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Dang X, Hanson BA, Orban ZS, Jimenez M, Suchy S, Koralnik IJ. Characterization of the brain virome in human immunodeficiency virus infection and substance use disorder. PLoS One 2024; 19:e0299891. [PMID: 38630782 PMCID: PMC11023569 DOI: 10.1371/journal.pone.0299891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/17/2024] [Indexed: 04/19/2024] Open
Abstract
Viruses can infect the brain in individuals with and without HIV-infection: however, the brain virome is poorly characterized. Metabolic alterations have been identified which predispose people to substance use disorder (SUD), but whether these could be triggered by viral infection of the brain is unknown. We used a target-enrichment, deep sequencing platform and bioinformatic pipeline named "ViroFind", for the unbiased characterization of DNA and RNA viruses in brain samples obtained from the National Neuro-AIDS Tissue Consortium. We analyzed fresh frozen post-mortem prefrontal cortex from 72 individuals without known viral infection of the brain, including 16 HIV+/SUD+, 20 HIV+/SUD-, 16 HIV-/SUD+, and 20 HIV-/SUD-. The average age was 52.3 y and 62.5% were males. We identified sequences from 26 viruses belonging to 11 viral taxa. These included viruses with and without known pathogenic potential or tropism to the nervous system, with sequence coverage ranging from 0.03 to 99.73% of the viral genomes. In SUD+ people, HIV-infection was associated with a higher total number of viruses, and HIV+/SUD+ compared to HIV-/SUD+ individuals had an increased frequency of Adenovirus (68.8 vs 0%; p<0.001) and Epstein-Barr virus (EBV) (43.8 vs 6.3%; p=0.037) as well as an increase in Torque Teno virus (TTV) burden. Conversely, in HIV+ people, SUD was associated with an increase in frequency of Hepatitis C virus, (25 in HIV+/SUD+ vs 0% in HIV+/SUD-; p=0.031). Finally, HIV+/SUD- compared to HIV-/SUD- individuals had an increased frequency of EBV (50 vs 0%; p<0.001) and an increase in TTV viral burden, but a decreased Adenovirus viral burden. These data demonstrate an unexpectedly high variety in the human brain virome, identifying targets for future research into the impact of these taxa on the central nervous system. ViroFind could become a valuable tool for monitoring viral dynamics in various compartments, monitoring outbreaks, and informing vaccine development.
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Affiliation(s)
- Xin Dang
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Barbara A. Hanson
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Zachary S. Orban
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Millenia Jimenez
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Stephen Suchy
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Birbeck GL, Mwenechanya M, Ume‐Ezeoke I, Mathews M, Bositis CM, Kalungwana L, Bearden D, Elafros M, Gelbard HA, Theodore WH, Koralnik IJ, Okulicz JF, Johnson BA, Musonda N, Siddiqi OK, Potchen MJ, Sikazwe I. Long-term outcomes after new onset seizure in children living with HIV: A cohort study. Epilepsia Open 2024; 9:750-757. [PMID: 38366961 PMCID: PMC10984287 DOI: 10.1002/epi4.12921] [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: 12/15/2023] [Revised: 01/17/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. METHODS Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. RESULTS Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. SIGNIFICANCE Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. PLAIN LANGUAGE SUMMARY This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.
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Affiliation(s)
- Gretchen L. Birbeck
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
- Chikankata Epilepsy Care TeamMazabukaZambia
| | | | | | - Manoj Mathews
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Christopher M. Bositis
- Department of Family and Community MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - David Bearden
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Melissa Elafros
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | | | | | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jason F. Okulicz
- Department of MedicineSan Antonio Military Medical CenterSan AntonioTexasUSA
| | - Brent A. Johnson
- Department of BiostatisticsUniversity of RochesterRochesterNew YorkUSA
| | - Namwiya Musonda
- University Teaching Hospitals Neurology Research OfficeLusakaZambia
| | - Omar K. Siddiqi
- University Teaching Hospitals Children's HospitalLusakaZambia
- Department of NeurologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Michael J. Potchen
- Department of Imaging SciencesUniversity of RochesterRochesterNew YorkUSA
- Zambian College of Medicine and SurgeryLusakaZambia
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Reid KJ, Ingram LT, Jimenez M, Orban ZS, Abbott SM, Grimaldi D, Knutson KL, Zee PC, Koralnik IJ, Maas MB. Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic. Sleep Adv 2024; 5:zpae002. [PMID: 38370438 PMCID: PMC10873785 DOI: 10.1093/sleepadvances/zpae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/27/2023] [Indexed: 02/20/2024]
Abstract
Introduction Fatigue, brain fog, and sleep disturbance are among the most common symptoms of postacute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality of life in patients with neurologic manifestations of PASC (Neuro-PASC). Methods Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH Toolbox cognitive tests, and 7 days of wrist actigraphy. Results The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p < 0.001), and later sleep midpoint (p = 0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with the severity of fatigue (p < 0.001), anxiety (p = 0.05), and depression (p < 0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency, and latency were associated with decreased performance in attention and processing speed. Conclusion Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.
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Affiliation(s)
- Kathryn J Reid
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Louis T Ingram
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zachary S Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Grimaldi
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L Knutson
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mathew B Maas
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Musukuma-Chifulo K, Ghebremichael M, Chilyabanyama ON, Bates M, Munsaka S, Simuyandi M, Chisenga C, Tembo J, Sinkala E, Koralnik IJ, Dang X, Chilengi R, Siddiqi OK. Characterizing Epstein-Barr virus infection of the central nervous system in Zambian adults living with HIV. J Neurovirol 2023; 29:706-712. [PMID: 37902948 DOI: 10.1007/s13365-023-01178-4] [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: 04/29/2023] [Revised: 09/20/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023]
Abstract
The significance of Epstein-Barr virus (EBV) detection in the cerebrospinal spinal fluid (CSF) in people living with HIV (PLWH) is not entirely understood. The detection of EBV DNA may represent active central nervous system (CNS) infection, reactivation in the setting of another CNS pathogen or due to impaired immunity, or detection of quiescent virus. We screened 470 adult PLWH in Zambia with neurological symptoms for the presence of EBV DNA in the CSF. We performed quantitative EBV PCR on the CSF and blood. We then performed quantitative EBV DNA PCR on the blood of controls with documented HIV viral suppression without CNS symptoms. The prevalence of EBV DNA in the CSF of patients with CNS symptoms was 28.9% (136/470). EBV DNA positivity was associated with younger age, shorter duration of HIV diagnosis, lower CSF glucose levels, higher CSF protein and white blood cell levels, and a positive CSF Mycobacterium tuberculosis result. The median EBV DNA load was 8000 cps/mL in both the CSF and blood with a range of 2000-2,753,000 cps/mL in the CSF and 1000 to 1,871,000 cps/mL in the blood. Molecular screening of CSF for other possible causes of infection identified Mycobacterium tuberculosis in 30.1% and cytomegalovirus (CMV) in 10.5% of samples. EBV DNA load in the blood and CSF was not associated with mortality. Our results suggest that even though EBV DNA was commonly detected in the CSF of our population, it appears to have limited clinical significance regardless of EBV DNA load.
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Affiliation(s)
- Kalo Musukuma-Chifulo
- Department of Biomedical Sciences, School of Health Sciences, The University of Zambia, Lusaka, Zambia.
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
| | - Musie Ghebremichael
- Harvard Medical School and Ragon Institute of Mass General, MIT and Harvard, Boston, MA, USA
| | | | - Matthew Bates
- HerpeZ, University Teaching Hospital, Lusaka, Zambia
- School of Life & Environmental Sciences, University of Lincoln, Lincoln, UK
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, The University of Zambia, Lusaka, Zambia
| | | | | | - John Tembo
- HerpeZ, University Teaching Hospital, Lusaka, Zambia
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Igor J Koralnik
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Xin Dang
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Roma Chilengi
- Zambia National Public Health Institute, Ministry of Health, 10101, Lusaka, Zambia
| | - Omar K Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Center for Vaccines and Virology Research, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Orban ZS, Visvabharathy L, Perez Giraldo GS, Jimenez M, Koralnik IJ. SARS-CoV-2-Specific Immune Responses in Patients With Postviral Syndrome After Suspected COVID-19. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200159. [PMID: 37612134 PMCID: PMC10448973 DOI: 10.1212/nxi.0000000000200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND OBJECTIVES Millions of Americans were exposed to SARS-CoV-2 early in the pandemic but could not get diagnosed with COVID-19 due to testing limitations. Many have developed a postviral syndrome (PVS) including neurologic manifestations similar to those with postacute sequelae of SARS-CoV-2 infection (Neuro-PASC). Owing to those circumstances, proof of SARS-CoV-2 infection was not required for evaluation at Northwestern Medicine's Neuro COVID-19 clinic. We sought to investigate clinical and immunologic findings suggestive of SARS-CoV-2 exposure in patients with PVS. METHODS We measured SARS-CoV-2-specific humoral and cell-mediated immune responses against Nucleocapsid and Spike proteins in 29 patients with PVS after suspected COVID-19, 32 confirmed age-matched/sex-matched Neuro-PASC (NP) patients, and 18 unexposed healthy controls. Neurologic symptoms and signs, comorbidities, quality of life, and cognitive testing data collected during clinic visits were studied retrospectively. RESULTS Of 29 patients with PVS, 12 (41%) had detectable humoral or cellular immune responses consistent with prior exposure to SARS-CoV-2. Of 12 PVS responders (PVS+), 75% harbored anti-Nucleocapsid and 50% harbored anti-Spike responses. Patients with PVS+ had similar neurologic symptoms as patients with NP, but clinic evaluation occurred 5.3 months later from the time of symptom onset (10.7 vs 5.4 months; p = 0.0006). Patients with PVS+ and NP had similar subjective impairments in quality of life measures including cognitive function and fatigue. Patients with PVS+ had similar results in objective cognitive measures of processing speed, attention, and executive function and better results in working memory than patients with NP. DISCUSSION Antibody and T-cell assays showed evidence of prior SARS-CoV-2 exposure in approximately 40% of the PVS group. Three-quarters of patients with PVS+ had detectable anti-Nucleocapsid and one-half anti-Spike responses, highlighting the importance of multitargeted COVID-19 immunologic evaluation and the limitations of commercially available diagnostic tests. Despite their persistent symptoms, lack of COVID-19 diagnosis likely delayed clinical care in patients with PVS. Our data suggest that millions of Americans presenting with PVS resembling Neuro-PASC were indeed exposed to SARS-CoV-2 at the beginning of the pandemic, and they deserve the same access to care and inclusion in research studies as patients with NP with confirmed COVID-19 diagnosis.
