1
|
Morrow SA. Cognitive Impairment in Multiple Sclerosis: Past, Present, and Future. Neuroimaging Clin N Am 2024; 34:469-479. [PMID: 38942528 DOI: 10.1016/j.nic.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Cognitive impairment in multiple sclerosis (MS) is common and can have negative effects on quality of life. The clinical presentation can be more subtle and insidious. Thus, cognitive impairment is often underrecognized by both persons with MS (PwMS) and clinicians, leading to underestimation disability due to MS. Recent evidence supports that relapses affect cognition in a similar pattern to other physical relapse symptoms and may be the only symptom of a relapse. Regular screening using validated tests for PwMS will improve the care provided and quality of life of PwMS.
Collapse
Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Foothills Medical Centre, 907 South Tower, 1403 29th Street NorthWest, Calgary, Alberta T2N 2T9, Canada.
| |
Collapse
|
2
|
Traboulsee A, Li DKB. Routine MR Imaging Protocol and Standardization in Central Nervous System Demyelinating Diseases. Neuroimaging Clin N Am 2024; 34:317-334. [PMID: 38942519 DOI: 10.1016/j.nic.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Standardized MR imaging protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and the appropriate use of MR imaging in routine clinical practice. Advances in using MR imaging to establish an earlier diagnosis of MS, safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MR imaging for diagnostic, prognostic, and monitoring purposes suggest a changing role of MR imaging for the management and care of MS patients. The MR imaging protocol emphasizes 3 dimensional acquisitions for optimal comparison over time.
Collapse
Affiliation(s)
- Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, University of British Columbia Hospital, 2211 Wesbrook Mall, Room S113, Vancouver, British Columbia V6T 2B5, Canada.
| | - David K B Li
- Department of Radiology, University of British Columbia, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada
| |
Collapse
|
3
|
Mahmoudi N, Wattjes MP. Treatment Monitoring in Multiple Sclerosis - Efficacy and Safety. Neuroimaging Clin N Am 2024; 34:439-452. [PMID: 38942526 DOI: 10.1016/j.nic.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Magnetic resonance imaging is the most sensitive method for detecting inflammatory activity in multiple sclerosis, particularly in the brain where it reveals subclinical inflammation. Established MRI markers include contrast-enhancing lesions and active T2 lesions. Recent promising markers like slowly expanding lesions and phase rim lesions are being explored for monitoring chronic inflammation, but require further validation for clinical use. Volumetric and quantitative MRI techniques are currently limited to clinical trials and are not yet recommended for routine clinical use. Additionally, MRI is crucial for detecting complications from disease-modifying treatments and for implementing MRI-based pharmacovigilance strategies, such as in patients treated with natalizumab.
Collapse
Affiliation(s)
- Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mike P Wattjes
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| |
Collapse
|
4
|
Ravano V, Andelova M, Piredda GF, Sommer S, Caneschi S, Roccaro L, Krasensky J, Kudrna M, Uher T, Corredor-Jerez RA, Disselhorst JA, Maréchal B, Hilbert T, Thiran JP, Richiardi J, Horakova D, Vaneckova M, Kober T. Microstructural characterization of multiple sclerosis lesion phenotypes using multiparametric longitudinal analysis. J Neurol 2024:10.1007/s00415-024-12568-x. [PMID: 39003428 DOI: 10.1007/s00415-024-12568-x] [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: 02/06/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND AND OBJECTIVES In multiple sclerosis (MS), slowly expanding lesions were shown to be associated with worse disability and prognosis. Their timely detection from cross-sectional data at early disease stages could be clinically relevant to inform treatment planning. Here, we propose to use multiparametric, quantitative MRI to allow a better cross-sectional characterization of lesions with different longitudinal phenotypes. METHODS We analysed T1 and T2 relaxometry maps from a longitudinal cohort of MS patients. Lesions were classified as enlarging, shrinking, new or stable based on their longitudinal volumetric change using a newly developed automated technique. Voxelwise deviations were computed as z-scores by comparing individual patient data to T1, T2 and T2/T1 normative values from healthy subjects. We studied the distribution of microstructural properties inside lesions and within perilesional tissue. RESULTS AND CONCLUSIONS Stable lesions exhibited the highest T1 and T2 z-scores in lesion tissue, while the lowest values were observed for new lesions. Shrinking lesions presented the highest T1 z-scores in the first perilesional ring while enlarging lesions showed the highest T2 z-scores in the same region. Finally, a classification model was trained to predict the longitudinal lesion type based on microstructural metrics and feature importance was assessed. Z-scores estimated in lesion and perilesional tissue from T1, T2 and T2/T1 quantitative maps carry discriminative and complementary information to classify longitudinal lesion phenotypes, hence suggesting that multiparametric MRI approaches are essential for a better understanding of the pathophysiological mechanisms underlying disease activity in MS lesions.
Collapse
Affiliation(s)
- Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University, Prague, Czech Republic
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
| | - Stefan Sommer
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Swiss Center for Muscoloskeletal Imaging (SCMI) Balgrist Campus, Zurich, Switzerland
| | - Samuele Caneschi
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Lucia Roccaro
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Matej Kudrna
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University, Prague, Czech Republic
| | - Ricardo A Corredor-Jerez
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jonathan A Disselhorst
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Geneva and Zurich, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
5
|
Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of Progression Independent of Relapses in Multiple Sclerosis. Ann Neurol 2024; 96:1-20. [PMID: 38568026 DOI: 10.1002/ana.26913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 02/15/2024] [Indexed: 06/20/2024]
Abstract
Clinical, pathological, and imaging evidence in multiple sclerosis (MS) suggests that a smoldering inflammatory activity is present from the earliest stages of the disease and underlies the progression of disability, which proceeds relentlessly and independently of clinical and radiological relapses (PIRA). The complex system of pathological events driving "chronic" worsening is likely linked with the early accumulation of compartmentalized inflammation within the central nervous system as well as insufficient repair phenomena and mitochondrial failure. These mechanisms are partially lesion-independent and differ from those causing clinical relapses and the formation of new focal demyelinating lesions; they lead to neuroaxonal dysfunction and death, myelin loss, glia alterations, and finally, a neuronal network dysfunction outweighing central nervous system (CNS) compensatory mechanisms. This review aims to provide an overview of the state of the art of neuropathological, immunological, and imaging knowledge about the mechanisms underlying the smoldering disease activity, focusing on possible early biomarkers and their translation into clinical practice. ANN NEUROL 2024;96:1-20.
Collapse
Affiliation(s)
- Massimiliano Calabrese
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - 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
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College, London, UK
| | - Elisa Colato
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battaglini
- Siena Imaging S.r.l., Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Owain W Howell
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Matilde Inglese
- Dipartimento di neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili - DINOGMI, University of Genova, Genoa, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Martin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Therapeutic Design Unit, Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Cellerys AG, Schlieren, Switzerland
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of Medicine, Burlington Danes, Imperial College London, London, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria A Rocca
- 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
| | - Agnese Tamanti
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Marco Vercellino
- Multiple Sclerosis Center & Neurologia I U, Department of Neuroscience, University Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Maria Villar
- Department of Immunology, Ramon y Cajal University Hospital. IRYCIS. REI, Madrid, Spain
| | - Massimo Filippi
- 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
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Magliozzi
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| |
Collapse
|
6
|
Klistorner S, Barnett MH, Parratt J, Yiannikas C, Klistorner A. Quantifying chronic lesion expansion in multiple sclerosis: Exploring imaging markers for longitudinal assessment. Mult Scler Relat Disord 2024; 87:105688. [PMID: 38824793 DOI: 10.1016/j.msard.2024.105688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Gradual expansion of multiple sclerosis lesions over time is known to have a significant impact on disease progression. However, accurately quantifying the volume changes in chronic lesions presents challenges due to their slow rate of progression and the need for longitudinal segmentation. Our study addresses this by estimating the expansion of chronic lesions using data collected over a 1-2 year period and exploring imaging markers that do not require longitudinal lesion segmentation. METHODS Pre- and post-gadolinium 3D-T1, 3D FLAIR and diffusion tensor images were acquired from 42 patients with MS. Lesion expansion, stratified by the severity of tissue damage as measured by mean diffusivity change, was analysed between baseline and 48 months (Progressive Volume/Severity Index, PVSI). Central brain atrophy (CBA) and the degree of tissue loss inside chronic lesions (measured by the change of T1 intensity and mean diffusivity (MD)) were used as surrogate markers. RESULTS CBA measured after 2 years of follow-up estimated lesion expansion at 4 years with a high degree of accuracy (r = 0.82, p < 0.001, ROC area under the curve 0.92, sensitivity of 94 %, specificity of 85 %). Increased MD within chronic lesions measured over 2 years was strongly associated with future expansion (r = 0.77, p < 0.001, ROC area under the curve 0.87, sensitivity of 81 % and specificity of 81 %). In contrast, change in lesion T1 hypointensity poorly explained future PVSI (best sensitivity and specificity 60 % and 59 % respectively). INTERPRETATION CBA and, to a lesser extent, the change in MD within chronic MS lesions, measured over a period of 2 years, can provide a reliable and sensitive estimate of the extent and severity of chronic lesion expansion.
