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Nobile S, Beauchemin P. Hypogammaglobulinemia and Infection Risk in an Ocrelizumab-treated Multiple Sclerosis Cohort. Can J Neurol Sci 2024:1-8. [PMID: 38343112 DOI: 10.1017/cjn.2024.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Ocrelizumab is an effective anti-CD20 therapy approved for Relapsing Remitting (RRMS) and Primary Progressive Multiple Sclerosis (PPMS). In clinical trials, a proportion of patients developed hypogammaglobulinemia which could contribute to infection risk. This study aimed to identify hypogammaglobulinemia and its risk factors and evaluate potentially associated serious infection risk in a real-world cohort of patients. METHODS All MS patients treated with ocrelizumab in a Quebec City MS clinic from January 2017 to August 2021 were included and detailed patient characteristics were collected by chart review. Levels of immunoglobulins (IgM, IgA and IgG) were assessed prior to each treatment. Serious infection was defined as an infection requiring hospitalization or emergency room treatment. Association between hypogammaglobulinemia and serious infection was analyzed. RESULTS A total of 266 patients (average follow-up 2.05 years) were included (87% RRMS). After 6 infusions, 32.8%, 3.5% and 4.2% of patients had at least one IgM, IgA and IgG hypogammaglobulinemia event respectively. Aside from pre-treatment hypogammaglobulinemia, there were no variables associated with on-treatment hypogammaglobulinemia. There was a total of 21 serious infections (3.36 and 12.33 per 100-person-years in RRMS and PPMS). Developing hypogammaglobulinemia during treatment was not associated with serious infection. A regression analysis did not show associations between serious infection and key disease characteristics. CONCLUSION Similar to ocrelizumab extension studies, our cohort demonstrated a significant rate of hypogammaglobulinemia over time, mostly with IgM. No association was found between hypogammaglobulinemia and serious infection.
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Affiliation(s)
- Steven Nobile
- Department of Neurology, Montreal Neurological Institute (McGill University), Montreal, QC, Canada
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Giacomini PS, Oh J, Morrow SA, Beauchemin P, Clift F, Devonshire V, Smyth P. Virtual Management of Multiple Sclerosis: Providing Access or Just Phoning it in? Can J Neurol Sci 2024; 51:113-116. [PMID: 37066757 DOI: 10.1017/cjn.2023.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Paul S Giacomini
- Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Fraser Clift
- Memorial University, St. John's, Newfoundland-Labrador, Canada
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Boudjani H, Fadda G, Dufort G, Antel J, Giacomini P, Levesque-Roy M, Oskoui M, Duquette P, Prat A, Girard M, Rebillard RM, Meijer I, Pinchefsky E, Nguyen CTE, Rossignol E, Rouleau J, Blanchard O, Khairallah N, Beauchemin P, Trudelle AM, Lapointe E, Saveriano A, Larochelle C. Clinical course, imaging, and pathological features of 45 adult and pediatric cases of myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2023; 76:104787. [PMID: 37320939 DOI: 10.1016/j.msard.2023.104787] [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: 01/18/2023] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described neuroinflammatory demyelinating disease. OBJECTIVE To better understand the clinical spectrum, risk factors and outcomes in MOGAD. METHODS Retrospective cohort study including all subjects harboring anti-MOG antibodies identified in major academic hospitals across the province of Quebec. RESULTS We identified 45 MOGAD cases. The minimal estimated point-prevalence was 0.52/100 000 in Quebec. Median age at presentation was 32 years (range 1-71) with equal sex ratio. Most frequent ethnic groups were Caucasians and Asians. The most frequent clinical manifestations at onset were optic neuritis (ON), affecting 56% of adults, and acute disseminated encephalomyelitis (ADEM), affecting 33% of children. First MRI was abnormal in 84% of cases. Most CSF samples showed pleocytosis without oligoclonal bands. Two brain biopsies revealed lipid-laden macrophages and reactive astrocytes. Despite steroids, only 38% had fully recovered at 4 weeks after onset. Half of pediatric and two thirds of adult-onset MOGAD subjects experienced relapses. At last follow-up, 69% showed residual deficits, which were moderate to severe in 17% of adults. CONCLUSION MOGAD has heterogeneous disease course, and it is not a benign disease for a substantial proportion of adults. Best disease-modifying therapies remain to be determined.
