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Tazza F, Schiavi S, Leveraro E, Cellerino M, Boffa G, Ballerini S, Dighero M, Uccelli A, Sbragia E, Aluan K, Inglese M, Lapucci C. Clinical and radiological correlates of apathy in multiple sclerosis. Mult Scler 2024; 30:247-256. [PMID: 38095151 DOI: 10.1177/13524585231217918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although apathy has been associated with fronto-striatal dysfunction in several neurological disorders, its clinical and magnetic resonance imaging (MRI) correlates have been poorly investigated in people with multiple sclerosis (PwMS). OBJECTIVES To evaluate clinical variables and investigate microstructural integrity of fronto-striatal grey matter (GM) and white matter (WM) structures using diffusion tensor imaging (DTI). METHODS A total of 123 PwMS (age: 40.25 ± 11.5; female: 60.9%; relapsing-remitting multiple sclerosis: 75.6%) were prospectively enrolled and underwent neurological and neuropsychological evaluation, including Expanded Disability Status Scale (EDSS), Apathy Evaluation Scale (AES-S), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS) and brain 3T-MRI volumes of whole brain, frontal/prefrontal cortex (PFC) and subcortical regions were calculated. DTI-derived metrics were evaluated in the same GM regions and in connecting WM tracts. RESULTS Apathetic PwMS (32.5%) showed lower education levels, higher HADS, MFIS scores and WM lesions volume than nonapathetic PwMS. Significant differences in DTI metrics were found in middle frontal, anterior cingulate and superior frontal PFC subregions and in caudate nuclei. Significant alterations were found in the right cingulum and left striatal-frontorbital tracts. CONCLUSIONS Apathy in PwMS is associated with higher levels of physical disability, depression, anxiety and fatigue together with lower educational backgrounds. Microstructural damage within frontal cortex, caudate and fronto-striatal WM bundles is a significant pathological substrate of apathy in multiple sclerosis (MS).
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Affiliation(s)
- Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Leveraro
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Ballerini
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mara Dighero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Kenda Aluan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Boccia VD, Saitta L, Inglese M, Lapucci C. Cortical ischemic lesions from atrial myxoma as a mimic of disease activity in an RRMS antiCD20-treated patient. Mult Scler 2023; 29:1688-1692. [PMID: 37712415 DOI: 10.1177/13524585231195356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Cortical lesions (CLs) detected with double inversion recovery (DIR) magnetic resonance imaging (MRI) are very helpful in differentiating multiple sclerosis (MS) from other neuroinflammatory diseases of the central nervous system (CNS), that is, neuromyelitis optica spectrum disorders (NMOSDs). Furthermore, CLs are closely related to motor and cognitive impairment. We report a case of a 48-year-old female MS patient who developed several CLs during anti-CD20 therapy. Some CLs disappeared during follow-up MRIs. In the suspicion of a treatment failure, the screening for the autologous hematopoietic stem cell transplant (AHSCT) was performed with the evidence of an atrial myxoma. In MS patients with new CLs, a comorbid ischemic pathology should be considered and carefully investigated.
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Affiliation(s)
- V D Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - L Saitta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Lapucci C, Boccia VD, Sirito T, Cellerino M, Mikulska M, Sticchi L, Inglese M. Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series. Mult Scler 2023; 29:1514-1517. [PMID: 37786976 DOI: 10.1177/13524585231204121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The vaccination with live attenuated vaccines is generally not recommended during natalizumab (NTZ), as it is included among immunosuppressive/immunomodulating therapies. Nevertheless, considering the lack of evidence of a non-Central Nervous System (CNS) immunosuppressive effect of NTZ, after a risk/benefit evaluation, we decided to vaccinate four multiple sclerosis (MS) patients (three with an indication to switch to ocrelizumab for high-risk Progressive Multifocal Leukoencephalopathy (PML) and one for pregnancy planning). No vaccine-related adverse events of any type nor varicella zoster virus (VZV) infections were observed. To the best of our knowledge, these case series represent the first description of the good safety profile of anti-VZV vaccination in MS patients during NTZ treatment.
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Affiliation(s)
| | - Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Tommaso Sirito
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Sticchi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Morbelli S, Gambella M, Raiola AM, Ghiggi C, Bauckneht M, Raimondo TD, Lapucci C, Sambuceti G, Inglese M, Angelucci E. Brain FDG-PET findings in chimeric antigen receptor T-cell therapy neurotoxicity for diffuse large B-cell lymphoma. J Neuroimaging 2023; 33:825-836. [PMID: 37291470 DOI: 10.1111/jon.13135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Chimeric antigen receptor (CAR) T-cell therapy is potentially associated with treatment-related toxicities mainly consisting of cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS). We evaluated brain metabolic correlates of CRS with and without ICANS in diffuse large B-cell lymphoma patients treated with CAR-T. METHODS Twenty-one refractory DLCBLs underwent whole-body and brain [18 F]-fluorodeoxyglucose (FDG) PET before and 30 days after treatment with CAR-T. Five patients did not develop inflammatory-related side effects, 11 patients developed CRS, while in 5 patients CRS evolved in ICANS. Baseline and post-CAR-T brain FDG-PET were compared with a local controls dataset to identify hypometabolic patterns both at single-patient and group levels (p < .05 after correction for family-wise error [FWE). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were computed on baseline FDG-PET and compared between patients' subgroups (t-test). RESULTS ICANS showed an extended and bilateral hypometabolic pattern mainly involving the orbitofrontal cortex, frontal dorsolateral cortex, and anterior cingulate (p < .003 FWE-corrected). CRS without ICANS showed significant hypometabolism in less extended clusters mainly involving bilateral medial and lateral temporal lobes, posterior parietal lobes, anterior cingulate, and cerebellum (p < .002 FWE-corrected). When compared, ICANS showed a more prominent hypometabolism in the orbitofrontal and frontal dorsolateral cortex in both hemispheres than CRS (p < .002 FWE-corrected). Mean baseline MTV and TLG were significantly higher in ICANS than CRS (p < .02). CONCLUSIONS Patients with ICANS are characterized by a frontolateral hypometabolic signature coherently with the hypothesis of ICANS as a predominant frontal syndrome and with the more prominent susceptibility of frontal lobes to cytokine-induced inflammation.
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Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Massimiliano Gambella
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Tania Di Raimondo
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Schiavi S, Palombo M, Zacà D, Tazza F, Lapucci C, Castellan L, Costagli M, Inglese M. Mapping tissue microstructure across the human brain on a clinical scanner with soma and neurite density image metrics. Hum Brain Mapp 2023; 44:4792-4811. [PMID: 37461286 PMCID: PMC10400787 DOI: 10.1002/hbm.26416] [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: 11/01/2022] [Revised: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
Soma and neurite density image (SANDI) is an advanced diffusion magnetic resonance imaging biophysical signal model devised to probe in vivo microstructural information in the gray matter (GM). This model requires acquisitions that include b values that are at least six times higher than those used in clinical practice. Such high b values are required to disentangle the signal contribution of water diffusing in soma from that diffusing in neurites and extracellular space, while keeping the diffusion time as short as possible to minimize potential bias due to water exchange. These requirements have limited the use of SANDI only to preclinical or cutting-edge human scanners. Here, we investigate the potential impact of neglecting water exchange in the SANDI model and present a 10-min acquisition protocol that enables to characterize both GM and white matter (WM) on 3 T scanners. We implemented analytical simulations to (i) evaluate the stability of the fitting of SANDI parameters when diminishing the number of shells; (ii) estimate the bias due to potential exchange between neurites and extracellular space in such reduced acquisition scheme, comparing it with the bias due to experimental noise. Then, we demonstrated the feasibility and assessed the repeatability and reproducibility of our approach by computing microstructural metrics of SANDI with AMICO toolbox and other state-of-the-art models on five healthy subjects. Finally, we applied our protocol to five multiple sclerosis patients. Results suggest that SANDI is a practical method to characterize WM and GM tissues in vivo on performant clinical scanners.
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Affiliation(s)
- Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
| | - Marco Palombo
- CUBRIC, School of PsychologyCardiff UniversityCardiffUK
- School of Computer Science and InformaticsCardiff UniversityCardiffUK
| | | | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- HNSR, IRRCS Ospedale Policlinico San MartinoGenoaItaly
| | - Lucio Castellan
- Department of NeuroradiologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Laboratory of Medical Physics and Magnetic ResonanceIRCCS Stella MarisPisaItaly
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
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Koudriavtseva T, Lorenzano S, Cellerino M, Truglio M, Fiorelli M, Lapucci C, D’Agosto G, Conti L, Stefanile A, Zannino S, Filippi MM, Cortese A, Piantadosi C, Maschio M, Maialetti A, Galiè E, Salvetti M, Inglese M. Tissue factor as a potential coagulative/vascular marker in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1226616. [PMID: 37583699 PMCID: PMC10424925 DOI: 10.3389/fimmu.2023.1226616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Objectives Recent studies supported coagulation involvement in multiple sclerosis, an inflammatory-demyelinating and degenerative disease of the central nervous system. The main objectives of this observational study were to identify the most specific pro-coagulative/vascular factors for multiple sclerosis pathogenesis and to correlate them with brain hemodynamic abnormalities. Methods We compared i) serum/plasma levels of complement(C)/coagulation/vascular factors, viral/microbiological assays, fat-soluble vitamins and lymphocyte count among people with multiple sclerosis sampled in a clinical remission (n=30; 23F/7M, 40 ± 8.14 years) or a relapse (n=30; 24F/6M, age 41 ± 10.74 years) and age/sex-matched controls (n=30; 23F/7M, 40 ± 8.38 years); ii) brain hemodynamic metrics at dynamic susceptibility contrast-enhanced 3T-MRI during relapse and remission, and iii) laboratory data with MRI perfusion metrics and clinical features of people with multiple sclerosis. Two models by Partial Least Squares Discriminant Analysis were performed using two groups as input: (1) multiple sclerosis vs. controls, and (2) relapsing vs. remitting multiple sclerosis. Results Compared to controls, multiple sclerosis patients had a higher Body-Mass-Index, Protein-C and activated-C9; and a lower activated-C4. Levels of Tissue-Factor, Tie-2 and P-Selectin/CD62P were lower in relapse compared to remission and HC, whereas Angiopoietin-I was higher in relapsing vs. remitting multiple sclerosis. A lower number of total lymphocytes was found in relapsing multiple sclerosis vs. remitting multiple sclerosis and controls. Cerebral-Blood-Volume was lower in normal-appearing white matter and left caudatum while Cerebral-Blood-Flow was inferior in bilateral putamen in relapsing versus remitting multiple sclerosis. The mean-transit-time of gadolinium-enhancing lesions negatively correlated with Tissue-Factor. The top-5 discriminating variables for model (1) were: EBV-EBNA-1 IgG, Body-Mass-Index, Protein-C, activated-C4 and Tissue-Factor whereas for model (2) were: Tissue-Factor, Angiopoietin-I, MCHC, Vitamin A and T-CD3. Conclusion Tissue-factor was one of the top-5 variables in the models discriminating either multiple sclerosis from controls or multiple sclerosis relapse from remission and correlated with mean-transit-time of gadolinium-enhancing lesions. Tissue-factor appears a promising pro-coagulative/vascular biomarker and a possible therapeutic target in relapsing-remitting multiple sclerosis. Clinical trial registration ClinicalTrials.gov, identifier NCT04380220.
