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Batran RA, Kamel M, Bahr A, Waheb J, Khalil A, Elsokary M. Multiple sclerosis: economic burden, therapeutic advances, and future forecasts in the Middle East and North Africa region. Expert Rev Pharmacoecon Outcomes Res 2024; 24:873-882. [PMID: 38832693 DOI: 10.1080/14737167.2024.2364832] [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: 12/11/2023] [Accepted: 06/03/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a persistent condition characterized by immune-mediated processes in the central nervous system, affecting around 2.8 million individuals globally. While historically less prevalent in the Middle East and North Africa (MENA) region, recent trends mirror the global rise in MS. AREA COVERED The impact of MS is substantial, particularly in the MENA region, with costs per patient surpassing nominal GDP per capita in certain countries. Disease-modifying therapies aim to alleviate MS effects, but challenges persist, especially in managing progressive MS as it shifts from inflammatory to neurodegenerative phases. Limited resources in the MENA region hinder care delivery, though awareness initiatives and multidisciplinary centers are emerging. Contrary to global projections of a decline in the MS market, the MENA region is poised for growth due to increased prevalence, healthcare expenditures, and infrastructure investments. EXPERT OPINION This review underscores the urgent necessity for effective treatments, robust disease management, and early diagnosis in tackling MS's repercussions in the MENA region. Bolstering resources tailored to MS patients and elevating the quality of care stand as pivotal strategies for enhancing health outcomes in this context. Taking decisive action holds the key to enhancing the overall well-being of individuals grappling with MS.
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Affiliation(s)
- Radwa Ahmed Batran
- Medical Affairs Department, Volaris LLC, Dubai, UAE
- Clinical Pharmacy & HEOR, Cairo University Hospitals, Cairo, Egypt
| | - Mohab Kamel
- Medical Affairs Department, Volaris LLC, Dubai, UAE
| | - Ayman Bahr
- Medical Affairs Department, Volaris LLC, Jeddah, Saudi Arabia
| | - Joseph Waheb
- Medical Affairs Department, Volaris LLC, Cairo, Egypt
| | - Ahmed Khalil
- Medical Affairs Department, Volaris LLC, Dubai, UAE
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Yousef H, Malagurski Tortei B, Castiglione F. Predicting multiple sclerosis disease progression and outcomes with machine learning and MRI-based biomarkers: a review. J Neurol 2024; 271:6543-6572. [PMID: 39266777 PMCID: PMC11447111 DOI: 10.1007/s00415-024-12651-3] [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: 05/08/2024] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 09/14/2024]
Abstract
Multiple sclerosis (MS) is a demyelinating neurological disorder with a highly heterogeneous clinical presentation and course of progression. Disease-modifying therapies are the only available treatment, as there is no known cure for the disease. Careful selection of suitable therapies is necessary, as they can be accompanied by serious risks and adverse effects such as infection. Magnetic resonance imaging (MRI) plays a central role in the diagnosis and management of MS, though MRI lesions have displayed only moderate associations with MS clinical outcomes, known as the clinico-radiological paradox. With the advent of machine learning (ML) in healthcare, the predictive power of MRI can be improved by leveraging both traditional and advanced ML algorithms capable of analyzing increasingly complex patterns within neuroimaging data. The purpose of this review was to examine the application of MRI-based ML for prediction of MS disease progression. Studies were divided into five main categories: predicting the conversion of clinically isolated syndrome to MS, cognitive outcome, EDSS-related disability, motor disability and disease activity. The performance of ML models is discussed along with highlighting the influential MRI-derived biomarkers. Overall, MRI-based ML presents a promising avenue for MS prognosis. However, integration of imaging biomarkers with other multimodal patient data shows great potential for advancing personalized healthcare approaches in MS.
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Affiliation(s)
- Hibba Yousef
- Technology Innovation Institute, Biotechnology Research Center, P.O.Box: 9639, Masdar City, Abu Dhabi, United Arab Emirates.
| | - Brigitta Malagurski Tortei
- Technology Innovation Institute, Biotechnology Research Center, P.O.Box: 9639, Masdar City, Abu Dhabi, United Arab Emirates
| | - Filippo Castiglione
- Technology Innovation Institute, Biotechnology Research Center, P.O.Box: 9639, Masdar City, Abu Dhabi, United Arab Emirates
- Institute for Applied Computing (IAC), National Research Council of Italy, Rome, Italy
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Paolicelli D, Borriello G, Clerici R, Colombo E, Croce D, D'Amico E, De Rossi N, Di Sapio A, Fenu G, Maimone D, Marfia GA, Moccia M, Perini P, Piscaglia MG, Razzolini L, Riccaboni M, Signoriello E, Agostoni G, Farina A, Mondino M, Berruto F, Tettamanti A, Donnaloja F, Tortorella C. Predicted Expenditure for Prescription Drugs for Multiple Sclerosis in the Italian Market Between 2023 and 2028: Results of the Oracle Project. Neurol Ther 2024; 13:1415-1430. [PMID: 39093539 PMCID: PMC11393242 DOI: 10.1007/s40120-024-00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic neurodegenerative disease that leads to impaired cognitive function and accumulation of disability, with significant socioeconomic burden. Serious unmet need in the context of managing MS has given rise to ongoing research efforts, leading to the launch of new drugs planned for the near future, and subsequent concerns about the sustainability of healthcare systems. This study assessed the changes in the Italian MS market and their impact on the expenditures of the Italian National Healthcare Service between 2023 and 2028. METHODS A horizon-scanning model was developed to estimate annual expenditure from 2023 to 2028. Annual expenditure for MS was calculated by combining the number of patients treated with each product (clinical inputs) and the yearly costs of therapy (economic inputs). Baseline inputs (2020-2022) were collected from IQVIA® real-world data, while input estimation for the 5-year forecast was integrated with analog analyses and the insights of clinicians and former payers. RESULTS The number of equivalent patients treated in 2028 in Italy was estimated at around 67,000, with an increase of 10% versus 2022. In terms of treatment pattern evolution, first-line treatments are expected to reduce their shares from 47% in 2022 to 27% in 2028, and Bruton tyrosine kinase inhibitors are expected to reach 23% of patient shares. Overall, expenditure for MS is estimated to decrease from €721 million in 2022 to €551 million in 2028, mainly due to losses of exclusivity and renegotiation of drug prices. CONCLUSION Despite the increase in the number of patients treated for MS and the launch of new molecules that will reach high market penetration, the model confirmed sustainability for the Italian National Healthcare Service.
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Affiliation(s)
- Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Giovanna Borriello
- Multiple Sclerosis Center, San Pietro Fatebenefratelli Hospital, Rome, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | | | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Croce
- Centre for Health Economics, Social and Health Care Management, University Carlo Castanea - LIUC, Castellanza, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia - P.O. Montichiari, Montichiari, Italy
| | - Alessia Di Sapio
- Department of Neurology and CRESM (Regional Referral Multiple Sclerosis Centre), University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Giuseppe Fenu
- Department of Neurology, Brotzu Hospital, Cagliari, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marcello Moccia
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital of Naples, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Paola Perini
- Department of Neurology, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Maria G Piscaglia
- Multiple Sclerosis Center, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | | | - Carla Tortorella
- Department of Neurosciences, Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Rome, Italy
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Ranasinghe P, Liyanage C, Sirisena N, Liyanage S, Priyadarshani CDN, Hendalage DPB, Dissanayake VHW. Frequency of pharmacogenomic variants affecting safety and efficacy of immunomodulators and biologics in a South Asian population from Sri Lanka. Hum Genomics 2024; 18:107. [PMID: 39334333 PMCID: PMC11438298 DOI: 10.1186/s40246-024-00674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Immunomodulators are important for management of autoimmune diseases and hematological malignancies. Significant inter-individual variation in drug response/reactions exists due to genetic polymorphisms. We describe frequency of identified genetic polymorphisms among Sri Lankans. METHODS Sri Lankan data were obtained from an anonymized database of 670 participants. Data on variants and global distribution of Minor Allele frequency (MAF) of other populations (South Asian, Ashkenazi-Jewish, East-Asian, European-Finnish, European-non-Finnish, Latino-American, African/African-American) were obtained from pharmGKB online database. RESULTS SLC19A1 (rs1051266) variant had a MAF (95% CI) of 63.3% (60.7-65.9). Other common variants included FCGR3A (rs396991), MTHFR (rs1801133), ITPA (rs1127354), CYP2C9*3 (rs1057910) and NUD15*3 (rs116855232), with MAFs of 35.3% (32.7-37.9), 12.2% (10.4-13.9), 10.9% (9.2-12.6), 9.8% (8.2-11.4), 8.3% (6.8-9.8) respectively. Less commonly present variants included CYP2C9*2 (rs1799853) (2.5%[1.7-3.4]), TPMT*3C (rs1142345) (1.9%[1.1-2.6]), TPMT*3B (rs1800460) (0.2%[0-0.5]), CYP3A5*6 (rs10264272) (0.2%[0-0.4]) and CYP3A4*18 (rs28371759) (0.1%[0-0.2]). The SLC19A1 (rs1051266), NUD15*3 (rs116855232), CYP2C9*3 (rs1057910), FCGR3A (rs396991), and ITPA (rs1127354) showed significantly higher frequencies in Sri Lankans compared to many other populations, exceptions include FCGR3A in Ashkenazi-Jewish and ITPA in East-Asians. Conversely, MTHFR (rs1801133), TPMT*3B (rs1800460), and CYP2C9*2 (rs1799853) were significantly less prevalent among Sri Lankans than in many other populations. Sri Lankans exhibited lower prevalence of TPMT*3C (rs1142345) compared to European-non-Finnish, Latino-Americans, and African/African-Americans; CYP3A4*18 (rs28371759) compared to East-Asians; and CYP3A5*6 (rs10264272) compared to African/African-Americans and Latino-Americans. CONCLUSION Sri Lankans exhibit higher frequencies in variants reducing methotrexate efficacy (SLC19A1), increasing azathioprine myelotoxicity (NUDT15), and lower frequencies in variants linked to increased azathioprine toxicity (TPMT*3B, TPMT*3C), reduced tacrolimus efficacy (CYP3A4*18), and methotrexate toxicity risk (MTHFR). Beneficial variants enhancing rituximab efficacy (FCGR3A) are more prevalent, while those reducing tacrolimus dosage (CYP3A5*6) are less common. This highlights need for targeted medication strategies to improve treatment outcomes.
