Do increased serum IL-12 and IL-23 levels affect cognitive function in patients with multiple sclerosis? A preliminary study

Aim of the study: To compare the serum levels of IL-12 and IL-23 between healthy volunteers and patients with multiple sclerosis with regard to their cognitive function. Materials and methods: A total of 21 patients with multiple sclerosis and 21 healthy individuals were enrolled into the study. The individuals were age- and sex-matched. Each participant was evaluated using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). The enzyme-linked immunosorbent assay was performed to assess the serum levels of IL-12 and IL-23. Results: The concentration of IL-12 was 1.61 ± 4.61 pg/mL in the group of patients with multiple sclerosis and 1.78 ± 3.54 pg/mL in the control group, p = 0.5009. The concentration of IL-23 was 19.04 ± 75.50 pg/mL in the study group and 5.50 ± 14.4 pg/mL in the control group, p = 0.5170. A significant difference was found between the control and study groups in the MoCA cognitive test (28 vs. 24 points, respectively, p < 0.0001). There was no significant difference in the Beck Depression Inventory and PSQI between the control and study groups. No significant correlations were found between the IL-12/IL-23 serum levels and psychological evaluations. Conclusions and clinical implications: The results obtained indicate that IL-12 and IL-23 may not play a role in the development of cognitive impairment. The assessment of cognitive impairment in patients with multiple sclerosis may have a screening value in preventing their cognitive deterioration.

Plasma Metabolic Disturbances in Parkinson's Disease Patients

Plasma from patients with Parkinson's disease (PD) is a valuable source of information indicating altered metabolites associated with the risk or progression of the disease. Neurotoxicity of dopaminergic neurons, which is triggered by aggregation of α-synuclein, is the main pathogenic feature of PD. However, a growing body of scientific reports indicates that metabolic changes may precede and directly contribute to neurodegeneration. Identification and characterization of the abnormal metabolic pattern in patients' plasma are therefore crucial for the search for potential PD biomarkers. The aims of the present study were (1) to identify metabolic alterations in plasma metabolome in subjects with PD as compared with the controls; (2) to find new potential markers, some correlations among them; (3) to identify metabolic pathways relevant to the pathophysiology of PD. Plasma samples from patients with PD (n = 25) and control group (n = 12) were collected and the gas chromatography-time-of-flight-mass spectrometry GC-TOFMS-based metabolomics approach was used to evaluate the metabolic changes based on the identified 14 metabolites with significantly altered levels using univariate and multivariate statistical analysis. The panel, including 6 metabolites (L-3-methoxytyrosine, aconitic acid, L-methionine, 13-docosenamide, hippuric acid, 9,12-octadecadienoic acid), was identified to discriminate PD from controls with the area under the curve (AUC) of 0.975, with an accuracy of 92%. We also used statistical criteria to identify the significantly altered level of metabolites. The metabolic pathways involved were associated with linoleic acid metabolism, mitochondrial electron transport chain, glycerolipid metabolism, and bile acid biosynthesis. These abnormal metabolic changes in the plasma of patients with PD were mainly related to the amino acid metabolism, TCA cycle metabolism, and mitochondrial function.

Unusual magnetic resonance imaging of the head in manganese and ephedrone intoxication - a case report

Manganese intoxication leads to the accumulation of manganese in the brain, mostly in the globus pallidus, which clinically manifests as a L-DOPA - resistant parkinsonian syndrome with specific symptoms, such as spastic-hypokinetic dysarthria and postural instability. A new kind of manganese poisoning associated with drug abuse has been reported in Eastern European countries.

A CASE REPORT

We present an adult patient with neurological abnormalities secondary to manganese intoxication related to the abuse of psychoactive substances. High serum levels of manganese, hyperintense lesions on T1-weighted magnetic resonance imaging (MRI), and parkinsonism in this case confirmed the diagnosis. MRI results showed accumulation of manganese in the basal ganglia which caused an increased signal in this area of the brain on T1 weighted sequence. This is the second case reported with diffuse high signal intensity of the entire white matter due to manganese and ephedron neurointoxication. To the best of our knowledge, this is the first time such extensive pathological changes to cerebellar white matter, located near the fourth ventricle, have been described.

