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Schiavetti I, Signori A, Albanese A, Frau J, Cocco E, Lorefice L, di Lemme S, Fantozzi R, Centonze D, Landi D, Marfia G, Signoriello E, Lus G, Zecca C, Gobbi C, Iodice R, Malimpensa L, Cordioli C, Ferraro D, Ruscica F, Pasquali L, Repice A, Immovilli P, Ferrò MT, Bonavita S, Di Filippo M, Abbadessa G, Govone F, Sormani MP. Therapeutic choices and disease activity after 2 years of treatment with cladribine: An Italian multicenter study (CladStop). Eur J Neurol 2024; 31:e16250. [PMID: 38549186 DOI: 10.1111/ene.16250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND PURPOSE Cladribine tablets, a purine analogue antimetabolite, offer a unique treatment regimen, involving short courses at the start of the first and second year, with no further treatment needed in years 3 and 4. However, comprehensive evidence regarding patient outcomes beyond the initial 24 months of cladribine treatment is limited. METHODS This retrospective, multicenter study enrolled 204 patients with multiple sclerosis who had completed the 2-year course of cladribine treatment. The primary outcomes were therapeutic choices and clinical disease activity assessed by annualized relapse rate after the 2-year treatment course. RESULTS A total of 204 patients were enrolled; most patients (75.4%) did not initiate new treatments in the 12 months postcladribine. The study found a significant reduction in annualized relapse rate at the 12-month follow-up after cladribine completion compared to the year prior to starting therapy (0.07 ± 0.25 vs. 0.82 ± 0.80, p < 0.001). Furthermore, patients with relapses during cladribine treatment were more likely to start new therapies, whereas older patients were less likely. The safety profile of cladribine was favorable, with lymphopenia being the primary registered adverse event. CONCLUSIONS This study provides insights into therapeutic choices and disease activity following cladribine treatment. It highlights cladribine's effectiveness in reducing relapse rates and disability progression, reaffirming its favorable safety profile. Real-world data, aligned with previous reports, draw attention to ocrelizumab and natalizumab as common choices after cladribine. However, larger, prospective studies for validation and a more comprehensive understanding of cladribine's long-term impact are necessary.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Angela Albanese
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Lorena Lorefice
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
| | - Sonia di Lemme
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Roberta Fantozzi
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Girolama Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Giacomo Lus
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli, Napoli, Italy
| | - Leonardo Malimpensa
- Mediterranean Neurological Institute Neuromed, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pozzilli, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Montichiari, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Ruscica
- Unità operativa di Neurologia, Fondazione Istituto G.Giglio, Palermo, Italy
| | - Livia Pasquali
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anna Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Paolo Immovilli
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Maria Teresa Ferrò
- Neurological Unit, Cerebrovascular Department, Neuroimmunology, Center for Multiple Sclerosis, ASST Crema, Crema, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Gianmarco Abbadessa
- I Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Flora Govone
- Centro Sclerosi Multipla-Neurologia di Mondovì, Cuneo, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Perri V, Zingaropoli MA, Pasculli P, Ciccone F, Tartaglia M, Baione V, Malimpensa L, Ferrazzano G, Mastroianni CM, Conte A, Ciardi MR. The Impact of Cytomegalovirus Infection on Natural Killer and CD8+ T Cell Phenotype in Multiple Sclerosis. Biology (Basel) 2024; 13:154. [PMID: 38534424 DOI: 10.3390/biology13030154] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Abstract
Multiple sclerosis (MS) is a debilitating neurological disease that has been classified as an immune-mediated attack on myelin, the protective sheath of nerves. Some aspects of its pathogenesis are still unclear; nevertheless, it is generally established that viral infections influence the course of the disease. Cytomegalovirus (CMV) is a major pathogen involved in alterations of the immune system, including the expansion of highly differentiated cytotoxic CD8+ T cells and the accumulation of adaptive natural killer (NK) cells expressing high levels of the NKG2C receptor. In this study, we evaluated the impact of latent CMV infection on MS patients through the characterization of peripheral NK cells, CD8+ T cells, and NKT-like cells using flow cytometry. We evaluated the associations between immune cell profiles and clinical features such as MS duration and MS progression, evaluated using the Expanded Disability Status Scale (EDSS). We showed that NK cells, CD8+ T cells, and NKT-like cells had an altered phenotype in CMV-infected MS patients and displayed high levels of the NKG2C receptor. Moreover, in MS patients, increased NKG2C expression levels were found to be associated with higher EDSS scores. Overall, these results support the hypothesis that CMV infection imprints the immune system by modifying the phenotype and receptor repertoire of NK and CD8+ T cells, suggesting a detrimental role of CMV on MS progression.
