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Chen W, Zhu L, Shen LL, Si SY, Liu JL. T Lymphocyte Subsets Profile and Toll-Like Receptors Responses in Patients with Herpes Zoster. J Pain Res 2023; 16:1581-1594. [PMID: 37220634 PMCID: PMC10200109 DOI: 10.2147/jpr.s405157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Herpes zoster (HZ) is caused by the varicella-zoster virus (VZV), and 20% of healthy humans and 50% of people with immune dysfunction have a high probability of suffering from HZ. This study aimed to screen dynamic immune signatures and explore the potential mechanism during HZ progression. Patients and Methods Peripheral blood samples from 31 HZ patients and 32 age-sex-matched healthy controls were collected and analyzed. The protein levels and gene levels of toll-like receptors (TLRs) were detected in peripheral blood mononuclear cells (PBMCs) by flow cytometry and quantitative real-time PCR. Further, the characteristics of T cell subsets and cytokines were detected via a cytometric bead array. Results Compared to healthy controls, the mRNA levels of TLR2, TLR4, TLR7, and TLR9 mRNA in PBMCs were significantly increased in HZ patients. The protein level of TLR4 and TLR7 was significantly increased in HZ patients, but the levels of TLR2 and TLR9 were dramatically decreased. The CD3+ T cells were constant in HZ and healthy controls. CD4+ T cells were decreased in HZ patients, while CD8+ T cells were increased, resulting in an improved CD4+/CD8+ T cells ratio. Further, it was found that Th2 and Th17 were not changed, but the decreased Th1 and upregulated Treg cells were found in HZ. The Th1/Th2 and Th17/Treg ratios were significantly decreased. Last, the levels of IL-6, IL-10, and IFN-γ were significantly increased, but IL-2, IL-4, and IL-17A had no significant changes. Conclusion The dysfunction of host's lymphocytes and activation of TLRs in PBMCs were the important mechanism in varicella-zoster virus induced herpes zoster. TLRs might be the core targets for the therapy drug development in treating HZ.
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Affiliation(s)
- Wei Chen
- Dermatology, Zhejiang Provincial Dermatology Hospital, Huzhou, Zhejiang, People’s Republic of China
| | - Lu Zhu
- Dermatology, Zhejiang Provincial Dermatology Hospital, Huzhou, Zhejiang, People’s Republic of China
| | - Li-Ling Shen
- Dermatology, Zhejiang Provincial Dermatology Hospital, Huzhou, Zhejiang, People’s Republic of China
| | - Shao-Yan Si
- Department of Comprehensive Basic Experiment, Strategic Support Force Medical Center, Bejing, People’s Republic of China
| | - Jun-Lian Liu
- Dermatology, Chui Yang Liu Hospital Affiliated Tsinghua University, Beijing, People’s Republic of China
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2
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Dimitri D, Pourcher V. Acute Varicella-Zoster Virus meningitis in a multiple sclerosis patient treated with fingolimod. Rev Neurol (Paris) 2022; 178:393-394. [PMID: 35000791 DOI: 10.1016/j.neurol.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- D Dimitri
- Department of Neurology, Hôpital du Kremlin Bicêtre, hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin Bicêtre, France.
| | - V Pourcher
- Infectious and Tropical Diseases Department, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie Assistance Publique-Hôpitaux de Paris, 45-83, Bd de l'Hôpital, 75013 Paris, France
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Wijburg MT, Warnke C, McGuigan C, Koralnik IJ, Barkhof F, Killestein J, Wattjes MP. Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications. J Neurol Neurosurg Psychiatry 2021; 92:177-188. [PMID: 33229453 DOI: 10.1136/jnnp-2020-324534] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.
