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Wright SL, Thompson AJ. Managing patients with late-onset neutropenia during treatment with ocrelizumab. Mult Scler 2024; 30:134. [PMID: 37888826 DOI: 10.1177/13524585231206219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Sarah L Wright
- Department of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Sahi N, Haider L, Chung K, Prados Carrasco F, Kanber B, Samson R, Thompson AJ, Gandini Wheeler-Kingshott CAM, Trip SA, Brownlee W, Ciccarelli O, Barkhof F, Tur C, Houlden H, Chard D. Genetic influences on disease course and severity, 30 years after a clinically isolated syndrome. Brain Commun 2023; 5:fcad255. [PMID: 37841069 PMCID: PMC10576246 DOI: 10.1093/braincomms/fcad255] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
Multiple sclerosis risk has a well-established polygenic component, yet the genetic contribution to disease course and severity remains unclear and difficult to examine. Accurately measuring disease progression requires long-term study of clinical and radiological outcomes with sufficient follow-up duration to confidently confirm disability accrual and multiple sclerosis phenotypes. In this retrospective study, we explore genetic influences on long-term disease course and severity; in a unique cohort of clinically isolated syndrome patients with homogenous 30-year disease duration, deep clinical phenotyping and advanced MRI metrics. Sixty-one clinically isolated syndrome patients [41 female (67%): 20 male (33%)] underwent clinical and MRI assessment at baseline, 1-, 5-, 10-, 14-, 20- and 30-year follow-up (mean age ± standard deviation: 60.9 ± 6.5 years). After 30 years, 29 patients developed relapsing-remitting multiple sclerosis, 15 developed secondary progressive multiple sclerosis and 17 still had a clinically isolated syndrome. Twenty-seven genes were investigated for associations with clinical outcomes [including disease course and Expanded Disability Status Scale (EDSS)] and brain MRI (including white matter lesions, cortical lesions, and brain tissue volumes) at the 30-year follow-up. Genetic associations with changes in EDSS, relapses, white matter lesions and brain atrophy (third ventricular and medullary measurements) over 30 years were assessed using mixed-effects models. HLA-DRB1*1501-positive (n = 26) patients showed faster white matter lesion accrual [+1.96 lesions/year (0.64-3.29), P = 3.8 × 10-3], greater 30-year white matter lesion volumes [+11.60 ml, (5.49-18.29), P = 1.27 × 10-3] and higher annualized relapse rates [+0.06 relapses/year (0.005-0.11), P = 0.031] compared with HLA-DRB1*1501-negative patients (n = 35). PVRL2-positive patients (n = 41) had more cortical lesions (+0.83 [0.08-1.66], P = 0.042), faster EDSS worsening [+0.06 points/year (0.02-0.11), P = 0.010], greater 30-year EDSS [+1.72 (0.49-2.93), P = 0.013; multiple sclerosis cases: +2.60 (1.30-3.87), P = 2.02 × 10-3], and greater risk of secondary progressive multiple sclerosis [odds ratio (OR) = 12.25 (1.15-23.10), P = 0.031] than PVRL2-negative patients (n = 18). In contrast, IRX1-positive (n = 30) patients had preserved 30-year grey matter fraction [+0.76% (0.28-1.29), P = 8.4 × 10-3], lower risk of cortical lesions [OR = 0.22 (0.05-0.99), P = 0.049] and lower 30-year EDSS [-1.35 (-0.87,-3.44), P = 0.026; multiple sclerosis cases: -2.12 (-0.87, -3.44), P = 5.02 × 10-3] than IRX1-negative patients (n = 30). In multiple sclerosis cases, IRX1-positive patients also had slower EDSS worsening [-0.07 points/year (-0.01,-0.13), P = 0.015] and lower risk of secondary progressive multiple sclerosis [OR = 0.19 (0.04-0.92), P = 0.042]. These exploratory findings support diverse genetic influences on pathological mechanisms associated with multiple sclerosis disease course. HLA-DRB1*1501 influenced white matter inflammation and relapses, while IRX1 (protective) and PVRL2 (adverse) were associated with grey matter pathology (cortical lesions and atrophy), long-term disability worsening and the risk of developing secondary progressive multiple sclerosis.
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Affiliation(s)
- Nitin Sahi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Lukas Haider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, 1090 Vienna, Austria
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Ferran Prados Carrasco
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Department of Clinical and Experimental Epilepsy, University College London, London WC1N 3BG, UK
| | - Rebecca Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - S Anand Trip
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Wallace Brownlee
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
| | - Frederik Barkhof
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Carmen Tur
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- MS Centre of Catalonia (Cemcat), Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen’s Square House, Queen’s Square, London, WC1N 3BG, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London W1T 7DN, UK
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Thompson AJ, Moccia M, Amato MP, Calabresi PA, Finlayson M, Hawton A, Lublin FD, Marrie RA, Montalban X, Panzara M, Sormani MP, Strum J, Vickrey BG, Coetzee T. Do the current MS clinical course descriptors need to change and if so how? A survey of the MS community. Mult Scler 2023; 29:1363-1372. [PMID: 37691493 PMCID: PMC10580678 DOI: 10.1177/13524585231196786] [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: 06/25/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The current clinical course descriptors of multiple sclerosis (MS) include a combination of clinical and magnetic resonance imaging (MRI) features. Recently there has been a growing call to base these descriptors more firmly on biological mechanisms. We investigated the implications of proposing a new mechanism-driven framework for describing MS. METHODS In a web-based survey, multiple stakeholders rated the need to change current MS clinical course descriptors, the definitions of disease course and their value in clinical practice and related topics. RESULTS We received 502 responses across 49 countries. In all, 77% of the survey respondents supported changing the current MS clinical course descriptors. They preferred a framework that informs treatment decisions, aids the design and conduct of clinical trials, allows patients to understand their disease, and links disease mechanisms and clinical expression of disease. Clinical validation before dissemination and ease of communication to patients were rated as the most important aspects to consider when developing any new framework for describing MS. CONCLUSION A majority of MS stakeholders agreed that the current MS clinical course descriptors need to change. Any change process will need to engage a wide range of affected stakeholders and be guided by foundational principles.
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Affiliation(s)
- Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Faculty of Brain Sciences, University College London, London, UK
| | - Marcello Moccia
- Department of Molecular Biology and Molecular Biotechnology, Federico II University of Naples, Naples, Italy Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Peter A Calabresi
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Annie Hawton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Fred D Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth Ann Marrie
- Departments of Medicine & Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia and Department of Neurology-Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Coetzee
- National Multiple Sclerosis Society, 733 Third Avenue, New York, NY 10017, USA
- National Multiple Sclerosis Society, New York, NY, USA
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Kuhlmann T, Moccia M, Coetzee T, Cohen JA, Correale J, Graves J, Marrie RA, Montalban X, Yong VW, Thompson AJ, Reich DS. Multiple sclerosis progression: time for a new mechanism-driven framework. Lancet Neurol 2023; 22:78-88. [PMID: 36410373 PMCID: PMC10463558 DOI: 10.1016/s1474-4422(22)00289-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 99.0] [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: 11/18/2021] [Revised: 05/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
Abstract
Traditionally, multiple sclerosis has been categorised by distinct clinical descriptors-relapsing-remitting, secondary progressive, and primary progressive-for patient care, research, and regulatory approval of medications. Accumulating evidence suggests that the clinical course of multiple sclerosis is better considered as a continuum, with contributions from concurrent pathophysiological processes that vary across individuals and over time. The apparent evolution to a progressive course reflects a partial shift from predominantly localised acute injury to widespread inflammation and neurodegeneration, coupled with failure of compensatory mechanisms, such as neuroplasticity and remyelination. Ageing increases neural susceptibility to injury and decreases resilience. These observations encourage a new consideration of the course of multiple sclerosis as a spectrum defined by the relative contributions of overlapping pathological and reparative or compensatory processes. New understanding of key mechanisms underlying progression and measures to quantify progressive pathology will potentially have important and beneficial implications for clinical care, treatment targets, and regulatory decision-making.
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Affiliation(s)
- Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany; Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Timothy Coetzee
- National Multiple Sclerosis Society (USA), New York, NY, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jorge Correale
- Fleni, Department of Neurology, Buenos Aires, Argentina; Institute of Biological Chemistry and Biophysics (IQUIFIB), CONICET/UBA, Buenos Aires, Argentina
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Ruth Ann Marrie
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia and Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Faculty of Brain Sciences, University College London, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Affiliation(s)
- Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
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Thompson AJ, Carroll W, Ciccarelli O, Comi G, Cross A, Donnelly A, Feinstein A, Fox RJ, Helme A, Hohlfeld R, Hyde R, Kanellis P, Landsman D, Lubetzki C, Marrie RA, Morahan J, Montalban X, Musch B, Rawlings S, Salvetti M, Sellebjerg F, Sincock C, Smith KE, Strum J, Zaratin P, Coetzee T. Charting a global research strategy for progressive MS-An international progressive MS Alliance proposal. Mult Scler 2021; 28:16-28. [PMID: 34850641 PMCID: PMC8688983 DOI: 10.1177/13524585211059766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive forms of multiple sclerosis (MS) affect more than 1 million individuals globally. Recent approvals of ocrelizumab for primary progressive MS and siponimod for active secondary progressive MS have opened the therapeutic door, though results from early trials of neuroprotective agents have been mixed. The recent introduction of the term 'active' secondary progressive MS into the therapeutic lexicon has introduced potential confusion to disease description and thereby clinical management. OBJECTIVE This paper reviews recent progress, highlights continued knowledge and proposes, on behalf of the International Progressive MS Alliance, a global research strategy for progressive MS. METHODS Literature searches of PubMed between 2015 and May, 2021 were conducted using the search terms "progressive multiple sclerosis", "primary progressive multiple sclerosis", "secondary progressive MS". Proposed strategies were developed through a series of in-person and virtual meetings of the International Progressive MS Alliance Scientific Steering Committee. RESULTS Sustaining and accelerating progress will require greater understanding of underlying mechanisms, identification of potential therapeutic targets, biomarker discovery and validation, and conduct of clinical trials with improved trial design. Encouraging developments in symptomatic and rehabilitative interventions are starting to address ongoing challenges experienced by people with progressive MS. CONCLUSION We need to manage these challenges and realise the opportunities in the context of a global research strategy, which will improve quality of life for people with progressive MS.
