S, Huang D, Wu L. Rituximab maintenance treatment outcomes in patients with relapsing neuromyelitis optica spectrum disorder: a monocentric retrospective analysis. Acta Neurol Belg 2024:10.1007/s13760-024-02555-4. [PMID: 38858290 DOI: 10.1007/s13760-024-02555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/07/2024] [Indexed: 06/12/2024]
Abstract
Some patients with neuromyelitis optica spectrum disorder (NMOSD) experience relapse after rituximab (RTX) treatment. In this retrospective study, we analyzed the recurrence-related clinical features, laboratory investigation results, and dosing protocol of 30 female patients with relapsing NMOSD with immunoglobulin G autoantibodies against aquaporin-4 and relapses during repeated 0.5 g RTX infusions as maintenance treatment. The median follow-up period was 6.62 years. Thirty-five episodes were observed, with myelitis being the most frequent. The median expanded disability status scale change score was 0.50. The recurrence rate decreased by 44.23%/year with RTX infusion. Approximately 85.71% of the patients showed relapse without RTX infusion within 10 months. Overall, RTX may be effective for relapsing NMOSD cases.
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Affiliation(s)
- Lianchen Xiao
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yanning Huang
- School of Medicine, Nankai University, Tianjin, China
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Neurology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Hui Sun
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sai Gao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Dehui Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
| | - Lei Wu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
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14
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Akatani R, Chihara N, Koto S, Mori S, Kurimoto T, Nakamura M, Tachibana H, Otsuka Y, Ueda T, Omori T, Sekiguchi K, Matsumoto R. Efficacy and safety of mycophenolate mofetil for steroid reduction in neuromyelitis optica spectrum disorder: a prospective cohort study. Immunol Med 2024; 47:85-92. [PMID: 38235761 DOI: 10.1080/25785826.2024.2304364] [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: 03/23/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease that can affect multiple generations and cause complications with long-term prednisolone treatment. This study aimed to evaluate the efficacy and safety of mycophenolate mofetil (MMF) in preventing NMOSD relapse while reducing prednisolone dosage. The trial involved nine patients with NMOSD who received MMF along with prednisolone dose reduction. MMF was effective in achieving prednisolone dose reduction without relapse in 77.8% of patients, with a significant decrease in mean annualized relapse rate. All adverse events were mild. The findings suggest that MMF could be a viable treatment option for middle-aged and older patients who require steroid reduction.Clinical trial registration number: jRCT, jRCTs051180080. Registered February 27th, 2019-retrospectively registered, https://jrct.niph.go.jp/en-latest-detail/jRCTs051180080.
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Affiliation(s)
- Ritsu Akatani
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norio Chihara
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shusuke Koto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sotaro Mori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuji Kurimoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisatsugu Tachibana
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihisa Otsuka
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiro Ueda
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Omori
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Fu J, Zhang Q, Wang J, Wang M, Zhang B, Zhu W, Qiu S, Geng Z, Cui G, Yu Y, Liao W, Zhang H, Gao B, Xu X, Han T, Yao Z, Qin W, Liu F, Liang M, Wang S, Xu Q, Xu J, Zhang P, Li W, Shi D, Wang C, Lui S, Yan Z, Chen F, Zhang J, Li J, Shen W, Miao Y, Wang D, Xian J, Gao JH, Zhang X, Xu K, Zuo XN, Zhang L, Ye Z, Cheng J, Li MJ, Yu C. Cross-ancestry genome-wide association studies of brain imaging phenotypes. Nat Genet 2024; 56:1110-1120. [PMID: 38811844 DOI: 10.1038/s41588-024-01766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/23/2024] [Indexed: 05/31/2024]
Abstract
Genome-wide association studies of brain imaging phenotypes are mainly performed in European populations, but other populations are severely under-represented. Here, we conducted Chinese-alone and cross-ancestry genome-wide association studies of 3,414 brain imaging phenotypes in 7,058 Chinese Han and 33,224 white British participants. We identified 38 new associations in Chinese-alone analyses and 486 additional new associations in cross-ancestry meta-analyses at P < 1.46 × 10-11 for discovery and P < 0.05 for replication. We pooled significant autosomal associations identified by single- or cross-ancestry analyses into 6,443 independent associations, which showed uneven distribution in the genome and the phenotype subgroups. We further divided them into 44 associations with different effect sizes and 3,557 associations with similar effect sizes between ancestries. Loci of these associations were shared with 15 brain-related non-imaging traits including cognition and neuropsychiatric disorders. Our results provide a valuable catalog of genetic associations for brain imaging phenotypes in more diverse populations.
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Affiliation(s)
- Jilian Fu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Quan Zhang
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Jianhua Wang
- Department of Bioinformatics, the Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, China
- Biomedical Institute, Henan Academy of Sciences, Zhengzhou, China
| | - Bing Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijun Qiu
- Department of Medical Imaging, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zuojun Geng
- Department of Medical Imaging, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guangbin Cui
- Functional and Molecular Imaging Key Lab of Shaanxi Province and Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yongqiang Yu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
- Molecular Imaging Research Center of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Zhang
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bo Gao
- Department of Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaojun Xu
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen Qin
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Feng Liu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Meng Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Sijia Wang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Qiang Xu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiayuan Xu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Dapeng Shi
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, China
| | - Caihong Wang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhihan Yan
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Jiance Li
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Yanwei Miao
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Xiaochu Zhang
- Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
| | - Kai Xu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi-Nian Zuo
- Developmental Population Neuroscience Research Center at IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Mulin Jun Li
- Department of Bioinformatics, the Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging and State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
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Kim KH, Chung YH, Min JH, Han HJ, Kim SW, Shin HY, Kwon YN, Kim SM, Lim YM, Kim H, Lee EJ, Jeong SH, Hyun JW, Kim SH, Kim HJ. Immunosuppressive therapy in elderly patients with neuromyelitis optica spectrum disorder: a retrospective multicentre study. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333644. [PMID: 38777578 DOI: 10.1136/jnnp-2024-333644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The risk-benefit relationship of immunosuppressive therapies (ISTs) for elderly patients with neuromyelitis optica spectrum disorder (NMOSD) is not well established. This study aimed to investigate the safety and efficacy of IST in elderly patients with NMOSD. METHODS This retrospective study analysed IST efficacy and safety in 101 patients with aquaporin-4 antibody-positive NMOSD aged over 65 years, treated for at least 6 months at five Korean referral centres, focusing on relapse rates, infection events and discontinuation due to adverse outcomes. RESULTS The mean age at disease onset was 59.8 years, and female-to-male ratio was 4:1. Concomitant comorbidities at NMOSD diagnosis were found in 87 patients (86%). The median Expanded Disability Status Scale score at the initiation of IST was 3.5. The administered ISTs included azathioprine (n=61, 60%), mycophenolate mofetil (MMF) (n=48, 48%) and rituximab (n=41, 41%). Over a median of 5.8 years of IST, 58% of patients were relapse-free. The median annualised relapse rate decreased from 0.76 to 0 (p<0.001), and 81% experienced improved or stabilised disability. Patients treated with rituximab had a higher relapse-free rate than those treated with azathioprine or MMF (p=0.022). During IST, 21 patients experienced 25 severe infection events (SIEs) over the age of 65 years, and 3 died from pneumonia. 14 patients (14%) experienced 17 adverse events that led to switching or discontinuation of IST. When comparing the incidence rates of SIEs and adverse events, no differences were observed among patients receiving azathioprine, MMF and rituximab. CONCLUSION In elderly patients with NMOSD, IST offers potential benefits in reducing relapse rates alongside a tolerable risk of adverse events.
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Affiliation(s)
- Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Hee Jo Han
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Young Nam Kwon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Seong Ho Jeong
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
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Rodin RE, Chitnis T. Soluble biomarkers for Neuromyelitis Optica Spectrum Disorders: a mini review. Front Neurol 2024; 15:1415535. [PMID: 38817544 PMCID: PMC11137173 DOI: 10.3389/fneur.2024.1415535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
The Neuromyelitis Optica Spectrum Disorders (NMOSD) constitute a spectrum of rare autoimmune diseases of the central nervous system characterized by episodes of transverse myelitis, optic neuritis, and other demyelinating attacks. Previously thought to be a subtype of multiple sclerosis, NMOSD is now known to be a distinct disease with unique pathophysiology, clinical course, and treatment options. Although there have been significant recent advances in the diagnosis and treatment of NMOSD, the field still lacks clinically validated biomarkers that can be used to stratify disease severity, monitor disease activity, and inform treatment decisions. Here we review many emerging NMOSD biomarkers including markers of cellular damage, neutrophil-to-lymphocyte ratio, complement, and cytokines, with a focus on how each biomarker can potentially be used for initial diagnosis, relapse surveillance, disability prediction, and treatment monitoring.