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Affiliation(s)
- Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK.
| | - Chiranthi Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nirmala Sirisena
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Sandamini Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - C D Nelanka Priyadarshani
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - D P Bhagya Hendalage
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Vajira H W Dissanayake
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
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Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Nationwide Update on Prevalence of Falls, Injurious Falls, Concerns About Falling, and Fall Prevention in Persons With Multiple Sclerosis. Am J Phys Med Rehabil 2024; 103:811-818. [PMID: 38466198 DOI: 10.1097/phm.0000000000002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The aim of the study is to estimate the current nationwide prevalence of falls, injurious falls, concerns about falling, and information on fall prevention among people with multiple sclerosis. DESIGN This is a cross-sectional national web-based survey that included 965 adult people with multiple sclerosis. Participants self-reported falls and injurious falls experienced in the past 6 months. Participants also provided information on their concerns about falling and information on fall prevention received. RESULTS A total of 56% reported falling in the past 6 months. The prevalence of falls at the population level ranges between 53% and 59%. Most falls occur inside of participants' homes (68%). About 30% of fallers reported an injurious fall. Most respondents, 87% expressed being concerned about falling and 68% reported they had cut down on activities due to their concerns about falling. Among participants who received information about falling (64%), only 9% received a formal fall prevention course. CONCLUSIONS Despite advances in falls research over the last decades, falling continues to be a highly prevalent problem for people with multiple sclerosis. About one-third of those falls result in injuries. Concerns about falling among fallers and nonfallers affect the performance of daily activities and independence. Few people receive a formal falls prevention education or training.
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Affiliation(s)
- Libak Abou
- From the Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (LA, CW, ALK); Department of Physical Medicine and Rehabilitation, Kaiser Permanente Health System, Redwood City, California (CM); and Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, Michigan (NEF)
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Brufau-Cochs M, Mansilla-Polo M, Morgado-Carrasco D. [Translated article] Risk of Skin Cancer Associated with Disease-Modifying Therapies in Multiple Sclerosis: A Comprehensive Evidence Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T781-T790. [PMID: 38972584 DOI: 10.1016/j.ad.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 07/09/2024] Open
Abstract
The use of disease-modifying therapies (DMT) has led to a paradigm shift in the management of multiple sclerosis. A comprehensive narrative review was conducted through an extensive literature search including Medline and Google Scholar to elucidate the link between DMT and the propensity of cutaneous malignancies. Sphingosine-1-phosphate receptor modulators, such as fingolimod and siponimod are associated with a higher risk of basal cell carcinoma (BCC), but not squamous cell carcinoma, or melanoma. The associated physiopathological mechanisms are not fully understood. Alemtuzumab and cladribine show isolated associations with skin cancer. Regarding other DMT, no increased risk has ever been found. Given the evidence currently available, it is of paramount importance to advocate for necessary dermatological assessments that should be individualized to the risk profile of each patient. Nonetheless, additional prospective studies are still needed to establish efficient dermatological follow-up protocols.
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Affiliation(s)
- M Brufau-Cochs
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Mansilla-Polo
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordá, Figueres, Girona, Spain.
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7
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Brufau-Cochs M, Mansilla-Polo M, Morgado-Carrasco D. Risk of skin cancer associated with disease-modifying therapies in multiple sclerosis: a comprehensive evidence review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:781-790. [PMID: 38307166 DOI: 10.1016/j.ad.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024] Open
Abstract
The use of disease-modifying therapies (DMT) has led to a paradigm shift in the management of multiple sclerosis. A comprehensive narrative review was conducted through an extensive literature search including Medline and Google Scholar to elucidate the link between DMT and the propensity of cutaneous malignancies. Sphingosine-1-phosphate receptor modulators, such as fingolimod and siponimod are associated with a higher risk of basal cell carcinoma (BCC), but not squamous cell carcinoma, or melanoma. The associated physiopathological mechanisms are not fully understood. Alemtuzumab and cladribine show isolated associations with skin cancer. Regarding other DMT, no increased risk has ever been found. Given the evidence currently available, it is of paramount importance to advocate for necessary dermatological assessments that should be individualized to the risk profile of each patient. Nonetheless, additional prospective studies are still needed to establish efficient dermatological follow-up protocols.
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Affiliation(s)
- M Brufau-Cochs
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - M Mansilla-Polo
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordá, Figueres, Girona, España.
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Carrillo-Mora P, Landa-Solís C, Valle-Garcia D, Luna-Angulo A, Avilés-Arnaut H, Robles-Bañuelos B, Sánchez-Chapul L, Rangel-López E. Kynurenines and Inflammation: A Remarkable Axis for Multiple Sclerosis Treatment. Pharmaceuticals (Basel) 2024; 17:983. [PMID: 39204088 PMCID: PMC11356993 DOI: 10.3390/ph17080983] [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: 06/22/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 09/03/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory autoimmune neurological disease characterized by the recurrent appearance of demyelinating lesions and progressive disability. Currently, there are multiple disease-modifying treatments, however, there is a significant need to develop new therapeutic targets, especially for the progressive forms of the disease. This review article provides an overview of the most recent studies aimed at understanding the inflammatory processes that are activated in response to the accumulation of kynurenine pathway (KP) metabolites, which exacerbate an imbalance between immune system cells (e.g., Th1, Th2, and T reg) and promote the release of pro-inflammatory interleukins that modulate different mechanisms: membrane-receptors function; nuclear factors expression; and cellular signals. Together, these alterations trigger cell death mechanisms in brain cells and promote neuron loss and axon demyelination. This hypothesis could represent a remarkable approach for disease-modifying therapies for MS. Here, we also provide a perspective on the repositioning of some already approved drugs involved in other signaling pathways, which could represent new therapeutic strategies for MS treatment.
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Affiliation(s)
- Paul Carrillo-Mora
- Clinical Neurosciences Division, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Carlos Landa-Solís
- Tissue Engineering, Cell Therapy, and Regenerative Medicine Unit, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - David Valle-Garcia
- Neuroimmunology Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico;
| | - Alexandra Luna-Angulo
- Neuromuscular Diseases Laboratory, Clinical Neurosciences Division, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Hamlet Avilés-Arnaut
- Faculty of Biological Sciences, Institute of Biotechnology, National Autonomous University of Nuevo Leon, Nuevo León 66455, Mexico;
| | - Benjamín Robles-Bañuelos
- Cell Reprogramming Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico;
| | - Laura Sánchez-Chapul
- Neuromuscular Diseases Laboratory, Clinical Neurosciences Division, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Edgar Rangel-López
- Cell Reprogramming Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico;
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Valadkevičienė D, Jatužis D, Žukauskaitė I, Bileviciute-Ljungar I. Can International Classification of Functioning, Disability and Health (ICF) Be Used for Prediction of Work Capacity and Employment Status in Multiple Sclerosis? J Clin Med 2024; 13:4195. [PMID: 39064236 PMCID: PMC11277909 DOI: 10.3390/jcm13144195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Multiple sclerosis (MS) affects many body functions and activities, including work capacity and ability to work. An evaluation of work-related parameters is important to understand the barriers to maintaining the job. The aim of this study was to evaluate if a Comprehensive International Classification of Functioning, Disability and Health (ICF) core set for MS can be used to predict work capacity and employment status. Methods: The cohort included 151 participants with MS (99 female/52 male, mean age 49 years) referred for a work capacity evaluation. Results: 71 (47.0%) were employed and a major part (131, 86.7%) had a work capacity between 20 and 40% with no difference between those who were employed and those who were unemployed. The analysis revealed that age and the following categories explained 68.8% of the work capacity: b770 Gait pattern functions; b730 Muscle power functions; b134 Sleep functions; d845 Acquiring, keeping and terminating a job; and b620 Urination functions. The following categories in 79.5% predicted ability to work: b164 Higher-level cognitive functions; d510 Washing oneself; d630; Preparing meals; and d870 Economic self-sufficiency. Conclusions: Here, we show that different functions/activities predicted work capacity in comparison with employment status in MS. Therefore, ICF should be implemented when assessing work ability.
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Affiliation(s)
- Daiva Valadkevičienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- The Agency for Protection of the Rights of Persons with Disabilities at the Ministry of Social Security and Labour of the Republic of Lithuania, LT-03223 Vilnius, Lithuania
| | - Dalius Jatužis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Irena Žukauskaitė
- Institute of Psychology, Faculty of Philosophy, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Indre Bileviciute-Ljungar
- Department of Clinical Science, Karolinska Institutet, SE-18288 Stockholm, Sweden
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, SE-11291 Stockholm, Sweden
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Borriello G, Chisari CG, Maimone D, Mirabella M, Paolicelli D, Assogna F, Caradonna S, Patti F. Cladribine effects on patient-reported outcomes and their clinical and biometric correlates in highly active relapsing multiple sclerosis at first switch: the observational, multicenter, prospective, phase IV CLADFIT-MS study. Front Neurol 2024; 15:1422078. [PMID: 39114529 PMCID: PMC11305121 DOI: 10.3389/fneur.2024.1422078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/05/2024] [Indexed: 08/10/2024] Open
Abstract
Patient-reported outcomes (PROs) are essential for understanding the effects of MS and its treatments on patients' lives; they play an important role in multiple sclerosis (MS) research and practice. We present the protocol for an observational study to prospectively assess the effect of cladribine tablets on PROs and their correlation to disability and physical activity in adults with highly active relapsing MS switching from a first disease modifying drug (DMD) to cladribine tablets in routine clinical practice at study sites in Italy. The primary objective will be to evaluate changes from baseline in the impact of highly active MS on self-assessed physical functioning 52 weeks after the switch to cladribine tablets using the Multiple Sclerosis Impact Scale-29 (MSIS-29). Secondary objectives will include self-assessed psychological impact of highly active MS in daily life and general health after the switch to cladribine tablets as well as changes in cognitive function, anxiety, and depression symptoms. Additional PRO measures will include the Hospital Anxiety and Depression Scale (HADS), the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire: Multiple Sclerosis (WPAI:MS), and the Patient-Reported Outcomes Measurement Information System (PROMIS). Wearable devices will acquire activity data (step counts, walking speed, time asleep, and energy expenditure). Additional clinical, radiological, and laboratory data will be collected when available during routine management. The findings will complement data from controlled trials by providing insight from daily clinical practice into the effect of cladribine tablets on the patient's experience and self-assessed impact of treatment on daily life.
