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Mimpen M, Kreiter D, Kempkens T, Knippenberg S, Hupperts R, Gerlach O. Humoral immune response after SARS-CoV-2 vaccination in cladribine-treated multiple sclerosis patients. Vaccine X 2024; 16:100445. [PMID: 38304878 PMCID: PMC10832451 DOI: 10.1016/j.jvacx.2024.100445] [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: 12/05/2022] [Revised: 09/22/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
Multiple sclerosis immunomodulatory treatments such as cladribine, which affects both B- and T-lymphocytes, can potentially alter the humoral response to SARS-CoV-2 vaccination. This monocenter retrospective study reports on anti-SARS-CoV-2 IgG antibody response in cladribine treated MS patients and we compare the response in patients vaccinated before and after an 18-week interval after last cladribine dose. Of the 34 patients (5 patients ≤ 18 weeks and 29 patients > 18 weeks after last cladribine dose) that were included, 32 reached seropositivity (94 %). All patients vaccinated < 18 weeks after last cladribine dose reached seropositivity. This study confirms findings of earlier reports that cladribine-treated MS patients show an adequate humoral response after SARS-CoV-2 vaccination, even when vaccinated early (≤18 weeks) after last cladribine dose.
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Affiliation(s)
- M. Mimpen
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - D. Kreiter
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T. Kempkens
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
| | - S. Knippenberg
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
| | - R. Hupperts
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - O. Gerlach
- Academic MS Center Zuyderland, Zuyderland Medical Center Sittard-Geleen, the Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
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Lorscheider J, Kuhle J, Izquierdo G, Lugaresi A, Havrdova E, Horakova D, Hupperts R, Duquette P, Girard M, Prat A, Grand'Maison F, Grammond P, Sola P, Ferraro D, Trojano M, Ramo-Tello C, Lechner-Scott J, Pucci E, Solaro C, Slee M, Van Pesch V, Sanchez Menoyo JL, van der Walt A, Butzkueven H, Kappos L, Kalincik T. Anti-inflammatory disease-modifying treatment and disability progression in primary progressive multiple sclerosis: a cohort study. Eur J Neurol 2018; 26:363-370. [PMID: 30298572 DOI: 10.1111/ene.13824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Treatment options in primary progressive multiple sclerosis (PPMS) are scarce and, with the exception of ocrelizumab, anti-inflammatory agents have failed to show efficacy in ameliorating disability progression. The aim of this study was to investigate a potential effect of anti-inflammatory disease-modifying treatment on disability outcomes in PPMS. METHODS Using MSBase, a large, international, observational database, we identified patients with PPMS who were either never treated or treated with a disease-modifying agent. Propensity score matching was used to select subpopulations with similar baseline characteristics. Expanded Disability Status Scale (EDSS) outcomes were compared with an intention-to-treat and an as-treated approach in paired, pairwise-censored analyses. RESULTS Of the 1284 included patients, 533 were matched (treated, n = 195; untreated n = 338). Median on-study pairwise-censored follow-up was 3.4 years (quartiles 1.2-5.5). No difference in the hazard of experiencing 3-month confirmed EDSS progression events was observed between the groups [hazard ratio (HR), 1.0; 95% confidence interval (CI), 0.6-1.7, P = 0.87]. We did not find significant differences in the hazards of confirmed EDSS improvement (HR, 1.0; 95% CI, 0.6-1.6, P = 0.91) or reaching a confirmed EDSS step ≥7 (HR, 1.1; 95% CI, 0.7-1.6, P = 0.69). CONCLUSION Our pooled analysis of disease-modifying agents suggests that these therapies have no substantial effect on short- to medium-term disability outcomes in PPMS.
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Affiliation(s)
- J Lorscheider
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - J Kuhle
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - G Izquierdo
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - A Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - E Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - R Hupperts
- Orbis Medical Center, Sittard, The Netherlands
| | | | - M Girard
- Hôpital Notre Dame, Montreal, Quebec
| | - A Prat
- Hôpital Notre Dame, Montreal, Quebec
| | - F Grand'Maison
- Neuro Rive-Sud, Hôpital Charles LeMoyne, Greenfield Park, Quebec
| | - P Grammond
- Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - P Sola
- Nuovo Ospedale Civile S.Agostino/Estense, Modena
| | - D Ferraro
- Nuovo Ospedale Civile S.Agostino/Estense, Modena
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - E Pucci
- Neurology Unit, ASUR Marche, AV3, Macerata
| | - C Solaro
- Hospedale P. A. Micone, Genova, Italy
| | - M Slee
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - V Van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - A van der Walt
- Department of Medicine, University of Melbourne, Melbourne, VIC.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC
| | - H Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, VIC.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC
| | - L Kappos
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - T Kalincik
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Schippling S, Langdon D, Solari A, Brochet B, Hupperts R, Piehl F, Lechner-Scott J, Montalban X, Keller B, Alexandri N. THUR 172 Phase iv study of cladribine tablets and quality of life: clarify-ms. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Authors Disclaimer: http://medpub-poster.merckgroup.com/ABN2018DISC_CLARIFY.pdfBackgroundRelapsing multiple sclerosis (RMS) negatively affects health-related quality of life (HRQoL).ObjectiveAn open-label, single-arm, exploratory Phase IV study in centres in Europe and Australia will assess HRQoL in RMS patients receiving CT 3.5 mg/kg (CT3.5).MethodsEligible patients will receive CT 3.5 (cumulative) over 2 years. HRQoL (Multiple Sclerosis Quality of Life-54 [MSQoL-54]) and other patient-reported outcomes (Fatigue Severity Scale; Hospital Anxiety and Depression Scale; Treatment Satisfaction Questionnaire for Medication v1.4) will be assessed at baseline, and at 6, 12, 24 months.Other outcomes include AEs, MRI measures (T1 Gd+ lesions, T2 lesions, brain atrophy), number of relapses, and disability/functioning measures (EDSS; 9-Hole Peg Test; Timed 25-Foot Walk and Brief International Cognitive Assessment for Multiple Sclerosis). The sample size estimation is based on the power to detect a mean difference of 5 points in MSQoL-54 composite score at 24 months vs baseline.ResultsThe study aims to recruit 356 adults with RMS by 2019. Final data are anticipated in 2022.ConclusionsThis study will explore the effects of CT on HRQoL outcomes, and describe the effects of CT on treatment satisfaction and disability/functioning.Disclosure statementThe trial is sponsored by Merck KGaA, Darmstadt, Germany.
