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Sen MK, Almuslehi MSM, Shortland PJ, Coorssen JR, Mahns DA. Revisiting the Pathoetiology of Multiple Sclerosis: Has the Tail Been Wagging the Mouse? Front Immunol 2020; 11:572186. [PMID: 33117365 PMCID: PMC7553052 DOI: 10.3389/fimmu.2020.572186] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Multiple Sclerosis (MS) is traditionally considered an autoimmune-mediated demyelinating disease, the pathoetiology of which is unknown. However, the key question remains whether autoimmunity is the initiator of the disease (outside-in) or the consequence of a slow and as yet uncharacterized cytodegeneration (oligodendrocytosis), which leads to a subsequent immune response (inside-out). Experimental autoimmune encephalomyelitis has been used to model the later stages of MS during which the autoimmune involvement predominates. In contrast, the cuprizone (CPZ) model is used to model early stages of the disease during which oligodendrocytosis and demyelination predominate and are hypothesized to precede subsequent immune involvement in MS. Recent studies combining a boost, or protection, to the immune system with disruption of the blood brain barrier have shown CPZ-induced oligodendrocytosis with a subsequent immune response. In this Perspective, we review these recent advances and discuss the likelihood of an inside-out vs. an outside-in pathoetiology of MS.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Mohammed S M Almuslehi
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Physiology, College of Veterinary Medicine, University of Diyala, Baqubah, Iraq
| | - Peter J Shortland
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Jens R Coorssen
- Departments of Health Sciences and Biological Sciences, Faculties of Applied Health Sciences and Mathematics & Science, Brock University, St. Catharines, ON, Canada
| | - David A Mahns
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Angwafor SA, Bell GS, Njamnshi AK, Singh G, Sander JW. Parasites and epilepsy: Understanding the determinants of epileptogenesis. Epilepsy Behav 2019; 92:235-244. [PMID: 30711777 DOI: 10.1016/j.yebeh.2018.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex, and other favorable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasite-induced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), the Netherlands.
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Mikita K, Thakur K, Anstey NM, Piera KA, Pardo CA, Weinberg JB, Mukemba J, Florence S, Mwaikambo ED, Granger DL, Sullivan DJ. Quantification of Plasmodium falciparum histidine-rich protein-2 in cerebrospinal spinal fluid from cerebral malaria patients. Am J Trop Med Hyg 2014; 91:486-92. [PMID: 24980497 DOI: 10.4269/ajtmh.14-0210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A cerebrospinal fluid (CSF) biomarker for cerebral malaria (CM) has not been validated. We examined the detection, semiquantification, and clinical use of the Plasmodium falciparum histidine-rich protein-2 (PfHRP-2) as a parasite antigen biomarker for CM. The PfHRP-2 was detected in archival CSF samples from CM patients from Tanzania both by a newly developed sensitive and specific immuno-polymerase chain reaction (72 of 73) and by rapid diagnostic tests (62 of 73). The geometric mean PfHRP-2 CSF concentration was 8.76 ng/mL with no differences in those who survived (9.2 ng/mL), those who died (11.1 ng/mL), and those with neurologic sequelae (10.8 ng/mL). All aparasitemic endemic and nonendemic control samples had undetectable CSF PfHRP-2. In a separate group of 11 matched plasma and CSF cerebral malaria patient samples, the ratio of plasma to CSF PfHRP-2 was 175. The CSF PfHRP-2 reflects elevated plasma PfHRP-2 rather than elevated CM-specific CSF ratios, falling short of a validated biomarker.
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Affiliation(s)
- Kei Mikita
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Kiran Thakur
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Nicholas M Anstey
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Kim A Piera
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Carlos A Pardo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - J Brice Weinberg
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Jackson Mukemba
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Salvatore Florence
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Esther D Mwaikambo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - Donald L Granger
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Royal Darwin Hospital, Darwin Australia; Duke University and Veterans Administration Medical Centers, Durham, North Carolina; Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; University of Utah School of Medicine and Veterans Administration Medical Center, Salt Lake City, Utah
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