Collapse
Affiliation(s)
- Samuel Klistorner
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Sydney Neuroimaging Analysis Centre, Camperdown, New South Wales, Australia
| | - John Parratt
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alexander Klistorner
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| |
Collapse
|
7
|
Spiezia AL, Scalia G, Petracca M, Caliendo D, Moccia M, Fiore A, Cerbone V, Lanzillo R, Brescia Morra V, Carotenuto A. Effect of siponimod on lymphocyte subsets in active secondary progressive multiple sclerosis and clinical implications. J Neurol 2024; 271:4281-4291. [PMID: 38632126 PMCID: PMC11233419 DOI: 10.1007/s00415-024-12362-9] [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: 01/04/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Circulating immune cells play a pathogenic role in multiple sclerosis (MS). However, the role of specific lymphocyte subpopulations is not unveiled yet, especially in progressive stages. We aimed to investigate lymphocyte changes during siponimod treatment in active secondary progressive MS (aSPMS) and their associations with clinical outcomes. METHODS We enrolled 46 aSPMS patients starting on siponimod treatment with at least 6 months of follow-up and two visits within the scheduled timeframes and 14 sex- and age-matched healthy controls (HCs). Clinical and laboratory data were collected retrospectively at baseline, 3rd, 6th, 12th, and 24th month for MS patients, and at baseline for HCs. RESULTS At baseline SPMS patients presented with increased naïve regulatory T lymphocytes (p = 0.02) vs. HCs. Over time, SPMS patients showed decreased T CD4+ (coeff. range = -24/-17, 95% CI range = -31.60 to -10.40), B lymphocyte (coeff. range = -3.77/-2.54, 95% CI range = -6.02 to -0.35), memory regulatory B cells (coeff. range = -0.78/-0.57, 95% CI range = -1.24 to -0.17) and CD4/CD8 ratio (coeff. range = -4.44/-0.67, 95% CI range = -1.61 to -0.17) from month 3 thereafter vs. baseline, and reduced CD3+CD20+ lymphocytes from month 12 thereafter (coeff. range = -0.32/-0.24, 95% CI range = -0.59 to -0.03). Patients not experiencing disability progression while on siponimod treatment showed B lymphocyte reduction from month 3 (coeff. range = -4.23/-2.32, 95% CI range = -7.53 to -0.15) and CD3+CD20+ lymphocyte reduction from month 12 (coeff. range = -0.32/-0.24, 95% CI range = -0.59 to -0.03) vs. patients experiencing progression. CONCLUSIONS Patients treated with siponimod showed a T and B lymphocyte reduction, especially CD4+, CD3+CD20+ and naïve regulatory T cells and memory regulatory B cells. Disability progression while on siponimod treatment was associated with a less pronounced effect on B and CD3+CD20+ lymphocytes.
Collapse
Affiliation(s)
- Antonio Luca Spiezia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giulia Scalia
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Daniele Caliendo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Antonia Fiore
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Vincenza Cerbone
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
8
|
Huerta MM, Conway DS, Planchon SM, Thoomukuntla B, Se-Hong O, Sakaie KE, Ontaneda D, Nakamura K. Longitudinal myelin content measures of slowly expanding lesions using 7T MRI in multiple sclerosis. J Neuroimaging 2024; 34:451-458. [PMID: 38778455 DOI: 10.1111/jon.13209] [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: 02/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Slowly expanding lesions (SELs) are thought to represent a subset of chronic active lesions and have been associated with clinical disability, severity, and disease progression. The purpose of this study was to characterize SELs using advanced magnetic resonance imaging (MRI) measures related to myelin and neurite density on 7 Tesla (T) MRI. METHODS The study design was retrospective, longitudinal, observational cohort with multiple sclerosis (n = 15). Magnetom 7T scanner was used to acquire magnetization-prepared 2 rapid acquisition gradient echo and advanced MRI including visualization of short transverse relaxation time component (ViSTa) for myelin, quantitative magnetization transfer (qMT) for myelin, and neurite orientation dispersion density imaging (NODDI). SELs were defined as lesions showing ≥12% of growth over 12 months on serial MRI. Comparisons of quantitative measures in SELs and non-SELs were performed at baseline and over time. Statistical analyses included two-sample t-test, analysis of variance, and mixed-effects linear model for MRI metrics between lesion types. RESULTS A total of 1075 lesions were evaluated. Two hundred twenty-four lesions (21%) were SELs, and 216 (96%) of the SELs were black holes. At baseline, compared to non-SELs, SELs showed significantly lower ViSTa (1.38 vs. 1.53, p < .001) and qMT (2.47 vs. 2.97, p < .001) but not in NODDI measures (p > .27). Longitudinally, only ViSTa showed a greater loss when comparing SEL and non-SEL (p = .03). CONCLUSIONS SELs have a lower myelin content relative to non-SELs without a difference in neurite measures. SELs showed a longitudinal decrease in apparent myelin water fraction reflecting greater tissue injury.
Collapse
Affiliation(s)
- Mina M Huerta
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah M Planchon
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Oh Se-Hong
- Department of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Ken E Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kunio Nakamura
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
9
|
Krieger S, Cook K, Hersh CM. Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold. Curr Opin Neurol 2024; 37:189-201. [PMID: 38535979 PMCID: PMC11064902 DOI: 10.1097/wco.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates the various levels of explanation through which the spectrum of disease is described and investigated both above and below the clinical threshold of detection, as framed by the topographical model of MS, to help advance a cogent mechanistic framework. RECENT FINDINGS Contemporary evidence has amended the view of MS as consisting of sequential disease phases in favor of a spectrum of disease with an admixture of interdependent and dynamic pathobiological axes driving tissue injury and progression. Recent studies have shown the presence of acute and compartmentalized inflammation and mechanisms of neurodegeneration beginning early and evolving throughout the disease continuum. Still, the gap between the understanding of immunopathologic processes in MS and the tools used to measure relevant molecular, laboratory, radiologic, and clinical metrics needs attention to enable better prognostication of disease and monitoring for changes along specific pathologic axes and variable treatment outcomes. SUMMARY Aligning on a consistently-applied mechanistic framework at distinct levels of explanation will enable greater precision across bench and clinical research, and inform discourse on drivers of disability progression and delivery of care for individuals with MS.
Collapse
Affiliation(s)
- Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai
| | - Karin Cook
- Medical Education Director, Neurology at Heartbeat/Publicis Health, New York
| | - Carrie M. Hersh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas, Nevada, USA
| |
Collapse
|
10
|
Vivó F, Solana E, Calvi A, Lopez‐Soley E, Reid LB, Pascual‐Diaz S, Garrido C, Planas‐Tardido L, Cabrera‐Maqueda JM, Alba‐Arbalat S, Sepulveda M, Blanco Y, Kanber B, Prados F, Saiz A, Llufriu S, Martinez‐Heras E. Microscopic fractional anisotropy outperforms multiple sclerosis lesion assessment and clinical outcome associations over standard fractional anisotropy tensor. Hum Brain Mapp 2024; 45:e26706. [PMID: 38867646 PMCID: PMC11170024 DOI: 10.1002/hbm.26706] [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: 12/11/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 06/14/2024] Open
Abstract
We aimed to compare the ability of diffusion tensor imaging and multi-compartment spherical mean technique to detect focal tissue damage and in distinguishing between different connectivity patterns associated with varying clinical outcomes in multiple sclerosis (MS). Seventy-six people diagnosed with MS were scanned using a SIEMENS Prisma Fit 3T magnetic resonance imaging (MRI), employing both conventional (T1w and fluid-attenuated inversion recovery) and advanced diffusion MRI sequences from which fractional anisotropy (FA) and microscopic FA (μFA) maps were generated. Using automated fiber quantification (AFQ), we assessed diffusion profiles across multiple white matter (WM) pathways to measure the sensitivity of anisotropy diffusion metrics in detecting localized tissue damage. In parallel, we analyzed structural brain connectivity in a specific patient cohort to fully grasp its relationships with cognitive and physical clinical outcomes. This evaluation comprehensively considered different patient categories, including cognitively preserved (CP), mild cognitive deficits (MCD), and cognitively impaired (CI) for cognitive assessment, as well as groups distinguished by physical impact: those with mild disability (Expanded Disability Status Scale [EDSS] <=3) and those with moderate-severe disability (EDSS >3). In our initial objective, we employed Ridge regression to forecast the presence of focal MS lesions, comparing the performance of μFA and FA. μFA exhibited a stronger association with tissue damage and a higher predictive precision for focal MS lesions across the tracts, achieving an R-squared value of .57, significantly outperforming the R-squared value of .24 for FA (p-value <.001). In structural connectivity, μFA exhibited more pronounced differences than FA in response to alteration in both cognitive and physical clinical scores in terms of effect size and number of connections. Regarding cognitive groups, FA differences between CP and MCD groups were limited to 0.5% of connections, mainly around the thalamus, while μFA revealed changes in 2.5% of connections. In the CP and CI group comparison, which have noticeable cognitive differences, the disparity was 5.6% for FA values and 32.5% for μFA. Similarly, μFA outperformed FA in detecting WM changes between the MCD and CI groups, with 5% versus 0.3% of connections, respectively. When analyzing structural connectivity between physical disability groups, μFA still demonstrated superior performance over FA, disclosing a 2.1% difference in connectivity between regions closely associated with physical disability in MS. In contrast, FA spotted a few regions, comprising only 0.6% of total connections. In summary, μFA emerged as a more effective tool than FA in predicting MS lesions and identifying structural changes across patients with different degrees of cognitive and global disability, offering deeper insights into the complexities of MS-related impairments.