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Affiliation(s)
- Rachel E. Rodin
- Department of Neurology, Brigham MS Center, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Tanuja Chitnis
- Department of Neurology, Brigham MS Center, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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18
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Sechi E, Puci M, Pateri MI, Zara P, Othmani S, Sotgiu S, Saddi MV, Leoni S, Fenu G, Melis M, Sotgiu G, Solla P, Cocco E, Frau J. Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia. Mult Scler Relat Disord 2024; 85:105522. [PMID: 38461730 DOI: 10.1016/j.msard.2024.105522] [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: 11/08/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013-2022). METHODS Patients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013-December 2022) and prevalence (December 31, 2022) were calculated. RESULTS A total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6-78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3-2.7) per million and 2.6 (1.9-3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7-2) per million and 1.8 (1.3-2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. CONCLUSIONS The epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, University Hospital of Sassari, Sassari, Italy.
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Maria Ida Pateri
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Pietro Zara
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Sabrine Othmani
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, University Hospital of Sassari, Sassari, Italy
| | | | - Stefania Leoni
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Giuseppe Fenu
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Paolo Solla
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
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Liao H, Fan P, Ruan H, Qiu W, Zhang M, Li H. Characteristics of recurrence risk perception and coping strategies in patients with neuromyelitis optica spectrum disorder: A qualitative study. Mult Scler Relat Disord 2024; 84:105419. [PMID: 38364767 DOI: 10.1016/j.msard.2023.105419] [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: 05/30/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Although neuromyelitis optica spectrum disorder (NMOSD) has high recurrence and disability rates, cases of relapses can be recognized, and timely intervention can be provided if the risk of relapse is properly perceived. However, there have been no studies to explore patients' perceptions of recurrence risk and coping strategies. This study aimed to explore the characteristics of relapse risk perception and coping strategies of patients with NMOSD. METHODS We adopted the phenomenological method of qualitative research. Face-to-face, semi-structured in-depth interviews were conducted with 15 patients with NMOSD. The interview data were then analyzed using the Colaizzi seven-step analysis. RESULTS The analysis revealed five major themes. The first theme was the 'perception of possibility of relapse', which included subjectively underestimating the likelihood of relapse and shifted from underestimation to overestimation; the second theme was 'relapse warning signs perception'; the third theme was 'perception of relapse triggers', which included understanding relapse triggers, potential misconceptions about relapse triggers, and no identifiable cause of recurrence; the fourth theme was 'perception of the relapse consequences', encompassing severe impairment of body structure and function, prominent psychological problems, limited family roles and social functions, and heavy financial burden; and the final theme was 'relapse risk coping strategies', which included actively yearning for and seeking information support, recurrence risk prevention/management, limitations of coping strategies. CONCLUSIONS This study's findings revealed that newly diagnosed patients as well as those who relapsed subjectively underestimated the likelihood of relapse before they had experienced multiple (two or more) relapses. In contrast, patients who had experienced multiple relapses had transitioned from initial underestimation to subsequent overestimation. Additionally, patients' compliance with medication was identified as a relapse-risk behaviors that was very manageable. The occurrence of relapse is associated with significant and extensive adverse effects on patients. Consequently, patients are eager to communicate with their healthcare providers regarding treatment planning and relapse management.
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Affiliation(s)
- Haifen Liao
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Ping Fan
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China
| | - Hengfang Ruan
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China
| | - Wei Qiu
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
| | - Huijuan Li
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
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20
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Sivaroja Y, Sowmini PR, Muralidharan K, Reddy PGPK, Mugundhan K. Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center. J Neurosci Rural Pract 2024; 15:313-319. [PMID: 38746498 PMCID: PMC11090556 DOI: 10.25259/jnrp_603_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/16/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. Materials and Methods In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. Results The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Conclusion Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.
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Affiliation(s)
- Yellaturi Sivaroja
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - P. R. Sowmini
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - K. Muralidharan
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - P. G. Pavan Kumar Reddy
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - K. Mugundhan
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
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Yu Y, Zhong M, Quan C, Ma C. Treatment access and satisfaction on disease-modifying therapies of neuromyelitis optica spectrum disorder patients in China: a cross-sectional survey. Ther Adv Neurol Disord 2024; 17:17562864241239105. [PMID: 38525489 PMCID: PMC10960978 DOI: 10.1177/17562864241239105] [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: 09/10/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare and debilitating disease that has become more widely recognized in China. Legislative measures have been implemented by the government to improve treatment access for rare diseases. Objectives To investigate the diagnostic journey, treatment status, treatment accessibility, and treatment satisfaction of the NMOSD patients on disease-modifying therapies (DMTs) in China. Design A patient online survey. Methods This cross-sectional online survey was conducted between November 2022 and January 2023. Patients over 18 years old and diagnosed with NMOSD were included. The questionnaire consisted of five sections covering demographics, diagnostic and treatment experiences, DMTs availability, cost and affordability, and treatment satisfaction using the Treatment Satisfaction Questionnaire for Medication (version II). Patient opinions and demands were also collected at the end of the survey. Results A total of 375 patients diagnosed with NMOSD were recruited, of which 321 patients used DMTs. It required 1.22 ± 3.22 years and 3.58 ± 4.24 hospital visits for a definitive diagnosis. One-third of the patients still needed to travel for over 2 h to access DMTs. The total treatment expenditure was estimated to be CNY 59,827.00 (USD 8315.95) a year. Drug expenses alone accounted for 52.22% of the average annual household income. The most common challenges perceived were the inability to afford treatment and a lack of effective options. No significant difference was found in treatment satisfaction among DMTs, except that rituximab scored lowest in convenience compared to other DMTs. Patients' age and travel time required to obtain medications were negatively associated with global treatment satisfaction. Conclusion In China, patients with NMOSD face challenges in obtaining proper treatment due to diagnostic difficulties, distant medication access, and high costs. Policies should prioritize improving disease education and alleviating financial burdens for the patients.
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Affiliation(s)
- Yue Yu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingkang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, National Center for Neurological Disorders, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunlai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
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22
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San Martin DL, Fukuda TG, Nascimento TS, Silva MB, Filho MBP, Forcadela M, Rocchi C, Gibbons E, Hamid S, Huda S, Oliveira-Filho J. Predictors of azathioprine and mycophenolate mofetil response in patients with neuromyelitis optica spectrum disorder: A cohort study. Mult Scler Relat Disord 2024; 83:105452. [PMID: 38277981 DOI: 10.1016/j.msard.2024.105452] [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: 10/25/2023] [Revised: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Relapse rates of 47 % have been reported in patients with neuromyelitis optica (NMOSD) using Azathioprine (AZA) and mycophenolate mofetil (MMF). Prediction of non-responders could help determine which patients are most likely to benefit from newer monoclonal antibody treatments from the outset. OBJECTIVES To identify predictors of AZA and MMF treatment response in NMOSD. METHODS Multicenter cohort study of NMOSD patients from Brazil and the United Kingdom, treated with AZA and MMF. An unsatisfactory response was defined as one severe or two non-severe attacks in a year. Cox regression was used to identify predictive factors of unsatisfactory response to AZA and MMF. RESULTS 103 NMOSD patients, mean age 38 years, 83% female, and 65% of Black ethnic group were included. An unsatisfactory IS response was observed in 42% of patients over 2.5 years (IQR 1.0-8.8) years. A severe preceding attack was more common in non-responders (31.1% x 76.7%, p = <0.001). In multivariable analysis, severe attack (RR 3.13; 95 % CI 1.37-7.18, p = 0.007) or higher annualized relapse rate (RR 4.84; 95 % CI 2.01-11.65, p = < 0.001) predicted an unsatisfactory response. Interestingly, Black NMOSD patients had a lower risk of poor response (RR 0.39, 95 % CI 0.17-0.85, p = 0.019). CONCLUSION Severe attack and a higher annualized relapse rate before AZA or MMF initiation were associated with an unsatisfactory IS response. In patients with these characteristics, treatment with higher-efficacy drugs should be considered from the outset.
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Affiliation(s)
| | - Thiago Gonçalves Fukuda
- Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil 40026-010
| | - Thiago Santos Nascimento
- Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil 40026-010
| | - Mariana Brito Silva
- Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil 40026-010
| | | | - Mirasol Forcadela
- NMOSD National Service, Walton Centre Foundation Trust Liverpool, United Kingdom L9 7LI.
| | - Chiara Rocchi
- NMOSD National Service, Walton Centre Foundation Trust Liverpool, United Kingdom L9 7LI.
| | - Emily Gibbons
- NMOSD National Service, Walton Centre Foundation Trust Liverpool, United Kingdom L9 7LI.
| | - Shahd Hamid
- NMOSD National Service, Walton Centre Foundation Trust Liverpool, United Kingdom L9 7LI.
| | - Saif Huda
- NMOSD National Service, Walton Centre Foundation Trust Liverpool, United Kingdom L9 7LI.
