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Koshorek J, Hu C, Wang Y, Grkovski R, Lin D, Fitzgerald K, Newsome SD, Mowry EM. Relevance of antinuclear antibody in diagnosis and characteristics of multiple sclerosis. Mult Scler Relat Disord 2024; 87:105639. [PMID: 38704876 DOI: 10.1016/j.msard.2024.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/05/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Criteria for multiple sclerosis (MS) diagnosis rely upon clinical and paraclinical data that are supportive of MS in the absence of a better explanation. Patients referred for consideration of a MS diagnosis often undergo an extensive serologic workup including antinuclear antibody (ANA) testing, even when an individual already meets diagnostic criteria for MS. It is unclear whether ANA serostatus is associated with clinical outcomes in MS. The present study aims to determine if ANA seropositivity in those referred with concern for MS differs in those who meet 2017 revised McDonald criteria compared to those who did not receive a diagnosis of MS. Associations between ANA seropositivity and clinical or radiological phenotype of MS patients are also explored. METHODS The cohort included people at least 18 years old, referred to our tertiary care MS center with concern for MS (regardless of prior diagnosis) who had an ANA test with known titer completed within one year of first evaluation. Electronic health record (EHR) charts were manually reviewed, and MRIs underwent blinded review by a radiologist with training in neuroradiology. Diagnosis of MS was determined by a neuroimmunologist and was based on 2017 revised McDonald Criteria. Results are reported as odds ratios from multivariable logistic regression analyses adjusted for age, sex at birth, race, smoking history, personal history of comorbid autoimmune conditions, and family history of autoimmunity. Within the MS cohort, similar analytical models were performed to assess association between ANA and clinical and radiological characteristics. RESULTS A final cohort of 258 patients was analyzed (out of 542 referrals): 106 nonMS and 152 with MS. There was no association between MS (vs. nonMS) diagnosis and ANA status (ANA positive n = 74) in the multivariable models (OR 1.5, 95 % CI 0.82, 2.72, p = 0.20). Among those with MS, there was no association of ANA seropositivity with the odds of atypical brain MRI features, number of cardinal MRI areas involved, location of MRI lesions, or of having an atypical presentation of first demyelinating event. Black race (OR 2.8, 95 % CI 1.27, 6.26, p = 0.01) and family history of autoimmunity (OR 2.1, 95 % CI 1.09, 3.98, p = 0.03) were independently associated with increased odds of ANA positivity. Within the MS cohort analysis, progressive MS (PMS; vs relapsing-remitting MS), a covariate in the model, appeared to be at higher odds of being ANA positive (OR 3.6, 95 % CI 1.03, 13.05, p = 0.046) but only when assessing mean area of cardinal MS locations. CONCLUSIONS While ANA testing does not appear to be useful in distinguishing MS from non-MS, it remains less clear as to whether it may be associated with differences in the clinical course of MS (relapsing-remitting vs progressive). Future studies should aim to systematically evaluate whether those who are ANA positive are more likely, in well-designed and representative prospective cohorts, to be diagnosed with or develop progressive MS. Whether a positive ANA early in MS is associated with increased risk over time of developing or diagnosing another systemic autoimmune disease would also be of interest.
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Affiliation(s)
- Jacqueline Koshorek
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Chen Hu
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yujie Wang
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Risto Grkovski
- Department of Radiology Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Doris Lin
- Department of Radiology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn Fitzgerald
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott D Newsome
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mustafa R, Flanagan EP, Duffy DJ, Weinshenker BG, Soldán MMP, Kunchok A, Kaisey M, Solomon AJ. Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey. J Neurol Sci 2023; 453:120781. [PMID: 37688999 DOI: 10.1016/j.jns.2023.120781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND There is limited evidence and lack of guidelines for diagnostic laboratory evaluation of patients with possible multiple sclerosis (MS). OBJECTIVE To survey neurologists on their practice of laboratory testing in patients with possible MS. METHODS An online survey was developed to query the frequency of serum and cerebrospinal fluid (CSF) studies ordered in the routine evaluation of patients with possible MS, and in three hypothetical clinical cases. Non-MS specialist neurologists who evaluate patients for MS in their practice were invited to participate by MedSurvey (a medical market research company). RESULTS The survey was completed by 190 neurologists. A mean of 17.2 (SD: 17.0) tests in serum and CSF were reported "always" ordered in the evaluation of patients with possible MS. CSF oligoclonal bands was the most frequently selected ("always" among 73.7% of participants). Antinuclear antibody (43.2%), erythrocyte sedimentation rate (34.2%), and thyroid stimulating hormone (31.6%) were also among the most frequently ordered. DISCUSSION Extensive laboratory evaluations are often completed in the evaluation of possible MS. However, many of these tests have poor specificity and false positive results could yield unnecessary increased costs, diagnostic delay, and potentially misdiagnosis. Further research is needed to identify optimal laboratory approaches for possible MS.