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Affiliation(s)
| | | | | | | | - Anne Cross
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | - Reinhard Hohlfeld
- Munich Cluster for Systems Neurology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Xavier Montalban
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy/Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Finn Sellebjerg
- Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | | | | | - Jon Strum
- International Progressive MS Alliance, Los Angeles, CA, USA
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Tur C, Grussu F, De Angelis F, Prados F, Kanber B, Calvi A, Eshaghi A, Charalambous T, Cortese R, Chard DT, Chataway J, Thompson AJ, Ciccarelli O, Gandini Wheeler-Kingshott CAM. Spatial patterns of brain lesions assessed through covariance estimations of lesional voxels in multiple Sclerosis: The SPACE-MS technique. Neuroimage Clin 2021; 33:102904. [PMID: 34875458 PMCID: PMC8654632 DOI: 10.1016/j.nicl.2021.102904] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Abstract
Predicting disability in progressive multiple sclerosis (MS) is extremely challenging. Although there is some evidence that the spatial distribution of white matter (WM) lesions may play a role in disability accumulation, the lack of well-established quantitative metrics that characterise these aspects of MS pathology makes it difficult to assess their relevance for clinical progression. This study introduces a novel approach, called SPACE-MS, to quantitatively characterise spatial distributional features of brain MS lesions, so that these can be assessed as predictors of disability accumulation. In SPACE-MS, the covariance matrix of the spatial positions of each patient's lesional voxels is computed and its eigenvalues extracted. These are combined to derive rotationally-invariant metrics known to be common and robust descriptors of ellipsoid shape such as anisotropy, planarity and sphericity. Additionally, SPACE-MS metrics include a neuraxis caudality index, which we defined for the whole-brain lesion mask as well as for the most caudal brain lesion. These indicate how distant from the supplementary motor cortex (along the neuraxis) the whole-brain mask or the most caudal brain lesions are. We applied SPACE-MS to data from 515 patients involved in three studies: the MS-SMART (NCT01910259) and MS-STAT1 (NCT00647348) secondary progressive MS trials, and an observational study of primary and secondary progressive MS. Patients were assessed on motor and cognitive disability scales and underwent structural brain MRI (1.5/3.0 T), at baseline and after 2 years. The MRI protocol included 3DT1-weighted (1x1x1mm3) and 2DT2-weighted (1x1x3mm3) anatomical imaging. WM lesions were semiautomatically segmented on the T2-weighted scans, deriving whole-brain lesion masks. After co-registering the masks to the T1 images, SPACE-MS metrics were calculated and analysed through a series of multiple linear regression models, which were built to assess the ability of spatial distributional metrics to explain concurrent and future disability after adjusting for confounders. Patients whose WM lesions laid more caudally along the neuraxis or were more isotropically distributed in the brain (i.e. with whole-brain lesion masks displaying a high sphericity index) at baseline had greater motor and/or cognitive disability at baseline and over time, independently of brain lesion load and atrophy measures. In conclusion, here we introduced the SPACE-MS approach, which we showed is able to capture clinically relevant spatial distributional features of MS lesions independently of the sheer amount of lesions and brain tissue loss. Location of lesions in lower parts of the brain, where neurite density is particularly high, such as in the cerebellum and brainstem, and greater spatial spreading of lesions (i.e. more isotropic whole-brain lesion masks), possibly reflecting a higher number of WM tracts involved, are associated with clinical deterioration in progressive MS. The usefulness of the SPACE-MS approach, here demonstrated in MS, may be explored in other conditions also characterised by the presence of brain WM lesions.
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Affiliation(s)
- Carmen Tur
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; MS Centre of Catalonia (Cemcat), Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, Spain.
| | - Francesco Grussu
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Floriana De Angelis
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; Centre for Medical Image Computing, Medical Physics and Biomedical Engineering Department, University College London, UK; e-Health Center, Universitat Oberta de Catalunya, Spain
| | - Baris Kanber
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering Department, University College London, UK
| | - Alberto Calvi
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Arman Eshaghi
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Thalis Charalambous
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Rosa Cortese
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Declan T Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
| | - Jeremy Chataway
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK; Department of Brain and Behavioural Sciences, University of Pavia, Italy; Brain Connectivity Centre, IRCCS Mondino Foundation, Pavia, Italy.
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8
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Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany/Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alan J Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, UK
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Eshaghi A, Young AL, Wijeratne PA, Prados F, Arnold DL, Narayanan S, Guttmann CRG, Barkhof F, Alexander DC, Thompson AJ, Chard D, Ciccarelli O. Author Correction: Identifying multiple sclerosis subtypes using unsupervised machine learning and MRI data. Nat Commun 2021; 12:3169. [PMID: 34016975 PMCID: PMC8137887 DOI: 10.1038/s41467-021-23538-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK.
| | - Alexandra L Young
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter A Wijeratne
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Charles R G Guttmann
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK
- VU University Medical Centre, Amsterdam, The Netherlands
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, Faculty of Engineering Sciences, University College London, London, UK
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research University College London Hospitals, Biomedical Research Centre, London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research University College London Hospitals, Biomedical Research Centre, London, UK
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10
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Haider L, Prados F, Chung K, Goodkin O, Kanber B, Sudre C, Yiannakas M, Samson RS, Mangesius S, Thompson AJ, Gandini Wheeler-Kingshott CAM, Ciccarelli O, Chard DT, Barkhof F. Cortical involvement determines impairment 30 years after a clinically isolated syndrome. Brain 2021; 144:1384-1395. [PMID: 33880511 PMCID: PMC8219364 DOI: 10.1093/brain/awab033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/10/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023] Open
Abstract
Many studies report an overlap of MRI and clinical findings between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), which in part is reflective of inclusion of subjects with variable disease duration and short periods of follow-up. To overcome these limitations, we examined the differences between RRMS and SPMS and the relationship between MRI measures and clinical outcomes 30 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis. Sixty-three patients were studied 30 years after their initial presentation with a clinically isolated syndrome; only 14% received a disease modifying treatment at any time point. Twenty-seven patients developed RRMS, 15 SPMS and 21 experienced no further neurological events; these groups were comparable in terms of age and disease duration. Clinical assessment included the Expanded Disability Status Scale, 9-Hole Peg Test and Timed 25-Foot Walk and the Brief International Cognitive Assessment For Multiple Sclerosis. All subjects underwent a comprehensive MRI protocol at 3 T measuring brain white and grey matter (lesions, volumes and magnetization transfer ratio) and cervical cord involvement. Linear regression models were used to estimate age- and gender-adjusted group differences between clinical phenotypes after 30 years, and stepwise selection to determine associations between a large sets of MRI predictor variables and physical and cognitive outcome measures. At the 30-year follow-up, the greatest differences in MRI measures between SPMS and RRMS were the number of cortical lesions, which were higher in SPMS (the presence of cortical lesions had 100% sensitivity and 88% specificity), and grey matter volume, which was lower in SPMS. Across all subjects, cortical lesions, grey matter volume and cervical cord volume explained 60% of the variance of the Expanded Disability Status Scale; cortical lesions alone explained 43%. Grey matter volume, cortical lesions and gender explained 43% of the variance of Timed 25-Foot Walk. Reduced cortical magnetization transfer ratios emerged as the only significant explanatory variable for the symbol digit modality test and explained 52% of its variance. Cortical involvement, both in terms of lesions and atrophy, appears to be the main correlate of progressive disease and disability in a cohort of individuals with very long follow-up and homogeneous disease duration, indicating that this should be the target of therapeutic interventions.
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Affiliation(s)
- Lukas Haider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Austria
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Olivia Goodkin
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Carole Sudre
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca S Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Declan T Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Frederik Barkhof
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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11
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Affiliation(s)
| | - Alan J Thompson
- UCL Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London, UK
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12
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Collorone S, Cawley N, Grussu F, Prados F, Tona F, Calvi A, Kanber B, Schneider T, Kipp L, Zhang H, Alexander DC, Thompson AJ, Toosy A, Wheeler-Kingshott CAG, Ciccarelli O. Reduced neurite density in the brain and cervical spinal cord in relapsing-remitting multiple sclerosis: A NODDI study. Mult Scler 2020; 26:1647-1657. [PMID: 31682198 DOI: 10.1177/1352458519885107] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) affects both brain and spinal cord. However, studies of the neuraxis with advanced magnetic resonance imaging (MRI) are rare because of long acquisition times. We investigated neurodegeneration in MS brain and cervical spinal cord using neurite orientation dispersion and density imaging (NODDI). OBJECTIVE The aim of this study was to investigate possible alterations, and their clinical relevance, in neurite morphology along the brain and cervical spinal cord of relapsing-remitting MS (RRMS) patients. METHODS In total, 28 RRMS patients and 20 healthy controls (HCs) underwent brain and spinal cord NODDI at 3T. Physical and cognitive disability was assessed. Individual maps of orientation dispersion index (ODI) and neurite density index (NDI) in brain and spinal cord were obtained. We examined differences in NODDI measures between groups and the relationships between NODDI metrics and clinical scores using linear regression models adjusted for age, sex and brain tissue volumes or cord cross-sectional area (CSA). RESULTS Patients showed lower NDI in the brain normal-appearing white matter (WM) and spinal cord WM than HCs. In patients, a lower NDI in the spinal cord WM was associated with higher disability. CONCLUSION Reduced neurite density occurs in the neuraxis but, especially when affecting the spinal cord, it may represent a mechanism of disability in MS.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Niamh Cawley
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Francesco Grussu
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Francesca Tona
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Alberto Calvi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Pathophysiology and Transplantation, Neurodegenerative Disease Unit, La Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Baris Kanber
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Torben Schneider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Philips UK, Guildford, UK
| | - Lucas Kipp
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Stanford MS Center, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Ahmed Toosy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Claudia Am Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy/Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
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13
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Lam KT, Taylor EL, Thompson AJ, Ruepp MD, Lochner M, Martinez MJ, Brozik JA. Direct Measurement of Single-Molecule Ligand-Receptor Interactions. J Phys Chem B 2020; 124:7791-7802. [PMID: 32790373 DOI: 10.1021/acs.jpcb.0c05474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Measuring the kinetics that govern ligand-receptor interactions is fundamental to our understanding of pharmacology. For ligand-gated ion channels, binding of an agonist triggers allosteric motions that open an integral ion-permeable pore. By mathematically modeling stochastic electrophysiological responses with high temporal resolution (ms), previous single channel studies have been able to infer the rate constants of ligands binding to these receptors. However, there are no reports of the direct measurement of the single-molecule binding events that are vital to how agonists exert their functional effects. For the first time, we report these direct measurements, the rate constants, and corresponding free energy changes, which describe the transitions between the different binding states. To achieve this, we use the super resolution technique: points accumulation for imaging in nanoscale topography (PAINT) to observe binding of ATP to orthosteric binding sites on the P2X1 receptor. Furthermore, an analysis of time-resolved single-molecule interactions is used to measure elementary rate constants and thermodynamic forces that drive the allosteric motions. These single-molecule measurements unequivocally establish the location of each binding states of the P2X1 receptor and the stochastic nature of the interaction with its native ligand. The analysis leads to the measurement of the forward and reverse rates from a weak ligand-binding state to a strong ligand binding state that is linked to allosteric motion and ion pore formation. These rates (kα = 1.41 sec-1 and kβ = 0.32 sec-1) were then used to determine the free energy associated with this critical mechanistic step (3.7 kJ/mol). Importantly, the described methods can be readily applied to all ligand-gated ion channels, and more broadly to the molecular interactions of other classes of membrane proteins.