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil 40026-010.
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Cobo-Calvo Á, Gómez-Ballesteros R, Orviz A, Díaz Sánchez M, Boyero S, Aguado-Valcarcel M, Sepúlveda M, Rebollo P, López-Laiz P, Maurino J, Téllez Lara N. Therapeutic inertia in the management of neuromyelitis optica spectrum disorder. Front Neurol 2024; 15:1341473. [PMID: 38450077 PMCID: PMC10915282 DOI: 10.3389/fneur.2024.1341473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction and objective Limited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists' TI in NMOSD. Methods An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists' characteristics and TI. Results A total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0-46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0-11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0-12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient's tolerability/safety when choosing a treatment were predictors of TI. Conclusion TI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Díaz Sánchez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | | | - María Sepúlveda
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Nieves Téllez Lara
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Jiang Y, Dai S, Pang R, Qin L, Zhang M, Liu H, Wang X, Zhang J, Peng G, Wang Y, Li W. Single-cell RNA sequencing reveals cell type-specific immune regulation associated with human neuromyelitis optica spectrum disorder. Front Immunol 2024; 15:1322125. [PMID: 38440735 PMCID: PMC10909925 DOI: 10.3389/fimmu.2024.1322125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction One rare type of autoimmune disease is called neuromyelitis optica spectrum disorder (NMOSD) and the peripheral immune characteristics of NMOSD remain unclear. Methods Here, single-cell RNA sequencing (scRNA-seq) is used to characterize peripheral blood mononuclear cells from individuals with NMOSD. Results The differentiation and activation of lymphocytes, expansion of myeloid cells, and an excessive inflammatory response in innate immunity are observed. Flow cytometry analyses confirm a significant increase in the percentage of plasma cells among B cells in NMOSD. NMOSD patients exhibit an elevated percentage of CD8+ T cells within the T cell population. Oligoclonal expansions of B cell receptors are observed after therapy. Additionally, individuals with NMOSD exhibit elevated expression of CXCL8, IL7, IL18, TNFSF13, IFNG, and NLRP3. Discussion Peripheral immune response high-dimensional single-cell profiling identifies immune cell subsets specific to a certain disease and identifies possible new targets for NMOSD.
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Affiliation(s)
- Yushu Jiang
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuhua Dai
- Department of Neurology, Zhoukou Central Hospital, Zhoukou, Henan, China
| | - Rui Pang
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lingzhi Qin
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Milan Zhang
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huiqin Liu
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaojuan Wang
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jiewen Zhang
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Gongxin Peng
- Center for Bioinformatics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yongchao Wang
- Department of Neurology, People’s Hospital of Yexian, Pingdingshan, Henan, China
| | - Wei Li
- Department of Neurology, Henan Joint International Research Laboratory Of Accurate Diagnosis, Treatment, Research And Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Gil-Rojas Y, Amaya-Granados D, Quiñones J, Robles A, Samacá-Samacá D, Hernández F. Measuring the economic burden of neuromyelitis optica spectrum disorder in Colombia. Mult Scler Relat Disord 2024; 82:105376. [PMID: 38141561 DOI: 10.1016/j.msard.2023.105376] [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: 02/07/2023] [Revised: 08/15/2023] [Accepted: 12/10/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To assess the economic burden of neuromyelitis optica spectrum disorder (NMOSD) in the Colombian context. METHODS Analyses were conducted from a societal perspective using the prevalence-based approach. Costs were expressed in 2022 US dollars (1 USD = $3,914.46 COP). Direct medical costs were assessed from a bottom-up approach. Indirect costs included loss of productivity of the patient and their caregivers. The economic burden of NMOSD in Colombia was estimated as the sum of direct and indirect costs. RESULTS The direct cost of treating a patient with NMOSD was USD$ 8,149.74 per year. When projecting costs nationwide, NMOSD would cost USD$ 7.2 million per year. Of these costs, 53.5% would be attributed to relapses and 34.4% to pharmacological therapy. Indirect costs potentially attributed to NMOSD in Colombia were estimated at USD$ 1.5 million per year per cohort. Of these, 78% are attributable to loss of patient productivity, mainly due to reduced access to the labor market and premature mortality. CONCLUSIONS The NMOSD has a representative economic burden at the patient level, with direct costs, particularly related to relapses and medicines, being the main component of total costs. These findings are useful evidence that requires attention from public policymakers in Colombia.
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Affiliation(s)
| | | | - Jairo Quiñones
- Director Unidad de Neuroinmunología, Fundación Valle del Lili, Cali, Colombia; Coordinador de la Especialización en Neurología, Universidad de Icesi, Cali, Colombia
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmun Rev 2024; 23:103499. [PMID: 38061621 DOI: 10.1016/j.autrev.2023.103499] [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: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system autoimmune disease. Aquaporin-4 antibody (AQP4-IgG) is present in over 75% of cases and criteria also exist for the diagnosis of seronegative NMOSD. AQP4-IgG NMOSD has a strong female predominance (9:1 ratio), with a median onset age of 40 years. Pregnancy in those with NMOSD is therefore an important topic. Fecundity in NMOSD is likely impaired, and for females who conceive, obstetric complications including miscarriages and pre-eclampsia are significantly higher in NMOSD compared to the general population and in related conditions such as multiple sclerosis (MS). In contrast to MS, NMOSD disease activity does not subside during pregnancy. Also, relapse risk substantially rises above pre-pregnancy rates in the early postpartum period. In view of the evolving landscape of NMOSD, we provide a contemporary update of the impacts of pregnancy in NMOSD.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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Carlsson O, Jonsson DI, Brundin L, Iacobaeus E. Relapses and Serious Infections in Patients with Neuromyelitis Optica Spectrum Disorder Treated with Rituximab: A Swedish Single-Center Study. J Clin Med 2024; 13:355. [PMID: 38256489 PMCID: PMC10816065 DOI: 10.3390/jcm13020355] [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: 11/23/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated relapsing-remitting disease of the central nervous system. The usage of rituximab, as relapse-preventive therapy, in NMOSD is common. We performed a single-center retrospective cohort study to assess the risk of relapses and severe infectious events (SIEs) in rituximab-treated NMOSD patients. This study included 24 aquaporin-4 IgG+ (AQP4+), 8 myelin-oligodendrocyte-protein IgG+ (MOG+), and 10 double-seronegative NMOSD patients. Relapses were observed in 50% of all patients during a mean treatment time of 4.0 (range: 0.5-8.25) years. The incidence risk ratio (IRR) of relapse was three times higher in MOG+ compared to AQP4+ patients (IRR: 3.0, 95% confidence interval (CI); 1.2-7.7). SIEs occurred in 40% of all patients during follow-up. AQP4+ patients conferred an increased risk of SIEs compared to MOG+ patients (IRR; 5.3, 95% CI; 1.2-24.3). Incomplete CD19+ B-lymphocyte suppression was not correlated with relapse risk (hazard ratio; 1.9, 95% CI; 0.7-5.2), and there was no correlation between IgG-levels and SIE risk (odds ratio; 2.0, 95% CI; 0.8-4.8). In conclusion, considerable risks of both relapses and SIEs were observed in NMOSD patients exposed to rituximab, which underlines the need for close clinical vigilance of disease activity and infections during treatment.
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Affiliation(s)
- Olof Carlsson
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Dagur Ingi Jonsson
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurophysiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lou Brundin
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
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Qin C, Chen M, Dong MH, Yang S, Zhang H, You YF, Zhou LQ, Chu YH, Tang Y, Pang XW, Wu LJ, Tian DS, Wang W. Soluble TREM2 triggers microglial dysfunction in neuromyelitis optica spectrum disorders. Brain 2024; 147:163-176. [PMID: 37740498 DOI: 10.1093/brain/awad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/21/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
Microglia-mediated neuroinflammation contributes to acute demyelination in neuromyelitis optica spectrum disorders (NMOSD). Soluble triggering receptor expressed on myeloid cells 2 (sTREM2) in the CSF has been associated with microglial activation in several neurodegenerative diseases. However, the basis for this immune-mediated attack and the pathophysiological role of sTREM2 in NMOSD remain to be elucidated. Here, we performed Mendelian randomization analysis and identified a genetic association between increased CSF sTREM2 and NMOSD risk. CSF sTREM2 was elevated in patients with NMOSD and was positively correlated with neural injury and other neuroinflammation markers. Single-cell RNA sequencing of human macrophage/microglia-like cells in CSF, a proxy for microglia, showed that increased CSF sTREM2 was positively associated with microglial dysfunction in patients with NMOSD. Furthermore, we demonstrated that sTREM2 is a reliable biomarker of microglial activation in a mouse model of NMOSD. Using unbiased transcriptomic and lipidomic screens, we identified that excessive activation, overwhelmed phagocytosis of myelin debris, suppressed lipid metabolism and enhanced glycolysis underlie sTREM2-mediated microglial dysfunction, possibly through the nuclear factor kappa B (NF-κB) signalling pathway. These molecular and cellular findings provide a mechanistic explanation for the genetic association between CSF sTREM2 and NMOSD risk and indicate that sTREM2 could be a potential biomarker of NMOSD progression and a therapeutic target for microglia-mediated neuroinflammation.