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Affiliation(s)
- Tatiana Koudriavtseva
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Cellerino
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mauro Truglio
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanna D’Agosto
- Clinical Pathology and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Gallicano Dermatological Institute, Rome, Italy
| | - Laura Conti
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Annunziata Stefanile
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Silvana Zannino
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | | | - Antonio Cortese
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Piantadosi
- Unità Operativa Complessa (UOC) Neurology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marta Maschio
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Andrea Maialetti
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Edvina Galiè
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience Mental Health and Sensory Organs (NEMOS), Sapienza University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Neurology, Mount Sinai Hospital, New York, NY, United States
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7
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Bouman PM, Noteboom S, Nobrega Santos FA, Beck ES, Bliault G, Castellaro M, Calabrese M, Chard DT, Eichinger P, Filippi M, Inglese M, Lapucci C, Marciniak A, Moraal B, Morales Pinzon A, Mühlau M, Preziosa P, Reich DS, Rocca MA, Schoonheim MM, Twisk JWR, Wiestler B, Jonkman LE, Guttmann CRG, Geurts JJG, Steenwijk MD. Multicenter Evaluation of AI-generated DIR and PSIR for Cortical and Juxtacortical Multiple Sclerosis Lesion Detection. Radiology 2023; 307:e221425. [PMID: 36749211 PMCID: PMC10102645 DOI: 10.1148/radiol.221425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/07/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 02/08/2023]
Abstract
Background Cortical multiple sclerosis lesions are clinically relevant but inconspicuous at conventional clinical MRI. Double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR) are more sensitive but often unavailable. In the past 2 years, artificial intelligence (AI) was used to generate DIR and PSIR from standard clinical sequences (eg, T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery sequences), but multicenter validation is crucial for further implementation. Purpose To evaluate cortical and juxtacortical multiple sclerosis lesion detection for diagnostic and disease monitoring purposes on AI-generated DIR and PSIR images compared with MRI-acquired DIR and PSIR images in a multicenter setting. Materials and Methods Generative adversarial networks were used to generate AI-based DIR (n = 50) and PSIR (n = 43) images. The number of detected lesions between AI-generated images and MRI-acquired (reference) images was compared by randomized blinded scoring by seven readers (all with >10 years of experience in lesion assessment). Reliability was expressed as the intraclass correlation coefficient (ICC). Differences in lesion subtype were determined using Wilcoxon signed-rank tests. Results MRI scans of 202 patients with multiple sclerosis (mean age, 46 years ± 11 [SD]; 127 women) were retrospectively collected from seven centers (February 2020 to January 2021). In total, 1154 lesions were detected on AI-generated DIR images versus 855 on MRI-acquired DIR images (mean difference per reader, 35.0% ± 22.8; P < .001). On AI-generated PSIR images, 803 lesions were detected versus 814 on MRI-acquired PSIR images (98.9% ± 19.4; P = .87). Reliability was good for both DIR (ICC, 0.81) and PSIR (ICC, 0.75) across centers. Regionally, more juxtacortical lesions were detected on AI-generated DIR images than on MRI-acquired DIR images (495 [42.9%] vs 338 [39.5%]; P < .001). On AI-generated PSIR images, fewer juxtacortical lesions were detected than on MRI-acquired PSIR images (232 [28.9%] vs 282 [34.6%]; P = .02). Conclusion Artificial intelligence-generated double inversion-recovery and phase-sensitive inversion-recovery images performed well compared with their MRI-acquired counterparts and can be considered reliable in a multicenter setting, with good between-reader and between-center interpretative agreement. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Zivadinov and Dwyer in this issue.
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Affiliation(s)
- Piet M. Bouman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Samantha Noteboom
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Fernando A. Nobrega Santos
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Erin S. Beck
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Gregory Bliault
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Marco Castellaro
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimiliano Calabrese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Declan T. Chard
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paul Eichinger
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimo Filippi
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Matilde Inglese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Caterina Lapucci
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Andrzej Marciniak
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Bastiaan Moraal
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Alfredo Morales Pinzon
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Mark Mühlau
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paolo Preziosa
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Daniel S. Reich
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Maria A. Rocca
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Menno M. Schoonheim
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jos W. R. Twisk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Benedict Wiestler
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Laura E. Jonkman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Charles R. G. Guttmann
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jeroen J. G. Geurts
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Martijn D. Steenwijk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
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8
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Lapucci C, Tazza F, Rebella S, Boffa G, Sbragia E, Bruschi N, Mancuso E, Mavilio N, Signori A, Roccatagliata L, Cellerino M, Schiavi S, Inglese M. Central vein sign and diffusion MRI differentiate microstructural features within white matter lesions of multiple sclerosis patients with comorbidities. Front Neurol 2023; 14:1084661. [PMID: 36970546 PMCID: PMC10030505 DOI: 10.3389/fneur.2023.1084661] [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: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction The Central Vein Sign (CVS) has been suggested as a potential biomarker to improve diagnostic specificity in multiple sclerosis (MS). Nevertheless, the impact of comorbidities on CVS performance has been poorly investigated so far. Despite the similar features shared by MS, migraine and Small Vessel Disease (SVD) at T2-weighted conventional MRI sequences, ex-vivo studies demonstrated their heterogeneous histopathological substrates. If in MS, inflammation, primitive demyelination and axonal loss coexist, in SVD demyelination is secondary to ischemic microangiopathy, while the contemporary presence of inflammatory and ischemic processes has been suggested in migraine. The aims of this study were to investigate the impact of comorbidities (risk factors for SVD and migraine) on the global and subregional assessment of the CVS in a large cohort of MS patients and to apply the Spherical Mean Technique (SMT) diffusion model to evaluate whether perivenular and non-perivenular lesions show distinctive microstructural features. Methods 120 MS patients stratified into 4 Age Groups performed 3T brain MRI. WM lesions were classified in "perivenular" and "non-perivenular" by visual inspection of FLAIR* images; mean values of SMT metrics, indirect estimators of inflammation, demyelination and fiber disruption (EXTRAMD: extraneurite mean diffusivity, EXTRATRANS: extraneurite transverse diffusivity and INTRA: intraneurite signal fraction, respectively) were extracted. Results Of the 5303 lesions selected for the CVS assessment, 68.7% were perivenular. Significant differences were found between perivenular and non-perivenular lesion volume in the whole brain (p < 0.001) and between perivenular and non-perivenular lesion volume and number in all the four subregions (p < 0.001 for all). The percentage of perivenular lesions decreased from youngest to oldest patients (79.7%-57.7%), with the deep/subcortical WM of oldest patients as the only subregion where the number of non-perivenular was higher than the number of perivenular lesions. Older age and migraine were independent predictors of a higher percentage of non-perivenular lesions (p < 0.001 and p = 0.013 respectively). Whole brain perivenular lesions showed higher inflammation, demyelination and fiber disruption than non perivenular lesions (p = 0.001, p = 0.001 and p = 0.02 for EXTRAMD, EXTRATRANS and INTRA respectively). Similar findings were found in the deep/subcortical WM (p = 0.001 for all). Compared to non-perivenular lesions, (i) perivenular lesions located in periventricular areas showed a more severe fiber disruption (p = 0.001), (ii) perivenular lesions located in juxtacortical and infratentorial regions exhibited a higher degree of inflammation (p = 0.01 and p = 0.05 respectively) and (iii) perivenular lesions located in infratentorial areas showed a higher degree of demyelination (p = 0.04). Discussion Age and migraine have a relevant impact in reducing the percentage of perivenular lesions, particularly in the deep/subcortical WM. SMT may differentiate perivenular lesions, characterized by higher inflammation, demyelination and fiber disruption, from non perivenular lesions, where these pathological processes seemed to be less pronounced. The development of new non-perivenular lesions, especially in the deep/subcortical WM of older patients, should be considered a "red flag" for a different -other than MS- pathophysiology.
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Affiliation(s)
- Caterina Lapucci
- HNSR, IRRCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisabetta Mancuso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicola Mavilio
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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9
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Boccia VD, Lapucci C, Cellerino M, Tazza F, Rossi A, Schiavi S, Mancardi MM, Inglese M. Evaluating the central vein sign in paediatric-onset multiple sclerosis: A case series study. Mult Scler 2023; 29:475-478. [PMID: 36514274 DOI: 10.1177/13524585221142319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The central vein sign (CVS) has been proposed as a biomarker of multiple sclerosis (MS). In adult-onset MS (AOMS), 40%-threshold of CVS positive (+) lesions demonstrated high accuracy for MS diagnosis. However, CVS+ lesions' performance has not been characterized in paediatric-onset (POMS) yet. We compared the CVS contribution to MS diagnosis in 10 POMS and 12 disease-duration-matched AOMS patients. Three POMS patients did not meet the 40%-threshold, while all AOMS patients were correctly diagnosed as having MS. The high proportion of periventricular confluent lesions, excluded from the CVS assessment, seemed to impair CVS sensitivity in POMS diagnosis.
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Affiliation(s)
- Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy/HNSR, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Rossi
- UO Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy/Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Schiavetti I, Barcellini L, Lapucci C, Tazza F, Cellerino M, Capello E, Franciotta D, Inglese M, Sormani MP, Uccelli A, Laroni A. CD19+ B cell values predict the increase of anti-SARS CoV2 antibodies in fingolimod-treated and COVID-19-vaccinated patients with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104494. [PMID: 36603292 PMCID: PMC9800324 DOI: 10.1016/j.msard.2022.104494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Treatment with fingolimod for multiple sclerosis (MS) reduces the efficacy of COVID-19 vaccination. The aim of this exploratory study was to evaluate whether main lymphocyte subsets and demographic features correlated to the subsequent increase in anti-SARS-CoV2 antibodies following the third dose of COVID-19 vaccination in fingolimod-treated MS patients. METHODS This was a prospective single-center observational exploratory study including a subgroup of adult patients with MS (pwMS) in treatment with fingolimod who underwent COVID-19 vaccination. The association of anti-SARS-CoV2 antibody levels (reported as the Log10 of the difference between the post and pre third dose levels) with the total number and percentage of CD3+ T and CD19+ B was assessed by a linear regression model adjusted for age and sex. RESULTS We found that peripheral blood CD19+ B lymphocytes before the third dose of vaccination in pwMS treated with fingolimod predict the subsequent increase of anti-SARS-CoV2 antibodies. CONCLUSION This work suggests that evaluating the percentage of CD19+ B cells may be important to identify patients at risk of not producing SARS-CoV-2 antibodies, with possible reduced protection from COVID-19.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova 16132, Italy
| | - Lucrezia Barcellini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Elisabetta Capello
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Diego Franciotta
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova 16132, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy.
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11
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Cellerino M, Schiavi S, Lapucci C, Sbragia E, Boffa G, Rolla-Bigliani C, Tonelli S, Boccia D, Bruschi N, Tazza F, Franciotta D, Inglese M. In-vivo characterization of macro- and microstructural injury of the subventricular zone in relapsing-remitting and progressive multiple sclerosis. Front Neurosci 2023; 17:1112199. [PMID: 37113155 PMCID: PMC10126477 DOI: 10.3389/fnins.2023.1112199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction The subventricular zone (SVZ) represents one of the main adult brain neurogenesis niche. In-vivo imaging of SVZ is very challenging and little is known about MRI correlates of SVZ macro- and micro-structural injury in multiple sclerosis (MS) patients. Methods The aim of the present study is to evaluate differences in terms of volume and microstructural changes [as assessed with the novel Spherical Mean Technique (SMT) model, evaluating: Neurite Signal fraction (INTRA); Extra-neurite transverse (EXTRATRANS) and mean diffusivity (EXTRAMD)] in SVZ between relapsing-remitting (RR) or progressive (P) MS patients and healthy controls (HC). We are also going to explore whether SVZ microstructural injury correlate with caudate (a nucleus that is in the vicinity of the SVZ) or thalamus (another well-defined grey matter area which is further from SVZ than caudate) volume and clinical disability. Clinical and brain MRI data were prospectively acquired from 20 HC, 101 RRMS, and 50 PMS patients. Structural and diffusion metrics inside the global SVZ, normal appearing (NA-) SVZ, caudate and thalamus were collected. Results We found a statistically significant difference between groups in terms of NA-SVZ EXTRAMD (PMS>RRMS>HC; p = 0.002), EXTRATRANS (PMS>RRMS>HC; p<0.0001), and INTRA (HC>RRMS>PMS; p = 0.009). Multivariable models showed that NA-SVZ metrics significantly predicted caudate (R 2 = 0.21, p < 0.0001), but not thalamus, atrophy. A statistically significant correlation between EXTRAMD and EXTRATRANS of the NA-SVZ and EDSS (r=0.25, p=0.003 and r=0.24, p = 0.003, respectively) was found. These findings were confirmed in analyses restricted to RRMS, but not to PMS patients. Discussion In conclusion, the microstructural damage we observed within the NA-SVZ of MS patients - reflecting higher free water content (higher EXTRAMD), cytoarchitecture disruption and astrogliosis (higher EXTRATRANS and lower INTRA) - was more evident in the progressive as compared to the relapsing phases of MS. These abnormalities were significantly associated with a more pronounced caudate atrophy and higher clinical disability scores. Our findings may support the neuroprotective role of SVZ in MS patients.
