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Elssayed A, AlRgaiba RI, AlZalbani MK, Hassan MRJ, AlMalki KH, AlGhannam AA, AlMudayfir ZF, Mohamed HAA, Sheikh MM, AlGhamdi AA, AlMarwani SI. Review on Diagnosis and Management Approach of Multiple Sclerosis. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2023. [DOI: 10.51847/gjcjdspajm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Au KM, Tisch R, Wang AZ. Immune Checkpoint Ligand Bioengineered Schwann Cells as Antigen-Specific Therapy for Experimental Autoimmune Encephalomyelitis. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2107392. [PMID: 34775659 PMCID: PMC8813901 DOI: 10.1002/adma.202107392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Indexed: 05/05/2023]
Abstract
Failure to establish immune tolerance leads to the development of autoimmune disease. The ability to regulate autoreactive T cells without inducing systemic immunosuppression represents a major challenge in the development of new strategies to treat autoimmune disease. Here, a translational method for bioengineering programmed death-ligand 1 (PD-L1)- and cluster of differentiation 86 (CD86)-functionalized mouse Schwann cells (SCs) to prevent and ameliorate multiple sclerosis (MS) in established mouse models of chronic and relapsing-remitting experimental autoimmune encephalomyelitis (EAE) is described. It is shown that the intravenous (i.v.) administration of immune checkpoint ligand functionalized mouse SCs modifies the course of disease and ameliorates EAE. Further, it is found that such bioengineered mouse SCs inhibit the differentiation of myelin-specific helper T cells into pathogenic T helper type-1 (Th 1) and type-17 (Th 17) cells, promote the development of tolerogenic myelin-specific regulatory T (Treg ) cells, and resolve inflammatory central nervous system microenvironments without inducing systemic immunosuppression.
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Affiliation(s)
- Kin Man Au
- Laboratory of Nano- and Translational Medicine, Carolina Center for Cancer Nanotechnology Excellence, Carolina Institute of Nanomedicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75230, USA
| | - Roland Tisch
- Department of Microbiology and Immunology School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew Z Wang
- Laboratory of Nano- and Translational Medicine, Carolina Center for Cancer Nanotechnology Excellence, Carolina Institute of Nanomedicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75230, USA
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Malmakova AE, Yu VK, Iskakova TK, Dauletbay P, Praliev KD, Baktybaeva LK. Synthesis and Myelostimulatory Activity of β-Cyclodextrin Complexes of 3,7-Diazabicyclo[3.3.1]Nonan-9-One Derivatives. Pharm Chem J 2020. [DOI: 10.1007/s11094-020-02243-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monteiro A, Rosado P, Rosado L, Fonseca AM, Paiva A. Alterations in circulating T cell functional subpopulations in interferon-beta treated multiple sclerosis patients: A pilot study. J Neuroimmunol 2020; 339:577113. [DOI: 10.1016/j.jneuroim.2019.577113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/21/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022]
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Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations. J Neurosci Nurs 2018; 50:167-170. [PMID: 29727394 DOI: 10.1097/jnn.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier. METHODS Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test. RESULTS Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not. CONCLUSIONS Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.
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Barry A, Cronin O, Ryan AM, Sweeney B, Yap SM, O'Toole O, Allen AP, Clarke G, O'Halloran KD, Downer EJ. Impact of Exercise on Innate Immunity in Multiple Sclerosis Progression and Symptomatology. Front Physiol 2016; 7:194. [PMID: 27313534 PMCID: PMC4889582 DOI: 10.3389/fphys.2016.00194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/16/2016] [Indexed: 12/21/2022] Open
Abstract
Multiple Sclerosis (MS), an idiopathic progressive immune-mediated neurological disorder of the central nervous system (CNS), is characterized by recurrent episodes of inflammatory demyelination and consequent axonal deterioration. It accounts for functional deterioration and lasting disability among young adults. A body of literature demonstrates that physical activity counteracts fatigue and depression and may improve overall quality of life in MS patients. Furthermore, much data indicates that exercise ameliorates chronic neuroinflammation and its related pathologies by tipping cytokine profiles toward an anti-inflammatory signature. Recent data has focused on the direct impact of exercise training on the innate immune system by targeting toll-like receptors (TLRs), signaling pattern recognition receptors that govern the innate immune response, shedding light on the physiological role of TLRs in health and disease. Indeed, TLRs continue to emerge as players in the neuroinflammatory processes underpinning MS. This review will highlight evidence that physical activity and exercise are potential immunomodulatory therapies, targeting innate signaling mechanism(s) to modulate MS symptom development and progression.
