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Virupakshaiah A, Moseley CE, Elicegui S, Gerwitz LM, Spencer CM, George E, Shah M, Cree BAC, Waubant E, Zamvil SS. Life-Threatening MOG Antibody-Associated Hemorrhagic ADEM With Elevated CSF IL-6. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200243. [PMID: 38630950 DOI: 10.1212/nxi.0000000000200243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Acute disseminated encephalomyelitis (ADEM) is one characteristic manifestation of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). A previously healthy man presented with retro-orbital headache and urinary retention 14 days after Tdap vaccination. Brain and spine MRI suggested a CNS demyelinating process. Despite treatment with IV steroids, he deteriorated, manifesting hemiparesis and later impaired consciousness, requiring intubation. A repeat brain MRI demonstrated new bilateral supratentorial lesions associated with venous sinus thrombosis, hemorrhage, and midline shift. Anti-MOG antibody was present at a high titer. CSF IL-6 protein was >2,000 times above the upper limits of normal. He improved after plasma exchange, then began monthly treatment alone with anti-IL-6 receptor antibody, tocilizumab, and has remained stable. This case highlights how adult-onset MOGAD, like childhood ADEM, can rapidly become life-threatening. The markedly elevated CSF IL-6 observed here supports consideration for evaluating CSF cytokines more broadly in patients with acute MOGAD.
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Affiliation(s)
- Akash Virupakshaiah
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Carson E Moseley
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Elicegui
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Lee M Gerwitz
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Collin M Spencer
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elizabeth George
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Maulik Shah
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Bruce A C Cree
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Emmanuelle Waubant
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
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Nasr Z, Virupakshaiah A, Schoeps VA, Cherbuin N, Casper TC, Waltz M, Hart J, Rodriguez M, Gorman MP, Benson LA, Chitnis T, Rensel M, Abrams A, Krupp L, Waldman AT, Lotze T, Aaen GS, Mar S, Schreiner T, Wheeler Y, Rose J, Shukla NM, Barcellos LF, Lucas R, Waubant E. Gene-environment interactions and risk of pediatric-onset multiple sclerosis associated with time spent outdoors. Mult Scler Relat Disord 2024; 82:105351. [PMID: 38141560 DOI: 10.1016/j.msard.2023.105351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/12/2023] [Accepted: 12/03/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Our previous study identified a significant association between lower time spent outdoors, as a proxy of sun exposure, and a higher risk of pediatric-onset multiple sclerosis (POMS). UV radiation modulates the expression of several genes, but it is unknown whether these genes modify the effect of sun exposure on POMS risk. METHODS In an age- and sex-matched case-control study, we evaluated the additive and multiplicative interactions between time spent outdoors and genetic non-HLA risk variants for developing POMS within the metabolic pathways of UV radiation, including CD28(rs6435203), CD86(rs9282641), and NFkB1(rs7665090) and the top two HLA risk factors (presence of DRB1×15 and absence of A*02). RESULTS In an adjusted model (332 POMS cases, 534 healthy controls), greater time compared to <30 min/day spent outdoors during the prior summer and higher UV radiation dose were associated with decreased odds of POMS (OR 0.66, 95% CI 0.56-0.78, p < 0.001; OR 0.78, 95 % CI 0.62-0.98, p = 0.04, respectively). No significant additive or multiplicative interactions were found between risk factors. CONCLUSIONS The exploration of gene-environment interactions in the risk of developing MS can unravel the underlying mechanisms involved. Although we do not have evidence that our candidate genes contribute to interactions, other genes may.