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Affiliation(s)
- Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Serena Tonelli
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Boccia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Diego Franciotta
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Matilde Inglese,
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12
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Sbragia E, Olobardi D, Novi G, Lapucci C, Cellerino M, Boffa G, Laroni A, Mikulska M, Sticchi L, Inglese M. Vaccinations in patients with multiple sclerosis: a real-world, single-center experience. Hum Vaccin Immunother 2022; 18:2099171. [PMID: 35863064 DOI: 10.1080/21645515.2022.2099171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccines prevent infections in patients with multiple sclerosis (MS). Though recommendations regarding vaccinating patients with MS have been recently published, real-world data regarding vaccines' planning in patients receiving disease-modifying drugs (DMDs) for MS are missing. Our aim was, therefore, to describe vaccination coverage rates, timing-proposal and safety in real-life vaccinating patients with MS undergoing DMDs before the start of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination campaign. Patients followed at our MS-center were referred to individualized immunization-programs customized to Italian recommendations, patients' risks, immunity to exanthematic diseases, ongoing DMDs, or therapy-start urgency. Disease-activity stated the need for an essential immunization-cycle, whose core was composed by four vaccines: meningococcal-B, pneumococcal conjugated, Haemophilus influenzae B, and meningococcal-ACWY vaccines. Vaccines were administered prior to the planned DMD-start when possible, inactivated-vaccines >2 weeks and live-vaccines >4 weeks before treatment-start. Patients received a 6-months clinical-/radiological-follow-up after immunization. One-hundred and ninety-five patients were vaccinated between April 2017 and January 2021. 124/195 (63.6%) started a vaccination-program before therapy-start/-switch and 108/124 (87.1%) effectively completed immunization before new therapy-start without any delay. The time needed for immunization-conclusion reached a median of 27 (confidence interval 22) days in 2020. No increase in clinical-/radiological-activity 3-/6-months after immunization was noted. In conclusion, our study confirmed feasibility and safety of a vaccination-protocol in patients with MS whose duration resulted in a median of 27 days.
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Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Dario Olobardi
- Hygiene Unit and Department of Health Sciences (DiSSal), IRCCS Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Giovanni Novi
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), IRCCS Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Laura Sticchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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13
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Costagli M, Lapucci C, Zacà D, Bruschi N, Schiavi S, Castellan L, Stemmer A, Roccatagliata L, Inglese M. Improved detection of multiple sclerosis lesions with T2-prepared double inversion recovery at 3T. J Neuroimaging 2022; 32:902-909. [PMID: 35776654 PMCID: PMC9544719 DOI: 10.1111/jon.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/30/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Double inversion recovery (DIR) imaging is used in multiple sclerosis (MS) clinical protocols to improve the detection of cortical and juxtacortical gray matter lesions by nulling confounding signals originating from the cerebrospinal fluid and white matter. Achieving a high isotropic spatial resolution, to depict the neocortex and its typically small lesions, is challenged by the reduced signal-to-noise ratio (SNR) determined by multiple tissue signal nulling. Here, we evaluate both conventional and optimized DIR implementations to improve tissue contrast (TC), SNR, and MS lesion conspicuity. METHODS DIR images were obtained from MS patients and healthy controls using both conventional and prototype implementations featuring a T2-preparation module (T2P), to improve SNR and TC, as well as an image reconstruction routine with iterative denoising (ID). We obtained quantitative measures of SNR and TC, and evaluated the visibility of MS cortical, cervical cord, and optic nerve lesions in the different DIR images. RESULTS DIR implementations adopting T2P and ID enabled improving the SNR and TC of conventional DIR. In MS patients, 34% of cortical, optic nerve, and cervical cord lesions were visible only in DIR images acquired with T2P, and not in conventional DIR images. In the studied cases, image reconstruction with ID did not improve lesion conspicuity. CONCLUSIONS DIR with T2P should be preferred to conventional DIR imaging in protocols studying MS patients, as it improves SNR and TC and determines an improvement in cortical, optic nerve, and cervical cord lesion conspicuity.
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Affiliation(s)
- Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,Laboratory of Medical Physicsand Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | | | | | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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14
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Lapucci C, Schiavi S, Signori A, Sbragia E, Bommarito G, Cellerino M, Uccelli A, Inglese M, Roccatagliata L, Pardini M. The role of disconnection in explaining disability in multiple sclerosis. Eur Radiol Exp 2022; 6:23. [PMID: 35672589 PMCID: PMC9174414 DOI: 10.1186/s41747-022-00277-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background In multiple sclerosis, the correlation between white matter lesion volumes (LV) and expanded disability status scale (EDSS) is at best moderate, leading to the “clinico-radiological paradox”, influenced by many factors, including the lack of information on the spatial localisation of each lesion on synthetic metrics such as LV. We used a probabilistic approach to provide the volume of WM tracts that may be disconnected by lesions and to evaluate its correlation with EDSS. Methods Forty-five patients (aged 37.4 ± 6.8 years, mean ± standard deviation; 30 females; 29 relapsing-remitting, 16 progressive) underwent 3-T magnetic resonance imaging. Both LV and the volume of the tracts crossing the lesioned regions (disconnectome volume, DV) were calculated using BCBtoolkit and correlated with EDSS. Results T1-weighted LV and DV significantly correlated with EDSS (p ≤ 0.006 r ≥ 0.413) as it was for T2-weighted LV and T2-weighted DV (p ≤ 0.004 r ≥ 0.430), but only T1-weighetd and T2-weighted DVs were EDSS significant predictors (p ≤ 0.001). The correlations of T1-weighted and T2-weighted LV with EDSS were significantly mediated by DV, while no effect of LV on the EDSS-DV correlation was observed. Conclusion The volume of disconnected WM bundles mediates the LV-EDSS correlation, representing the lonely EDSS predictor.
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Affiliation(s)
- Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy. .,IRRCS Ospedale Policlinico San Martino, Largo P. Daneo, 3, 16132, Genoa, Italy.
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Giulia Bommarito
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo P. Daneo, 3, 16132, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo P. Daneo, 3, 16132, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo P. Daneo, 3, 16132, Genoa, Italy
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15
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Sormani MP, Schiavetti I, Inglese M, Carmisciano L, Laroni A, Lapucci C, Visconti V, Serrati C, Gandoglia I, Tassinari T, Perego G, Brichetto G, Gazzola P, Mannironi A, Stromillo ML, Cordioli C, Landi D, Clerico M, Signoriello E, Cocco E, Frau J, Ferrò MT, Di Sapio A, Pasquali L, Ulivelli M, Marinelli F, Pizzorno M, Callari G, Iodice R, Liberatore G, Caleri F, Repice AM, Cordera S, Battaglia MA, Salvetti M, Franciotta D, Uccelli A. Breakthrough SARS-CoV-2 infections after COVID-19 mRNA vaccination in MS patients on disease modifying therapies during the Delta and the Omicron waves in Italy. EBioMedicine 2022; 80:104042. [PMID: 35526306 PMCID: PMC9069178 DOI: 10.1016/j.ebiom.2022.104042] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 02/23/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In this study we aimed to monitor the risk of breakthrough SARS-CoV-2 infection in patients with MS (pwMS) under different DMTs and to identify correlates of reduced protection. METHODS This is a prospective Italian multicenter cohort study, long-term clinical follow-up of the CovaXiMS (Covid-19 vaccine in Multiple Sclerosis) study. 1855 pwMS scheduled for SARS-CoV-2 mRNA vaccination were enrolled and followed up to a mean time of 10 months. The cumulative incidence of breakthrough Covid-19 cases in pwMS was calculated before and after December 2021, to separate the Delta from the Omicron waves and to account for the advent of the third vaccine dose. FINDINGS 1705 pwMS received 2 m-RNA vaccine doses, 21/28 days apart. Of them, 1508 (88.5%) had blood assessment 4 weeks after the second vaccine dose and 1154/1266 (92%) received the third dose after a mean interval of 210 days (range 90-342 days) after the second dose. During follow-up, 131 breakthrough Covid-19 infections (33 during the Delta and 98 during the Omicron wave) were observed. The probability to be infected during the Delta wave was associated with SARS-CoV-2 antibody levels measured after 4 weeks from the second vaccine dose (HR=0.57, p < 0.001); the protective role of antibodies was preserved over the whole follow up (HR=0.57, 95%CI=0.43-0.75, p < 0.001), with a significant reduction (HR=1.40, 95%CI=1.01-1.94, p=0.04) for the Omicron cases. The third dose significantly reduced the risk of infection (HR=0.44, 95%CI=0.21-0.90,p=0.025) during the Omicron wave. INTERPRETATION The risk of breakthrough SARS-CoV-2 infections is mainly associated with reduced levels of the virus-specific humoral immune response. FUNDING Supported by FISM - Fondazione Italiana Sclerosi Multipla - cod. 2021/Special-Multi/001 and financed or co-financed with the '5 per mille' public funding.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Valeria Visconti
- Laboratory Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Serrati
- Department of Neurology, Imperia Hospital, Imperia, Italy
| | | | | | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese, Italy
| | | | - Maria Laura Stromillo
- Clinica Neurologica e Malattie Neurometaboliche, Università degli Studi di Siena, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Italy
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST Crema, Italy
| | - Alessia Di Sapio
- Department of Neurology, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, Frosinone, Italy
| | | | - Graziella Callari
- UOC Neurologia e Centro SM Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Anna Maria Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy; Department of Life Sciences, University of Siena, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Diego Franciotta
- Autoimmunology Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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16
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Palmeri S, Ponzano M, Ivaldi F, Signori A, Lapucci C, Casella V, Ferrò MT, Vigo T, Inglese M, Mancardi GL, Uccelli A, Laroni A. Impact of Natural Killer (NK) Cells on Immune Reconstitution, and Their Potential as a Biomarker of Disease Activity, in Alemtuzumab-Treated Patients with Relapsing Remitting Multiple Sclerosis: An Observational Study. CNS Drugs 2022; 36:83-96. [PMID: 34894339 DOI: 10.1007/s40263-021-00875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Defining immune mechanisms leading to multiple sclerosis (MS) is difficult, due to the great inter-individual difference in immune system responses. The anti-CD52 antibody alemtuzumab transiently abolishes differences in immune parameters among individuals, allowing analysis of subsequent immune cell repopulation patterns, and their possible role in MS. OBJECTIVE To evaluate the correlation between innate and adaptive immune cell subsets and disease activity in MS in the context of treatment with alemtuzumab. METHODS A two-center observational cohort of patients treated with alemtuzumab underwent immune profiling of T, B, and natural killer (NK) cells, biomarker, clinical and radiological follow-up. RESULTS After treatment, the percentage of NK and B cells increased; NK, T- and B-cell populations underwent a profound rearrangement. Within the effector T-cell compartment, treatment led to a transient decrease, followed by an increase, of T-helper 1 cells, and to a transient decrease of T-helper 17 cells. Within the T-regulatory compartment, naïve T-regulatory cells increased. Within the B-cell compartment, memory B cells and mature B cells decreased, whereas transitional B cells increased. Within the NK cell compartment, CD56bright NK cells increased. Subjects without disease activity had a greater decrease in serum NfL and greater NK cell/CD3+ T cell ratio. NK cell numbers at baseline and after treatment influenced reconstitution of T and B cells, being inversely correlated with the reconstitution of proinflammatory CD3+ T cells and mature B cells, and directly correlated to the increase in transitional B cells. CONCLUSIONS The results of this study provide novel evidence that NK cells influence reconstitution of adaptive immune cells upon alemtuzumab and that patients with a successful response to alemtuzumab have an early immune reconstitution dominated by NK cells.