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Affiliation(s)
- Alison Barry
- Department of Physiology, School of Medicine, University College Cork Cork, Ireland
| | - Owen Cronin
- Department of Medicine, Cork University Hospital Cork, Ireland
| | - Aisling M Ryan
- Department of Neurology, Cork University Hospital Cork, Ireland
| | - Brian Sweeney
- Department of Neurology, Cork University Hospital Cork, Ireland
| | | | | | - Andrew P Allen
- Department of Psychiatry and Neurobehavioral Science, APC Microbiome Institute, University College Cork Cork, Ireland
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioral Science, APC Microbiome Institute, University College Cork Cork, Ireland
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, University College Cork Cork, Ireland
| | - Eric J Downer
- Department of Physiology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, University of Dublin Dublin, Ireland
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Kulakova OG, Tsareva EY, Lvovs D, Favorov AV, Boyko AN, Favorova OO. Comparative pharmacogenetics of multiple sclerosis: IFN-β versus glatiramer acetate. Pharmacogenomics 2014; 15:679-85. [PMID: 24798724 DOI: 10.2217/pgs.14.26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Various diseases require the selection of preferable treatment out of available alternatives. Multiple sclerosis (MS), an autoimmune inflammatory/neurodegenerative disease of the CNS, requires long-term medication with either specific disease-modifying therapy (DMT) - IFN-β or glatiramer acetate (GA) - which remain the only first-line DMTs in all countries. A significant share of MS patients are resistant to treatment with one or the other DMT; therefore, the earliest choice of preferable DMT is of particular importance. A number of conventional pharmacogenetic studies performed up to the present day have identified the treatment-sensitive genetic biomarkers that might be specific for the particular drug; however, the suitable biomarkers for selection of one or another first-line DMT are remained to be found. Comparative pharmacogenetic analysis may allow the identification of the discriminative genetic biomarkers, which may be more informative for an a priori DMT choice than those found in conventional pharmacogenetic studies. The search for discriminative markers of preferable first-line DMT, which differ in carriage between IFN-β responders and GA responders as well as between IFN-β nonresponders and GA nonresponders, has been performed in 253 IFN-β-treated MS patients and 285 GA-treated MS patients. A bioinformatics algorithm for identification of composite biomarkers (allelic sets) was applied on a unified set of immune-response genes, which are relevant for IFN-β and/or GA modes of action, and identical clinical criteria of treatment response. We found the range of discriminative markers, which include polymorphic variants of CCR5, IFNAR1, TGFB1, DRB1 or CTLA4 genes, in different combinations. Every allelic set includes the CCR5 genetic variant, which probably suggests its crucial role in the modulation of the DMT response. Special attention should be given to the (CCR5*d+ IFNAR1*G) discriminative combination, which clearly points towards IFN-β treatment choice for carriers of this combination. As a whole the comparative approach provides an option for the identification of prognostic composite biomarkers for a preferable medication among available alternatives.
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Affiliation(s)
- Olga G Kulakova
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, 117997, Moscow, Russia
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Mizee MR, Nijland PG, van der Pol SMA, Drexhage JAR, van het Hof B, Mebius R, van der Valk P, van Horssen J, Reijerkerk A, de Vries HE. Astrocyte-derived retinoic acid: a novel regulator of blood-brain barrier function in multiple sclerosis. Acta Neuropathol 2014; 128:691-703. [PMID: 25149081 DOI: 10.1007/s00401-014-1335-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 08/15/2014] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) lesions are characterized by the presence of activated astrocytes, which are thought to actively take part in propagating lesion progression by secreting pro-inflammatory mediators. Conversely, reactive astrocytes may exert disease-dampening effects through the production of trophic factors and anti-inflammatory mediators. Astrocytic control of the blood-brain barrier (BBB) is crucial for normal brain homeostasis and BBB disruption is a well-established early event in MS lesion development. Here, we set out to unravel potential protective effects of reactive astrocytes on BBB function under neuroinflammatory conditions as seen in MS, where we focus on the role of the brain morphogen retinoic acid (RA). Immunohistochemical analysis revealed that retinaldehyde dehydrogenase 2 (RALDH2), a key enzyme for RA synthesis, is highly expressed by reactive astrocytes throughout white matter lesions compared to control and normal appearing white matter. In vitro modeling of reactive astrocytes resulted in increased expression of RALDH2, enhanced RA synthesis, and a protective role for astrocyte-derived RA on BBB function during inflammation-induced barrier loss. Furthermore, RA induces endothelial immune quiescence and decreases monocyte adhesion under inflammatory conditions. Finally, we demonstrated that RA attenuated oxidative stress in inflamed endothelial cells, through activation of the antioxidant transcription factor nuclear factor E2 related factor 2. In summary, RA synthesis by reactive astrocytes represents an endogenous protective response to neuroinflammation, possibly aimed at protecting the BBB against inflammatory insult. A better understanding of RA signaling in MS pathophysiology may lead to the discovery of novel targets to halt disease progression.