Collapse
Affiliation(s)
- F. Vivó
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - E. Solana
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - A. Calvi
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - E. Lopez‐Soley
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - L. B. Reid
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - S. Pascual‐Diaz
- Institute of Neurosciences, Department of Medicine, School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - C. Garrido
- Magnetic Resonance Imaging Core FacilityInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - L. Planas‐Tardido
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - J. M. Cabrera‐Maqueda
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - S. Alba‐Arbalat
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - M. Sepulveda
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - Y. Blanco
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - B. Kanber
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain ScienceUniversity College of LondonLondonUK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
| | - F. Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain ScienceUniversity College of LondonLondonUK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
- E‐Health CenterUniversitat Oberta de CatalunyaBarcelonaSpain
| | - A. Saiz
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - S. Llufriu
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| | - E. Martinez‐Heras
- Neuroimmunology and Multiple Sclerosis Unit Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaFundació de Recerca Clínic Barcelona‐Institut d'Investigacions Biomèdiques August Pi i Sunyer and Universitat de BarcelonaBarcelonaSpain
| |
Collapse
|
11
|
Chomyk A, Kucinski R, Kim J, Christie E, Cyncynatus K, Gossman Z, Chen Z, Richardson B, Cameron M, Turner T, Dutta R, Trapp B. Transcript Profiles of Microglia/Macrophage Cells at the Borders of Chronic Active and Subpial Gray Matter Lesions in Multiple Sclerosis. Ann Neurol 2024; 95:907-916. [PMID: 38345145 PMCID: PMC11060930 DOI: 10.1002/ana.26877] [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: 08/21/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Microglia/macrophages line the border of demyelinated lesions in both cerebral white matter and the cortex in the brains of multiple sclerosis patients. Microglia/macrophages associated with chronic white matter lesions are thought to be responsible for slow lesion expansion and disability progression in progressive multiple sclerosis, whereas those lining gray matter lesions are less studied. Profiling these microglia/macrophages could help to focus therapies on genes or pathways specific to lesion expansion and disease progression. METHODS We compared the morphology and transcript profiles of microglia/macrophages associated with borders of white matter (WM line) and subpial gray matter lesions (GM line) using laser capture microscopy. We performed RNA sequencing on isolated cells followed by immunocytochemistry to determine the distribution of translational products of transcripts increased in WM line microglia. RESULTS Cells in the WM line appear activated, with shorter processes and larger cell bodies, whereas those in the GM line appear more homeostatic, with smaller cell bodies and multiple thin processes. Transcript profiling revealed 176 genes in WM lines and 111 genes in GM lines as differentially expressed. Transcripts associated with immune activation and iron homeostasis were increased in WM line microglia, whereas genes belonging to the canonical Wnt signaling pathway were increased in GM line microglia. INTERPRETATION We propose that the mechanisms of demyelination and dynamics of lesion expansion are responsible for differential transcript expression in WM lines and GM lines, and posit that increased expression of the Fc epsilon receptor, spleen tyrosine kinase, and Bruton's tyrosine kinase, play a key role in regulating microglia/macrophage function at the border of chronic active white matter lesions. ANN NEUROL 2024;95:907-916.
Collapse
Affiliation(s)
- Anthony Chomyk
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rikki Kucinski
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihye Kim
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emilie Christie
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kaitlyn Cyncynatus
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary Gossman
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zhihong Chen
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Richardson
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Cameron
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Ranjan Dutta
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bruce Trapp
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Parsi S, Zhu C, Motlagh NJ, Kim D, Küllenberg EG, Kim HH, Gillani RL, Chen JW. Basic Science of Neuroinflammation and Involvement of the Inflammatory Response in Disorders of the Nervous System. Magn Reson Imaging Clin N Am 2024; 32:375-384. [PMID: 38555147 PMCID: PMC10987041 DOI: 10.1016/j.mric.2024.01.003] [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] [Indexed: 04/02/2024]
Abstract
Neuroinflammation is a key immune response observed in many neurologic diseases. Although an appropriate immune response can be beneficial, aberrant activation of this response recruits excessive proinflammatory cells to cause damage. Because the central nervous system is separated from the periphery by the blood-brain barrier (BBB) that creates an immune-privileged site, it has its own unique immune cells and immune response. Moreover, neuroinflammation can compromise the BBB causing an influx of peripheral immune cells and factors. Recent advances have brought a deeper understanding of neuroinflammation that can be leveraged to develop more potent therapies and improve patient selection.
Collapse
Affiliation(s)
- Sepideh Parsi
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cindy Zhu
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Negin Jalali Motlagh
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daeki Kim
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Enrico G Küllenberg
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyung-Hwan Kim
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca L Gillani
- Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division, Massachusetts Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John W Chen
- Institute for Innovation in Imaging, Neurovascular Research Unit, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
13
|
Stuart CM, Varatharaj A, Zou Y, Darekar A, Domjan J, Gandini Wheeler-Kingshott CAM, Perry VH, Galea I. Systemic inflammation associates with and precedes cord atrophy in progressive multiple sclerosis. Brain Commun 2024; 6:fcae143. [PMID: 38712323 PMCID: PMC11073756 DOI: 10.1093/braincomms/fcae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024] Open
Abstract
In preclinical models of multiple sclerosis, systemic inflammation has an impact on the compartmentalized inflammatory process within the central nervous system and results in axonal loss. It remains to be shown whether this is the case in humans, specifically whether systemic inflammation contributes to spinal cord or brain atrophy in multiple sclerosis. Hence, an observational longitudinal study was conducted to delineate the relationship between systemic inflammation and atrophy using magnetic resonance imaging: the SIMS (Systemic Inflammation in Multiple Sclerosis) study. Systemic inflammation and progression were assessed in people with progressive multiple sclerosis (n = 50) over two and a half years. Eligibility criteria included: (i) primary or secondary progressive multiple sclerosis; (ii) age ≤ 70; and (iii) Expanded Disability Status Scale ≤ 6.5. First morning urine was collected weekly to quantify systemic inflammation by measuring the urinary neopterin-to-creatinine ratio using a validated ultra-performance liquid chromatography mass spectrometry technique. The urinary neopterin-to-creatinine ratio temporal profile was characterized by short-term responses overlaid on a background level of inflammation, so these two distinct processes were considered as separate variables: background inflammation and inflammatory response. Participants underwent MRI at the start and end of the study, to measure cervical spinal cord and brain atrophy. Brain and cervical cord atrophy occurred on the study, but the most striking change was seen in the cervical spinal cord, in keeping with the corticospinal tract involvement that is typical of progressive disease. Systemic inflammation predicted cervical cord atrophy. An association with brain atrophy was not observed in this cohort. A time lag between systemic inflammation and cord atrophy was evident, suggesting but not proving causation. The association of the inflammatory response with cord atrophy depended on the level of background inflammation, in keeping with experimental data in preclinical models where the effects of a systemic inflammatory challenge on tissue injury depended on prior exposure to inflammation. A higher inflammatory response was associated with accelerated cord atrophy in the presence of background systemic inflammation below the median for the study population. Higher background inflammation, while associated with cervical cord atrophy itself, subdued the association of the inflammatory response with cord atrophy. Findings were robust to sensitivity analyses adjusting for potential confounders and excluding cases with new lesion formation. In conclusion, systemic inflammation associates with, and precedes, multiple sclerosis progression. Further work is needed to prove causation since targeting systemic inflammation may offer novel treatment strategies for slowing neurodegeneration in multiple sclerosis.