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Affiliation(s)
- Serena Palmeri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy.,University of Genova and IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Federico Ivaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Valentina Casella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerebrovascular Department, ASST Crema, Crema, Italy
| | - Tiziana Vigo
- IRRCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy.,IRRCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy. .,IRRCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
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17
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Cellerino M, Boffa G, Lapucci C, Tazza F, Sbragia E, Mancuso E, Bruschi N, Minguzzi S, Ivaldi F, Poirè I, Laroni A, Mancardi G, Capello E, Uccelli A, Novi G, Inglese M. Predictors of Ocrelizumab Effectiveness in Patients with Multiple Sclerosis. Neurotherapeutics 2021; 18:2579-2588. [PMID: 34553320 PMCID: PMC8457546 DOI: 10.1007/s13311-021-01104-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
Data regarding effectiveness and safety of ocrelizumab in the post-marking setting are lacking. The aim of our study was to provide effectiveness and safety data of ocrelizumab treatment in patients with relapsing-remitting (RR-) and progressive multiple sclerosis (PMS) and to evaluate clinical and immunological predictors of early treatment response. In this single-center prospective observational study, we investigated effectiveness outcomes (time-to-confirmed disability worsening, time-to-first relapse, time-to-first evidence of MRI activity and time-to-first evidence of disease activity), clinical and immunological predictors of early treatment response, and incidence of adverse events (AEs). One hundred and fifty-three subjects were included (93 RRMS; 84 females). Median follow-up was 1.9 (1.3-2.7). At 2-year follow-up (FU), disability worsening-free survival were 90.5%, 64.7%, and 68.8% for RRMS, primary-progressive MS (PPMS), and secondary-progressive MS (SPMS) patients, respectively. At 2-year FU, 67.1%, 72.7%, and 81.3% of patients with RRMS, PPMS, and SPMS were free of MRI activity, with NEDA-3 percentages of 62.1%, 54.6%, and 55.1%, respectively. Lower baseline EDSS was independently associated with a reduced risk of disability worsening (HR(95%CI) = 1.45(1.05-2.00), p = 0.024) and previous treatment exposure was independently associated with increased probability of radiological activity (HR = 2.53(1.05-6.10), p = 0.039). At 6-month FU, CD8 + cell decrease was less pronounced in patients with inflammatory activity (p = 0.022). Six patients (3.9%) discontinued ocrelizumab due to severe AEs. Our findings suggest that ocrelizumab is an effective treatment in real-world patients with RRMS and PMS, with a manageable safety profile. Better outcomes were observed in treatment-naïve patients and in patients with a low baseline disability level. Depletion of CD8 + cells could underlie early therapeutic effects of ocrelizumab.
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Affiliation(s)
- Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
- Laboratory of Experimental Neurosciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Elisabetta Mancuso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | | | - Federico Ivaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
| | - Ilaria Poirè
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
- Scientific Clinical Institutes Maugeri IRCCS, Pavia, Italy
| | | | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Giovanni Novi
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Largo Paolo Daneo 3, 16100, Genoa, Italy.
- Departments of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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18
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Moiola L, Zanetta C, Di Cristinzi M, Nozzolillo A, Rinaldi F, Brambilla L, Annovazzi P, Lus G, Puorro G, Frau J, Malucchi S, Bianco A, Lapucci C, Marfia G, Gallo A, Cerqua R, Cavalla P, Filippi M. Italian multicenter observational study on real-life experience with alemtuzumab in naïve patients with aggressive multiple sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Sormani MP, Inglese M, Schiavetti I, Carmisciano L, Laroni A, Lapucci C, Da Rin G, Serrati C, Gandoglia I, Tassinari T, Perego G, Brichetto G, Gazzola P, Mannironi A, Stromillo ML, Cordioli C, Landi D, Clerico M, Signoriello E, Frau J, Ferrò MT, Di Sapio A, Pasquali L, Ulivelli M, Marinelli F, Callari G, Iodice R, Liberatore G, Caleri F, Repice AM, Cordera S, Battaglia MA, Salvetti M, Franciotta D, Uccelli A. Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies. EBioMedicine 2021; 72:103581. [PMID: 34563483 PMCID: PMC8456129 DOI: 10.1016/j.ebiom.2021.103581] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [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: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In patients with Multiple Sclerosis (pwMS) disease-modifying therapies (DMTs) affects immune response to antigens. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response. METHODS We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARS-Cov-2 vaccination with mRNA vaccines (BNT162b2, Pfizer/BioNTech,Inc or mRNA-1273, Moderna Tx,Inc). A blood collection before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche-Diagnostics). The log-transform of the antibody levels was analyzed by multivariable linear regression. FINDINGS 780 pwMS (76% BNT162b2 and 24% mRNA-1273) had pre- and 4-week post-vaccination blood assessments. 87 (11·2%) were untreated, 154 (19·7%) on ocrelizumab, 25 (3·2%) on rituximab, 85 (10·9%) on fingolimod, 25 (3·2%) on cladribine and 404 (51·7%) on other DMTs. 677 patients (86·8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariable analysis, the antibody levels of patients on ocrelizumab (201-fold decrease (95%CI=128-317), p < 0·001), fingolimod (26-fold decrease (95%CI=16-42), p < 0·001) and rituximab (20-fold decrease (95%CI=10-43), p < 0·001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3·25-fold higher antibody level (95%CI=2·46-4·27) than with the BNT162b2 vaccine (p < 0·001). The antibody levels on anti-CD20 therapies correlated to the time since last infusion, and rituximab had longer intervals (mean=386 days) than ocrelizumab patients (mean=129 days). INTERPRETATION In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3·25-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those on the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. FUNDING FISM[2021/Special-Multi/001]; Italian Ministry of Health'Progetto Z844A 5 × 1000'.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Giorgio Da Rin
- Laboratory Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Serrati
- Department of Neurology, Imperia Hospital, Imperia, Italy
| | | | | | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese
| | | | | | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino Università di Torino
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST Crema
| | - Alessia Di Sapio
- Department of Neurology, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, via Armando Fabi, Frosinone, Italy
| | | | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Anna Maria Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy; Department of Life Sciences, University of Siena, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Diego Franciotta
- Autoimmunology Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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20
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Russo CV, Saccà F, Frau J, Annovazzi P, Signoriello E, Bonavita S, Grasso R, Clerico M, Cordioli C, Laroni A, Capobianco M, Torri Clerici V, Sartori A, Cavalla P, Maniscalco GT, La Gioia S, Caleri F, Giugno A, Iodice R, Carotenuto A, Cocco E, Fenu G, Zaffaroni M, Baroncini D, Lus G, Gallo A, De Mercanti SF, Lapucci C, Di Francescantonio V, Brambilla L, Sormani MP, Signori A. A real-world study of alemtuzumab in a cohort of Italian patients. Eur J Neurol 2021; 29:257-266. [PMID: 34558755 PMCID: PMC9293282 DOI: 10.1111/ene.15121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/02/2023]
Abstract
Background and purpose Real‐world data on alemtuzumab are limited and do not provide evidence of its effectiveness after various disease‐modifying therapies (DMTs). Our aim was to provide real‐world data on the impact of clinical variables and previous DMTs on clinical response to alemtuzumab. Methods Sixteen Italian multiple sclerosis centers retrospectively included patients who started alemtuzumab from January 2015 to December 2018, and recorded demographics, previous therapies, washout duration, relapses, Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging data. Negative binomial regression models were used to assess the effect of factors on annualized relapse (ARR) after alemtuzumab initiation. Results We studied 322 patients (mean age 36.8 years, median EDSS score 3, median follow‐up 1.94 years). Previous treatments were: fingolimod (106), natalizumab (80), first‐line oral agents (56), first‐line injectables (interferon/glatiramer acetate; 30), and other drugs (15). Thirty‐five patients were treatment‐naïve. The pre‐alemtuzumab ARR was 0.99 and decreased to 0.13 during alemtuzumab treatment (p < 0.001). The number of previous‐year relapses was associated with alemtuzumab ARR (adjusted risk ratio [RR] 1.38, p = 0.009). Progression‐free survival was 94.5% after 1 year, and 89.2% after 2 years of alemtuzumab treatment. EDSS score improvement occurred in 13.5% after 1 year, and 20.6% after 2 years. Re‐baselining patients after 6 months of alemtuzumab treatment, led to no evidence of disease activity status in 71.6% after 1 year and 58.9% after 2 years. Conclusions Alemtuzumab decreases ARR independent of previous therapy, including patients with disease activity during natalizumab treatment. Overall, 90% of patients showed no disease progression, and 20% an improvement after 2 years of alemtuzumab.
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Affiliation(s)
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Napoli, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | | | | | | | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, Torino, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy
| | - Alice Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Marco Capobianco
- SC Neurologia e Centro di Riferimento Regionale SM - AOU S. Luigi, Orbassano, Torino, Italy
| | - Valentina Torri Clerici
- Neuro-Immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milano, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy
| | - Paola Cavalla
- MS Center, City of Health & Science University Hospital, Torino, Italy
| | | | - Sara La Gioia
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Caleri
- Neurology Department, F. Tappeiner Hospital Meran (BZ) of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Alessia Giugno
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rosa Iodice
- NSRO Department, University of Naples Federico II, Napoli, Italy
| | | | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | - Giacomo Lus
- University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Antonio Gallo
- University of Campania "Luigi Vanvitelli", Napoli, Italy
| | | | - Caterina Lapucci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | | | - Laura Brambilla
- Neuro-Immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milano, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
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21
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Cellerino M, Priano L, Bruschi N, Boffa G, Petracca M, Novi G, Lapucci C, Sbragia E, Uccelli A, Inglese M. Relationship Between Retinal Layer Thickness and Disability Worsening in Relapsing-Remitting and Progressive Multiple Sclerosis. J Neuroophthalmol 2021; 41:329-334. [PMID: 33399416 DOI: 10.1097/wno.0000000000001165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data regarding the predictive value of optical coherence tomography (OCT)-derived measures are lacking, especially in progressive multiple sclerosis (PMS). Accordingly, we aimed at investigating whether a single OCT assessment can predict a disability risk in both relapsing-remitting MS (RRMS) and PMS. METHODS One hundred one patients with RRMS and 79 patients with PMS underwent Spectral-Domain OCT, including intraretinal layer segmentation. All patients had at least 1 Expanded Disability Status Scale (EDSS) measurement during the subsequent follow-up (FU). Differences in terms of OCT metrics and their association with FU disability were assessed by analysis of covariance and linear regression models, respectively. RESULTS The median FU was 2 years (range 1-5.5 years). The baseline peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell + inner plexiform layer (GCIPL) were thinner in PMS compared with RRMS (P = 0.02 and P = 0.003, respectively). In the RRMS population, multivariable models showed that the GCIPL significantly correlated with FU disability (0.04 increase in the EDSS for each 1-μm decrease in the baseline GCIPL, 95% confidence interval: 0.006-0.08; P = 0.02). The baseline GCIPL was thinner in patients with RRMS with FU-EDSS >4 compared with those with FU-EDSS ≤4, and individuals in the highest baseline GCIPL tertile had a significantly lower FU-EDSS score than those in the middle and lowest tertile (P = 0.01 and P = 0.001, respectively). These findings were not confirmed in analyses restricted to patients with PMS. CONCLUSIONS Among OCT-derived metrics, GCIPL thickness had the strongest association with short-medium term disability in patients with RRMS. The predictive value of OCT metrics in the longer term will have to be further investigated, especially in PMS.
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Affiliation(s)
- Maria Cellerino
- Department of Neuroscience (MC, LP, NB, GB, GN, CL, ES, AU, MI), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy ; Departments of Neurology (MP, MI), Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Neurology (AU, MI) Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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22
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Tazza F, Lapucci C, Cellerino M, Boffa G, Novi G, Poire I, Mancuso E, Bruschi N, Sbragia E, Laroni A, Capello E, Inglese M. Personalizing ocrelizumab treatment in Multiple Sclerosis: What can we learn from Sars-Cov2 pandemic? J Neurol Sci 2021; 427:117501. [PMID: 34044238 PMCID: PMC8133824 DOI: 10.1016/j.jns.2021.117501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/18/2021] [Revised: 04/25/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
During SARS-CoV-2 pandemic, we adopted a personalized delayed protocol for ocrelizumab infusions in Relapsing Remitting Multiple Sclerosis (RRMS) patients according to the national recommendations. Out of the 83 RRMS patients whose infusion was scheduled between March and December 2020, 56 patients experienced a delay in treatment based on MS severity and SARS-CoV2 infection risk profile. In most cases, the immunophenotype was performed monthly to guide re-infusions. Specifically, B CD19 + cells repopulation rate was monitored. Mean infusion delay was 103,1 [SD 40,6] days, and none of the patients presented relapses or active disease at MRI at the end of the observation period. Treatment naïve status and the interval between immunophenotyping and the last ocrelizumab infusion were predictors of earlier B CD19 + cells repopulation. Two patients contracted SARS-CoV2 with complete recovery. Definitive data about Sars-Cov2 vaccine efficacy in patients treated with ocrelizumab are still lacking. Our findings suggest that a personalized treatment with a delayed infusion schedule does not compromise ocrelizumab short-term efficacy and may help to lengthen the therapeutic window for an effective response to SARS-CoV2 vaccine.