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Affiliation(s)
- Zahra Nasr
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
| | - Akash Virupakshaiah
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Vinicius Andreoli Schoeps
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
| | - T Charles Casper
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael Waltz
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Janace Hart
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Mark P Gorman
- Boston Childrens Hospital, Boston, Massachusetts, USA
| | | | - Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Lauren Krupp
- New York University Medical Center, New York City, New York, USA
| | - Amy T Waldman
- Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tim Lotze
- Texas Children's Hospital, Houston, Texas, USA
| | - Gregory S Aaen
- Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Soe Mar
- Washington University in St. Louis, St Louis, Missouri, USA
| | - Teri Schreiner
- Childrens Hospital Colorado/University of Colorado, Aurora, Colorado, USA
| | | | - John Rose
- George E. Wahlen Department of Veterans Affairs Medical Center, University of Utah, Salt Lake City, UT, USA
| | - Nikita Melani Shukla
- Baylor College of Medicine/Texas Children's Hospital, Neurology and Developmental Neuroscience, Houston, Texas, USA
| | - Lisa F Barcellos
- Genetic Epidemiology and Genomics Laboratory, Divisions of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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Schoeps VA, Zhou X, Horton MK, Zhu F, McCauley KE, Nasr Z, Virupakshaiah A, Gorman MP, Benson LA, Weinstock‐Guttman B, Waldman A, Banwell BL, Bar‐Or A, Marrie RA, van Domselaar G, O'Mahony J, Mirza AI, Bernstein CN, Yeh EA, Casper TC, Lynch SV, Tremlett H, Baranzini S, Waubant E. Short-chain fatty acid producers in the gut are associated with pediatric multiple sclerosis onset. Ann Clin Transl Neurol 2024; 11:169-184. [PMID: 37955284 PMCID: PMC10791026 DOI: 10.1002/acn3.51944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The relationship between multiple sclerosis and the gut microbiome has been supported by animal models in which commensal microbes are required for the development of experimental autoimmune encephalomyelitis. However, observational study findings in humans have only occasionally converged when comparing multiple sclerosis cases and controls which may in part reflect confounding by comorbidities and disease duration. The study of microbiome in pediatric-onset multiple sclerosis offers unique opportunities as it is closer to biological disease onset and minimizes confounding by comorbidities and environmental exposures. METHODS A multicenter case-control study in which 35 pediatric-onset multiple sclerosis cases were 1:1 matched to healthy controls on age, sex, self-reported race, ethnicity, and recruiting site. Linear mixed effects models, weighted correlation network analyses, and PICRUSt2 were used to identify microbial co-occurrence networks and for predicting functional abundances based on marker gene sequences. RESULTS Two microbial co-occurrence networks (one reaching significance after adjustment for multiple comparisons; q < 0.2) were identified, suggesting interdependent bacterial taxa that exhibited association with disease status. Both networks indicated a potentially protective effect of higher relative abundance of bacteria observed in these clusters. Functional predictions from the significant network suggested a contribution of short-chain fatty acid producers through anaerobic fermentation pathways in healthy controls. Consistent family-level findings from an independent Canadian-US study (19 case/control pairs) included Ruminococaccaeae and Lachnospiraceae (p < 0.05). Macronutrient intake was not significantly different between cases and controls, minimizing the potential for dietary confounding. INTERPRETATION Our results suggest that short-chain fatty acid producers may be important contributors to multiple sclerosis onset.
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Affiliation(s)
- Vinicius A. Schoeps
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Xiaoyuan Zhou
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mary K. Horton
- Division of EpidemiologyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Feng Zhu
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kathryn E. McCauley
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Zahra Nasr
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Akash Virupakshaiah
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mark P. Gorman
- Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
| | - Leslie A. Benson
- Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
| | | | - Amy Waldman
- Department of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brenda L. Banwell
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amit Bar‐Or
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruth Ann Marrie
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Gary van Domselaar
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Julia O'Mahony
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Ali I. Mirza
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - E. Ann Yeh
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Susan V. Lynch
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Helen Tremlett
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sergio Baranzini
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Emmanuelle Waubant
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, Arona J, Stern WA, Chong J, Hart J, Zamvil SS, Sati P, Henry RG, Waubant E. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:1736-1747. [PMID: 37897254 PMCID: PMC10687802 DOI: 10.1177/13524585231204414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. METHODS T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. RESULTS The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1-10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). CONCLUSION The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.
