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Baka P, Birklein F, Bittner S, Sommer C. Reply to "Serum neurofilament light chain and small fiber neuropathy: Every cloud has a silver lining" by D. Plantone and G. Primiano. Eur J Neurol 2024; 31:e16245. [PMID: 38376082 DOI: 10.1111/ene.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Panoraia Baka
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
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Khalil M, Teunissen CE, Lehmann S, Otto M, Piehl F, Ziemssen T, Bittner S, Sormani MP, Gattringer T, Abu-Rumeileh S, Thebault S, Abdelhak A, Green A, Benkert P, Kappos L, Comabella M, Tumani H, Freedman MS, Petzold A, Blennow K, Zetterberg H, Leppert D, Kuhle J. Neurofilaments as biomarkers in neurological disorders - towards clinical application. Nat Rev Neurol 2024; 20:269-287. [PMID: 38609644 DOI: 10.1038/s41582-024-00955-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
Neurofilament proteins have been validated as specific body fluid biomarkers of neuro-axonal injury. The advent of highly sensitive analytical platforms that enable reliable quantification of neurofilaments in blood samples and simplify longitudinal follow-up has paved the way for the development of neurofilaments as a biomarker in clinical practice. Potential applications include assessment of disease activity, monitoring of treatment responses, and determining prognosis in many acute and chronic neurological disorders as well as their use as an outcome measure in trials of novel therapies. Progress has now moved the measurement of neurofilaments to the doorstep of routine clinical practice for the evaluation of individuals. In this Review, we first outline current knowledge on the structure and function of neurofilaments. We then discuss analytical and statistical approaches and challenges in determining neurofilament levels in different clinical contexts and assess the implications of neurofilament light chain (NfL) levels in normal ageing and the confounding factors that need to be considered when interpreting NfL measures. In addition, we summarize the current value and potential clinical applications of neurofilaments as a biomarker of neuro-axonal damage in a range of neurological disorders, including multiple sclerosis, Alzheimer disease, frontotemporal dementia, amyotrophic lateral sclerosis, stroke and cerebrovascular disease, traumatic brain injury, and Parkinson disease. We also consider the steps needed to complete the translation of neurofilaments from the laboratory to the management of neurological diseases in clinical practice.
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Affiliation(s)
- Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Charlotte E Teunissen
- Neurochemistry Laboratory Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Sylvain Lehmann
- LBPC-PPC, Université de Montpellier, INM INSERM, IRMB CHU de Montpellier, Montpellier, France
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Simon Thebault
- Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Ari Green
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuel Comabella
- Neurology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hayrettin Tumani
- Department of Neurology, CSF Laboratory, Ulm University Hospital, Ulm, Germany
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Axel Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, P. R. China
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.
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Koerbel K, Maiworm M, Schaller-Paule M, Schäfer JH, Jakob J, Friedauer L, Steffen F, Bittner S, Foerch C, Yalachkov Y. Evaluating the utility of serum NfL, GFAP, UCHL1 and tTAU as estimates of CSF levels and diagnostic instrument in neuroinflammation and multiple sclerosis. Mult Scler Relat Disord 2024; 87:105644. [PMID: 38701697 DOI: 10.1016/j.msard.2024.105644] [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: 01/25/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND This study aimed to evaluate the utility of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCHL1) and total tau (tTAU) serum concentrations as approximation for cerebrospinal fluid (CSF) concentrations of the respective biomarkers in the context of neuroinflammation and multiple sclerosis (MS). METHODS NfL, GFAP, UCHL1 and tTAU concentrations in serum and CSF were measured in 183 patients (122 with neuroinflammatory disease and 61 neurological or somatoform disease controls) using the single molecule array HD-1 analyzer (Quanterix, Boston, MA). Spearman's rank correlations were computed between serum and CSF concentrations. In a second step, the effects of age, BMI, gadolinium-enhancing lesions in MRI, integrity of the blood-brain barrier (BBB) and presence of acute relapse were accounted for by computing partial correlations. The analyses were repeated for a subsample consisting of MS phenotype patients only (n = 118). EDSS, MS disease activity and acute relapse were considered as additional covariates. Receiver operating characteristic (ROC) analysis was performed for each serum/CSF biomarker concentration to assess how well the particular biomarker concentration differentiates MS patients from somatoform disease controls. Correlations between serum and CSF levels as well as area under the curve (AUC) values were compared for the different biomarkers using z-test statistics. RESULTS Serum concentrations correlated positively with CSF levels for NfL (r = 0.705, p < 0.01) as well as for GFAP (r = 0.259, p < 0.01). Correlation coefficients were significantly higher for NfL than for GFAP (z = 5.492, p < 0.01). We found no significant serum-CSF correlations for UCHL1 or tTAU. After adjusting for covariates, the results remained unchanged. In the analysis focusing only on MS patients, the results were replicated. ROC analysis demonstrated similarly acceptable performance of serum and CSF NfL values in differentiating MS phenotype patients from somatoform disease controls. AUC values were significantly higher for serum and CSF NfL compared to other biomarkers. CONCLUSION NfL and GFAP but not UCHL1 or tTAU serum concentrations are associated with CSF levels of the respective biomarker. NfL exhibits more robust correlations between its serum and CSF concentrations as compared to GFAP independently from BBB integrity, clinical and radiological covariates. Both serum and CSF NfL values differentiate between MS and controls.