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Affiliation(s)
- Hayet Boudjani
- Department of Neurology and Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Giulia Fadda
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gabrielle Dufort
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jack Antel
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Paul Giacomini
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Myriam Levesque-Roy
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Pierre Duquette
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Prat
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Marc Girard
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rose-Marie Rebillard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Inge Meijer
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Elana Pinchefsky
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Cam-Tu Emilie Nguyen
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Elsa Rossignol
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jacinthe Rouleau
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Ophtalmology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Oliver Blanchard
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Nicole Khairallah
- Hôpital Maisonneuve-Rosemont (HMR), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Philippe Beauchemin
- Centre Hospitalier Universitaire de Québec-Université Laval, Division of neurology, Department of Medicine, Université Laval, Québec, QC, Canada
| | - Anne-Marie Trudelle
- Centre Hospitalier Universitaire de Québec-Université Laval, Division of neurology, Department of Medicine, Université Laval, Québec, QC, Canada
| | - Emmanuelle Lapointe
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Neurology, Department of medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alexander Saveriano
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Catherine Larochelle
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada.
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Chan C, Beauchemin P, Sayao AL, Carruthers M. Autoimmune storm following alemtuzumab. BMJ Case Rep 2022; 15:15/6/e248037. [DOI: 10.1136/bcr-2021-248037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Alemtuzumab has been associated with the emergence of secondary autoimmune diseases. We report a case of a patient with relapsing–remitting multiple sclerosis who developed a refractory immune thrombocytopaenia associated with vasculitis, myelofibrosis and later Guillain-Barré syndrome following alemtuzumab. The medical community should be aware of unusual and unexpected adverse events that may be associated with alemtuzumab, especially when occurring simultaneously in the same patient.
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Bensaidane MR, Picher-Martel V, Émond F, De Serres G, Dupré N, Beauchemin P. Case Report: Acute Necrotizing Encephalopathy Following COVID-19 Vaccine. Front Neurol 2022; 13:872734. [PMID: 35572945 PMCID: PMC9099242 DOI: 10.3389/fneur.2022.872734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Acute necrotizing encephalopathy (ANE) is a rare neurological disorder arising from a para- or post-infectious "cytokine storm. "It has recently been reported in association with coronavirus disease 2019 (COVID-19) infection. Methods A 56-year-old male with a diagnosis of ANE 48 h following the first dose of ChAdOx1 nCoV-19 vaccination was investigated. Cytokine analyses on serum and cerebrospinal fluid (CSF) were performed. The patient was treated with high-dose corticosteroids and followed clinically and radiologically. Results Favorable clinical and radiological outcomes were noted. There was an upregulation in serum levels of CXCL5, CXCL1, Il-8, IL-15, CCL2, TGF-B, and EGF, and up-regulation in CSF levels of CXCL5, IL-2, IL-3, and IL-8. Discussion As COVID-19 infection has been previously reported as a possible rare cause of ANE, we speculate on an aberrant immune response mechanism that was brought about by the vaccine. To increase our understanding of the pathogenesis of ANE in the context of COVID-19 vaccination and to better define its clinical features and outcomes, clinicians and scientists should continue reporting convincing cases of such entities.
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Affiliation(s)
- Mohamed Reda Bensaidane
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Vincent Picher-Martel
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, CERVO Brain Research Centre, Quebec, QC, Canada
| | - François Émond
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Nicolas Dupré
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Philippe Beauchemin
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
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MacDougall M, El-Hajj Sleiman J, Beauchemin P, Rangachari M. SARS-CoV-2 and Multiple Sclerosis: Potential for Disease Exacerbation. Front Immunol 2022; 13:871276. [PMID: 35572514 PMCID: PMC9102605 DOI: 10.3389/fimmu.2022.871276] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
While the respiratory tract is the primary route of entry for SARS-CoV-2, evidence shows that the virus also impacts the central nervous system. Intriguingly, case reports have documented SARS-CoV-2 patients presenting with demyelinating lesions in the brain, spinal cord, and optic nerve, suggesting possible implications in neuroimmune disorders such as multiple sclerosis (MS) and other related neuroimmune disorders. However, the cellular mechanisms underpinning these observations remain poorly defined. The goal of this paper was to review the literature to date regarding possible links between SARS-CoV-2 infection and neuroimmune demyelinating diseases such as MS and its related disorders, with the aim of positing a hypothesis for disease exacerbation. The literature suggests that SARS-CoV, SARS-CoV-2, and orthologous murine coronaviruses invade the CNS via the olfactory bulb, spreading to connected structures via retrograde transport. We hypothesize that a glial inflammatory response may contribute to damaged oligodendrocytes and blood brain barrier (BBB) breakdown, allowing a second route for CNS invasion and lymphocyte infiltration. Potential for molecular mimicry and the stimulation of autoreactive T cells against myelin is also described. It is imperative that further studies on SARS-CoV-2 neuroinvasion address the adverse effects of the virus on myelin and exacerbation of MS symptoms, as nearly 3 million people suffer from MS worldwide.