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Affiliation(s)
- Giovanna Borriello
- Multiple Sclerosis Center, San Pietro Fatebenefratelli Hospital, Rome, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | - Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
- UOS Multiple Sclerosis, AOU Policlinico “G Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca per la Sclerosi Multipla “Anna Paola Batocchi”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Damiano Paolicelli
- Neurology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), Policlinico General Hospital, University of Study of Bari, Bari, Italy
| | | | - Sandro Caradonna
- Merck Serono S.p.A. Italy, An Affiliate of Merck KGaA, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
- UOS Multiple Sclerosis, AOU Policlinico “G Rodolico-San Marco”, University of Catania, Catania, Italy
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11
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Schuldesz AC, Maganti RK, Tudor R, Cornea A, Prodan M, Toma AO, Fericean RM, Simu M. Impact of Ocrelizumab on Disease Progression, Memory Improvement, and Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis: A Longitudinal MRI and Clinical Criteria Analysis. Diseases 2024; 12:127. [PMID: 38920559 PMCID: PMC11202762 DOI: 10.3390/diseases12060127] [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: 05/12/2024] [Revised: 06/09/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive neurological disorder that significantly impacts quality of life and functionality. Ocrelizumab, a monoclonal antibody targeting CD20-positive B cells, has emerged as a treatment for relapsing-remitting MS (RRMS). This study aimed to assess the impact of ocrelizumab on disease progression and quality of life over a longitudinal course, utilizing clinical criteria and magnetic resonance imaging (MRI) analyses. Conducted at the Neurology Department of Pius Brinzeu Clinical Emergency Hospital in Western Romania from 2020 to 2023, this observational study enrolled 93 patients with RRMS who commenced ocrelizumab therapy. The study employed the Expanded Disability Status Scale (EDSS) and MRI to evaluate disease progression, while quality of life was assessed using the World Health Organisation Quality of Life (WHOQOL) questionnaire, Beck Depression Index (BDI), and MOCA scales. Significant improvements were observed post-treatment. EDSS scores decreased from 4.61 to 4.08 (p = 0.038), indicating reduced disability. MRI analyses showed a substantial decrease in expansive lesions (from 67.74% to 26.88%, p < 0.001) and an increase in stationary lesions (from 32.26% to 73.12%, p < 0.001). Quality of life improvements were notable in the physical (from 58.42 to 64.84, p = 0.005) and environmental domains (from 63.21 to 68.44, p = 0.033). Cognitive functions, assessed via Montreal Cognitive Assessment (MOCA), showed a significant total score increase from 20.38 to 22.30 (p < 0.001). Subgroup analysis revealed more pronounced effects in females and younger patients, with a significant reduction in depressive symptoms measured by BDI scores (from 14.35 to 11.62, p = 0.003). Ocrelizumab significantly reduced disease activity and disability in RRMS patients, as demonstrated by improvements in EDSS scores and MRI findings. Quality of life and cognitive functions also showed considerable enhancements. These findings support ocrelizumab's efficacy in not only managing MS symptoms but also improving overall patient well-being.
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Affiliation(s)
- Amanda Claudia Schuldesz
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.C.S.); (M.P.)
| | - Ram Kiram Maganti
- School of General Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar 563101, India;
| | - Raluca Tudor
- Discipline of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (R.T.); (A.C.); (M.S.)
| | - Amalia Cornea
- Discipline of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (R.T.); (A.C.); (M.S.)
| | - Mihaela Prodan
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.C.S.); (M.P.)
| | - Ana-Olivia Toma
- Discipline of Dermatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Dermatology, Timisoara Municipal Emergency Hospital, 300254 Timisoara, Romania;
| | - Roxana Manuela Fericean
- Department of Dermatology, Timisoara Municipal Emergency Hospital, 300254 Timisoara, Romania;
| | - Mihaela Simu
- Discipline of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (R.T.); (A.C.); (M.S.)
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12
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Nawar AA, Farid AM, Wally R, Tharwat EK, Sameh A, Elkaramany Y, Asla MM, Kamel WA. Efficacy and safety of stem cell transplantation for multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2024; 14:12545. [PMID: 38822024 PMCID: PMC11143245 DOI: 10.1038/s41598-024-62726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
Multiple sclerosis (MS) is a common autoimmune neurological disease affecting patients' motor, sensory, and visual performance. Stem Cell Transplantation (SCT) is a medical intervention where a patient is infused with healthy stem cells with the purpose of resetting their immune system. SCT shows remyelinating and immunomodulatory functions in MS patients, representing a potential therapeutic option. We conducted this systematic review and meta-analysis that included randomized control trials (RCTs) of SCT in MS patients to investigate its clinical efficacy and safety, excluding observational and non-English studies. After systematically searching PubMed, Web of Science, Scopus, and Cochrane Library until January 7, 2024, nine RCTs, including 422 patients, were eligible. We assessed the risk of bias (ROB) in these RCTs using Cochrane ROB Tool 1. Data were synthesized using Review Manager version 5.4 and OpenMeta Analyst software. We also conducted subgroup and sensitivity analyses. SCT significantly improved patients expanded disability status scale after 2 months (N = 39, MD = - 0.57, 95% CI [- 1.08, - 0.06], p = 0.03). SCT also reduced brain lesion volume (N = 136, MD = - 7.05, 95% CI [- 10.69, - 3.4], p = 0.0002). The effect on EDSS at 6 and 12 months, timed 25-foot walk (T25-FW), and brain lesions number was nonsignificant. Significant adverse events (AEs) included local reactions at MSCs infusion site (N = 25, RR = 2.55, 95% CI [1.08, 6.03], p = 0.034) and hematological disorders in patients received immunosuppression and autologous hematopoietic SCT (AHSCT) (N = 16, RR = 2.33, 95% CI [1.23, 4.39], p = 0.009). SCT can improve the disability of MS patients and reduce their brain lesion volume. The transplantation was generally safe and tolerated, with no mortality or significant serious AEs, except for infusion site reactions after mesenchymal SCT and hematological AEs after AHSCT. However, generalizing our results is limited by the sparse number of RCTs conducted on AHSCT. Our protocol was registered on PROSPERO with a registration number: CRD42022324141.
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Affiliation(s)
| | | | - Rim Wally
- Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
| | - Engy K Tharwat
- Bioinformatics Group, Centre for Informatics Science, School of Information Technology and Computer Science, Nile University, Giza, Egypt
| | - Ahmed Sameh
- Biotechnology Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Yomna Elkaramany
- Biotechnology Department, Faculty of Science, Cairo University, Giza, Egypt
| | | | - Walaa A Kamel
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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13
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Cotter M, Quinn SM, Fearon U, Ansboro S, Rakovic T, Southern JM, Kelly VP, Connon SJ. A new class of 7-deazaguanine agents targeting autoimmune diseases: dramatic reduction of synovial fibroblast IL-6 production from human rheumatoid arthritis patients and improved performance against murine experimental autoimmune encephalomyelitis. RSC Med Chem 2024; 15:1556-1564. [PMID: 38784475 PMCID: PMC11110761 DOI: 10.1039/d4md00028e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/17/2024] [Indexed: 05/25/2024] Open
Abstract
A simple in vitro assay involving the measurement of IL-6 production in human synovial fibroblasts from rheumatoid arthritis patients has been utilised to select candidates from a targeted library of queuine tRNA ribosyltransferase (QTRT) substrates for subsequent in vivo screening in murine experimental autoimmune encephalomyelitis (EAE - a model of multiple sclerosis). The in vitro activity assay discriminated between poor and excellent 7-deazaguanine QTRT substrates and allowed the identification of several structures which subsequently outperformed the previous lead in EAE. Two molecules were of significant promise: one rigidified analogue of the lead, and another considerably simpler structure incorporating an oxime motif which differs structurally from the lead to a considerable extent. These studies provide data from human cells for the first time and have expanded both the chemical space and current understanding of the structure-activity relationship underpinning the remarkable potential of 7-deazguanines in a Multiple Sclerosis disease model.
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Affiliation(s)
- Michelle Cotter
- School of Chemistry, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Shauna M Quinn
- School of Biochemistry & Immunology, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Ursula Fearon
- School of Medicine, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Sharon Ansboro
- School of Medicine, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Tatsiana Rakovic
- School of Medicine, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - John M Southern
- School of Chemistry, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Vincent P Kelly
- School of Biochemistry & Immunology, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
| | - Stephen J Connon
- School of Chemistry, Trinity College, Trinity Biomedical Sciences Institute 152-160 Pearse Street Dublin Ireland
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14
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Filippi M, Ferrè L, Zanetta C, Rizzi C, Pessina G, Assogna F, Rocca MA. Prospective observational study to evaluate treatment satisfaction and effectiveness in patients with relapsing multiple sclerosis starting cladribine tablets (CLADREAL) in Italy. Front Neurol 2024; 15:1379712. [PMID: 38638312 PMCID: PMC11024245 DOI: 10.3389/fneur.2024.1379712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Disease-modifying therapies (DMTs) for multiple sclerosis (MS) reduce relapse frequency, magnetic resonance imaging (MRI) activity, and slow disability progression. Numerous DMTs are approved for relapsing forms of MS although real-world data on patient-reported outcomes (PROs) and quality of life (QoL) are needed to inform treatment choice. Immune reconstitution therapy with cladribine tablets is a highly effective treatment for relapsing MS (RMS). We present the protocol for an observational study to prospectively assess the effectiveness of cladribine tablets on clinical and MRI parameters as well as on PROs, including treatment satisfaction, QoL, sleep quality, self-perceived health, fatigue, and physical function. Enrolled patients at study sites in Italy will be adults with RMS (including relapsing-remitting and active secondary progressive MS) who are either treatment naïve or have received at least one first-line disease modifying DMT or no more than one second-line DMT. The primary objective will be change in global treatment satisfaction measured with the Treatment Satisfaction Questionnaire for Medication Version 1.4 approximately 24 months after initiating cladribine tablets in patients switching from previous DMTs. Secondary objectives will include global treatment satisfaction at earlier timepoints, will comprise treatment naïve patients, and will quantify treatment effectiveness and tolerability. We will also assess relapses, disability progression, MRI activity, and other PROs at approximately 12 and 24 months. The findings will provide insight from daily clinical practice into the patient's experience to complement data from controlled trials and inform treatment choice. EU PAS Registration Number EUPAS49334 filed 17/10/2022.