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Viana de Andrade ACD, Brito ÉA, Harris OMO, Viana de Andrade APD, Leite MF, Pithon MM. Development of systemic sarcoidosis and xanthoma planum during multiple sclerosis treatment with interferon-beta 1a: Case Report. Int J Dermatol 2014; 54:e140-5. [DOI: 10.1111/ijd.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | - Érica Andrade Brito
- Department of Health; Southwest Bahia State University - UESB; Jequié Bahia Brazil
| | | | | | | | - Matheus Melo Pithon
- Department of Health; Southwest Bahia State University - UESB; Jequié Bahia Brazil
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Sá MJ, de Sá J, Sousa L. Relapsing-remitting multiple sclerosis: patterns of response to disease-modifying therapies and associated factors: a national survey. Neurol Ther 2014; 3:89-99. [PMID: 26000225 PMCID: PMC4386429 DOI: 10.1007/s40120-014-0019-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Current treatments for relapsing–remitting multiple sclerosis (RRMS) are only partially effective. The objective of this study was to characterize treatment response in RRMS patients in Portugal to 12-month therapy with first-line disease-modifying therapies. Methods In this retrospective study, neurologists at participating centers completed survey questionnaires using records of patients with RRMS who had received first-line treatment with one of five European Medicine Agency-approved agents in the 12 months prior to inclusion in the survey. Sub-optimal responders included patients treated for at least 1 year, and who had ≥1 relapse(s) or an increase of 1.5 points on the Expanded Disability Status Scale (EDSS; if baseline EDSS was 0) or an increase of ≥0.5 points (baseline EDSS ≥1). Optimal responders included patients treated for at least 1 year without relapse and who had an increase of <1.5 points on EDSS (if baseline EDSS was 0) or no increase in EDSS (baseline EDSS ≥1). Results Data for 1,131 patients from 15 centers were analyzed. Twenty-six percent (95% confidence interval 23–28%) of patients had sub-optimal treatment response. Duration of therapy (P < 0.001), age at the start of therapy (P = 0.03), and baseline EDSS score (P < 0.001), were significantly different among treatments. Sub-optimal treatment response appeared to be related only to a more severe EDSS score at baseline and did not differ among therapies. Conclusion Neurologists should closely monitor patients to optimize treatment strategies and better control disease, improving prognosis. Electronic supplementary material The online version of this article (doi:10.1007/s40120-014-0019-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria José Sá
- Centro Hospitalar São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - João de Sá
- Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal
| | - Lívia Sousa
- Centro Hospitalar e Universitário de Coimbra, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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Gironi M, Borgiani B, Cursano C, Saresella M, Piancone F, Mariani E, Marventano I, Martinelli V, Comi G, Clerici M, Rovaris M, Furlan R. The Peripheral Network between Oxidative Stress and Inflammation in Multiple Sclerosis. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Reactive oxygen species (ROS) are mainly produced by microglia and macrophages during inflammation-driven oxidative burst. However, they can in turn affect the reactivity and function of immune cells. For the first time, the relationship between these two key players involved in Multiple Sclerosis (MS) was evaluated at peripheral level. We performed an in-depth immune-phenotypic and functional analysis of MBP (Myelin Basic Protein)-stimulated Peripheral Blood Mononuclear Cells (PBMCs) by flow-cytometry. In addition, blood Coenzyme-Q10 (CoQ10), total, oxidized and reduced forms of glutathione (GSTot, GSSG, GSH), malondialdehyde (MDA), ROS, anti-oxidized-low-density-lipoproteins antibodies (anti-oxLDL), and anti-oxidant-power (PAO) were studied in 31 untreated MS patients (MSnoTP), 23 MS patients (MSTP) treated with Disease Modifying Drugs (DMDs) and 39 matched controls (HC). The focus of our study was the correlation between oxidative stress biomarkers and distribution of immune-phenotypes across the 3 studied groups. In MSnoTP an inverse correlation between MDA and apoptotic cells (CD4+ AnnexinV+TIM3+) was detected (rs= − 0.50, p= 0.01). Ml functional phenotype (CD14+IL6+) and TH17 cells (CD4+IL22+) inversely (rs= − 0.48) and directly (rs= 0.46) correlated (p = 0.01) with Anti-oxLDL antibodies and GSSG, respectively. The latter direct correlation was shown also in MSTP. Notably, in this group, we also detected a direct correlation between CD4+ IL4+ and CD4+ IL25+ (TH2 phenotype) with CoQ10 (rs= 0.54) and GSH (rs= 0.46) (p< 0.03), two crucial anti-oxidants. Again, a direct correlation was found between CD8+ BDNF+ cells (suppressor phenotype) and anti-oxLDL (rs= 0.48, p= 0.03). Surprisingly, we measured an inverse correlation between CD14+ IL10+ cells (M2 immune-regulatory cells) with GSH (rs= − 0.59, p< 0.001). Our findings endorse the idea of a relationship between pro-inflammatory cells and pro-oxidative environment, even at peripheral level. Interestingly, the correlation between CD4+ IL10+cells and a defective anti-oxidant equipment might be regarded as evidence of the involvement of these cells during an inflammatory/oxidative phase that they try to control. The finding of this link only in MSTP patients might suggest that DMDs can provide an alternative way to counteract inflammation, regardless of an absolute increase of these immune-regulatory cells.