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Affiliation(s)
- Kimberly Koerbel
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany.
| | - Michelle Maiworm
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Martin Schaller-Paule
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany; Practice for Neurology and Psychiatry Eltville, Eltville am Rhein, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Jasmin Jakob
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lucie Friedauer
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Foerch
- Department of Neurology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Yavor Yalachkov
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
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Baka P, Steenken L, Escolano-Lozano F, Steffen F, Papagianni A, Sommer C, Pogatzki-Zahn E, Hirsch S, Protopapa M, Bittner S, Birklein F. Studying serum neurofilament light chain levels as a potential new biomarker for small fiber neuropathy. Eur J Neurol 2024; 31:e16192. [PMID: 38189534 DOI: 10.1111/ene.16192] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosing small fiber neuropathies can be challenging. To address this issue, whether serum neurofilament light chain (sNfL) could serve as a potential biomarker of damage to epidermal Aδ- and C-fibers was tested. METHODS Serum NfL levels were assessed in 30 patients diagnosed with small fiber neuropathy and were compared to a control group of 19 healthy individuals. Electrophysiological studies, quantitative sensory testing and quantification of intraepidermal nerve fiber density after skin biopsy were performed in both the proximal and distal leg. RESULTS Serum NfL levels were not increased in patients with small fiber neuropathy compared to healthy controls (9.1 ± 3.9 and 9.4 ± 3.8, p = 0.83) and did not correlate with intraepidermal nerve fiber density at the lateral calf or lateral thigh or with other parameters of small fiber impairment. CONCLUSION Serum NfL levels cannot serve as a biomarker for small fiber damage.
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Affiliation(s)
- Panoraia Baka
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Livia Steenken
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Fabiola Escolano-Lozano
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Silke Hirsch
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Protopapa
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Winter Y, Groppa S, Uphaus T, Ellwardt E, Fuest S, Meuth S, Bittner S, Hayani E. Cerebral vasculitis as a clinical manifestation of neurosarcoidosis: A scoping review. Autoimmun Rev 2024; 23:103528. [PMID: 38492907 DOI: 10.1016/j.autrev.2024.103528] [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: 02/27/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
The occurrence of cerebral vasculitis in individuals with neurosarcoidosis (NS) is considered to be rare. Although the number of relevant publications has increased in recent years, evidence is mostly limited to case reports. To obtain a better understanding of this rare and severe manifestation of disease, we carried out a scoping review on cerebral vasculitis in patients diagnosed with NS. The results of the review indicate that the diagnosis of cerebral vasculitis in patients with NS is made especially in patients with systemic sarcoidosis. However, recurrent strokes in patients with NS remains the main indicator of cerebral vasculitis. A tissue biopsy is considered the gold standard to confirm the diagnosis despite occasional false-negative results. Glucocorticoids and steroid-sparing agents are the most successful current treatments. Favorable outcomes were observed with strategies targeting TNFα and B cells. The goal of this review is to summarize the current literature and treatment options for cerebral vasculitis in patients with NS.
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Affiliation(s)
- Yaroslav Winter
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Philipps-University Marburg, Baldingerstr, 35043 Marburg, Germany.