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Affiliation(s)
- Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Ferrè
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Zanetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Rizzi
- Merck Serono S.p.A., An Affiliate of Merck KGaA, Rome, Italy
| | | | | | - Maria A. Rocca
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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15
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Jones RR, Turkoz I, Ait-Tihyaty M, DiBernardo A, Houtchens MK, Havrdová EK. Efficacy and Safety of Ponesimod Compared with Teriflunomide in Female Patients with Relapsing Multiple Sclerosis: Findings from the Pivotal OPTIMUM Study. J Womens Health (Larchmt) 2024; 33:480-490. [PMID: 38301149 DOI: 10.1089/jwh.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background: Multiple sclerosis (MS) is threefold more prevalent in women than men. However, sex-specific efficacy analysis for MS disease-modifying therapies is not typically performed. Methods: Post hoc analyses of data from female patients enrolled in the phase 3, double-blind OPTIMUM study of relapsing MS were carried out. Eligible adults were randomized to ponesimod 20 mg or teriflunomide 14 mg once daily for up to 108 weeks. The primary endpoint was annualized relapse rate (ARR); secondary endpoints included change in symptom domain of Fatigue Symptom and Impact Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS) at week 108, number of combined unique active lesions (CUALs) per year on magnetic resonance imaging, and time to 12- and 24-week confirmed disability accumulation (CDA). Results: A total of 735 female patients (581 of childbearing potential) were randomized to ponesimod (n = 363, 49.4%) or teriflunomide (n = 372, 50.6%). Relative risk reduction in the ARR for ponesimod versus teriflunomide was 33.1% (mean, 0.192 vs. 0.286, respectively; p < 0.002). Mean difference in FSIQ-RMS for ponesimod versus teriflunomide was -4.34 (0.12 vs. 4.46; p = 0.002); rate ratio in CUALs per year, 0.601 (1.45 vs. 2.41; p < 0.0001), and hazard ratio for time to 12- and 24-week CDA risk estimates, 0.83 (10.7% vs. 12.9%; p = 0.38) and 0.91 (8.8% vs. 9.7%; p = 0.69), respectively. Incidence of treatment-emergent adverse events was similar between treatment groups (89.0% and 90.1%). Conclusions: Analyses demonstrate the efficacy and safety of ponesimod, versus active comparator, for women with relapsing MS, supporting data-informed decision-making for women with MS. Clinical Trial Registration Number: NCT02425644.
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Affiliation(s)
- Robyn R Jones
- Office of Chief Medical Officer, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Ibrahim Turkoz
- Department of Statistics and Decision Sciences, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Maria Ait-Tihyaty
- Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Allitia DiBernardo
- Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Maria K Houtchens
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eva Kubala Havrdová
- Department of Neurology, First Medical Faculty, Charles University, Prague, Czech Republic
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16
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Alito A, Fontana JM, Franzini Tibaldeo E, Verme F, Piterà P, Miller E, Cremascoli R, Brioschi A, Capodaglio P. Whole-Body Cryostimulation in Multiple Sclerosis: A Scoping Review. J Clin Med 2024; 13:2003. [PMID: 38610768 PMCID: PMC11012586 DOI: 10.3390/jcm13072003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Multiple sclerosis (MS) is the most common cause of non-traumatic long-term disability in young adults. Whole-body cryostimulation (WBC) is a cold-based physical therapy known to induce physiological exercise-mimicking changes in the cardiovascular, neuromuscular, immune, and endocrine systems and to influence functional and psychological parameters by exposing the human body to cryogenic temperatures (≤-110 °C) for 2-3 min. The purpose of this scoping review is to present an overall view on the potential role of WBC as an adjuvant therapy in the treatment of MS. PubMed, ScienceDirect, Embase, and Web of Science were searched up to 30 November 2023, and a total of 13 articles were included. WBC may have beneficial antioxidant effects as a short-term adjuvant treatment in MS. There were no significant changes in antioxidant enzymes, nitric oxide levels, metalloproteinase levels, blood counts, rheology, and biochemistry. WBC can lead to a reduction in fatigue and an improvement in functional status, with a significant effect on both mental and physical well-being. There were no reported adverse effects. The results suggest that WBC may complement therapeutic options for patients with MS, as the effects of cryogenic cold stimulation have been shown to activate antioxidant processes and improve functional status, mood, anxiety, and fatigue.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy;
| | - Jacopo Maria Fontana
- IRCCS, Istituto Auxologico Italiano, Orthopedic Rehabilitation Unit, Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Piancavallo, 28921 Verbania, Italy; (J.M.F.); (P.C.)
| | - Eleonora Franzini Tibaldeo
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Torino, 10121 Torino, Italy;
| | - Federica Verme
- IRCCS, Istituto Auxologico Italiano, Orthopedic Rehabilitation Unit, Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Piancavallo, 28921 Verbania, Italy; (J.M.F.); (P.C.)
| | - Paolo Piterà
- Department of Clinical and Biological Sciences, University of Turin, 10043 Torino, Italy;
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland;
| | - Riccardo Cremascoli
- IRCCS, Istituto Auxologico Italiano, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital, Piancavallo, 28921 Verbania, Italy; (R.C.); (A.B.)
| | - Andrea Brioschi
- IRCCS, Istituto Auxologico Italiano, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital, Piancavallo, 28921 Verbania, Italy; (R.C.); (A.B.)
| | - Paolo Capodaglio
- IRCCS, Istituto Auxologico Italiano, Orthopedic Rehabilitation Unit, Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Piancavallo, 28921 Verbania, Italy; (J.M.F.); (P.C.)
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Torino, 10121 Torino, Italy;
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17
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Riley N, Drudge C, Nelson M, Haltner A, Barnett M, Broadley S, Butzkueven H, McCombe P, Van der Walt A, Wong EOY, Merschhemke M, Adlard N, Walker R, Samjoo IA. Comparative efficacy of ofatumumab versus oral therapies for relapsing multiple sclerosis patients using propensity score analyses and simulated treatment comparisons. Ther Adv Neurol Disord 2024; 17:17562864241239453. [PMID: 38525490 PMCID: PMC10960976 DOI: 10.1177/17562864241239453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background Evidence from network meta-analyses (NMAs) and real-world propensity score (PS) analyses suggest monoclonal antibodies (mAbs) offer a therapeutic advantage over currently available oral therapies and, therefore, warrant consideration as a distinct group of high-efficacy disease-modifying therapies (DMTs) for patients with relapsing multiple sclerosis (RMS). This is counter to the current perception of these therapies by some stakeholders, including payers. Objectives A multifaceted indirect treatment comparison (ITC) approach was undertaken to clarify the relative efficacy of mAbs and oral therapies. Design Two ITC methods that use individual patient data (IPD) to adjust for between-trial differences, PS analyses and simulated treatment comparisons (STCs), were used to compare the mAb ofatumumab versus the oral therapies cladribine, fingolimod, and ozanimod. Data sources and methods As IPD were available for trials of ofatumumab and fingolimod, PS analyses were conducted. Given summary-level data were available for cladribine, fingolimod, and ozanimod trials, STCs were conducted between ofatumumab and each of these oral therapies. Three efficacy outcomes were compared: annualized relapse rate (ARR), 3-month confirmed disability progression (3mCDP), and 6-month CDP (6mCDP). Results The PS analyses demonstrated ofatumumab was statistically superior to fingolimod for ARR and time to 3mCDP but not time to 6mCDP. In STCs, ofatumumab was statistically superior in reducing ARR and decreasing the proportion of patients with 3mCDP compared with cladribine, fingolimod, and ozanimod and in decreasing the proportion with 6mCP compared with fingolimod and ozanimod. These findings were largely consistent with recently published NMAs that identified mAb therapies as the most efficacious DMTs for RMS. Conclusion Complementary ITC methods showed ofatumumab was superior to cladribine, fingolimod, and ozanimod in lowering relapse rates and delaying disability progression among patients with RMS. Our study supports the therapeutic superiority of mAbs over currently available oral DMTs for RMS and the delineation of mAbs as high-efficacy therapies.
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Affiliation(s)
- Nicholas Riley
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | | | - Morag Nelson
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | | | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Pamela McCombe
- UQ Centre for Clinical Research Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Rob Walker
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | - Imtiaz A. Samjoo
- EVERSANA, Value and Evidence, 113-3228 South Service Road, Burlington, ON, Canada, L7N 3H8
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18
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Tsai CC, Jette S, Tremlett H. Disease-modifying therapies used to treat multiple sclerosis and the gut microbiome: a systematic review. J Neurol 2024; 271:1108-1123. [PMID: 38078977 DOI: 10.1007/s00415-023-12107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND The gut microbiome may play a role in multiple sclerosis (MS). However, its relationship with the disease-modifying therapies (DMTs) remains unclear. We systematically reviewed the literature to examine the relationship between DMTs and the gut microbiota among persons with MS (pwMS). METHODS MEDLINE, EMBASE, Web of Science, and Scopus were searched (01/2007-09/2022) for studies evaluating potential gut microbiota differences in diversity, taxonomic relative abundances, and functional capacity between DMT-exposed/unexposed pwMS or before/after DMT initiation. All US FDA-approved MS DMTs (1993-09/2022) and rituximab were included. RESULTS Of the 410 studies, 11 were included, totalling 1243 pwMS. Of these, 821 were DMT exposed and 473 unexposed, including 51 assessed before/after DMT initiation. DMT use duration ranged from 14 days to > 6 months. No study found a difference in gut microbiota alpha-diversity between DMT exposed/unexposed (p > 0.05). One study observed a difference in beta-diversity between interferon-beta users/DMT non-users (weighted UniFrac, p = 0.006). All studies examined taxa-level differences, but most (6) combined different DMTs. Two or more studies reported eight genera (Actinomyces, Bacteroides, Clostridium sensu stricto 1, Haemophilus, Megasphaera, Pseudomonas, Ruminiclostridium 5, Turicibacter) and one species (Ruthenibacterium lactatiformans) differing in the same direction between DMT exposed/unexposed. DMT users had lower relative abundances of carbohydrate degradation and reductive tricarboxylic acid cycle I pathway than non-users (p < 0.05), but findings could not be attributed to a specific DMT. DISCUSSION While DMT use (versus no use) was not associated with gut microbiota diversity differences, taxa-level differences were observed. Further work is warranted, as most studies were cross-sectional, few examined functionality, and DMTs were combined.