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Affiliation(s)
- Valentina Perri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Ciccone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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3
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Arisi I, Malimpensa L, Manzini V, Brandi R, Gosetti di Sturmeck T, D’Amelio C, Crisafulli S, Ferrazzano G, Belvisi D, Malerba F, Florio R, Pascale E, Soreq H, Salvetti M, Cattaneo A, D’Onofrio M, Conte A. Cladribine and ocrelizumab induce differential miRNA profiles in peripheral blood mononucleated cells from relapsing-remitting multiple sclerosis patients. Front Immunol 2023; 14:1234869. [PMID: 38152407 PMCID: PMC10751352 DOI: 10.3389/fimmu.2023.1234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023] Open
Abstract
Background and objectives Multiple sclerosis (MS) is a chronic, progressive neurological disease characterized by early-stage neuroinflammation, neurodegeneration, and demyelination that involves a spectrum of heterogeneous clinical manifestations in terms of disease course and response to therapy. Even though several disease-modifying therapies (DMTs) are available to prevent MS-related brain damage-acting on the peripheral immune system with an indirect effect on MS lesions-individualizing therapy according to disease characteristics and prognostic factors is still an unmet need. Given that deregulated miRNAs have been proposed as diagnostic tools in neurodegenerative/neuroinflammatory diseases such as MS, we aimed to explore miRNA profiles as potential classifiers of the relapsing-remitting MS (RRMS) patients' prospects to gain a more effective DMT choice and achieve a preferential drug response. Methods A total of 25 adult patients with RRMS were enrolled in a cohort study, according to the latest McDonald criteria before (pre-cladribine, pre-CLA; pre-ocrelizumab, pre-OCRE, time T0) and after high-efficacy DMTs, time T1, 6 months post-CLA (n = 10, 7 F and 3 M, age 39.0 ± 7.5) or post-OCRE (n = 15, 10 F and 5 M, age 40.5 ± 10.4) treatment. A total of 15 age- and sex-matched healthy control subjects (9 F and 6 M, age 36.3 ± 3.0) were also selected. By using Agilent microarrays, we analyzed miRNA profiles from peripheral blood mononuclear cells (PBMC). miRNA-target networks were obtained by miRTargetLink, and Pearson's correlation served to estimate the association between miRNAs and outcome clinical features. Results First, the miRNA profiles of pre-CLA or pre-OCRE RRMS patients compared to healthy controls identified modulated miRNA patterns (40 and seven miRNAs, respectively). A direct comparison of the two pre-treatment groups at T0 and T1 revealed more pro-inflammatory patterns in the pre-CLA miRNA profiles. Moreover, both DMTs emerged as being capable of reverting some dysregulated miRNAs toward a protective phenotype. Both drug-dependent miRNA profiles and specific miRNAs, such as miR-199a-3p, miR-29b-3p, and miR-151a-3p, emerged as potentially involved in these drug-induced mechanisms. This enabled the selection of miRNAs correlated to clinical features and the related miRNA-mRNA network. Discussion These data support the hypothesis of specific deregulated miRNAs as putative biomarkers in RRMS patients' stratification and DMT drug response.