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Affiliation(s)
- M. Gironi
- INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - B. Borgiani
- INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - C. Cursano
- CAM, Polidiagnostic Center, Monza, Italy
| | | | | | - E. Mariani
- CAM, Polidiagnostic Center, Monza, Italy
| | | | - V. Martinelli
- INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - G. Comi
- INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - M. Clerici
- IRCCS, Don Gnocchi Foundation, Milan, Italy
| | - M. Rovaris
- IRCCS, Don Gnocchi Foundation, Milan, Italy
| | - R. Furlan
- INSPE, San Raffaele Scientific Institute, Milan, Italy
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Reick C, Ellrichmann G, Thöne J, Scannevin RH, Saft C, Linker RA, Gold R. Neuroprotective dimethyl fumarate synergizes with immunomodulatory interferon beta to provide enhanced axon protection in autoimmune neuroinflammation. Exp Neurol 2014; 257:50-6. [PMID: 24731948 DOI: 10.1016/j.expneurol.2014.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/26/2014] [Accepted: 04/04/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite recent advances in development of treatments for multiple sclerosis, there is still an unmet need for more effective and also safe therapies. Based on the modes of action of interferon-beta (IFN-β) and dimethyl fumarate (DMF), we hypothesized that anti-inflammatory and neuroprotective effects may synergize in experimental autoimmune encephalomyelitis (EAE). METHODS EAE was induced in C57BL/6 mice by immunization with MOG35-55-peptide. Murine IFN-β was injected s.c. every other day at 10.000IU, and DMF was provided at 15mg/kg by oral gavage twice daily. Control mice received PBS injections and were treated by oral gavage with the vehicle methylcellulose. Mice were scored daily by blinded observers and histological, FACS and cytokine studies were performed to further elucidate the underlying mechanism of action. RESULTS Combination therapy significantly ameliorated EAE disease course in comparison to controls and monotherapy with IFN-β. Histological analyses showed a significant effect on axon preservation with almost twice as much axons present in inflamed lesions as compared to control. Remarkably, the effect on axonal preservation was more pronounced under combination therapy than with both monotherapies. Neither monotherapy nor combination therapy demonstrated modulation of cytokines and frequency of antigen presenting cells. DISCUSSION Combination of IFN-β and DMF resulted in greater beneficial effects with improved tissue protection as compared to the respective monotherapies. Further combination studies of these safe therapies in human disease are warranted.
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Affiliation(s)
- Christiane Reick
- Department of Neurology St. Josef-Hospital, Ruhr-University Bochum, Germany; International Graduate School of Neuroscience, Ruhr-University Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology St. Josef-Hospital, Ruhr-University Bochum, Germany.