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Affiliation(s)
- Chia-Chen Tsai
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, Room S126, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 2B5, Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sophia Jette
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, Room S126, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 2B5, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, Room S126, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 2B5, Canada.
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19
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Hoffmann O, Paul F, Haase R, Kern R, Ziemssen T. Preferences, Adherence, and Satisfaction: Three Years of Treatment Experiences of People with Multiple Sclerosis. Patient Prefer Adherence 2024; 18:455-466. [PMID: 38406376 PMCID: PMC10894675 DOI: 10.2147/ppa.s452849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Background To reduce the risk of long-term disability in people with Multiple Sclerosis (pwMS), an increasing number of disease-modifying immune therapies (DMT) are available, involving diverse mechanisms of action, levels of efficacy, treatment risks, and tolerability aspects. Including patient preferences and expectations in shared decision-making may improve treatment satisfaction, adherence, and persistence. Purpose To investigate long-term alignment of individual preferences and expectations of pwMS with their actual DMT and its effect on treatment satisfaction, health-related quality of life (HRQoL), adherence, and treatment discontinuation. Methods A total of 401 pwMS beginning a new DMT were enrolled from 2015 to 2018 in a non-interventional study at three German MS centres. Patient preferences regarding DMT, TSQM-9, SF36, and self-reported adherence as well as relapses and EDSS were recorded at baseline and every 3 to 6 months for up to 3 years. Results Efficacy and tolerability were the highest-ranking preferences at baseline. Actual selection of DMT corresponded more closely to safety than efficacy, tolerability, or convenience preferences. Participants reported excellent adherence throughout the study. DMT persistence was 69.0%, with earlier discontinuation for injectable vs oral or infusion therapies. Breakthrough disease, rather than patient-reported outcomes, was the main driver of DMT discontinuation. For all routes of administration, global treatment satisfaction increased over time despite lower satisfaction with convenience. Several patterns of changing preferences were observed. Conclusion This study provides insight into the interaction of DMT preferences of pwMS with their actual treatment experience. Treatment decisions should be aligned with long-term expectations of pwMS to promote continuous adherence.
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Affiliation(s)
- Olaf Hoffmann
- Department of Neurology, Alexianer St. Josefs-Krankenhaus Potsdam, Potsdam, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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20
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Schrader TO, Lorrain KI, Bagnol D, Edu GC, Broadhead A, Baccei C, Poon MM, Stebbins KJ, Xiong Y, Lorenzana AO, Chan JR, Green AJ, Lorrain DS, Chen A. Identification and In Vivo Evaluation of Myelination Agent PIPE-3297, a Selective Kappa Opioid Receptor Agonist Devoid of β-Arrestin-2 Recruitment Efficacy. ACS Chem Neurosci 2024; 15:685-698. [PMID: 38265210 DOI: 10.1021/acschemneuro.3c00807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Structure-activity relationship studies led to the discovery of PIPE-3297, a fully efficacious and selective kappa opioid receptor (KOR) agonist. PIPE-3297, a potent activator of G-protein signaling (GTPγS EC50 = 1.1 nM, 91% Emax), did not elicit a β-arrestin-2 recruitment functional response (Emax < 10%). Receptor occupancy experiments performed with the novel KOR radiotracer [3H]-PIPE-3113 revealed that subcutaneous (s.c.) administration of PIPE-3297 at 30 mg/kg in mice achieved 90% occupancy of the KOR in the CNS 1 h post dose. A single subcutaneous dose of PIPE-3297 in healthy mice produced a statistically significant increase of mature oligodendrocytes (P < 0.0001) in the KOR-enriched striatum, an effect that was not observed in animals predosed with the selective KOR antagonist norbinaltorphimine. An equivalent dose given to mice in an open-field activity-monitoring system revealed a small KOR-independent decrease in total locomotor activity versus vehicle measured between 60 and 75 min post dose. Daily doses of PIPE-3297 at both 3 and 30 mg/kg s.c. reduced the disease score in the mouse experimental autoimmune encephalomyelitis (EAE) model. Visually evoked potential (VEP) N1 latencies were also significantly improved versus vehicle in both dose groups, and latencies matched those of untreated animals. Taken together, these findings highlight the potential therapeutic value of functionally selective G-protein KOR agonists in demyelinating disease, which may avoid the sedating side effects typically associated with classical nonbiased KOR agonists.
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Affiliation(s)
- Thomas O Schrader
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Kym I Lorrain
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Didier Bagnol
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Geraldine C Edu
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Alexander Broadhead
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Christopher Baccei
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Michael M Poon
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Karin J Stebbins
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Yifeng Xiong
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Ariana O Lorenzana
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Jonah R Chan
- Department of Neurology, University of California, San Francisco, San Francisco, California 94143, United States
| | - Ari J Green
- Department of Neurology, University of California, San Francisco, San Francisco, California 94143, United States
| | - Daniel S Lorrain
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
| | - Austin Chen
- Contineum Therapeutics, Suite 200, 10578 Science Center Drive, San Diego, California 92121, United States
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21
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Chaudhary P, Lockwood H, Stowell C, Bushong E, Reynaud J, Yang H, Gardiner SK, Wiliams G, Williams I, Ellisman M, Marsh-Armstrong N, Burgoyne C. Retrolaminar Demyelination of Structurally Intact Axons in Nonhuman Primate Experimental Glaucoma. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 38407858 PMCID: PMC10902877 DOI: 10.1167/iovs.65.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/28/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To determine if structurally intact, retrolaminar optic nerve (RON) axons are demyelinated in nonhuman primate (NHP) experimental glaucoma (EG). Methods Unilateral EG NHPs (n = 3) were perfusion fixed, EG and control eyes were enucleated, and foveal Bruch's membrane opening (FoBMO) 30° sectoral axon counts were estimated. Optic nerve heads were trephined; serial vibratome sections (VSs) were imaged and colocalized to a fundus photograph establishing their FoBMO location. The peripheral neural canal region within n = 5 EG versus control eye VS comparisons was targeted for scanning block-face electron microscopic reconstruction (SBEMR) using micro-computed tomographic reconstructions (µCTRs) of each VS. Posterior laminar beams within each µCTR were segmented, allowing a best-fit posterior laminar surface (PLS) to be colocalized into its respective SBEMR. Within each SBEMR, up to 300 axons were randomly traced until they ended (nonintact) or left the block (intact). For each intact axon, myelin onset was identified and myelin onset distance (MOD) was measured relative to the PLS. For each EG versus control SBEMR comparison, survival analyses compared EG and control MOD. Results MOD calculations were successful in three EG and five control eye SBEMRs. Within each SBEMR comparison, EG versus control eye axon loss was -32.9%, -8.3%, and -15.2% (respectively), and MOD was increased in the EG versus control SBEMR (P < 0.0001 for each EG versus control SBEMR comparison). When data from all three EG eye SBEMRs were compared to all five control eye SBEMRs, MOD was increased within the EG eyes. Conclusions Structurally intact, RON axons are demyelinated in NHP early to moderate EG. Studies to determine their functional status are indicated.
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Affiliation(s)
- Priya Chaudhary
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Howard Lockwood
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Cheri Stowell
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Eric Bushong
- National Center for Microscopy & Imaging Research, UCSD, La Jolla, California, United States
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Wiliams
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Imee Williams
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Mark Ellisman
- National Center for Microscopy & Imaging Research, UCSD, La Jolla, California, United States
| | - Nick Marsh-Armstrong
- Department of Ophthalmology, University of California, Davis, California, United States
| | - Claude Burgoyne
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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22
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Bou Rjeily N, Mowry EM, Ontaneda D, Carlson AK. Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis: What Is the Future of Multiple Sclerosis Treatment? Neurol Clin 2024; 42:185-201. [PMID: 37980115 DOI: 10.1016/j.ncl.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Treatment options for patients newly diagnosed with multiple sclerosis (MS) are expanding with the continuous development and approval of new disease-modifying therapies (DMTs). The optimal initial treatment strategy, however, remains unclear. The 2 main treatment paradigms currently employed are the escalation (ESC) approach and the early highly effective treatment (EHT) approach. The ESC approach consists of starting a lower- or moderate-efficacy DMT, which offers a potentially safer approach, while the EHT approach favors higher-efficacy treatment early in the disease course, despite a potential increase in risk. Randomized clinical trials aiming to directly compare these approaches in newly diagnosed MS patients are currently underway.
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Affiliation(s)
- Nicole Bou Rjeily
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA; Department of Epidemiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Daniel Ontaneda
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA
| | - Alise K Carlson
- Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA.
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23
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Wang H, Shi P, Shi X, Lv Y, Xie H, Zhao H. Surprising magic of CD24 beyond cancer. Front Immunol 2024; 14:1334922. [PMID: 38313430 PMCID: PMC10834733 DOI: 10.3389/fimmu.2023.1334922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 02/06/2024] Open
Abstract
CD24 has emerged as a molecule of significant interest beyond the oncological arena. Recent studies have unveiled its surprising and diverse roles in various biological processes and diseases. This review encapsulates the expanding spectrum of CD24 functions, delving into its involvement in immune regulation, cancer immune microenvironment, and its potential as a therapeutic target in autoimmune diseases and beyond. The 'magic' of CD24, once solely attributed to cancer, now inspires a new paradigm in understanding its multifunctionality in human health and disease, offering exciting prospects for medical advancements.