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erik Ellwardt
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Helios-HSK Wiesbaden, Wiesbaden, Germany
| | - Sven Fuest
- Department of Neurology, Hephata Klinik, Schwalmstadt, Germany
| | - Sven Meuth
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany; Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eyad Hayani
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Boesl F, Goereci Y, Schweitzer F, Finke C, Schild AK, Bittner S, Steffen F, Schröder M, Quitschau A, Heine J, Warnke C, Franke C. Cognitive decline in post-COVID-19 syndrome does not correspond with persisting neuronal or astrocytic damage. Sci Rep 2024; 14:5326. [PMID: 38438479 PMCID: PMC10912552 DOI: 10.1038/s41598-024-55881-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Cognitive impairment is the most frequent symptom reported in post-COVID-19 syndrome (PCS). Aetiology of cognitive impairment in PCS is still to be determined. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are increased in acute COVID-19. Their role as biomarkers in other neurological disorders is under debate. We analysed serum levels of NfL and GFAP as markers for neuronal and astrocytic damage in 53 patients presenting to a PCS Neurology outpatient clinic. Only individuals with self-reported cognitive complaints were included. In these individuals, cognitive complaints were further assessed by comprehensive neuropsychological assessment (NPA). Patients were categorized into subgroups of subjective cognitive decline, single domain impairment, or multi-domain impairment. Serum NfL was in normal range, however an increase of serum GFAP was detected in 4% of patients. Serum NfL and GFAP levels correlated with each other, even when adjusting for patient age (r = 0.347, p = 0.012). NPA showed deficits in 70%; 40% showing impairment in several tested domains. No significant differences were found between serum NfL- and GFAP-levels comparing patients with subjective cognitive decline, single domain impairment, or multi-domain impairment. Persistent neuronal or astrocytic damage did not correlate with cognitive impairment in PCS.
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Affiliation(s)
- Fabian Boesl
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ann-Katrin Schild
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Maria Schröder
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anneke Quitschau
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Josephine Heine
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
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7
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Wilson D, Chan D, Chang L, Mathis R, Verberk I, Montalban X, Comabella M, Fissolo N, Bielekova B, Masvekar R, Chitnis T, Ziemssen T, Akgün K, Blennow K, Zetterberg H, Brück W, Giovannoni G, Gnanapavan S, Bittner S, Zipp F, Comi G, Furlan R, Lehmann S, Thebault S, Freedman M, Bar-Or A, Kramer M, Otto M, Halbgebauer S, Hrusovsky K, Plavina T, Khalil M, Piehl F, Wiendl H, Kappos L, Maceski A, Willemse E, Leppert D, Teunissen C, Kuhle J. Development and multi-center validation of a fully automated digital immunoassay for neurofilament light chain: toward a clinical blood test for neuronal injury. Clin Chem Lab Med 2024; 62:322-331. [PMID: 37702323 DOI: 10.1515/cclm-2023-0518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Neurofilament light chain (NfL) has emerged as a promising biomarker for detecting and monitoring axonal injury. Until recently, NfL could only be reliably measured in cerebrospinal fluid, but digital single molecule array (Simoa) technology has enabled its precise measurement in blood samples where it is typically 50-100 times less abundant. We report development and multi-center validation of a novel fully automated digital immunoassay for NfL in serum for informing axonal injury status. METHODS A 45-min immunoassay for serum NfL was developed for use on an automated digital analyzer based on Simoa technology. The analytical performance (sensitivity, precision, reproducibility, linearity, sample type) was characterized and then cross validated across 17 laboratories in 10 countries. Analytical performance for clinical NfL measurement was examined in individual patients with relapsing remitting multiple sclerosis (RRMS) after 3 months of disease modifying treatment (DMT) with fingolimod. RESULTS The assay exhibited a lower limit of detection (LLoD) of 0.05 ng/L, a lower limit of quantification (LLoQ) of 0.8 ng/L, and between-laboratory imprecision <10 % across 17 validation sites. All tested samples had measurable NfL concentrations well above the LLoQ. In matched pre-post treatment samples, decreases in NfL were observed in 26/29 RRMS patients three months after DMT start, with significant decreases detected in a majority of patients. CONCLUSIONS The sensitivity characteristics and reproducible performance across laboratories combined with full automation make this assay suitable for clinical use for NfL assessment, monitoring in individual patients, and cross-comparisons of results across multiple sites.