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Affiliation(s)
- F Tazza
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Laboratory of Experimental Neurosciences, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - G Boffa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - G Novi
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - I Poire
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Mancuso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - N Bruschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - A Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Capello
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
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Affiliation(s)
- Alberto Coccia
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy.
| | - Caterina Lapucci
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Monica Bandettini di Poggio
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Matteo Grazzini
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Matilde Inglese
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Cinzia Finocchi
- Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genoa, Italy
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24
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Sbragia E, Colombo E, Pollio C, Cellerino M, Lapucci C, Inglese M, Mancardi G, Boffa G. Embracing resilience in multiple sclerosis: a new perspective from COVID-19 pandemic. PSYCHOL HEALTH MED 2021; 27:352-360. [PMID: 33899615 DOI: 10.1080/13548506.2021.1916964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in several psychological consequences. Past epidemiological experiences already showed the deep albeit heterogeneous psychological repercussions of pandemics. Nevertheless, little is known about COVID-19 outbreak and the possible strategies for boosting resilience in patients with chronic diseases such as Multiple Sclerosis (MS). Therefore, we designed a study aiming to assess the changes in mental distress during COVID-19 outbreak in patients with MS and to identifyfactors contributing to resilience's development.We enrolled 106 patients (69 relapsing-remitting, 20 secondary-progressive, and 17 primary-progressive) whose neuropsychological assessment before the COVID-19 pandemic (1 January 2019-1 March 2020) was available. It consisted of Brief International Cognitive Assessment for MS (BICAMS), Hospital Anxiety and Depression Scale (HADS) and patient-reported MS Neuropsychological Screening Questionnaire (MSNQ-P). All patients were re-tested during Italian lockdown through an online survey, comprehensive of sociodemographic information, HADS self-rating Scale, MSNQ-P Questionnaire and finally Connor-Davidson Resilience self-rating Scale (CD-RISC 25), in order to evaluate resilience.No significant changes in HADS and MSNQ-P scores were detected during COVID-19 pandemic in our population. Though, pre-existing lower HADS and MSNQ-P scores but not demographic, disease- and treatment-related elements were found significantly (p < 0.0001) and independently associated with a better resilience attitude.
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Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Eleonora Colombo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Chiara Pollio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy.,Scientific Clinical Institutes Maugeri IRCCS, Genova, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
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25
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Koudriavtseva T, Stefanile A, Fiorelli M, Lapucci C, Lorenzano S, Zannino S, Conti L, D'Agosto G, Pimpinelli F, Di Domenico EG, Mandoj C, Giannarelli D, Donzelli S, Blandino G, Salvetti M, Inglese M. Coagulation/Complement Activation and Cerebral Hypoperfusion in Relapsing-Remitting Multiple Sclerosis. Front Immunol 2020; 11:548604. [PMID: 33193314 PMCID: PMC7655134 DOI: 10.3389/fimmu.2020.548604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/03/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is a demyelinating disease of the central nervous system with an underlying immune-mediated and inflammatory pathogenesis. Innate immunity, in addition to the adaptive immune system, plays a relevant role in MS pathogenesis. It represents the immediate non-specific defense against infections through the intrinsic effector mechanism “immunothrombosis” linking inflammation and coagulation. Moreover, decreased cerebral blood volume (CBV), cerebral blood flow (CBF), and prolonged mean transit time (MTT) have been widely demonstrated by MRI in MS patients. We hypothesized that coagulation/complement and platelet activation during MS relapse, likely during viral infections, could be related to CBF decrease. Our specific aims are to evaluate whether there are differences in serum/plasma levels of coagulation/complement factors between relapsing-remitting (RR) MS patients (RRMS) in relapse and those in remission and healthy controls as well as to assess whether brain hemodynamic changes detected by MRI occur in relapse compared with remission. This will allow us to correlate coagulation status with perfusion and demographic/clinical features in MS patients. Materials and Methods This is a multi-center, prospective, controlled study. RRMS patients (1° group: 30 patients in relapse; 2° group: 30 patients in remission) and age/sex-matched controls (3° group: 30 subjects) will be enrolled in the study. Patients and controls will be tested for either coagulation/complement (C3, C4, C4a, C9, PT, aPTT, fibrinogen, factor II, VIII, and X, D-dimer, antithrombin, protein C, protein S, von-Willebrand factor), soluble markers of endothelial damage (thrombomodulin, Endothelial Protein C Receptor), antiphospholipid antibodies, lupus anticoagulant, complete blood count, viral serological assays, or microRNA microarray. Patients will undergo dynamic susceptibility contrast-enhanced MRI using a 3.0-T scanner to evaluate CBF, CBV, MTT, lesion number, and volume. Statistical Analysis ANOVA and unpaired t-tests will be used. The level of significance was set at p ≤ 0.05. Discussion Identifying a link between activation of coagulation/complement system and cerebral hypoperfusion could improve the identification of novel molecular and/or imaging biomarkers and targets, leading to the development of new effective therapeutic strategies in MS. Clinical Trial Registration Clinicaltrials.gov, identifier NCT04380220.
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Affiliation(s)
- Tatiana Koudriavtseva
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annunziata Stefanile
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Silvana Zannino
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanna D'Agosto
- Clinical Pathology and Microbiology Unit, IRCC San Gallicano Institute, Rome, Italy
| | - Fulvia Pimpinelli
- Clinical Pathology and Microbiology Unit, IRCC San Gallicano Institute, Rome, Italy
| | | | - Chiara Mandoj
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Biostatistics, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Donzelli
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience Mental Health and Sensory Organs (NEMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Carmisciano L, Signori A, Pardini M, Novi G, Lapucci C, Nesi L, Gallo E, Laroni A, Cellerino M, Meli R, Sbragia E, Filippi L, Uccelli A, Inglese M, Sormani MP. Assessing upper limb function in multiple sclerosis using an engineered glove. Eur J Neurol 2020; 27:2561-2567. [PMID: 32805743 DOI: 10.1111/ene.14482] [Citation(s) in RCA: 4] [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: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The importance of upper limb function in multiple sclerosis (MS) is increasingly recognized, especially for the evaluation of patients with progressive MS with reduced mobility. Two sensor-engineered gloves, able to measure quantitatively the timing of finger opposition movements, were previously used to assess upper limb disability in MS. The aims of the present study were: (1) to confirm the association between glove-derived variables and standard measures of MS disability in a larger cohort; (2) to assess the correlation with quantitative magnetic resonance imaging (MRI) and quality of life (QoL) measures; and (3) to determine if the glove-derived variables offer advantages over the standard measure for assessing upper limb function in MS, namely, the Nine-Hole Peg Test (9HPT). METHODS Sixty-five patients with MS, stable on disease-modifying treatment, were evaluated at baseline using the glove, and through clinical examination (Expanded Disability Status Scale, Symbol Digit Modalities Test, Timed 25-Foot Walk Test and 9HPT), MRI evaluation and QoL questionnaires. Correlations between the glove-derived variables and clinical, MRI and QoL variables were assessed using Spearman's rank correlation coefficient analysis. RESULTS Glove-derived variables significantly differed between patients with relapsing-remitting and those with progressive MS, with similar or slightly higher correlations of the 9HPT with clinical variables. We found greater correlations of the QoL physical component with glove-derived variables than with the 9HPT, and a significant correlation of its mental component with the glove-derived variables but not with the 9HPT. CONCLUSION The study results, confirming previous findings and showing advantages over the 9HPT, encourage the investigation of sensitivity to change in glove-derived variables in a longitudinal setting.
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Affiliation(s)
- L Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - G Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Nesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Gallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - R Meli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Filippi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - A Uccelli
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M Inglese
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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27
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Novi G, Bovis F, Fabbri S, Tazza F, Gazzola P, Maietta I, Currò D, Bruschi N, Roccatagliata L, Boffa G, Lapucci C, Pesce G, Cellerino M, Solaro C, Laroni A, Capello E, Mancardi G, Sormani M, Inglese M, Uccelli A. Tailoring B cell depletion therapy in MS according to memory B cell monitoring. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/5/e845. [PMID: 32753406 PMCID: PMC7413707 DOI: 10.1212/nxi.0000000000000845] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/05/2020] [Indexed: 11/15/2022]
Abstract
Objective We wanted to evaluate efficacy on inflammatory parameters of rituximab (RTX)-personalized reinfusion scheme using a memory B cell–based treatment regimen. Methods This is a prospective, uncontrolled, open-label study including patients with MS treated with RTX in 2 Italian MS units. All patients were treated with RTX induction, followed by maintenance infusion at the dosage of 375 mg/m2, according to memory B cell repopulation (0.05% of peripheral-blood mononuclear cells [PBMCs] for the first 2 years, 0.1% of PBMC for the third year). MS activity was assessed as clinical or MRI activity. Results One hundred two patients were included in the analysis. Mean follow-up was 2.40 years (range 0.57–7.15 years). The annualized relapse rate (ARR) was 0.67 in the year before RTX start and decreased to 0.01 in the 3 years after RTX initiation (global ARR). The proportion of patient with MS activity (i.e., relapse or MRI activity) was 63.16% in the year before RTX start and decreased to 8.7% (0–6 months), 1.3% (6–12 months), 0% (12–24 months), and 0% (24–36 months). Annualized RTX infusion rates were 1.67 (95% confidence interval [CI]: 1.43–1.94), 0.76 (95% CI: 0.58–0.98), and 0.78 (95% CI: 0.52–1.12) for the first 3 years after RTX initiation, respectively. Patients were reinfused with a mean infusion interval of 367 days (range 181–839 days). Conclusion The results of this study show that the memory B cell–based RTX reinfusion protocol is able to reduce the mean number of RTX reinfusions with persistent reduction of disease activity. Classification of evidence This study provides Class IV evidence that for patients with MS, a memory B cell–based RTX reinfusion protocol can reduce the mean number of RTX reinfusions with persistent reduction of disease activity.
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Affiliation(s)
- Giovanni Novi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy.
| | - Francesca Bovis
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Sabrina Fabbri
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Francesco Tazza
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Paola Gazzola
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Ilaria Maietta
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Daniela Currò
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Nicolò Bruschi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Luca Roccatagliata
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Giacomo Boffa
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Caterina Lapucci
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Giampaola Pesce
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Maria Cellerino
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Claudio Solaro
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Alice Laroni
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Elisabetta Capello
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Gianluigi Mancardi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Mariapia Sormani
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Matilde Inglese
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Antonio Uccelli
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
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Boffa G, Lapucci C, Sbragia E, Varaldo R, Raiola AM, Currò D, Roccatagliata L, Capello E, Laroni A, Mikulska M, Gualandi F, Uccelli A, Angelucci E, Mancardi GL, Inglese M. Aggressive multiple sclerosis: a single-centre, real-world treatment experience with autologous haematopoietic stem cell transplantation and alemtuzumab. Eur J Neurol 2020; 27:2047-2055. [PMID: 32418281 DOI: 10.1111/ene.14324] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/14/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE The best therapeutic approach for aggressive relapsing-remitting multiple sclerosis remains unknown. The objective was to compare the efficacy and safety of autologous haematopoietic stem cell transplantation (aHSCT) and alemtuzumab in aggressive relapsing-remitting multiple sclerosis. METHODS The time to first relapse, time to confirmed disability worsening, time to first evidence of magnetic resonance imaging (MRI) activity and time to first evidence of disease activity were compared between the two treatment groups. Secondary outcomes included the 12, 24 and 36 month annualized relapse rate (ARR) and the 6-month confirmed Expanded Disability Status Scale (EDSS) changes at months 12 and 24. RESULTS Fifty-seven patients treated with aHSCT (n = 25) or alemtuzumab (n = 32) were included. At baseline, aHSCT patients had a higher EDSS (median score 6 vs. 3; P < 0.001), higher ARR (mean ARR 3.2 vs. 1.7; P = 0.001) and a higher number of baseline T1 gadolinium-enhancing lesions on MRI (mean number 15.5 vs. 1.6; P < 0.001). NEDA-3 (no evidence of disease activity) status was more frequently achieved in aHSCT-treated patients than in alemtuzumab-treated patients [75% vs. 56% of patients at the end of the observation period; hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.08-0.84; P = 0.023]. aHSCT significantly reduced the risk of relapse (relapse-free survival 84% vs. 69%; HR 0.13, 95% CI 0.02-0.63; P = 0.012) and MRI activity (MRI-activity-free survival 85% vs. 59%; HR 0.13, 95% CI 0.03-0.59; P = 0.009). The ARR at 36 months was significantly lower in the aHSCT group (0.05 vs. 0.35, P = 0.02). A significant effect of aHSCT in promoting EDSS improvement compared with alemtuzumab was noted (P = 0.035). CONCLUSIONS Alemtuzumab and aHSCT are effective treatment choices for aggressive multiple sclerosis. aHSCT seems to be superior to alemtuzumab in inducing complete disease control and in promoting short-term disability improvement.