| | - Jan Thöne
- Department of Neurology St. Josef-Hospital, Ruhr-University Bochum, Germany
| | | | - Carsten Saft
- Department of Neurology St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Ralf A Linker
- Department of Neurology, University of Erlangen, Germany
| | - Ralf Gold
- Department of Neurology St. Josef-Hospital, Ruhr-University Bochum, Germany; International Graduate School of Neuroscience, Ruhr-University Bochum, Germany
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da Silva AM, Santos ME. JCV epidemiology in MS (JEMS)--epidemiology of anti-JCV antibody prevalence in multiple sclerosis patients--Portuguese data. J Neurol Sci 2013; 337:119-22. [PMID: 24369270 DOI: 10.1016/j.jns.2013.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/16/2013] [Accepted: 11/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy, caused by oligodendrocyte lytic infection by JCVirus, is a growing concern for patients undergoing immune modulatory therapies for treatment of autoimmune diseases, such as multiple sclerosis (MS). The objective of JEMS was to describe the prevalence of anti-JCV antibodies in MS patients and to assess the various factors associated to it. METHODS Serum samples were collected and tested for anti-JCV antibody using the STRATIFY JCV™ assay in 131 Portuguese MS patients. Factors potentially associated with prevalence were also evaluated, as well as the effect of established risk factors. RESULTS In the population of 131 Portuguese patients included in the JEMS, the overall anti-JCV antibody prevalence was 69.5% (95% CI, 61.6-77.4). The anti-JCV antibody prevalence did not seem to be influenced by demographic characteristics, although results demonstrate a non-significant trend for increased prevalence with age. Disease characteristics, treatment duration, treatment history, prior immunosuppressive therapy use and natalizumab exposure duration did not seem to be associated with anti-JCV prevalence. CONCLUSION The results of Portuguese MS patients participating in the JEMS study present some differences when compared with the global population and literature results. An overall prevalence higher than expected raises awareness for data confirmation with greater sample size studies.
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Asensio-Sánchez VM, Trujillo-Guzmán L, Ramoa-Osorio R. [Cystoid macular oedema after fingolimod treatment in multiple sclerosis]. ACTA ACUST UNITED AC 2013; 89:104-6. [PMID: 24269406 DOI: 10.1016/j.oftal.2012.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 07/04/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
CASE REPORT A woman, treated with immunomodulatory and immunosuppressive drugs for multiple sclerosis, developed macular oedema 4 months after oral fingolimod administration. The patient was previously seen by an ophthalmologist, with a normal anterior segment and funduscopic examination. Four months after the treatment she referred to decreased visual acuity in both eyes. The funduscopic and OCT examination now revealed cystoid macular oedema (CME). DISCUSSION Attention to visual changes and periodic funduscopic examinations are an important part of monitoring while using fingolimod. In our patient early recognition and discontinuation of fingolimod did not result in resolution of the CME.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
| | - L Trujillo-Guzmán
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - R Ramoa-Osorio
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
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Glatiramer acetate ameliorates experimental autoimmune neuritis. Immunol Cell Biol 2013; 92:164-9. [DOI: 10.1038/icb.2013.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 12/12/2022]
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16
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Exercise therapy and multiple sclerosis: a systematic review. J Neurol 2013; 261:1651-61. [DOI: 10.1007/s00415-013-7183-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/31/2013] [Indexed: 11/26/2022]
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Sá MJ. Physiopathology of symptoms and signs in multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:733-40. [PMID: 22990733 DOI: 10.1590/s0004-282x2012000900016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 04/23/2012] [Indexed: 11/22/2022]
Abstract
UNLABELLED The physiopathology of symptoms and signs in multiple sclerosis (MS) is a less divulged topic albeit its importance in the patients' management. OBJECTIVE It was to summarize the main biophysical and biochemical mechanisms which produce the clinical manifestations in MS. RESULTS The mechanisms underpinning neurological deficits are described in the relapsing and in the progressive phases, stressing inflammatory and neurodegenerative components, especially demyelination, axonal damage and conduction impairment. Transient worsening based in Uhthoff's phenomenon, mechanisms producing positive symptoms, as paraesthesias and Lhermitte sign due to axonal hyperexcitability and ephaptic interactions, and development of cortical symptoms will also be addressed. The variety of processes leading to neural repair and functional recovery in the remitting phase is focused, as remyelination and adaptive changes due to neural plasticity. CONCLUSION The awareness of mechanisms producing symptoms in MS emphasises the role of symptomatic and rehabilitation therapies in the improvement of patients' well-being.
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Affiliation(s)
- Maria José Sá
- Department of Neurology, Centro Hospitalar São João, Faculty of Health Sciences, Universidade Fernando Pessoa, Porto, Portugal.