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Affiliation(s)
- Ivan Arisi
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Leonardo Malimpensa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Valeria Manzini
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | - Rossella Brandi
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | | | - Chiara D’Amelio
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | - Sebastiano Crisafulli
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Belvisi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Malerba
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | - Rita Florio
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | - Esterina Pascale
- Department of Medical-Surgical Sciences and of Biotechnologies, “Sapienza” University of Rome, Rome, Italy
| | - Hermona Soreq
- The Edmond and Lily Safra Center of Brain Science and The Life Sciences Institute, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marco Salvetti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Antonino Cattaneo
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
- Bio@SNS Laboratory of Biology, Scuola Normale Superiore, Pisa, Italy
| | - Mara D’Onofrio
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, Rome, Italy
| | - Antonella Conte
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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4
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Zingaropoli MA, Pasculli P, Tartaglia M, Dominelli F, Ciccone F, Taglietti A, Perri V, Malimpensa L, Ferrazzano G, Iannetta M, Del Borgo C, Lichtner M, Mastroianni CM, Conte A, Ciardi MR. Evaluation of BAFF, APRIL and CD40L in Ocrelizumab-Treated pwMS and Infectious Risk. Biology (Basel) 2023; 12:biology12040587. [PMID: 37106787 PMCID: PMC10135639 DOI: 10.3390/biology12040587] [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] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The anti-CD20 monoclonal antibody ocrelizumab has been widely employed in the treatment of people with multiple sclerosis (pwMS). However, its B-cell-depleting effect may induce a higher risk of infectious events and alterations in the secretion of B-cell-activating factors, such as BAFF, APRIL and CD40L. METHODS The aim of this study was to investigate plasma BAFF, APRIL and CD40L levels and their relationship with infectious risk in ocrelizumab-treated pwMS at baseline (T0), at 6 months (T6) and at 12 months (T12) after starting the treatment. As a control group, healthy donors (HD) were enrolled too. RESULTS A total of 38 pwMS and 26 HD were enrolled. At baseline, pwMS showed higher plasma BAFF (p < 0.0001), APRIL (p = 0.0223) and CD40L (p < 0.0001) levels compared to HD. Compared to T0, plasma BAFF levels were significantly increased at both T6 and T12 (p < 0.0001 and p < 0.0001, respectively). Whereas plasma APRIL and CD40L levels were decreased at T12 (p = 0.0003 and p < 0.0001, respectively). When stratifying pwMS according to the development of an infectious event during the 12-month follow-up period in two groups-with (14) and without an infectious event (24)-higher plasma BAFF levels were observed at all time-points; significantly, in the group with an infectious event compared to the group without an infectious event (T0: p < 0.0001, T6: p = 0.0056 and T12: p = 0.0400). Conclusions: BAFF may have a role as a marker of immune dysfunction and of infectious risk.
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Affiliation(s)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Ciccone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Ambra Taglietti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Valentina Perri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Leonardo Malimpensa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, 00133 Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza University of Rome, 04110 Latina, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza University of Rome, 04110 Latina, Italy
- Department of Neurosciences Mental Health and Sensory Organs, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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5
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Tartaglia M, Canevelli M, Malimpensa L, Belvisi D, Baione V, Ferrazzano G, Leodori G, Berardelli A, Conte A. Neurophysiological and clinical biomarkers of secondary progressive multiple sclerosis: A cross-sectional study. Front Neurol 2023; 14:1138600. [PMID: 37006502 PMCID: PMC10060628 DOI: 10.3389/fneur.2023.1138600] [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: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Timely diagnosis of secondary progressive multiple sclerosis (SPMS) represents a clinical challenge. The Frailty Index, a quantitative frailty measure, and the Neurophysiological Index, a combined measure of sensorimotor cortex inhibitory mechanism parameters, have recently emerged as promising tools to support SPMS diagnosis. The aim of this study was to explore the possible relationship between these two indices in MS. MS participants underwent a clinical evaluation, Frailty Index administration, and neurophysiological assessment. Frailty and Neurophysiological Index scores were found to be higher in SPMS and correlated with each other, thus suggesting that they may capture similar SPMS-related pathophysiological mechanisms.
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Affiliation(s)
- Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurophysiology, IRCCS Neuromed, Pozzilli, Italy
| | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurophysiology, IRCCS Neuromed, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurophysiology, IRCCS Neuromed, Pozzilli, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurophysiology, IRCCS Neuromed, Pozzilli, Italy
- *Correspondence: Antonella Conte
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6
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Baione V, Canevelli M, Belvisi D, Buscarinu MC, Bellucci G, Fantozzi R, Nicoletti CG, Malatuni G, Cortese A, De Giglio L, Tartaglia M, Ferrazzano G, Malimpensa L, Leodori G, Bruno G, Ferraro E, Marfia GA, Centonze D, Salvetti M, Conte A. Frailty and relapse activity in multiple sclerosis: A longitudinal observation. Mult Scler Relat Disord 2023; 72:104603. [PMID: 36905818 DOI: 10.1016/j.msard.2023.104603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Recent cross-sectional investigations suggest a relationship between frailty, as measured by Frailty Index (FI), and multiple sclerosis (MS). However, if and how frailty is associated with relapse activity in MS is still unknown. To explore this issue, a one-year follow-up study involving 471 patients was conducted. A univariate regression model showed an inverse association between baseline FI score and the presence of relapse, which was also confirmed in the multivariate model. These results suggest that frailty may reflect pathophysiological mechanisms involved in MS disease activity and that the FI may be used as an enrichment criterion in clinical trials.