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Affiliation(s)
- Zachary S Orban
- From the Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lavanya Visvabharathy
- From the Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gina S Perez Giraldo
- From the Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Millenia Jimenez
- From the Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Igor J Koralnik
- From the Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Hanson BA, Visvabharathy L, Orban ZS, Jimenez M, Batra A, Liotta EM, DeLisle RK, Klausner JD, Cohen P, Padhye AS, Tachas G, Koralnik IJ. Plasma proteomics show altered inflammatory and mitochondrial proteins in patients with neurologic symptoms of post-acute sequelae of SARS-CoV-2 infection. Brain Behav Immun 2023; 114:462-474. [PMID: 37704012 PMCID: PMC10718560 DOI: 10.1016/j.bbi.2023.08.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/17/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
Persistent symptoms of COVID-19 survivors constitute long COVID syndrome, also called post-acute sequelae of SARS-CoV-2 infection (PASC). Neurologic manifestations of PASC (Neuro-PASC) are particularly debilitating, long lasting, and poorly understood. To gain insight into the pathogenesis of PASC, we leveraged a well-characterized group of Neuro-PASC (NP) patients seen at our Neuro-COVID-19 clinic who had mild acute COVID-19 and never required hospitalization to investigate their plasma proteome. Using the SomaLogic platform, SomaScan, the plasma concentration of >7000 proteins was measured from 92 unvaccinated individuals, including 48 NP patients, 20 COVID-19 convalescents (CC) without lingering symptoms, and 24 unexposed healthy controls (HC) to interrogate underlying pathobiology and potential biomarkers of PASC. We analyzed the plasma proteome based on post-COVID-19 status, neurologic and non-neurologic symptoms, as well as subjective and objective standardized tests for changes in quality-of-life (QoL) and cognition associated with Neuro-PASC. The plasma proteome of NP patients differed from CC and HC subjects more substantially than post-COVID-19 groups (NP and CC combined) differed from HC. Proteomic differences in NP patients 3-9 months following acute COVID-19 showed alterations in inflammatory proteins and pathways relative to CC and HC subjects. Proteomic associations with Neuro-PASC symptoms of brain fog and fatigue included changes in markers of DNA repair, oxidative stress, and neutrophil degranulation. Furthermore, we discovered a correlation between NP patients lower subjective impression of recovery to pre-COVID-19 baseline with an increase in the concentration of the oxidative phosphorylation protein COX7A1, which was also associated with neurologic symptoms and fatigue, as well as impairment in QoL and cognitive dysfunction. Finally, we identified other oxidative phosphorylation-associated proteins correlating with central nervous system symptoms. Our results suggest ongoing inflammatory changes and mitochondrial involvement in Neuro-PASC and pave the way for biomarker validation for use in monitoring and development of therapeutic intervention for this debilitating condition.
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Affiliation(s)
- Barbara A Hanson
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Zachary S Orban
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Millenia Jimenez
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ayush Batra
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eric M Liotta
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Pinchas Cohen
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | | | - George Tachas
- Antisense Therapeutics Limited, Toorak, Victoria, Australia
| | - Igor J Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Batra A, Nath A, Koralnik IJ. Postacute Sequelae of SARS-CoV-2 Infection. JAMA 2023; 330:1491-1492. [PMID: 37847279 DOI: 10.1001/jama.2023.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Ayush Batra
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Igor J Koralnik
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Visvabharathy L, Hanson BA, Orban ZS, Lim PH, Palacio NM, Jimenez M, Clark JR, Graham EL, Liotta EM, Tachas G, Penaloza-MacMaster P, Koralnik IJ. Corrigendum: Neuro-PASC is characterized by enhanced CD4+ and diminished CD8+ T cell responses to SARSCoV-2 Nucleocapsid protein. Front Immunol 2023; 14:1275925. [PMID: 37691950 PMCID: PMC10484630 DOI: 10.3389/fimmu.2023.1275925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1155770.].
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Affiliation(s)
- Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A. Hanson
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Zachary S. Orban
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Patrick H. Lim
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Nicole M. Palacio
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Millenia Jimenez
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jeffrey R. Clark
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Edith L. Graham
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eric M. Liotta
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - George Tachas
- Drug Discovery & Patents, Antisense Therapeutics Ltd., Melbourne, VIC, Australia
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Giraldo GSP, Ali ST, Kang AK, Patel TR, Budhiraja S, Gaelen JI, Lank GK, Clark JR, Mukherjee S, Singer T, Venkatesh A, Orban ZS, Lim PH, Jimenez M, Miller J, Taylor C, Szymanski AL, Scarpelli J, Graham EL, Balabanov RD, Barcelo BE, Cahan JG, Ruckman K, Shepard AG, Slutzky MW, LaFaver K, Kumthekar PU, Shetty NK, Carroll KS, Ho SU, Lukas RV, Batra A, Liotta EM, Koralnik IJ. Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity. Ann Neurol 2023; 94:146-159. [PMID: 36966460 PMCID: PMC10724021 DOI: 10.1002/ana.26649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. METHODS Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. RESULTS PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. INTERPRETATION PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.
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Affiliation(s)
- Gina S. Perez Giraldo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sareen T. Ali
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony K. Kang
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tulsi R. Patel
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Budhiraja
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jordan I. Gaelen
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace K. Lank
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey R. Clark
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Mukherjee
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey Singer
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aditi Venkatesh
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zachary S. Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick H. Lim
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Janet Miller
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carolyn Taylor
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - April L Szymanski
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica Scarpelli
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edith L. Graham
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roumen D. Balabanov
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bianca E. Barcelo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua G. Cahan
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kaitlyn Ruckman
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alan G. Shepard
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marc W. Slutzky
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathrin LaFaver
- Saratoga Hospital Medical Group, Neurology, Saratoga Springs, NY
| | - Priya U. Kumthekar
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neil K. Shetty
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine S. Carroll
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sam U. Ho
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rimas V. Lukas
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ayush Batra
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric M. Liotta
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Igor J. Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Visvabharathy L, Hanson BA, Orban ZS, Lim PH, Palacio NM, Jimenez M, Clark JR, Graham EL, Liotta EM, Tachas G, Penaloza-MacMaster P, Koralnik IJ. Neuro-PASC is characterized by enhanced CD4+ and diminished CD8+ T cell responses to SARS-CoV-2 Nucleocapsid protein. Front Immunol 2023; 14:1155770. [PMID: 37313412 PMCID: PMC10258318 DOI: 10.3389/fimmu.2023.1155770] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Many people with long COVID symptoms suffer from debilitating neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC). Although symptoms of Neuro-PASC are widely documented, it is still unclear whether PASC symptoms impact virus-specific immune responses. Therefore, we examined T cell and antibody responses to SARS-CoV-2 Nucleocapsid protein to identify activation signatures distinguishing Neuro-PASC patients from healthy COVID convalescents. Results We report that Neuro-PASC patients exhibit distinct immunological signatures composed of elevated CD4+ T cell responses and diminished CD8+ memory T cell activation toward the C-terminal region of SARS-CoV-2 Nucleocapsid protein when examined both functionally and using TCR sequencing. CD8+ T cell production of IL-6 correlated with increased plasma IL-6 levels as well as heightened severity of neurologic symptoms, including pain. Elevated plasma immunoregulatory and reduced pro-inflammatory and antiviral response signatures were evident in Neuro-PASC patients compared with COVID convalescent controls without lasting symptoms, correlating with worse neurocognitive dysfunction. Discussion We conclude that these data provide new insight into the impact of virus-specific cellular immunity on the pathogenesis of long COVID and pave the way for the rational design of predictive biomarkers and therapeutic interventions.
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Affiliation(s)
- Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A. Hanson
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Zachary S. Orban
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Patrick H. Lim
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Nicole M. Palacio
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Millenia Jimenez
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jeffrey R. Clark
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Edith L. Graham
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eric M. Liotta
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - George Tachas
- Drug Discovery & Patents, Antisense Therapeutics Ltd., Melbourne, VIC, Australia
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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11
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Bailey J, Lavelle B, Miller J, Jimenez M, Lim PH, Orban ZS, Clark JR, Tomar R, Ludwig A, Ali ST, Lank GK, Zielinski A, Mylvaganam R, Kalhan R, Muayed ME, Mutharasan RK, Liotta EM, Sznajder JI, Davidson C, Koralnik IJ, Sala MA. Multidisciplinary Center Care for Long COVID Syndrome - a Retrospective Cohort Study. Am J Med 2023:S0002-9343(23)00328-5. [PMID: 37220832 DOI: 10.1016/j.amjmed.2023.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 02/02/2023] [Revised: 04/17/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Persistent multi-organ symptoms after COVID-19 have been termed "long COVID" or "post-acute sequelae of SARS-CoV-2 infection" (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers. METHODS We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19. RESULTS We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results. CONCLUSIONS The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.
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Affiliation(s)
- Joseph Bailey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University.
| | - Bianca Lavelle
- McGaw Medical Center, Northwestern University Feinberg School of Medicine
| | - Janet Miller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Millenia Jimenez
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Patrick H Lim
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Zachary S Orban
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Jeffrey R Clark
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Ria Tomar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Amy Ludwig
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Sareen T Ali
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Grace K Lank
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Allison Zielinski
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Ruben Mylvaganam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Malek El Muayed
- Division of Endocrinology, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - R Kannan Mutharasan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Eric M Liotta
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Jacob I Sznajder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Charles Davidson
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University
| | - Igor J Koralnik
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Marc A Sala
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University
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12
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Visvabharathy L, Zhu C, Orban ZS, Yarnoff K, Palacio N, Jimenez M, Lim PH, Penaloza-MacMaster P, Koralnik IJ. Autoantibody production is enhanced after mild SARS-CoV-2 infection despite vaccination in individuals with and without long COVID. medRxiv 2023:2023.04.07.23288243. [PMID: 37090595 PMCID: PMC10120795 DOI: 10.1101/2023.04.07.23288243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Long COVID patients who experienced severe acute SARS-CoV-2 infection can present with humoral autoimmunity. However, whether mild SARS-CoV-2 infection increases autoantibody responses and whether vaccination can decrease autoimmunity in long COVID patients is unknown. Here, we demonstrate that mild SARS-CoV-2 infection increases autoantibodies associated with systemic lupus erythematosus (SLE) and inflammatory myopathies in long COVID patients with persistent neurologic symptoms to a greater extent than COVID convalescent controls at 8 months post-infection. Furthermore, high titers of SLE-associated autoantibodies in long COVID patients are associated with impaired cognitive performance and greater symptom severity, and subsequent vaccination/booster does not decrease autoantibody titers. In summary, we found that mild SARS-CoV-2 infection can induce persistent humoral autoimmunity in both long COVID patients and healthy COVID convalescents, suggesting that a reappraisal of vaccination and mitigation strategies is warranted.