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Affiliation(s)
- Rafid Mustafa
- Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA.
| | - Eoin P Flanagan
- Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Dustin J Duffy
- Biostatistics, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, University of Virginia Health, Charlottesville, VA, USA
| | - M Mateo Paz Soldán
- Department of Neurology, University of Utah Health, Salt Lake City, UT, USA
| | - Amy Kunchok
- Department of Neurology, Mellen Center for Multiple Sclerosis, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at The University of Vermont Medical Center, Burlington, VT, USA
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Solomon AJ, Arrambide G, Brownlee WJ, Flanagan EP, Amato MP, Amezcua L, Banwell BL, Barkhof F, Corboy JR, Correale J, Fujihara K, Graves J, Harnegie MP, Hemmer B, Lechner-Scott J, Marrie RA, Newsome SD, Rocca MA, Royal W, Waubant EL, Yamout B, Cohen JA. Differential diagnosis of suspected multiple sclerosis: an updated consensus approach. Lancet Neurol 2023; 22:750-768. [PMID: 37479377 DOI: 10.1016/s1474-4422(23)00148-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/23/2023]
Abstract
Accurate diagnosis of multiple sclerosis requires careful attention to its differential diagnosis-many disorders can mimic the clinical manifestations and paraclinical findings of this disease. A collaborative effort, organised by The International Advisory Committee on Clinical Trials in Multiple Sclerosis in 2008, provided diagnostic approaches to multiple sclerosis and identified clinical and paraclinical findings (so-called red flags) suggestive of alternative diagnoses. Since then, knowledge of disorders in the differential diagnosis of multiple sclerosis has expanded substantially. For example, CNS inflammatory disorders that present with syndromes overlapping with multiple sclerosis can increasingly be distinguished from multiple sclerosis with the aid of specific clinical, MRI, and laboratory findings; studies of people misdiagnosed with multiple sclerosis have also provided insights into clinical presentations for which extra caution is warranted. Considering these data, an update to the recommended diagnostic approaches to common clinical presentations and key clinical and paraclinical red flags is warranted to inform the contemporary clinical evaluation of patients with suspected multiple sclerosis.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, University Health Center, Burlington, VT, USA.
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wallace J Brownlee
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Eoin P Flanagan
- Departments of Neurology and Laboratory Medicine and Pathology and the Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Brenda L Banwell
- Department of Neurology, University of Pennsylvania, Division of Child Neurology, Philadelphia, PA, USA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - John R Corboy
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jorge Correale
- Department of Neurology, Fleni Institute of Biological Chemistry and Physical Chemistry (IQUIFIB), Buenos Aires, Argentina; National Council for Scientific and Technical Research/University of Buenos Aires, Buenos Aires, Argentina
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Koriyama, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | | | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Medical Faculty, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW Australia; Hunter Medical Research Institute Neurology, University of Newcastle, Newcastle, NSW, Australia
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Walter Royal
- Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Emmanuelle L Waubant
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Shah AA, Piche J, Stewart B, Lyness C, Callaghan B, Solomon AJ. Limited diagnostic utility of serologic testing for neurologic manifestations of systemic disease in the evaluation of suspected multiple sclerosis: A single-center observational study. Mult Scler Relat Disord 2023; 69:104443. [PMID: 36521385 DOI: 10.1016/j.msard.2022.104443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/14/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical evaluation of a new diagnosis of MS typically includes serologic testing to evaluate for its many mimics, yet there is little data to guide approaches to such testing. OBJECTIVE To evaluate for the frequency and clinical significance of serologic testing for MS diagnostic evaluations. METHODS In a single MS subspeciality center retrospective study, new patient evaluations for MS over the course of a year were identified, and the results of serologic testing and diagnostic evaluation extracted. Retrospective longitudinal diagnostic assessment was performed to confirm the accuracy of initial serological testing assessments. RESULTS 150 patients had 823 serologic tests. 40 (5%) tests were positive, and resulted in 117 additional serologic tests, 10 radiographs, and 2 biopsies. 77 (51%) patients were diagnosed with a non-demyelinating disorder. Serologic testing results did not change any diagnosis, yet in some patients, it resulted in unnecessary additional testing and diagnostic delay. CONCLUSIONS Serologic testing in the clinical assessment for routine MS resulted in unnecessary diagnostic delay, additional testing, and considerable healthcare cost.