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Affiliation(s)
- K-T Lam
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - E L Taylor
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - A J Thompson
- Department of Pharmacology, University of Cambridge, Cambridge CB2 1TN United Kingdom
| | - M-D Ruepp
- UK Dementia Research Institute at King's College London, London WC2R 2LS U.K.,Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, 3012 Bern, Switzerland
| | - M Lochner
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, 3012 Bern, Switzerland
| | - Michael J Martinez
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - J A Brozik
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
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14
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Lublin FD, Coetzee T, Cohen JA, Marrie RA, Thompson AJ. The 2013 clinical course descriptors for multiple sclerosis: A clarification. Neurology 2020; 94:1088-1092. [PMID: 32471886 PMCID: PMC7455332 DOI: 10.1212/wnl.0000000000009636] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
The clinical courses of multiple sclerosis were defined in 1996 and refined in 2013 to provide a time-based assessment of the current status of the individual. These definitions have been successfully used by clinicians, clinical trialists, and regulatory authorities. Recent regulatory decisions produced variations and discrepancies in the use of the clinical course descriptions. We provide here a clarification of the concepts underlying these descriptions and restate the principles used in their development. Importantly, we highlight the critical importance of time framing the disease course modifiers activity and progression and clarify the difference between the terms worsening and progressing.
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Affiliation(s)
- Fred D Lublin
- From the Department of Neurology (F.D.L.), Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY; National Multiple Sclerosis Society (T.C.), New York, NY; Department of Neurology (J.A.C.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, OH; Departments of Internal Medicine (Neurology) and Community Health Sciences (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; and Faculty of Brain Sciences (A.J.T.), University College, London, United Kingdom.
| | - Timothy Coetzee
- From the Department of Neurology (F.D.L.), Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY; National Multiple Sclerosis Society (T.C.), New York, NY; Department of Neurology (J.A.C.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, OH; Departments of Internal Medicine (Neurology) and Community Health Sciences (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; and Faculty of Brain Sciences (A.J.T.), University College, London, United Kingdom
| | - Jeffrey A Cohen
- From the Department of Neurology (F.D.L.), Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY; National Multiple Sclerosis Society (T.C.), New York, NY; Department of Neurology (J.A.C.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, OH; Departments of Internal Medicine (Neurology) and Community Health Sciences (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; and Faculty of Brain Sciences (A.J.T.), University College, London, United Kingdom
| | - Ruth A Marrie
- From the Department of Neurology (F.D.L.), Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY; National Multiple Sclerosis Society (T.C.), New York, NY; Department of Neurology (J.A.C.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, OH; Departments of Internal Medicine (Neurology) and Community Health Sciences (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; and Faculty of Brain Sciences (A.J.T.), University College, London, United Kingdom
| | - Alan J Thompson
- From the Department of Neurology (F.D.L.), Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY; National Multiple Sclerosis Society (T.C.), New York, NY; Department of Neurology (J.A.C.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, OH; Departments of Internal Medicine (Neurology) and Community Health Sciences (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; and Faculty of Brain Sciences (A.J.T.), University College, London, United Kingdom
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15
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Tur C, Kanber B, Eshaghi A, Altmann DR, Khaleeli Z, Prados F, Ourselin S, Thompson AJ, Gandini Wheeler-Kingshott CA, Toosy AT, Ciccarelli O. Clinical relevance of cortical network dynamics in early primary progressive MS. Mult Scler 2020; 26:442-456. [PMID: 30799709 DOI: 10.1177/1352458519831400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/11/2023]
Abstract
BACKGROUND Structural cortical networks (SCNs) reflect the covariance between the cortical thickness of different brain regions, which may share common functions and a common developmental evolution. SCNs appear abnormal in neurodegenerative conditions such as Alzheimer's and Parkinson's diseases, but have never been assessed in primary progressive multiple sclerosis (PPMS). OBJECTIVE The aim of this study was to test whether SCNs are abnormal in early PPMS and change over 5 years, and correlate with disability worsening. METHODS A total of 29 PPMS patients and 13 healthy controls underwent clinical and brain magnetic resonance imaging (MRI) assessments for 5 years. Baseline and 5-year follow-up cortical thickness values were obtained and used to build correlation matrices, considered as weighted graphs to obtain network metrics. Bootstrap-based statistics assessed SCN differences between patients and controls and between patients with fast and slow progression. RESULTS At baseline, patients showed features of lower connectivity (p = 0.02) and efficiency (p < 0.001) than controls. Over 5 years, patients, especially those with fastest clinical progression, showed significant changes suggesting an increase in network connectivity (p < 0.001) and efficiency (p < 0.02), not observed in controls. CONCLUSION SCNs are abnormal in early PPMS. Longitudinal SCN changes demonstrated a switch from low- to high-efficiency networks especially among fast progressors, indicating their clinical relevance.
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Affiliation(s)
- Carmen Tur
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Baris Kanber
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London, UK
| | - Arman Eshaghi
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/Department of Computer Science, Centre for Medical Image Computing (CMIC), University College London (UCL), London, UK
| | - Dan R Altmann
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/Department of Medical Statistics, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Zhaleh Khaleeli
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Ferran Prados
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London, UK
| | - Sebastian Ourselin
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London, UK/School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London and St Thomas' Hospital, London, UK
| | - Alan J Thompson
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Claudia Am Gandini Wheeler-Kingshott
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy/Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Ahmed T Toosy
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, UCL Institute of Neurology, University College London (UCL), London, UK/National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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16
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Charalambous T, Clayden JD, Powell E, Prados F, Tur C, Kanber B, Chard D, Ourselin S, Wheeler-Kingshott CAMG, Thompson AJ, Toosy AT. Disrupted principal network organisation in multiple sclerosis relates to disability. Sci Rep 2020; 10:3620. [PMID: 32108146 PMCID: PMC7046772 DOI: 10.1038/s41598-020-60611-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/13/2020] [Indexed: 01/15/2023] Open
Abstract
Structural network-based approaches can assess white matter connections revealing topological alterations in multiple sclerosis (MS). However, principal network (PN) organisation and its clinical relevance in MS has not been explored yet. Here, structural networks were reconstructed from diffusion data in 58 relapsing-remitting MS (RRMS), 28 primary progressive MS (PPMS), 36 secondary progressive (SPMS) and 51 healthy controls (HCs). Network hubs' strengths were compared with HCs. Then, PN analysis was performed in each clinical subtype. Regression analysis was applied to investigate the associations between nodal strength derived from the first and second PNs (PN1 and PN2) in MS, with clinical disability. Compared with HCs, MS patients had preserved hub number, but some hubs exhibited reduced strength. PN1 comprised 10 hubs in HCs, RRMS and PPMS but did not include the right thalamus in SPMS. PN2 comprised 10 hub regions with intra-hemispheric connections in HCs. In MS, this subnetwork did not include the right putamen whilst in SPMS the right thalamus was also not included. Decreased nodal strength of the right thalamus and putamen from the PNs correlated strongly with higher clinical disability. These PN analyses suggest distinct patterns of disruptions in MS subtypes which are clinically relevant.
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Affiliation(s)
- Thalis Charalambous
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Jonathan D Clayden
- UCL GOS Institute of Child Health, University College London, London, UK
| | - Elizabeth Powell
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Ferran Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, WC1V 6LJ, UK
- eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Carmen Tur
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Baris Kanber
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, WC1V 6LJ, UK
| | - Declan Chard
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Sebastien Ourselin
- Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, WC1V 6LJ, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Alan J Thompson
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ahmed T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
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17
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Thompson AJ, Cohen JA, Kim HJ, Geurts J. MSJ 2020 - Editorial comment. Mult Scler 2020; 26:134. [PMID: 32052712 DOI: 10.1177/1352458519899322] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan J Thompson
- Faculty of Brain Sciences, University College London, London, UK
| | | | - Ho Jin Kim
- Research Institute and Hospital of the National Cancer Center, Goyang, South Korea
| | - Jeroen Geurts
- VU University Medical Centre, Amsterdam, The Netherlands
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18
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Cortese R, Tur C, Prados F, Schneider T, Kanber B, Moccia M, Wheeler-Kingshott CAG, Thompson AJ, Barkhof F, Ciccarelli O. Ongoing microstructural changes in the cervical cord underpin disability progression in early primary progressive multiple sclerosis. Mult Scler 2020; 27:28-38. [PMID: 31961242 DOI: 10.1177/1352458519900971] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathology in the spinal cord of patients with primary progressive multiple sclerosis (PPMS) contributes to disability progression. We previously reported abnormal Q-space imaging (QSI)-derived indices in the spinal cord at baseline in patients with early PPMS, suggesting early neurodegeneration. OBJECTIVE The aim was to investigate whether changes in spinal cord QSI over 3 years in the same cohort are associated with disability progression and if baseline QSI metrics predict clinical outcome. METHODS Twenty-three PPMS patients and 23 healthy controls recruited at baseline were invited for follow-up cervical cord 3T magnetic resonance imaging (MRI) and clinical assessment after 1 year and 3 years. Cord cross-sectional area (CSA) and QSI measures were obtained, together with standard brain MRI measures. Mixed-effect models assessed MRI changes over time and their association with clinical changes. Linear regression identified baseline MRI indices associated with disability at 3 years. RESULTS Over time, patients deteriorated clinically and showed an increase in cord QSI indices of perpendicular diffusivity that was associated with disability worsening, independently of the decrease in CSA. Higher perpendicular diffusivity and lower CSA at baseline predicted worse disability at 3 years. CONCLUSION Increasing spinal cord perpendicular diffusivity may indicate ongoing neurodegeneration, which underpins disability progression in PPMS, independently of the development of spinal cord atrophy.
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Affiliation(s)
- Rosa Cortese
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Carmen Tur
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College of London, London, UK/Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Baris Kanber
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College of London, London, UK/Biomedical Research Centre, University College London Hospitals (UCLH), National Institute for Health Research (NIHR), London, UK
| | - Marcello Moccia
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University, Naples, Italy
| | - Claudia Am Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy/Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Department of Radiology and Nuclear Medicine, MS Centre Amsterdam, VU Medical Centre, Amsterdam, The Netherlands/Biomedical Research Centre, University College London Hospitals (UCLH), National Institute for Health Research (NIHR), London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Biomedical Research Centre, University College London Hospitals (UCLH), National Institute for Health Research (NIHR), London, UK
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19
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Freund P, Seif M, Weiskopf N, Friston K, Fehlings MG, Thompson AJ, Curt A. MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers. Lancet Neurol 2019; 18:1123-1135. [DOI: 10.1016/s1474-4422(19)30138-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
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20
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Papaluca T, O'Keefe J, Bowden S, Doyle JS, Stoove M, Hellard M, Thompson AJ. Prevalence of baseline HCV NS5A resistance associated substitutions in genotype 1a, 1b and 3 infection in Australia. J Clin Virol 2019; 120:84-87. [PMID: 31606586 DOI: 10.1016/j.jcv.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/22/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Direct-acting antivirals (DAA) have revolutionised hepatitis C virus (HCV) treatment, and most regimens include an NS5A inhibitor. Certain amino-acid substitutions confer resistance to NS5A inhibitors, termed resistance-associated substitutions (RAS). If present at baseline, they can reduce virological response rates. Population-based sequencing (PBS) is generally used for baseline sequencing, however next generation sequencing (NGS) reduces the threshold for detection of sequences encoding RAS from 20% to 5%. We determined the prevalence of NS5A RAS at baseline amongst Australian chronically infected with genotype (GT)1a, GT1b and GT3 HCV, using both PBS and NGS. METHODS Samples from DAA-naïve individuals were received at the Victorian Infectious Disease Reference Laboratory between June 2016 and December 2018. All samples were analysed for NS5A RAS using PBS. A subset of GT1 HCV samples were processed using NGS technology (Vela Diagnostics, Singapore) to determine the improvement in sensitivity. RESULTS In total, 672 samples were analysed using PBS. The baseline prevalence of NS5A RAS was 7.6% for GT1a (n = 25/329), 15.7% for GT1b (n = 8/51) and 15.1% for GT3 (n = 44/292). NGS only marginally increased sensitivity for NS5A RAS at baseline in GT1a (16% vs 17%) and GT1b (29% vs 36%). CONCLUSION The prevalence of NS5A RAS in GT1a HCV in Australia was low compared with international data, and was similar to other reported international prevalence for GT1b and GT3 infection. NGS at baseline only marginally increased sensitivity for the detection of NS5A RAS in patients with GT1 HCV and cannot be recommended for routine use at baseline in clinical practice.