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Affiliation(s)
| | | | | | | | - Inge Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam, University Medical Centers, Amsterdam, The Netherlands
| | - Xavier Montalban
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Manuel Comabella
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Nicolas Fissolo
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Bibi Bielekova
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ruturaj Masvekar
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, Dresden University of Technology, Dresden, Germany
| | - Katja Akgün
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, Dresden University of Technology, Dresden, Germany
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Wolfgang Brück
- Institute for Neuropathology at the University Medical Center, Göttingen, Germany
| | - Gavin Giovannoni
- Department of Neurology, Barts Health NHS Trust, The Royal London Hospital, E1 1FR, London, UK
| | - Sharmilee Gnanapavan
- Department of Neurology, Barts Health NHS Trust, The Royal London Hospital, E1 1FR, London, UK
| | - Stefan Bittner
- University Medical Center Mainz, Department of Neurology, Mainz, Germany
| | - Frauke Zipp
- University Medical Center Mainz, Department of Neurology, Mainz, Germany
| | - Giancarlo Comi
- Institute of Experimental Neurology, Division of Neuroscience, University Vita e Salute San Raffaele and IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, University Vita e Salute San Raffaele and IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Simon Thebault
- University of Ottawa, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Freedman
- University of Ottawa, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Markus Otto
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Steffen Halbgebauer
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
| | | | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Aleksandra Maceski
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eline Willemse
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam, University Medical Centers, Amsterdam, The Netherlands
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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8
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Jakimovski D, Bittner S, Zivadinov R, Morrow SA, Benedict RH, Zipp F, Weinstock-Guttman B. Multiple sclerosis. Lancet 2024; 403:183-202. [PMID: 37949093 DOI: 10.1016/s0140-6736(23)01473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 11/12/2023]
Abstract
Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ralph Hb Benedict
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
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9
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Fleischer V, Gonzalez-Escamilla G, Pareto D, Rovira A, Sastre-Garriga J, Sowa P, Høgestøl EA, Harbo HF, Bellenberg B, Lukas C, Ruggieri S, Gasperini C, Uher T, Vaneckova M, Bittner S, Othman AE, Collorone S, Toosy AT, Meuth SG, Zipp F, Barkhof F, Ciccarelli O, Groppa S. Prognostic value of single-subject grey matter networks in early multiple sclerosis. Brain 2024; 147:135-146. [PMID: 37642541 PMCID: PMC10766234 DOI: 10.1093/brain/awad288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
The identification of prognostic markers in early multiple sclerosis (MS) is challenging and requires reliable measures that robustly predict future disease trajectories. Ideally, such measures should make inferences at the individual level to inform clinical decisions. This study investigated the prognostic value of longitudinal structural networks to predict 5-year Expanded Disability Status Scale (EDSS) progression in patients with relapsing-remitting MS (RRMS). We hypothesized that network measures, derived from MRI, outperform conventional MRI measurements at identifying patients at risk of developing disability progression. This longitudinal, multicentre study within the Magnetic Resonance Imaging in MS (MAGNIMS) network included 406 patients with RRMS (mean age = 35.7 ± 9.1 years) followed up for 5 years (mean follow-up = 5.0 ± 0.6 years). EDSS was determined to track disability accumulation. A group of 153 healthy subjects (mean age = 35.0 ± 10.1 years) with longitudinal MRI served as controls. All subjects underwent MRI at baseline and again 1 year after baseline. Grey matter atrophy over 1 year and white matter lesion load were determined. A single-subject brain network was reconstructed from T1-weighted scans based on grey matter atrophy measures derived from a statistical parameter mapping-based segmentation pipeline. Key topological measures, including network degree, global efficiency and transitivity, were calculated at single-subject level to quantify network properties related to EDSS progression. Areas under receiver operator characteristic (ROC) curves were constructed for grey matter atrophy and white matter lesion load, and the network measures and comparisons between ROC curves were conducted. The applied network analyses differentiated patients with RRMS who experience