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Affiliation(s)
- Anna A Shah
- Department of Neurology & Rocky Mountain MS Center, University of Colorado School of Medicine, Academic Office 1, B-185, 12631 East 17th Avenue, Aurora, CO 80045, USA.
| | - Jessica Piche
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | | | - Brian Callaghan
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Lartner College of Medicine at the University of Vermont School, Burlington, VT, USA
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Hora JSI, da Silva MCR, Braga CLS, Loureiro AM, Alves ATNN, Lourenço SDQC, Vasconcelos CCF. "Dry Oral and Ocular Manifestations and Autoantibodies Characteristic of Primary Sjögren's Syndrome in Multiple Sclerosis". Mult Scler Relat Disord 2022; 62:103783. [DOI: 10.1016/j.msard.2022.103783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
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Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic inflammatory diseases of the central nervous system (CNS). They may cause inflammation in the brain, spinal cord and optic nerve. Both conditions must be differentiated from CNS manifestations of other systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome, autoinflammtory diseases and sarcoidosis, since amongst others myelitis and optic nerve inflammation may also occur in these conditions. Nevertheless, coexistence of MS or NMOSD with rheumatic disorders such as SLE or Sjögren's syndrome has also been reported especially in NMOSD. Since the therapeutic approach is different it is important to determine a clear diagnosis. In addition some drugs used in rheumatic disease such as anti-tumor necrosis factor biologics may induce inflammatory disease of the CNS and should be avoided in MS. An interdisciplinary approach between neuroimmunology and rheumatology is important for optimal care and treatment in such patients.
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Dal-Bianco A, Wenhoda F, Rommer PS, Weber M, Altmann P, Kraus J, Leutmezer F, Salhofer-Polanyi S. Do elevated autoantibodies in patients with multiple sclerosis matter? Acta Neurol Scand 2019; 139:238-246. [PMID: 30447159 DOI: 10.1111/ane.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The incidence and clinical impact of serum autoantibodies in patients with multiple sclerosis (MS) are controversially discussed. The aim of the study was to reassess the value of elevated serum autoantibodies in our MS study cohort. MATERIAL & METHODS In total, 176 MS patients were retrospectively analyzed for coexistence and clinical impact of increased serum autoantibody levels. RESULTS The 18.8% of the MS cohort showed elevated serum autoantibody levels, but only 10.2% of all MS patients were diagnosed with a further autoimmune disease (AI). Patients with elevated serum autoantibodies (AABS) were not significantly more often diagnosed with a clinical manifest AI as compared to patients with negative autoantibodies (P = 0.338). MS patients with disease duration of more than 10 years showed no significant increase of positive autoantibodies as compared to patients with a more recent disease onset (P = 1). MS patients with elevated serum autoantibodies did not exhibit a significantly worse disease course (P = 0.428). CONCLUSIONS According to our data, elevated serum autoantibodies do not have the potential to serve as a prognostic tool for disease severity in patients with MS Since MS patients with positive serum AABS did not significantly more often suffer from clinical manifest AIs than MS patients with negative serum AABS, the role of routine testing of serum AABS in MS patients should be critically called into question.