Collapse
Affiliation(s)
- Charlotte M Stuart
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Aravinthan Varatharaj
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Yukai Zou
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Angela Darekar
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Janine Domjan
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Neuroinflammation, Faculty of Brain Sciences, NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - V Hugh Perry
- School of Biological Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
14
|
Klistorner S, Barnett MH, Wang C, Parratt J, Yiannikas C, Klistorner A. Longitudinal enlargement of choroid plexus is associated with chronic lesion expansion and neurodegeneration in RRMS patients. Mult Scler 2024; 30:496-504. [PMID: 38318807 PMCID: PMC11010552 DOI: 10.1177/13524585241228423] [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: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE We explored dynamic changes in the choroid plexus (CP) in patients with relapsing-remitting multiple sclerosis (RRMS) and assessed its relationship with chronic lesion expansion and atrophy in various brain compartments. METHODS Fifty-seven RRMS patients were annually assessed for a minimum of 48 months with 3D FLAIR, pre- and post-contrast 3D T1 and diffusion-weighted magnetic resonance imaging (MRI). The CP was manually segmented at baseline and last follow-up. RESULTS The volume of CP significantly increased by 1.4% annually. However, the extent of CP enlargement varied considerably among individuals (ranging from -3.6 to 150.8 mm3 or -0.2% to 6.3%). The magnitude of CP enlargement significantly correlated with central (r = 0.70, p < 0.001) and total brain atrophy (r = -0.57, p < 0.001), white (r = -0.61, p < 0.001) and deep grey matter atrophy (r = -0.60, p < 0.001). Progressive CP enlargement was significantly associated with the volume and extent of chronic lesion expansion (r = 0.60, p < 0.001), but not with the number or volume of new lesions. CONCLUSION This study provides evidence of progressive CP enlargement in patients with RRMS. Our findings also demonstrate that enlargement of the CP volume is linked to the expansion of chronic lesions and neurodegeneration of periventricular white and grey matter in RRMS patients.
Collapse
Affiliation(s)
- Samuel Klistorner
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | - John Parratt
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Alexander Klistorner
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
15
|
Arnold DL, Elliott C, Martin EC, Hyvert Y, Tomic D, Montalban X. Effect of Evobrutinib on Slowly Expanding Lesion Volume in Relapsing Multiple Sclerosis: A Post Hoc Analysis of a Phase 2 Trial. Neurology 2024; 102:e208058. [PMID: 38335474 PMCID: PMC11067693 DOI: 10.1212/wnl.0000000000208058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/19/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic active lesions (CALs) are demyelinated multiple sclerosis (MS) lesions with ongoing microglia/macrophage activity, resulting in irreversible neuronal damage and axonal loss. Evobrutinib is a highly selective, covalent, CNS-penetrant, Bruton tyrosine kinase inhibitor. This post hoc analysis evaluated the effect of evobrutinib on slowly expanding lesion (SEL) volume, an MRI marker of CALs, assessed baseline-week 48 in a phase 2, double-blind, randomized trial (NCT02975349) in relapsing MS (RMS). METHODS In the 48-week, double-blind trial, adult patients received evobrutinib (25 mg once daily [QD], 75 mg QD, or 75 mg twice daily [BID]), placebo (switched to evobrutinib 25 mg QD after week 24), or open-label dimethyl fumarate (DMF) 240 mg BID. SELs were defined as slowly and consistently radially expanding areas of preexisting T2 lesions of ≥10 contiguous voxels (∼30 mm3) over time. SELs were identified by MRI and assessed by the Jacobian determinant of the nonlinear deformation from baseline to week 48. SEL volume analysis, stratified by baseline T2 lesion volume tertiles, was based on week 48/end-of-treatment status (completers/non-completers). Treatment effect was analyzed using the stratified Hodges-Lehmann estimate of shift in distribution and stratified Wilcoxon rank-sum test. Comparisons of evobrutinib and DMF vs placebo/evobrutinib 25 mg QD were made. Subgroup analyses used pooled treatment groups (evobrutinib high dose [75 mg QD/BID] vs low dose [placebo/evobrutinib 25 mg QD]). RESULTS The SEL analysis set included 223 patients (mean [SD] age: 42.4 [10.7] years; 69.3% female; 87.4% relapsing/remitting MS). Mean (SD) SEL volume was 2,099 (2,981.0) mm3 with evobrutinib 75 mg BID vs 2,681 (3,624.2) mm3 with placebo/evobrutinib 25 mg QD. Median number of SELs/patient ranged from 7 to 11 across treatments. SEL volume decreased with increasing evobrutinib dose vs placebo/evobrutinib 25 mg QD, and no difference with DMF vs placebo/evobrutinib 25 mg QD was noted. SEL volume significantly decreased with evobrutinib 75 mg BID vs placebo/evobrutinib 25 mg QD (-474.5 mm3 [-1,098.0 to -3.0], p = 0.047) and vs DMF (-711.6 [-1,290.0 to -149.0], p = 0.011). SEL volume was significantly reduced for evobrutinib high vs low dose within baseline Expanded Disability Status Scale ≥3.5 and longer disease duration (≥8.5 years) subgroups. DISCUSSION Evobrutinib reduced SEL volume in a dose-dependent manner in RMS, with a significant reduction with evobrutinib 75 mg BID. This is evident that evobrutinib affects brain lesions associated with chronic inflammation and tissue loss. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov number: NCT02975349. Submitted to ClinicalTrials.gov on November 29, 2016. First patient enrolled: March 7, 2017. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that evobrutinib reduces the volume of SELs assessed on MRI comparing baseline with week 48, in patients with RMS.
Collapse
Affiliation(s)
- Douglas L Arnold
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Colm Elliott
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Emily C Martin
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Yann Hyvert
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Davorka Tomic
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- From the Montreal Neurological Institute (D.L.A.), McGill University; NeuroRx Research (D.L.A., C.E.), Montreal, Quebec, Canada; EMD Serono (E.C.M.), Billerica, MA; The Healthcare Business of Merck KGaA (Y.H.); Ares Trading SA (D.T.), Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany; and Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (X.M.), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
16
|
Nakamura K, Thoomukuntla B, Bena J, Cohen JA, Fox RJ, Ontaneda D. Ibudilast reduces slowly enlarging lesions in progressive multiple sclerosis. Mult Scler 2024; 30:369-380. [PMID: 38286755 PMCID: PMC11190892 DOI: 10.1177/13524585231224702] [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] [Indexed: 01/31/2024]
Abstract
BACKGROUND Ibudilast has shown beneficial effects on several imaging outcomes in progressive multiple sclerosis (MS). Slowly enlarging lesions are a proposed imaging biomarker of compartmentalized inflammation within chronic active lesions. OBJECTIVE To assess the treatment effect of ibudilast on slowly enlarging lesion volumes over 96 weeks from a phase II clinical trial of ibudilast (Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in Multiple Sclerosis [SPRINT-MS]). METHODS In total, 255 participants with progressive MS from 28 sites were randomized to oral ibudilast or placebo. Participants with at least four analyzable magnetic resonance imaging (MRI) were included. Slowly enlarging lesions were quantified using Jacobian determinant maps. A linear model was used to assess the effect of ibudilast. Magnetization transfer ratio within slowly enlarging lesions was assessed to determine the effect of ibudilast on tissue integrity. RESULTS In total, 195 participants were included in this analysis. Ibudilast significantly decreased slowly enlarging lesion volume (23%, p = 0.003). Ibudilast also reduced magnetization transfer ratio change in slowly enlarging lesions: 0.22%/year, p = 0.04. CONCLUSION Ibudilast showed a significant effect on baseline volume of lesions that were slowly enlarging and magnetization transfer ratio in slowly enlarging lesions. The results support the use of slowly enlarging lesions for assessment of compartmentalized inflammation represented by chronic active lesions and provide further support for the neuroprotective effects of ibudilast in progressive MS.
Collapse
Affiliation(s)
- Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bhaskar Thoomukuntla
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
17
|
Federau C, Hainc N, Edjlali M, Zhu G, Mastilovic M, Nierobisch N, Uhlemann JP, Paganucci S, Granziera C, Heinzlef O, Kipp LB, Wintermark M. Evaluation of the quality and the productivity of neuroradiological reading of multiple sclerosis follow-up MRI scans using an intelligent automation software. Neuroradiology 2024; 66:361-369. [PMID: 38265684 PMCID: PMC10859335 DOI: 10.1007/s00234-024-03293-3] [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: 09/24/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The assessment of multiple sclerosis (MS) lesions on follow-up magnetic resonance imaging (MRI) is tedious, time-consuming, and error-prone. Automation of low-level tasks could enhance the radiologist in this work. We evaluate the intelligent automation software Jazz in a blinded three centers study, for the assessment of new, slowly expanding, and contrast-enhancing MS lesions. METHODS In three separate centers, 117 MS follow-up MRIs were blindly analyzed on fluid attenuated inversion recovery (FLAIR), pre- and post-gadolinium T1-weighted images using Jazz by 2 neuroradiologists in each center. The reading time was recorded. The ground truth was defined in a second reading by side-by-side comparison of both reports from Jazz and the standard clinical report. The number of described new, slowly expanding, and contrast-enhancing lesions described with Jazz was compared to the lesions described in the standard clinical report. RESULTS A total of 96 new lesions from 41 patients and 162 slowly expanding lesions (SELs) from 61 patients were described in the ground truth reading. A significantly larger number of new lesions were described using Jazz compared to the standard clinical report (63 versus 24). No SELs were reported in the standard clinical report, while 95 SELs were reported on average using Jazz. A total of 4 new contrast-enhancing lesions were found in all reports. The reading with Jazz was very time efficient, taking on average 2min33s ± 1min0s per case. Overall inter-reader agreement for new lesions between the readers using Jazz was moderate for new lesions (Cohen kappa = 0.5) and slight for SELs (0.08). CONCLUSION The quality and the productivity of neuroradiological reading of MS follow-up MRI scans can be significantly improved using the dedicated software Jazz.
