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Ladakis DC, Pedrini E, Reyes-Mantilla MI, Sanjayan M, Smith MD, Fitzgerald KC, Pardo CA, Reich DS, Absinta M, Bhargava P. Metabolomics of Multiple Sclerosis Lesions Demonstrates Lipid Changes Linked to Alterations in Transcriptomics-Based Cellular Profiles. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200219. [PMID: 38547430 DOI: 10.1212/nxi.0000000000200219] [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: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES People with multiple sclerosis (MS) have a dysregulated circulating metabolome, but the metabolome of MS brain lesions has not been studied. The aims of this study were to identify differences in the brain tissue metabolome in MS compared with controls and to assess its association with the cellular profile of corresponding tissue. METHODS MS tissues included samples from the edge and core of chronic active or inactive lesions and periplaque white matter (WM). Control specimens were obtained from normal WM. Metabolomic analysis was performed using mass-spectrometry coupled with liquid/gas chromatography and subsequently integrated with single-nucleus RNA-sequencing data by correlating metabolite abundances with relative cell counts, as well as individual genes using Multiomics Factor Analysis (MOFA). RESULTS Seventeen samples from 5 people with secondary progressive MS and 8 samples from 6 controls underwent metabolomic profiling identifying 783 metabolites. MS lesions had higher levels of sphingosines (false discovery rate-adjusted p-value[q] = 2.88E-05) and sphingomyelins and ceramides (q = 2.15E-07), but lower nucleotide (q = 0.05), energy (q = 0.001), lysophospholipid (q = 1.86E-07), and monoacylglycerol (q = 0.04) metabolite levels compared with control WM. Periplaque WM had elevated sphingomyelins and ceramides (q = 0.05) and decreased energy metabolites (q = 0.01) and lysophospholipids (q = 0.05) compared with control WM. Sphingolipids and membrane lipid metabolites were positively correlated with astrocyte and immune cell abundances and negatively correlated with oligodendrocytes. On the other hand, long-chain fatty acid, endocannabinoid, and monoacylglycerol pathways were negatively correlated with astrocyte and immune cell populations and positively correlated with oligodendrocytes. MOFA demonstrated associations between differentially expressed metabolites and genes involved in myelination and lipid biosynthesis. DISCUSSION MS lesions and perilesional WM demonstrated a significantly altered metabolome compared with control WM. Many of the altered metabolites were associated with altered cellular composition and gene expression, indicating an important role of lipid metabolism in chronic neuroinflammation in MS.
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Affiliation(s)
- Dimitrios C Ladakis
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Edoardo Pedrini
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Maria I Reyes-Mantilla
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Muraleetharan Sanjayan
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Matthew D Smith
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Kathryn C Fitzgerald
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Carlos A Pardo
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Daniel S Reich
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Martina Absinta
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Pavan Bhargava
- From the Department of Neurology (D.C.L., M.I.R.-M., M.S., M.D.S., K.C.F., C.A.P., D.S.R., M.A., P.B.), Johns Hopkins University School of Medicine, Baltimore, MD; Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Translational Neuroradiology Section (D.S.R., M.A.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Ladakis DC, Reyes-Mantilla MI, Gadani SP, Mace JW, Dominguez-Penuela SC, Appiah MJ, Smith MD, Bhargava P, Fox RJ, Saidha S, Calabresi PA. Serum macrophage migration inhibitory factor levels predict brain atrophy in people with primary progressive multiple sclerosis. Mult Scler 2024; 30:35-43. [PMID: 37982154 DOI: 10.1177/13524585231213164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Macrophage migration inhibitory factor (MIF) is a cytokine linked to multiple sclerosis (MS) progression that is thought to be inhibited by ibudilast. SPRINT-MS was a phase 2 placebo-controlled trial of ibudilast in progressive multiple sclerosis (PMS). OBJECTIVE To determine whether baseline MIF levels predict imaging outcomes and assess the effects of ibudilast on serum and cerebrospinal fluid (CSF) MIF levels in people with PMS treated with ibudilast. METHODS Participants in the SPRINT-MS trial were treated with either ibudilast or placebo and underwent brain magnetic resonance imaging (MRI) every 24 weeks over a duration of 96 weeks. MIF was measured in serum and CSF. RESULTS MIF levels were compared with imaging outcomes in 223 participants from the SPRINT-MS study. In the primary progressive multiple sclerosis (PPMS) cohort, males had higher serum (p < 0.001) and CSF (p = 0.01) MIF levels, as compared with females. Higher baseline serum MIF levels in PPMS were associated with faster brain atrophy (beta = -0.113%, 95% confidence interval (CI): -0.204% to -0.021%; p = 0.016). These findings were not observed in secondary progressive multiple sclerosis (SPMS). Ibudilast did not affect either serum or CSF MIF levels. CONCLUSIONS Serum MIF levels were associated with male sex and predicted brain atrophy in PPMS, but not SPMS. Ibudilast did not demonstrate an effect on MIF levels, as compared with placebo, although we cannot exclude a functional effect.