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Affiliation(s)
- He Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Shi
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinyu Shi
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaqing Lv
- Department of Outpatient, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongwei Xie
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hai Zhao
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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24
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Keenan A, Le HH, Gandhi K, Adedokun L, Jones E, Unsworth M, Pike J, Trenholm E. Shared Decision-Making in the Treatment of Multiple Sclerosis: Results of a Cross-Sectional, Real-World Survey in Europe and the United States. Patient Prefer Adherence 2024; 18:137-149. [PMID: 38249686 PMCID: PMC10799568 DOI: 10.2147/ppa.s440410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a neurodegenerative disease characterized by progressive deterioration of cognitive and physical functioning, reducing activities of daily living and quality of life (QoL). Several treatments are available that modify the course of the disease and reduce the frequency of relapses. Although effective, all treatment options are accompanied by adverse events, and this study aimed to assess the extent to which patients were involved in the choice of treatment. Methods Data were drawn from the Adelphi Multiple Sclerosis Disease Specific Program (DSP)™, a cross-sectional survey of healthcare practitioners (HCP) and their patients with MS in real-world clinical settings in Europe and the United States (US) between December 2020 and July 2021. HCPs reported patient demographics, clinical characteristics, current and previous treatment, and treatment outcomes. Patients voluntarily completed questionnaires reporting the physical and psychological impact of their MS and its treatment. Regression analysis with inverse probability of treatment weighting was used to compare treatment outcomes in patients actively involved in their current treatment choice with those who were not. Results Of a total of 692 patients, median age 40 years and 64% female, mostly diagnosed with relapsing-remitting MS, those who were involved in shared decision-making tended to choose oral therapies such as dimethyl fumarate more often than HCPs. MS had greater impact on physical and psychological functioning in patients whose HCP made treatment decisions solely. Patients involved in decision-making reported greater satisfaction with their treatment and a better QoL. Discussion Because no single optimal therapy exists for patients with MS, treatments should be individualized with consideration of patients' preferences. Our study shows that shared decision-making is under-utilized in the management of MS and supports the benefits of patient involvement. Conclusion Patients who have an active role in treatment decision-making show improved wellbeing and QoL, and overall treatment satisfaction.
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Affiliation(s)
- Alexander Keenan
- Scientific Affairs, Janssen Pharmaceuticals Inc., Titusville, NJ, USA
| | - Hoa H Le
- Scientific Affairs, Janssen Pharmaceuticals Inc., Titusville, NJ, USA
| | - Kavita Gandhi
- Research and Development, Janssen Pharmaceuticals Inc., Titusville, NJ, USA
| | - Lola Adedokun
- Research and Development, Janssen-Cilag Ltd, High Wycombe, UK
| | - Eddie Jones
- Central Nervous System, Adelphi Real World, Bollington, Cheshire, UK
| | - Mia Unsworth
- Central Nervous System, Adelphi Real World, Bollington, Cheshire, UK
| | - James Pike
- Statistics & Data Analytics, Adelphi Real World, Bollington, Cheshire, UK
| | - Emily Trenholm
- Central Nervous System, Adelphi Real World, Bollington, Cheshire, UK
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25
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Phan NM, Nguyen TL, Shin H, Trinh TA, Kim J. ROS-Scavenging Lignin-Based Tolerogenic Nanoparticle Vaccine for Treatment of Multiple Sclerosis. ACS NANO 2023; 17:24696-24709. [PMID: 38051295 DOI: 10.1021/acsnano.3c04497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Multiple sclerosis (MS) is a demyelinating autoimmune disease, in which the immune system attacks myelin. Although systemic immunosuppressive agents have been used to treat MS, long-term treatment with these drugs causes undesirable side effects such as altered glucose metabolism, insomnia, and hypertension. Herein, we propose a tolerogenic therapeutic vaccine to treat MS based on lignin nanoparticles (LNP) with intrinsic reactive oxygen species (ROS)-scavenging capacity derived from their phenolic moieties. The LNP loaded with autoantigens of MS allowed for inducing tolerogenic DCs with low-level expression of costimulatory molecules while presenting antigenic peptides. Intravenous injection of an LNP-based tolerogenic vaccine into an experimental autoimmune encephalomyelitis (EAE) model led to durable antigen-specific immune tolerance via inducing regulatory T cells (Tregs). Autoreactive T helper type 1 cells, T helper type 17 cells, and inflammatory antigen presentation cells (APCs) were suppressed in the central nervous system (CNS), ameliorating ongoing MS in early and late disease states. Additionally, the incorporation of dexamethasone into an LNP-based tolerogenic nanovaccine could further improve the recovery of EAE mice in the severe chronic stage. As lignin is the most abundant biomass and waste byproduct in the pulping industry, a lignin-based tolerogenic vaccine could be a novel, cost-effective, high-value vaccine platform with potent therapeutic efficiency in treating autoimmune diseases.
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Affiliation(s)
- Ngoc Man Phan
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Thanh Loc Nguyen
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Hyunsu Shin
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Thuy An Trinh
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Jaeyun Kim
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
- Institute of Quantum Biophysics (IQB), Sungkyunkwan University, Suwon 16419, Republic of Korea
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Hecker M, Frahm N, Zettl UK. Update and Application of a Deep Learning Model for the Prediction of Interactions between Drugs Used by Patients with Multiple Sclerosis. Pharmaceutics 2023; 16:3. [PMID: 38276481 PMCID: PMC10819178 DOI: 10.3390/pharmaceutics16010003] [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: 09/25/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Patients with multiple sclerosis (MS) often take multiple drugs at the same time to modify the course of disease, alleviate neurological symptoms and manage co-existing conditions. A major consequence for a patient taking different medications is a higher risk of treatment failure and side effects. This is because a drug may alter the pharmacokinetic and/or pharmacodynamic properties of another drug, which is referred to as drug-drug interaction (DDI). We aimed to predict interactions of drugs that are used by patients with MS based on a deep neural network (DNN) using structural information as input. We further aimed to identify potential drug-food interactions (DFIs), which can affect drug efficacy and patient safety as well. We used DeepDDI, a multi-label classification model of specific DDI types, to predict changes in pharmacological effects and/or the risk of adverse drug events when two or more drugs are taken together. The original model with ~34 million trainable parameters was updated using >1 million DDIs recorded in the DrugBank database. Structure data of food components were obtained from the FooDB database. The medication plans of patients with MS (n = 627) were then searched for pairwise interactions between drug and food compounds. The updated DeepDDI model achieved accuracies of 92.2% and 92.1% on the validation and testing sets, respectively. The patients with MS used 312 different small molecule drugs as prescription or over-the-counter medications. In the medication plans, we identified 3748 DDIs in DrugBank and 13,365 DDIs using DeepDDI. At least one DDI was found for most patients (n = 509 or 81.2% based on the DNN model). The predictions revealed that many patients would be at increased risk of bleeding and bradycardic complications due to a potential DDI if they were to start a disease-modifying therapy with cladribine (n = 242 or 38.6%) and fingolimod (n = 279 or 44.5%), respectively. We also obtained numerous potential interactions for Bruton's tyrosine kinase inhibitors that are in clinical development for MS, such as evobrutinib (n = 434 DDIs). Food sources most often related to DFIs were corn (n = 5456 DFIs) and cow's milk (n = 4243 DFIs). We demonstrate that deep learning techniques can exploit chemical structure similarity to accurately predict DDIs and DFIs in patients with MS. Our study specifies drug pairs that potentially interact, suggests mechanisms causing adverse drug effects, informs about whether interacting drugs can be replaced with alternative drugs to avoid critical DDIs and provides dietary recommendations for MS patients who are taking certain drugs.
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Affiliation(s)
- Michael Hecker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (U.K.Z.)
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27
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Wang H, Zhang X, Li H, Sun Z, Zhong Y. Gender differences in the burden of multiple sclerosis in China from 1990 to 2019 and its 25-year projection: An analysis of the Global Burden of Diseases Study. Health Sci Rep 2023; 6:e1738. [PMID: 38033712 PMCID: PMC10685393 DOI: 10.1002/hsr2.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background and Aims Multiple sclerosis (MS) is a crippling, chronic, gender-related disease that causes burdens to individuals and society. China has a considerable and increasing population of MS. We aim to analyze the gender disparities in the burden of MS in China and predict the trends. Methods The study was conducted based on the Global Burden of Disease Study 2019. Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of MS in China from 1990 to 2019 was descriptively analyzed by year, gender, and age group. The Nordpred package in R (version 4.2.2) was used for age-period-cohort analysis to predict the all-ages numbers and age-standardized rates of incidence, prevalence, deaths, and DALYs in China from 2020 to 2044. Results The number of prevalent cases of MS in 2019 reached 18,143.56 (95% uncertainty intervals [UI]: 13,997.71-22,658.60) in males and 24,427.11 (95% UI: 18,906.02-30,530.21) in females in China. The peak age of prevalence was shifted from 40-44 years in 1990 to 45-49 years in 2019 in females but remained unchanged in males. In contrast to the increased age-standardized prevalence rate, the age-standardized death rate (ASDR) and age-standardized DALYs rate showed downward trends, which were more significant in females. Different from the global, Chinese males showed lower prevalence but higher deaths and DALYs than females for age-standardized rates and numbers. In the next 25 years, the patient population will remain large and peak around 44,599.78 in 2025-2029. The ASDR, age-standardized DALYs rate, and DALYs number were expected to decrease. The improvements in deaths and DALYs will be more significant in females. Conclusion Males with MS had a lower prevalence but higher deaths and DALYs than females in China. The ASDR and age-standardized DALYs rate have reduced over the past 30 years and were expected to continue decreasing, especially in females. The burden of MS will remain notable in the next 25 years.