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Affiliation(s)
- Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akash Virupakshaiah
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vinicius A Schoeps
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amit Akula
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Haojun Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Arona
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janace Hart
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Nasr Z, Schoeps VA, Ziaei A, Virupakshaiah A, Adams C, Casper TC, Waltz M, Rose J, Rodriguez M, Tillema JM, Chitnis T, Graves JS, Benson L, Rensel M, Krupp L, Waldman AT, Weinstock-Guttman B, Lotze T, Greenberg B, Aaen G, Mar S, Schreiner T, Hart J, Simpson-Yap S, Mesaros C, Barcellos LF, Waubant E. Gene-environment interactions increase the risk of paediatric-onset multiple sclerosis associated with household chemical exposures. J Neurol Neurosurg Psychiatry 2023; 94:518-525. [PMID: 36725329 PMCID: PMC10272045 DOI: 10.1136/jnnp-2022-330713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND We previously reported an association between household chemical exposures and an increased risk of paediatric-onset multiple sclerosis. METHODS Using a case-control paediatric multiple sclerosis study, gene-environment interaction between exposure to household chemicals and genotypes for risk of paediatric-onset multiple sclerosis was estimated.Genetic risk factors of interest included the two major HLA multiple sclerosis risk factors, the presence of DRB1*15 and the absence of A*02, and multiple sclerosis risk variants within the metabolic pathways of common household toxic chemicals, including IL-6 (rs2069852), BCL-2 (rs2187163) and NFKB1 (rs7665090). RESULTS 490 paediatric-onset multiple sclerosis cases and 716 controls were included in the analyses. Exposures to insect repellent for ticks or mosquitos (OR 1.47, 95% CI 1.06 to 2.04, p=0.019), weed control products (OR 2.15, 95% CI 1.51 to 3.07, p<0.001) and plant/tree insect or disease control products (OR 3.25, 95% CI 1.92 to 5.49, p<0.001) were associated with increased odds of paediatric-onset multiple sclerosis. There was significant additive interaction between exposure to weed control products and NFKB1 SNP GG (attributable proportions (AP) 0.48, 95% CI 0.10 to 0.87), and exposure to plant or disease control products and absence of HLA-A*02 (AP 0.56; 95% CI 0.03 to 1.08). There was a multiplicative interaction between exposure to weed control products and NFKB1 SNP GG genotype (OR 2.30, 95% CI 1.00 to 5.30) but not for other exposures and risk variants. No interactions were found with IL-6 and BCL-2 SNP GG genotypes. CONCLUSIONS The presence of gene-environment interactions with household toxins supports their possible causal role in paediatric-onset multiple sclerosis.
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Affiliation(s)
- Zahra Nasr
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Vinicius Andreoli Schoeps
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Amin Ziaei
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Akash Virupakshaiah
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Cameron Adams
- Genetic Epidemiology and Genomics Laboratory, Divisions of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | - Michael Waltz
- University of Utah Health, Salt Lake City, Utah, USA
| | - John Rose
- University of Utah Health, Salt Lake City, Utah, USA
| | | | | | - Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical school, Boston, Massachusetts, USA
| | | | - Leslie Benson
- Childrens Hospital Boston, Boston, Massachusetts, USA
| | | | - Lauren Krupp
- New York University Medical Center, New York City, New York, USA
| | - Amy T Waldman
- Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Tim Lotze
- Texas Children's Hospital, Houston, Texas, USA
| | | | - Gregory Aaen
- Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Soe Mar
- Washington University in St. Louis, St Louis, Missouri, USA
| | | | - Janace Hart
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, The University of Melbourne School of Population and Global Health, Melbourne, Carlton, Australia
- Clinical Outcomes Research Unit (CORe), Royal Melbourne Hospital, The University of Melbourne, Melbourne, Parkville, Australia
- Multiple Sclerosis Flagship, Menzies Institute for Medical Research, University of Tasmania, Tasmania, Hobart, Australia
| | - Clementina Mesaros
- Department of Systems Pharmacology and Translational Therapeutics (SPATT), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa F Barcellos
- Genetic Epidemiology and Genomics Laboratory, Divisions of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Department of Integrative Biology, University of California Berkeley, Berkeley, California, USA
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
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Virupakshaiah A, Ladakis DC, Nourbakhsh B, Bhargava P, Dilwali S, Schoeps V, Borkowski K, Newman JW, Waubant E. Several serum lipid metabolites are associated with relapse risk in pediatric-onset multiple sclerosis. Mult Scler 2023; 29:936-944. [PMID: 37199529 PMCID: PMC10524330 DOI: 10.1177/13524585231171517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND The circulating metabolome is altered in multiple sclerosis (MS), but its prognostic capabilities have not been extensively explored. Lipid metabolites might be of particular interest due to their multiple roles in the brain, as they can serve as structural components, energy sources, and bioactive molecules. Gaining a deeper understanding of the disease may be possible by examining the lipid metabolism in the periphery, which serves as the primary source of lipids for the brain. OBJECTIVE To determine if altered serum lipid metabolites are associated with the risk of relapse and disability in children with MS. METHODS We collected serum samples from 61 participants with pediatric-onset MS within 4 years of disease onset. Prospective longitudinal relapse data and cross-sectional disability measures (Expanded Disability Status Scale [EDSS]) were collected. Serum metabolomics was performed using untargeted liquid chromatography and mass spectrometry. Individual lipid metabolites were clustered into pre-defined pathways. The associations between clusters of metabolites and relapse rate and EDSS score were estimated utilizing negative binomial and linear regression models, respectively. RESULTS We found that serum acylcarnitines (relapse rate: normalized enrichment score [NES] = 2.1, q = 1.03E-04; EDSS: NES = 1.7, q = 0.02) and poly-unsaturated fatty acids (relapse rate: NES = 1.6, q = 0.047; EDSS: NES = 1.9, q = 0.005) were associated with higher relapse rates and EDSS, while serum phosphatidylethanolamines (relapse rate: NES = -2.3, q = 0.002; EDSS: NES = -2.1, q = 0.004), plasmalogens (relapse rate: NES = -2.5, q = 5.81E-04; EDSS: NES = -2.1, q = 0.004), and primary bile acid metabolites (relapse rate: NES = -2.0, q = 0.02; EDSS: NES = -1.9, q = 0.02) were associated with lower relapse rates and lower EDSS. CONCLUSION This study supports the role of some lipid metabolites in pediatric MS relapses and disability.