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Affiliation(s)
- T Papaluca
- St Vincent's Hospital and the University of Melbourne, Australia
| | - J O'Keefe
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - S Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - J S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia; Burnet Institute, Melbourne Australia
| | - M Stoove
- Burnet Institute, Melbourne Australia
| | - M Hellard
- Burnet Institute, Melbourne Australia
| | - A J Thompson
- St Vincent's Hospital and the University of Melbourne, Australia.
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21
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Foris B, Thompson AJ, von Keyserlingk MAG, Melzer N, Weary DM. Automatic detection of feeding- and drinking-related agonistic behavior and dominance in dairy cows. J Dairy Sci 2019; 102:9176-9186. [PMID: 31400897 DOI: 10.3168/jds.2019-16697] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/27/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022]
Abstract
Accurate assessments of social behavior and dominance relationships in cattle can be time consuming. We investigated whether replacements at the feed bunk and water trough-one type of agonistic interaction-can be used to automatically assess dominance relationships. Our study set out to (1) validate a replacement detection algorithm using combined data from electronic feed and water bins, and (2) investigate the applicability of this algorithm to identify individual dominance scores and group-level social hierarchy in freestall-housed dairy cows. We used 4 groups of lactating cows kept in different group sizes (11 to 20 cows) located at 2 research facilities. In both facilities, feed and water were provided via automated feeding systems. A trained observer recorded all agonistic interactions in the pen over multiple days using video. Data from the electronic feed and water bins for the same days were analyzed using an algorithm to detect replacements (i.e., visits where a receiver cow was competitively replaced by an actor cow). Most agonistic interactions at the feed bunk were replacements. These replacements were associated with a brief interval between the time the receiver cow left the bin and the actor cow took her place; the optimal threshold to detect these replacements varied from 22 to 27 s between groups, independent of stocking density. The recall and precision of an algorithm based upon this threshold was high (on average >0.8), comparable to that of trained human observers. We improved data preparation by controlling for detection errors and included filtering to reduce false positives. This resulted in a >20% decrease in false positives and an increase in precision of 0.043. The dominance hierarchy based upon algorithm-detected replacements was similar to that based upon total agonistic interactions observed in the pen; the Spearman rank correlation coefficient between these hierarchies varied among the groups from 0.81 to 0.96. We conclude that data from electronic feed and water bins can accurately estimate agonistic behavior and dominance relationships among dairy cows.
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Affiliation(s)
- B Foris
- Institute of Genetics and Biometry, Leibniz Institute for Farm Animal Biology, 18196 Dummerstorf, Germany
| | - A J Thompson
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - M A G von Keyserlingk
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - N Melzer
- Institute of Genetics and Biometry, Leibniz Institute for Farm Animal Biology, 18196 Dummerstorf, Germany.
| | - D M Weary
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
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22
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Eshaghi A, Marinescu RV, Young AL, Firth NC, Prados F, Jorge Cardoso M, Tur C, De Angelis F, Cawley N, Brownlee WJ, De Stefano N, Laura Stromillo M, Battaglini M, Ruggieri S, Gasperini C, Filippi M, Rocca MA, Rovira A, Sastre-Garriga J, Geurts JJG, Vrenken H, Wottschel V, Leurs CE, Uitdehaag B, Pirpamer L, Enzinger C, Ourselin S, Gandini Wheeler-Kingshott CA, Chard D, Thompson AJ, Barkhof F, Alexander DC, Ciccarelli O. Progression of regional grey matter atrophy in multiple sclerosis. Brain 2019; 141:1665-1677. [PMID: 29741648 PMCID: PMC5995197 DOI: 10.1093/brain/awy088] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/09/2018] [Indexed: 12/15/2022] Open
Abstract
See Stankoff and Louapre (doi:10.1093/brain/awy114) for a scientific commentary on this article. Grey matter atrophy is present from the earliest stages of multiple sclerosis, but its temporal ordering is poorly understood. We aimed to determine the sequence in which grey matter regions become atrophic in multiple sclerosis and its association with disability accumulation. In this longitudinal study, we included 1417 subjects: 253 with clinically isolated syndrome, 708 with relapsing-remitting multiple sclerosis, 128 with secondary-progressive multiple sclerosis, 125 with primary-progressive multiple sclerosis, and 203 healthy control subjects from seven European centres. Subjects underwent repeated MRI (total number of scans 3604); the mean follow-up for patients was 2.41 years (standard deviation = 1.97). Disability was scored using the Expanded Disability Status Scale. We calculated the volume of brain grey matter regions and brainstem using an unbiased within-subject template and used an established data-driven event-based model to determine the sequence of occurrence of atrophy and its uncertainty. We assigned each subject to a specific event-based model stage, based on the number of their atrophic regions. Linear mixed-effects models were used to explore associations between the rate of increase in event-based model stages, and T2 lesion load, disease-modifying treatments, comorbidity, disease duration and disability accumulation. The first regions to become atrophic in patients with clinically isolated syndrome and relapse-onset multiple sclerosis were the posterior cingulate cortex and precuneus, followed by the middle cingulate cortex, brainstem and thalamus. A similar sequence of atrophy was detected in primary-progressive multiple sclerosis with the involvement of the thalamus, cuneus, precuneus, and pallidum, followed by the brainstem and posterior cingulate cortex. The cerebellum, caudate and putamen showed early atrophy in relapse-onset multiple sclerosis and late atrophy in primary-progressive multiple sclerosis. Patients with secondary-progressive multiple sclerosis showed the highest event-based model stage (the highest number of atrophic regions, P < 0.001) at the study entry. All multiple sclerosis phenotypes, but clinically isolated syndrome, showed a faster rate of increase in the event-based model stage than healthy controls. T2 lesion load and disease duration in all patients were associated with increased event-based model stage, but no effects of disease-modifying treatments and comorbidity on event-based model stage were observed. The annualized rate of event-based model stage was associated with the disability accumulation in relapsing-remitting multiple sclerosis, independent of disease duration (P < 0.0001). The data-driven staging of atrophy progression in a large multiple sclerosis sample demonstrates that grey matter atrophy spreads to involve more regions over time. The sequence in which regions become atrophic is reasonably consistent across multiple sclerosis phenotypes. The spread of atrophy was associated with disease duration and with disability accumulation over time in relapsing-remitting multiple sclerosis.
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Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, UK
| | - Razvan V Marinescu
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, UK
| | - Nicholas C Firth
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, UK
| | - Ferran Prados
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - M Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Carmen Tur
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Niamh Cawley
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Wallace J Brownlee
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - M Laura Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Serena Ruggieri
- Department of Neurosciences, S Camillo Forlanini Hospital, Rome, Italy.,Department of Neurology and Psychiatry, University of Rome Sapienza, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- MR Unit and Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (CEMCAT), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VUmc MS Center, Neuroscience Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Viktor Wottschel
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Cyra E Leurs
- Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Uitdehaag
- Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| | - Claudia A Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK.,Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
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23
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Affiliation(s)
- David H Miller
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK
| | - Alan J Thompson
- Faculty of Brain Sciences, University College London, London, UK
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24
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Eshaghi A, Kievit RA, Prados F, Sudre CH, Nicholas J, Cardoso MJ, Chan D, Nicholas R, Ourselin S, Greenwood J, Thompson AJ, Alexander DC, Barkhof F, Chataway J, Ciccarelli O. Applying causal models to explore the mechanism of action of simvastatin in progressive multiple sclerosis. Proc Natl Acad Sci U S A 2019; 116:11020-11027. [PMID: 31072935 PMCID: PMC6561162 DOI: 10.1073/pnas.1818978116] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Understanding the mode of action of drugs is a challenge with conventional methods in clinical trials. Here, we aimed to explore whether simvastatin effects on brain atrophy and disability in secondary progressive multiple sclerosis (SPMS) are mediated by reducing cholesterol or are independent of cholesterol. We applied structural equation models to the MS-STAT trial in which 140 patients with SPMS were randomized to receive placebo or simvastatin. At baseline, after 1 and 2 years, patients underwent brain magnetic resonance imaging; their cognitive and physical disability were assessed on the block design test and Expanded Disability Status Scale (EDSS), and serum total cholesterol levels were measured. We calculated the percentage brain volume change (brain atrophy). We compared two models to select the most likely one: a cholesterol-dependent model with a cholesterol-independent model. The cholesterol-independent model was the most likely option. When we deconstructed the total treatment effect into indirect effects, which were mediated by brain atrophy, and direct effects, simvastatin had a direct effect (independent of serum cholesterol) on both the EDSS, which explained 69% of the overall treatment effect on EDSS, and brain atrophy, which, in turn, was responsible for 31% of the total treatment effect on EDSS [β = -0.037; 95% credible interval (CI) = -0.075, -0.010]. This suggests that simvastatin's beneficial effects in MS are independent of its effect on lowering peripheral cholesterol levels, implicating a role for upstream intermediate metabolites of the cholesterol synthesis pathway. Importantly, it demonstrates that computational models can elucidate the causal architecture underlying treatment effects in clinical trials of progressive MS.