Collapse
Affiliation(s)
- Christian Federau
- AI Medical AG, Goldhaldenstr 22a, 8702, Zollikon, Switzerland.
- University of Zürich, Zürich, Switzerland.
| | - Nicolin Hainc
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Myriam Edjlali
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, Paris, France
- Laboratoire d'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hopsitalier Frédéric Joliot, Orsay, France
| | | | - Milica Mastilovic
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, Paris, France
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nathalie Nierobisch
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Jan-Philipp Uhlemann
- University of Zürich, Zürich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | | | | | - Olivier Heinzlef
- Department of Neurology, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
- CRC SEP IDF Ouest, Poissy-Garches, France
| | - Lucas B Kipp
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Stanford University, Stanford, USA
- MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
18
|
Chertcoff A, Schneider R, Azevedo CJ, Sicotte N, Oh J. Recent Advances in Diagnostic, Prognostic, and Disease-Monitoring Biomarkers in Multiple Sclerosis. Neurol Clin 2024; 42:15-38. [PMID: 37980112 DOI: 10.1016/j.ncl.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease. Currently, a combination of clinical features, MRI, and cerebrospinal fluid markers are used in clinical practice for diagnosis and treatment decisions. In recent years, there has been considerable effort to develop novel biomarkers that better reflect the pathologic substrates of the disease to aid in diagnosis and early prognosis, evaluation of ongoing inflammatory activity, detection and monitoring of disease progression, prediction of treatment response, and monitoring of disease-modifying treatment safety. In this review, the authors provide an overview of promising recent developments in diagnostic, prognostic, and disease-monitoring/treatment-response biomarkers in MS.
Collapse
Affiliation(s)
- Anibal Chertcoff
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Raphael Schneider
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine, University of Southern California, HCT 1520 San Pablo Street, Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Nancy Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, 127 S San Vicente Boulevard, 6th floor, Suite A6600, Los Angeles, CA 90048, USA
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
19
|
Jakimovski D, Bittner S, Zivadinov R, Morrow SA, Benedict RH, Zipp F, Weinstock-Guttman B. Multiple sclerosis. Lancet 2024; 403:183-202. [PMID: 37949093 DOI: 10.1016/s0140-6736(23)01473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 11/12/2023]
Abstract
Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ralph Hb Benedict
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
20
|
Bellanca CM, Augello E, Mariottini A, Bonaventura G, La Cognata V, Di Benedetto G, Cantone AF, Attaguile G, Di Mauro R, Cantarella G, Massacesi L, Bernardini R. Disease Modifying Strategies in Multiple Sclerosis: New Rays of Hope to Combat Disability? Curr Neuropharmacol 2024; 22:1286-1326. [PMID: 38275058 PMCID: PMC11092922 DOI: 10.2174/1570159x22666240124114126] [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: 05/04/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is the most prevalent chronic autoimmune inflammatory- demyelinating disorder of the central nervous system (CNS). It usually begins in young adulthood, mainly between the second and fourth decades of life. Usually, the clinical course is characterized by the involvement of multiple CNS functional systems and by different, often overlapping phenotypes. In the last decades, remarkable results have been achieved in the treatment of MS, particularly in the relapsing- remitting (RRMS) form, thus improving the long-term outcome for many patients. As deeper knowledge of MS pathogenesis and respective molecular targets keeps growing, nowadays, several lines of disease-modifying treatments (DMT) are available, an impressive change compared to the relative poverty of options available in the past. Current MS management by DMTs is aimed at reducing relapse frequency, ameliorating symptoms, and preventing clinical disability and progression. Notwithstanding the relevant increase in pharmacological options for the management of RRMS, research is now increasingly pointing to identify new molecules with high efficacy, particularly in progressive forms. Hence, future efforts should be concentrated on achieving a more extensive, if not exhaustive, understanding of the pathogenetic mechanisms underlying this phase of the disease in order to characterize novel molecules for therapeutic intervention. The purpose of this review is to provide a compact overview of the numerous currently approved treatments and future innovative approaches, including neuroprotective treatments as anti-LINGO-1 monoclonal antibody and cell therapies, for effective and safe management of MS, potentially leading to a cure for this disease.
Collapse
Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Alice Mariottini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Gabriele Bonaventura
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Valentina La Cognata
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Attaguile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| |
Collapse
|
21
|
Calvi A, Mendelsohn Z, Hamed W, Chard D, Tur C, Stutters J, MacManus D, Kanber B, Wheeler-Kingshott CAMG, Barkhof F, Prados F. Treatment reduces the incidence of newly appearing multiple sclerosis lesions evolving into chronic active, slowly expanding lesions: A retrospective analysis. Eur J Neurol 2024; 31:e16092. [PMID: 37823722 DOI: 10.1111/ene.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Newly appearing lesions in multiple sclerosis (MS) may evolve into chronically active, slowly expanding lesions (SELs), leading to sustained disability progression. The aim of this study was to evaluate the incidence of newly appearing lesions developing into SELs, and their correlation to clinical evolution and treatment. METHODS A retrospective analysis of a fingolimod trial in primary progressive MS (PPMS; INFORMS, NCT00731692) was undertaken. Data were available from 324 patients with magnetic resonance imaging scans up to 3 years after screening. New lesions at year 1 were identified with convolutional neural networks, and SELs obtained through a deformation-based method. Clinical disability was assessed annually by Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test, Timed 25-Foot Walk, and Paced Auditory Serial Addition Test. Linear, logistic, and mixed-effect models were used to assess the relationship between the Jacobian expansion in new lesions and SELs, disability scores, and treatment status. RESULTS One hundred seventy patients had ≥1 new lesions at year 1 and had a higher lesion count at screening compared to patients with no new lesions (median = 27 vs. 22, p = 0.007). Among the new lesions (median = 2 per patient), 37% evolved into definite or possible SELs. Higher SEL volume and count were associated with EDSS worsening and confirmed disability progression. Treated patients had lower volume and count of definite SELs (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.01, p = 0.015; β = -0.36, 95% CI = -0.67 to -0.06, p = 0.019, respectively). CONCLUSIONS Incident chronic active lesions are common in PPMS, and fingolimod treatment can reduce their number.
Collapse
Affiliation(s)
- Alberto Calvi
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Fundació Clinic per a la Recerca Biomèdica, Barcelona, Spain
| | - Zoe Mendelsohn
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Weaam Hamed
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Mansoura University Hospital, Mansoura, Egypt
| | - Declan Chard
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Carmen Tur
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jon Stutters
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - David MacManus
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - Baris Kanber
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Frederik Barkhof
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam, the Netherlands
| | - Ferran Prados
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
22
|
Hartung HP, Cree BA, Barnett M, Meuth SG, Bar-Or A, Steinman L. Bioavailable central nervous system disease-modifying therapies for multiple sclerosis. Front Immunol 2023; 14:1290666. [PMID: 38162670 PMCID: PMC10755740 DOI: 10.3389/fimmu.2023.1290666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
Disease-modifying therapies for relapsing multiple sclerosis reduce relapse rates by suppressing peripheral immune cells but have limited efficacy in progressive forms of the disease where cells in the central nervous system play a critical role. To our knowledge, alemtuzumab, fumarates (dimethyl, diroximel, and monomethyl), glatiramer acetates, interferons, mitoxantrone, natalizumab, ocrelizumab, ofatumumab, and teriflunomide are either limited to the periphery or insufficiently studied to confirm direct central nervous system effects in participants with multiple sclerosis. In contrast, cladribine and sphingosine 1-phosphate receptor modulators (fingolimod, ozanimod, ponesimod, and siponimod) are central nervous system-penetrant and could have beneficial direct central nervous system properties.