EDSS progression over 5 years through lower values for network degree [H(2) = 30.0, P < 0.001] and global efficiency [H(2) = 31.3, P < 0.001] from healthy controls but also from patients without progression. For transitivity, the comparisons showed no difference between the groups [H(2) = 1.5, P = 0.474]. Most notably, changes in network degree and global efficiency were detected independent of disease activity in the first year. The described network reorganization in patients experiencing EDSS progression was evident in the absence of grey matter atrophy. Network degree and global efficiency measurements demonstrated superiority of network measures in the ROC analyses over grey matter atrophy and white matter lesion load in predicting EDSS worsening (all P-values < 0.05). Our findings provide evidence that grey matter network reorganization over 1 year discloses relevant information about subsequent clinical worsening in RRMS. Early grey matter restructuring towards lower network efficiency predicts disability accumulation and outperforms conventional MRI predictors.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Barbara Bellenberg
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Serena Ruggieri
- Department of Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sara Collorone
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Ahmed T Toosy
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Frederik Barkhof
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, 1100 DD Amsterdam, Netherlands
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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10
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Eisenhut K, Faber J, Engels D, Gerhards R, Lewerenz J, Doppler K, Sommer C, Markewitz R, Falk KK, Rössling R, Pruess H, Finke C, Wickel J, Geis C, Ratuszny D, Pfeffer LK, Bittner S, Piepgras J, Kraft A, Klausewitz J, Nuscher B, Kümpfel T, Thaler FS. Early Neuroaxonal Damage in Neurologic Disorders Associated With GAD65 Antibodies. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200176. [PMID: 37914416 PMCID: PMC10624332 DOI: 10.1212/nxi.0000000000200176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Neurodegeneration is considered a relevant pathophysiologic feature in neurologic disorders associated with antibodies against glutamic acid decarboxylase 65 (GAD65). In this study, we investigate surrogates of neuroaxonal damage in relation to disease duration and clinical presentation. METHODS In a multicentric cohort of 50 patients, we measured serum neurofilament light chain (sNfL) in relation to disease duration and disease phenotypes, applied automated MRI volumetry, and analyzed clinical characteristics. RESULTS In patients with neurologic disorders associated with GAD65 antibodies, we detected elevated sNfL levels early in the disease course. By contrast, this elevation of sNfL levels was less pronounced in patients with long-standing disease. Increased sNfL levels were observed in patients presenting with cerebellar ataxia and limbic encephalitis, but not in those with stiff person syndrome. Using MRI volumetry, we identified atrophy predominantly of the cerebellar cortex, cerebellar superior posterior lobe, and cerebral cortex with similar atrophy patterns throughout all clinical phenotypes. DISCUSSION Together, our data provide evidence for early neuroaxonal damage and support the need for timely therapeutic interventions in GAD65 antibody-associated neurologic disorders.
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Affiliation(s)
- Katharina Eisenhut
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jennifer Faber
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Daniel Engels
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Ramona Gerhards
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jan Lewerenz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kathrin Doppler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Claudia Sommer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Robert Markewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kim K Falk
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Rosa Rössling
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Harald Pruess
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Carsten Finke
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jonathan Wickel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Christian Geis
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Dominica Ratuszny
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Lena K Pfeffer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Stefan Bittner
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Johannes Piepgras
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Andrea Kraft
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jaqueline Klausewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Brigitte Nuscher
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Tania Kümpfel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Franziska S Thaler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys.