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Affiliation(s)
- Heng Wang
- Department of Ophthalmology, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xia Zhang
- Department of Ophthalmology, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Heyan Li
- Beijing Tongren Eye Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Zixi Sun
- Department of Ophthalmology, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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28
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Jiang H, Zhou C, Qiu L, Gropler RJ, Brier MR, Wu GF, Cross AH, Perlmutter JS, Benzinger TLS, Tu Z. Quantitative Analysis of S1PR1 Expression in the Postmortem Multiple Sclerosis Central Nervous System. ACS Chem Neurosci 2023; 14:4039-4050. [PMID: 37882753 PMCID: PMC11037862 DOI: 10.1021/acschemneuro.3c00581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disease that is characterized by demyelination and inflammation in the central nervous system (CNS). Previous studies demonstrated that sphingosine-1-phosphate receptor (S1PR) modulators effectively inhibit S1PR1 in immune cell trafficking and reduce entry of pathogenic cells into the CNS. Studies have also implicated a nonimmune, inflammatory role of S1PR1 within the CNS in MS. In this study, we explored the expression of S1PR1 in the development and progression of demyelinating pathology of MS by quantitative assessment of S1PR1 expression using our S1PR1-specific radioligand, [3H]CS1P1, in the postmortem human CNS tissues including cortex, cerebellum, and spinal cord of MS cases and age- and sex-matched healthy cases. Immunohistochemistry with whole slide scanning for S1PR1 and various myelin proteins was also performed. Autoradiographic analysis using [3H]CS1P1 showed that the expression of S1PR1 was statistically significantly elevated in lesions compared to nonlesion regions in the MS cases, as well as normal healthy controls. The uptake of [3H]CS1P1 in the gray matter and nonlesion white matter did not significantly differ between healthy and MS CNS tissues. Saturation autoradiography analysis showed an increased binding affinity (Kd) of [3H]CS1P1 to S1PR1 in both gray matter and white matter of MS brains compared to healthy brains. Our blocking study using NIBR-0213, a S1PR1 antagonist, indicated [3H]CS1P1 is highly specific to S1PR1. Our findings demonstrated the activation of S1PR1 and an increased uptake of [3H]CS1P1 in the lesions of MS CNS. In summary, our quantitative autoradiography analysis using [3H]CS1P1 on human postmortem tissues shows the feasibility of novel imaging strategies for MS by targeting S1PR1.
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Affiliation(s)
- Hao Jiang
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Charles Zhou
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Lin Qiu
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Robert J Gropler
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Matthew R Brier
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Gregory F Wu
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Joel S Perlmutter
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Tammie L S Benzinger
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri 63110, United States
| | - Zhude Tu
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, United States
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29
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Kråkenes T, Wergeland S, Al-Sharabi N, Mohamed-Ahmed S, Fromreide S, Costea DE, Mustafa K, Bø L, Kvistad CE. The neuroprotective potential of mesenchymal stem cells from bone marrow and human exfoliated deciduous teeth in a murine model of demyelination. PLoS One 2023; 18:e0293908. [PMID: 37943848 PMCID: PMC10635499 DOI: 10.1371/journal.pone.0293908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is characterized by chronic inflammation, demyelination, and axonal degeneration within the central nervous system (CNS), for which there is no current treatment available with the ability to promote neuroprotection or remyelination. Some aspects of the progressive form of MS are displayed in the murine cuprizone model, where demyelination is induced by the innate immune system without major involvement of the adaptive immune system. Mesenchymal stem cells (MSCs) are multipotent cells with immunomodulatory and neuroprotective potential. In this study, we aimed to assess the neuroprotective potential of MSCs from bone marrow (BM-MSCs) and stem cells from human exfoliated deciduous teeth (SHED) in the cuprizone model. METHODS Human BM-MSCs and SHED were isolated and characterized. Nine-week-old female C57BL/6 mice were randomized to receive either human BM-MSCs, human SHED or saline intraperitoneally. Treatments were administered on day -1, 14 and 21. Outcomes included levels of local demyelination and inflammation, and were assessed with immunohistochemistry and histology. RESULTS BM-MSCs were associated with increased myelin content and reduced microglial activation whereas mice treated with SHED showed reduced microglial and astroglial activation. There were no differences between treatment groups in numbers of mature oligodendrocytes or axonal injury. MSCs were identified in the demyelinated corpus callosum in 40% of the cuprizone mice in both the BM-MSC and SHED group. CONCLUSION Our results suggest a neuroprotective effect of MSCs in a toxic MS model, with demyelination mediated by the innate immune system.
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Affiliation(s)
- Torbjørn Kråkenes
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stig Wergeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Niyaz Al-Sharabi
- Tissue Engineering Group, Center of Translational Oral Research (TOR), Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Samih Mohamed-Ahmed
- Tissue Engineering Group, Center of Translational Oral Research (TOR), Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Siren Fromreide
- Center for Cancer Biomarkers CCBIO and Gades Laboratory for Pathology, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Daniela-Elana Costea
- Center for Cancer Biomarkers CCBIO and Gades Laboratory for Pathology, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Kamal Mustafa
- Tissue Engineering Group, Center of Translational Oral Research (TOR), Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Lars Bø
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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30
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Diebold M, Fehrenbacher L, Frosch M, Prinz M. How myeloid cells shape experimental autoimmune encephalomyelitis: At the crossroads of outside-in immunity. Eur J Immunol 2023; 53:e2250234. [PMID: 37505465 DOI: 10.1002/eji.202250234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is an animal model of central nervous system (CNS) autoimmunity. It is most commonly used to mimic aspects of multiple sclerosis (MS), a demyelinating disorder of the human brain and spinal cord. The innate immune response displays one of the core pathophysiological features linked to both the acute and chronic stages of MS. Hence, understanding and targeting the innate immune response is essential. Microglia and other CNS resident MUs, as well as infiltrating myeloid cells, diverge substantially in terms of both their biology and their roles in EAE. Recent advances in the field show that antigen presentation, as well as disease-propagating and regulatory interactions with lymphocytes, can be attributed to specific myeloid cell types and cell states in EAE lesions, following a distinct temporal pattern during disease initiation, propagation and recovery. Furthermore, single-cell techniques enable the assessment of characteristic proinflammatory as well as beneficial cell states, and identification of potential treatment targets. Here, we discuss the principles of EAE induction and protocols for varying experimental paradigms, the composition of the myeloid compartment of the CNS during health and disease, and systematically review effects on myeloid cells for therapeutic approaches in EAE.
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Affiliation(s)
- Martin Diebold
- Institute of Neuropathology, University Medical Center Freiburg, Freiburg, Germany
| | - Luca Fehrenbacher
- Institute of Neuropathology, University Medical Center Freiburg, Freiburg, Germany
| | - Maximilian Frosch
- Institute of Neuropathology, University Medical Center Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, University Medical Center Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
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31
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Ramos V, Reis M, Ferreira L, Silva AM, Ferraz R, Vieira M, Vasconcelos V, Martins R. Stalling the Course of Neurodegenerative Diseases: Could Cyanobacteria Constitute a New Approach toward Therapy? Biomolecules 2023; 13:1444. [PMID: 37892126 PMCID: PMC10604708 DOI: 10.3390/biom13101444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Neurodegenerative diseases (NDs) are characterized by progressive and irreversible neuronal loss, accompanied by a range of pathological pathways, including aberrant protein aggregation, altered energy metabolism, excitotoxicity, inflammation, and oxidative stress. Some of the most common NDs include Alzheimer's Disease (AD), Parkinson's Disease (PD), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), and Huntington's Disease (HD). There are currently no available cures; there are only therapeutic approaches that ameliorate the progression of symptoms, which makes the search for new drugs and therapeutic targets a constant battle. Cyanobacteria are ancient prokaryotic oxygenic phototrophs whose long evolutionary history has resulted in the production of a plethora of biomedically relevant compounds with anti-inflammatory, antioxidant, immunomodulatory, and neuroprotective properties, that can be valuable in this field. This review summarizes the major NDs and their pathophysiology, with a focus on the anti-neurodegenerative properties of cyanobacterial compounds and their main effects.
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Affiliation(s)
- Vitória Ramos
- School of Health, Polytechnic Institute of Porto (ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (V.R.); (A.M.S.); (R.F.); (M.V.)
| | - Mariana Reis
- Interdisciplinary Centre of Marine and Environmental Research, University of Porto (CIIMAR/CIMAR), Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; (M.R.); (L.F.); (V.V.)
| | - Leonor Ferreira
- Interdisciplinary Centre of Marine and Environmental Research, University of Porto (CIIMAR/CIMAR), Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; (M.R.); (L.F.); (V.V.)
- Department of Biology, Faculty of Sciences, University of Porto (FCUP), Rua do Campo Alegre, Edifício FC4, 4169-007 Porto, Portugal
| | - Ana Margarida Silva
- School of Health, Polytechnic Institute of Porto (ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (V.R.); (A.M.S.); (R.F.); (M.V.)
| | - Ricardo Ferraz
- School of Health, Polytechnic Institute of Porto (ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (V.R.); (A.M.S.); (R.F.); (M.V.)
- Associated Laboratory for Green Chemistry—Network of Chemistry and Technology (LAQV-REQUIMTE), Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal
| | - Mónica Vieira
- School of Health, Polytechnic Institute of Porto (ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (V.R.); (A.M.S.); (R.F.); (M.V.)
- Center for Translational Health and Medical Biotechnology Research (TBIO/ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
| | - Vitor Vasconcelos
- Interdisciplinary Centre of Marine and Environmental Research, University of Porto (CIIMAR/CIMAR), Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; (M.R.); (L.F.); (V.V.)
- Department of Biology, Faculty of Sciences, University of Porto (FCUP), Rua do Campo Alegre, Edifício FC4, 4169-007 Porto, Portugal
| | - Rosário Martins
- School of Health, Polytechnic Institute of Porto (ESS/P.PORTO), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (V.R.); (A.M.S.); (R.F.); (M.V.)
- Interdisciplinary Centre of Marine and Environmental Research, University of Porto (CIIMAR/CIMAR), Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; (M.R.); (L.F.); (V.V.)
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Cotter M, Varghese S, Chevot F, Fergus C, Kelly VP, Connon SJ, Southern JM. Queuine Analogues Incorporating the 7-Aminomethyl-7-deazaguanine Core: Structure-Activity Relationships in the Treatment of Experimental Autoimmune Encephalomyelitis. ChemMedChem 2023; 18:e202300207. [PMID: 37350546 DOI: 10.1002/cmdc.202300207] [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: 04/17/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
A library of queuine analogues targeting the modification of tRNA isoacceptors for Asp, Asn, His and Tyr catalysed by queuine tRNA ribosyltransferase (QTRT, also known as TGT) was evaluated in the treatment of a chronic multiple sclerosis model: murine experimental autoimmune encephalomyelitis. Several active 7-deazaguanines emerged, together with a structure-activity relationship involving the necessity for a flexible alkyl chain of fixed length.