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Affiliation(s)
- G Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - R Varaldo
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - A M Raiola
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - D Currò
- Department of Neurology, San Paolo Hospital, Savona, Italy
| | - L Roccatagliata
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E Capello
- Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Division of Infectious Diseases, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - F Gualandi
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - A Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Angelucci
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - G L Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Scientific Clinical Institutes Maugeri IRCCS, Pavia - Genova Nervi, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Pardini M, Nobili F, Arnaldi D, Morbelli S, Bauckneht M, Rissotto R, Serrati C, Serafini G, Lapucci C, Ghio L, Amore M, Massucco D, Sassos D, Bonzano L, Mancardi GL, Roccatagliata L. 123I-FP-CIT SPECT validation of nigro-putaminal MRI tractography in dementia with Lewy bodies. Eur Radiol Exp 2020; 4:27. [PMID: 32363488 PMCID: PMC7196565 DOI: 10.1186/s41747-020-00153-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Assessment of nigrostriatal degeneration is a key element to discriminate between dementia with Lewy bodies (DLB) and Alzheimer disease (AD), and it is often evaluated using ioflupane (123I-FP-CIT) single-photon emission computed tomography (SPECT). Given the limited availability of 123I-FP-CIT SPECT, we evaluated if a mask-based approach to nigroputaminal magnetic resonance imaging (MRI) diffusion-weighted tractography could be able to capture microstructural changes reflecting nigroputaminal degeneration in DLB. Methods A nigroputaminal bundle mask was delineated on 12 healthy volunteers (HV) and applied to MRI diffusion-weighted data of 18 subjects with DLB, 21 subjects with AD and another group of 12 HV. The correlation between nigroputaminal fractional anisotropy (FA) values and 123I-FP-CIT SPECT findings was investigated. Shapiro-Wilk, ANOVA, ANCOVA, and parametric correlation statistics as well as receiver operating characteristic (ROC) analysis were used. Results DLB patients showed a higher nigroputaminal FA values compared with both AD and HV-controls groups (p = 0.001 for both comparisons), while no difference was observed between HV-controls and AD groups (p = 0.450); at ROC analysis, the area under the curve for the discriminating DLB and AD subjects was 0.820; FA values correlated with 123I-FP-CIT values (on the left, r = -0.670; on the right, r = -720). No significant differences were observed for the FA of the corticospinal tract across the three groups (p = 0.740). Conclusions In DLB, nigroputaminal degeneration could be reliably assessed on MRI diffusion scans using a mask of nigroputaminal bundle trajectory. Nigroputaminal FA in DLB patients correlated with 123I-FP-CIT values data may allow to differentiate these patients from AD patients and HV-controls.
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Affiliation(s)
- Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Silvia Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Carlo Serrati
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Lucio Ghio
- Psychiatry Branch, Galliera Hospital, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | | | - Davide Sassos
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
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Boffa G, Bruschi N, Cellerino M, Lapucci C, Novi G, Sbragia E, Capello E, Uccelli A, Inglese M. Fingolimod and Dimethyl-Fumarate-Derived Lymphopenia is not Associated with Short-Term Treatment Response and Risk of Infections in a Real-Life MS Population. CNS Drugs 2020; 34:425-432. [PMID: 32193826 DOI: 10.1007/s40263-020-00714-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND The association between treatment-related lymphopenia in multiple sclerosis, drug efficacy and the risk of infections is not yet fully understood. OBJECTIVE The objective of this study was to assess whether lymphopenia is associated with short-term treatment response and infection rate in a real-life multiple sclerosis population treated with fingolimod and dimethyl-fumarate. We assessed the associations between baseline absolute lymphocyte count and the lymphocyte mean percentage decrease at 6 and 12 months with treatment response and the occurrence of adverse events over 12 months in the entire cohort of patients and in the two treatment groups separately. METHODS This is a retrospective observational real-world study of patients with multiple sclerosis treated with fingolimod and dimethyl-fumarate at the MS Center of the University of Genoa between 2011 and 2018. Patients with at least 12 months of follow-up were eligible if [1] they had an Expanded Disability Status Scale assessment at baseline and 12 months after treatment onset, [2] they had undergone brain magnetic resonance imaging at baseline and after 12 months, and [3] absolute lymphocyte counts were available at baseline, 6 and 12 months. Patients shifting from dimethyl-fumarate to fingolimod or vice versa were excluded from the analysis. RESULTS In total, 137 and 75 patients treated with fingolimod and dimethyl-fumarate, respectively, were included in the analysis. At 12 months, fingolimod-treated patients were more likely to experience grade II and grade III lymphopenia compared with dimethyl-fumarate patients (p < 0.001, χ2 = 94) and had a higher lymphocyte mean percentage decrease (p < 0.001, U = 540). A higher number of previous therapies and a lower baseline absolute lymphocyte count were predictors of lymphopenia at 6 months (p = 0.047, odds ratio = 1.60 and p = 0.014, odds ratio = 1.1) and 12 months (p = 0.003, odds ratio = 1.97 and p = 0.023, odds ratio = 1.1). In fingolimod-treated patients only, female sex and a higher Expanded Disability Status Scale score were predictors of lymphopenia at 12 months (p = 0.006, odds ratio = 7.58 and p = 0.03, odds ratio = 1.56). Neither absolute lymphocyte count at 6 and 12 months nor the mean percentage decrease at 6 and 12 months predicted No Evidence of Disease Activity (NEDA-3) status at 1 year, the occurrence of relapses, disease activity on MRI or disability progression. CONCLUSIONS Our findings suggest that peripheral blood lymphocyte changes are not associated with short-term treatment response and with the rate of infections during fingolimod and dimethyl-fumarate treatment in real-world patients. Higher treatment exposure and a lower baseline absolute lymphocyte count are risk factors for lymphopenia development during fingolimod and dimethyl-fumarate therapy.
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Affiliation(s)
- Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanni Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisabetta Capello
- Ospedale Policlinico San Martino IRCCS, Largo Daneo 3, 16100, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Largo Daneo 3, 16100, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy. .,Ospedale Policlinico San Martino IRCCS, Largo Daneo 3, 16100, Genoa, Italy.
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Lapucci C, Romano N, Schiavi S, Saitta L, Uccelli A, Boffa G, Pardini M, Signori A, Castellan L, Inglese M, Roccatagliata L. Degree of microstructural changes within T1-SE versus T1-GE hypointense lesions in multiple sclerosis: relevance for the definition of "black holes". Eur Radiol 2020; 30:3843-3851. [PMID: 32162002 DOI: 10.1007/s00330-020-06761-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/08/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To retrospectively evaluate the different performances of T1-SE and T1-GE sequences in detecting hypointense lesions in multiple sclerosis (MS), to quantify the degree of microstructural damage within lesions and to correlate them with patient clinical status. METHODS Sixty clinically isolated syndrome (CIS) and MS patients underwent brain magnetic resonance imaging (MRI) on 1.5-T and 3-T scanners. We identified T2 fluid-attenuated inversion recovery hyperintense lesions with no hypointense signal on T1-SE/T1-GE (a), hypointense lesions only on T1-GE (b), and hypointense lesions on both T1-SE and T1-GE sequences (c). We compared mean lesion number (LN) and volume (LV) identified on T1-SE and T1-GE sequences, correlating them with Expanded Disability Status Scale (EDSS); fractional anisotropy (FA) and mean diffusivity (MD) values inside each lesion type were extracted and normal-appearing white matter (NAWM). RESULTS Thirty-five patients were female. Mean age was 39.2 (± 7.8); median EDSS was 3 (± 2). There were 23 CIS, 21 relapsing-remitting (RR), and 16 progressive MS. T1-GE and T1-SE LN and LV were significantly different (p < 0.001), both correlating with EDSS. Both FA and MD metrics resulted significantly different among the three lesion groups and NAWM (p < 0.001). FA and MD values extracted from (b) and (c) showed statistically significant differences (p < 0.001), while for (a) and (b), the differences were not significant (p = 0.31 for FA and p = 0.62 for MD). CONCLUSION T1-SE hypointense lesions demonstrated a more pronounced degree of microstructural damage. T1-weighted sequence type must be more carefully evaluated in clinical and research settings. KEY POINTS • T1-weighted spin-echo (T1-SE) images detect chronic hypointense lesions (so called black holes) associated with more severe microstructural changes. • In the last years, three-dimensional (3D) T1-weighted gradient-echo (T1-GE) sequences are often utilized in lieu of T1-SE acquisition, more so at 3 T or higher fields. • T1-weighted sequence type must be more carefully evaluated in clinical and research settings in the definition of "black holes" in MS, in order to avoid the overestimation of the effective severe tissue damage.
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Affiliation(s)
- Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
| | - Nicola Romano
- Department of Health Sciences (DISSAL) -Radiology Section, University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Computer Science, University of Verona, Verona, Italy
| | - Laura Saitta
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL) - Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Lucio Castellan
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL) -Radiology Section, University of Genoa, Genoa, Italy.,Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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32
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Cellerino M, Ivaldi F, Pardini M, Rotta G, Vila G, Bäcker-Koduah P, Berge T, Laroni A, Lapucci C, Novi G, Boffa G, Sbragia E, Palmeri S, Asseyer S, Høgestøl E, Campi C, Piana M, Inglese M, Paul F, Harbo HF, Villoslada P, Kerlero de Rosbo N, Uccelli A. Impact of treatment on cellular immunophenotype in MS: A cross-sectional study. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/3/e693. [PMID: 32139439 PMCID: PMC7136062 DOI: 10.1212/nxi.0000000000000693] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022]
Abstract
Objective To establish cytometry profiles associated with disease stages and immunotherapy in MS. Methods Demographic/clinical data and peripheral blood samples were collected from 227 patients with MS and 82 sex- and age-matched healthy controls (HCs) enrolled in a cross-sectional study at 4 European MS centers (Spain, Italy, Germany, and Norway). Flow cytometry of isolated peripheral blood mononuclear cells was performed in each center using specifically prepared antibody-cocktail Lyotubes; data analysis was centralized at the Genoa center. Differences in immune cell subsets were assessed between groups of untreated patients with relapsing-remitting or progressive MS (RRMS or PMS) and HCs and between groups of patients with RRMS taking 6 commonly used disease-modifying drugs. Results In untreated patients with MS, significantly higher frequencies of Th17 cells in the RRMS population compared with HC and lower frequencies of B-memory/B-regulatory cells as well as higher percentages of B-mature cells in patients with PMS compared with HCs emerged. Overall, the greatest deviation in immunophenotype in MS was observed by treatment rather than disease course, with the strongest impact found in fingolimod-treated patients. Fingolimod induced a decrease in total CD4+ T cells and in B-mature and B-memory cells and increases in CD4+ and CD8+ T-regulatory and B-regulatory cells. Conclusions Our highly standardized, multisite cytomics data provide further understanding of treatment impact on MS immunophenotype and could pave the way toward monitoring immune cells to help clinical management of MS individuals.