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Hobart J, Hupperts R, Linnebank M, Acosta C, McNeill M, Lima G. Health-related quality of life improved in people with multiple sclerosis who had clinically meaningful changes in walking ability with PR-Fampridine: Post hoc analysis of enhance. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoogerwerf A, Bol Y, Lobbestael J, Hupperts R, Heugten C. Mindfulness-based cognitive therapy for severely fatigued multiple sclerosis patients: A waiting list controlled study. J Rehabil Med 2017; 49:497-504. [DOI: 10.2340/16501977-2237] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bergamaschi R, Montomoli C, Mallucci G, Lugaresi A, Izquierdo G, Grand'Maison F, Duquette P, Shaygannejad V, Alroughani R, Grammond P, Boz C, Iuliano G, Zwanikken C, Petersen T, Lechner-Scott J, Hupperts R, Butzkueven H, Pucci E, Oreja-Guevara C, Cristiano E, Pia Amato MP, Havrdova E, Fernandez-Bolanos R, Spelman T, Trojano M. BREMSO: a simple score to predict early the natural course of multiple sclerosis. Eur J Neurol 2015; 22:981-9. [DOI: 10.1111/ene.12696] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- R. Bergamaschi
- Inter-Department Multiple Sclerosis Research Centre; Neurological Institute IRCCS Mondino; Pavia Italy
| | - C. Montomoli
- Unit of Biostatistics and Clinical Epidemiology; Department of Public Health; University of Pavia; Pavia Italy
| | - G. Mallucci
- Inter-Department Multiple Sclerosis Research Centre; Neurological Institute IRCCS Mondino; Pavia Italy
| | - A. Lugaresi
- MS Centre; Department of Neuroscience and Imaging; University ‘G. d'Annunzio’; Chieti Italy
| | - G. Izquierdo
- Hospital Universitario Virgen Macarena; Sevilla Spain
| | | | | | - V. Shaygannejad
- Al-Zahra Hospital; Isfahan University of Medical Sciences; Isfahan Iran
| | | | | | - C. Boz
- Karadeniz Technical University; Trabzon Turkey
| | - G. Iuliano
- Ospedali Riuniti di Salerno; Salerno Italy
| | - C. Zwanikken
- University Hospital Nijmegen; Nijmegen The Netherlands
| | - T. Petersen
- Aarhus University Hospital; Aarhus C Denmark
| | | | | | - H. Butzkueven
- Department of Neurology; Box Hill Hospital; Monash University; Box Hill Vic. Australia
| | - E. Pucci
- Ospedale di Macerata; Salerno Italy
| | | | | | - M. P. Pia Amato
- Department NEUROFARBA; Section of Neurosciences; University of Florence; Florence Italy
| | | | | | - T. Spelman
- University of Melbourne; Melbourne Australia
| | - M. Trojano
- Department of Basic Medical Sciences; Neuroscience and Sense Organs; University of Bari; Bari Italy
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Peelen E, Damoiseaux J, Muris AH, Knippenberg S, Smolders J, Hupperts R, Thewissen M. Increased inflammasome related gene expression profile in PBMC may facilitate T helper 17 cell induction in multiple sclerosis. Mol Immunol 2015; 63:521-9. [PMID: 25458313 DOI: 10.1016/j.molimm.2014.10.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/01/2014] [Accepted: 10/11/2014] [Indexed: 01/12/2023]
Abstract
The NLRP3 inflammasome is a macromolecular complex importantly involved in IL-1β processing. A role for this has been described in multiple sclerosis (MS). One mechanism by which IL-1β might be involved in MS is by inducing pathogenic Th17 cells, i.e. GM-CSF+ Th17 cells. In the present study, we show that expression of the inflammasome related genes, NLRP3, caspase-1, IL-1β and the IL-1β/IL-1Ra ratio, was increased in PBMC from MS patients compared to healthy controls (HC). However, in an in vitro inflammasome activity assay with PBMC, IL-1β protein secretion and the IL-1β/IL-1Ra protein ratio were similar in MS patients and HC. Th cells cultured in the presence of supernatant derived from LPS/ATP inflammasome activated PBMC showed increased Th17 and GM-CSF+ Th17 cell frequencies in HC and MS patients and decreased anti-inflammatory IL-10+Th cell frequency in HC compared to Th cells cultured in the presence of control supernatant. Moreover, addition of the immune modulator calcitriol to the former condition resulted in reduced frequencies of Th17 and GM-CSF+Th17 cells, and also of IL-10+ Th cells. Evidently, our data indicate that inflammasome activity can skew the Th cell population toward a more pro-inflammatory composition, an effect that might be inhibited by vitamin D, and that might be importantly involved in inflammation within the central nervous system.