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Affiliation(s)
- L Visvabharathy
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - C Zhu
- Genomics and Microarray Core Facility, University of Texas Southwestern Medical Center
| | - ZS Orban
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - K Yarnoff
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - N Palacio
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University
| | - M Jimenez
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - PH Lim
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - P Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University
| | - IJ Koralnik
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University
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13
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Dangi T, Sanchez S, Lew MH, Awakoaiye B, Visvabharathy L, Richner JM, Koralnik IJ, Penaloza-MacMaster P. Pre-existing immunity modulates responses to mRNA boosters. Cell Rep 2023; 42:112167. [PMID: 36857186 PMCID: PMC9928730 DOI: 10.1016/j.celrep.2023.112167] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/08/2022] [Revised: 12/19/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
mRNA vaccines are effective in preventing severe COVID-19, but breakthrough infections, emerging variants, and waning immunity warrant the use of boosters. Although mRNA boosters are being implemented, the extent to which pre-existing immunity influences the efficacy of boosters remains unclear. In a cohort of individuals primed with the mRNA-1273 or BNT162b2 vaccines, we report that lower antibody levels before boost are associated with higher fold-increase in antibody levels after boost, suggesting that pre-existing antibody modulates the immunogenicity of mRNA vaccines. Our studies in mice show that pre-existing antibodies accelerate the clearance of vaccine antigen via Fc-dependent mechanisms, limiting the amount of antigen available to prime B cell responses after mRNA boosters. These data demonstrate a "tug of war" between pre-existing antibody responses and de novo B cell responses following mRNA vaccination, and they suggest that transient downmodulation of antibody effector function may improve the efficacy of mRNA boosters.
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Affiliation(s)
- Tanushree Dangi
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sarah Sanchez
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Min Han Lew
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Bakare Awakoaiye
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Justin M Richner
- Department of Microbiology and Immunology, University of Illinois Chicago College of Medicine, Chicago, IL 60612, USA
| | - Igor J Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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14
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Hatchwell E, Smith EB, Jalilzadeh S, Bruno CD, Taoufik Y, Hendel-Chavez H, Liblau R, Brassat D, Martin-Blondel G, Wiendl H, Schwab N, Cortese I, Monaco MC, Imberti L, Capra R, Oksenberg JR, Gasnault J, Stankoff B, Richmond TA, Rancour DM, Koralnik IJ, Hanson BA, Major EO, Chow CR, Eis PS. Progressive multifocal leukoencephalopathy genetic risk variants for pharmacovigilance of immunosuppressant therapies. Front Neurol 2022; 13:1016377. [PMID: 36588876 PMCID: PMC9795231 DOI: 10.3389/fneur.2022.1016377] [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: 08/10/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) is a rare and often lethal brain disorder caused by the common, typically benign polyomavirus 2, also known as JC virus (JCV). In a small percentage of immunosuppressed individuals, JCV is reactivated and infects the brain, causing devastating neurological defects. A wide range of immunosuppressed groups can develop PML, such as patients with: HIV/AIDS, hematological malignancies (e.g., leukemias, lymphomas, and multiple myeloma), autoimmune disorders (e.g., psoriasis, rheumatoid arthritis, and systemic lupus erythematosus), and organ transplants. In some patients, iatrogenic (i.e., drug-induced) PML occurs as a serious adverse event from exposure to immunosuppressant therapies used to treat their disease (e.g., hematological malignancies and multiple sclerosis). While JCV infection and immunosuppression are necessary, they are not sufficient to cause PML. Methods We hypothesized that patients may also have a genetic susceptibility from the presence of rare deleterious genetic variants in immune-relevant genes (e.g., those that cause inborn errors of immunity). In our prior genetic study of 184 PML cases, we discovered 19 candidate PML risk variants. In the current study of another 152 cases, we validated 4 of 19 variants in both population controls (gnomAD 3.1) and matched controls (JCV+ multiple sclerosis patients on a PML-linked drug ≥ 2 years). Results The four variants, found in immune system genes with strong biological links, are: C8B, 1-57409459-C-A, rs139498867; LY9 (alias SLAMF3), 1-160769595-AG-A, rs763811636; FCN2, 9-137779251-G-A, rs76267164; STXBP2, 19-7712287-G-C, rs35490401. Carriers of any one of these variants are shown to be at high risk of PML when drug-exposed PML cases are compared to drug-exposed matched controls: P value = 3.50E-06, OR = 8.7 [3.7-20.6]. Measures of clinical validity and utility compare favorably to other genetic risk tests, such as BRCA1 and BRCA2 screening for breast cancer risk and HLA-B*15:02 pharmacogenetic screening for pharmacovigilance of carbamazepine to prevent Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Conclusion For the first time, a PML genetic risk test can be implemented for screening patients taking or considering treatment with a PML-linked drug in order to decrease the incidence of PML and enable safer use of highly effective therapies used to treat their underlying disease.
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Affiliation(s)
- Eli Hatchwell
- Population Bio UK, Inc., Oxfordshire, United Kingdom,*Correspondence: Eli Hatchwell
| | | | | | | | - Yassine Taoufik
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Saclay and INSERM 1186, Institut Gustave Roussy, Villejuif, France
| | - Houria Hendel-Chavez
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Saclay and INSERM 1186, Institut Gustave Roussy, Villejuif, France
| | - Roland Liblau
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Immunology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - David Brassat
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Immunology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - Guillaume Martin-Blondel
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Infectious and Tropical Diseases, Toulouse University Hospital Center, Toulouse, France
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nicholas Schwab
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Maria Chiara Monaco
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Luisa Imberti
- Centro di Ricerca Emato-Oncologica AIL (CREA) and Diagnostic Department, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ruggero Capra
- Lombardia Multiple Sclerosis Network, Brescia, Italy
| | - Jorge R. Oksenberg
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jacques Gasnault
- Department of Internal Medicine, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Bruno Stankoff
- Department of Neurology, Hôpital Saint-Antoine, Paris, France
| | | | | | - Igor J. Koralnik
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A. Hanson
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugene O. Major
- Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | | | - Peggy S. Eis
- Population Bio, Inc., New York, NY, United States,Peggy S. Eis
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15
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Dangi T, Sanchez S, Class J, Richner M, Visvabharathy L, Chung YR, Bentley K, Stanton RJ, Koralnik IJ, Richner JM, Penaloza-MacMaster P. Improved control of SARS-CoV-2 by treatment with a nucleocapsid-specific monoclonal antibody. J Clin Invest 2022; 132:162282. [PMID: 36219482 PMCID: PMC9711872 DOI: 10.1172/jci162282] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein is the main antigen in all approved COVID-19 vaccines and is also the only target for monoclonal antibody (mAb) therapies. Immune responses to other viral antigens are generated after SARS-CoV-2 infection, but their contribution to the antiviral response remains unclear. Here, we interrogated whether nucleocapsid-specific antibodies can improve protection against SARS-CoV-2. We first immunized mice with a nucleocapsid-based vaccine and then transferred sera from these mice into naive mice, followed by challenge with SARS-CoV-2. We show that mice that received nucleocapsid-specific sera or a nucleocapsid-specific mAb exhibited enhanced control of SARS-CoV-2. Nucleocapsid-specific antibodies elicited NK-mediated, antibody-dependent cellular cytotoxicity (ADCC) against infected cells. To our knowledge, these findings provide the first demonstration in the coronavirus literature that antibody responses specific to the nucleocapsid protein can improve viral clearance, providing a rationale for the clinical evaluation of nucleocapsid-based mAb therapies to treat COVID-19.
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Affiliation(s)
- Tanushree Dangi
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Sanchez
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacob Class
- Department of Microbiology and Immunology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Michelle Richner
- Department of Microbiology and Immunology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Young Rock Chung
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kirsten Bentley
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Richard J Stanton
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Igor J Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justin M Richner
- Department of Microbiology and Immunology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Pablo Penaloza-MacMaster
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Adrissi J, Chomba M, Chishimba L, Zimba S, Koralnik IJ, Saylor D. The case of a 42-year-old man with progressive gait instability, dysarthria, and dysphagia. Ann Clin Transl Neurol 2022; 10:144-145. [PMID: 36350078 PMCID: PMC9852388 DOI: 10.1002/acn3.51678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jennifer Adrissi
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Mashina Chomba
- Department of Internal MedicineUniversity of Zambia – School of MedicineLusakaZambia
| | - Lorraine Chishimba
- Department of Internal MedicineUniversity of Zambia – School of MedicineLusakaZambia
| | - Stanley Zimba
- Department of Internal MedicineUniversity Teaching Hospital – Adult HospitalLusakaZambia
| | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Deanna Saylor
- Department of Internal MedicineUniversity of Zambia – School of MedicineLusakaZambia,Department of Internal MedicineUniversity Teaching Hospital – Adult HospitalLusakaZambia,Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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17
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Visvabharathy L, Hanson BA, Orban ZS, Lim PH, Palacio NM, Jimenez M, Clark JR, Graham EL, Liotta EM, Tachas G, Penaloza-MacMaster P, Koralnik IJ. T cell responses to SARS-CoV-2 in people with and without neurologic symptoms of long COVID. medRxiv 2022:2021.08.08.21261763. [PMID: 34401886 PMCID: PMC8366804 DOI: 10.1101/2021.08.08.21261763] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many people experiencing long COVID syndrome, or post-acute sequelae of SARS-CoV-2 infection (PASC), suffer from debilitating neurologic symptoms (Neuro-PASC). However, whether virus-specific adaptive immunity is affected in Neuro-PASC patients remains poorly understood. We report that Neuro-PASC patients exhibit distinct immunological signatures composed of elevated humoral and cellular responses toward SARS-CoV-2 Nucleocapsid protein at an average of 6 months post-infection compared to healthy COVID convalescents. Neuro-PASC patients also had enhanced virus-specific production of IL-6 from and diminished activation of CD8+ T cells. Furthermore, the severity of cognitive deficits or quality of life disturbances in Neuro-PASC patients were associated with a reduced diversity of effector molecule expression in T cells but elevated IFN-γ production to the C-terminal domain of Nucleocapsid protein. Proteomics analysis showed enhanced plasma immunoregulatory proteins and reduced pro-inflammatory and antiviral response proteins in Neuro-PASC patients compared with healthy COVID convalescents, which were also correlated with worse neurocognitive dysfunction. These data provide new insight into the pathogenesis of long COVID syndrome and a framework for the rational design of predictive biomarkers and therapeutic interventions.