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11
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Hahn M, Hayani E, Bitar L, Gröschel S, Steffen F, Protopapa M, Othman A, Bittner S, Zipp F, Gröschel K, Uphaus T. Strict blood pressure control following thrombectomy is associated with neuronal injury and poor functional outcome. Ann Clin Transl Neurol 2023; 10:2255-2265. [PMID: 37743753 PMCID: PMC10723244 DOI: 10.1002/acn3.51909] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Mechanical thrombectomy (MT) has become standard treatment in acute ischemic stroke due to large vessel occlusion (LVO). However, optimal blood pressure (BP) management following successful recanalization remains unclear. We aim to investigate the association of strictly achieving BP targets of ≤160/90 mmHg with the extent of neuronal loss and functional outcome. METHODS In patients prospectively enrolled in the Gutenberg-Stroke-Study (May 2018-November 2019), BP was measured half-hourly for 24 h following MT. Based on achieving BP target of ≤160/90 mmHg, patients with successful recanalization of LVO were divided into "low-BP" group (BP ≤ 160/90 mmHg) or "high-BP" group (BP > 160/90 mmHg). Neuronal loss was quantified by serum-based measurement of neurofilament light chain (sNfL) after three days. BP groups and association of BP parameters with sNfL were investigated by correlation analyses and multiple regression modeling. RESULTS Of 253 enrolled patients (mean age 73.1 ± 12.9 years, 53.4% female), 165 met inclusion criteria. 21.2% (n = 35) strictly achieved "low-BP" target. "low-BP" was associated with unfavorable functional outcome at 90-day follow-up (aOR [95%CI]: 5.88 [1.88-18.32], p = 0.002) and decreased health-related quality of life (mean EQ-5D-index 0.45 ± 0.28 vs 0.63 ± 0.31, p = 0.009). sNfL levels were increased in "low-BP" patients (median [IQR] 239.7 [168.4-303.4] vs 118.8 [52.5-220.5] pg/mL, p = 0.026). Hypotensive episodes were more frequent in the "low-BP" group (48.6% vs 29.2%, p = 0.031). sNfL level could identify patients who had experienced hypotensive episodes with high discriminative ability (AUC [95%CI]: 0.68 [0.56-0.78], p = 0.007). INTERPRETATION Strict BP control (≤160/90 mmHg) within 24 h following successful recanalization of LVO by MT is associated with increased neuronal injury, displayed by higher sNfL levels, and poorer functional outcome, potentially indicating hypotension-induced neuronal loss during post-MT phase.
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Affiliation(s)
- Marianne Hahn
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Eyad Hayani
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Lynn Bitar
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Sonja Gröschel
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Falk Steffen
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Maria Protopapa
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Ahmed Othman
- Department of NeuroradiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Stefan Bittner
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Frauke Zipp
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Klaus Gröschel
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Timo Uphaus
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
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12
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Brummer T, Schillner M, Steffen F, Kneilmann F, Wasser B, Uphaus T, Zipp F, Bittner S. Spatial transcriptomics and neurofilament light chain reveal changes in lesion patterns in murine autoimmune neuroinflammation. J Neuroinflammation 2023; 20:262. [PMID: 37957728 PMCID: PMC10644497 DOI: 10.1186/s12974-023-02947-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE Ongoing neuroaxonal damage is a major contributor to disease progression and long-term disability in multiple sclerosis. However, spatio-temporal distribution and pathophysiological mechanisms of neuroaxonal damage during acute relapses and later chronic disease stages remain poorly understood. METHODS Here, we applied immunohistochemistry, single-molecule array, spatial transcriptomics, and microglia/axon co-cultures to gain insight into spatio-temporal neuroaxonal damage in experimental autoimmune encephalomyelitis (EAE). RESULTS Association of spinal cord white matter lesions and blood-based neurofilament light (sNfL) levels revealed a distinct, stage-dependent anatomical pattern of neuroaxonal damage: in chronic EAE, sNfL levels were predominately associated with anterolateral lumbar lesions, whereas in early EAE sNfL showed no correlation with lesions in any anatomical location. Furthermore, neuroaxonal damage in late EAE was largely confined to white matter lesions but showed a widespread distribution in early EAE. Following this pattern of neuroaxonal damage, spatial transcriptomics revealed a widespread cyto- and chemokine response at early disease stages, whereas late EAE was characterized by a prominent glial cell accumulation in white matter lesions. These findings were corroborated by immunohistochemistry and microglia/axon co-cultures, which further revealed a strong association between CNS myeloid cell activation and neuroaxonal damage both in vivo and in vitro. INTERPRETATION Our findings indicate that CNS myeloid cells may play a crucial role in driving neuroaxonal damage in EAE. Moreover, neuroaxonal damage can progress in a stage-dependent centripetal manner, transitioning from normal-appearing white matter to focal white matter lesions. These insights may contribute to a better understanding of neurodegeneration and elevated sNfL levels observed in multiple sclerosis patients at different disease stages.