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Affiliation(s)
- E Peelen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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Rolf L, Muris AH, Damoiseaux J, van Daele M, Hupperts R. Paroxysmal atrial fibrillation after initiation of fingolimod for multiple sclerosis treatment. Neurology 2014; 82:1008-9. [DOI: 10.1212/wnl.0000000000000218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Knippenberg S, Damoiseaux J, Bol Y, Hupperts R, Taylor BV, Ponsonby AL, Dwyer T, Simpson S, van der Mei IAF. Higher levels of reported sun exposure, and not vitamin D status, are associated with less depressive symptoms and fatigue in multiple sclerosis. Acta Neurol Scand 2014; 129:123-31. [PMID: 23763464 DOI: 10.1111/ane.12155] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Insufficient sun exposure and vitamin D deficiency have both been associated with increased risk of multiple sclerosis (MS). Depressi on, anxiety, fatigue and cognitive impairment are prevalent and disabling symptoms in MS. Our objective was to examine the associations between personal sun exposure and serum 25-hydroxyvitamin D (25(OH)D), and depression, anxiety, fatigue and cognition. METHODS A total of 198 participants with multiple sclerosis were followed prospectively for an average of 2.3 years. Assessments of serum 25(OH)D, sun exposure, depression, anxiety and fatigue were carried out biannually; cognition was assessed annually. RESULTS Personal reported sun exposure was inversely associated with depression scores (β -0.26 (95%CI -0.40, -0.12);P ≤ 0.001) and fatigue scores (β -0.65 (95%CI -1.23, -0.07); P = 0.028). Only high levels of 25(OH)D (>80 nm) were inversely associated depression scores (β -0.64 (95%CI -1.15, -0.13); P = 0.015), but this was not significant after adjustment for reported sun exposure. No associations were seen between reported sun exposure or serum 25(OH)D levels and anxiety or cognition scores. CONCLUSION We found that higher levels reported sun exposure, rather than 25(OH)D levels, were associated with less depressive symptoms and levels of fatigue. The role of UV or light therapy will need to be evaluated in randomized controlled trials to confirm an effect on these symptoms in MS.
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Affiliation(s)
- S. Knippenberg
- School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
- Department of Internal Medicine; Division of Clinical and Experimental Immunology; Maastricht University Medical Center; Maastricht The Netherlands
| | - J. Damoiseaux
- Central Diagnostic Laboratory; Maastricht University Medical Center; Maastricht The Netherlands
| | - Y. Bol
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
- Department of Medical Psychology and Psychiatry; Orbis Medical Center; Sittard The Netherlands
| | - R. Hupperts
- School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
| | - B. V. Taylor
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - A.-L. Ponsonby
- Murdoch Childrens Research Institute; The University of Melbourne; Melbourne Victoria Australia
| | - T. Dwyer
- Murdoch Childrens Research Institute; The University of Melbourne; Melbourne Victoria Australia
| | - S. Simpson
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - I. A. F. van der Mei
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
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Verheul F, Smolders J, Trojano M, Lepore V, Zwanikken C, Amato MP, Grand'Maison F, Butzkueven H, Marrosu M, Duquette P, Comi G, Izquierdo G, Grammond P, Lus G, Petersen T, Bergamaschi R, Giuliani G, Boz C, Coniglio G, Van Pesch V, Lechner-Scott J, Cavalla P, Granella F, Avolio C, Fiol M, Poehlau D, Saladino ML, Gallo P, Deri N, Oleschko Arruda W, Paine M, Ferro M, Barnett M, Cabrera-Gomez JA, Slee M, Moore F, Shaw C, Petkovska-Boskova T, Rutherford M, Engelsen O, Damoiseaux J, Hupperts R. Fluctuations of MS births and UV-light exposure. Acta Neurol Scand 2013; 127:301-8. [PMID: 22970985 DOI: 10.1111/ane.12007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) are more frequently born in spring when compared to autumn. Fluctuation of UV-light has been hypothesized to drive this phenomenon. AIM To assess the correlation between fluctuation of sunlight and birth season in persons with MS. METHODS For this record-linkage study, we collected from the international MSBase and the Italian MS iMed-web databases the dates of birth of 11,415 patients with MS from 36 centres from 15 countries worldwide and compared these to dates of live-births from national registries. From all participating sites, we collected data on UV-light fluctuation and assessed its correlation with seasonal fluctuation in MS births. RESULTS Compared with the reference cohort, an increased proportion of persons with MS were born in spring and a decreased proportion in autumn (odds ratio (OR) to be born in spring versus autumn = 1.158, χ² = 36.347, P < 0.001). There was no significantly increased fluctuation of MS births with increased quartile of ambient UV-light fluctuation (Ptrend = 0.086). CONCLUSION Seasonal fluctuation of MS births as found in this worldwide cohort of patients with MS did not correlate with variation in seasonal fluctuation of UV-light. Most likely, it results from a complex interplay between fluctuation of sunlight, behavioural factors, other environmental factors and (epi)genetic factors.