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Affiliation(s)
- Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Barbara A. Hanson
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Zachary S. Orban
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Patrick H. Lim
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Nicole M. Palacio
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Millenia Jimenez
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Jeffrey R. Clark
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Edith L. Graham
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Eric M. Liotta
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - George Tachas
- Director, Drug Discovery & Patents, Antisense Therapeutics Ltd., Melbourne, Australia
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
| | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL 60611 USA
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18
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Visvabharathy L, Orban ZS, Koralnik IJ. Case report: Treatment of long COVID with a SARS-CoV-2 antiviral and IL-6 blockade in a patient with rheumatoid arthritis and SARS-CoV-2 antigen persistence. Front Med (Lausanne) 2022; 9:1003103. [PMID: 36213654 PMCID: PMC9537824 DOI: 10.3389/fmed.2022.1003103] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC) in ∼30% of all infected individuals. Here, we present a case of PASC in a patient with rheumatoid arthritis characterized by viral persistence in the nasopharynx for 6 months after acute infection. We demonstrate transient disappearance of antigen persistence and decreased antiviral and autoimmune T cell responses after nirmatrelvir/ritonavir and tocilizumab treatment. Case presentation A 37-year-old female with a 7-year history of rheumatoid arthritis enrolled in a COVID-19 research study was found to continuously test SARS-CoV-2 antigen positive in the nasopharynx for 6 months after acute infection. She simultaneously presented with new-onset PASC symptoms including chronic occipital headache and periods of intense fatigue 8 weeks after acute infection. The patient was prescribed nirmatrelvir/ritonavir to treat SARS-CoV-2 persistence at 3.5 months post-acute infection and observed a reduction in PASC symptoms 3 weeks after completing antiviral treatment. After resurgence of PASC symptoms, she stopped treatment with tocilizumab for rheumatoid arthritis to attempt complete SARS-CoV-2 viral clearance. The severity of the patient's PASC symptoms subsequently increased, and she developed new-onset brain fog in addition to previous symptoms, which resolved after resumption of tocilizumab treatment. Assessment of adaptive immune responses demonstrated that nirmatrelvir/ritonavir and tocilizumab treatment decreased antiviral and autoreactive T cell activation. After resuming tocilizumab treatment, the patient's PASC symptoms were significantly reduced, but nasopharyngeal antigen positivity remained. Conclusion These data suggest that nirmatrelvir/ritonavir should be considered in the treatment of PASC in patients who have SARS-CoV-2 antigen persistence, though care must be taken to monitor the patient for symptom resurgence or viral reactivation. In addition, the IL-6 inhibitor tocilizumab may ameliorate PASC symptoms in patients with persistent headache, fatigue, and brain fog.
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Affiliation(s)
- Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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19
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Chomba M, Siddiqi OK, Fwoloshi S, Mubanga E, Koralnik IJ, Marra C, Saylor D. Clinical presentation and outcomes of syphilitic meningitis among hospitalized adults in lusaka, Zambia. Int J STD AIDS 2022; 33:1038-1044. [DOI: 10.1177/09564624221112568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Few studies exist to describe the characteristics of symptomatic syphilitic meningitis, particularly in sub-Saharan Africa, despite a global resurgence. Methods We conducted a retrospective analysis of a cohort of adults with meningitis presenting to Zambia’s largest referral hospital between April 2014 and December 2017. Individuals with pyogenic bacterial and cryptococcal meningitis were excluded from this cohort. We calculated the prevalence of syphilitic meningitis in the cohort and described the demographic, clinical and laboratory characteristics and outcomes. Results Of 512 participants, 273 were male, mean age was 37 ± 11 years and 84% were people living with HIV. The prevalence of syphilitic meningitis was 5% with in-hospital and 1-year mortality of 17% and 53%, respectively. Participants with syphilitic meningitis had lower Glasgow Coma Scores than those with other forms of meningitis. Among people living with HIV, those with syphilitic meningitis were less likely to have meningismus and had higher CSF white cell counts. Conclusions Syphilitic meningitis was found in 5% of Zambian adults presenting with non-pyogenic bacterial meningitis and non-cryptococcal meningitis, and one-year mortality was high. A high degree of clinical suspicion for syphilitic meningitis in all individuals with meningitis in Zambia is recommended, especially in people living with HIV.
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Affiliation(s)
- Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Omar K Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Neurology, Harvard Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sombo Fwoloshi
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Eugene Mubanga
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Igor J Koralnik
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina Marra
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Deanna Saylor
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Abstract
As of May 2022, there have been more than 527 million infections with severe acute respiratory disease coronavirus type 2 (SARS-CoV-2) and over 6.2 million deaths from Coronavirus Disease 2019 (COVID-19) worldwide. COVID-19 is a multisystem illness with important neurologic consequences that impact long-term morbidity and mortality. In the acutely ill, the neurologic manifestations of COVID-19 can include distressing but relatively benign symptoms such as headache, myalgias, and anosmia; however, entities such as encephalopathy, stroke, seizures, encephalitis, and Guillain-Barre Syndrome can cause neurologic injury and resulting disability that persists long after the acute pulmonary illness. Furthermore, as many as one-third of patients may experience persistent neurologic symptoms as part of a Post-Acute Sequelae of SARS-CoV-2 infection (Neuro-PASC) syndrome. This Neuro-PASC syndrome can affect patients who required hospitalization for COVID-19 or patients who did not require hospitalization and who may have had minor or no pulmonary symptoms. Given the large number of individuals affected and the ability of neurologic complications to impair quality of life and productivity, the neurologic manifestations of COVID-19 are likely to have major and long-lasting personal, public health, and economic consequences. While knowledge of disease mechanisms and therapies acquired prior to the pandemic can inform us on how to manage patients with the neurologic manifestations of COVID-19, there is a critical need for improved understanding of specific COVID-19 disease mechanisms and development of therapies that target the neurologic morbidities of COVID-19. This current perspective reviews evidence for proposed disease mechanisms as they inform the neurologic management of COVID-19 in adult patients while also identifying areas in need of further research.
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Affiliation(s)
- Edith L Graham
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Igor J Koralnik
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Eric M Liotta
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA.
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21
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Stamm B, Royan R, Clark JR, Hoffman SC, Shlobin NA, Orban ZS, Lim PH, Koralnik IJ, Liotta EM, Batra A. Patient Income Does Not Predict Disability or Mortality in Hospitalized COVID-19 Patients in a Large Health Care System in the Chicago Metropolitan Area. J Health Care Poor Underserved 2022; 33:1215-1229. [DOI: 10.1353/hpu.2022.0108] [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: 11/11/2022]
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22
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Dangi T, Sanchez S, Lew MH, Visvabharathy L, Richner J, Koralnik IJ, Penaloza-MacMaster P. Pre-existing immunity modulates responses to mRNA boosters. bioRxiv 2022:2022.06.27.497248. [PMID: 35794898 PMCID: PMC9258286 DOI: 10.1101/2022.06.27.497248] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
mRNA vaccines have shown high efficacy in preventing severe COVID-19, but breakthrough infections, emerging variants and waning antibody levels have warranted the use of boosters. Although mRNA boosters have been widely implemented, the extent to which pre-existing immunity influences the efficacy of boosters remains unclear. In a cohort of individuals primed with the mRNA-1273 or BNT162b2 vaccines, we observed that lower antibody levels before boost were associated with higher fold-increase in antibody levels after boost, suggesting that pre-existing antibody modulates the boosting capacity of mRNA vaccines. Mechanistic studies in mice show that pre-existing antibodies significantly limit antigen expression and priming of B cell responses after mRNA vaccination. Furthermore, we demonstrate that the relative superiority of an updated Omicron vaccine over the original vaccine is critically dependent on the serostatus of the host. These data demonstrate that pre-existing immunity dictates responses to mRNA vaccination, elucidating specific circumstances when updated SARS-CoV-2 vaccines confer superior protection to original vaccines.
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Affiliation(s)
- Tanushree Dangi
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sarah Sanchez
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Min Han Lew
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Justin Richner
- Department of Microbiology & Immunology, University of Illinois Chicago College of Medicine, Chicago, IL 60612
| | - Igor J. Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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23
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Ravishankar M, Dallah I, Mathews M, Bositis CM, Mwenechanya M, Kalungwana‐Mambwe L, Bearden D, Navis A, Elafros MA, Gelbard H, Theodore WH, Koralnik IJ, Okulicz JF, Johnson BA, Belessiotis C, Ciccone O, Thornton N, Tsuboyama M, Siddiqi OK, Potchen MJ, Sikazwe I, Birbeck GL. Clinical characteristics and outcomes after new-onset seizure among Zambian children with HIV during the antiretroviral therapy era. Epilepsia Open 2022; 7:315-324. [PMID: 35305291 PMCID: PMC9159241 DOI: 10.1002/epi4.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new-onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30-day mortality and cause of death are also reported. METHODS Children living with HIV (CLWHIV) with new-onset seizures were prospectively evaluated at one large urban teaching hospital and two non-urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. RESULTS From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2-10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non-accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty-two (30%) children died within 30 days of the index seizure. SIGNIFICANCE Despite widespread ART roll out in Zambia, new-onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.