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Affiliation(s)
| | - Fritz Wenhoda
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | | | - Michael Weber
- Department of Radiology; Medical University of Vienna; Vienna Austria
| | - Patrick Altmann
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - Jörg Kraus
- Department of Laboratory Medicine; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Department of Neurology, Medical Faculty; Heinrich-Heine-University; Düsseldorf Germany
| | - Fritz Leutmezer
- Department of Neurology; Medical University of Vienna; Vienna Austria
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8
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Trebst C, Kümpfel T. [Neuroimmunology and rheumatology: overlap and differential diagnoses]. DER NERVENARZT 2018. [PMID: 30215132 DOI: 10.1007/s00115-018-0597-y"] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic inflammatory diseases of the central nervous system (CNS). They may cause inflammation in the brain, spinal cord and optic nerve. Both conditions must be differentiated from CNS manifestations of other systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome, autoinflammtory diseases and sarcoidosis, since amongst others myelitis and optic nerve inflammation may also occur in these conditions. Nevertheless, coexistence of MS or NMOSD with rheumatic disorders such as SLE or Sjögren's syndrome has also been reported especially in NMOSD. Since the therapeutic approach is different it is important to determine a clear diagnosis. In addition some drugs used in rheumatic disease such as anti-tumor necrosis factor biologics may induce inflammatory disease of the CNS and should be avoided in MS. An interdisciplinary approach between neuroimmunology and rheumatology is important for optimal care and treatment in such patients.
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Affiliation(s)
- C Trebst
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T Kümpfel
- Institut für klinische Neuroimmunologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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10
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Arakelyan A, Nersisyan L, Poghosyan D, Khondkaryan L, Hakobyan A, Löffler-Wirth H, Melanitou E, Binder H. Autoimmunity and autoinflammation: A systems view on signaling pathway dysregulation profiles. PLoS One 2017; 12:e0187572. [PMID: 29099860 PMCID: PMC5669448 DOI: 10.1371/journal.pone.0187572] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Autoinflammatory and autoimmune disorders are characterized by aberrant changes in innate and adaptive immunity that may lead from an initial inflammatory state to an organ specific damage. These disorders possess heterogeneity in terms of affected organs and clinical phenotypes. However, despite the differences in etiology and phenotypic variations, they share genetic associations, treatment responses and clinical manifestations. The mechanisms involved in their initiation and development remain poorly understood, however the existence of some clear similarities between autoimmune and autoinflammatory disorders indicates variable degrees of interaction between immune-related mechanisms. METHODS Our study aims at contributing to a holistic, pathway-centered view on the inflammatory condition of autoimmune and autoinflammatory diseases. We have evaluated similarities and specificities of pathway activity changes in twelve autoimmune and autoinflammatory disorders by performing meta-analysis of publicly available gene expression datasets generated from peripheral blood mononuclear cells, using a bioinformatics pipeline that integrates Self Organizing Maps and Pathway Signal Flow algorithms along with KEGG pathway topologies. RESULTS AND CONCLUSIONS The results reveal that clinically divergent disease groups share common pathway perturbation profiles. We identified pathways, similarly perturbed in all the studied diseases, such as PI3K-Akt, Toll-like receptor, and NF-kappa B signaling, that serve as integrators of signals guiding immune cell polarization, migration, growth, survival and differentiation. Further, two clusters of diseases were identified based on specifically dysregulated pathways: one gathering mostly autoimmune and the other mainly autoinflammatory diseases. Cluster separation was driven not only by apparent involvement of pathways implicated in adaptive immunity in one case, and inflammation in the other, but also by processes not explicitly related to immune response, but rather representing various events related to the formation of specific pathophysiological environment. Thus, our data suggest that while all of the studied diseases are affected by activation of common inflammatory processes, disease-specific variations in their relative balance are also identified.