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Affiliation(s)
- F. Verheul
- Groene Hart Ziekenhuis; Gouda; The Netherlands
| | | | | | - V. Lepore
- Consorzio Mario Negri Sud; Santa Maria Imbaro; Italy
| | | | | | | | - H. Butzkueven
- Department of Medicine; Melbourne Brain Centre; University of Melbourne; Melbourne; Vic.; Australia
| | | | | | - G. Comi
- University of Milan; Milan; Italy
| | | | | | - G. Lus
- Second University of Naples; Naples; Italy
| | | | | | | | - C. Boz
- Karadeniz Technical University; Trabzon; Turkey
| | | | - V. Van Pesch
- Cliniques Universitaires Saint-Luc; Brussels; Belgium
| | | | | | | | | | - M. Fiol
- FLENI; Buenos Aires; Argentina
| | | | | | - P. Gallo
- University of Padova; Padova; Italy
| | - N. Deri
- Hospital Fernandez; Buenos Aires; Argentina
| | | | - M. Paine
- St Vincent's Hospital; Melbourne; Vic.; Australia
| | | | - M. Barnett
- Brain and Mind Research Institute; Sydney; NSW; Australia
| | | | - M. Slee
- Flinders Medical Centre; Bedford Park; SA; Australia
| | - F. Moore
- Jewish General Hospital; Montreal; Canada
| | - C. Shaw
- Geelong Hospital; Geelong; Vic.; Australia
| | | | | | - O. Engelsen
- Norwegian Institute for Air Research; Tromsø; Norway
| | - J. Damoiseaux
- Maastricht University Medical Center; Maastricht; The Netherlands
| | - R. Hupperts
- Orbis Medical Center; Sittard; The Netherlands
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Peelen E, Thewissen M, Knippenberg S, Smolders J, Muris AH, Menheere P, Tervaert JWC, Hupperts R, Damoiseaux J. Fraction of IL-10+ and IL-17+ CD8 T cells is increased in MS patients in remission and during a relapse, but is not influenced by immune modulators. J Neuroimmunol 2013; 258:77-84. [PMID: 23517930 DOI: 10.1016/j.jneuroim.2013.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/31/2013] [Accepted: 02/19/2013] [Indexed: 12/22/2022]
Abstract
In the present study, circulating proportions of CD8(+) T (Tc) cell subsets, including IL-17 (Tc17) and IL-10 (Tc10) producing cells, were assessed in relapsing-remitting MS (RRMS) patients and a possible effect of beta interferon (IFN-β), glatiramer acetate (GA), and vitamin D (VitD) on these cell subsets was investigated. We show that both Tc17 and Tc10 cell fractions are elevated in the circulation of RRMS patients in remission compared to healthy subjects and that these Tc subsets remain unaffected by current immune modulating regimens.
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Affiliation(s)
- E Peelen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
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Bol Y, Smolders J, Duits A, Lange IMJ, Romberg-Camps M, Hupperts R. Fatigue and heat sensitivity in patients with multiple sclerosis. Acta Neurol Scand 2012; 126:384-9. [PMID: 22404677 DOI: 10.1111/j.1600-0404.2012.01660.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS), and heat is often reported as a trigger. Although it is assumed that this heat sensitivity is specific for MS, the evidence for disease specificity is limited. We studied the relationship between fatigue, heat sensitivity, and environmental temperature, and its specificity for MS. MATERIALS AND METHODS We compared 88 MS patients with 76 patients with ulcerative colitis (UC), another chronic auto-immune disease. As most important outcome measures, heat sensitivity, physical fatigue, mental fatigue, environmental temperature, and ambient UV-light levels were determined. RESULTS More patients with MS reported heat sensitivity for fatigue, compared to patients with UC (53.4% vs 35.5%, respectively, P = 0.016). However, heat-sensitive patients were equally fatigued as heat-insensitive patients. Climatological data, including day temperature and amount of ambient UV light, were not related to fatigue in both heat-sensitive and heat-insensitive patients with MS. CONCLUSIONS Our findings support the assumption that heat sensitivity regarding fatigue has an MS-specific component. Although patients with MS experience a relationship between environmental temperature and fatigue, objective assessment by climatological data could not confirm this.