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18
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Interferon-beta therapy in multiple sclerosis: the short-term and long-term effects on the patients' individual gene expression in peripheral blood. Mol Neurobiol 2013; 48:737-56. [PMID: 23636981 DOI: 10.1007/s12035-013-8463-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/16/2013] [Indexed: 01/17/2023]
Abstract
Therapy with interferon-beta (IFN-beta) is a mainstay in the management of relapsing-remitting multiple sclerosis (MS), with proven long-term effectiveness and safety. Much has been learned about the molecular mechanisms of action of IFN-beta in the past years. Previous studies described more than a hundred genes to be modulated in expression in blood cells in response to the therapy. However, for many of these genes, the precise temporal expression pattern and the therapeutic relevance are unclear. We used Affymetrix microarrays to investigate in more detail the gene expression changes in peripheral blood mononuclear cells from MS patients receiving subcutaneous IFN-beta-1a. The blood samples were obtained longitudinally at five different time points up to 2 years after the start of therapy, and the patients were clinically followed up for 5 years. We examined the functions of the genes that were upregulated or downregulated at the transcript level after short-term or long-term treatment. Moreover, we analyzed their mutual interactions and their regulation by transcription factors. Compared to pretreatment levels, 96 genes were identified as highly differentially expressed, many of them already after the first IFN-beta injection. The interactions between these genes form a large network with multiple feedback loops, indicating the complex crosstalk between innate and adaptive immune responses during therapy. We discuss the genes and biological processes that might be important to reduce disease activity by attenuating the proliferation of autoreactive immune cells and their migration into the central nervous system. In summary, we present novel insights that extend the current knowledge on the early and late pharmacodynamic effects of IFN-beta therapy and describe gene expression differences between the individual patients that reflect clinical heterogeneity.
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Carvalho AT, Sá MJ. Switching and escalating therapy in long-lasting multiple sclerosis: not always necessary. ISRN NEUROLOGY 2013; 2012:451457. [PMID: 23316389 PMCID: PMC3539327 DOI: 10.5402/2012/451457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 12/04/2022]
Abstract
Although therapy switch is common among patients with multiple sclerosis (MS), sometimes the initial prescribed treatment is maintained for a long period with clinical stability, low disability, and nonsignificant side effects. We aim to describe demographic and clinical characteristics of patients treated in our MS clinic with the same disease-modifying drug (DMD) lasting for >12 years. From the cohort of 51 patients followed in our MS clinic with relapse-remitting MS who started an DMD between 1996 and 1999, we found a high percentage (51%) of patients who were efficiently treated with the first DMD. These patients were mainly females, with low annualized relapse rate and Multiple Sclerosis Severity Score (MSSS). Our results may be related to the open and multidisciplinary model of our MS clinic organization. Identifying characteristics associated with therapy persistence may be useful in developing strategies to improve therapy effectiveness.
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Affiliation(s)
- Ana Teresa Carvalho
- MS Clinic, Department of Neurology, Centro Hospitalar de São João, 4200-319 Porto, Portugal ; Department of Neurology, Centro Hospitalar de Vila Nova Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
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Sternberg Z. Autonomic dysfunction: A unifying multiple sclerosis theory, linking chronic cerebrospinal venous insufficiency, vitamin D3, and Epstein-Barr virus. Autoimmun Rev 2012; 12:250-9. [DOI: 10.1016/j.autrev.2012.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/22/2012] [Indexed: 12/18/2022]
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Mameli G, Poddighe L, Mei A, Uleri E, Sotgiu S, Serra C, Manetti R, Dolei A. Expression and activation by Epstein Barr virus of human endogenous retroviruses-W in blood cells and astrocytes: inference for multiple sclerosis. PLoS One 2012; 7:e44991. [PMID: 23028727 PMCID: PMC3459916 DOI: 10.1371/journal.pone.0044991] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/15/2012] [Indexed: 11/20/2022] Open
Abstract
Background Proposed co-factors triggering the pathogenesis of multiple sclerosis (MS) are the Epstein Barr virus (EBV), and the potentially neuropathogenic MSRV (MS-associated retrovirus) and syncytin-1, of the W family of human endogenous retroviruses. Methodology/Principal Findings In search of links, the expression of HERV-W/MSRV/syncytin-1, with/without exposure to EBV or to EBV glycoprotein350 (EBVgp350), was studied on peripheral blood mononuclear cells (PBMC) from healthy volunteers and MS patients, and on astrocytes, by discriminatory env-specific RT-PCR assays, and by flow cytometry. Basal expression of HERV-W/MSRV/syncytin-1 occurs in astrocytes and in monocytes, NK, and B, but not in T cells. This uneven expression is amplified in untreated MS patients, and dramatically reduced during therapy. In astrocytes, EBVgp350 stimulates the expression of HERV-W/MSRV/syncytin-1, with requirement of the NF-κB pathway. In EBVgp350-treated PBMC, MSRVenv and syncytin-1 transcription is activated in B cells and monocytes, but not in T cells, nor in the highly expressing NK cells. The latter cells, but not the T cells, are activated by proinflammatory cytokines. Conclusions/Significance In vitro EBV activates the potentially immunopathogenic and neuropathogenic HERV-W/MSRV/syncytin-1, in cells deriving from blood and brain. In vivo, pathogenic outcomes would depend on abnormal situations, as in late EBV primary infection, that is often symptomatic, or/and in the presence of particular host genetic backgrounds. In the blood, HERV-Wenv activation might induce immunopathogenic phenomena linked to its superantigenic properties. In the brain, toxic mechanisms against oligodendrocytes could be established, inducing inflammation, demyelination and axonal damage. Local stimulation by proinflammatory cytokines and other factors might activate further HERV-Ws, contributing to the neuropathogenity. In MS pathogenesis, a possible model could include EBV as initial trigger of future MS, years later, and HERV-W/MSRV/syncytin-1 as actual contributor to MS pathogenicity, in striking parallelism with disease behaviour.