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Affiliation(s)
- Dimitrios C Ladakis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria I Reyes-Mantilla
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sachin P Gadani
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jackson W Mace
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mayaa J Appiah
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Smith
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pavan Bhargava
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Koshorek J, Wang Y, Maldonado DP, Reyes-Mantilla MI, Obando D, Balshi A, Comisac M, Pasricha PJ, Newsome SD. The many faces of gastrointestinal dysfunction in stiff person syndrome spectrum disorders. Front Neurol 2023; 14:1273256. [PMID: 37869142 PMCID: PMC10587580 DOI: 10.3389/fneur.2023.1273256] [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: 08/05/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction The effect of stiff person syndrome spectrum disorders (SPSD) on the gastrointestinal tract (GIT) is unknown. This case series aims to characterize the prevalence and types of GI dysfunction in individuals with SPSD. Methods A retrospective chart review included individuals diagnosed with SPSD with descriptors of GI symptoms in their medical records. SPSD phenotypes, type of motility test performed, and dysmotility pattern (upper, lower, or diffuse) were assessed. Descriptive statistics and univariate chi-square analyses were utilized. Results Of 240 individuals with SPSD, 32% reported GI symptoms, most were female (83.1%), and white (74%), with a median age at time of GI symptom onset of 50 ± 13 years. Most common symptoms reported were dysphagia (45%), constipation (40%), and nausea/vomiting (23%). Most individuals had classic SPS (47%) followed by SPS-plus (29%) and 82.9% were positive for serum antiGAD65 antibodies. Of 36 patients that underwent at least one GI motility test, 26 had evidence of upper, lower, or diffuse GI dysmotility (44.4%, 17%, and 4%, respectively). The group who did not undergo testing had a higher proportion of patients with DM. Discussion There is a high prevalence of GI symptoms and transit abnormalities in patients with SPSD. Future prospective, longitudinal studies are warranted to further assess GI symptoms in the context of SPSD and to determine if individuals with GI symptoms differ in prognosis or treatment response from those without GI symptoms. In the meantime, there should be a low threshold for motility testing in patients with SPSD.