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Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom;
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, United Kingdom
| | - Rogier A Kievit
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, United Kingdom
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom
- Centre for Medical Image Computing, UCL Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
- Universitat Oberta de Catalunya, Barcelona 08018, Spain
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
- UCL Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Jennifer Nicholas
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - M Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Dennis Chan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Richard Nicholas
- Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - John Greenwood
- University College London Institute of Ophthalmology, University College London, London EC1V 9EL, United Kingdom
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London W1T 7DN, United Kingdom
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, United Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London W1T 7DN, United Kingdom
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Medisch Centrum, 1007 MB Amsterdam, The Netherlands
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1B 5EH, United Kingdom
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London W1T 7DN, United Kingdom
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25
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Thompson AJ, Weary DM, Bran JA, Daros RR, Hötzel MJ, von Keyserlingk MAG. Lameness and lying behavior in grazing dairy cows. J Dairy Sci 2019; 102:6373-6382. [PMID: 31079902 DOI: 10.3168/jds.2018-15717] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 09/18/2018] [Accepted: 03/10/2019] [Indexed: 11/19/2022]
Abstract
Lameness is a serious welfare issue for dairy cows. To date, the majority of studies have focused on its effect on health and behavior at the herd level. The objectives of this study were to identify (1) between-cow and (2) within-cow changes in lying behavior associated with consistent and changing lameness status in grazing dairy cows. Previous studies of lying behavior in grazing dairy cows have not considered the effect of precipitation, so a third aim was to determine the effect of precipitation on lying behavior. A total of 252 dairy cows from 6 pasture-based farms in southern Brazil were gait scored weekly to assess lameness using a 5-point scale [1-5, numerical rating score (NRS)] for 4 consecutive weeks. Cows were considered to have consistent lameness if they were scored as lame (NRS ≥3) on each of the 4 visits and considered to have a changing lameness status if scored as being nonlame (NRS <3) on at least 1 of the 4 visits. Cows classified as having a changing lameness status were further classified as developed, recovered, or inconsistent. Lying behavior (daily lying time, mean lying bout duration, and daily number of lying bouts) was recorded continuously for 3 wk using leg-mounted accelerometers. Cow-level variables included parity, days in milk, and body condition score. Regional precipitation and temperature were recorded hourly. Because only 1 primiparous cow was identified as lame at each of the 4 visits, the between-cow analysis of lameness was run on multiparous cows only. The overall prevalence of clinical lameness on the first visit was 39%, with development and recovery rates of 16 and 10% over the 4 visits, respectively. The between-cow effect of consistent lameness status on daily lying time and number of lying bouts was dependent on precipitation; consistently lame cows had reduced lying time and lying bouts on days with rain compared with days without rain. There was no within-cow effect of changing lameness status on any of the lying behaviors. Precipitation was associated with decreased daily lying time, increased mean lying bout duration, and decreased daily number of lying bouts. The results of this research provide the first evidence that the effect of consistent lameness status on lying behavior is associated with rainfall in grazing dairy cows. Future work measuring lying behavior of grazing dairy cows should include precipitation as a covariate.
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Affiliation(s)
- A J Thompson
- Animal Welfare Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - D M Weary
- Animal Welfare Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - J A Bran
- Laboratório de Etologia Aplicada e Bem-Estar Animal, Departamento de Zootecnia e Desenvolvimento Rural, Universidade Federal de Santa Catarina, Florianópolis, 88034-001, Brazil
| | - R R Daros
- Animal Welfare Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - M J Hötzel
- Laboratório de Etologia Aplicada e Bem-Estar Animal, Departamento de Zootecnia e Desenvolvimento Rural, Universidade Federal de Santa Catarina, Florianópolis, 88034-001, Brazil
| | - M A G von Keyserlingk
- Animal Welfare Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, V6T 1Z4, Canada.
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26
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Thompson AJ, Reingold SC, Cohen JA. Applying the 2017 McDonald diagnostic criteria for multiple sclerosis - Authors' reply. Lancet Neurol 2019; 17:499-500. [PMID: 29778360 DOI: 10.1016/s1474-4422(18)30168-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Alan J Thompson
- Faculty of Brain Sciences, University College London, London, UK
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27
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Charalambous T, Tur C, Prados F, Kanber B, Chard DT, Ourselin S, Clayden JD, A M Gandini Wheeler-Kingshott C, Thompson AJ, Toosy AT. Structural network disruption markers explain disability in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:219-226. [PMID: 30467210 PMCID: PMC6518973 DOI: 10.1136/jnnp-2018-318440] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/26/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate whether structural brain network metrics correlate better with clinical impairment and information processing speed in multiple sclerosis (MS) beyond atrophy measures and white matter lesions. METHODS This cross-sectional study included 51 healthy controls and 122 patients comprising 58 relapsing-remitting, 28 primary progressive and 36 secondary progressive. Structural brain networks were reconstructed from diffusion-weighted MRIs and standard metrics reflecting network density, efficiency and clustering coefficient were derived and compared between subjects' groups. Stepwise linear regression analyses were used to investigate the contribution of network measures that explain clinical disability (Expanded Disability Status Scale (EDSS)) and information processing speed (Symbol Digit Modalities Test (SDMT)) compared with conventional MRI metrics alone and to determine the best statistical model that explains better EDSS and SDMT. RESULTS Compared with controls, network efficiency and clustering coefficient were reduced in MS while these measures were also reduced in secondary progressive relative to relapsing-remitting patients. Structural network metrics increase the variance explained by the statistical models for clinical and information processing dysfunction. The best model for EDSS showed that reduced network density and global efficiency and increased age were associated with increased clinical disability. The best model for SDMT showed that lower deep grey matter volume, reduced efficiency and male gender were associated with worse information processing speed. CONCLUSIONS Structural topological changes exist between subjects' groups. Network density and global efficiency explained disability above non-network measures, highlighting that network metrics can provide clinically relevant information about MS pathology.
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Affiliation(s)
- Thalis Charalambous
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Carmen Tur
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Ferran Prados
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Baris Kanber
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Declan T Chard
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Sebastian Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Jonathan D Clayden
- UCL GOS Institute of Child Health, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
- Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Alan J Thompson
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Ahmed T Toosy
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
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Thompson AJ, Antel J, Carroll W(B, Geurts J. MSJ 2019 - Editorial comment. Mult Scler 2019; 25:4-5. [DOI: 10.1177/1352458518819096] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan J Thompson
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jack Antel
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | | | - Jeroen Geurts
- VU University Medical Centre, Amsterdam, The Netherlands
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Losseff NA, Kingsley DPE, McDonald WI, Miller DH, Thompson AJ. Clinical and Magnetic Resonance Imaging Predictors of Disability in Primary and Secondary Progressive Multiple Sclerosis. Mult Scler 2018. [DOI: 10.1177/135245859600100406] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of magnetic resonance imaging (MRI) in predicting disability in multiple sclerosis (MS) remains unclear. In this study 21 patients with primary and secondary progressive MS were reviewed 5 years following a serial MRI study of 6 months duration. In the secondary progressive group (n=11) there was a significant relationship between the occurrence of enhancing lesions and clinical relapses during the initial 6 months and increase in diability 5 years later. For both groups change in disability over the initial study period was predictive of outcome. These results suggest that the presence and frequency of gadolinium enhancement (a marker of inflammation) and changes in disability over a short period are predictive of future deterioration in progressive patients.
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Affiliation(s)
- NA Losseff
- NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - DPE Kingsley
- NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - WI McDonald
- NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - DH Miller
- NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - AJ Thompson
- NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Seif M, Curt A, Thompson AJ, Grabher P, Weiskopf N, Freund P. Quantitative MRI of rostral spinal cord and brain regions is predictive of functional recovery in acute spinal cord injury. Neuroimage Clin 2018; 20:556-563. [PMID: 30175042 PMCID: PMC6115607 DOI: 10.1016/j.nicl.2018.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/11/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
Objective To reveal the immediate extent of trauma-induced neurodegenerative changes rostral to the level of lesion and determine the predictive clinical value of quantitative MRI (qMRI) following acute spinal cord injury (SCI). Methods Twenty-four acute SCI patients and 23 healthy controls underwent a high-resolution T1-weighted protocol. Eighteen of those patients and 20 of controls additionally underwent a multi-parameter mapping (MPM) MRI protocol sensitive to the content of tissue structure, including myelin and iron. Patients were examined clinically at baseline, 2, 6, 12, and 24 months post-SCI. We assessed volume and microstructural changes in the spinal cord and brain using T1-weighted MRI, magnetization transfer (MT), longitudinal relaxation rate (R1), and effective transverse relaxation rate (R2*) maps. Regression analysis determined associations between acute qMRI parameters and recovery. Results At baseline, cord area and its anterior-posterior width were decreased in patients, whereas MT, R1, and R2* parameters remained unchanged in the cord. Within the cerebellum, volume decrease was paralleled by increases of MT and R2* parameters. Early grey matter changes were observed within the primary motor cortex and limbic system. Importantly, early volume and microstructural changes of the cord and cerebellum predicted functional recovery following injury. Conclusions Neurodegenerative changes rostral to the level of lesion occur early in SCI, with varying temporal and spatial dynamics. Early qMRI markers of spinal cord and cerebellum are predictive of functional recovery. These neuroimaging biomarkers may supplement clinical assessments and provide insights into the potential of therapeutic interventions to enhance neural plasticity.
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Key Words
- APW, anterior posterior width
- Acute micro-structural changes
- Brain and spinal cord atrophy
- ISNCSCI, international standards for the neurological classification of spinal cord injury
- LRW, left right width
- MPM, multi-parameter mapping
- MT, magnetization transfer
- PD*, effective proton density
- Quantitative neuroimaging
- R1, longitudinal relaxation rate
- R2*, effective transverse relaxation rate
- ROI, region of interest
- SCA, spinal cord area
- SCI, spinal cord injury
- SCIM, spinal cord independence measure
- Spinal cord injury
- VBCT, voxel based cortical thickness
- VBM, voxel based morphometry
- VBQ, voxel based quantification
- Voxel-based morphometry and quantification
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Armin Curt
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland
| | - Alan J Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Patrick Grabher
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK.
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Tur C, Eshaghi A, Altmann DR, Jenkins TM, Prados F, Grussu F, Charalambous T, Schmidt A, Ourselin S, Clayden JD, Wheeler-Kingshott CAMG, Thompson AJ, Ciccarelli O, Toosy AT. Structural cortical network reorganization associated with early conversion to multiple sclerosis. Sci Rep 2018; 8:10715. [PMID: 30013173 PMCID: PMC6048099 DOI: 10.1038/s41598-018-29017-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/02/2018] [Indexed: 11/09/2022] Open
Abstract
Brain structural covariance networks (SCNs) based on pairwise statistical associations of cortical thickness data across brain areas reflect underlying physical and functional connections between them. SCNs capture the complexity of human brain cortex structure and are disrupted in neurodegenerative conditions. However, the longitudinal assessment of SCN dynamics has not yet been explored, despite its potential to unveil mechanisms underlying neurodegeneration. Here, we evaluated the changes of SCNs over 12 months in patients with a first inflammatory-demyelinating attack of the Central Nervous System and assessed their clinical relevance by comparing SCN dynamics of patients with and without conversion to multiple sclerosis (MS) over one year. All subjects underwent clinical and brain MRI assessments over one year. Brain cortical thicknesses for each subject and time point were used to obtain group-level between-area correlation matrices from which nodal connectivity metrics were obtained. Robust bootstrap-based statistical approaches (allowing sampling with replacement) assessed the significance of longitudinal changes. Patients who converted to MS exhibited significantly greater network connectivity at baseline than non-converters (p = 0.02) and a subsequent connectivity loss over time (p = 0.001-0.02), not observed in non-converters' network. These findings suggest SCN analysis is sensitive to brain tissue changes in early MS, reflecting clinically relevant aspects of the condition. However, this is preliminary work, indicated by the low sample sizes, and its results and conclusions should be treated with caution and confirmed with larger cohorts.