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Affiliation(s)
- Giuseppe Mameli
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Luciana Poddighe
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Alessandra Mei
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Elena Uleri
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Department of Neurosciences and MIS, University of Sassari, Sassari, Italy
| | - Caterina Serra
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Roberto Manetti
- Department of Clinical, Experimental and Oncological Medicine, University of Sassari, Sassari, Italy
| | - Antonina Dolei
- Department of Biomedical Sciences and Centre of Excellence for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
- * E-mail:
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Hundeshagen A, Hecker M, Paap BK, Angerstein C, Kandulski O, Fatum C, Hartmann C, Koczan D, Thiesen HJ, Zettl UK. Elevated type I interferon-like activity in a subset of multiple sclerosis patients: molecular basis and clinical relevance. J Neuroinflammation 2012; 9:140. [PMID: 22727118 PMCID: PMC3464734 DOI: 10.1186/1742-2094-9-140] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/22/2012] [Indexed: 12/26/2022] Open
Abstract
Background A subset of patients with multiple sclerosis (MS) shows an increased endogenous IFN-like activity before initiation of IFN-beta treatment. The molecular basis of this phenomenon and its relevance to predict individual therapy outcomes are not yet fully understood. We studied the expression patterns of these patients, the prognostic value of an elevated IFN-like activity, and the gene regulatory effects of exogenously administered IFN-beta. Methods Microarray gene expression profiling was performed for 61 MS patients using peripheral blood mononuclear cells obtained before and after 1 month of IFN-beta therapy. Expression levels of genes involved in pathways either inducing or being activated by IFN-beta were compared between patients with high (MX1high cohort) and low (MX1low cohort) endogenous IFN-like activity. Patients were followed for 5 years and relapses as well as progression on the expanded disability status scale (EDSS) were documented. Results Before the start of therapy, 11 patients presented elevated mRNA levels of IFN-stimulated genes indicative of a relatively high endogenous IFN-like activity (MX1high). In these patients, pathogen receptors (for example, TLR7, RIG-I and IFIH1) and transcription factors were also expressed more strongly, which could be attributed to an overactivity of IFN-stimulated gene factor 3 (ISGF3, a complex formed by STAT1, STAT2 and IFN regulatory factor 9). After 1 month of IFN-beta therapy, the expression of many pathway genes was significantly induced in MX1low patients, but remained unaltered in MX1high patients. During follow-up, relapse rate and changes in EDSS were comparable between both patient groups, with differences seen between different types of IFN-beta drug application. Conclusions Therapeutic IFN-beta induces the transcription of several genes involved in IFN-related pathways. In a subgroup of MS patients, the expression of these genes is already increased before therapy initiation, possibly driven by an overexpression of ISGF3. Patients with high and low endogenous IFN-like activity showed similar clinical long-term courses of disease. Different results were obtained for different IFN-beta drug preparations, and this merits further investigation.