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Affiliation(s)
- Arsen Arakelyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
- Department of Bioinformatics and Bioengineering, Russian-Armenian University, Yerevan, Armenia
| | - Lilit Nersisyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
- Zaven and Sonia Akian College of Science and Engineering, American University of Armenia, Yerevan, Armenia
| | - David Poghosyan
- Group of Immune Response Regulation, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Lusine Khondkaryan
- Group of Immune Response Regulation, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Anna Hakobyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Henry Löffler-Wirth
- Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
| | - Evie Melanitou
- Department of Parasitology and Insect Vectors, Institut Pasteur, Paris, France
| | - Hans Binder
- Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
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Chen C, Xiaobo S, Yuge W, Yaqing S, Ling F, Lisheng P, Zhengqi L, Wei Q. Multiple Autoantibodies and Neuromyelitis Optica Spectrum Disorders. Neuroimmunomodulation 2016; 23:151-156. [PMID: 27603214 DOI: 10.1159/000448286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the relationship between neuromyelitis optica spectrum disorder (NMOSD) and autoantibodies. METHODS Blood samples of 108 NMOSD patients and 38 controls were collected from January 2012 to August 2014. Immunological parameters, including anti-aquaporin 4, antinuclear, anti-ribonucleoprotein, anti-SM, anti-SSA/Ro, anti-SSB/La and anti-ribosomal P-protein autoantibodies were examined. RESULTS The NMOSD group exhibited a significantly higher percentage of anti-aquaporin 4 antibodies compared with the control group (76.9 vs. 0.0%, p = 0). The positive rates for antinuclear and anti-SSA antibodies in the NMOSD group were also higher than in the control group (35.2 vs. 11.8%, p = 0.001; 13.0 vs. 0.0%, p = 0.044). In total, 36.1% of the patients in the NMOSD group were seropositive for autoantibodies but only 8.3% were diagnosed with definite systemic autoimmune disorders. CONCLUSIONS NMOSD is closely associated with elevated autoantibodies, particularly antinuclear and anti-SSA/Ro antibodies. NMOSD rarely coexists with organ-specific autoimmune diseases.
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Affiliation(s)
- Chen Chen
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Brito-Zerón P, Theander E, Baldini C, Seror R, Retamozo S, Quartuccio L, Bootsma H, Bowman SJ, Dörner T, Gottenberg JE, Mariette X, Bombardieri S, de Vita S, Mandl T, Ng WF, Kruize AA, Tzioufas A, Vitali C, Buyon J, Izmirly P, Fox R, Ramos-Casals M, on behalf of the EULAR Sjögren Synd. Early diagnosis of primary Sjögren’s syndrome: EULAR-SS task force clinical recommendations. Expert Rev Clin Immunol 2015; 12:137-56. [DOI: 10.1586/1744666x.2016.1109449] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Features of anti-aquaporin 4 antibody-seropositive Chinese patients with neuromyelitis optica spectrum optic neuritis. J Neurol 2015; 262:2293-304. [DOI: 10.1007/s00415-015-7844-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/04/2023]
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Toledano M, Weinshenker BG, Solomon AJ. A Clinical Approach to the Differential Diagnosis of Multiple Sclerosis. Curr Neurol Neurosci Rep 2015; 15:57. [DOI: 10.1007/s11910-015-0576-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Malyavantham K, Weinstock-Guttman B, Suresh L, Zivadinov R, Shanahan T, Badgett D, Ramanathan M. Humoral Responses to Diverse Autoimmune Disease-Associated Antigens in Multiple Sclerosis. PLoS One 2015; 10:e0129503. [PMID: 26065913 PMCID: PMC4466031 DOI: 10.1371/journal.pone.0129503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/09/2015] [Indexed: 01/18/2023] Open
Abstract
To compare frequencies of autoreactive antibody responses to endogenous disease-associated antigens in healthy controls (HC), relapsing and progressive MS and to assess their associations with clinical and MRI measures of MS disease progression.