Collapse
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Palacký University Olomouc, Olomouc, Czechia
| | - Bruce A.C. Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lawrence Steinman
- Department of Neurology and Neurological Sciences, Beckman Center for Molecular Medicine, Stanford University Medical Center, Stanford, CA, United States
| |
Collapse
|
23
|
Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [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] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
Collapse
Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
24
|
Maggi P, Bulcke CV, Pedrini E, Bugli C, Sellimi A, Wynen M, Stölting A, Mullins WA, Kalaitzidis G, Lolli V, Perrotta G, El Sankari S, Duprez T, Li X, Calabresi PA, van Pesch V, Reich DS, Absinta M. B cell depletion therapy does not resolve chronic active multiple sclerosis lesions. EBioMedicine 2023; 94:104701. [PMID: 37437310 PMCID: PMC10436266 DOI: 10.1016/j.ebiom.2023.104701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Chronic active lesions (CAL) in multiple sclerosis (MS) have been observed even in patients taking high-efficacy disease-modifying therapy, including B-cell depletion. Given that CAL are a major determinant of clinical progression, including progression independent of relapse activity (PIRA), understanding the predicted activity and real-world effects of targeting specific lymphocyte populations is critical for designing next-generation treatments to mitigate chronic inflammation in MS. METHODS We analyzed published lymphocyte single-cell transcriptomes from MS lesions and bioinformatically predicted the effects of depleting lymphocyte subpopulations (including CD20 B-cells) from CAL via gene-regulatory-network machine-learning analysis. Motivated by the results, we performed in vivo MRI assessment of PRL changes in 72 adults with MS, 46 treated with anti-CD20 antibodies and 26 untreated, over ∼2 years. FINDINGS Although only 4.3% of lymphocytes in CAL were CD20 B-cells, their depletion is predicted to affect microglial genes involved in iron/heme metabolism, hypoxia, and antigen presentation. In vivo, tracking 202 PRL (150 treated) and 175 non-PRL (124 treated), none of the treated paramagnetic rims disappeared at follow-up, nor was there a treatment effect on PRL for lesion volume, magnetic susceptibility, or T1 time. PIRA occurred in 20% of treated patients, more frequently in those with ≥4 PRL (p = 0.027). INTERPRETATION Despite predicted effects on microglia-mediated inflammatory networks in CAL and iron metabolism, anti-CD20 therapies do not fully resolve PRL after 2-year MRI follow up. Limited tissue turnover of B-cells, inefficient passage of anti-CD20 antibodies across the blood-brain-barrier, and a paucity of B-cells in CAL could explain our findings. FUNDING Intramural Research Program of NINDS, NIH; NINDS grants R01NS082347 and R01NS082347; Dr. Miriam and Sheldon G. Adelson Medical Research Foundation; Cariplo Foundation (grant #1677), FRRB Early Career Award (grant #1750327); Fund for Scientific Research (FNRS).
Collapse
Affiliation(s)
- Pietro Maggi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium; Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
| | - Colin Vanden Bulcke
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Edoardo Pedrini
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Céline Bugli
- Plateforme Technologique de Support en Méthodologie et Calcul Statistique, Université Catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Maxence Wynen
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Anna Stölting
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - William A Mullins
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Grigorios Kalaitzidis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Lolli
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Gaetano Perrotta
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Souraya El Sankari
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Xu Li
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Martina Absinta
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
25
|
Temmerman J, Engelborghs S, Bjerke M, D’haeseleer M. Cerebrospinal fluid inflammatory biomarkers for disease progression in Alzheimer's disease and multiple sclerosis: a systematic review. Front Immunol 2023; 14:1162340. [PMID: 37520580 PMCID: PMC10374015 DOI: 10.3389/fimmu.2023.1162340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023] Open
Abstract
Inflammatory processes are involved in the pathophysiology of both Alzheimer's disease (AD) and multiple sclerosis (MS) but their exact contribution to disease progression remains to be deciphered. Biomarkers are needed to define pathophysiological processes of these disorders, who may increasingly co-exist in the elderly generations of the future, due to the rising prevalence in both and ameliorated treatment options with improved life expectancy in MS. The purpose of this review was to provide a systematic overview of inflammatory biomarkers, as measured in the cerebrospinal fluid (CSF), that are associated with clinical disease progression. International peer-reviewed literature was screened using the PubMed and Web of Science databases. Disease progression had to be measured using clinically validated tests representing baseline functional and/or cognitive status, the evolution of such clinical scores over time and/or the transitioning from one disease stage to a more severe stage. The quality of included studies was systematically evaluated using a set of questions for clinical, neurochemical and statistical characteristics of the study. A total of 84 papers were included (twenty-five for AD and 59 for MS). Elevated CSF levels of chitinase-3-like protein 1 (YKL-40) were associated with disease progression in both AD and MS. Osteopontin and monocyte chemoattractant protein-1 were more specifically related to disease progression in AD, whereas the same was true for interleukin-1 beta, tumor necrosis factor alpha, C-X-C motif ligand 13, glial fibrillary acidic protein and IgG oligoclonal bands in MS. We observed a broad heterogeneity of studies with varying cohort characterization, non-disclosure of quality measures for neurochemical analyses and a lack of adequate longitudinal designs. Most of the retrieved biomarkers are related to innate immune system activity, which seems to be an important mediator of clinical disease progression in AD and MS. Overall study quality was limited and we have framed some recommendations for future biomarker research in this field. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021264741.
Collapse
Affiliation(s)
- Joke Temmerman
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Jette, Brussels, Belgium
- Universiteit Antwerpen, Department of Biomedical Sciences and Institute Born-Bunge, Reference Center for Biological Markers of Dementia (BIODEM), Wilrijk, Antwerp, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Jette, Brussels, Belgium
| | - Sebastiaan Engelborghs
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Jette, Brussels, Belgium
- Universiteit Antwerpen, Department of Biomedical Sciences and Institute Born-Bunge, Reference Center for Biological Markers of Dementia (BIODEM), Wilrijk, Antwerp, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Jette, Brussels, Belgium
| | - Maria Bjerke
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Jette, Brussels, Belgium
- Universiteit Antwerpen, Department of Biomedical Sciences and Institute Born-Bunge, Reference Center for Biological Markers of Dementia (BIODEM), Wilrijk, Antwerp, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Jette, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Department of Clinical Biology, Laboratory of Clinical Neurochemistry, Jette, Brussels, Belgium
| | - Miguel D’haeseleer
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Jette, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Jette, Brussels, Belgium
- National MS Center (NMSC), Neurology, Melsbroek, Steenokkerzeel, Belgium
| |
Collapse
|
26
|
Bittner S, Pape K, Klotz L, Zipp F. Implications of immunometabolism for smouldering MS pathology and therapy. Nat Rev Neurol 2023:10.1038/s41582-023-00839-6. [PMID: 37430070 DOI: 10.1038/s41582-023-00839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
Clinical symptom worsening in patients with multiple sclerosis (MS) is driven by inflammation compartmentalized within the CNS, which results in chronic neuronal damage owing to insufficient repair mechanisms. The term 'smouldering inflammation' summarizes the biological aspects underlying this chronic, non-relapsing and immune-mediated mechanism of disease progression. Smouldering inflammation is likely to be shaped and sustained by local factors in the CNS that account for the persistence of this inflammatory response and explain why current treatments for MS do not sufficiently target this process. Local factors that affect the metabolic properties of glial cells and neurons include cytokines, pH value, lactate levels and nutrient availability. This Review summarizes current knowledge of the local inflammatory microenvironment in smouldering inflammation and how it interacts with the metabolism of tissue-resident immune cells, thereby promoting inflammatory niches within the CNS. The discussion highlights environmental and lifestyle factors that are increasingly recognized as capable of altering immune cell metabolism and potentially responsible for smouldering pathology in the CNS. Currently approved MS therapies that target metabolic pathways are also discussed, along with their potential for preventing the processes that contribute to smouldering inflammation and thereby to progressive neurodegenerative damage in MS.
Collapse
Affiliation(s)
- Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Katrin Pape
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| |
Collapse
|
27
|
Everest E, Uygunoglu U, Tutuncu M, Bulbul A, Onat UI, Unal M, Avsar T, Saip S, Bilge U, Turanli ET, Siva A. Prospective outcome analysis of multiple sclerosis cases reveals candidate prognostic cerebrospinal fluid markers. PLoS One 2023; 18:e0287463. [PMID: 37339131 DOI: 10.1371/journal.pone.0287463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Predicting the long-term disability outcomes of multiple sclerosis (MS) cases is challenging. OBJECTIVE We prospectively analysed our previous MS cohort with initial cerebrospinal fluid (CSF) proteomics data to reveal disability markers after 8.2±2.2 years of follow-up. METHODS Patients with regular follow-up visits were assigned into two groups: those with an age-related MS severity (ARMSS) score ≥5 (unfavourable course group, N = 27) and ARMSS score <5 (favourable course group, N = 67). A machine learning-based algorithm was applied to reveal candidate poor prognosis-associated initial CSF proteins, which were measured in an independent MS cohort (verification group, N = 40) by ELISA. Additionally, the correlation of initial clinical and radiological parameters with long-term disability was analysed. RESULTS CSF alpha-2-macroglobulin (P = 0.0015), apo-A1 (P = 0.0016), and haptoglobin (P = 0.0003) protein levels, as well as cerebral lesion load (>9 lesions) on magnetic resonance imaging, gait disturbance (P = 0.04), and bladder/bowel symptoms (P = 0.01) were significantly higher in the unfavourable course group than in the favourable course group. Optic nerve involvement evident on initial magnetic resonance imaging (P = 0.002) and optic neuritis (P = 0.01) were more frequent in the favourable course group. CONCLUSION The herein identified initial CSF protein levels, in addition to the clinical and radiological parameters at disease onset, have predictive value for long-term disability in MS cases.