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Affiliation(s)
- Alexander Hundeshagen
- Department of Neurology, Division of Neuroimmunology, University of Rostock, Germany
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Borisow N, Döring A, Pfueller CF, Paul F, Dörr J, Hellwig K. Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy. EPMA J 2012; 3:9. [PMID: 22738272 PMCID: PMC3464716 DOI: 10.1186/1878-5085-3-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/22/2012] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis is the most common chronic autoimmune disease of the central nervous system which preferentially affects females at childbearing age. For this reason, patients and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth. Preventive and personalized treatment approaches are considered, because topics as heredity, risk of congenital malformations, influence of pregnancy on MS and aspects of drug therapy during the period of conception, pregnancy, puerperium and lactation have to be discussed. Here, we provide an overview about the current state of knowledge regarding these issues.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
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Guimarães J, Sá MJ. Cognitive dysfunction in multiple sclerosis. Front Neurol 2012; 3:74. [PMID: 22654782 PMCID: PMC3359427 DOI: 10.3389/fneur.2012.00074] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 04/14/2012] [Indexed: 01/21/2023] Open
Abstract
In Multiple Sclerosis (MS) prevalence studies of community and clinical samples, indicate that 45-60% of patients are cognitively impaired. These cognitive dysfunctions have been traditionally described as heterogeneous, but more recent studies suggest that there is a specific pattern of MS-related cognitive dysfunctions. With the advent of disease-modifying medications for MS and emphasis on early intervention and treatment, detection of cognitive impairment at its earliest stage becomes particularly important. In this review the authors address: the cognitive domains most commonly impaired in MS (memory, attention, executive functions, speed of information processing, and visual-spatial abilities); the pathophysiological mechanism implied in MS cognitive dysfunction and correlated brain MRI features; the importance of neuropsychological assessment of MS patients in different stages of the disease and the influence of its course on cognitive performance; the most used tests and batteries for neuropsychological assessment; therapeutic strategies to improve cognitive abilities.
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Affiliation(s)
- Joana Guimarães
- MS Clinic, Department of Neurology, Centro Hospitalar São JoãoPorto, Portugal
- Faculty of Medicine, University of PortoPorto, Portugal
| | - Maria José Sá
- MS Clinic, Department of Neurology, Centro Hospitalar São JoãoPorto, Portugal
- Faculty of Health Sciences, University Fernando PessoaPorto, Portugal
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Hecker M, Paap BK, Goertsches RH, Kandulski O, Fatum C, Koczan D, Hartung HP, Thiesen HJ, Zettl UK. Reassessment of blood gene expression markers for the prognosis of relapsing-remitting multiple sclerosis. PLoS One 2011; 6:e29648. [PMID: 22216338 PMCID: PMC3246503 DOI: 10.1371/journal.pone.0029648] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/02/2011] [Indexed: 01/04/2023] Open
Abstract
Despite considerable advances in the treatment of multiple sclerosis, current drugs are only partially effective. Most patients show reduced disease activity with therapy, but still experience relapses, increasing disability, and new brain lesions. Since there are no reliable clinical or biological markers of disease progression, long-term prognosis is difficult to predict for individual patients. We identified 18 studies that suggested genes expressed in blood as predictive biomarkers. We validated the prognostic value of those genes with three different microarray data sets comprising 148 patients in total. Using these data, we tested whether the genes were significantly differentially expressed between patients with good and poor courses of the disease. Poor progression was defined by relapses and/or increase of disability during a two-year follow-up, independent of the administered therapy. Of 110 genes that have been proposed as predictive biomarkers, most could not be confirmed in our analysis. However, the G protein-coupled membrane receptor GPR3 was expressed at significantly lower levels in patients with poor disease progression in all data sets. GPR3 has therefore a high potential to be a biomarker for predicting future disease activity. In addition, we examined the IL17 cytokines and receptors in more detail and propose IL17RC as a new, promising, transcript-based biomarker candidate. Further studies are needed to better understand the roles of these receptors in multiple sclerosis and its treatment and to clarify the utility of GPR3 and IL17RC expression levels in the blood as markers of long-term prognosis.
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Affiliation(s)
- Michael Hecker
- Steinbeis Transfer Center for Proteome Analysis, Rostock, Germany.
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Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis -- an integral component of disease management. EPMA J 2011; 3:2. [PMID: 22738091 PMCID: PMC3375103 DOI: 10.1007/s13167-011-0136-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/02/2011] [Indexed: 11/28/2022]
Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory disorder of the central nervous system (CNS) in young adults. The disease causes a wide range of symptoms depending on the localization and characteristics of the CNS pathology. In addition to drug-based immunomodulatory treatment, both drug-based and non-drug approaches are established as complementary strategies to alleviate existing symptoms and to prevent secondary diseases. In particular, physical therapy like exercise and physiotherapy can be customized to the individual patient's needs and has the potential to improve the individual outcome. However, high quality systematic data on physical therapy in MS are rare. This article summarizes the current knowledge on the influence of physical activity and exercise on disease-related symptoms and physical restrictions in MS patients. Other treatment strategies such as drug treatments or cognitive training were deliberately excluded for the purposes of this article.
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Affiliation(s)
- Andrea Döring
- NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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