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Affiliation(s)
- Tobias Brummer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Miriam Schillner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Flores Kneilmann
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Beatrice Wasser
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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13
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Kim K, Bittner S, Jin Y, Zeng Y, Wang QJ, Cao H. Impact of Cavity Geometry on Microlaser Dynamics. Phys Rev Lett 2023; 131:153801. [PMID: 37897774 DOI: 10.1103/physrevlett.131.153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/08/2023] [Indexed: 10/30/2023]
Abstract
We experimentally investigate spatiotemporal lasing dynamics in semiconductor microcavities with various geometries, featuring integrable or chaotic ray dynamics. The classical ray dynamics directly impacts the lasing dynamics, which is primarily determined by the local directionality of long-lived ray trajectories. The directionality of optical propagation dictates the characteristic length scales of intensity variations, which play a pivotal role in nonlinear light-matter interactions. While wavelength-scale intensity variations tend to stabilize lasing dynamics, modulation on much longer scales causes spatial filamentation and irregular pulsation. Our results will pave the way to control the lasing dynamics by engineering the cavity geometry and ray dynamical properties.
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Affiliation(s)
- Kyungduk Kim
- Department of Applied Physics, Yale University, New Haven, Connecticut 06520, USA
| | - Stefan Bittner
- Université de Lorraine, CentraleSupélec, LMOPS, 2 rue Edouard Belin, Metz 57070, France
- Chair in Photonics, CentraleSupélec, LMOPS, 2 rue Edouard Belin, Metz 57070, France
| | - Yuhao Jin
- Center for OptoElectronics and Biophotonics, School of Electrical and Electronic Engineering, School of Physical and Mathematical Science, and Photonics Institute, Nanyang Technological University, 639798 Singapore
| | - Yongquan Zeng
- Center for OptoElectronics and Biophotonics, School of Electrical and Electronic Engineering, School of Physical and Mathematical Science, and Photonics Institute, Nanyang Technological University, 639798 Singapore
| | - Qi Jie Wang
- Center for OptoElectronics and Biophotonics, School of Electrical and Electronic Engineering, School of Physical and Mathematical Science, and Photonics Institute, Nanyang Technological University, 639798 Singapore
| | - Hui Cao
- Department of Applied Physics, Yale University, New Haven, Connecticut 06520, USA
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Brahmer A, Geiß C, Lygeraki A, Neuberger E, Tzaridis T, Nguyen TT, Luessi F, Régnier-Vigouroux A, Hartmann G, Simon P, Endres K, Bittner S, Reiners KS, Krämer-Albers EM. Assessment of technical and clinical utility of a bead-based flow cytometry platform for multiparametric phenotyping of CNS-derived extracellular vesicles. Cell Commun Signal 2023; 21:276. [PMID: 37803478 PMCID: PMC10559539 DOI: 10.1186/s12964-023-01308-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Extracellular vesicles (EVs) originating from the central nervous system (CNS) can enter the blood stream and carry molecules characteristic of disease states. Therefore, circulating CNS-derived EVs have the potential to serve as liquid-biopsy markers for early diagnosis and follow-up of neurodegenerative diseases and brain tumors. Monitoring and profiling of CNS-derived EVs using multiparametric analysis would be a major advance for biomarker as well as basic research. Here, we explored the performance of a multiplex bead-based flow-cytometry assay (EV Neuro) for semi-quantitative detection of CNS-derived EVs in body fluids. METHODS EVs were separated from culture of glioblastoma cell lines (LN18, LN229, NCH82) and primary human astrocytes and measured at different input amounts in the MACSPlex EV Kit Neuro, human. In addition, EVs were separated from blood samples of small cohorts of glioblastoma (GB), multiple sclerosis (MS) and Alzheimer's disease patients as well as healthy controls (HC) and subjected to the EV Neuro assay. To determine statistically significant differences between relative marker signal intensities, an unpaired samples t-test or Wilcoxon rank sum test were computed. Data were subjected to tSNE, heatmap clustering, and correlation analysis to further explore the relationships between disease state and EV Neuro data. RESULTS Glioblastoma cell lines and primary human astrocytes showed distinct EV profiles. Signal intensities were increasing with higher EV input. Data normalization improved identification of markers that deviate from a common profile. Overall, patient blood-derived EV marker profiles were constant, but individual EV populations were significantly increased in disease compared to healthy controls, e.g. CD36+EVs in glioblastoma and GALC+EVs in multiple sclerosis. tSNE and heatmap clustering analysis separated GB patients from HC, but not MS patients from HC. Correlation analysis revealed a potential association of CD107a+EVs with neurofilament levels in blood of MS patients and HC. CONCLUSIONS The semi-quantitative EV Neuro assay demonstrated its utility for EV profiling in complex samples. However, reliable statistical results in biomarker studies require large sample cohorts and high effect sizes. Nonetheless, this exploratory trial confirmed the feasibility of discovering EV-associated biomarkers and monitoring circulating EV profiles in CNS diseases using the EV Neuro assay. Video Abstract.