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Affiliation(s)
- Michelle Cotter
- School of Chemistry, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - Sreeja Varghese
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - Franciane Chevot
- School of Chemistry, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - Claire Fergus
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - Vincent P Kelly
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - Stephen J Connon
- School of Chemistry, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
| | - J Mike Southern
- School of Chemistry, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Trinity College, Dublin, Ireland
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Yue H, Shah SB, Modzelewski KL, Knobel M, Copeli F, Kao L. A Grave Set of Diagnoses: A Case of Mania with Comorbid Autoimmune Thyroiditis Precipitated by Multiple Sclerosis Treatment. Harv Rev Psychiatry 2023; 31:242-247. [PMID: 37615524 DOI: 10.1097/hrp.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Han Yue
- From Department of Psychiatry, Tufts Medical Center, Boston, MA (Dr. Yue); Harvard Medical School (Dr. Shah); Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA (Dr. Modzelewski); Department of Endocrinology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Modzelewski); Department of Psychiatry, Veteran Affairs Boston Healthcare System, Boston, MA (Drs. Knobel and Kao); BrightView Health, Boston, MA (Dr. Copeli); Power of Recovery, Revere, MA (Dr. Copeli); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Kao)
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Misiak B, Samochowiec J, Kowalski K, Gaebel W, Bassetti CLA, Chan A, Gorwood P, Papiol S, Dom G, Volpe U, Szulc A, Kurimay T, Kärkkäinen H, Decraene A, Wisse J, Fiorillo A, Falkai P. The future of diagnosis in clinical neurosciences: Comparing multiple sclerosis and schizophrenia. Eur Psychiatry 2023; 66:e58. [PMID: 37476977 PMCID: PMC10486256 DOI: 10.1192/j.eurpsy.2023.2432] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The ongoing developments of psychiatric classification systems have largely improved reliability of diagnosis, including that of schizophrenia. However, with an unknown pathophysiology and lacking biomarkers, its validity still remains low, requiring further advancements. Research has helped establish multiple sclerosis (MS) as the central nervous system (CNS) disorder with an established pathophysiology, defined biomarkers and therefore good validity and significantly improved treatment options. Before proposing next steps in research that aim to improve the diagnostic process of schizophrenia, it is imperative to recognize its clinical heterogeneity. Indeed, individuals with schizophrenia show high interindividual variability in terms of symptomatic manifestation, response to treatment, course of illness and functional outcomes. There is also a multiplicity of risk factors that contribute to the development of schizophrenia. Moreover, accumulating evidence indicates that several dimensions of psychopathology and risk factors cross current diagnostic categorizations. Schizophrenia shares a number of similarities with MS, which is a demyelinating disease of the CNS. These similarities appear in the context of age of onset, geographical distribution, involvement of immune-inflammatory processes, neurocognitive impairment and various trajectories of illness course. This article provides a critical appraisal of diagnostic process in schizophrenia, taking into consideration advancements that have been made in the diagnosis and management of MS. Based on the comparison between the two disorders, key directions for studies that aim to improve diagnostic process in schizophrenia are formulated. All of them converge on the necessity to deconstruct the psychosis spectrum and adopt dimensional approaches with deep phenotyping to refine current diagnostic boundaries.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | | | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Claudio L. A. Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Switzerland
| | - Philip Gorwood
- Université Paris Cité, INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Paris, France
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Sergi Papiol
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, B-2610Antwerp, Belgium
- Multiversum Psychiatric Hospital, B-2530Boechout, Belgium
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, 60126Ancona, Italy
| | - Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Tamas Kurimay
- Department of Psychiatry, St. Janos Hospital, Budapest, Hungary
| | | | - Andre Decraene
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Leuven, Belgium
| | - Jan Wisse
- Century House, Wargrave Road, Henley-on-Thames, OxfordshireRG9 2LT, UK
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336Munich, Germany
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Foettinger F, Pilz G, Wipfler P, Harrer A, Kern JM, Trinka E, Moser T. Immunomodulatory Aspects of Therapeutic Plasma Exchange in Neurological Disorders—A Pilot Study. Int J Mol Sci 2023; 24:ijms24076552. [PMID: 37047524 PMCID: PMC10095570 DOI: 10.3390/ijms24076552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is used for drug-resistant neuroimmunological disorders, but its mechanism of action remains poorly understood. We therefore prospectively explored changes in soluble, humoral, and cellular immune components associated with TPE. We included ten patients with neurological autoimmune disorders that underwent TPE and assessed a panel of clinically relevant pathogen-specific antibodies, total serum immunoglobulin (Ig) levels, interleukin-6 (IL-6, pg/mL), C-reactive protein (CRP, mg/dL), procalcitonin (PCT, µg/L) and major lymphocyte subpopulations (cells/µL). Blood was collected prior to TPE (pre-TPE, baseline), immediately after TPE (post-TPE), as well as five weeks (follow-up1) and 130 days (follow-up2) following TPE. Pathogen-specific antibody levels were reduced by −86% (p < 0.05) post-TPE and recovered to 55% (follow-up1) and 101% (follow-up2). Ig subclasses were reduced by −70–89% (p < 0.0001) post-TPE with subsequent complete (IgM/IgA) and incomplete (IgG) recovery throughout the follow-ups. Mean IL-6 and CRP concentrations increased by a factor of 3–4 at post-TPE (p > 0.05) while PCT remained unaffected. We found no alterations in B- and T-cell populations. No adverse events related to TPE occurred. TPE induced a profound but transient reduction in circulating antibodies, while the investigated soluble immune components were not washed out. Future studies should explore the effects of TPE on particular cytokines and assess inflammatory lymphocyte lineages to illuminate the mode of action of TPE beyond autoantibody removal.
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Avramouli A, Krokidis MG, Exarchos TP, Vlamos P. In Silico Structural Analysis Predicting the Pathogenicity of PLP1 Mutations in Multiple Sclerosis. Brain Sci 2022; 13:42. [PMID: 36672024 PMCID: PMC9856082 DOI: 10.3390/brainsci13010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The X chromosome gene PLP1 encodes myelin proteolipid protein (PLP), the most prevalent protein in the myelin sheath surrounding the central nervous system. X-linked dysmyelinating disorders such as Pelizaeus-Merzbacher disease (PMD) or spastic paraplegia type 2 (SPG2) are typically caused by point mutations in PLP1. Nevertheless, numerous case reports have shown individuals with PLP1 missense point mutations which also presented clinical symptoms and indications that were consistent with the diagnostic criteria of multiple sclerosis (MS), a disabling disease of the brain and spinal cord with no current cure. Computational structural biology methods were used to assess the impact of these mutations on the stability and flexibility of PLP structure in order to determine the role of PLP1 mutations in MS pathogenicity. The analysis showed that most of the variants can alter the functionality of the protein structure such as R137W variants which results in loss of helix and H140Y which alters the ordered protein interface. In silico genomic methods were also performed to predict the significance of these mutations associated with impairments in protein functionality and could suggest a better definition for therapeutic strategies and clinical application in MS patients.
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Affiliation(s)
| | - Marios G. Krokidis
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 491 00 Corfu, Greece
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Cannabinoid CB2 Receptors in Neurodegenerative Proteinopathies: New Insights and Therapeutic Potential. Biomedicines 2022; 10:biomedicines10123000. [PMID: 36551756 PMCID: PMC9775106 DOI: 10.3390/biomedicines10123000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Some of the most prevalent neurodegenerative disorders, including Alzheimer's and Parkinson's disease, are proteinopathies characterized by the accumulation of specific protein aggregates in the brain. Such misfolded protein aggregates can trigger modulation of the innate and adaptive immune systems and subsequently lead to chronic neuroinflammation that drives the onset and progression of neurodegenerative diseases. Since there is still no effective disease-modifying treatment, new therapeutic targets for neurodegenerative proteinopathies have been sought. The endocannabinoid system, and in particular the cannabinoid CB2 receptors, have been extensively studied, due to their important role in neuroinflammation, especially in microglial cells. Several studies have shown promising effects of CB2 receptor activation on reducing protein aggregation-based pathology as well as on attenuating inflammation and several dementia-related symptoms. In this review, we discuss the available data on the role of CB2 receptors in neuroinflammation and the potential benefits and limitations of specific agonists of these receptors in the therapy of neurodegenerative proteinopathies.
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Antal DC, Schreiner TG, Crihan TE, Ignat BE, San Antonio-Arce V, Cuciureanu ID. Seizures and multiple sclerosis‑more than an epidemiological association (Review). Exp Ther Med 2022; 24:689. [PMID: 36277158 PMCID: PMC9535632 DOI: 10.3892/etm.2022.11625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
In order to increase the quality of life of patients with epilepsy, it is essential to develop tools that facilitate early disease diagnosis and encourage the use of individualized therapies. The association between seizures and other neurological pathologies is well known but incompletely explained, with multiple sclerosis (MS)-seizures correlation being a relevant example. In this context, the present review aimed to highlight the most important facts related to the association between the heterogeneous group of epileptic pathology and MS, in order to provide initial directions for establishing a diagnostic and therapeutic protocol. The first part reviewed the most relevant epidemiological and clinical data on seizures; MS association. Subsequently, it highlighted the most common and actually accepted pathophysiological mechanisms that try to explain the association between the two pathologies. Finally, the importance of paraclinical investigations and the optimal choice of antiseizure-based therapies with respect to seizures associated with MS are presented, also revealing several directions that should be explored in the near future.
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Affiliation(s)
- Dorin Cristian Antal
- Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, Iași 700115, Romania
- Neurology Department, Clinical Rehabilitation Hospital, Iași 700661, Romania
| | - Thomas Gabriel Schreiner
- Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, Iași 700115, Romania
- Neurology Department, Clinical Rehabilitation Hospital, Iași 700661, Romania
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest 050474, Romania
| | | | - Bogdan Emilian Ignat
- Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, Iași 700115, Romania
- Neurology Department, Clinical Rehabilitation Hospital, Iași 700661, Romania
| | - Victoria San Antonio-Arce
- Freiburg Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79085 Freiburg im Breisgau, Germany
| | - Iulian Dan Cuciureanu
- Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, Iași 700115, Romania
- Neurology Department 1, Clinical Emergency Hospital Prof. Dr. N. Oblu, Iași 700309, Romania
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