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Affiliation(s)
- Martijn T Wijburg
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clemens Warnke
- Department of Neurology, University Hospital Köln, University of Cologne, Köln, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital & University College Dublin, Dublin, Ireland
| | - Igor J Koralnik
- Department of Neurological Sciences, Division of Neuroinfectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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Antigen-shift in varicella-zoster virus-specific T-cell immunity over the course of Fingolimod-treatment in relapse-remitting multiple sclerosis patients. Mult Scler Relat Disord 2019; 38:101859. [PMID: 31855843 DOI: 10.1016/j.msard.2019.101859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/22/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fingolimod (FTY) applied as treatment regimen of relapsing-remitting multiple sclerosis (RRMS) induces downregulation of sphingosine-1-phosphate receptors on the lymphocytes. As a result CC chemokine receptor type 7 (CCR7) expressing lymphocytes are retained within the peripheral lymph nodes thus suppressing their accumulation into the cerebrospinal fluid of multiple sclerosis (MS) patients and hampering disease progress. Unfortunately, MS patients treated with FTY suffer from an increased incidence of varicella-zoster virus (VZV) infections which has been associated with a decrease of VZV immediate early 63 (IE63)-specific T-cell immunity. To elucidate VZV-specific T-cell immunity over the course of FTY-treatment, we analyzed T-cell immunity for immediate early, early and late VZV-antigens. METHODS T-cell immune responses were detected via intracellular IFN-γ staining after stimulation with VZV-specific peptide mixes for IE62 and IE63 and recombinant proteins for open reading frame 26 (ORF26), ORF9 and glycoprotein E (gE) using flow cytometry. Analyzed samples comprised of different groups including 18 patients with RRMS at baseline (BL), 6 and 12 months after FTY-treatment start, 12 patients with long-term (LT) FTY-treatment, one FTY-treated patient, before and after VZV-reactivation. In addition, VZV-specific IgG and IgM titers were assessed by ELISA. RESULTS After FTY-treatment start, absolute numbers of CCR7 expressing CD4+ T cells and CD8+T cells dropped rapidly. However, VZV-specific immunity could be detected in the majority of RRMS patients throughout FTY-treatment with increasing prevalence after 6 months of treatment. We found an increase in the prevalence of VZV-specific IFN-γ+CD8+ T-cell immunity in FTY-treated patients after six months of therapy, while in parallel VZV-specific IFN-γ+CD4+ T cells declined dramatically. Additionally, a strong correlation between VZV-specific IgG serum titers and the percentage of RRMS patients with detectable VZV-specific T cells was observed (r = 0.985). Most remarkably, FTY-treated RRMS patients presented a shift in the predominant CD8+ T cell-mediated antigen-response from immediate early (IE62) to early virus antigens (ORF26) six months after treatment in parallel to a decrease of VZV-specific CD4+ T-cell immunity. ORF26-specific CD8+ T cells still dominated the VZV-specific cellular immunity at month 12 after FTY-treatment start and in LT FTY-treated MS patients. In a RRMS patient an increase of VZV-specific CD4+ T cells at VZV-reactivation accompanied with a four-fold increase of a VZV-specific IgG titer was detected which might indicate an important role in cellular immune control of VZV-infections. CONCLUSION Monitoring VZV-specific T-cell immunity might provide a valuable tool to RRMS patient risk management during FTY-treatment.
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Klotz L, Havla J, Schwab N, Hohlfeld R, Barnett M, Reddel S, Wiendl H. Risks and risk management in modern multiple sclerosis immunotherapeutic treatment. Ther Adv Neurol Disord 2019; 12:1756286419836571. [PMID: 30967901 PMCID: PMC6444778 DOI: 10.1177/1756286419836571] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
In recent years, there has been a paradigm shift in the treatment of multiple
sclerosis (MS) owing to the approval of a number of new drugs with very distinct
mechanisms of action. All approved disease-modifying drugs primarily work
directly on the immune system. However, the identification of an ‘optimal
choice’ for individual patients with regard to treatment efficacy, treatment
adherence and side-effect profile has become increasingly complex including
conceptual as well as practical considerations. Similarly, there are
peculiarities and specific requirements with regard to treatment monitoring,
especially in relation to immunosuppression, the development of secondary
immune-related complications, as well as the existence of drug-specific on- and
off-target effects. Both classical immunosuppression and selective immune
interventions generate a spectrum of potential therapy-related complications.
This article provides a comprehensive overview of available immunotherapeutics
for MS and their risks, detailing individual mechanisms of action and
side-effect profiles. Furthermore, practical recommendations for patients
treated with modern MS immunotherapeutics are provided.