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Affiliation(s)
- C Tur
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.
| | - A Eshaghi
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1E 7JE, UK
| | - D R Altmann
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Medical Statistics Department, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - T M Jenkins
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
| | - F Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 7JE, UK
| | - F Grussu
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1E 7JE, UK
| | - T Charalambous
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
| | - A Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - S Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 7JE, UK
| | - J D Clayden
- UCL Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | - C A M G Wheeler-Kingshott
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - A J Thompson
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - O Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - A T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
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Tabke MC, Sarturi JO, Galyean ML, Trojan SJ, Brooks JC, Johnson BJ, Martin J, Baggerman J, Thompson AJ. Effects of tannic acid on growth performance, carcass characteristics, digestibility, nitrogen volatilization, and meat lipid oxidation of steers fed steam-flaked corn-based finishing diets. J Anim Sci 2018; 95:5124-5136. [PMID: 29293728 DOI: 10.2527/jas2017.1464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Effects of a tannic acid blend (ByPro; Silvateam USA, Ontario, CA) added to steam-flaked corn-based fishing diets on beef cattle growth performance, carcass characteristics, nutrient digestibility, fecal N volatilization, and meat lipid oxidation were evaluated. Steers ( = 144; 349 ± 25 kg initial BW) were blocked by initial BW and assigned randomly to 1 of 3 treatments with 12 pens/treatment and 4 steers/pen and fed ad libitum. Treatments included a control (CON; no ByPro) and ByPro fed at 30 or 60 g DM/steer daily (30-ByPro and 60-ByPro, respectively). Pen fecal samples were collected 7 d after cattle were shipped to slaughter for estimation of N volatilization. Strip loins were aged for 21 d for evaluation of color and antioxidant activity. Intake quadratically increased ( = 0.05) from d 0 to 35, whereas linear trends were observed for increased DMI from d 0 to 105 and d 0 to slaughter ( = 0.07 and = 0.06, respectively), resulting in a 3.7% greater overall DMI for 60-ByPro than for CON. No differences were detected for carcass-adjusted ADG ( = 0.65) or G:F ( = 0.17). Carcass characteristics including HCW ( = 0.52), fat thickness ( = 0.32), LM area ( = 0.57), quality grade ( = 0.44), yield grade ( = 0.29), and percentage of condemned livers ( = 0.13) were not affected by treatments. Apparent total tract digestibility of starch linearly decreased tendency ( = 0.03) with increasing ByPro dose, whereas tends for a linear decrease ( = 0.09) in CP and a quadratic increase ( = 0.09) in OM digestibility were observed. No effects of treatment ( ≥ 0.39) were noted for fecal N volatilization. An increase ( < 0.01) in metmyoglobin in strip loin steaks was observed with ByPro inclusion. Oxymyoglobin decreased ( < 0.01) as display day progressed, except on d 5, at which time CON and 30-ByPro steaks had lower proportions than 60-ByPro steaks. Only subtle changes in discoloration ratio and deoxymyoglobin were observed, whereas no effects ( ≥ 0.43) for pH or thiobarbituric acid reactive substances were noted. Feeding ByPro increased DMI during the first half of the feeding period without negatively affecting gain efficiency; however, fecal N retention was not altered by ByPro. ByPro did not negatively affect meat quality or carcass characteristics, and it did not seem to affect retail meat antioxidant activity.
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Abstract
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. Careful consideration is required when choosing the correct treatment, balancing the side-effect profile with efficacy and escalating as clinically appropriate. This move towards more personalised medicine is supported by a clinical guideline published in 2018. Finally, a comprehensive management programme is strongly recommended for all patients with multiple sclerosis, enhancing health-related quality of life through advocating wellness, addressing aggravating factors, and managing comorbidities. The greatest remaining challenge for multiple sclerosis is the development of treatments incorporating neuroprotection and remyelination to treat and ultimately prevent the disabling, progressive forms of the condition.
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Affiliation(s)
- Alan J Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Sergio E Baranzini
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeroen Geurts
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Olga Ciccarelli
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Affiliation(s)
- Alan J Thompson
- Faculty of Brain Sciences, University College London, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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35
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Smith ZKF, Thompson AJ, Hutcheson JP, Nichols WT, Johnson BJ. 156 Evaluation of Long Acting Combination Implants Containing Trenbolone Acetate and Estradiol-17β on Live Performance, Carcass Traits, and Sera Metabolites in Finishing Steers. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Huber E, David G, Thompson AJ, Weiskopf N, Mohammadi S, Freund P. Dorsal and ventral horn atrophy is associated with clinical outcome after spinal cord injury. Neurology 2018; 90:e1510-e1522. [PMID: 29592888 PMCID: PMC5921039 DOI: 10.1212/wnl.0000000000005361] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/24/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate whether gray matter pathology above the level of injury, alongside white matter changes, also contributes to sensorimotor impairments after spinal cord injury. METHODS A 3T MRI protocol was acquired in 17 tetraplegic patients and 21 controls. A sagittal T2-weighted sequence was used to characterize lesion severity. At the C2-3 level, a high-resolution T2*-weighted sequence was used to assess cross-sectional areas of gray and white matter, including their subcompartments; a diffusion-weighted sequence was used to compute voxel-based diffusion indices. Regression models determined associations between lesion severity and tissue-specific neurodegeneration and associations between the latter with neurophysiologic and clinical outcome. RESULTS Neurodegeneration was evident within the dorsal and ventral horns and white matter above the level of injury. Tract-specific neurodegeneration was associated with prolonged conduction of appropriate electrophysiologic recordings. Dorsal horn atrophy was associated with sensory outcome, while ventral horn atrophy was associated with motor outcome. White matter integrity of dorsal columns and corticospinal tracts was associated with daily-life independence. CONCLUSION Our results suggest that, next to anterograde and retrograde degeneration of white matter tracts, neuronal circuits within the spinal cord far above the level of injury undergo transsynaptic neurodegeneration, resulting in specific gray matter changes. Such improved understanding of tissue-specific cord pathology offers potential biomarkers with more efficient targeting and monitoring of neuroregenerative (i.e., white matter) and neuroprotective (i.e., gray matter) agents.
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Affiliation(s)
- Eveline Huber
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Gergely David
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Alan J Thompson
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Nikolaus Weiskopf
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Siawoosh Mohammadi
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Patrick Freund
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany.
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Thompson AJ, Antel J, Carroll WM, Geurts J. MSJ 2018—editorial comment. Mult Scler 2018; 24:90-91. [DOI: 10.1177/1352458518756517] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan J Thompson
- UCL Institute of Neurology, University College London, London, UK
| | - Jack Antel
- Montreal Neurological Hospital, Montreal, QC, Canada
| | - William M Carroll
- Perron Institute and Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jeroen Geurts
- VU University Medical Center, Amsterdam, The Netherlands
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Eshaghi A, Prados F, Brownlee WJ, Altmann DR, Tur C, Cardoso MJ, De Angelis F, van de Pavert SH, Cawley N, De Stefano N, Stromillo ML, Battaglini M, Ruggieri S, Gasperini C, Filippi M, Rocca MA, Rovira A, Sastre‐Garriga J, Vrenken H, Leurs CE, Killestein J, Pirpamer L, Enzinger C, Ourselin S, Wheeler‐Kingshott CAG, Chard D, Thompson AJ, Alexander DC, Barkhof F, Ciccarelli O. Deep gray matter volume loss drives disability worsening in multiple sclerosis. Ann Neurol 2018; 83:210-222. [PMID: 29331092 PMCID: PMC5838522 DOI: 10.1002/ana.25145] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Gray matter (GM) atrophy occurs in all multiple sclerosis (MS) phenotypes. We investigated whether there is a spatiotemporal pattern of GM atrophy that is associated with faster disability accumulation in MS. METHODS We analyzed 3,604 brain high-resolution T1-weighted magnetic resonance imaging scans from 1,417 participants: 1,214 MS patients (253 clinically isolated syndrome [CIS], 708 relapsing-remitting [RRMS], 128 secondary-progressive [SPMS], and 125 primary-progressive [PPMS]), over an average follow-up of 2.41 years (standard deviation [SD] = 1.97), and 203 healthy controls (HCs; average follow-up = 1.83 year; SD = 1.77), attending seven European centers. Disability was assessed with the Expanded Disability Status Scale (EDSS). We obtained volumes of the deep GM (DGM), temporal, frontal, parietal, occipital and cerebellar GM, brainstem, and cerebral white matter. Hierarchical mixed models assessed annual percentage rate of regional tissue loss and identified regional volumes associated with time-to-EDSS progression. RESULTS SPMS showed the lowest baseline volumes of cortical GM and DGM. Of all baseline regional volumes, only that of the DGM predicted time-to-EDSS progression (hazard ratio = 0.73; 95% confidence interval, 0.65, 0.82; p < 0.001): for every standard deviation decrease in baseline DGM volume, the risk of presenting a shorter time to EDSS worsening during follow-up increased by 27%. Of all longitudinal measures, DGM showed the fastest annual rate of atrophy, which was faster in SPMS (-1.45%), PPMS (-1.66%), and RRMS (-1.34%) than CIS (-0.88%) and HCs (-0.94%; p < 0.01). The rate of temporal GM atrophy in SPMS (-1.21%) was significantly faster than RRMS (-0.76%), CIS (-0.75%), and HCs (-0.51%). Similarly, the rate of parietal GM atrophy in SPMS (-1.24-%) was faster than CIS (-0.63%) and HCs (-0.23%; all p values <0.05). Only the atrophy rate in DGM in patients was significantly associated with disability accumulation (beta = 0.04; p < 0.001). INTERPRETATION This large, multicenter and longitudinal study shows that DGM volume loss drives disability accumulation in MS, and that temporal cortical GM shows accelerated atrophy in SPMS than RRMS. The difference in regional GM atrophy development between phenotypes needs to be taken into account when evaluating treatment effect of therapeutic interventions. Ann Neurol 2018;83:210-222.