CONCLUSIONS

We suggest that chronic exposure to manganese and ephedron damaged the white matter in the cerebral hemispheres and continued to affect the periventricular area of the fourth ventricle, causing continuous changes to the white matter.

Diagnostic and therapeutic difficulties in patient with cerebral venous thrombosis - a case report

Cerebral venous infarction also known as cerebral venous thrombosis (CVT) is a rare disease. It is more common in young adults, but three times more common in women than in men. The clinical picture of CVT may vary and non-specific manifestations often delay correct diagnosis. Headaches of various location, nature and severity occur in 90% of cases. Radiology findings in the central nervous system include bilateral cerebral involvement and foci location that does not correspond to arterial supply. More than 100 factors that may predispose to CVT have been identified. The aetiology of CVT remains unknown in about 20% of patients.

A CARE REPORT

In this paper we present a case of 35-year-old woman at 27 weeks of gestation, who was admitted to the hospital after the first epileptic seizure in her life. The patient's history revealed the headaches that had lasted for about 3 months prior. The patient had no family history of hypercoagulability. The patient was diagnosed with CVT - a hemorrhagic lesion in the left hemisphere of the brain as a result of dural sinus thrombosis. Anticoagulant treatment according to current guidelines was started with good results.

Brain MRI features and scoring of leukodystrophy in adult-onset Krabbe disease

Objective

To perform a systematic analysis and scoring of brain MRI white matter hyperintensities (WMH) in adult-onset Krabbe disease.

Methods

We retrospectively collected basic clinical data and the first available brain MRI from patients with confirmed Krabbe disease with first clinical manifestations beyond 10 years of age. Data were obtained from our reference center for lysosomal diseases (n = 6) and from contacted authors of published articles describing patients with adult-onset Krabbe disease (n = 15). T2-weighted fluid-attenuated inversion recovery images of each patient were analyzed and scored using a radiologic score of WMH in a single center.

Results

The corticospinal tract was always affected by WMH (100% of patients), however, with some distinctions along the tract: the precentral gyrus (100%), corona radiata (95%), and posterior internal capsule (81%) were highly abnormal, whereas the mesencephalon (57%), pons (52%), and medulla oblongata (5%) were less affected. WMH were also frequently present in the posterior lateral periventricular white matter (95%), optic radiations (86%), postcentral gyrus (71%), medial lemniscus (62%), and corpus callosum, especially in the isthmus (71%), whereas the genu was always normal. A few patients did not have the classical MRI pattern but extensive hyperintensities (n = 3), or patchy distribution of hyperintensities mimicking an acquired etiology (n = 2), or very subtle hyperintensities of the corticospinal tract (n = 1).

Conclusions

We specified the main locations of WMH, which were observed in the earliest stages of the disease and were also present in patients with atypical MRI pattern, highlighting the importance of radiologic features to guide the diagnosis.

The impact of multiple sclerosis relapse treatment on migration of effector T cells--Preliminary study

Migration of inflammatory cells from the blood to the central nervous system (CNS) is crucial for development of multiple sclerosis (MS). Inhibition of this process would allow to control disease activity. The first step confirming this approach would be the analysis of the impact of effective MS relapse therapy on migration of effector T cells. The aim of the study was to analyze the influence of methylprednisolone (MP) on the migratory activity of effector CD4+ T cells from MS patients. Moreover, to study the potential mechanism of this process we studied expression of chemokine receptors on migrating cells.

MATERIAL AND METHODS

Peripheral blood samples were obtained from relapsing-remitting MS (RR-MS) patients during relapse (n=23) and from control group (n=23). After isolation CD4+ T cells were incubated with various concentrations of MP. Then they were stimulated in chemotaxis assay with chemokines CCL3 or CXCL10 or were used to CCR1 and CXCR3 expression analysis.

RESULTS

CXCL10- and CCL3-stimulated migration of CD4+ T cells was significantly increased in MS. MP was able to reduce in vitro migration of effector T cells induced by CXCL10, but not by CCL3. Inhibition by MP was dose-dependent. Expression of analyzed chemokine receptors was unaltered after MP incubation.

CONCLUSIONS

MP reduced CD4+ T cells migration induced by CXCL10 without affecting CXCR3 expression. These observations demonstrate one of the potential mechanisms of MP action in MS, distinct from inducing cell apoptosis, and suggests the new targets for development of more effective MS treatments.