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Affiliation(s)
- Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Man Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ming-Hao Dong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sheng Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hang Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yun-Fan You
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yue Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Wei Pang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, NY 14600, USA
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, China
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Keehn CC, Yazdian A, Hunt PJ, Davila-Siliezar P, Laylani NA, Lee AG. Monoclonal antibodies in neuro-ophthalmology. Saudi J Ophthalmol 2024; 38:13-24. [PMID: 38628411 PMCID: PMC11017005 DOI: 10.4103/sjopt.sjopt_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 04/19/2024] Open
Abstract
Neuro-ophthalmologic diseases include a broad range of disorders affecting the afferent and efferent visual pathways. Recently, monoclonal antibody (mAb) therapies have emerged as a promising targeted approach in the management of several of these complex conditions. Here, we describe the mechanism-specific applications and advancements in neuro-ophthalmologic mAb therapies. The application of mAbs in neuro-ophthalmologic diseases highlights our increasing understanding of disease-specific mechanisms in autoimmune conditions such as neuromyelitis optica, thyroid eye disease, and myasthenia gravis. Due to the specificity of mAb therapies, applications in neuro-ophthalmologic diseases have yielded exceptional clinical outcomes, including both reduced rate of relapse and progression to disability, visual function preservation, and quality of life improvement. These advancements have not only expanded the range of treatable neuro-ophthalmologic diseases but also reduced adverse events and increased the response rate to treatment. Further research into neuro-ophthalmologic disease mechanisms will provide accurate and specific targeting of important disease mediators through applications of future mAbs. As our understanding of these diseases and the relevant therapeutic targets evolve, we will continue to build on our understanding of how mAbs interfere with disease pathogenesis, and how these changes improve clinical outcomes and quality of life for patients.
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Affiliation(s)
- Caroline C. Keehn
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Arman Yazdian
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Patrick J. Hunt
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Noor A. Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
- Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, USA
- Department of Ophthalmology, Texas A and M College of Medicine, Bryan, Texas, USA
- Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Nwaze C, Eghwrudjakpor Y, Chinedu-Anunaso N. AQUAPORIN-4 (AQP-4) IMMUNOGLOBULIN G SEROPOSITIVE NEUROMYELITIS OPTICA: A REVIEW AND CASE REPORT. Ann Ib Postgrad Med 2023; 21:79-84. [PMID: 38706629 PMCID: PMC11065186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/30/2023] [Indexed: 05/07/2024] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a relatively new terminology composed to encompass patients with neuromyelitis optica (NMO) and related immunological conditions. The diagnosis of this condition requires a seropositive aquaporin-4 immunoglobulin G (AQP-4 IgG), the presence of at least one core clinical characteristic and the exclusion of alternative diagnoses. Very few cases have been reported in sub-Saharan Africa. Objective The aim of this article is to report a classical case of NMOSD with AQP-4 IgG seropositivity and normal brain, cervical and thoracic MRI findings. Result We report a 25-year-old Nigerian woman who presented with recurrent and alternating weakness, pain and numbness of all limbs, associated with episodic painful left-sided tonic spasms and urinary incontinence. She had earlier had symptoms of recurrent, episodic and alternating loss of vision in both eyes, associated with ocular pain.Examination findings revealed an intact mental status, no cranial nerve deficit and no focal limb weakness. Right-sided deep tendon reflexes were exaggerated. Vital signs were within normal limits. Brain MRI, Cervical spine MRI and Thoracic spine MRI all revealed normal findings. Serum aquaporin-4 IgG assay returned positive with a titer of 1:32.She was commenced on high dose steroids and there was gradual improvement of symptoms. Conclusion These findings confirmed the diagnosis of neuromyelitis optica spectrum disorder, and satisfies the diagnostic criteria published in 2015 by the International Panel for NMO Diagnosis (IPND).
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Affiliation(s)
- C Nwaze
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
| | - Y Eghwrudjakpor
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
| | - N Chinedu-Anunaso
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
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Zhang L, Xue Y, Yuan C, Du X, Wang X, Guo L, Li B. Decreased SIRT1 mRNA expression in peripheral blood mononuclear cells from patients with neuromyelitis optica spectrum disorders. Acta Neurol Belg 2023; 123:2287-2294. [PMID: 37294424 DOI: 10.1007/s13760-023-02300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Sirtuin (SIRT)1, as a molecular link between immunity and metabolic pathways, is a key immune response regulator. The significance of SIRT1 in peripheral blood mononuclear cells (PBMCs) of neuromyelitis optica spectrum disorder (NMOSD) has not been investigated. Here, we aimed to evaluate the SIRT1 mRNA level in PBMCs of patients with NMOSD and its clinical relevance and explore the potential mechanism of SIRT1 action. METHODS A total of 65 patients with NMOSD and 60 normal controls from North China were enrolled. Using real-time fluorescence quantitative-polymerase chain reaction, mRNA levels were detected in PBMCs, and protein levels were detected using western blotting. RESULTS Compared to the healthy controls and chronic-phase patients with NMOSD, SIRT1 mRNA and protein levels in PBMCs of NMOSD patients with acute attack were significantly downregulated (p < 0.0001). ∆EDSS scores (EDSS scores in the acute phase-EDSS scores before the recent attack) were higher in NMOSD patients with low SIRT1 mRNA level than in patients with high SIRT1 expression (p = 0.042). SIRT1 mRNA level in patients with acute-phase NMSOD was positively correlated with lymphocyte and monocyte counts and negatively correlated with neutrophil counts and the neutrophil-to-lymphocyte ratio. Furthermore, the transcription factor FOXP3 mRNA level was significantly positively correlated with the SIRT1 mRNA level in PBMCs of patients with acute-phase NMOSD. CONCLUSIONS Our study indicated that SIRT1 mRNA expression was downregulated in the PBMCs of patients with acute-phase NMOSD, and its level was correlated with the clinical parameters of the patients, suggesting a potential role of SIRT1 in NMOSD.
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Affiliation(s)
- Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Yumei Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
- Department of Pharmacy, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Congcong Yuan
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
- Department of Neurology, Baoding First Central Hospital, Baoding, China
| | - Xiaochen Du
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xuan Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China.
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China.
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China.
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China.
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Cao F, Wang Y, Wei R, Li C, Cheng Y, Zhou Y, Jin T, Zhang H, Lin L, Xu B. Peripheral Blood Th1/Th17 Immune Cell Shift is Associated with Disease Activity and Severity of AQP4 Antibody Sero-Positive Neuromyelitis Optica Spectrum Disorder. Neuropsychiatr Dis Treat 2023; 19:2413-2421. [PMID: 37965529 PMCID: PMC10642349 DOI: 10.2147/ndt.s425759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose Neuromyelitis optica spectrum disorder (NMOSD) is a rare recurrent autoimmune disease of the central nervous system. However, to date, the peripheral blood profile of the T helper cell subsets in NMOSD remains controversial and poorly understood. This study aimed to compare the levels of helper T cell subsets in the peripheral blood from patients with NMOSD in different phases of the disease and studied their correlation with the clinical severity of the disease. Patients and methods We used flow cytometry with cellular membrane surface staining to measure the levels of helper T cell subsets in 50 patients with NMOSD during the attack (n = 25) and remission (n = 25) phases and in 21 healthy controls. Results Patients with NMOSD had higher levels of Th1 and Th17 cells in the attack phase compared to parallel populations in the remission phase and healthy controls. Th1/Th2 and Th17/Treg ratios were positively correlated with the severity of the disease in the attack phase of NMOSD. In contrast, Treg cell levels were negatively correlated with the severity of the disease in the attack phase in patients with NMOSD. Conclusion The peripheral blood immune profile in NMOSD towards a Th1/Th17 cell-mediated pro-inflammatory immune response, which is associated with disease activity and severity of neuromyelitis optica spectrum disorder.