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Affiliation(s)
- Madison MacDougall
- Department of Biological Sciences, Salisbury University, Salisbury, MD, United States
- Department of Psychology, Salisbury University, Salisbury, MD, United States
| | - Jad El-Hajj Sleiman
- Division of Neurology, Department of Medicine, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Philippe Beauchemin
- Division of Neurology, Department of Medicine, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Manu Rangachari
- Axe Neurosciences, Centre de Recherche du CHU de Québec – Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Doss PMIA, Umair M, Baillargeon J, Fazazi R, Fudge N, Akbar I, Yeola AP, Williams JB, Leclercq M, Joly-Beauparlant C, Beauchemin P, Ruda GF, Alpaugh M, Anderson AC, Brennan PE, Droit A, Lassmann H, Moore CS, Rangachari M. Male sex chromosomal complement exacerbates the pathogenicity of Th17 cells in a chronic model of central nervous system autoimmunity. Cell Rep 2021; 34:108833. [PMID: 33691111 DOI: 10.1016/j.celrep.2021.108833] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/13/2020] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
Sex differences in multiple sclerosis (MS) incidence and severity have long been recognized. However, the underlying cellular and molecular mechanisms for why male sex is associated with more aggressive disease remain poorly defined. Using a T cell adoptive transfer model of chronic experimental autoimmune encephalomyelitis (EAE), we find that male Th17 cells induce disease of increased severity relative to female Th17 cells, irrespective of whether transferred to male or female recipients. Throughout the disease course, a greater frequency of male Th17 cells produce IFNγ, a hallmark of pathogenic Th17 responses. Intriguingly, XY chromosomal complement increases the pathogenicity of male Th17 cells. An X-linked immune regulator, Jarid1c, is downregulated in pathogenic male murine Th17 cells, and functional experiments reveal that it represses the severity of Th17-mediated EAE. Furthermore, Jarid1c expression is downregulated in CD4+ T cells from MS-affected individuals. Our data indicate that male sex chromosomal complement critically regulates Th17 cell pathogenicity.
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Affiliation(s)
- Prenitha Mercy Ignatius Arokia Doss
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Muhammad Umair
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Joanie Baillargeon
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Reda Fazazi
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Neva Fudge
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada
| | - Irshad Akbar
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Asmita Pradeep Yeola
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - John B Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada
| | - Mickael Leclercq
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Charles Joly-Beauparlant
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Philippe Beauchemin
- Department of Neurology, CHU de Québec-Université Laval, Quebec City, QC G1V 4G2, Canada; Faculty of Medicine, Université Laval, 1050 ave de la Médecine, Quebec City, QC, Canada
| | - Gian Filipo Ruda
- Target Discovery Institute and NIHR, Oxford Biomedical Research Centre, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Melanie Alpaugh
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada
| | - Ana C Anderson
- Evergrande Center for Immunologic Diseases and Ann Romney Center for Neurologic Diseases, Harvard Medical School and Brigham & Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Paul E Brennan
- Target Discovery Institute and NIHR, Oxford Biomedical Research Centre, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK; Alzheimer's Research UK, Oxford Drug Discovery Institute, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Arnaud Droit
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada; Faculty of Medicine, Université Laval, 1050 ave de la Médecine, Quebec City, QC, Canada
| | - Hans Lassmann
- Division of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, Vienna 1090, Austria
| | - Craig S Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada; Department of Neurology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada
| | - Manu Rangachari
- axe Neurosciences, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, 2705 boulevard Laurier, Quebec City, QC G1V 4G2, Canada; Faculty of Medicine, Université Laval, 1050 ave de la Médecine, Quebec City, QC, Canada.