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Affiliation(s)
- Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | | | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giorgia Malatuni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | | | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giuseppe Bruno
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Girolama Alessandra Marfia
- IRCCS Neuromed, Pozzilli, IS, Italy; Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, IS, Italy; Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
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7
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Dominelli F, Zingaropoli MA, Tartaglia M, Tortellini E, Guardiani M, Perri V, Pasculli P, Ciccone F, Malimpensa L, Baione V, Napoli A, Gaeta A, Lichtner M, Conte A, Mastroianni CM, Ciardi MR. Multiple sclerosis-disease modifying therapies affect humoral and T-cell response to mRNA COVID-19 vaccine. Front Immunol 2022; 13:1050183. [PMID: 36532061 PMCID: PMC9753571 DOI: 10.3389/fimmu.2022.1050183] [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: 09/21/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background The mRNA vaccines help protect from COVID-19 severity, however multiple sclerosis (MS) disease modifying therapies (DMTs) might affect the development of humoral and T-cell specific response to vaccination. Methods The aim of the study was to evaluate humoral and specific T-cell response, as well as B-cell activation and survival factors, in people with MS (pwMS) under DMTs before (T0) and after two months (T1) from the third dose of vaccine, comparing the obtained findings to healthy donors (HD). All possible combinations of intracellular IFNγ, IL2 and TNFα T-cell production were evaluated, and T-cells were labelled "responding T-cells", those cells that produced at least one of the three cytokines of interest, and "triple positive T-cells", those cells that produced simultaneously all the three cytokines. Results The cross-sectional evaluation showed no significant differences in anti-S antibody titers between pwMS and HD at both time-points. In pwMS, lower percentages of responding T-cells at T0 (CD4: p=0.0165; CD8: p=0.0022) and triple positive T-cells at both time-points compared to HD were observed (at T0, CD4: p=0.0007 and CD8: p=0.0703; at T1, CD4: p=0.0422 and CD8: p=0.0535). At T0, pwMS showed higher plasma levels of APRIL, BAFF and CD40L compared to HD (p<0.0001, p<0.0001 and p<0.0001, respectively) and at T1, plasma levels of BAFF were still higher in pwMS compared to HD (p=0.0022).According to DMTs, at both T0 and T1, lower anti-S antibody titers in the depleting/sequestering-out compared to the enriching-in pwMS subgroup were found (p=0.0410 and p=0.0047, respectively) as well as lower percentages of responding CD4+ T-cells (CD4: p=0.0394 and p=0.0004, respectively). Moreover, the depleting/sequestering-out subgroup showed higher percentages of IFNγ-IL2-TNFα+ T-cells at both time-points, compared to the enriching-in subgroup in which a more heterogeneous cytokine profile was observed (at T0 CD4: p=0.0187; at T0 and T1 CD8: p =0.0007 and p =0.0077, respectively). Conclusion In pwMS, humoral and T-cell response to vaccination seems to be influenced by the different DMTs. pwMS under depleting/sequestering-out treatment can mount cellular responses even in the presence of a low positive humoral response, although the cellular response seems qualitatively inferior compared to HD. An understanding of T-cell quality dynamic is needed to determine the best vaccination strategy and in general the capability of immune response in pwMS under different DMT.
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Affiliation(s)
- Federica Dominelli
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy,*Correspondence: Maria Antonella Zingaropoli,
| | - Matteo Tartaglia
- Department of Human Neurosciences, Multiple Sclerosis Centre, Sapienza, University of Rome, Rome, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Valentina Perri
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Federica Ciccone
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Leonardo Malimpensa
- Department of Human Neurosciences, Multiple Sclerosis Centre, Sapienza, University of Rome, Rome, Italy
| | - Viola Baione
- Department of Human Neurosciences, Multiple Sclerosis Centre, Sapienza, University of Rome, Rome, Italy
| | - Anna Napoli
- Department of Molecular medicine, Sapienza, University of Rome, Rome, Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza, University of Rome, Latina, Italy,Department of Neurosciences Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Multiple Sclerosis Centre, Sapienza, University of Rome, Rome, Italy,Scientific Hospitalization and Treatment Institute, Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | | | - Maria Rosa Ciardi
- Department of Public Health and Infectious diseases, Sapienza, University of Rome, Rome, Italy
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