Collapse
Affiliation(s)
- Elif Everest
- Department of Molecular Biology and Genetics, Faculty of Science and Letters, Istanbul Technical University, Istanbul, Turkey
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Melih Tutuncu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alper Bulbul
- Department of Biostatistics and Bioinformatics, Institute of Health Sciences, Acibadem University, Istanbul, Turkey
| | - Umut Inci Onat
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Turkey
| | - Mehmetcan Unal
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Turkey
| | - Timucin Avsar
- Department of Medical Biology, Faculty of Medicine, Basic Medical Sciences, Bahcesehir University, Istanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ugur Bilge
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Eda Tahir Turanli
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Turkey
- Graduate School of Natural and Applied Sciences, Molecular and Translational Biomedicine Program, Acibadem University, Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
28
|
Calvi A, Clarke MA, Prados F, Chard D, Ciccarelli O, Alberich M, Pareto D, Rodríguez Barranco M, Sastre-Garriga J, Tur C, Rovira A, Barkhof F. Relationship between paramagnetic rim lesions and slowly expanding lesions in multiple sclerosis. Mult Scler 2023; 29:352-362. [PMID: 36515487 PMCID: PMC9972234 DOI: 10.1177/13524585221141964] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) markers for chronic active lesions in MS include slowly expanding lesions (SELs) and paramagnetic rim lesions (PRLs). OBJECTIVES To identify the relationship between SELs and PRLs in MS, and their association with disability. METHODS 61 people with MS (pwMS) followed retrospectively with MRI including baseline susceptibility-weighted imaging, and longitudinal T1 and T2-weighted scans. SELs were computed using deformation field maps; PRLs were visually identified. Mixed-effects models assessed differences in Expanded Disability Status Scale (EDSS) score changes between the group defined by the presence of SELs and or PRLs. RESULTS The median follow-up time was 3.2 years. At baseline, out of 1492 lesions, 616 were classified as SELs, and 80 as PRLs. 92% of patients had ⩾ 1 SEL, 56% had ⩾ 1 PRL, while both were found in 51%. SELs compared to non-SELs were more likely to also be PRLs (7% vs. 4%, p = 0.027). PRL counts positively correlated with SEL counts (ρ= 0.28, p = 0.03). SEL + PRL + patients had greater increases in EDSS over time (beta = 0.15/year, 95% confidence interval (0.04, 0.27), p = 0.009) than SEL+PRL-patients. CONCLUSION SELs are more numerous than PRLs in pwMS. Compared with either SELs or PRLs found in isolation, their joint occurrence was associated with greater clinical progression.
Collapse
Affiliation(s)
- Alberto Calvi
- A Calvi Queen Square MS Centre, Department
of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, WC1B 5 EH, UK.
| | | | - Ferran Prados
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK/e-Health Centre, Universitat Oberta de
Catalunya, Barcelona, Spain
| | - Declan Chard
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Biomedical Research Centre,
National Institute for Health Research (NIHR) and University College London
Hospitals (UCLH), London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Biomedical Research Centre,
National Institute for Health Research (NIHR) and University College London
Hospitals (UCLH), London, UK
| | - Manel Alberich
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Marta Rodríguez Barranco
- Neurology-Neuroimmunology Department, Multiple
Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron Barcelona Hospital
Campus, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple
Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron Barcelona Hospital
Campus, Barcelona, Spain
| | - Carmen Tur
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Neurology-Neuroimmunology
Department, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Frederik Barkhof
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK Biomedical Research Centre, National
Institute for Health Research (NIHR) and University College London Hospitals
(UCLH), London, UK/Radiology & Nuclear medicine, VU University Medical
Centre, Amsterdam, The Netherlands
| |
Collapse
|
29
|
Advances in Neurodegenerative Diseases. J Clin Med 2023; 12:jcm12051709. [PMID: 36902495 PMCID: PMC10002914 DOI: 10.3390/jcm12051709] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Neurological disorders are the leading cause of physical and cognitive disability across the globe, currently affecting approximately 15% of the worldwide population [...].
Collapse
|
30
|
Potentially toxic elements in the brains of people with multiple sclerosis. Sci Rep 2023; 13:655. [PMID: 36635465 PMCID: PMC9837144 DOI: 10.1038/s41598-022-27169-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023] Open
Abstract
Potentially toxic elements such as lead and aluminium have been proposed to play a role in the pathogenesis of multiple sclerosis (MS), since their neurotoxic mechanisms mimic many of the pathogenetic processes in MS. We therefore examined the distribution of several potentially toxic elements in the autopsied brains of people with and without MS, using two methods of elemental bio-imaging. Toxicants detected in the locus ceruleus were used as indicators of past exposures. Autometallography of paraffin sections from multiple brain regions of 21 MS patients and 109 controls detected inorganic mercury, silver, or bismuth in many locus ceruleus neurons of both groups, and in widespread blood vessels, oligodendrocytes, astrocytes, and neurons of four MS patients and one control. Laser ablation-inductively coupled plasma-mass spectrometry imaging of pons paraffin sections from all MS patients and 12 controls showed that combinations of iron, silver, lead, aluminium, mercury, nickel, and bismuth were present more often in the locus ceruleus of MS patients and were located predominantly in white matter tracts. Based on these results, we propose that metal toxicants in locus ceruleus neurons weaken the blood-brain barrier, enabling multiple interacting toxicants to pass through blood vessels and enter astrocytes and oligodendroglia, leading to demyelination.
Collapse
|
31
|
Oship D, Jakimovski D, Bergsland N, Horakova D, Uher T, Vaneckova M, Havrdova E, Dwyer MG, Zivadinov R. Assessment of T2 lesion-based disease activity volume outcomes in predicting disease progression in multiple sclerosis over 10 years. Mult Scler Relat Disord 2022; 67:104187. [PMID: 36150263 DOI: 10.1016/j.msard.2022.104187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/16/2022] [Accepted: 09/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND New/enlarging T2 lesion count and T2-lesion volume (LV) are used as conventional secondary endpoints in clinical trials of patients with multiple sclerosis (PwMS). However, those outcomes may have several limitations, such as inability to account for heterogeneity of lesion formation/enlargement frequency and their dynamic volumetric behavior. Measurement of volume rather than count of new/enlarging lesions may be more representative outcome of dynamic changes over time. OBJECTIVES To investigate whether new/enlarging T2-LV is more predictive of confirmed disability progression (CDP), compared to total T2-LV or new/enlarging T2 lesion count over long-term follow-up. METHODS We studied 176 early relapsing-remitting PwMS who were followed with annual MRI examinations over 10 years. T2-LV, new/enlarging T2-LV, and new/enlarging lesion count were determined. Cumulative count/volumes were obtained. 10-year CDP was confirmed after 48-weeks. ANCOVA analysis detected MRI outcome differences in stable (n = 76) and CDP (n = 100) groups at different time points, after correction for multiple comparisons. RESULTS PwMS with CDP had greater cumulative new/enlarging T2-LV at 4 years (p = 0.049), and enlarging T2-LV at 4- (p = 0.039) and 6-year follow-up (p = 0.032), compared to stable patients. PwMS with CDP did not differ from stable ones in new/enlarging T2 lesion count or total T2-LV at any of the study timepoints. PwMS with Expanded Disability Status Scale change >2.0 had significantly greater enlarging T2 lesion count (p = 0.01) and enlarging T2-LV (p = 0.038) over the 10-year follow-up. CONCLUSION Enlargement of T2 lesions is more strongly associated with long-term disability progression compared to other conventional T2 lesion-based outcomes.
Collapse
Affiliation(s)
- Devon Oship
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States.
| |
Collapse
|
32
|
Zuroff L, Rezk A, Shinoda K, Espinoza DA, Elyahu Y, Zhang B, Chen AA, Shinohara RT, Jacobs D, Alcalay RN, Tropea TF, Chen-Plotkin A, Monsonego A, Li R, Bar-Or A. Immune aging in multiple sclerosis is characterized by abnormal CD4 T cell activation and increased frequencies of cytotoxic CD4 T cells with advancing age. EBioMedicine 2022; 82:104179. [PMID: 35868128 PMCID: PMC9305354 DOI: 10.1016/j.ebiom.2022.104179] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Immunosenescence (ISC) describes age-related changes in immune-system composition and function. Multiple sclerosis (MS) is a lifelong inflammatory condition involving effector and regulatory T-cell imbalance, yet little is known about T-cell ISC in MS. We examined age-associated changes in circulating T cells in MS compared to normal controls (NC). METHODS Forty untreated MS (Mean Age 43·3, Range 18-72) and 49 NC (Mean Age 48·6, Range 20-84) without inflammatory conditions were included in cross-sectional design. T-cell subsets were phenotypically and functionally characterized using validated multiparametric flow cytometry. Their aging trajectories, and differences between MS and NC, were determined using linear mixed-effects models. FINDINGS MS patients demonstrated early and persistent redistribution of naïve and memory CD4 T-cell compartments. While most CD4 and CD8 T-cell aging trajectories were similar between groups, MS patients exhibited abnormal age-associated increases of activated (HLA-DR+CD38+; (P = 0·013) and cytotoxic CD4 T cells, particularly in patients >60 (EOMES: P < 0·001). Aging MS patients also failed to upregulate CTLA-4 expression on both CD4 (P = 0·014) and CD8 (P = 0·009) T cells, coupled with abnormal age-associated increases in frequencies of B cells expressing costimulatory molecules. INTERPRETATION While many aspects of T-cell aging in MS are conserved, the older MS patients harbour abnormally increased frequencies of CD4 T cells with activated and cytotoxic effector profiles. Age-related decreased expression of T-cell co-inhibitory receptor CTLA-4, and increased B-cell costimulatory molecule expression, may provide a mechanism that drives aberrant activation of effector CD4 T cells that have been implicated in progressive disease. FUNDING Stated in Acknowledgements section of manuscript.