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Affiliation(s)
- Fangzheng Cao
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Yiqi Wang
- Department of Neurology, Center for Rehabilitation Medicine, People’s Hospital of Hangzhou Medical College, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China
| | - Ruili Wei
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Chunrong Li
- Department of Neurology, Center for Rehabilitation Medicine, People’s Hospital of Hangzhou Medical College, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China
| | - Yifan Cheng
- Department of Neurology, Center for Rehabilitation Medicine, People’s Hospital of Hangzhou Medical College, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China
| | - Yu Zhou
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Tianyu Jin
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Houwen Zhang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Luting Lin
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Bin Xu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Hor JY, Fujihara K. Epidemiology of myelin oligodendrocyte glycoprotein antibody-associated disease: a review of prevalence and incidence worldwide. Front Neurol 2023; 14:1260358. [PMID: 37789888 PMCID: PMC10542411 DOI: 10.3389/fneur.2023.1260358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 10/05/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an inflammatory demyelinating disease of the central nervous system (CNS) with the presence of conformation-sensitive antibodies against MOG. The spectrum of MOGAD includes monophasic/relapsing optic neuritis, myelitis, neuromyelitis optica spectrum disorder (NMOSD) phenotype without aquaporin 4 (AQP4) antibodies, acute/multiphasic demyelinating encephalomyelitis (ADEM/MDEM)-like presentation, and brainstem and cerebral cortical encephalitis. There is no apparent female preponderance in MOGAD, and MOGAD can onset in all age groups (age at onset is approximately 30 years on average, and approximately 30% of cases are in the pediatric age group). While prevalence and incidence data have been available for AQP4+ NMOSD globally, such data are only beginning to accumulate for MOGAD. We reviewed the currently available data from population-based MOGAD studies conducted around the world: three studies in Europe, three in Asia, and one joint study in the Americas. The prevalence of MOGAD is approximately 1.3-2.5/100,000, and the annual incidence is approximately 3.4-4.8 per million. Among White people, the prevalence of MOGAD appears to be slightly higher than that of AQP4+ NMOSD. No obvious latitude gradient was observed in the Japanese nationwide survey. The data available so far showed no obvious racial preponderance or strong HLA associations in MOGAD. However, precedent infection was reported in approximately 20-40% of MOGAD cases, and this is worthy of further investigation. Co-existing autoimmune disorders are less common in MOGAD than in AQP4+ NMOSD, but NMDAR antibodies may occasionally be positive in patients with MOGAD. More population-based studies in different populations and regions are useful to further inform the epidemiology of this disease.
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Affiliation(s)
- Jyh Yung Hor
- Department of Neurology, Penang General Hospital, Penang, Malaysia
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Koriyama, Japan
- Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
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Yong HYF, Burton JM. A Clinical Approach to Existing and Emerging Therapeutics in Neuromyelitis Optica Spectrum Disorder. Curr Neurol Neurosci Rep 2023; 23:489-506. [PMID: 37540387 DOI: 10.1007/s11910-023-01287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics. RECENT FINDINGS This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
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Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada
| | - Jodie M Burton
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Chen X, Xiao J, Zhou LQ, Yu WX, Chen M, Chu YH, Shang K, Deng G, Song WH, Qin C, Pan DJ, Tian DS. Research hotspots and trends on neuromyelitis optica spectrum disorders: insights from bibliometric analysis. Front Immunol 2023; 14:1135061. [PMID: 37520556 PMCID: PMC10373306 DOI: 10.3389/fimmu.2023.1135061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are demyelinating diseases of the central nervous system, have drawn the attention of many researchers due to the relapsing courses and cumulative disability. A first bibliometric analysis of NMOSD was conducted to identify the research hotspots and emerging trends. Articles relevant to NMOSD published in the core collection of Web of Science were retrieved and analyzed through visualized analysis using CiteSpace and VOSviewer, focusing on annual publication trends, countries, institutions, authors, journals, and keywords. The analysis showed that over the past 30 years, publications related to NMOSD had shown steady growth with slight fluctuations. The United States played an important part in this field, with the highest outputs and the greatest number of citations. Research hotspots of NMOSD had gradually shifted from the definition, biomarkers, and diagnostic criteria to diagnosis and treatment, particularly immunotherapy. This bibliometric analysis provides researchers with a theoretical basis for studying NMOSD and offers guidance for future research directions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Chuan Qin
- *Correspondence: Dai-Shi Tian, ; Deng-Ji Pan, ; Chuan Qin,
| | - Deng-Ji Pan
- *Correspondence: Dai-Shi Tian, ; Deng-Ji Pan, ; Chuan Qin,
| | - Dai-Shi Tian
- *Correspondence: Dai-Shi Tian, ; Deng-Ji Pan, ; Chuan Qin,
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Jagannath P, K MS, S SMA, Kulkarni A, Prashanth PSSS, Madan H, Anand A. Neuromyelitis optica spectrum disorder with AQP4-IgG presenting as area postrema syndrome and progressing to myelitis: A rare case report. Clin Case Rep 2023; 11:e7636. [PMID: 37415585 PMCID: PMC10319961 DOI: 10.1002/ccr3.7636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
Key Clinical Message Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. Management involves intravenous glucocorticoids, plasma exchange, and preventive immunotherapy. Abstract Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. The majority of patients have positive AQP4-Ab. Diagnosis is based on clinical and imaging findings. These patients can be treated with intravenous glucocorticoids, plasma exchange, and preventive immunotherapy.
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Affiliation(s)
| | - Mohammed Suhail K
- Department of General MedicineM S Ramaiah Medical CollegeBengaluruIndia
| | | | - Ashwin Kulkarni
- Department of General MedicineM S Ramaiah Medical CollegeBengaluruIndia
| | | | - Hritik Madan
- Adesh Medical College and HospitalKurukshetraHaryanaIndia
| | - Ayush Anand
- BP Koirala Institute of Health SciencesDharanNepal
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Paul F, Marignier R, Palace J, Arrambide G, Asgari N, Bennett JL, Cree BAC, De Sèze J, Fujihara K, Kim HJ, Hornby R, Huda S, Kissani N, Kleiter I, Kuwabara S, Lana-Peixoto M, Law L, Leite MI, Pandit L, Pittock SJ, Quan C, Ramanathan S, Rotstein D, Saiz A, Sato DK, Vaknin-Dembinsky A. International Delphi Consensus on the Management of AQP4-IgG+ NMOSD: Recommendations for Eculizumab, Inebilizumab, and Satralizumab. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200124. [PMID: 37258412 DOI: 10.1212/nxi.0000000000200124] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is a rare debilitating autoimmune disease of the CNS. Three monoclonal antibodies were recently approved as maintenance therapies for aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD (eculizumab, inebilizumab, and satralizumab), prompting the need to consider best practice therapeutic decision-making for this indication. Our objective was to develop validated statements for the management of AQP4-IgG-seropositive NMOSD, through an evidence-based Delphi consensus process, with a focus on recommendations for eculizumab, inebilizumab, and satralizumab. METHODS We recruited an international panel of clinical experts in NMOSD and asked them to complete a questionnaire on NMOSD management. Panel members received a summary of evidence identified through a targeted literature review and provided free-text responses to the questionnaire based on both the data provided and their clinical experience. Responses were used to generate draft statements on NMOSD-related themes. Statements were voted on over a maximum of 3 rounds; participation in at least 1 of the first 2 rounds was mandatory. Panel members anonymously provided their level of agreement (6-point Likert scale) on each statement. Statements that failed to reach a predefined consensus threshold (≥67%) were revised based on feedback and then voted on in the next round. Final statements were those that met the consensus threshold (≥67%). RESULTS The Delphi panel comprised 24 experts, who completed the Delphi process in November 2021 after 2 voting rounds. In round 1, 23/25 statements reached consensus and were accepted as final. The 2 statements that failed to reach consensus were revised. In round 2, both revised statements reached consensus. Twenty-five statements were agreed in total: 11 on initiation of or switching between eculizumab, inebilizumab, and satralizumab; 3 on monotherapy/combination therapy; 7 on safety and patient population considerations; 3 on biomarkers/patient-reported outcomes; and 1 on research gaps. DISCUSSION An established consensus method was used to develop statements relevant to the management of AQP4-IgG-seropositive NMOSD. These international statements will be valuable for informing individualized therapeutic decision-making and could form the basis for standardized practice guidelines.