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Affiliation(s)
- Y. Bol
- Orbis Medical Centre; Sittard-Geleen; the Netherlands
| | | | - A. Duits
- Maastricht University Medical Centre; Maastricht; the Netherlands
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Hughes S, Spelman T, Gray O, Boz C, Trojano M, Zwanikken C, Lugaresi A, Izquierdo J, Duquette P, Girard M, Grand'Maison F, Grammond P, Oreja-Guevara C, Hupperts R, Petersen T, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Edite Rio M, van Pesch V, Pia Amato M, Iuliano G, Fiol M, Slee M, Verheul F, Cristiano E, Fernández Bolaños R, Saladino D, Poehlau M, Deri N, Oleschko Arruda W, Cabrera-Gomez J, Paine M, Vella N, Herbert J, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, Vetere S, McDonnell G, Hawkins S, Kee F, Butzkueven H. EXPOSURE TO INTERFERON-β THERAPY IN EARLY PREGNANCY: A LITERATURE REVIEW OF PREGNANCY OUTCOMES IN WOMEN WITH MULTIPLE SCLEROSIS. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Grimaldi L, Barkhof F, Beelke M, Burton J, Holmoy T, Hupperts R, Killestein J, Rieckmann P, Schluep M, Smolders J. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis. Neurology 2012; 78:841. [PMID: 22411961 DOI: 10.1212/01.wnl.0000413180.13413.ce] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Knippenberg S, Bol Y, Smolders J, Hupperts R, Damoiseaux J. Response: relationship between vitamin D and depression in multiple sclerosis. Acta Neurol Scand 2012. [DOI: 10.1111/j.1600-0404.2011.01640.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - J. Smolders
- Netherlands Institute for Neuroscience; Amsterdam; The Netherlands
| | | | - J. Damoiseaux
- Laboratory for Clinical Immunology; Maastricht University Medical Center; Maastricht; The Netherlands
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Lechner-Scott J, Spencer B, de Malmanche T, Attia J, Fitzgerald M, Trojano M, Grand'Maison F, Gomez JAC, Izquierdo G, Duquette P, Girard M, Grammond P, Oreja-Guevara C, Hupperts R, Bergamaschi R, Boz C, Giuliani G, van Pesch V, Iuliano G, Fiol M, Cristiano E, Verheul F, Saladino ML, Slee M, Barnett M, Deri N, Flechter S, Vella N, Shaw C, Herbert J, Moore F, Petkovska-Boskova T, Jokubaitis V, Butzkueven H. The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude. Mult Scler 2011; 18:974-82. [PMID: 22185806 DOI: 10.1177/1352458511431729] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the advent of MRI scanning, the value of lumbar puncture to assess oligoclonal band (OCB) status-for the diagnosis of multiple sclerosis (MS) is increasingly uncertain. One major issue is that the reported frequency of cerebrospinal fluid (CSF)-restricted oligoclonal banding for the diagnosis of MS varies considerably in different studies. In addition, the relationship between OCB positivity and disease outcome remains uncertain, as reported studies are generally too small to assess comparative disability outcomes with sufficient power. METHODS In order to further investigate variation of OCB positivity in patients with MS, we utilized MSBase, a longitudinal, Web-based collaborative MS outcomes registry following clinical cohorts in several continents and latitudes. We also assessed whether OCB positivity affects long-term disability outcome. RESULTS A total of 13,242 patient records were obtained from 37 MS specialist centres in 19 different countries. OCB status was documented in 4481 (34%) patients and 80% of these were OCB positive. The presence of OCB was associated with degree of latitude (p = 0.02). Furthermore, the outcome of patients negative for CSF-specific OCB was significantly better in comparison to the OCB positive patients, as assessed by Expanded Disability Status Scale change (p < 0.001). CONCLUSIONS The results of this study indicate that latitude could explain some of the inconsistencies in OCB status reported in different populations. The study confirms that OCB positivity in MS is associated with a worse long-term prognosis.
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Knippenberg S, Bol Y, Damoiseaux J, Hupperts R, Smolders J. Vitamin D status in patients with MS is negatively correlated with depression, but not with fatigue. Acta Neurol Scand 2011; 124:171-5. [PMID: 20880265 DOI: 10.1111/j.1600-0404.2010.01447.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depressive symptoms and fatigue are frequent and disabling symptoms of multiple sclerosis (MS). Depression and fatigue have been associated with a poor vitamin D status, and a poor vitamin D status is often found in MS. AIM Assess whether vitamin D status contributes to depressive symptoms and fatigue in MS. METHODS Patients with MS that participated in previous studies in which depression and fatigue were assessed and of whom serum 25-hydroxyvitamin D (25(OH)D) levels were available within a timeframe of less than one half-life of 25(OH)D were included. Depression and fatigue were assessed with the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory. RESULTS Fifty-nine patients were included. Mean scores of fatigue and depression were 14.6 (SD 4.2) and 6.2 (SD 4.4), respectively. The mean vitamin D status was 62.3 nm (SD 27.8). Vitamin D status correlated negatively with depression (r=-0.326, P=0.006). No significant correlation was found between vitamin D status and fatigue. In a multiple regression model, vitamin D status was not a significant contributor to depression, after controlling for age Expanded Disability Status Scale score and fatigue (P=0.078). Alternatively, depression and fatigue did not contribute to vitamin D status. DISCUSSION This study shows a negative correlation between vitamin D status and depressive symptoms in patients with MS. Although multiple confounders exist, we observed an indication that vitamin D status might contribute to the presence of depressive symptoms in MS. Therefore, further studies on vitamin D in MS should include depressive symptoms as outcome measures to confirm these findings.