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Affiliation(s)
- Maria Cellerino
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Federico Ivaldi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Matteo Pardini
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Gianluca Rotta
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Gemma Vila
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Priscilla Bäcker-Koduah
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Tone Berge
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Alice Laroni
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Caterina Lapucci
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Giovanni Novi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Giacomo Boffa
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Serena Palmeri
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Susanna Asseyer
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Einar Høgestøl
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Cristina Campi
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Michele Piana
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Friedemann Paul
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Hanne F Harbo
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Pablo Villoslada
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Nicole Kerlero de Rosbo
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy
| | - Antonio Uccelli
- From the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (M.C., F.I., M.P., A.L., C.L., G.N., G.B., E.S., S.P., M.I., N.K.d.R.) and Center of Excellence for Biomedical Research (A.U.), University of Genoa, Italy; BD Biosciences Italy (G.R.), Milan; Institut d'Investigacions Biomediques August Pi Sunyer (G.V., P.V.), Barcelona, Spain; Charité Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine (P.B.-K., S.A., F.P.), Germany; Department of Research, Innovation and Education (T.B.), Neuroscience Research Unit, Oslo University Hospital; Department of Mechanical Electronics and Chemical Engineering (T.B.), Oslo Metropolitan University, Norway; University of Oslo (E.H., H.F.H.) and Oslo University Hospital (H.F.H.), Norway; Department of Mathematics and Padova Neuroscience Center (C.C.), University of Padua, Italy; Department of Mathematics (M.P.), University of Genoa, Italy; and IRCCS Ospedale Policlinico San Martino (A.L., M.P., M.I., A.U.), Genoa, Italy.
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Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Cellerino M, Cordano C, Boffa G, Bommarito G, Petracca M, Sbragia E, Novi G, Lapucci C, Capello E, Uccelli A, Inglese M. Relationship between retinal inner nuclear layer, age, and disease activity in progressive MS. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/5/e596. [PMID: 31454778 PMCID: PMC6705649 DOI: 10.1212/nxi.0000000000000596] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate whether inner nuclear layer (INL) thickness as assessed with optical coherence tomography differs between patients with progressive MS (P-MS) according to age and disease activity. METHODS In this retrospective longitudinal analysis, differences in terms of peripapillary retinal nerve fiber layer (pRNFL), ganglion cell layer + inner plexiform layer (GCIPL), INL and T1/T2 lesion volumes (T1LV/T2LV) were assessed between 84 patients with P-MS and 36 sex- and age-matched healthy controls (HCs) and between patients stratified according to age (cut-off: 51 years) and evidence of clinical/MRI activity in the previous 12 months RESULTS: pRNFL and GCIPL thickness were significantly lower in patients with P-MS than in HCs (p = 0.003 and p < 0.0001, respectively). INL was significantly thicker in patients aged < 51 years compared to the older ones and HCs (38.2 vs 36.5 and 36.7 μm; p = 0.038 and p = 0.04, respectively) and in those who presented MRI activity (new T2/gadolinium-enhancing lesions) in the previous 12 months compared to the ones who did not and HCs (39.5 vs 36.4 and 36.7 μm; p = 0.003 and p = 0.008, respectively). Recent MRI activity was significantly predicted by greater INL thickness (Nagelkerke R2 0.36, p = 0.001). CONCLUSIONS INL thickness was higher in younger patients with P-MS with recent MRI activity, a criterion used in previous studies to identify a specific subset of patients with P-MS who best responded to disease-modifying treatment. If this finding is confirmed, we suggest that INL thickness might be a useful tool in stratification of patients with P-MS for current and experimental treatment choice.
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Affiliation(s)
- Maria Cellerino
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Christian Cordano
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Giacomo Boffa
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Giulia Bommarito
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Maria Petracca
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Giovanni Novi
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Caterina Lapucci
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Elisabetta Capello
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Antonio Uccelli
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) (M.C., C.C., G. Boffa, G. Bommarito, E.S., G.N., C.L., A.U., M.I.), University of Genoa, Italy; Department of Neurology (C.C.), Multiple Sclerosis Center, University of California, San Francisco; Departments of Neurology, Radiology and Neuroscience (M.P., M.I.), Icahn School of Medicine at Mount Sinai, New York; and Ospedale Policlinico San Martino-IRCCS (E.C., A.U., M.I.), Genoa, Italy.
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Lapucci C, Benedetti L, Tavarelli C, Serrati C, Godani M, Schenone A, Franciotta D. "Limbic encephalitis with acute onset and Hu antibodies treated with rituximab: Paraneoplastic or non-paraneoplastic disorder?". Clin Neurol Neurosurg 2019; 184:105424. [PMID: 31330415 DOI: 10.1016/j.clineuro.2019.105424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022]
Abstract
Paraneoplastic limbic encephalitis (PLE) associated with Hu antibodies is a rare autoimmune disorder usually characterized by subacute onset of slowly progressive neurocognitive symptoms. Small cell lung carcinoma is the most frequent PLE-associated cancer, which negatively affects the prognosis of the disease. We report on a patient with acute onset of confusional state and disorganized speech. Cerebrospinal fluid analysis and brain MRI temporal lesions corroborated the diagnostic suspects toward infectious or autoimmune encephalitis but testing for onconeural antibodies suggested the alternative diagnosis of PLE, in the absence of cancer (total-body CT and PET were negative). The patient's serum was positive for Hu antibodies, thus leading to a diagnosis of PLE. First-line immunotherapies were ineffective on the neurocognitive symptoms, which improved after rituximab. Six months later, a retropharyngeal peri-jugular mass was histopathologically diagnosed as a metastasis of lung neuroendocrine tumor. Still clinically improved, the patient died from the oncological disease-related complications. Testing for onconeural antibodies should be considered in patients with clinico-radiological features of acute infectious or autoimmune encephalitis.
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Affiliation(s)
- C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genoa, Italy.
| | - L Benedetti
- Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - C Tavarelli
- Department of Neuroradiology, S. Andrea Hospital, La Spezia, Italy
| | - C Serrati
- Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Godani
- Department of Neurology, S. Andrea Hospital, La Spezia, Italy
| | - A Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genoa, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Lapucci C, Romano N, Boffa G, Saitta L, Nobili F, Mancardi G, Mandich P, Grandis M. E200k Familial Creutzfeldt-Jakob Disease Presenting with Subacute Multiple Cranial Neuropathy. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Unusual clinical presentations in patients with E200K familial Creutzfeldt-Jakob Disease (fCJD) have been rarely reported. Herein, we described a case of E200K fCJD presenting with subacute cranial multiple neuropathy, initially suspected to be paraneoplastic or due to a leptomeningeal carcinomatosis, considering the neoplastic comorbidity of the patient. Surprisingly, brain MRI was highly suggestive of CJD. Brain histological examination confirmed the diagnosis. Genetic tests led to the definite diagnosis of E200K fCJD. To the best of our knowledge, the current case provides the first report of a histologically-confirmed E200K fCJD starting with cranial multiple neuropathy and may widen the spectrum of the clinical variability of CJD, also in its genetic variant. Unusual presentations may lead, as in this case, to incorrect diagnostic hypothesis and unuseful therapeutic attempts in the first phase of the diagnostic process. Also in the genetic variant of CJD, brain MRI demonstrated a very high sensitivity to detect the typical abnormalities since the earliest phases of the disease.
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37
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Lapucci C, Boffa G, Massa F, Franciotta D, Castelletti L, Uccelli A, Morbelli S, Nobili F, Benedetti L, Roccatagliata L. Could arterial spin labelling perfusion imaging uncover the invisible in N-methyl-d-aspartate receptor encephalitis? Eur J Neurol 2019; 26:e86-e87. [PMID: 31099961 DOI: 10.1111/ene.13977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- C Lapucci
- DINOGMI, University of Genoa, Genoa, Italy
| | - G Boffa
- DINOGMI, University of Genoa, Genoa, Italy.,Neurology Department, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - F Massa
- DINOGMI, University of Genoa, Genoa, Italy.,Neurology Department, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS - Mondino Foundation, Pavia, Italy
| | - L Castelletti
- Neuroradiology Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - A Uccelli
- DINOGMI, University of Genoa, Genoa, Italy.,Neurology Department, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - S Morbelli
- DISSAL, University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - F Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,Neurology Department, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - L Benedetti
- Neurology Department, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - L Roccatagliata
- Neuroradiology Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,DISSAL, University of Genoa, Genoa, Italy
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38
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Boffa G, Lapucci C, Morbelli SD, Nobili FM. Two-way crossed cerebellar diaschisis in a clinically isolated syndrome suggestive of multiple sclerosis. Q J Nucl Med Mol Imaging 2019; 63:225-226. [PMID: 31089076 DOI: 10.23736/s1824-4785.19.03171-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The term diaschisis refers to a neural dysfunction manifesting in anatomically intact, but functionally related, brain regions distant from a primary lesion. Here we report the diaschisis phenomenon as a consequence of a first demyelinating event in the middle and superior cerebellar peduncles in both the ipsilateral cerebellar hemisphere and in the contralateral thalamus and cerebral cortex (two-way crossed cerebellar diaschisis), resulting in the simultaneous disruption of the afferent cortico-ponto-cerebellar pathway and the efferent cerebellar-thalamo-cortical pathway. The use of 18F-FDG-PET could help clarifying in vivo the distant pathophysiological effect of focal lesions in inflammatory diseases such as multiple sclerosis.
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Affiliation(s)
- Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy - .,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy -
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
| | - Silvia D Morbelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
| | - Flavio M Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
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39
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Cabona C, Beronio A, Martinelli I, Briani C, Lapucci C, Serrati C, Delucchi S, Mannironi A, Benedetti L. Are basketball players more likely to develop Hirayama disease? J Neurol Sci 2019; 400:142-144. [PMID: 30951991 DOI: 10.1016/j.jns.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/23/2018] [Revised: 02/21/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
Hirayama disease is a rare neurological disease affecting primarily men in the second to third decades. To date there are only few reports from Italy. We report the case of three young basketball players who presented with clinical, electrophysiological and MRI findings suggestive for Hirayama disease. Although the pathophysiology of the disease is still unknown, several hypotheses have been suggested and two of these are the disproportionate growth of cervical spine and cervical cord/roots during adolescence and the chronic traumatism. We think that, in our cases, the height of basketball players combined with the constant stress caused by the sport, could have contributed to the development of the Hirayama disease. With this report we would stress the importance to be careful to consider this pathology in order to avoid misdiagnosis predictive of poor prognosis in young patients.
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Affiliation(s)
- Corrado Cabona
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova and IRCCS, Policlinico San Martino, Genova, Italy.
| | | | | | - Chiara Briani
- Department of Neurosciences, University of Padova, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova and IRCCS, Policlinico San Martino, Genova, Italy
| | - Carlo Serrati
- Department of Neuroscience, Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova and IRCCS, Policlinico San Martino, Genova, Italy
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40
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Lapucci C, Baroncini D, Cellerino M, Boffa G, Callegari I, Pardini M, Novi G, Sormani MP, Mancardi GL, Ghezzi A, Zaffaroni M, Uccelli A, Inglese M, Roccatagliata L. Different MRI patterns in MS worsening after stopping fingolimod. Neurol Neuroimmunol Neuroinflamm 2019; 6:e566. [PMID: 31086807 PMCID: PMC6481223 DOI: 10.1212/nxi.0000000000000566] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/15/2022]
Abstract
Objective To analyze MRI images in patients with MS who experienced worsening of neurologic status (WNS) after stopping fingolimod (FTY). Methods In this retrospective study, demographic, clinical, and radiologic data of patients with MS who experienced WNS after stopping FTY were retrospectively collected. We introduced the "δExpanded Disability Status Scale (EDSS)-ratio" to identify patients who, after FTY withdrawal, showed an inflammatory flare-up exceeding the highest lifetime disease activity level. Patients with δEDSS-ratio > 1 were enrolled in the study. Results Eight patients were identified. The mean (SD) age of the 8 (7 female) patients was 35.3 (4.9) years. The mean FTY treatment duration was 3.1 (0.8) years. The mean FTY discontinuation-WNS interval was 4 (0.9) months. The 4 patients with δEDSS-ratio ≥ 2 developed severe monophasic WNS (EDSS score above 8.5), characterized by clinical features and MRI findings not typical of MS, which we classified as "tumefactive demyelination pattern" (TDL) and "Punctuated pattern" (PL). Conversely, patients whose δEDSS-ratio was between 1 and 2 had clinical features and brain MRI compatible with a more typical, even if aggressive, MS relapse. In patients with TDL and PL, the flare-up of inflammatory activity led to severe tissue damage resulting in T2 but also T1 lesion volume increase at 6-month follow-up. Conclusions Peculiar MRI features (TDL and PL), different from a typical MS flare-up, might occur in some patients who experienced WNS after stopping FTY. Further studies, also involving immunologic biomarkers, are necessary to investigate TDL or PL pathophysiology.