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Affiliation(s)
| | | | | | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, NY, United States of America
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
| | | | - Darlene Badgett
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
| | - Murali Ramanathan
- Department of Neurology, State University of New York, Buffalo, NY, United States of America
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
- * E-mail:
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16
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Negrotto L, Tur C, Tintoré M, Arrambide G, Sastre-Garriga J, Río J, Comabella M, Nos C, Galán I, Vidal-Jordana A, Simon E, Castilló J, Palavra F, Mitjana R, Auger C, Rovira À, Montalban X. Should we systematically test patients with clinically isolated syndrome for auto-antibodies? Mult Scler 2015; 21:1802-10. [DOI: 10.1177/1352458515575338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 01/20/2023]
Abstract
Background: Several autoimmune diseases (ADs) can mimic multiple sclerosis (MS). For this reason, testing for auto-antibodies (auto-Abs) is often included in the diagnostic work-up of patients with a clinically isolated syndrome (CIS). Objective: The purpose was to study how useful it was to systematically determine antinuclear-antibodies, anti-SSA and anti-SSB in a non-selected cohort of CIS patients, regarding the identification of other ADs that could represent an alternative diagnosis. Methods: From a prospective CIS cohort, we selected 772 patients in which auto-Ab levels were tested within the first year from CIS. Baseline characteristics of auto-Ab positive and negative patients were compared. A retrospective revision of clinical records was then performed in the auto-Ab positive patients to identify those who developed ADs during follow-up. Results: One or more auto-Ab were present in 29.4% of patients. Only 1.8% of patients developed other ADs during a mean follow-up of 6.6 years. In none of these cases the concurrent AD was considered the cause of the CIS. In all cases the diagnosis of the AD resulted from the development of signs and/or symptoms suggestive of each disease. Conclusion: Antinuclear-antibodies, anti-SSA and anti-SSB should not be routinely determined in CIS patients but only in those presenting symptoms suggestive of other ADs.
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Affiliation(s)
- Laura Negrotto
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Angela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Eva Simon
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Filipe Palavra
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
| | - Raquel Mitjana
- Radiology Department (IDI), Vall d’Hebron University Hospital, Spain
| | - Cristina Auger
- Radiology Department (IDI), Vall d’Hebron University Hospital, Spain
| | - Àlex Rovira
- Radiology Department (IDI), Vall d’Hebron University Hospital, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Spain
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Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
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Marrie RA, Reider N, Cohen J, Stuve O, Sorensen PS, Cutter G, Reingold SC, Trojano M. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Mult Scler 2014; 21:282-93. [PMID: 25533299 PMCID: PMC4429166 DOI: 10.1177/1352458514564490] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: As new therapies emerge which increase the risk of autoimmune disease it is increasingly important to understand the incidence of autoimmune disease in multiple sclerosis (MS). Objective: The purpose of this review is to estimate the incidence and prevalence of comorbid autoimmune disease in MS. Methods: The PUBMED, EMBASE, SCOPUS and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles were searched, and abstracts were independently screened by two reviewers. The data were abstracted by one reviewer using a standardized data collection form, and the findings were verified by a second reviewer. We assessed quality of the included studies using a standardized approach and conducted meta-analyses of population-based studies. Results: Sixty-one articles met the inclusion criteria. We observed substantial heterogeneity with respect to the populations studied, methods of ascertaining comorbidity, and reporting of findings. Based solely on population-based studies, the most prevalent autoimmune comorbidities were psoriasis (7.74%) and thyroid disease (6.44%). Our findings also suggest an increased risk of inflammatory bowel disease, likely uveitis and possibly pemphigoid. Conclusion: Fewer than half of the studies identified were of high quality. Population-based studies that report age, sex and ethnicity-specific estimates of incidence and prevalence are needed in jurisdictions worldwide.