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Affiliation(s)
- S Knippenberg
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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18
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Govarts C, Somers K, Hupperts R, Stinissen P, Somers V. Analysis of antibody reactivity in paired cerebrospinal fluid and serum of a relapsing remitting multiple sclerosis patient. Autoimmunity 2010; 42:699-704. [PMID: 19835487 DOI: 10.3109/08916930903176513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Increasing evidence indicates an involvement of B cells in multiple sclerosis (MS). However, little is known about antigenic targets recognized by antibodies present in blood and cerebrospinal fluid (CSF) of MS patients. This study was therefore aimed at identifying the antigen reactivity of antibodies present in CSF and compares the identified antibody profile with that of the serum of the same patient using cDNA phage display. Selection rounds on paired CSF and serum of this patient identified 13 antigenic targets of which 5 were enriched by serum antibodies and 2 were identified by CSF antibodies. Interestingly, the six remaining antigenic targets were shown to be recognized by both CSF and serum antibodies. These findings point towards both common as well as distinct antibody profiles in CSF and serum of MS patients.
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Affiliation(s)
- C Govarts
- Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg, School of Life Sciences, Diepenbeek, Belgium
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Fraussen J, Vrolix K, Martinez-Martinez P, Hupperts R, Van Diepen A, Meulemans E, De Baets M, Stinissen P, Somers V. F.133. Antibody-producing Monoclonal B Cell Lines from Multiple Sclerosis Patients Obtained by B Cell Immortalization. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Somers K, Hupperts R, Zwanikken C, Stinissen P, Somers V. S.32. Antibodies Against Sperm Associated Antigen 16 as a Novel Disease Marker for Multiple Sclerosis. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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De Stefano N, Filippi M, Confavreux C, Vermersch P, Simu M, Sindic C, Hupperts R, Bajenaru O, Edan G, Grimaldi L, Marginean I, Medaer R, Orefice G, Pascu I, Pelletier J, Sanders E, Scarpini E, Mancardi GL. The results of two multicenter, open-label studies assessing efficacy, tolerability and safety of protiramer, a high molecular weight synthetic copolymeric mixture, in patients with relapsing–remitting multiple sclerosis. Mult Scler 2008; 15:238-43. [DOI: 10.1177/1352458508098269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Two pilot studies were conducted to evaluate safety, tolerability, and efficacy of two doses of Protiramer (TV-5010) in patients with relapsing–remitting multiple sclerosis. Background Both glatiramer acetate and TV-5010 are synthetic copolymers comprised the same four amino acids in a defined molar ratio. TV-5010 has higher average molecular weight than Glatiramer acetate and might be hypothesized that glatiramoids with higher molecular weight might be more immunoreactive than lower molecular weight peptides, thus increasing therapeutic potential and allowing for less frequent dosing. Methods In the two separate studies, after a 10 week pretreatment period, TV-5010 was given subcutaneously once weekly at 15 mg and 30 mg for 36 weeks. The primary end point was a reduction in the number of magnetic resonance imaging active lesions (i.e., T1-weigthed gadolinium-enhancing and new T2-weighted lesions) between the pretreatment period and the end of study. Results Both TV-5010 doses were generally well tolerated. The treatment with TV-5010 at a dose of 15 mg/wk did not show any significant effect. In contrast, in patients treated with at a dose of 30 mg/wk, a significant reduction in the mean number of gadolinium-enhancing (−58.8%; P = 0.0013) and new T2-W (−50%; P = 0.0002) lesions was observed. However, a large decrease in the mean number of both gadolinium-enhancing (−55%) and new T2-W (−40%) lesions during the pretreatment period made difficult the interpretation of the efficacy assessments. Conclusions Further studies are needed to confirm these preliminary data on safety and efficacy of TV-5010 at a weekly dose of 30 mg.