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Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Wallace J. Brownlee
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel R. Altmann
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Medical Statistics DepartmentLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Carmen Tur
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - M. Jorge Cardoso
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Steven H. van de Pavert
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Niamh Cawley
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Nicola De Stefano
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - M. Laura Stromillo
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Marco Battaglini
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Serena Ruggieri
- Department of NeurosciencesS Camillo Forlanini HospitalRomeItaly
- Department of Neurology and PsychiatryUniversity of Rome SapienzaRomeItaly
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Maria A. Rocca
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Alex Rovira
- MR Unit and Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Jaume Sastre‐Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Hugo Vrenken
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Cyra E. Leurs
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Lukas Pirpamer
- Department of NeurologyMedical University of GrazGrazAustria
| | - Christian Enzinger
- Department of NeurologyMedical University of GrazGrazAustria
- Division of Neuroradiology, Vascular & Interventional Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Sebastien Ourselin
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Claudia A.M. Gandini Wheeler‐Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Brain MRI 3T Mondino Research CenterC. Mondino National Neurological InstitutePaviaItaly
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Alan J. Thompson
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel C. Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
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McCaughan GW, Thwaites PA, Roberts SK, Strasser SI, Mitchell J, Morales B, Mason S, Gow P, Wigg A, Tallis C, Jeffrey G, George J, Thompson AJ, Parker FC, Angus PW. Sofosbuvir and daclatasvir therapy in patients with hepatitis C-related advanced decompensated liver disease (MELD ≥ 15). Aliment Pharmacol Ther 2018; 47:401-411. [PMID: 29205432 DOI: 10.1111/apt.14404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/14/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antiviral therapy for hepatitis C has the potential to improve liver function in patients with decompensated cirrhosis. AIMS To examine the virological response and effect of viral clearance in patients with decompensated hepatitis C cirrhosis all with MELD scores ≥15 following sofosbuvir/daclatasvir ± ribavirin. METHODS We prospectively collected data on patients who commenced sofosbuvir/daclatasvir for 24-weeks under the Australian patient supply program (TOSCAR) and analysed outcomes including sustained viral response at 12 weeks (SVR12), death and transplant. RESULTS 108 patients (M/F, 79/29; median age 56years; Child-Pugh 10; MELD 16; genotype 1/3, 55/47) received sofosbuvir/daclatasvir and two also received ribavirin. On intention-to-treat, the SVR12 rate was 70% (76/108). Seventy-eight patients completed 24-weeks therapy. SVR12 was achieved in 56 of these patients on per-protocol-analysis (76%). SVR12 was 80% in genotype 1 compared to 69% in genotype 3. Thirty patients failed to complete therapy. In patients achieving SVR12, median MELD and Child-Pugh fell from 16(IQR15-17) to 14(12-17) and 10(9-11) to 8(7-9), respectively (P<.001). In those who died, MELD increased from 16 to 23 at death (P=.036). Patients who required transplantation had a significantly higher baseline MELD (20) compared to those patients completing treatment (16) (P=.0010). The odds ratio for transplant in patients with baseline MELD ≥20 was 13.8(95%CI 2.78-69.04). CONCLUSIONS SVR12 rates with sofosbuvir/daclatasvir in advanced liver disease are lower than in compensated disease. Although treatment improves MELD and Child-Pugh in most patients, a significant proportion will die or require transplantation. In those with MELD ≥20, it may be better to delay treatment until post-transplant.
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Affiliation(s)
- G W McCaughan
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P A Thwaites
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Vic., Australia
| | - S K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Vic., Australia
| | - S I Strasser
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - J Mitchell
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Vic., Australia
| | - B Morales
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Vic., Australia
| | - S Mason
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P Gow
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Vic., Australia
| | - A Wigg
- South Australian Liver Transplant Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - C Tallis
- Queensland Liver Transplant Unit, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - G Jeffrey
- Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - J George
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW, Australia
| | - A J Thompson
- St Vincent's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - F C Parker
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Vic., Australia
| | - P W Angus
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Vic., Australia
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Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D, Clanet M, Comi G, Derfuss T, Fazekas F, Hartung HP, Havrdova E, Hemmer B, Kappos L, Liblau R, Lubetzki C, Marcus E, Miller DH, Olsson T, Pilling S, Selmaj K, Siva A, Sorensen PS, Sormani MP, Thalheim C, Wiendl H, Zipp F. ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler 2018; 24:96-120. [PMID: 29353550 DOI: 10.1177/1352458517751049] [Citation(s) in RCA: 391] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex disease with new drugs becoming available in the past years. There is a need for a reference tool compiling current data to aid professionals in treatment decisions. OBJECTIVES To develop an evidence-based clinical practice guideline for the pharmacological treatment of people with MS. METHODS This guideline has been developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and following the updated EAN recommendations. Clinical questions were formulated in Patients-Intervention-Comparator-Outcome (PICO) format and outcomes were prioritized. The quality of evidence was rated into four categories according to the risk of bias. The recommendations with assigned strength (strong and weak) were formulated based on the quality of evidence and the risk-benefit balance. Consensus between the panelists was reached by use of the modified nominal group technique. RESULTS A total of 10 questions were agreed, encompassing treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and treatment strategies in MS and pregnancy. The guideline takes into account all disease-modifying drugs approved by the European Medicine Agency (EMA) at the time of publication. A total of 21 recommendations were agreed by the guideline working group after three rounds of consensus. CONCLUSION The present guideline will enable homogeneity of treatment decisions across Europe.
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Affiliation(s)
- Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ralf Gold
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany
| | - Alan J Thompson
- Department of Brain Repair & Rehabilitation and Faculty of Brain Sciences, University College London Institute of Neurology, London, UK
| | - Susana Otero-Romero
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Pia Amato
- Department of Neurosciences, Psychology, Drugs and Child Health Area (NEUROFARBA), Section Neurosciences, University of Florence, Florence, Italy
| | | | - Michel Clanet
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Giancarlo Comi
- Neurological Department, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Universita' Vita-Salute San Raffaele, Milan, Italy
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Hans Peter Hartung
- Multiple Sclerosis Center, Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Roland Liblau
- INSERM UMR U1043 - CNRS U5282, Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France
| | - Catherine Lubetzki
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1127, ICM-GHU Pitié-Salpêtrière, Paris, France
| | - Elena Marcus
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - David H Miller
- NMR Research Unit and Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, UK
| | - Tomas Olsson
- Neuroimmunology Unit, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Krysztof Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Axel Siva
- Clinical Neuroimmunology Unit and MS Clinic, Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Tur C, Moccia M, Barkhof F, Chataway J, Sastre-Garriga J, Thompson AJ, Ciccarelli O. Assessing treatment outcomes in multiple sclerosis trials and in the clinical setting. Nat Rev Neurol 2018; 14:75-93. [PMID: 29326424 DOI: 10.1038/nrneurol.2017.171] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Increasing numbers of drugs are being developed for the treatment of multiple sclerosis (MS). Measurement of relevant outcomes is key for assessing the efficacy of new drugs in clinical trials and for monitoring responses to disease-modifying drugs in individual patients. Most outcomes used in trial and clinical settings reflect either clinical or neuroimaging aspects of MS (such as relapse and accrual of disability or the presence of visible inflammation and brain tissue loss, respectively). However, most measures employed in clinical trials to assess treatment effects are not used in routine practice. In clinical trials, the appropriate choice of outcome measures is crucial because the results determine whether a drug is considered effective and therefore worthy of further development; in the clinic, outcome measures can guide treatment decisions, such as choosing a first-line disease-modifying drug or escalating to second-line treatment. This Review discusses clinical, neuroimaging and composite outcome measures for MS, including patient-reported outcome measures, used in both trials and the clinical setting. Its aim is to help clinicians and researchers navigate through the multiple options encountered when choosing an outcome measure. Barriers and limitations that need to be overcome to translate trial outcome measures into the clinical setting are also discussed.
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Affiliation(s)
- Carmen Tur
- Queen Square Multiple Sclerosis Centre, University College of London Institute of Neurology, London WC1B 5EH, UK
| | - Marcello Moccia
- Queen Square Multiple Sclerosis Centre, University College of London Institute of Neurology, London WC1B 5EH, UK.,Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Federico II University, Via Sergio Pansini 5, Naples 80131, Italy
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, University College of London Institute of Neurology, London WC1B 5EH, UK.,Institute of Healthcare Engineering, University College London, Engineering Front Building, Room 2.01, 2nd Floor, Torrington Place, WC1E 7JE London, UK.,Vrije Universiteit (VU) University Medical Centre - Radiology and Nuclear Medicine, Van der Boechorststraat 7 F/A-114, 1081 BT Amsterdam, Netherlands.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, 170 Tottenham Court Rd, W1T 7HA London, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, University College of London Institute of Neurology, London WC1B 5EH, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, 170 Tottenham Court Rd, W1T 7HA London, UK
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology and Neuroimmunology, Vall d'Hebron University Hospital, 119-129, 08035 Barcelona, Spain
| | - Alan J Thompson
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, 170 Tottenham Court Rd, W1T 7HA London, UK.,University College London Faculty of Brain Sciences, Institute of Neurology, Department of Brain Repair and Rehabilitation, Queen Square, London WC1N 3BG, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, University College of London Institute of Neurology, London WC1B 5EH, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, 170 Tottenham Court Rd, W1T 7HA London, UK
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Younossi ZM, Stepanova M, Jacobson IM, Asselah T, Gane EJ, Lawitz E, Foster GR, Roberts SK, Thompson AJ, Willems BE, Welzel TM, Pearlman B, Younossi I, Racila A, Henry L. Sofosbuvir and velpatasvir with or without voxilaprevir in direct-acting antiviral-naïve chronic hepatitis C: patient-reported outcomes from POLARIS 2 and 3. Aliment Pharmacol Ther 2018; 47:259-267. [PMID: 29181842 DOI: 10.1111/apt.14423] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 09/28/2017] [Accepted: 10/28/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic hepatitis C infection leads to impairment of patient-reported outcomes (PROs). Treatment with direct-acting antiviral regimens results in short- and long-term improvement of these outcomes. AIM To assess PROs in patients treated with a newly developed direct-acting antiviral, a fixed-dose combination of sofosbuvir/velpatasvir (SOF/VEL) with/without voxilaprevir (VOX). METHODS The PRO data were collected from participants of POLARIS-2 and POLARIS-3 clinical trials (DAA-naïve, all HCV genotypes). Participants self-administered SF-36v2, FACIT-F, CLDQ-HCV and WPAI:SHP instruments at baseline, during treatment, and in follow-up. RESULTS Of 1160 patients, 611 received SOF/VEL/VOX and 549 received SOF/VEL (52.8 ± 11.0 years, 55.9% male, 75.4% treatment-naïve, 33.9% cirrhotic). The sustained viral response at 12 weeks (SVR12) rates were 95%-98%. During treatment, improvements in most PRO scores were significant (all but one P < .01) and ranged from, on average, +2.3 to +15.0 points (on a 0-100 scale) by the end of treatment. These improvements were similar between SOF/VEL/VOX and SOF/VEL arms (all P > .05). After treatment discontinuation, patients treated with both regimens achieved significant and clinically meaningful PRO gains (+2.7 to +16.7 by post-treatment week 12, +3.9 to +20.1 by post-treatment week 24; all but one P < .001). Multivariate analysis showed that depression, anxiety and cirrhosis were the most consistent independent predictors of PRO impairment while no association of PROs with the treatment regimen choice was found (all P > .05). CONCLUSIONS The pan-genotypic regimens with SOF/VEL with or without VOX not only have excellent efficacy and safety, but also significantly positively impact patients' experience both during treatment and after achieving sustained virologic response in DAA-naïve patients with HCV.