Collapse
Affiliation(s)
- Leah Zuroff
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ayman Rezk
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Koji Shinoda
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Diego A Espinoza
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yehezqel Elyahu
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences; Zlotowski Neuroscience Center and Regenerative Medicine and Stem Cell Research Center; and National Institute for Biotechnology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Bo Zhang
- Department of Cardiology, The fourth affiliated hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
| | - Andrew A Chen
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dina Jacobs
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Roy N Alcalay
- Department of Neurology, Columbia University, New York, NY 10032, USA; The Center for Movement Disorders, Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6423914, Israel
| | - Thomas F Tropea
- Department of Neurology, Perelman school of medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman school of medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alon Monsonego
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences; Zlotowski Neuroscience Center and Regenerative Medicine and Stem Cell Research Center; and National Institute for Biotechnology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Rui Li
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Amit Bar-Or
- The Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
33
|
Breaching Brain Barriers: B Cell Migration in Multiple Sclerosis. Biomolecules 2022; 12:biom12060800. [PMID: 35740925 PMCID: PMC9221446 DOI: 10.3390/biom12060800] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/25/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) known for the manifestation of demyelinated lesions throughout the CNS, leading to neurodegeneration. To date, not all pathological mechanisms that drive disease progression are known, but the clinical benefits of anti-CD20 therapies have put B cells in the spotlight of MS research. Besides their pathological effects in the periphery in MS, B cells gain access to the CNS where they can contribute to disease pathogenesis. Specifically, B cells accumulate in perivascular infiltrates in the brain parenchyma and the subarachnoid spaces of the meninges, but are virtually absent from the choroid plexus. Hence, the possible migration of B cells over the blood-brain-, blood-meningeal-, and blood-cerebrospinal fluid (CSF) barriers appears to be a crucial step to understanding B cell-mediated pathology. To gain more insight into the molecular mechanisms that regulate B cell trafficking into the brain, we here provide a comprehensive overview of the different CNS barriers in health and in MS and how they translate into different routes for B cell migration. In addition, we review the mechanisms of action of diverse therapies that deplete peripheral B cells and/or block B cell migration into the CNS. Importantly, this review shows that studying the different routes of how B cells enter the inflamed CNS should be the next step to understanding this disease.
Collapse
|
34
|
Collongues N, Becker G, Jolivel V, Ayme-Dietrich E, de Seze J, Binamé F, Patte-Mensah C, Monassier L, Mensah-Nyagan AG. A Narrative Review on Axonal Neuroprotection in Multiple Sclerosis. Neurol Ther 2022; 11:981-1042. [PMID: 35610531 PMCID: PMC9338208 DOI: 10.1007/s40120-022-00363-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 01/08/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) resulting in demyelination and neurodegeneration. The therapeutic strategy is now largely based on reducing inflammation with immunosuppressive drugs. Unfortunately, when disease progression is observed, no drug offers neuroprotection apart from its anti-inflammatory effect. In this review, we explore current knowledge on the assessment of neurodegeneration in MS and look at putative targets that might prove useful in protecting the axon from degeneration. Among them, Bruton's tyrosine kinase inhibitors, anti-apoptotic and antioxidant agents, sex hormones, statins, channel blockers, growth factors, and molecules preventing glutamate excitotoxicity have already been studied. Some of them have reached phase III clinical trials and carry a great message of hope for our patients with MS.
Collapse
Affiliation(s)
- Nicolas Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France. .,Center for Clinical Investigation, INSERM U1434, Strasbourg, France. .,Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France. .,University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.
| | - Guillaume Becker
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Valérie Jolivel
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Estelle Ayme-Dietrich
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Jérôme de Seze
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.,Center for Clinical Investigation, INSERM U1434, Strasbourg, France.,Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Fabien Binamé
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Christine Patte-Mensah
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Laurent Monassier
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Ayikoé Guy Mensah-Nyagan
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| |
Collapse
|
35
|
Calvi A, Tur C, Chard D, Stutters J, Ciccarelli O, Cortese R, Battaglini M, Pietroboni A, De Riz M, Galimberti D, Scarpini E, De Stefano N, Prados F, Barkhof F. Slowly expanding lesions relate to persisting black-holes and clinical outcomes in relapse-onset multiple sclerosis. Neuroimage Clin 2022; 35:103048. [PMID: 35598462 PMCID: PMC9130104 DOI: 10.1016/j.nicl.2022.103048] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Slowly expanding lesions (SELs) are MRI markers of chronic active lesions in multiple sclerosis (MS). T1-hypointense black holes, and reductions in magnetization transfer ratio (MTR) are pathologically correlated with myelin and axonal loss. While all associated with progressive MS, the relationship between these lesion's metrics and clinical outcomes in relapse-onset MS has not been widely investigated. OBJECTIVES To explore the relationship of SELs with T1-hypointense black holes, and longitudinal T1 intensity contrast ratio and MTR, their correlation to brain volume, and their contribution to MS disability in relapse-onset patients. METHODS 135 patients with relapsing-remitting MS (RRMS) were studied with clinical assessments and brain MRI (T2/FLAIR and T1-weighted scans at 1.5/3 T) at baseline and two subsequent follow-ups; a subset of 83 patients also had MTR acquisitions. Early-onset patients were defined when the baseline disease duration was ≤ 5 years (n = 85). SELs were identified using deformation field maps from the manually segmented baseline T2 lesions and differentiated from the non-SELs. Persisting black holes (PBHs) were defined as a subset of T2 lesions with a signal below a patient-specific grey matter T1 intensity in a semi-quantitative manner. SELs, PBH counts, and brain volume were computed, and their associations were assessed through Spearman and Pearson correlation. Clusters of patients according to low (up to 2), intermediate (3 to 10), or high (more than 10) SEL counts were determined with a Gaussian generalised mixture model. Mixed-effects and logistic regression models assessed volumes, T1 and MTR within SELs, and their correlation with Expanded Disability Status Scale (EDSS) and confirmed disability progression (CDP). RESULTS Mean age at study onset was 35.5 years (73% female), disease duration 5.5 years and mean time to last follow-up 6.5 years (range 1 to 12.5); median baseline EDSS 1.5 (range 0 to 5.5) and a mean EDSS change of 0.31 units at final follow-up. Among 4007 T2 lesions, 27% were classified as SELs and 10% as PBHs. Most patients (n = 65) belonged to the cluster with an intermediate SEL count (3 to 10 SELs). The percentage of PBHs was higher in SELs than non-SELs (up to 61% vs 44%, p < 0.001) and within-patient SEL volumes positively correlated with PBH volumes (r = 0.53, p < 0.001). SELs showed a decrease in T1 intensity over time (beta = -0.004, 95%CI -0.005 to -0.003, p < 0.001), accompanied by lower cross-sectional baseline and follow-up MTR. In mixed-effects models, EDSS worsening was predicted by the SEL log-volumes increase over time (beta = 0.11, 95%CI 0.03 to 0.20, p = 0.01), which was confirmed in the sub-cohort of patients with early onset MS (beta = 0.14, 95%CI 0.04 to 0.25, p = 0.008). In logistic regressions, a higher risk for CDP was associated with SEL volumes (OR = 5.15, 95%CI 1.60 to 16.60, p = 0.006). CONCLUSIONS SELs are associated with accumulation of more destructive pathology as indicated by an association with PBH volume, longitudinal reduction in T1 intensity and MTR. Higher SEL volumes are associated with clinical progression, while lower ones are associated with stability in relapse-onset MS.
Collapse
Affiliation(s)
- Alberto Calvi
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Corresponding author.
| | - Carmen Tur
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Declan Chard
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Jonathan Stutters
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Rosa Cortese
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Marco Battaglini
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Anna Pietroboni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Milena De Riz
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Nicola De Stefano
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Ferran Prados
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Frederik Barkhof
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
36
|
Wood H. Slowly expanding lesions are linked to multiple sclerosis progression. Nat Rev Neurol 2022; 18:252. [PMID: 35361966 DOI: 10.1038/s41582-022-00654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
37
|
Simmons SB, Ontaneda D. Slowly Expanding Lesions: A New Target for Progressive Multiple Sclerosis Trials? Neurology 2022; 98:699-700. [PMID: 35277445 DOI: 10.1212/wnl.0000000000200230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sarah B Simmons
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
| |
Collapse
|