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Beauchemin P, Iorio R, Traboulsee AL, Field T, Tinker AV, Carruthers RL. Paraneoplastic Neuromyelitis Optica Spectrum Disorder: A single center cohort description with two cases of histological validation. Mult Scler Relat Disord 2018; 20:37-42. [DOI: 10.1016/j.msard.2017.12.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
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Beauchemin P, Carruthers R. Response to: Tocilizumab, neuromyelitis optica (NMO), and multiple sclerosis. Mult Scler 2016; 22:1892-1893. [PMID: 27068553 DOI: 10.1177/1352458516643398] [Citation(s) in RCA: 2] [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] [Received: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Philippe Beauchemin
- Hôpital de l'Enfant-Jésus, CHU de Québec, Département des sciences neurologiques, Université Laval, Québec City, QC, Canada .,UBC Hospital MS Clinic, Department of Neurology, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Robert Carruthers
- UBC Hospital MS Clinic, Department of Neurology, University of British Columbia (UBC), Vancouver, BC, Canada
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Abstract
Background: Interleukin-6 (IL6) blockage is a treatment strategy used in many inflammatory conditions. Trials in Neuromyelitis Optica Spectrum Disorder (NMOSD) are ongoing. Secondary auto-immunity affecting the central nervous system (CNS) is well described with some biologic agents, mainly tumor necrosis factor (TNF)-alpha inhibitors. These treatments can also aggravate patients with known multiple sclerosis (MS). Objectives: To describe a case of a patient who developed MS using another biologic, IL6 receptor antibody Tocilizumab. Results: A 48-year-old woman developed MS while on treatment with Tocilizumab for Rheumatoid Arthritis (RA). This is the first published report of this association. It has obvious implications for NMOSD patients receiving anti-IL6 therapy. Development of new white matter lesions suggestive of MS in a patient treated with anti-IL6 therapy might represent an important complication of therapy. Conclusion: This case illustrates that Tocilizumab might cause secondary auto-immunity in CNS. It is important to be aware of this potential complication as anti-IL6 therapy might become an option for the treatment NMOSD.
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Affiliation(s)
- Philippe Beauchemin
- Hôpital de l’Enfant-Jésus du CHU de Québec, Département des sciences neurologiques, Université Laval/UBC MS Clinic, Department of Neurology, UBC, Vancouver, BC, Canada
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Noreau A, Beauchemin P, Dionne-Laporte A, Dion PA, Rouleau GA, Dupré N. Exome sequencing revealed PMM2 gene mutations in a French-Canadian family with congenital atrophy of the cerebellum. Cerebellum Ataxias 2014; 1:8. [PMID: 26331032 PMCID: PMC4552392 DOI: 10.1186/2053-8871-1-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/10/2014] [Accepted: 05/16/2014] [Indexed: 11/10/2022]
Abstract
Two affected and one unaffected siblings from a French-Canadian family were evaluated in our neurogenetic clinic. The oldest brother had intentional and postural hand tremor while his youngest sister presented mild ataxia, a similar hand tremor and global developmental delay. Brain MRIs of the two affected family members further revealed a significant cerebellar atrophy. For this study we conducted a whole exome sequencing (WES) investigation using genomic DNA prepared from the affected brother and sister, alongside DNA prepared from their unaffected mother, and identified two mutations previously reported to cause a rare disorder known as Congenital Disorder of Glycosylation, type Ia (CDG1A) (OMIM #212065). This study emphasizes how the diagnosis of patients presenting a mild tremor phenotype associated with cerebellar atrophy may benefit from WES in establishing genetic defects associated with their conditions.
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Affiliation(s)
- Anne Noreau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada ; Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec Canada
| | - Philippe Beauchemin
- Faculty of Medicine of Laval University and the Department of Neurological Sciences of the Centre Hopitalier, Universitaire de Québec, 1401, 18th Street, Quebec, QC G1J 1Z4 Canada
| | | | | | - Patrick A Dion
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada ; Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec Canada ; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada ; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec Canada
| | - Nicolas Dupré
- Faculty of Medicine of Laval University and the Department of Neurological Sciences of the Centre Hopitalier, Universitaire de Québec, 1401, 18th Street, Quebec, QC G1J 1Z4 Canada
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