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Affiliation(s)
- Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Canada
| | - Nadia Reider
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Per S Sorensen
- Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
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Watanabe M, Kondo T, Murakata K, Kageyama T, Shibata Y, Takahashi T, Nomura K, Matsumoto S. Antibodies to neural and non-neural autoantigens in Japanese patients with CNS demyelinating disorders. J Neuroimmunol 2014; 274:155-60. [DOI: 10.1016/j.jneuroim.2014.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/29/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
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20
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Li H, Zhang Y, Yi Z, Huang D, Wei S. Frequency of autoantibodies and connective tissue diseases in Chinese patients with optic neuritis. PLoS One 2014; 9:e99323. [PMID: 24950188 PMCID: PMC4064964 DOI: 10.1371/journal.pone.0099323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/13/2014] [Indexed: 12/29/2022] Open
Abstract
Background Optic neuritis (ON) is often associated with other clinical or serological markers of connective tissue diseases (CTDs). To date, the effects of autoantibodies on ON are not clear. Purpose To assess the prevalence, clinical patterns, and short outcomes of autoantibodies and Sjögren’s syndrome (SS) involvement in Chinese ON patients and evaluate the relationship between ON, including their subtypes, and autoantibodies. Methods A total of 190 ON patients were divided into recurrent ON (RON), bilateral ON (BON), and isolated monocular ON (ION). Demographic, clinical, and serum autoantibodies data were compared between them with and without SS involvement. Serum was drawn for antinuclear antibody (ANA), extractable nuclear antigen antibodies (SSA/SSB), rheumatoid factor (RF), anticardiolipin antibodies (ACA), and anti-double-stranded DNA antibody (A-ds DNA), anticardiolipin antibody (ACLs), anti-β2-glycoprotein I (β2-GPI) and Aquaporin-4 antibodies (AQP4-Ab). Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate the atrophy of the optic nerve. Results 68 patients (35.79%) had abnormal autoantibodies, 26(13.68%) patients met diagnostic criteria for CTDs, including 15(7.89%) patients meeting the criteria for SS. Antibodies including SSA/SSB 23 (30.26%) (p1 and p 2<0.001) and AQP4–Ab10 (13.16%) (p1 = 0.044, p2 = 0.01) were significantly different in patients in the RON group when compared with those in the BON (P1 = RON VS ION) and ION (p2 = RON VS ION) groups. SS was more common in RON patients (p1 = 0.04, p2 = 0.028). There was no significant difference between SSA/SSB positive and negative patients in disease characteristics or severity. Similar results were obtained when SS was diagnosed in SSA/SSB positive patients. Conclusion RON and BON were more likely associated with abnormal autoantibodies; furthermore, AQP4 antibody, SSA/SSB and SS were more common in the RON patients. AQP4 antibodydetermination is crucial in RON patients who will develop NMO. However, when compared with other autoantibodies, SSA/SSB detected in patients was not significantly associated with disease characteristics or severity.
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Affiliation(s)
- Hongyang Li
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ophthalmology, The General Hospital of Beijing Military Region, Beijing, China
| | - Zuohuizi Yi
- Department of Ophthalmology, The People’s Hospital Affiliated Wuhan University, Wuhan, China
| | - Dehui Huang
- Department of Neurology, The Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital, Beijing, China
- * E-mail:
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Klein B, Lütz-Meindl U, Kerschbaum HH. From the nucleus to the plasma membrane: translocation of the nuclear proteins histone H3 and lamin B1 in apoptotic microglia. Apoptosis 2014; 19:759-75. [PMID: 24558118 DOI: 10.1007/s10495-014-0970-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nuclear autoantibodies have been found in patients with autoimmune diseases. One possible source for nuclear antigens are apoptotic cells. However, the mechanism of how apoptotic cells make nuclear factors accessible to the immune system is still elusive. In the present study, we investigated the redistribution of nuclear components after UV irradiation in the microglial cell line BV-2 and in primary mouse microglia at the ultrastructural level. We used transmission electron microscopy-coupled electron energy loss spectroscopy (EELS) to measure phosphorus as an indicator for nucleic acids and immunogold labeling to detect histone H3 and lamin B1 in apoptotic cells. EELS revealed elevated concentrations of phosphorus in nuclear and cytoplasmic condensed chromatin compared to the remaining cytoplasm. Furthermore, immunolabeling of lamin B1 and histone H3 was detected in apoptotic microglia not only in the nucleus, but also in the cytoplasm, and even at the plasma membrane. Confocal images of apoptotic microglia, which were not previously permeabilized, showed patches of histone H3 and lamin B1 labeling at the cell surface. The pan-caspase inhibitor Z-VAD-FMK (carbobenzoxy-valyl-alanyl-aspartyl-[O-methyl]-fluoromethylketone) prevented the occurrence of cytoplasmic condensed chromatin in apoptotic microglia. Our findings indicate that nuclear components leak from the nucleus into the cytoplasm in apoptotic microglia. At least histone H3 and lamin B1 reach the cell surface, this may promote autoreactive processes.
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Affiliation(s)
- Barbara Klein
- Department of Cell Biology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria,
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