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Affiliation(s)
| | - Ifunanya Dallah
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Manoj Mathews
- University Teaching Hospitals Children's HospitalLusakaZambia
| | | | | | | | - David Bearden
- University of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - Harris Gelbard
- University of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Igor J. Koralnik
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | | | | | - Ornella Ciccone
- University Teaching Hospitals Children's HospitalLusakaZambia
- University of ZambiaLusakaZambia
| | | | | | | | - Michael J. Potchen
- University of Rochester Medical CenterRochesterNew YorkUSA
- Zambian College of Medicine & SurgeryLusakaZambia
| | | | - Gretchen L. Birbeck
- University Teaching Hospitals Children's HospitalLusakaZambia
- Epilepsy DivisionDepartment of NeurologyUniversity of RochesterRochesterNew YorkUSA
- Epilepsy Care TeamChikankata HospitalMazabukaZambia
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24
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Ali ST, Kang AK, Patel TR, Clark JR, Perez-Giraldo GS, Orban ZS, Lim PH, Jimenez M, Graham EL, Batra A, Liotta EM, Koralnik IJ. Evolution of neurologic symptoms in non-hospitalized COVID-19 "long haulers". Ann Clin Transl Neurol 2022; 9:950-961. [PMID: 35607826 PMCID: PMC9268866 DOI: 10.1002/acn3.51570] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022] Open
Abstract
Objective We characterized the evolution of neurologic symptoms and self‐perceived recovery of non‐hospitalized COVID‐19 “long haulers” 6–9 months after their initial Neuro‐COVID‐19 clinic evaluation. Methods In this follow‐up study on the first 100 patients, 50 SARS‐CoV‐2 laboratory‐positive (SARS‐CoV‐2+), and 50 laboratory‐negative (SARS‐CoV‐2−), evaluated at our Neuro‐COVID‐19 clinic between May and November 2020, patients completed phone questionnaires on their neurologic symptoms, subjective impression of recovery and quality of life. Results Of 52 patients who completed the study (27 SARS‐CoV‐2+, 25 SARS‐CoV‐2−) a median 14.8 (range 11–18) months after symptom onset, mean age was 42.8 years, 73% were female, and 77% were vaccinated for SARS‐CoV‐2. Overall, there was no significant change in the frequency of most neurologic symptoms between first and follow‐up evaluations, including “brain fog” (81 vs. 71%), numbness/tingling (69 vs. 65%), headache (67 vs. 54%), dizziness (50 vs. 54%), blurred vision (34 vs. 44%), tinnitus (33 vs. 42%), and fatigue (87 vs. 81%). However, dysgeusia and anosmia decreased overall (63 vs. 27%, 58 vs. 21%, both p < 0.001). Conversely, heart rate and blood pressure variation (35 vs. 56%, p = 0.01) and gastrointestinal symptoms (27 vs. 48%, p = 0.04) increased at follow‐up. Patients reported improvements in their recovery, cognitive function, and fatigue, but quality of life measures remained lower than the US normative population (p < 0.001). SARS‐CoV‐2 vaccination did not have a positive or detrimental impact on cognitive function or fatigue. Interpretation Non‐hospitalized COVID‐19 “long haulers” continue to experience neurologic symptoms, fatigue, and compromised quality of life 14.8 months after initial infection.
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Affiliation(s)
- Sareen T Ali
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony K Kang
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tulsi R Patel
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey R Clark
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gina S Perez-Giraldo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zachary S Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick H Lim
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edith L Graham
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ayush Batra
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric M Liotta
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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25
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Hanson BA, Visvabharathy L, Ali ST, Kang AK, Patel TR, Clark JR, Lim PH, Orban ZS, Hwang SS, Mattoon D, Batra A, Liotta EM, Koralnik IJ. Plasma Biomarkers of Neuropathogenesis in Hospitalized Patients With COVID-19 and Those With Postacute Sequelae of SARS-CoV-2 Infection. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/3/e1151. [PMID: 35256481 PMCID: PMC8901169 DOI: 10.1212/nxi.0000000000001151] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Although patients hospitalized with COVID-19 frequently present with encephalopathy, those with mild initial COVID-19 disease who never required hospitalization also often develop neurologic symptoms as part of postacute sequelae of severe acute respiratory coronavirus type 2 (SARS-CoV-2) infection (neuro-PASC). The pathogenic mechanisms of COVID-19 encephalopathy and neuro-PASC are unknown. We sought to establish biochemical evidence of CNS injury in those patients and their association with neuropsychiatric manifestations and SARS-CoV-2 antigenemia. METHODS We recruited hospitalized, posthospitalized, and nonhospitalized patients with confirmed diagnosis of COVID-19 with neurologic symptoms in addition to healthy control (HC) subjects. Plasma neurofilament light chain (pNfL), plasma glial fibrillary acidic protein (pGFAP), and plasma SARS-CoV-2 Nucleocapsid antigen (pN Ag) were measured by HD-X Simoa analyzer (Quanterix) and compared with neuropsychiatric symptoms, patient-reported quality-of-life measures, and standardized cognitive assessments. Neuroglial scores (pGFAP/pNfL) were calculated to estimate the relative contribution of astroglial and neuronal involvement. RESULTS We enrolled a total of 64 study participants, including 9 hospitalized patients with COVID-19 encephalopathy (CE), 9 posthospitalization neuro-PASC (PNP) patients, 38 nonhospitalized neuro-PASC (NNP) patients, and 8 HC subjects. Patients with CE were older, had higher pNfL and pGFAP concentrations, and more frequent pN Ag detection than all neuro-PASC groups. PNP and NNP patients exhibited similar PASC symptoms, decreased quality-of-life measures, and cognitive dysfunction, and 1 of the 38 (2.6%) NNP patients had pN Ag detectable 3 weeks postsymptoms onset. Patients with neuro-PASC presenting with anxiety/depression had higher neuroglial scores, which were correlated with increased anxiety on quality-of-life measures. DISCUSSION pNfL, pGFAP, and pN Ag measurements indicate neuronal dysfunction and systemic involvement in hospitalized COVID-19 patients with encephalopathy. Detection of SARS-CoV-2 N Ag in blood 3 weeks after symptoms onset in a nonhospitalized patient suggests that prolonged antigenic stimulation, or possibly latent infection, may occur. Anxiety was associated with evidence of astroglial activation in patients with neuro-PASC. These data shed new light on SARS-Cov-2 neuropathogenesis and demonstrate the value of plasma biomarkers across the COVID-19 disease spectrum.
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Affiliation(s)
- Barbara A Hanson
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Lavanya Visvabharathy
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Sareen T Ali
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Anthony K Kang
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Tulsi R Patel
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Jeffrey R Clark
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Patrick H Lim
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Zachary S Orban
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Soyoon S Hwang
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Dawn Mattoon
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Ayush Batra
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Eric M Liotta
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Igor J Koralnik
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA.
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26
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Dangi T, Palacio N, Sanchez S, Park M, Class J, Visvabharathy L, Ciucci T, Koralnik IJ, Richner J, Macmaster PP. Cross-protection by SARS vaccines is improved by booster vaccination. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.125.21] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have shown extraordinary efficacy against SARS-CoV-2. Recently, we demonstrated that prime-boost coronavirus vaccine regimens can protect against heterologous coronaviruses (Dangi, The Journal of Clinical Investigation, 2021). However, it remains unclear whether boosters are required for such cross-protection. In this study, we show that booster immunizations are critical to elicit cross-protection against heterologous coronaviruses. We first vaccinated BALB/c mice intramuscularly with a poxvirus-based SARS-CoV-1 vaccine developed in 2004 (MVA-SARS-CoV-1) and compared cross-protection following an intranasal SARS-CoV-2 challenge, evaluating cross-protection after a prime-only regimen versus a prime-boost regimen. Interestingly, we show cross-protection only in mice that received boosters. We are currently testing the durability of cross-protection elicited by prime-boost vaccine regimens, and we are also extending these results to humans. Overall, our findings provide a rationale for universal coronavirus vaccines, and highlights the importance of boosters as a strategy to broaden cross-protection to other coronaviruses different than SARS-CoV-2.
Supported by NIDA DP2 Avenir (1DP2DA051912-01) EREEP Grant Northwestern University
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Affiliation(s)
- Tanushree Dangi
- 1Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Nicole Palacio
- 1Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Sarah Sanchez
- 1Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Mincheol Park
- 1Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Jacob Class
- 2Department of Microbiology & Immunology, University of Illinois at Chicago, Chicago
| | - Lavanya Visvabharathy
- 3Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Thomas Ciucci
- 4Department of Microbiology & Immunology, Center for Vaccine Biology and Immunology University of Rochester, Rochester
| | - Igor J. Koralnik
- 3Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Justin Richner
- 2Department of Microbiology & Immunology, University of Illinois at Chicago, Chicago
| | - Pablo Penaloza Macmaster
- 1Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago
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27
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Wechsler LR, Koralnik IJ. Global Teleneurology. Ann Neurol 2022; 91:443-444. [PMID: 35218048 DOI: 10.1002/ana.26334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence R Wechsler
- Department of Neurology, University of Pennsylvania and Perelman School of Medicine
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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28
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Patel Z, Franz CK, Bharat A, Walter JM, Wolfe LF, Koralnik IJ, Deshmukh S. Diaphragm and Phrenic Nerve Ultrasound in COVID-19 Patients and Beyond: Imaging Technique, Findings, and Clinical Applications. J Ultrasound Med 2022; 41:285-299. [PMID: 33772850 PMCID: PMC8250472 DOI: 10.1002/jum.15706] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 05/23/2023]
Abstract
The diaphragm, the principle muscle of inspiration, is an under-recognized contributor to respiratory disease. Dysfunction of the diaphragm can occur secondary to lung disease, prolonged ventilation, phrenic nerve injury, neuromuscular disease, and central nervous system pathology. In light of the global pandemic of coronavirus disease 2019 (COVID-19), there has been growing interest in the utility of ultrasound for evaluation of respiratory symptoms including lung and diaphragm sonography. Diaphragm ultrasound can be utilized to diagnose diaphragm dysfunction, assess severity of dysfunction, and monitor disease progression. This article reviews diaphragm and phrenic nerve ultrasound and describes clinical applications in the context of COVID-19.
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Affiliation(s)
- Zaid Patel
- AMITA Health Saint Francis HospitalEvanstonIllinoisUSA
| | - Colin K. Franz
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago)ChicagoIllinoisUSA
- Department of Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - James M. Walter
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Lisa F Wolfe
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Swati Deshmukh
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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29
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Dangi T, Palacio N, Sanchez S, Park M, Class J, Visvabharathy L, Ciucci T, Koralnik IJ, Richner JM, Penaloza-MacMaster P. Cross-protective immunity following coronavirus vaccination and coronavirus infection. J Clin Invest 2021; 131:151969. [PMID: 34623973 DOI: 10.1172/jci151969] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 06/01/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have shown efficacy against SARS-CoV-2, it is unknown if coronavirus vaccines can also protect against other coronaviruses that may infect humans in the future. Here, we show that coronavirus vaccines elicited cross-protective immune responses against heterologous coronaviruses. In particular, we show that a severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) vaccine developed in 2004 and known to protect against SARS-CoV-1 conferred robust heterologous protection against SARS-CoV-2 in mice. Similarly, prior coronavirus infections conferred heterologous protection against distinct coronaviruses. Cross-reactive immunity was also reported in patients with coronavirus disease 2019 (COVID-19) and in individuals who received SARS-CoV-2 vaccines, and transfer of plasma from these individuals into mice improved protection against coronavirus challenges. These findings provide the first demonstration to our knowledge that coronavirus vaccines (and prior coronavirus infections) can confer broad protection against heterologous coronaviruses and establish a rationale for universal coronavirus vaccines.