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Affiliation(s)
- N De Stefano
- Neurology and Neurometabolic Unit, Department of Neurological & Behavioral Sciences, University of Siena, Siena, Italy
| | - M Filippi
- Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | - C Confavreux
- Service de Neurologie-A, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - P Vermersch
- Neurology Clinic, CHU de Lille, Hôpital Roger-Salengro, Lille Cedex, France
| | - M Simu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - C Sindic
- Department of Neurology, Cliniques Universitaires St Luc, Bruxelles, Belgium
| | - R Hupperts
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - O Bajenaru
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - G Edan
- Department of Neurology, University Hospital, Pontchaillou, Rennes, France
| | - L Grimaldi
- Neurology Unit, Fondazione Istituto San Raffaele “G.Giglio” Cefalù, Palermo, Italy
| | - I Marginean
- Department of Neurology, County Clinical Hospital Cluj, Cluj Napoca, Romania
| | - R Medaer
- Department of Neurology, University Hasselt, Diepenbeek, Belgium
| | - G Orefice
- Department of Neurological Sciences, University of Naples Federico II, Napoli, Italy
| | - I Pascu
- Department of Neurology, County Clinical Hospital, Targu Mures, Romania
| | - J Pelletier
- Department of Neurology, CHU Timone, Marseille Cedex 5, France
| | - E Sanders
- 16Department of Neurology, Amphia Hospital Molengracht - Breda, The Netherlands
| | - E Scarpini
- 17Department of Neurology, IRCCS, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - GL Mancardi
- 18Department of Neurosciences, Ophthalmology and Genetic, Neurology Clinic II, University of Genova, Genova, Italy
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Smolders J, Menheere P, Kessels A, Damoiseaux J, Hupperts R. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Mult Scler 2008; 14:1220-4. [PMID: 18653736 DOI: 10.1177/1352458508094399] [Citation(s) in RCA: 244] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple Sclerosis is associated with low serum levels of 25-hydroxyvitamin D (25(OH)D). We investigated the association between serum levels of 25(OH)D and 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active metabolite, and clinical MS severity as expressed by EDSS-score and relapse rate. STUDY-DESIGN Cross-sectional study. PATIENTS AND METHODS Serum samples from 267 MS patients were collected for 25(OH)D and 1,25(OH)2D measurement. Clinical MS parameters at the date of serum sampling were determined. RESULTS Both metabolite levels were significantly lower in the progressive forms compared to the relapsing remitting (RR)MS phenotype. In RRMS patients (disease course < or = 5 years), high 25(OH)D levels were associated with a high chance of remaining relapse-free. Low 25(OH)D levels were associated with high EDSS-scores. 1,25(OH)2D was not directly associated with relapse rate or EDSS-score, and was dependent of age and 25(OH)D level. CONCLUSION Serum levels of 25(OH)D were associated with both relapse rate and disability in MS patients. These results are suggestive for a disease modulating effect of the serum concentrations of 25(OH)D on MS. The low circulating 1,25(OH)2D levels in progressive MS are due to older age and lower 25(OH)D levels. The potential consequences for vitamin D supplementation in MS will be discussed.
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Affiliation(s)
- J Smolders
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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Govarts C, Somers K, Hupperts R, Stinissen P, Somers V. Exploring cDNA Phage Display for Autoantibody Profiling in the Serum of Multiple Sclerosis Patients: Optimization of the Selection Procedure. Ann N Y Acad Sci 2007; 1109:372-84. [PMID: 17785326 DOI: 10.1196/annals.1398.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We applied a cDNA phage display method called serological antigen selection (SAS) to identify immunogenic targets that evoke an autoantibody response in the serum of multiple sclerosis (MS) patients. This method involves the display of a cDNA expression library, in this study a MS brain library, on filamentous phage and subsequent selection using patient immunoglobulin G (IgG). To apply the SAS technology for autoantibodies in the serum of MS patients, an optimization was necessary to deplete cDNA products that encode IgG fragments derived from B cells present in the MS brain plaques. We describe a differential screening procedure in which positive selection rounds on MS serum and negative selection rounds on healthy control serum were alternated to optimize the selection procedure. As a result, a substantial decrease of IgG-displaying phage clones was observed after each negative selection round, thereby preventing an overgrowth of IgG-displaying phage clones. Our depletion strategy was therefore successful in preventing the enrichment of IgG-displaying phage clones. This approach will facilitate the identification of possible MS-related antigens.
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Affiliation(s)
- C Govarts
- Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg, School of Life Sciences, Agoralaan, Building A, B-3590 Diepenbeek, Belgium
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Somers V, Govarts C, Hellings N, Hupperts R, Stinissen P. Profiling the autoantibody repertoire by serological antigen selection. J Autoimmun 2005; 25:223-8. [PMID: 16256306 DOI: 10.1016/j.jaut.2005.09.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 06/06/2005] [Accepted: 09/06/2005] [Indexed: 11/29/2022]
Abstract
The identification of disease related autoantigens targeted by pathogenic T- and B-cell responses is crucial for the development of improved therapies for autoimmune diseases. To identify immunogenic targets recognized by the humoral immune response, we have recently applied a novel and powerful molecular approach, named 'serological antigen selection' (SAS). This method involves the display of a cDNA expression library on filamentous phage and subsequent selection on patient immunoglobulin G (IgG). In the present study, we have cloned a cDNA repertoire from a multiple sclerosis (MS) patient in pVI phage display vectors and performed selections on pooled MS cerebrospinal fluid (CSF) samples immobilized with anti-human IgG. To further streamline this procedure, we report an optimized SAS procedure in which we have successfully established methods for enrichment of MS-specific candidate antigens. In conclusion, the broad applicability of the SAS method makes it a highly promising method for investigating the autoimmune repertoire.
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Affiliation(s)
- V Somers
- Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg, School of Life Sciences, Agoralaan, Building A, B-3590 Diepenbeek, Belgium.