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Affiliation(s)
- Jacqueline Koshorek
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yujie Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Maria I. Reyes-Mantilla
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Danielle Obando
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexandra Balshi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Comisac
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pankaj Jay Pasricha
- Department of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Mayo Clinic in Arizona Department of Medicine, Scottsdale, AZ, United States
| | - Scott D. Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Pimentel Maldonado DA, Balshi A, Hu C, Fitzgerald KC, Koshorek J, Reyes-Mantilla MI, Obando D, Wang Y, Newsome SD. Respiratory Symptoms are Common in Stiff Person Syndrome Spectrum Disorders and are Associated with Number of Body Regions Involved. Eur J Neurol 2023. [PMID: 37154293 DOI: 10.1111/ene.15825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/21/2022] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Stiff Person Syndrome (SPS)-spectrum disorders (SPSSD) cause spasms and rigidity throughout different body regions and can be associated with apnea and acute respiratory failure. There is limited data on the prevalence and predictors of respiratory symptoms with spasms (RSwS) in SPSSD. We sought to characterize the spirometry patterns and the frequency and predictors of RSwS in a large SPSSD cohort. METHODS Participants were recruited from the Johns Hopkins SPS Center between 1997 and 2021, as part of an ongoing, longitudinal observational study. Medical records were reviewed to assess demographics and clinical characteristics. Data were analyzed using descriptive statistics and multivariable logistic regression models. RESULTS One-hundred and ninety-nine participants (mean age 53.4 + 13.6 years, median time-to-diagnosis 36 (66) months, 74.9% women, 69.8% white, 62.8% classic SPS phenotype) were included in final analyses; 35.2% of participants reported RSwS, of which 24.3% underwent spirometry as part of routine clinical care. Obstructive (23.5%) and restrictive (23.5%) patterns were most commonly observed in those with SPSSD. An increasing number of body regions involved predicted the presence of RSwS (OR 1.95; CI 1.50-2.53); those with >5 body regions involved (vs. <4) had higher odds (OR 6.19; CI 2.81 - 13.62) of experiencing RSwS in adjusted models. Two patients died from SPSSD-associated respiratory compromise. CONCLUSIONS RSwS are common in SPSSD and may be predicted by an increasing number of body regions involved by SPSSD. Close clinical monitoring and having a low threshold to obtain spirometry should be considered in people with SPSSD.
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Affiliation(s)
| | - Alexandra Balshi
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Chen Hu
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Jacqueline Koshorek
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Maria I Reyes-Mantilla
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Danielle Obando
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Yujie Wang
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
- University of Washington School of Medicine, Department of Neurology, Seattle, WA, USA
| | - Scott D Newsome
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
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Ruiz-Bedoya CA, Mota F, Tucker EW, Mahmud FJ, Reyes-Mantilla MI, Erice C, Bahr M, Flavahan K, De Jesus P, Kim J, Foss CA, Peloquin CA, Hammoud DA, Ordonez AA, Pardo CA, Jain SK. High-dose rifampin improves bactericidal activity without increased intracerebral inflammation in animal models of tuberculous meningitis. J Clin Invest 2022; 132:155851. [PMID: 35085105 PMCID: PMC8920328 DOI: 10.1172/jci155851] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/14/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Tuberculous meningitis (TB meningitis) is the most severe form of tuberculosis (TB), requiring 12 months of multidrug treatment for cure, and is associated with high morbidity and mortality. High-dose rifampin (35 mg/kg/d) is safe and improves the bactericidal activity of the standard-dose (10 mg/kg/d) rifampin-containing TB regimen in pulmonary TB. However, there are conflicting clinical data regarding its benefit for TB meningitis, where outcomes may also be associated with intracerebral inflammation. We conducted cross-species studies in mice and rabbits, demonstrating that an intensified high-dose rifampin-containing regimen has significantly improved bactericidal activity for TB meningitis over the first-line, standard-dose rifampin regimen, without an increase in intracerebral inflammation. Positron emission tomography in live animals demonstrated spatially compartmentalized, lesion-specific pathology, with postmortem analyses showing discordant brain tissue and cerebrospinal fluid rifampin levels and inflammatory markers. Longitudinal multimodal imaging in the same cohort of animals during TB treatment as well as imaging studies in two cohorts of TB patients demonstrated that spatiotemporal changes in localized blood-brain barrier disruption in TB meningitis are an important driver of rifampin brain exposure. These data provide unique insights into the mechanisms underlying high-dose rifampin in TB meningitis with important implications for developing new antibiotic treatments for infections.
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Affiliation(s)
- Camilo A Ruiz-Bedoya
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Filipa Mota
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Elizabeth W Tucker
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Farina J Mahmud
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Maria I Reyes-Mantilla
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Clara Erice
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Melissa Bahr
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Kelly Flavahan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Patricia De Jesus
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - John Kim
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Catherine A Foss
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Charles A Peloquin
- Infectious Disease Pharmacokinetics Laboratory, University of Florida College of Pharmacy, Gainesville, United States of America
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, NIH, Bethesda, United States of America
| | - Alvaro A Ordonez
- Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Sanjay K Jain
- Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, United States of America
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