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Affiliation(s)
- Tanushree Dangi
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nicole Palacio
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah Sanchez
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mincheol Park
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob Class
- Department of Microbiology and Immunology, University of Illinois at Chicago (UIC), Chicago, Illinois, USA
| | - Lavanya Visvabharathy
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas Ciucci
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester, Rochester, New York, USA.,Department of Microbiology and Immunology, Center for Vaccine Biology and Immunology, University of Rochester, Rochester, New York, USA
| | - Igor J Koralnik
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justin M Richner
- Department of Microbiology and Immunology, University of Illinois at Chicago (UIC), Chicago, Illinois, USA
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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30
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Siddiqi OK, Ghebremichael M, Musukuma K, Dang X, Mubanga E, Birbeck GL, Love S, Buback C, Kosloff B, Ayles H, Atadzhanov M, Koralnik IJ. LTA4H Prevalence and Mortality in Adult Zambians with Tuberculous Meningitis. Ann Neurol 2021; 90:994-998. [PMID: 34595756 DOI: 10.1002/ana.26240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022]
Abstract
We conducted a prospective cohort study to determine the prevalence of leukotriene A4 hydrolase (LTA4H) polymorphisms in Zambian adults with tuberculous meningitis (TBM) and its association with mortality. We completed genotype testing on 101 definite cases of TBM and 119 consecutive non-TBM controls. The distribution of genotypes among TBM patients was as follows: C/C (0.83), C/T (0.14), T/T (0.03). There was no significant difference in genotype distribution between TBM and non-TBM patients. We found no relationship between LTA4H polymorphism and survival. Prospective studies are needed to determine the benefit of adjuvant steroids in TBM based upon population LTA4H genotype. ANN NEUROL 2021.
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Affiliation(s)
- Omar K Siddiqi
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Musie Ghebremichael
- Harvard Medical School and Ragon Institute of MGH, MIT, and Harvard, Boston, MA
| | - Kalo Musukuma
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Xin Dang
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eugene Mubanga
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY.,University Teaching Hospital, Neurology Research Office, Lusaka, Zambia
| | - Shawn Love
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Clayton Buback
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Barry Kosloff
- Zambart, Lusaka, Zambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Masharip Atadzhanov
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Igor J Koralnik
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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31
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O’Hara BA, Gee GV, Haley SA, Morris-Love J, Nyblade C, Nieves C, Hanson BA, Dang X, Turner TJ, Chavin JM, Lublin A, Koralnik IJ, Atwood WJ. Teriflunomide Inhibits JCPyV Infection and Spread in Glial Cells and Choroid Plexus Epithelial Cells. Int J Mol Sci 2021; 22:ijms22189809. [PMID: 34575975 PMCID: PMC8468119 DOI: 10.3390/ijms22189809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Several classes of immunomodulators are used for treating relapsing-remitting multiple sclerosis (RRMS). Most of these disease-modifying therapies, except teriflunomide, carry the risk of progressive multifocal leukoencephalopathy (PML), a severely debilitating, often fatal virus-induced demyelinating disease. Because teriflunomide has been shown to have antiviral activity against DNA viruses, we investigated whether treatment of cells with teriflunomide inhibits infection and spread of JC polyomavirus (JCPyV), the causative agent of PML. Treatment of choroid plexus epithelial cells and astrocytes with teriflunomide reduced JCPyV infection and spread. We also used droplet digital PCR to quantify JCPyV DNA associated with extracellular vesicles isolated from RRMS patients. We detected JCPyV DNA in all patients with confirmed PML diagnosis (n = 2), and in six natalizumab-treated (n = 12), two teriflunomide-treated (n = 7), and two nonimmunomodulated (n = 2) patients. Of the 21 patients, 12 (57%) had detectable JCPyV in either plasma or serum. CSF was uniformly negative for JCPyV. Isolation of extracellular vesicles did not increase the level of detection of JCPyV DNA versus bulk unprocessed biofluid. Overall, our study demonstrated an effect of teriflunomide inhibiting JCPyV infection and spread in glial and choroid plexus epithelial cells. Larger studies using patient samples are needed to correlate these in vitro findings with patient data.
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Affiliation(s)
- Bethany A. O’Hara
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
| | - Gretchen V. Gee
- MassBiologics, University of Massachusetts Medical School, Worcester, MA 01601, USA;
| | - Sheila A. Haley
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
| | - Jenna Morris-Love
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
| | - Charlotte Nyblade
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
| | - Chris Nieves
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
| | - Barbara A. Hanson
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60007, USA; (B.A.H.); (X.D.); (I.J.K.)
| | - Xin Dang
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60007, USA; (B.A.H.); (X.D.); (I.J.K.)
| | | | | | - Alex Lublin
- Sanofi, Cambridge, MA 02114, USA; (T.J.T.); (J.M.C.); (A.L.)
| | - Igor J. Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60007, USA; (B.A.H.); (X.D.); (I.J.K.)
| | - Walter J. Atwood
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02903, USA; (B.A.O.); (S.A.H.); (J.M.-L.); (C.N.); (C.N.)
- Correspondence: ; Tel.: +1-401-863-3116
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32
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Bernard-Valnet R, Koralnik IJ, Du Pasquier R. Advances in Treatment of Progressive Multifocal Leukoencephalopathy. Ann Neurol 2021; 90:865-873. [PMID: 34405435 PMCID: PMC9291129 DOI: 10.1002/ana.26198] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
Progressive multifocal encephalopathy (PML) is a severe demyelinating disease of the central nervous system (CNS) caused by JC virus (JCV), which occurs in immunocompromised individuals. Management of PML relies on restoration of immunity within the CNS. However, when this restoration cannot be readily achieved, PML has a grim prognosis. Innovative strategies have shown promise in promoting anti‐JCV immune responses, and include T‐cell adoptive transfer or immune checkpoint inhibitor therapies. Conversely, management of immune reconstitution inflammatory syndrome, particularly in iatrogenic PML, remains a major challenge. In this paper, we review recent development in the treatment of PML. ANN NEUROL 2021;90:865–873
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Affiliation(s)
- Raphaël Bernard-Valnet
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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33
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Abstract
BACKGROUND The diagnosis of neurosyphilis relies on cerebrospinal fluid (CSF) abnormalities (pleocytosis, elevated protein) and CSF-Venereal Disease Research Laboratory (VDRL) test. In resource-limited settings, the CSF-VDRL test may not be widely available. METHODS We optimized a commercial immunochromatographic strip test, the DPP Chembio syphilis assay, for performance with CSF and tested centrifuged CSF samples of 71 patients with syphilis (35 with neurosyphilis and 36 without neurosyphilis). A CSF dilution of 1:4 was chosen based on agreement with CSF pools with documented results from the CSF-VDRL test and fluorescent treponemal antibody absorption test on CSF. Using an electronic reader, we obtained unit values of treponemal and nontreponemal antibodies for all study samples and generated a receiver operating characteristic curve; using the Youden index, we established diagnostic cutoffs with optimal sensitivity and specificity. RESULTS Diagnostic sensitivity of the nontreponemal test was 80% (95% confidence interval, 63%-92%) and specificity was 97% (95% confidence interval, 85%-100%) for neurosyphilis diagnosis using a reactive CSF-VDRL that improved after neurosyphilis therapy as a criterion standard. CONCLUSIONS In this small study, the DPP Chembio test showed promising results for neurosyphilis diagnosis. Further studies are needed to assess its performance in resource-limited settings.
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Affiliation(s)
- Hemil Gonzalez
- Rush University Medical Center, Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
- John H. Stroger Jr. Hospital of Cook County, Department of Infectious Diseases, Chicago, Illinois
| | - Igor J Koralnik
- Northwestern University Feinberg School of Medicine, Davee Department of Neurology, Chicago, Illinois
| | - Gregory D Huhn
- Rush University Medical Center, Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
- John H. Stroger Jr. Hospital of Cook County, Department of Infectious Diseases, Chicago, Illinois
| | - Lauren C Tantalo
- Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington
| | - Ethan M Ritz
- Rush University Medical Center, Bioinformatics and Biostatistics Core, Chicago, Illinois
| | - Zachary Orban
- Northwestern University Feinberg School of Medicine, Davee Department of Neurology, Chicago, Illinois
| | - Christina M Marra
- Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington
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34
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Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, DiBiase RM, Jia DT, Balabanov R, Ho SU, Batra A, Liotta EM, Koralnik IJ. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers". Ann Clin Transl Neurol 2021; 8:1073-1085. [PMID: 33755344 PMCID: PMC8108421 DOI: 10.1002/acn3.51350] [Citation(s) in RCA: 364] [Impact Index Per Article: 121.3] [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: 02/24/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Most SARS-CoV-2-infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non-hospitalized Covid-19 "long haulers". METHODS This is a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive (SARS-CoV-2+ ) and 50 laboratory-negative (SARS-CoV-2- ) individuals) presenting to our Neuro-Covid-19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid-19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient-reported quality of life measures and standardized cognitive assessments. RESULTS Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS-CoV-2+ than SARS-CoV-2- patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS-CoV-2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic-matched US population (T-score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). INTERPRETATION Non-hospitalized Covid-19 "long haulers" experience prominent and persistent "brain fog" and fatigue that affect their cognition and quality of life.
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Affiliation(s)
- Edith L. Graham
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey R. Clark
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Zachary S. Orban
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Patrick H. Lim
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - April L. Szymanski
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Carolyn Taylor
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rebecca M. DiBiase
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Dan Tong Jia
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Roumen Balabanov
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sam U. Ho
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ayush Batra
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Eric M. Liotta
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Igor J. Koralnik
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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35
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Clark JR, Liotta EM, Reish NJ, Shlobin NA, Hoffman SC, Orban ZS, Lim PH, Koralnik IJ, Batra A. Abnormal movements in hospitalized COVID-19 patients: A case series. J Neurol Sci 2021; 423:117377. [PMID: 33676146 PMCID: PMC7908881 DOI: 10.1016/j.jns.2021.117377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Abnormal movements in Covid-19 patients have been reported with varying degree of frequency, prompting neurologic consultation and additional diagnostic evaluation. We sought to evaluate the frequency and etiology of abnormal movements among hospitalized Covid-19 patients undergoing neurologic consultation. METHODS We retrospectively analyzed the first 50 consecutive patients with confirmed Covid-19 hospitalized at our tertiary medical care center who underwent acute inpatient neurology consultation from March 2020 through May 2020. Indication for neurologic consultation and diagnostic studies performed were identified by electronic medical record review. RESULTS Of the 50 initial consultation requests, 11 (22.0%) patients were evaluated for abnormal movements (nine male and two female). Myoclonus was diagnosed in 6/11 (54.5%) patients. Additionally, two patients were diagnosed with seizures (confirmed on EEG in one), while two additional patients were diagnosed with tremor (physiologic and probable functional). A single case of serotonin syndrome was also identified. CONCLUSION Abnormal movements observed in hospitalized Covid-19 patients can have a wide range of etiologies and were a frequent initial indication for neurologic consultation. Myoclonus was the most frequent type of abnormal movement observed. Early clinical recognition and directed diagnostic work-up is essential for accurate diagnoses in these patients.