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Affiliation(s)
- Akash Virupakshaiah
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Dimitrios C Ladakis
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Pavan Bhargava
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Sonam Dilwali
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Vinicius Schoeps
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kamil Borkowski
- West Coast Metabolomics Center, University of California Davis, Davis, CA, USA
| | - John W Newman
- West Coast Metabolomics Center, University of California Davis, Davis, CA, USA United States Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, USA Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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Virupakshaiah A, Teixeira SR, Sotardi S, Liu G, Agarwal S. Frontonasal Dysplasia: A Diagnostic Challenge with Fetal MRI in Twin Pregnancy. Child Neurol Open 2023; 10:2329048X231157147. [PMID: 36910596 PMCID: PMC9996711 DOI: 10.1177/2329048x231157147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
Callosal agenesis is a complex condition with disruption in the steps such as cellular proliferation, migration, axonal growth, guidance, or glial patterning at the midline. Agenesis of the corpus callosum (AgCC) is associated with diverse midline craniofacial malformations affecting the frontal-cranial and midface skeleton. Diagnosing midline abnormalities prenatally can be challenging, especially in twin pregnancies, due to poor resolution of skull base structures on fetal MRI, basal cephalocele could be mistaken for fluid in the nasopharynx, motion limitation, and fetal positioning. Our case highlights the importance of evaluation for other associated midline anomalies when there is callosal agenesis.
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Affiliation(s)
- Akash Virupakshaiah
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
| | - Sara Reis Teixeira
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Susan Sotardi
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Grant Liu
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
| | - Sonika Agarwal
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
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Karlin A, Vossough A, Agarwal S, Jacobwitz MN, Virupakshaiah A, Beslow LA. Spinal Cord Infarct Due to Fibrocartilaginous Embolism. Neuropediatrics 2021; 52:224-225. [PMID: 33111299 DOI: 10.1055/s-0040-1718918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alexis Karlin
- Division of Child Neurology, Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Arastoo Vossough
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sonika Agarwal
- Division of Child Neurology, Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Marin N Jacobwitz
- Division of Child Neurology, Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Akash Virupakshaiah
- Division of Child Neurology, Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Lauren A Beslow
- Division of Child Neurology, Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Tencer J, Virupakshaiah A, Campbell IM, Zackai EH, Zarnow D, Agarwal S. A Case of Prenatally Diagnosed Periventricular Nodular Heterotopia in a Surviving Male Patient with FLNA Mutation. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0041-1725017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
FLNA is a gene on the X chromosome that encodes Filamin A, a widely expressed protein crucial for forming the cell cytoskeleton and mediating cell signaling. Loss-of-function mutations have been associated with periventricular nodular heterotopia (PVNH) with associated epilepsy and intellectual deficits, as well as cardiovascular disease, connective tissue disorders, pulmonary disease, bleeding diathesis, and gastrointestinal disease. Alternatively, gain-of-function mutations have been described with otopalatodigital spectrum disorders.The loss-of-function variants of FLNA associated with PVNH have historically been considered lethal in males, often prenatally or by the first year of life. However, more surviving males with FLNA variants are being described. Most of the surviving males have missense or distal truncating mutations or a degree of mosaicism. Others are thought to have splice site mutations or in-frame exon skipping leading to production of some degree of functional Filamin A as possible mechanisms of survival.Here, we presented a case of a 20-month-old small but developmentally appropriate and healthy male infant who was prenatally diagnosed with PVNH, and postnatally found to have a nonsense variant of the FLNA gene. This mutation has not been previously clinically described or published to our knowledge.