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Affiliation(s)
- Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Building A1, Albert Schweitzer Campus 1, 48149 Münster, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital; Data Integration for Future Medicine consortium (DIFUTURE), Ludwig-Maximilians University, Munich, Germany
| | - Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians University, Munich, Germany Munich Cluster for Systems Neurology, Ludwig-Maximilians University, Munich, Germany
| | | | - Stephen Reddel
- Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Building A1, Albert Schweitzer Campus 1, 48149 Münster, Germany
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Harrer A, Pilz G, Oppermann K, Sageder M, Afazel S, Haschke-Becher E, Rispens T, de Vries A, McCoy M, Stevanovic V, Hitzl W, Trinka E, Kraus J, Sellner J, Wipfler P. From natalizumab to fingolimod in eight weeks — Immunological, clinical, and radiological data in quest of the optimal switch. Clin Immunol 2017; 176:87-93. [DOI: 10.1016/j.clim.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 02/04/2023]
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Bermúdez-Morales VH, Castrejon-Salgado R, Torres-Poveda K, de Jesús Flores-Rivera J, Flores-Aldana M, Madrid-Marina V, Hernández-Girón C. Papel de las enfermedades infecciosas en el desarrollo de la esclerosis múltiple: evidencia científica. NEUROLOGÍA ARGENTINA 2017. [PMCID: PMC7154617 DOI: 10.1016/j.neuarg.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introducción La esclerosis múltiple (EM) es el trastorno inflamatorio más común del sistema nervioso central (SNC) y la causa principal de discapacidad neurológica en adultos jóvenes. Los factores ambientales e infecciosos han sido fuertemente asociados al incremento de la ocurrencia de la enfermedad, hasta más del doble, en los últimos 10 años. En este artículo de revisión se describen los principales hallazgos reportados sobre la relación entre ciertas infecciones virales y bacterianas con la aparición y progresión de la EM. Métodos Se realizó un plan metodológico de búsqueda de artículos científicos relacionados con infección y EM, mediante la búsqueda de artículos científicos, principalmente publicados en inglés, en las plataformas virtuales de Pubmed, Medline y Cochrane. Para la búsqueda se utilizaron como palabras claves (términos MeSH): «virus, bacteria, autoimmune disease of the nervous system, multiple sclerosis». Se eligieron artículos publicados en revistas indexadas durante los últimos 15 años. Resultados Estudios epidemiológicos sugieren que la EM tiene un componente etiológico infeccioso que origina un proceso inflamatorio que puede contribuir a la iniciación o exacerbación de la enfermedad. Particularmente, la infección viral y los eventos de desmielinización en el SNC puede deberse a la penetración de un virus como el virus Epstein-Barr (EBV), a través del torrente sanguíneo, específicamente hacia el SNC. Por otro lado, las infecciones bacterianas crónicas pueden causar procesos de desmielinización en el SNC que agravan la enfermedad de EM. Conclusiones Este estudio contribuye a aportar evidencia científica donde se demuestra la multicausalidad implicada en la ocurrencia de la EM. Aún falta desarrollar más estudios epidemiológicos que demuestren y comprueben la relación y la implicación de agentes virales y bacterianos en el origen, el desarrollo y la severidad de la enfermedad.
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Affiliation(s)
- Victor Hugo Bermúdez-Morales
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ricardo Castrejon-Salgado
- Médico familiar, Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social, Xochitepec, Morelos, México
| | - Kirvis Torres-Poveda
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - José de Jesús Flores-Rivera
- Médico neurólogo, Departamento de enfermedades desmielinizantes, Instituto nacional de neurología y neurocirugía, Ciudad de México (CDMX), México
| | - Mario Flores-Aldana
- Profesor investigador, Centro de Investigación en Salud Poblacional, CISP, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Vicente Madrid-Marina
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Carlos Hernández-Girón
- Profesor investigador, Centro de Investigación en Salud Poblacional, CISP, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Autor para correspondencia.
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Boyko AN, Gusev EI. Current algorithms of diagnosis and treatment of multiple sclerosis based on the individual assessment of the patient. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:92-106. [DOI: 10.17116/jnevro20171172292-106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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