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Motl RW, Sandroff BM, Kwakkel G, Dalgas U, Feinstein A, Heesen C, Feys P, Thompson AJ. Exercise in patients with multiple sclerosis. Lancet Neurol 2017; 16:848-856. [DOI: 10.1016/s1474-4422(17)30281-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/06/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
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Cawley N, Tur C, Prados F, Plantone D, Kearney H, Abdel-Aziz K, Ourselin S, Wheeler-Kingshott CAMG, Miller DH, Thompson AJ, Ciccarelli O. Spinal cord atrophy as a primary outcome measure in phase II trials of progressive multiple sclerosis. Mult Scler 2017; 24:932-941. [DOI: 10.1177/1352458517709954] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To measure the development of spinal cord (SC) atrophy over 1 year in patients with progressive multiple sclerosis (PMS) and determine the sample sizes required to demonstrate a reduction in spinal cord cross-sectional area (SC-CSA) as an outcome measure in clinical trials. Methods: In total, 44 PMS patients (26 primary progressive multiple sclerosis (PPMS), 18 secondary progressive multiple sclerosis (SPMS)) and 29 healthy controls (HCs) were studied at baseline and 12 months. SC-CSA was measured using the three-dimensional (3D) fast field echo sequences acquired at 3T and the active surface model. Multiple linear regressions were used to investigate changes in imaging measurements. Results: PPMS patients had shorter disease duration, lower Expanded Disability Status Scale (EDSS) and larger SC-CSA than SPMS patients. All patients together showed a significantly greater decrease in percentage SC-CSA change than HCs, which was driven by the PPMS. All patients deteriorated over 1 year, but no association was found between percentage SC-CSA change and clinical changes. The sample size per arm required to detect a 50% treatment effect over 1 year, at 80% power, was 57 for PPMS and 546 for SPMS. Conclusion: SC-CSA may become an outcome measure in trials of PPMS patients, when they are at an early stage of the disease, have moderate disability and modest SC atrophy.
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Affiliation(s)
- Niamh Cawley
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Carmen Tur
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Ferran Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK/Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London (UCL), London, UK
| | - Domenico Plantone
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Hugh Kearney
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Khaled Abdel-Aziz
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
| | - Sebastian Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London (UCL), London, UK
| | | | - David H Miller
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK/UCL Hospitals Biomedical Research Centre, London, UK
| | - Alan J Thompson
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK/UCL Hospitals Biomedical Research Centre, London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK/UCL Hospitals Biomedical Research Centre, London, UK
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Thompson AJ, Smith ZKF, Corbin MJ, Harper LB, Johnson BJ. Ionophore strategy affects growth performance and carcass characteristics in feedlot steers. J Anim Sci 2017; 94:5341-5349. [PMID: 28046158 DOI: 10.2527/jas.2016-0841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
One hundred ninety-two steers (BW = 354 ± 23.5 kg) were used in a randomized block design to evaluate the effects of ionophore and ractopamine hydrochloride (RH) supplementation strategies on performance and carcass characteristics. Twelve pens of 4 steers were assigned to each of the following treatments: unsupplemented control (CON), laidlomycin propionate (12.1 mg/kg DM) with or without RH (LPRH and LP, respectively), and monensin sodium (36.4 mg/kg DM) with RH (MSRH). Steers were fed for 151 d, of which respective treatments received RH (Actogain; Zoetis, Florham Park, NJ) at a rate of 300 mg/(animal · d) for the final 32 d. Laidlomycin was removed from the LPRH treatment during this period, as no combination feeding has been approved. Upon harvest, carcass data were collected by trained personnel, and subsequent analysis of the LM was conducted to estimate tenderness using Warner-Bratzler shear force (WBSF). Prior to RH supplementation, both LP and LPRH had greater ADG ( ≤ 0.02) and G:F ( < 0.01) than CON, whereas MSRH was intermediate. During the final 32 d, MSRH improved G:F ( ≤ 0.02) compared to all other treatments and tended to increase ADG over unsupplemented controls ( = 0.05). Cattle receiving LP without RH had significantly greater BW at d 151 than CON ( = 0.02), whereas both RH treatments tended to improve final BW ( ≤ 0.09). Ionophores improved ADG ( ≤ 0.03) and G:F ( < 0.01) for the entire feeding period, and although LP-supplemented cattle had greater DMI for the final 32 d than both RH treatments ( ≤ 0.01), intakes for the 151-d trial were similar among treatments. Carcass weights were greater ( = 0.04) in cattle fed LP with no RH than CON, where cattle yielded an average of 12 kg more HCW. Ractopamine increased LM area in MSRH-supplemented cattle ( = 0.03) and tended to increase LM area for steers receiving LPRH ( = 0.07). Longissimus steaks of MSRH-supplemented cattle had greater WBSF values than CON ( = 0.04) after 7 d of postmortem aging and greater WBSF values than LPRH steaks after 28 d ( = 0.03). All other carcass and WBSF measurements were similar among treatments. The results of this study indicate that LP supplementation without RH may yield a performance similar to and carcass responses associated with the administration of a β-agonist. These results also suggest that performance and carcass characteristics for cattle fed LP are similar to those of cattle fed monensin throughout the feeding period.
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Ontaneda D, Thompson AJ, Fox RJ, Cohen JA. Progressive multiple sclerosis: prospects for disease therapy, repair, and restoration of function. Lancet 2017; 389:1357-1366. [PMID: 27889191 DOI: 10.1016/s0140-6736(16)31320-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 12/25/2022]
Abstract
Multiple sclerosis is a major cause of neurological disability, which accrues predominantly during progressive forms of the disease. Although development of multifocal inflammatory lesions is the underlying pathological process in relapsing-remitting multiple sclerosis, the gradual accumulation of disability that characterises progressive multiple sclerosis seems to result more from diffuse immune mechanisms and neurodegeneration. As a result, the 14 anti-inflammatory drugs that have regulatory approval for treatment of relapsing-remitting multiple sclerosis have little or no efficacy in progressive multiple sclerosis without inflammatory lesion activity. Effective therapies for progressive multiple sclerosis that prevent worsening, reverse damage, and restore function are a major unmet need. In this Series paper we summarise the current status of therapy for progressive multiple sclerosis and outline prospects for the future.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan J Thompson
- Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology, Faculty of Brain Sciences, London, UK
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Thompson AJ, Marks LH, Goudie MJ, Rojas-Pena A, Handa H, Potkay JA. A small-scale, rolled-membrane microfluidic artificial lung designed towards future large area manufacturing. Biomicrofluidics 2017; 11:024113. [PMID: 28798849 PMCID: PMC5533476 DOI: 10.1063/1.4979676] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/22/2017] [Indexed: 05/22/2023]
Abstract
Artificial lungs have been used in the clinic for multiple decades to supplement patient pulmonary function. Recently, small-scale microfluidic artificial lungs (μAL) have been demonstrated with large surface area to blood volume ratios, biomimetic blood flow paths, and pressure drops compatible with pumpless operation. Initial small-scale microfluidic devices with blood flow rates in the μl/min to ml/min range have exhibited excellent gas transfer efficiencies; however, current manufacturing techniques may not be suitable for scaling up to human applications. Here, we present a new manufacturing technology for a microfluidic artificial lung in which the structure is assembled via a continuous "rolling" and bonding procedure from a single, patterned layer of polydimethyl siloxane (PDMS). This method is demonstrated in a small-scale four-layer device, but is expected to easily scale to larger area devices. The presented devices have a biomimetic branching blood flow network, 10 μm tall artificial capillaries, and a 66 μm thick gas transfer membrane. Gas transfer efficiency in blood was evaluated over a range of blood flow rates (0.1-1.25 ml/min) for two different sweep gases (pure O2, atmospheric air). The achieved gas transfer data closely follow predicted theoretical values for oxygenation and CO2 removal, while pressure drop is marginally higher than predicted. This work is the first step in developing a scalable method for creating large area microfluidic artificial lungs. Although designed for microfluidic artificial lungs, the presented technique is expected to result in the first manufacturing method capable of simply and easily creating large area microfluidic devices from PDMS.
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Affiliation(s)
| | - L H Marks
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA
| | - M J Goudie
- College of Engineering, University of Georgia, Athens, Georgia 30602, USA
| | - A Rojas-Pena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - H Handa
- College of Engineering, University of Georgia, Athens, Georgia 30602, USA
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Abstract
BACKGROUND There is a growing number of cohorts and registries collecting phenotypic and genotypic data from groups of multiple sclerosis patients. Improved awareness and better coordination of these efforts is needed. OBJECTIVE The purpose of this report is to provide a global landscape of the major longitudinal MS patient data collection efforts and share recommendations for increasing their impact. METHODS A workshop that included over 50 MS research and clinical experts from both academia and industry was convened to evaluate how current and future MS cohorts could be better used to provide answers to urgent questions about progressive MS. RESULTS The landscape analysis revealed a significant number of largely uncoordinated parallel studies. Strategic oversight and direction is needed to streamline and leverage existing and future efforts. A number of recommendations for enhancing these efforts were developed. CONCLUSIONS Better coordination, increased leverage of evolving technology, cohort designs that focus on the most important unanswered questions, improved access, and more sustained funding will be needed to close the gaps in our understanding of progressive MS and accelerate the development of effective therapies.
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Affiliation(s)
- Bruce F Bebo
- National Multiple Sclerosis Society, New York, NY, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Karen Lee
- Multiple Sclerosis Society of Canada, Toronto, ON, Canada
| | - Ursula Utz
- Division of Extramural Research, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, USA
| | - Alan J Thompson
- Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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Affiliation(s)
- Hanneke E Hulst
- Department of Anatomy & Neurosciences, VU University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Jeroen Jg Geurts
- Department of Anatomy & Neurosciences, VU University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Davies GR, Hadjiprocopis A, Altmann DR, Chard DT, Griffin CM, Rashid W, Parker GJ, Tofts PS, Kapoor R, Thompson AJ, Miller DH. Normal-appearing grey and white matter T1 abnormality in early relapsing–remitting multiple sclerosis: a longitudinal study. Mult Scler 2017; 13:169-77. [PMID: 17439881 DOI: 10.1177/1352458506070726] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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] [Indexed: 11/17/2022]
Abstract
Objective To investigate the presence and evolution of T1 relaxation time abnormalities in normal-appearing white matter (NAWM) and grey matter (GM), early in the course of relapsing–remitting multiple sclerosis (MS). Methods Twenty-three patients with early relapsing–remitting MS and 14 healthy controls were imaged six monthly for up to three years. Mean follow-up was 26 months for MS patients and 24 months for controls. Dual-echo fast-spin echo and gradient-echo proton-density and T1-weighted data sets (permitting the calculation of a T1 map) were acquired in all subjects. GM and NAWM T1 histograms were produced and a hierarchical regression model was used to investigate changes in T1 over time. Results At baseline, significant patient-control differences were seen, both in NAWM (P = 0.001) and in GM (P = 0.01). At follow-up, there was no evidence for a serial change in either mean T1 or peak-location for either NAWM or GM. There was weak evidence for a decline in patient NAWM peak-height and also evidence for a decline in control GM peak-height. Conclusion There are significant and persistent abnormalities of NAWM and GM T1 in early relapsing-remitting MS. Further studies should address whether such T1 measures have a role in prognosis or therapeutic monitoring. Multiple Sclerosis 2007; 13:169–177. http://msj.sagepub.com
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Affiliation(s)
- G R Davies
- NMR Research Unit, Institute of Neurology, University College London, Queen Square, London, UK
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