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Hupperts R, Broadley S, Mander A, Clayton D, Compston DA, Robertson NP. Patterns of disease in concordant parent-child pairs with multiple sclerosis. Neurology 2001; 57:290-5. [PMID: 11468314 DOI: 10.1212/wnl.57.2.290] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although the exact etiology of MS remains elusive, there is good evidence that genetic factors play an important role. These factors are likely to be polygenic, exerting both independent and interactive effects on the expression of MS. They may determine susceptibility and/or shape the clinical course. METHODS The authors studied clinical phenotype in 245 concordant parent-child pairs recruited from a national register of familial disease over a 10-year period. Data were examined in order to determine the effect of parental sex on expression of disease in the offspring. RESULTS Allowing for the observed sex ratio of 2.6 F:1 M in this group of patients, sex pairings of parents and offspring were close to those expected. When assessed independently there was no evidence that either the sex of the affected offspring or the line of inheritance influenced disability, age at onset, or disease course. However, trends were observed toward greater disability and an increased frequency of primary progressive disease in offspring of affected fathers and an earlier age at onset in offspring of affected mothers. The highest mean Expanded Disability Status Scale score was observed in male offspring of affected fathers (5.64) and this group was also more likely to have primary progressive disease (OR 1.92). Thirty-one percent of families had an additionally affected offspring with no preferential maternal or paternal transmission. CONCLUSIONS In offspring of concordant parent-child families with MS who are at high risk of inheriting increased numbers of susceptibility genes there is no evidence for a parent of origin effect distorting sex ratios in affected offspring, but parent of origin may influence disability and disease course as well as increasing the risk to additional offspring within the same family. The mechanism of these effects is not clear but may result from interactions between genes encoded at different loci (epistasis), which each independently influence susceptibility and phenotype.
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Affiliation(s)
- R Hupperts
- University of Cambridge Neurology Unit, Addenbrooke's Hospital, Cambridge,, UK
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Abstract
Streptococcus suis infection is a zoonosis that has been mainly reported in pig-rearing and pork-consuming countries. The most common disease manifestation is meningitis, often associated with cochleovestibular signs. The causative agent is Streptococcus suis serotype 2, found as a commensal in the tonsils of its natural host, the pig. Persons at risk are mostly those with an occupational exposure to domestic pigs or their meat products. A case of meningitis caused by Streptococcus suis in a poacher who had killed and butchered a wild boar is reported. It appears that wild boar hunters are at additional risk of contracting the disease.
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Affiliation(s)
- T Halaby
- Department of Medical Microbiology, Maastricht University Hospital, The Netherlands.
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Lodder J, Hupperts R, Boreas A, Kessels F. The size of territorial brain infarction on CT relates to the degree of internal carotid artery obstruction. J Neurol 1996; 243:345-9. [PMID: 8965108 DOI: 10.1007/bf00868409] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied the relationship between infarct size and degree of internal carotid artery stenosis in 227 stroke patients without a source of embolism in the heart, who had a CT-verified territorial brain infarct. We used logistic regression analysis adjusting for differences between groups in co-associated variables such as age, sex, hypertension, diabetes mellitus, and a history of ischaemic heart disease. Ipsilateral carotid stenosis greater than 50% was more strongly associated with large than small infarcts; adjusted odds ration [(a)OR]: 4.56; 95% confidence interval (CI): 1.21-17.2; P = 0.02. For ipsilateral carotid occlusion the association was even stronger--(a)OR: 36.80; 95% CI: 2.54-533; P = 0.007. When large infarcts were compared with infarcts of small and moderate size together the ORs were 2.29, 95% CI 1.14-4.58 and 2.57, 95% CI 1.17-5.67 for carotid stenosis or occlusion, respectively. Our data show a relationship between greater than 50% carotid stenosis or occlusion and large brain infarcts. We suggest that haemodynamic impairment may contribute to infarct size in territorial infarcts of non-cardiac origin.
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Affiliation(s)
- J Lodder
- Department of Neurology, University Hospital Maastricht, The Netherlands
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Hupperts R, Wetzelaer W, Heuts-van Raak L, Lodder J. Is haemodynamical compromise a specific cause of border zone brain infarcts following cardiac surgery? Eur Neurol 1995; 35:276-80. [PMID: 8542916 DOI: 10.1159/000117149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We evaluated the hypothesis that if hypotension or hypoperfusion is a major cause of border zone brain infarction, infarcts following cardiac surgery will be likely to be located in the vascular border zone areas, whereas cerebral perfusion would be lower compared with non-border zone infarcts. Ten of 37 patients with brain infarction following cardiac surgery had an infarct in one of the vascular border zones on CT. Haemodynamical characteristics and clinical features did not differ between border zone infarcts and remaining infarct subgroups. We conclude that compared with stroke series brain infarcts following cardiac surgery are more frequently located in one of the vascular border zone areas, but peri-operative haemodynamic compromise alone does not sufficiently explain this difference. Other possible mechanisms, such as showers of (micro-)emboli, should also be considered.
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Affiliation(s)
- R Hupperts
- Department of Neurology, University Hospital Maastricht, The Netherlands
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