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Affiliation(s)
- Friedemann Paul
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Romain Marignier
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Jacqueline Palace
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Georgina Arrambide
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Nasrin Asgari
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Jeffrey L Bennett
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Bruce Anthony Campbell Cree
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Jérôme De Sèze
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Kazuo Fujihara
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ho Jin Kim
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Rebecca Hornby
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Saif Huda
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Najib Kissani
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ingo Kleiter
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Satoshi Kuwabara
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Marco Lana-Peixoto
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Lisa Law
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - M Isabel Leite
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Lekha Pandit
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Sean J Pittock
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Chao Quan
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Sudarshini Ramanathan
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Dalia Rotstein
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Albert Saiz
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Douglas Kazutoshi Sato
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Adi Vaknin-Dembinsky
- From the Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany; Hospices Civils de Lyon (R.M.), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 et CNRS UMR5292; Université Claude Bernard Lyon 1 (R.M.), France; John Radcliff Hospital (J.P.); Clinical Neurology Oxford University (J.P.), Oxford, United Kingdom; Servei de Neurologia-Neuroimmunologia (G.A.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Vall d'Hebron Institut de Recerca (G.A.), Vall d'Hebron Hospital Universitari; Universitat Autònoma de Barcelona (G.A.), Spain; Departments of Regional Health Research and Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Department of Neurology (N.A.), Slagelse Hospital, Denmark; Programs in Neuroscience and Immunology (J.L.B.), Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (B.A.C.C.), UCSF Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (J.D.S.), Hôpitaux Universitaires de Strasbourg; INSERM U1119 Biopathologie de la Myéline (J.D.S.), Neuroprotection et Stratégies Thérapeutique; Clinical Investigation Center (J.D.S.), Hôpitaux Universitaires de Strasbourg, France; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine, and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea; Oxford PharmaGenesis Ltd (R.H., L.L.); Department of Neurology (S.H.), Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Medical Research Center (N.K.), Marrakesh Medical School, Cadi Ayyad University; Neurology Department (N.K.), University Teaching Hospital Mohammed VI, Marrakesh, Morocco; Department of Neurology (I.K.), St Josef-Hospital, Ruhr-University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (S.K.), Graduate School of Medicine, Chiba University, Japan; CIEM MS Research Center (M.L.-P.), Federal University of Minas Gerais, Belo Horizonte, Brazil; John Radcliffe Hospital (M.I.L.), University of Oxford, United Kingdom; KS Hegde Medical Academy Director (L.P.), Center for Advanced Neurological Research, Nitte University, Mangalore, India; Neurology (S.J.P.), Laboratory Medicine and Pathology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN; Department of Neurology and Rare Disease Center (C.Q.), National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, China; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Australia; Division of Neurology (D.R.), Department of Medicine, University of Toronto, Ontario, Canada; Neuroimmunology and Multiple Sclerosis Unit (A.S.), Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Spain; School of Medicine (D.K.S.), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurology and Laboratory of Neuroimmunology and The Agnes-Ginges Center for Neurogenetics (A.V.-D.), Hadassah-Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Harel T, Gorman EF, Wallin MT. New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review. Front Neurol 2023; 14:1099758. [PMID: 37426444 PMCID: PMC10323143 DOI: 10.3389/fneur.2023.1099758] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare chronic neuroinflammatory autoimmune condition. Since the onset of the COVID-19 pandemic, there have been reports of NMOSD clinical manifestations following both SARS-CoV-2 infections and COVID-19 vaccinations. Objective This study aims to systematically review the published literature of NMOSD clinical manifestations associated with SARS-CoV-2 infections and COVID-19 vaccinations. Methods A Boolean search of the medical literature was conducted between December 1, 2019 to September 1, 2022, utilizing Medline, Cochrane Library, Embase, Trip Database, Clinicaltrials.gov, Scopus, and Web of Science databases. Articles were collated and managed on Covidence® software. The authors independently appraised the articles for meeting study criteria and followed PRISMA guidelines. The literature search included all case reports and case series that met study criteria and involved NMOSD following either the SARS-CoV-2 infection or the COVID-19 vaccination. Results A total of 702 articles were imported for screening. After removing 352 duplicates and 313 articles based on exclusion criteria, 34 articles were analyzed. A total of 41 cases were selected, including 15 patients that developed new onset NMOSD following a SARS-CoV-2 infection, 21 patients that developed de novo NMOSD following COVID-19 vaccination, 3 patients with known NMOSD that experienced a relapse following vaccination, and 2 patients with presumed Multiple Sclerosis (MS) that was unmasked as NMOSD post-vaccination. There was a female preponderance of 76% among all NMOSD cases. The median time interval between the initial SARS-CoV-2 infection symptoms and NMOSD symptom onset was 14 days (range 3-120 days) and the median interval between COVID-19 vaccination and onset of NMO symptoms was 10 days (range 1 to 97 days). Transverse myelitis was the most common neurological manifestation in all patient groups (27/41). Management encompassed acute treatments such as high dose intravenous methylprednisolone, plasmapheresis, and intravenous immunoglobulin (IVIG) and maintenance immunotherapies. The majority of patients experienced a favorable outcome with complete or partial recovery, but 3 patients died. Conclusion This systematic review suggests that there is an association between NMOSD and SARS-CoV-2 infections and COVID-19 vaccinations. This association requires further study using quantitative epidemiological assessments in a large population to better quantify the risk.
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Affiliation(s)
- Tamar Harel
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE), Baltimore VA Medical Center, Baltimore, MD, United States
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Emily F. Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Mitchell T. Wallin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE), Baltimore VA Medical Center, Baltimore, MD, United States
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
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Su Y, Ruan Z, Li S, Li Z, Chang T. Emerging trends and research foci of neuromyelitis optica spectrum disorder: a 20-year bibliometric analysis. Front Immunol 2023; 14:1177127. [PMID: 37346048 PMCID: PMC10281505 DOI: 10.3389/fimmu.2023.1177127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating syndrome of the central nervous system. A tremendous amount of literature on NMOSD has been published. This study aimed to perform a bibliometric analysis of the publications on NMOSD and show its hotspots and development trends. Methods We used the Web of Science Core Collection as a database and searched the literature published between 2002 and 2022. CiteSpace, VOSviewer, online bibliometric platform, and R-bibliometrix were used to conduct bibliometric analysis and network visualization, including the number of publications, citations, countries/regions, institutions, journals, authors, references, and keywords. Results A total of 3,057 publications on NMOSD were published in 198 journals by 200 authors at 200 institutions from 93 countries/regions. The United States published the most literature and made great contributions to this field. The Mayo Clinic was the institution with the largest number of publications. The journal with the most publications was Multiple Sclerosis and Related Disorders, and the most co-cited journal was Neurology. The author with the most publications was Fujihara, K., while the most frequently co-cited author was Wingerchuk, DM. The current research hotspots may be focused on "efficacy," "multicenter," "interleukin-6 receptor blockade," "safety," "azathioprine," "tolerance," and "adult". Conclusion This study was the first bibliometric analysis of publications on the NMOSD field, visualizing its bibliometric characteristics and gaining insight into the direction, hotspots, and development of global NMOSD research, which may provide helpful information for researchers. Future research hotspots might be conducting randomized controlled trials on targeted immunotherapy in the NMOSD field.
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Affiliation(s)
- Yue Su
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shicao Li
- Department of Pharmacy, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
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Vegda M, Panda S, Bhatnagar KR. Utility of optical coherence tomography in patients of central immune mediated demyelinating diseases - A prospective study. eNeurologicalSci 2023; 31:100464. [PMID: 37132011 PMCID: PMC10149178 DOI: 10.1016/j.ensci.2023.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive tool to measure thickness of various layers of retina. Recently, retinal nerve fibre layer (RNFL) and ganglion cell and inner plexiform layer (GCIP) thinning has been observed in OCT in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), This study compared OCT profile, along with visual acuity (VA), color vision (CV), contrast saturation (CS) and visual evoked potentials (VEP) in two main cohorts of MS and NMOSD and with controls, during acute episode of optic neuritis (ON), at 3 and 6 months. We found that changes of ON were present in 75% of MS eyes and in 45% of NMOSD patients. Of these, subclinical involvement was present in 56.25% of MS eyes and only in 5% of NMOSD eyes suggesting frequent subclinical involvement in the former. Mean RNFL was 95.23 ± 15.53 in MS and 66.14 ± 43.73 in NMOSD after 6 months of ON episode. Thinning of NQ and IQ was observed in NMOSD eyes in the immediate period after ON attack. At 6 months relative sparing of RNFL in TQ was observed in NMOSD ON eyes and MS ON showed predilection for involvement of TQ.