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Affiliation(s)
- Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Damiano Baroncini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Ilaria Callegari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giovanni Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Maria Pia Sormani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Angelo Ghezzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Mauro Zaffaroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics (C.L., M.C., G.B., M.P., G.N., G.L.M., A.U., M.I.), Maternal and Child Health (DiNOGMI), University of Genoa; Multiple Sclerosis Centre (D.B., A.G., M.Z.), Gallarate Hospital, ASST of Valle Olona, Gallarate; Department of Neurology (M.C., G.B., M.P., G.L.M., A.U.), Ospedale Policlinico San Martino-Sistema Sanitario Regione; Liguria -Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia; IRCCS Foundation C. Mondino National Neurological Institute (I.C.), Pavia; Department of Health Sciences (DISSAL) (M.P.S., L. R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Department of Radiology and Neuroscience (M.I.), Icahn School of Medicine at Mount Sinai, New York; and Department of Neuroradiology (L.R.), Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Bauckneht M, Capitanio S, Raffa S, Roccatagliata L, Pardini M, Lapucci C, Marini C, Sambuceti G, Inglese M, Gallo P, Cecchin D, Nobili F, Morbelli S. Molecular imaging of multiple sclerosis: from the clinical demand to novel radiotracers. EJNMMI Radiopharm Chem 2019; 4:6. [PMID: 31659498 PMCID: PMC6453990 DOI: 10.1186/s41181-019-0058-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Brain PET imaging with different tracers is mainly clinically used in the field of neurodegenerative diseases and brain tumors. In recent years, the potential usefulness of PET has also gained attention in the field of MS. In fact, MS is a complex disease and several processes can be selected as a target for PET imaging. The use of PET with several different tracers has been mainly evaluated in the research setting to investigate disease pathophysiology (i.e. phenotypes, monitoring of progression) or to explore its use a surrogate end-point in clinical trials. Results We have reviewed PET imaging studies in MS in humans and animal models. Tracers have been grouped according to their pathophysiological targets (ie. tracers for myelin kinetic, neuroinflammation, and neurodegeneration). The emerging clinical indication for brain PET imaging in the differential diagnosis of suspected tumefactive demyelinated plaques as well as the clinical potential provided by PET images in view of the recent introduction of PET/MR technology are also addressed. Conclusion While several preclinical and fewer clinical studies have shown results, full-scale clinical development programs are needed to translate molecular imaging technologies into a clinical reality that could ideally fit into current precision medicine perspectives.
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Affiliation(s)
- Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
| | - Selene Capitanio
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Stefano Raffa
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Clinica Neurologica, IRCCS Ospedale Policlinico, San Martino, Genoa, Italy
| | - Caterina Lapucci
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.,CNR Institute of Molecular Bioimaging and Physiology, Milan, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Matilde Inglese
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Clinica Neurologica, IRCCS Ospedale Policlinico, San Martino, Genoa, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences DNS, University of Padua, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, Padova University Hospital, Padua, Italy.,Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Clinica Neurologica, IRCCS Ospedale Policlinico, San Martino, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
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Lapucci C, Saitta L, Bommarito G, Sormani MP, Pardini M, Bonzano L, Mancardi GL, Gasperini C, Giorgio A, Inglese M, De Stefano N, Roccatagliata L. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? Neurology 2019; 92:e1739-e1744. [DOI: 10.1212/wnl.0000000000007266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/07/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied.MethodsIn this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes.ResultsCompared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL; p < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%).ConclusionsPVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis.Classification of evidenceThis study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.
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Lapucci C, Gualandi F, Mikulska M, Palmeri S, Mancardi G, Uccelli A, Laroni A. Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. Mult Scler Relat Disord 2018; 26:52-54. [PMID: 30223229 DOI: 10.1016/j.msard.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alemtuzumab is a monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS). The only report of Serum Sickness (SS) in a MS patient occurred during treatment with natalizumab. Non-protein drugs, such as some antibiotics, may induce "SS-like" reactions (SSLR), whose clinical and laboratory features may partially overlap with the traditional SS. OBJECTIVE To report a case of SS/SSLR in a RRMS patient treated with alemtuzumab. CASE REPORT A 42-year-old-woman with RRMS developed SS/SSLR in the first week after the first alemtuzumab treatment. Concomitant medications included trimethoprim-sulfamethoxazole at low dose. Intravenous methylprednisolone therapy led to clinical resolution and normalization of serum inflammatory markers. CONCLUSION SS/SSLR should be considered in patients treated with alemtuzumab developing delayed fever, rash and arthralgia and differentiated with Infusion Associated Reactions (IARs) and infections.
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Affiliation(s)
- C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | - F Gualandi
- Department of Hematology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - S Palmeri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - G Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - A Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Cordano C, Armezzani A, Veroni J, Pardini M, Sassos D, Infante MT, Tacchino A, Lapucci C, Cellerino M, Calabrò V, Ciullo L, Nourbakhsh B. Osteopathic Manipulative Therapy and Multiple Sclerosis: A Proof-of-Concept Study. J Osteopath Med 2018; 118:531-536. [PMID: 30073336 DOI: 10.7556/jaoa.2018.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Research on the effect of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) on chronic symptoms of multiple sclerosis (MS) is lacking. Objective To evaluate the effect of OMTh on chronic symptoms of MS. Methods Patients with MS who were evaluated at the neurology clinic at Genoa University in Italy were recruited for this study. Participants received 5 forty-minute MS health education sessions (control group) or 5 OMTh sessions (OMTh group). All participants completed a questionnaire that assessed their level of clinical disability, fatigue, depression, anxiety, and quality of life before the first session, 1 week after the final session, and 6 months after the final session. The Extended Disability Status Scale, a modified Fatigue Impact Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the 12-item Short Form Health Survey were used to assess clinical disability, fatigue, depression, anxiety, and quality of life, respectively. Results Twenty-two participants were included in the study (10 in the control group and 12 in the OMTh group). In the OMTh group, statistically significant improvements in fatigue and depression were found 1 week after the final session (P=.002 and P<.001, respectively). An increase in quality of life was also found in the OMTh group 1 week after the final session (P=.36). Conclusion Results demonstrate that OMTh should be considered in the treatment of patients with chronic symptoms of MS.
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Lapucci C, Capello E, Romano N, Guolo F, Mavilio N, Roccatagliata L. Rapidly ascending necrotizing myelopathy with widespread brain white matter involvement following intrathecal methotrexate and cytosine arabinoside treatment in an adult with T cell acute lymphoblastic leukemia. Neurol Sci 2018; 39:1637-1639. [DOI: 10.1007/s10072-018-3435-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/26/2018] [Indexed: 05/29/2023]
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Romano N, Zawaideh JP, Fischetti A, Lapucci C, Gennaro S, Muda A. Nerve ultrasound in emergency room: a case of traumatic ischiatic nerve neurotmesis. Med Ultrason 2018; 20:255-256. [PMID: 29730696 DOI: 10.11152/mu-1446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 22 years-old-man was admitted to emergency after trauma. He suffered multiple deep cuts on his left leg. A lesion of the ischiatic nerve was suspected, and an ultrasound (US) evaluation was requested to confirm it. The study was conducted in the emergency room using a linear ultrasound transducer of 6-15 MHz and demonstrated the completely truncation of the ischiatic nerve (neurotmesis - Sunderland Grade V) with the proximal end retracted up to about 3cm from the edge of the wound. It was a very useful information for the neurosurgeon who after performed an end-to-end neurorrhaphy with suturation of perineurium. This short report underlines the importance of US, that thanks to its high spatial resolution and its time- and cost-effectiveness, can be considered a very important tool for the physician in emergency room to characterize peripheral nerve lesions.
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Affiliation(s)
- Nicola Romano
- Department of Radiology, University of Genoa, Italy.
| | | | | | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
| | - Sergio Gennaro
- Department of Neurosurgery and Neurotraumatology, Polyclinic San Martino, Genoa.
| | - Alessandro Muda
- Department of Radiology, Polyclinic San Martino, Genoa, Italy.
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Novi G, Ghezzi A, Pizzorno M, Lapucci C, Bandini F, Annovazzi P, Mancardi GL, Uccelli A. Dramatic rebounds of MS during pregnancy following fingolimod withdrawal. Neurol Neuroimmunol Neuroinflamm 2017; 4:e377. [PMID: 28804745 PMCID: PMC5532747 DOI: 10.1212/nxi.0000000000000377] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Giovanni Novi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Angelo Ghezzi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Matteo Pizzorno
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Fabio Bandini
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Pietro Annovazzi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Giovanni L Mancardi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Antonio Uccelli
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
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Bonzano L, Sormani MP, Tacchino A, Abate L, Lapucci C, Mancardi GL, Uccelli A, Bove M. Quantitative assessment of finger motor impairment in multiple sclerosis. PLoS One 2013; 8:e65225. [PMID: 23741485 PMCID: PMC3669283 DOI: 10.1371/journal.pone.0065225] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 01/17/2013] [Accepted: 04/24/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To address the disability impact on fine hand motor functions in patients with Multiple Sclerosis (MS) by quantitatively measuring finger opposition movements, with the aim of providing a new “score” integrating current methods for disability assessment. Methods 40 MS patients (Expanded Disability Status Scale (EDSS): 0–7) and 80 healthy controls (HC) performed a repetitive finger-to-thumb opposition sequence with their dominant hand at spontaneous and maximal velocity, and uni- and bi-manually metronome-paced. A sensor-engineered glove was used to measure finger motor performance. Twenty-seven HC were tested twice, one month apart, to assess test-retest reliability. Results The motor parameters showed a good reproducibility in HC and demonstrated significantly worse performance in MS patients with respect to HC. A multivariate model revealed that rate of movement in the spontaneous velocity condition and inter-hand interval (IHI), indicating bimanual coordination, contributed independently to differentiate the two groups. A finger motor impairment score based on these two parameters was able to discriminate HC from MS patients with very low EDSS scores (p<0.001): a significant difference was already evident for patients with EDSS = 0. Further, in the MS group, some motor performance parameters correlated with the clinical scores. In particular, significant correlations were found between IHI and EDSS (r = 0.56; p<0.0001), MS Functional Composite (r = −0.40; p = 0.01), Paced Auditory Serial Addition (r = −0.38; p = 0.02). No motor performance parameter correlated with Timed 25-Foot Walk. Conclusions A simple, quantitative, objective method measuring finger motor performance could be used to define a score discriminating healthy controls and MS patients, even with very low disability. This sensitivity might be of crucial importance for monitoring the disease course and the treatment effects in early MS patients, when changes in the EDSS are small or absent.
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Affiliation(s)
- Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Biostatistics Unit, University of Genoa, Genoa, Italy
| | - Andrea Tacchino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Lucia Abate
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marco Bove
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
- * E-mail:
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Bertelli M, Cecchin S, Lorusso L, Sidoti V, Fabbri A, Lapucci C, Buda A, Pandolfo M. Identification of a novel mutation in the spastin gene (SPG4) in an Italian family with hereditary spastic paresis. Panminerva Med 2006; 48:193-7. [PMID: 17122756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hereditary spastic paraparesis (HSP) includes a heterogeneous group of neurodegenerative diseases characterised by progressive spasticity and hyper-reflexia of the lower limbs. Autosomal dominant HSP type 4 is the most common clinical form, accounting for about 40-50% of autosomal dominant HSP families. This form is due to mutation of the gene encoding spastin (SPG4), an ATP-ase associated with a variety of cellular function (AAA). Here we describe a novel missense mutation (1297T>C; 391L>P) in exon 8 of SPG4 gene, identified in 2 members (mother and son) of an Italian family with autosomal dominant HSP, clinically pure in the mother and complicated in the son. The mutation lies in a highly conserved AAA box domain between amino acids 342 and 599 in spastin sequence. In both patients, this novel mutation was associated with the absence of relatively common clinical characteristics, such as vibratory sensory deficit and loss of sphincter control, and partial temporal epilepsy, particularly in the son, with infantile onset, secondarily generalised and moderately severe neuropsychiatric symptoms.
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Affiliation(s)
- M Bertelli
- Mauro Baschirotto Institute for Rare Diseases, BIRD Foundation Onlus, Costozza (VI), Italy.
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Bertelli M, Cecchin S, Fabbri A, Lapucci C, Gasparini P. Exclusion of chromosome region 22q12.1-q12.3 as a second locus for Costello syndrome. Panminerva Med 2006; 48:145-6. [PMID: 16953153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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