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Affiliation(s)
- Jeffrey R Clark
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Eric M Liotta
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nicholas J Reish
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nathan A Shlobin
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Steven C Hoffman
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Zachary S Orban
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Patrick H Lim
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Igor J Koralnik
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Liotta EM, Batra A, Koralnik IJ. Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City. Neurology 2021; 96:550. [PMID: 33723026 DOI: 10.1212/wnl.0000000000011613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Liotta EM, Batra A, Koralnik IJ. Reply to COVID-19 encephalopathy, Bayes rule, and a plea for case-control studies. Ann Clin Transl Neurol 2021; 8:726. [PMID: 33512080 PMCID: PMC7951091 DOI: 10.1002/acn3.51287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eric M. Liotta
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ayush Batra
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Igor J. Koralnik
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Wijburg MT, Warnke C, McGuigan C, Koralnik IJ, Barkhof F, Killestein J, Wattjes MP. Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications. J Neurol Neurosurg Psychiatry 2021; 92:177-188. [PMID: 33229453 DOI: 10.1136/jnnp-2020-324534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.
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Affiliation(s)
- Martijn T Wijburg
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clemens Warnke
- Department of Neurology, University Hospital Köln, University of Cologne, Köln, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital & University College Dublin, Dublin, Ireland
| | - Igor J Koralnik
- Department of Neurological Sciences, Division of Neuroinfectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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Fernandez CE, Franz CK, Ko JH, Walter JM, Koralnik IJ, Ahlawat S, Deshmukh S. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology 2020; 298:E117-E130. [PMID: 33258748 PMCID: PMC7709352 DOI: 10.1148/radiol.2020203116] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With surging numbers of patients with coronavirus disease 2019 (COVID-19) throughout the world, neuromuscular complications and rehabilitation concerns are becoming more apparent. Peripheral nerve injury can occur in patients with COVID-19 secondary to postinfectious inflammatory neuropathy, prone positioning-related stretch and/or compression injury, systemic neuropathy, or nerve entrapment from hematoma. Imaging of peripheral nerves in patients with COVID-19 may help to characterize nerve abnormality, to identify site and severity of nerve damage, and to potentially elucidate mechanisms of injury, thereby aiding the medical diagnosis and decision-making process. This review article aims to provide a first comprehensive summary of the current knowledge of COVID-19 and peripheral nerve imaging.
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Affiliation(s)
- Claire E Fernandez
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Colin K Franz
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Jason H Ko
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - James M Walter
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Igor J Koralnik
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Shivani Ahlawat
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Swati Deshmukh
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
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Breville G, Koralnik IJ, Lalive PH. Brainstem progressive multifocal leukoencephalopathy. Eur J Neurol 2020; 28:1016-1021. [PMID: 33128290 DOI: 10.1111/ene.14617] [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: 06/22/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Progressive multifocal leukoencephalopathy (PML) is a severe infection caused by the polyomavirus JC that develops in the central nervous system (CNS) of immunosuppressed patients. The infection frequently starts in the brain hemispheres and can spread into other CNS regions such as the brainstem. Initial isolated PML brainstem lesions are exceptional. We aimed to describe the challenging diagnosis of PML with isolated brainstem lesions at the time of disease onset. METHODS We describe a case of PML starting with an isolated brainstem lesion and reviewed clinical, radiological, and biological features of all the reported cases of isolated brainstem PML. RESULTS Isolated brainstem PML at disease onset is extremely rare. In addition to our case, only nine PML cases presenting with strictly isolated radioanatomical brainstem location at the time of disease onset were retrieved through the literature. All patients share similar brain magnetic resonance imaging features, without contrast enhancement. Eight patients presented with initial clinical worsening, but full recovery occurred in three patients, partial recovery in two, and death in three. Even if prognosis is reserved because of the surrounding vital structures in the brainstem, clinical recovery may occur. CONCLUSIONS This case report and literature review emphasize that isolated brainstem lesion is an atypical presentation of PML at disease onset.
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Affiliation(s)
- Gautier Breville
- Division of Neurology, Department of Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | - Igor J Koralnik
- Division of Neuro-Infectious Diseases and Global Neurology, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrice H Lalive
- Division of Neurology, Department of Neurosciences, Geneva University Hospital, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
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Navis A, Dallah I, Mabeta C, Musukuma K, Siddiqi OK, Bositis CM, Koralnik IJ, Gelbard HA, Theodore WH, Okulicz JF, Johnson BA, Sikazwe I, Bearden DR, Birbeck GL. Evaluating the impact of antiretroviral and antiseizure medication interactions on treatment effectiveness among outpatient clinic attendees with HIV in Zambia. Epilepsia 2020; 61:2705-2711. [PMID: 33084053 DOI: 10.1111/epi.16723] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Interactions between enzyme-inducing anti-seizure medications (EI-ASMs) and antiretroviral drugs (ARVs) can lead to decreased ARV levels and may increase the likelihood of viral resistance. We conducted a study to determine if co-usage of ARVs and EI-ASMs is associated with ARV-resistant human immunodeficiency virus (HIV) among people living with HIV in Zambia. METHODS Eligible participants were ≥18 years of age and concurrently taking ASMs and ARVs for at least 1 month of the prior 6-month period. Data were obtained regarding medication and HIV history. CD4 counts, plasma viral loads (pVLs), and HIV genotype and resistance profile in participants with a pVL >1000 copies/mL were obtained. Pearson's test of independence was used to determine whether treatment with EI-ASM was associated with pVL >1000/mL copies. RESULTS Of 50 participants, 41 (82%) were taking carbamazepine (37 on monotherapy), and all had stable regimens in the prior 6 months. Among the 13 ARV regimens used, 68% had a tenofovir/lamivudine backbone. The majority (94%) were on a stable ARV regimen for >6 months. Median CD4 nadir was 205 cells/mm3 (interquartile range [IQR] 88-389), and 60% of participants had commenced ARV treatment before advanced disease occurred. Mean CD4 count at enrollment was 464 cells/mm3 (SD 226.3). Seven participants (14%) had a CD4 count <200 cells/mm3 . Four (8%) had a pVL >1000 copies/mL; all were on carbamazepine. Three participants with elevated pVL had a CD4 count <200 cells/mm3 . None had documented adherence concerns by providers; however, two had events concerning for clinical failure. HIV genotype testing showed mutations in three participants. Carbamazepine was not found to correlate with elevated pVL (P = .58). SIGNIFICANCE EI-ASMs are commonly used in sub-Saharan Africa. Despite concurrent use of EI-ASMs and ARVs, the majority of participants showed CD4 counts >200 cells/mm3 and were virally suppressed. Carbamazepine was not associated with an increased risk of virological failure or ARV-resistant HIV.
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Affiliation(s)
- Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ifunanya Dallah
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | | | - Kalo Musukuma
- University Teaching Hospitals Children's Hospital, Lusaka, Zambia
| | - Omar K Siddiqi
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Igor J Koralnik
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Harris A Gelbard
- Departments of Neurology, Pediatrics, Neuroscience and Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA
| | - William H Theodore
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jason F Okulicz
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio-Ft Sam Houston, Houston, TX, USA
| | - Brent A Johnson
- Department of Biostatistics, Center for AIDS Research, University of Rochester, Rochester, NY, USA
| | - Izukanji Sikazwe
- Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - David R Bearden
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Chikankata Epilepsy Care Team, Mazabuka, Zambia.,University Teaching Hospitals Children's Hospital, Lusaka, Zambia
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Liotta EM, Batra A, Clark JR, Shlobin NA, Hoffman SC, Orban ZS, Koralnik IJ. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol 2020; 7:2221-2230. [PMID: 33016619 PMCID: PMC7664279 DOI: 10.1002/acn3.51210] [Citation(s) in RCA: 292] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Covid‐19 can involve multiple organs including the nervous system. We sought to characterize the neurologic manifestations, their risk factors, and associated outcomes in hospitalized patients with Covid‐19. Methods We examined neurologic manifestations in 509 consecutive patients admitted with confirmed Covid‐19 within a hospital network in Chicago, Illinois. We compared the severity of Covid‐19 and outcomes in patients with and without neurologic manifestations. We also identified independent predictors of any neurologic manifestations, encephalopathy, and functional outcome using binary logistic regression. Results Neurologic manifestations were present at Covid‐19 onset in 215 (42.2%), at hospitalization in 319 (62.7%), and at any time during the disease course in 419 patients (82.3%). The most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%). Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4% of patients each). Severe respiratory disease requiring mechanical ventilation occurred in 134 patients (26.3%). Independent risk factors for developing any neurologic manifestation were severe Covid‐19 (OR 4.02; 95% CI 2.04–8.89; P < 0.001) and younger age (OR 0.982; 95% CI 0.968–0.996; P = 0.014). Of all patients, 362 (71.1%) had a favorable functional outcome at discharge (modified Rankin Scale 0–2). However, encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11–0.42; P < 0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; P < 0.001). Interpretation Neurologic manifestations occur in most hospitalized Covid‐19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.