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Affiliation(s)
- Monalisa Vegda
- DM Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Samhita Panda
- DM Neurology, Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
- Corresponding author.
| | - Kavita R. Bhatnagar
- MS Ophthalmology, Department of Ophthalmology, All India Institute Of Medical Sciences, Jodhpur, India
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Bian J, Sun J, Chang H, Wei Y, Cong H, Yao M, Xiao F, Wang H, Zhao Y, Liu J, Zhang X, Yin L. Profile and potential role of novel metabolite biomarkers, especially indoleacrylic acid, in pathogenesis of neuromyelitis optica spectrum disorders. Front Pharmacol 2023; 14:1166085. [PMID: 37324490 PMCID: PMC10263123 DOI: 10.3389/fphar.2023.1166085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory and demyelinating disorder that can lead to serious disability and mortality. Humoral fluid biomarkers with specific, convenient, and efficient profiles that could characterize and monitor disease activity or severity are very useful. We aimed to develop a sensitive and high-throughput liquid chromatography-tandem mass spectrometry (LC-MS)/MS-based analytical method for novel biomarkers finding in NMOSD patients and verified its function tentatively. Methods: Serum samples were collected from 47 NMOSD patients, 18 patients with other neurological disorders (ONDs), and 35 healthy controls (HC). Cerebrospinal fluid (CSF) samples were collected from 18 NMOSD and 17 OND patients. Three aromatic amino acids (phenylalanine, tyrosine, and tryptophan) and nine important metabolites that included phenylacetylglutamine (PAGln), indoleacrylic acid (IA), 3-indole acetic acid (IAA), 5-hydroxyindoleacetic acid (HIAA), hippuric acid (HA), I-3-carboxylic acid (I-3-CA), kynurenine (KYN), kynurenic acid (KYNA), and quinine (QUIN) were analyzed by using the liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based method. The profile of IA was further analyzed, and its function was verified in an astrocyte injury model stimulated by NMO-IgG, which represents important events in NMOSD pathogenesis. Results: In the serum, tyrosine and some of the tryptophan metabolites IA and I-3-CA decreased, and HIAA increased significantly in NMOSD patients. The CSF levels of phenylalanine and tyrosine showed a significant increase exactly during the relapse stage, and IA in the CSF was also increased markedly during the relapse and remission phases. All conversion ratios had similar profiles with their level fluctuations. In addition, the serum IA levels negatively correlated with glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) levels in the serum of NMOSD patients were measured by using ultra-sensitive single-molecule arrays (Simoa). IA showed an anti-inflammatory effect in an in vitro astrocyte injury model. Conclusion: Our data suggest that essential aromatic amino acid tryptophan metabolites IA in the serum or CSF may serve as a novel promising biomarker to monitor and predict the activity and severity of NMOSD disease. Supplying or enhancing IA function can promote anti-inflammatory responses and may have therapeutic benefits.
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Affiliation(s)
- Jiangping Bian
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiali Sun
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haoxiao Chang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuzhen Wei
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hengri Cong
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengyuan Yao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fuyao Xiao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huabing Wang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaobo Zhao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xinghu Zhang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Yin
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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42
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Quispe-Vicuña C, Cabanillas-Lazo M, Mauricio-Vilchez C, Munive-Degregori A, Barja-Ore J, Mayta-Tovalino F. Bibliometric analyses of global output on neuromyelitis optica spectrum disorder. Oman J Ophthalmol 2023; 16:293-297. [PMID: 37602166 PMCID: PMC10433079 DOI: 10.4103/ojo.ojo_300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a neuroimmune disease, i.e. under constant research. The aim of this bibliometric study is to perform a bibliometric indicator analysis of the worldwide academic production of NMOSD during the period 2017-2021. METHODS A bibliographic search was assessed in the Scopus database to identify NMOSD-related articles published during the period 2017-2021. Collected publications were exported and analyzed in Scival (Elsevier). Bibliographic data were described through absolute values and percentages in descriptive tables. VOSviewer was used to visualize collaborative networks. RESULTS A total of 1920 documents were collected, and the highest percentage of these belonged to the area of neurology. Friedemann Paul was the author with the highest scientific production, but Brian Weinshenker had the greatest impact worldwide. Three of the institutions with the highest production were North American. Multiple sclerosis and related disorders were the journal with the highest production of publications. Most papers were published in Q1 or Q2 journals. CONCLUSION NMOSD-related articles are mostly published in first and second quartile journals, which would reflect a high interest of the scientific community. Publications with international collaboration reported a higher impact. Although African and South American regions have considerable prevalence of this disease, they do not have institutions with high productivity developing research on this disease.
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Affiliation(s)
- Carlos Quispe-Vicuña
- Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación Y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Miguel Cabanillas-Lazo
- Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación Y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Cesar Mauricio-Vilchez
- Academic Department, Faculty of Medical Technology, Universidad Nacional Federico Villarreal, Lima, Peru
| | | | - John Barja-Ore
- Research Direction, Universidad Privada del Norte, Lima, Peru
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Jarius S, Aktas O, Ayzenberg I, Bellmann-Strobl J, Berthele A, Giglhuber K, Häußler V, Havla J, Hellwig K, Hümmert MW, Kleiter I, Klotz L, Krumbholz M, Kümpfel T, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Tumani H, Wildemann B, Trebst C. Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J Neurol 2023:10.1007/s00415-023-11634-0. [PMID: 37022481 DOI: 10.1007/s00415-023-11634-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 04/07/2023]
Abstract
The term 'neuromyelitis optica spectrum disorders' (NMOSD) is used as an umbrella term that refers to aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica (NMO) and its formes frustes and to a number of closely related clinical syndromes without AQP4-IgG. NMOSD were originally considered subvariants of multiple sclerosis (MS) but are now widely recognized as disorders in their own right that are distinct from MS with regard to immunopathogenesis, clinical presentation, optimum treatment, and prognosis. In part 1 of this two-part article series, which ties in with our 2014 recommendations, the neuromyelitis optica study group (NEMOS) gives updated recommendations on the diagnosis and differential diagnosis of NMOSD. A key focus is on differentiating NMOSD from MS and from myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD), which shares significant similarity with NMOSD with regard to clinical and, partly, radiological presentation, but is a pathogenetically distinct disease. In part 2, we provide updated recommendations on the treatment of NMOSD, covering all newly approved drugs as well as established treatment options.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | | | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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Mohammadi S, Gouravani M, Salehi MA, Arevalo JF, Galetta SL, Harandi H, Frohman EM, Frohman TC, Saidha S, Sattarnezhad N, Paul F. Optical coherence tomography angiography measurements in multiple sclerosis: a systematic review and meta-analysis. J Neuroinflammation 2023; 20:85. [PMID: 36973708 PMCID: PMC10041805 DOI: 10.1186/s12974-023-02763-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent literature on multiple sclerosis (MS) demonstrates the growing implementation of optical coherence tomography-angiography (OCT-A) to discover potential qualitative and quantitative changes in the retina and optic nerve. In this review, we analyze OCT-A studies in patients with MS and examine its utility as a surrogate or precursor to changes in central nervous system tissue. METHODS PubMed and EMBASE were systematically searched to identify articles that applied OCT-A to evaluate the retinal microvasculature measurements in patients with MS. Quantitative data synthesis was performed on all measurements which were evaluated in at least two unique studies with the same OCT-A devices, software, and study population compared to controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level. RESULTS The study selection process yielded the inclusion of 18 studies with a total of 1552 evaluated eyes in 673 MS-associated optic neuritis (MSON) eyes, 741 MS without optic neuritis (MSNON eyes), and 138 eyes without specification for the presence of optic neuritis (ON) in addition to 1107 healthy control (HC) eyes. Results indicated that MS cases had significantly decreased whole image superficial capillary plexus (SCP) vessel density when compared to healthy control subjects in the analyses conducted on Optovue and Topcon studies (both P < 0.0001). Likewise, the whole image vessel densities of deep capillary plexus (DCP) and radial peripapillary capillary (RPC) were significantly lower in MS cases compared to HC (all P < 0.05). Regarding optic disc area quadrants, MSON eyes had significantly decreased mean RPC vessel density compared to MSNON eyes in all quadrants except for the inferior (all P < 0.05). Results of the analysis of studies that used prototype Axsun machine revealed that MSON and MSNON eyes both had significantly lower ONH flow index compared to HC (both P < 0.0001). CONCLUSIONS This systematic review and meta-analysis of the studies reporting OCT-A measurements of people with MS confirmed the tendency of MS eyes to exhibit reduced vessel density in the macular and optic disc areas, mainly in SCP, DCP, and RPC vessel densities.
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Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Mohammad Amin Salehi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran.
