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Mickael ME, Bhaumik S, Chakraborti A, Umfress AA, van Groen T, Macaluso M, Totenhagen J, Sorace AG, Bibb JA, Standaert DG, Basu R. RORγt-Expressing Pathogenic CD4 + T Cells Cause Brain Inflammation during Chronic Colitis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:2054-2066. [PMID: 35379749 PMCID: PMC10103644 DOI: 10.4049/jimmunol.2100869] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/11/2022] [Indexed: 01/09/2023]
Abstract
Neurobehavioral disorders and brain abnormalities have been extensively reported in both Crohn's disease and ulcerative colitis patients. However, the mechanism causing neuropathological disorders in inflammatory bowel disease patients remains unknown. Studies have linked the Th17 subset of CD4+ T cells to brain diseases associated with neuroinflammation and cognitive impairment, including multiple sclerosis, ischemic brain injury, and Alzheimer's disease. To better understand how CD4+ T lymphocytes contribute to brain pathology in chronic intestinal inflammation, we investigated the development of brain inflammation in the T cell transfer model of chronic colitis. Our findings demonstrate that CD4+ T cells infiltrate the brain of colitic Rag1 -/- mice in proportional levels to colitis severity. Colitic mice developed hypothalamic astrogliosis that correlated with neurobehavioral disorders. Moreover, the brain-infiltrating CD4+ T cells expressed Th17 cell transcription factor retinoic acid-related orphan receptor γt (RORγt) and displayed a pathogenic Th17 cellular phenotype similar to colonic Th17 cells. Adoptive transfer of RORγt-deficient naive CD4+ T cells failed to cause brain inflammation and neurobehavioral disorders in Rag1 -/- recipients, with significantly less brain infiltration of CD4+ T cells. The finding is mirrored in chronic dextran sulfate sodium-induced colitis in Rorcfl/fl Cd4-Cre mice that showed lower frequency of brain-infiltrating CD4+ T cells and astrogliosis despite onset of significantly more severe colitis compared with wild-type mice. These findings suggest that pathogenic RORγt+CD4+ T cells that aggravate colitis migrate preferentially into the brain, contributing to brain inflammation and neurobehavioral disorders, thereby linking colitis severity to neuroinflammation.
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Affiliation(s)
| | - Suniti Bhaumik
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Ayanabha Chakraborti
- Department of Surgery, Neuroscience, and Neurology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Alan A Umfress
- Department of Surgery, Neuroscience, and Neurology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas van Groen
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL
| | - John Totenhagen
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.,Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL; and
| | - James A Bibb
- Department of Surgery, Neuroscience, and Neurology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.,Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Rajatava Basu
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL;
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Atmaca MM, Gurses C. Status Epilepticus and Multiple Sclerosis: A Case Presentation and Literature Review. Clin EEG Neurosci 2018; 49:328-334. [PMID: 29161897 DOI: 10.1177/1550059417693732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To search the literature for the frequency, pathogenesis, prognosis, and treatment of seizures and status epilepticus (SE) in patients with multiple sclerosis (MS). METHODS We report 2 patients with MS who presented with SE and review the literature. RESULTS Seizures and SE episodes worsened during MS relapses in the first patient. SE episodes and MS relapses significantly decreased after initiation of natalizumab treatment but she still had seizures and was taking 4 antiepileptic drugs (AEDs). The second patient had super refractory SE and was treated with AEDs and coma induction; SE was controlled in 1 week. Antibodies against glycine receptors were reported in her serum after her death. CONCLUSION SE has been reported to remain refractory to conventional AEDs, and improve with treatment of MS relapse. Seizures often occur during MS relapses, and might be the presenting symptom of MS or the only symptom of a relapse. Patients with MS and epilepsy have been reported to have more severe MS disease courses. Seizures are refractory to treatment in patients with MS with chronic epilepsy; however, prognosis is quite good in patients experiencing provoked seizures during an MS relapse. Since some EEG findings may have prognostic value, their evaluation is invaluable for the determination of outcome. No treatment guidelines have been specified for patients with MS and SE. However, treatment with AEDs, ideally new-generation AEDs, and an MS treatment review with a new protocol will ensure a fast response to the improvement of SE.
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Affiliation(s)
- Murat Mert Atmaca
- 1 Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gurses
- 1 Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Shahmohammadi S, Sahraian MA, Shahmohammadi A, Doosti R, Zare-Mirzaie A, Naser Moghadasi A. A presentation of ulcerative colitis after rituximab therapy in a patient with multiple sclerosis and literature review. Mult Scler Relat Disord 2018. [PMID: 29524758 DOI: 10.1016/j.msard.2018.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiple sclerosis (MS) is one of the most important demyelinating diseases that affects the central nervous system. Its treatment often involves a long-term disease modifying therapy. According to some studies, the prevalence of autoimmune disorders, such as autoimmune hepatitis (AIH) and ulcerative colitis (UC) is higher in MS patients than in the normal population. There are also few studies that have reported the onset of UC after rituximab therapy. The present study presents a report of a 31-years old female patient suffering from aggressive multiple sclerosis, which developed into autoimmune hepatitis during the MS therapy. Thereafter, she received rituximab for the treating both MS and AIH. One week after the third cycle of rituximab (6 doses of 1000 mg), she experienced abdominal pain, fever, and severe bloody diarrhea; finally, she was diagnosed with ulcerative colitis (UC). It seems that the administration of certain immunomodulators or immunosuppressive drugs may have a main role in the exacerbation of some autoimmune diseases.
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Affiliation(s)
- Sareh Shahmohammadi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Iranian Center for Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abootorab Shahmohammadi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Doosti
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zare-Mirzaie
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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