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Affiliation(s)
- Eric M Liotta
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey R Clark
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steven C Hoffman
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zachary S Orban
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Igor J Koralnik
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abstract
In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs, including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms, including virus‐induced hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (CNS), and postinfectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis, and endothelialitis. In the peripheral nervous system, COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome, and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. Although our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19. ANN NEUROL 2020;88:1–11 ANN NEUROL 2020;88:1–11
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Affiliation(s)
- Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kenneth L Tyler
- Department of Neurology, Medicine, and Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
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44
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Eis PS, Bruno CD, Richmond TA, Koralnik IJ, Hanson BA, Major EO, Chow CR, Hendel-Chavez H, Stankoff B, Gasnault J, Taoufik Y, Hatchwell E. Germline Genetic Risk Variants for Progressive Multifocal Leukoencephalopathy. Front Neurol 2020; 11:186. [PMID: 32256442 PMCID: PMC7094807 DOI: 10.3389/fneur.2020.00186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/10/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disorder of the brain caused by reactivation of the JC virus (JCV), a polyomavirus that infects at least 60% of the population but is asymptomatic or results in benign symptoms in most people. PML occurs as a secondary disease in a variety of disorders or as a serious adverse event from immunosuppressant agents, but is mainly found in three groups: HIV-infected patients, patients with hematological malignancies, or multiple sclerosis (MS) patients on the immunosuppressant therapy natalizumab. It is severely debilitating and is deadly in ~50% HIV cases, ~90% of hematological malignancy cases, and ~24% of MS-natalizumab cases. A PML risk prediction test would have clinical utility in all at risk patient groups but would be particularly beneficial in patients considering therapy with immunosuppressant agents known to cause PML, such as natalizumab, rituximab, and others. While a JC antibody test is currently used in the clinical decision process for natalizumab, it is suboptimal because of its low specificity and requirement to periodically retest patients for seroconversion or to assess if a patient's JCV index has increased. Whereas a high specificity genetic risk prediction test comprising host genetic risk variants (i.e., germline variants occurring at higher frequency in PML patients compared to the general population) could be administered one time to provide clinicians with additional risk prediction information that is independent of JCV serostatus. Prior PML case reports support the hypothesis that PML risk is greater in patients with a genetically caused immunodeficiency disorder. To identify germline PML risk variants, we performed exome sequencing on 185 PML cases (70 in a discovery cohort and 115 in a replication cohort) and used the gnomAD variant database for interpretation. Our study yielded 19 rare variants (maximum allele frequency of 0.02 in gnomAD ethnically matched populations) that impact 17 immune function genes (10 are known to cause inborn errors of immunity). Modeling of these variants in a PML genetic risk test for MS patients considering natalizumab treatment indicates that at least a quarter of PML cases may be preventable.
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Affiliation(s)
- Peggy S Eis
- Population Bio, Inc., New York, NY, United States
| | | | - Todd A Richmond
- Richmond Bioinformatics Consulting, Seattle, WA, United States
| | - Igor J Koralnik
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A Hanson
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugene O Major
- Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | | | - Houria Hendel-Chavez
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Sud, INSERM 1184, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
| | - Bruno Stankoff
- Department of Neurology, Hôpital Saint-Antoine, Paris, France
| | - Jacques Gasnault
- Department of Internal Medicine, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Yassine Taoufik
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Sud, INSERM 1184, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
| | - Eli Hatchwell
- Population Bio UK, Inc., Oxfordshire, United Kingdom
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Waldrop G, Goetz TG, Siddiqi OK, Koralnik IJ, Shah H, Thakur KT. The World Health Organization's Essential Diagnostics List: Diagnostics for neurologic disorders. Neurology 2020; 93:680-683. [PMID: 31591174 DOI: 10.1212/wnl.0000000000008247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Greer Waldrop
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL
| | - Teddy G Goetz
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL
| | - Omar K Siddiqi
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL
| | - Igor J Koralnik
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL
| | - Hiral Shah
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL
| | - Kiran T Thakur
- From the Department of Neurology (G.W., H.S., K.T.T.), Community and Global Neurology Program, Columbia University Irving Medical Center; Vagelos College of Physicians and Surgeons (L.G.G.), Columbia University, New York; Department of Neurology, Global Neurology Program (O.K.S.) and Department of Internal Medicine, Center for Vaccines and Virology Research (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; and Department of Neurological Sciences (I.J.K.), Rush University Medical Center, Chicago, IL.
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Sierra Morales F, Koralnik IJ, Gautam S, Samaan S, Sloane JA. Correction to: Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate. J Neurol 2019; 267:132. [PMID: 31758256 DOI: 10.1007/s00415-019-09626-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Unfortunately, the given name and family name of first author was incorrectly tagged in the xml data, therefore it is abbreviated wrongly as "Morales FS" in Pubmed. The correct given name is Fabian and family name is Sierra Morales. Auhtor name should be abbreviated as Sierra Morales F.
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Affiliation(s)
- Fabian Sierra Morales
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Igor J Koralnik
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shiva Gautam
- Division of Biostatistics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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Cogswell AC, Maski K, Scammell TE, Tucker D, Orban ZS, Koralnik IJ. Children with Narcolepsy type 1 have increased T-cell responses to orexins. Ann Clin Transl Neurol 2019; 6:2566-2572. [PMID: 31730293 PMCID: PMC6917326 DOI: 10.1002/acn3.50908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
Narcolepsy type 1 (NT1) is caused by severe loss of the orexin neurons, and is highly associated with HLA DQB1*06:02. Using intracellular cytokine staining, we observed a higher frequency of IFN‐γ‐ and TNF‐α‐producing CD4+ and CD8+ T‐cells in response to orexins in 27 children with NT1 compared to 15 healthy control children. Conversely, no such difference was observed between 14 NT1 and 16 HC adults. In addition, priming with flu peptides amplified the T‐cell response to orexins in children with NT1. Our data suggests that NT1 may be caused by an autoimmune T‐cell response to orexins, possibly triggered by flu antigens.
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Affiliation(s)
- Andrew C Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Kiran Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas E Scammell
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dominique Tucker
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Zachary S Orban
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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Morales FS, Koralnik IJ, Gautam S, Samaan S, Sloane JA. Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate. J Neurol 2019. [PMID: 31583427 DOI: 10.1007/s00415‐019‐09557‐w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To identify risk factors for DMF-induced lymphopenia and characterize its impact on T lymphocyte subsets in MS patients. METHODS We performed a retrospective analysis of 194 RRMS patients treated with DMF at the Beth Israel Deaconess Medical Center (BIDMC) over a median of 17 months. We reviewed demographics, ethnic background, prior medication history, complete blood counts and T lymphocyte subsets. Possible lymphopenia risk factors examined included age, prior natalizumab exposure, vitamin D levels, and concomitant exposure to carbamazepine, opiates, tobacco, or steroids. Lymphopenia was defined as grade 1: absolute lymphocytes count (ALC) 800-999/μl; grade 2: ALC 500-799/μl; grade 3: ALC 200-499/μl; and grade 4: ALC < 200/μl. RESULTS Of 194 DMF-treated patients, 73 (38%) developed lymphopenia and reached an ALC nadir after a median of 504 days (range 82-932). Risk of developing DMF-induced lymphopenia increased with BMI 25-30, older age, white ethnicity, non-smoking status, and lowest quartile baseline ALC. Prior exposure to natalizumab or concomitant steroid, opiates or carbamazepine/oxcarbamazepine use was not associated with lymphopenia. Compared to baseline levels, CD8 T cells were significantly more reduced than CD4 cells. CD8 counts were more commonly reduced with age or white ethnicity. Subjects with BMI 25-30 was associated with a higher risk of abnormal CD4 cell count reductions. In contrast, non-smokers were more likely to experience reductions in both CD4 and CD8 counts while on DMF. CONCLUSIONS Patients with low baseline lymphocyte counts, with intermediate BMI, with white ethnicity, with advanced age, or with no tobacco use, had a significantly higher incidence of lymphopenia on DMF. Intermediate BMI or lowest quartile baseline ALC predicted low CD4 levels, while advanced age or white ethnicity predicted low CD8 levels from DMF exposure.
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Affiliation(s)
- Fabian Sierra Morales
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Igor J Koralnik
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shiva Gautam
- Division of Biostatistics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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Morales FS, Koralnik IJ, Gautam S, Samaan S, Sloane JA. Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate. J Neurol 2019; 267:125-131. [PMID: 31583427 DOI: 10.1007/s00415-019-09557-w] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To identify risk factors for DMF-induced lymphopenia and characterize its impact on T lymphocyte subsets in MS patients. METHODS We performed a retrospective analysis of 194 RRMS patients treated with DMF at the Beth Israel Deaconess Medical Center (BIDMC) over a median of 17 months. We reviewed demographics, ethnic background, prior medication history, complete blood counts and T lymphocyte subsets. Possible lymphopenia risk factors examined included age, prior natalizumab exposure, vitamin D levels, and concomitant exposure to carbamazepine, opiates, tobacco, or steroids. Lymphopenia was defined as grade 1: absolute lymphocytes count (ALC) 800-999/μl; grade 2: ALC 500-799/μl; grade 3: ALC 200-499/μl; and grade 4: ALC < 200/μl. RESULTS Of 194 DMF-treated patients, 73 (38%) developed lymphopenia and reached an ALC nadir after a median of 504 days (range 82-932). Risk of developing DMF-induced lymphopenia increased with BMI 25-30, older age, white ethnicity, non-smoking status, and lowest quartile baseline ALC. Prior exposure to natalizumab or concomitant steroid, opiates or carbamazepine/oxcarbamazepine use was not associated with lymphopenia. Compared to baseline levels, CD8 T cells were significantly more reduced than CD4 cells. CD8 counts were more commonly reduced with age or white ethnicity. Subjects with BMI 25-30 was associated with a higher risk of abnormal CD4 cell count reductions. In contrast, non-smokers were more likely to experience reductions in both CD4 and CD8 counts while on DMF. CONCLUSIONS Patients with low baseline lymphocyte counts, with intermediate BMI, with white ethnicity, with advanced age, or with no tobacco use, had a significantly higher incidence of lymphopenia on DMF. Intermediate BMI or lowest quartile baseline ALC predicted low CD4 levels, while advanced age or white ethnicity predicted low CD8 levels from DMF exposure.
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Affiliation(s)
- Fabian Sierra Morales
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.,Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Igor J Koralnik
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.,Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shiva Gautam
- Division of Biostatistics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA
| | - Jacob A Sloane
- Division of Neuro-Immunology, Department of Neurology, Beth Israel Deaconess Medical Center, Multiple Sclerosis Center, Harvard Medical School, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
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Abstract
Neurosyphilis is caused by the bacterium Treponema pallidum subspecies pallidum (T. pallidum). The organism gains entry into the central nervous system (CNS) early (primary syphilis or chancre phase) in the course of infection. While most patients are able to mount an immune response that effectively clears CNS invasion without long-term complications, a minority go on to develop asymptomatic or symptomatic neurosyphilis. Neurosyphilis has been divided into early and late stages. The early stages include asymptomatic meningitis, symptomatic meningitis, gumma, and meningovascular syphilis, while the late stages include dementia paralytica and tabes dorsalis. Ocular and otologic syphilis can occur at any time but often accompany the acute meningitis of early neurosyphilis. The diagnosis of symptomatic neurosyphilis requires meeting clinical, serologic, and cerebrospinal fluid (CSF) criteria, while the diagnosis of asymptomatic neurosyphilis relies on serologic and CSF criteria alone. In the last several decades, a persistent rise in syphilitic meningitis and other forms of early neurosyphilis have been seen in the human immunodeficiency virus-positive population, principally in men who have sex with men. This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection.
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Affiliation(s)
- Hemil Gonzalez
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Christina M Marra
- Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington
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