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven L Galetta
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Elliot M Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Teresa C Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Neda Sattarnezhad
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, Stanford Multiple Sclerosis Center, Stanford University, Stanford, USA
| | - Friedemann Paul
- Department of Neurology, Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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45
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Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
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Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
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Barbosa LM, Valerio F, Pereira SLA, da Silva VA, de Lima Rodrigues AL, Galhardoni R, Yeng LT, Rosi J, Conforto AB, Lucato LT, Lemos MD, Teixeira MJ, de Andrade DC. Site matters: Central neuropathic pain characteristics and somatosensory findings after brain and spinal cord lesions. Eur J Neurol 2023; 30:1443-1452. [PMID: 36773324 DOI: 10.1111/ene.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND It is unknown if different etiologies or lesion topographies influence central neuropathic pain (CNP) clinical manifestation. METHODS We explored the symptom-somatosensory profile relationships in CNP patients with different types of lesions to the central nervous system to gain insight into CNP mechanisms. We compared the CNP profile through pain descriptors, standardized bedside examination, and quantitative sensory test in two different etiologies with segregated lesion locations: the brain, central poststroke pain (CPSP, n = 39), and the spinal cord central pain due to spinal cord injury (CPSCI, n = 40) in neuromyelitis optica. RESULTS Results are expressed as median (25th to 75th percentiles). CPSP presented higher evoked and paroxysmal pain scores compared to CPSCI (p < 0.001), and lower cold thermal limen (5.6°C [0.0-12.9]) compared to CPSCI (20.0°C [4.2-22.9]; p = 0.004). CPSCI also had higher mechanical pain thresholds (784.5 mN [255.0-1078.0]) compared to CPSP (235.2 mN [81.4-1078.0], p = 0.006) and higher mechanical detection threshold compared to control areas (2.7 [1.5-6.2] vs. 1.0 [1.0-3.3], p = 0.007). Evoked pain scores negatively correlated with mechanical pain thresholds (r = -0.38, p < 0.001) and wind-up ratio (r = -0.57, p < 0.001). CONCLUSIONS CNP of different etiologies may present different pain descriptors and somatosensory profiles, which is likely due to injury site differences within the neuroaxis. This information may help better design phenotype mechanism correlations and impact trial designs for the main etiologies of CNP, namely stroke and spinal cord lesions. This study provides evidence that topography may influence pain symptoms and sensory profile. The findings suggest that CNP mechanisms might vary according to pain etiology or lesion topography, impacting future mechanism-based treatment choices.
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Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, São Paulo, Brazil.,Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Zyla-Jackson K, Walton DA, Plafker KS, Kovats S, Georgescu C, Brush RS, Tytanic M, Agbaga MP, Plafker SM. Dietary protection against the visual and motor deficits induced by experimental autoimmune encephalomyelitis. Front Neurol 2023; 14:1113954. [PMID: 36937529 PMCID: PMC10017782 DOI: 10.3389/fneur.2023.1113954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Five to eight percent of the world population currently suffers from at least one autoimmune disorder. Despite multiple immune modulatory therapies for autoimmune demyelinating diseases of the central nervous system, these treatments can be limiting for subsets of patients due to adverse effects and expense. To circumvent these barriers, we investigated a nutritional intervention in mice undergoing experimental autoimmune encephalomyelitis (EAE), a model of autoimmune-mediated demyelination that induces visual and motor pathologies similar to those experienced by people with multiple sclerosis (MS). Methods EAE was induced in female and male mice and the impact of limiting dietary carbohydrates by feeding a ketogenic diet (KD) enriched in medium chain triglycerides (MCTs), alpha-linolenic acid (an omega-3 fatty acid), and fiber was evaluated in both a preventive regimen (prior to immunization with MOG antigen) and an interventional regimen (following the onset of symptoms). Motor scores were assigned daily and visual acuity was measured using optokinetic tracking. Immunohistochemical analyses of optic nerves were done to assess inflammatory infiltrates and myelination status. Fatty acid and cytokine profiling from blood were performed to evaluate systemic inflammatory status. Results The KD was efficacious when fed as a preventive regimen as well as when initiated as an interventional regimen following symptom onset. The KD minimally impacted body weight during the experimental time course, increased circulating ketones, prevented motor and ocular deficits, preserved myelination of the optic nerve, and reduced infiltration of immune cells to optic nerves. The KD also increased anti-inflammatory-associated omega-3 fatty acids in the plasma and reduced select cytokines in the circulation associated with EAE-mediated pathological inflammation. Discussion In light of ongoing clinical trials using dietary strategies to treat people with MS, these findings support that a KD enriched in MCTs, omega-3 fatty acids, and fiber promotes a systemic anti-inflammatory milieu and ameliorates autoimmune-induced demyelinating visual and motor deficits.
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Affiliation(s)
- Katarzyna Zyla-Jackson
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Dorothy A. Walton
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Kendra S. Plafker
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Susan Kovats
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Constantin Georgescu
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Richard S. Brush
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Madison Tytanic
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Martin-Paul Agbaga
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Scott M. Plafker
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Scott M. Plafker
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48
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Liu T, Li L, Guo X, Li Q, Jia D, Ma L. Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom. Eur J Med Res 2022; 27:315. [PMID: 36582004 PMCID: PMC9798654 DOI: 10.1186/s40001-022-00949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. METHODS Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. RESULTS Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. CONCLUSION The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
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Affiliation(s)
- Ting Liu
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Lijuan Li
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Xiaopeng Guo
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Qifu Li
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Dandan Jia
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Lin Ma
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
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Liu J, Zhang C, Xie Y, Zhou L, Guo L, Li B, Jia Z, Zhang J, Sugimoto K, Gao Y. Demyelinating diseases of the central nervous system registry for patients with traditional Chinese medicine: Rationale and design of a prospective, multicenter, observational study. Front Pharmacol 2022; 13:981300. [DOI: 10.3389/fphar.2022.981300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Traditional Chinese medicine (TCM), a main form of complementary and alternative medicine provides a potential possibility for demyelinating disease of the central nervous system (DDC) management and has been applied in considerable amounts of patients with this disorder. Nevertheless, powerful real-world evidences regarding the epidemiological and clinical characteristics, safety, and outcomes of TCM in DDC are lacking. The primary objective of the Demyelinating Diseases of the Central Nervous System Registry for Patients with Traditional Chinese Medicine (DATE-TCM) is to create an organized multicenter data collection structure to define integrative characteristics of DDC patients treated with TCM in an endeavor to fill these knowledge gaps to better inform clinical care and health policy.Method: This study provides a prospective and voluntary registry by using a web-based system. Baseline data will be recorded and subsequently regular follow-up visits will be implemented every 3–6 months for a total of 5 years. The primary outcome is Annualized Aggregate Relapse Rate at 5-year follow-up.Results: DATE-TCM is currently designed to capture the multidimensional (epidemiologic, demographic, clinical, etc.) features of DDC patients receiving TCM treatment, the type and long-term safety and efficacy of TCM intervenes in the DDC populations, as well as the interaction of TCM treatments and disease modifying therapies in the management of DDC, aiming to include 2000 eligible adult DDC patients with TCM intervenes from 35 participating centers, covering 77.4% of provincial administrative regions of mainland China.Conclusion: DATE-TCM is the first, largest, most geographically extensive, and standard registry-based observational study that systematically document the real-world data regarding the TCM application in the DDC populations, which will be extraordinarily important for clarifying the comprehensive characteristics and outcomes of TCM in DDC, further shed light on standardizing and optimizing the TCM measures for DDC management and establishing evidence-based clinical practice guidelines for TCM application in DDC.
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Shrestha R, Kharel G. A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD. Oxf Med Case Reports 2022; 2022:omac109. [PMID: 36299670 PMCID: PMC9589462 DOI: 10.1093/omcr/omac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system caused by severe immune-mediated demyelination and axonal destruction, mainly affecting optic nerves and the spinal cord. We describe a 26-year-old Nepalese woman with recent onset of headache, nausea, vomiting and hiccups indicative of Area Postrema Syndrome (APS). The antibody test for aquaporin-4 was strongly positive. Brain magnetic resonance imaging (MRI) showed a bilateral hyperintense signal in the area postrema (AP). The patient started on methylprednisolone, and then azathioprine was added. However, the patient was readmitted because of tingling in her right upper extremity and sudden onset of tremors. An MRI scan showed an enlarged lesion in AP. Rituximab was started on top of the previous treatment, and a second dose was given after 2 weeks. The patient had been monitored regularly and symptom-free for 5 months. Hence, we emphasize the immediate need for a diagnostic approach for NMOSD management.
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Affiliation(s)
- Ramesh Shrestha
- Correspondence address. Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu, 44600, Nepal. Tel +9779863856230; E-mail:
| | - Ghanshyam Kharel
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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