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Affiliation(s)
- Jaclyn Tencer
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Akash Virupakshaiah
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ian M. Campbell
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Elaine H. Zackai
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Deborah Zarnow
- Division of Radiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Sonika Agarwal
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Virupakshaiah A, Dalakas MC, Desai N, Mintzer S, Ratliff J. LGI1 encephalitis with squamous lung-cell carcinoma: Resolution after tumor resection. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e905. [PMID: 33037051 PMCID: PMC7577548 DOI: 10.1212/nxi.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 09/11/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Akash Virupakshaiah
- From the Department of Neurology (A.V., M.C.D., N.D., S.M., J.R.), Thomas Jefferson University, Philadelphia, PA; and Neuroimmunology Unit (M.C.D.), Department of Pathophysiology Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Marinos C Dalakas
- From the Department of Neurology (A.V., M.C.D., N.D., S.M., J.R.), Thomas Jefferson University, Philadelphia, PA; and Neuroimmunology Unit (M.C.D.), Department of Pathophysiology Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Neeja Desai
- From the Department of Neurology (A.V., M.C.D., N.D., S.M., J.R.), Thomas Jefferson University, Philadelphia, PA; and Neuroimmunology Unit (M.C.D.), Department of Pathophysiology Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Scott Mintzer
- From the Department of Neurology (A.V., M.C.D., N.D., S.M., J.R.), Thomas Jefferson University, Philadelphia, PA; and Neuroimmunology Unit (M.C.D.), Department of Pathophysiology Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Jeffrey Ratliff
- From the Department of Neurology (A.V., M.C.D., N.D., S.M., J.R.), Thomas Jefferson University, Philadelphia, PA; and Neuroimmunology Unit (M.C.D.), Department of Pathophysiology Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
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Suresh SH, Chakraborty A, Virupakshaiah A, Kumar N. Efficacy and Safety of Levetiracetam and Carbamazepine as Monotherapy in Partial Seizures. Epilepsy Res Treat 2015; 2015:415082. [PMID: 26798511 PMCID: PMC4698781 DOI: 10.1155/2015/415082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022]
Abstract
Introduction. Levetiracetam (LEV) is a newer antiepileptic drug with better pharmacokinetic profile. Currently, it is frequently used for the treatment of partial seizures. The present study was undertaken to compare the efficacy and safety of LEV and Carbamazepine (CBZ) in partial epilepsy. Methods. This was a prospective, open labeled, randomized study. It was conducted in participants suffering from partial seizures after the approval of ethics committee and written informed consent. The first group received Tab LEV (500 to 3000 mg/day) and the second group received Tab CBZ (300 to 600 mg/day). The primary outcomes were efficacy and safety. The secondary outcome was the Quality of Life (QOL). Efficacy was assessed by comparing the seizure freedom rates at the end of 6 months. Safety profile was evaluated by comparing the adverse effects. QOL was assessed by QOLIE-10 scale. Results. The overall seizure freedom rate at the end of 6 months was 71.42% in CBZ group compared to 78.57% in LEV group (p = 0.2529). Both LEV and CBZ reported a similar incidence of adverse reactions. LEV group reported more behavioral changes like increased aggression and anxiety. Also, it showed better QOL compared to the CBZ group. Conclusion. LEV monotherapy and CBZ monotherapy demonstrated similar efficacy for treatment of partial epilepsy and were found to be well tolerated.
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Affiliation(s)
| | - Ananya Chakraborty
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, No. 82 EPIP Area, Whitefield, Bangalore 560037, India
| | - Akash Virupakshaiah
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, No. 82 EPIP Area, Whitefield, Bangalore 560037, India
| | - Nithin Kumar
- Department of Neurology, Columbia Asia Hospital, Whitefield, Bangalore 560066, India
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Sabaretnam M, Virupakshaiah A, Baruah R. Natural ear rings. Clin Case Rep 2015; 3:333-4. [PMID: 25984317 PMCID: PMC4427380 DOI: 10.1002/ccr3.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 11/17/2022] Open
Abstract
Ear lobe keloids are common following ear piercing and these lesions are conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, anti mitotic agents, silicone sheet, pressure clips, and cryotherapy have been used. The Challenge is to have a good cosmetic outcome with minimal recurrence.
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Affiliation(s)
- Mayilvaganan Sabaretnam
- Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore
| | - Akash Virupakshaiah
- Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore
| | - Rishiraj Baruah
- Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore
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