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Affiliation(s)
- Alexandra Brahmer
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany.
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Carsten Geiß
- Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Andriani Lygeraki
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Elmo Neuberger
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen- Bonn-Cologne-Düsseldorf, Partner Site Bonn, University of Bonn, Bonn, Germany
| | - Tinh Thi Nguyen
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Institute of Molecular Biology, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne Régnier-Vigouroux
- Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin S Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Eva-Maria Krämer-Albers
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany.
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15
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Bittner S, Zipp F. IL-17 receptor goes solo in autoimmune inflammation. Immunity 2023; 56:1977-1980. [PMID: 37703825 DOI: 10.1016/j.immuni.2023.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
IL-17-blocking antibodies have shown little clinical effect in some autoimmune diseases such as multiple sclerosis. In this issue of Immunity, Luo et al. demonstrate that SHP2-Act1 complexes can mediate autonomous IL-17R signaling in the absence of the IL-17 ligand itself.
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Affiliation(s)
- Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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16
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Salmen A, Hoepner R, Fleischer V, Heldt M, Gisevius B, Motte J, Ruprecht K, Schneider R, Fisse AL, Grüter T, Lukas C, Berthele A, Giglhuber K, Flaskamp M, Mühlau M, Kirschke J, Bittner S, Groppa S, Lüssi F, Bayas A, Meuth S, Heesen C, Trebst C, Wildemann B, Then Bergh F, Antony G, Kümpfel T, Paul F, Nischwitz S, Tumani H, Zettl U, Hemmer B, Wiendl H, Zipp F, Gold R. Factors associated with depressive mood at the onset of multiple sclerosis - an analysis of 781 patients of the German NationMS cohort. Ther Adv Neurol Disord 2023; 16:17562864231197309. [PMID: 37692259 PMCID: PMC10492471 DOI: 10.1177/17562864231197309] [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: 05/11/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Depression has a major impact on the disease burden of multiple sclerosis (MS). Analyses of overlapping MS and depression risk factors [smoking, vitamin D (25-OH-VD) and Epstein-Barr virus (EBV) infection] and sex, age, disease characteristics and neuroimaging features associated with depressive symptoms in early MS are scarce. Objectives To assess an association of MS risk factors with depressive symptoms within the German NationMS cohort. Design Cross-sectional analysis within a multicenter observational study. Methods Baseline data of n = 781 adults with newly diagnosed clinically isolated syndrome or relapsing-remitting MS qualified for analysis. Global and region-specific magnetic resonance imaging (MRI)-volumetry parameters were available for n = 327 patients. Association of demographic factors, MS characteristics and risk factors [sex, age, smoking, disease course, presence of current relapse, expanded disability status scale (EDSS) score, fatigue (fatigue scale motor cognition), 25-OH-VD serum concentration, EBV nuclear antigen-1 IgG (EBNA1-IgG) serum levels] and depressive symptoms (Beck Depression Inventory-II, BDI-II) was tested as a primary outcome by multivariable linear regression. Non-parametric correlation and group comparison were performed for associations of MRI parameters and depressive symptoms. Results Mean age was 34.3 years (95% confidence interval: 33.6-35.0). The female-to-male ratio was 2.3:1. At least minimal depressive symptoms (BDI-II > 8) were present in n = 256 (32.8%), 25-OH-VD deficiency (<20 ng/ml) in n = 398 (51.0%), n = 246 (31.5%) participants were smokers. Presence of current relapse [coefficient (c) = 1.48, p = 0.016], more severe fatigue (c = 0.26, p < 0.0001), lower 25-OH-VD (c = -0.03, p = 0.034) and smoking (c = 0.35, p = 0.008) were associated with higher BDI-II scores. Sex, age, disease course, EDSS, month of visit, EBNA1-IgG levels and brain volumes at baseline were not. Conclusion Depressive symptoms need to be assessed in early MS. Patients during relapse seem especially vulnerable to depressive symptoms. Contributing factors such as fatigue, vitamin D deficiency and smoking, could specifically be targeted in future interventions and should be investigated in prospective studies.
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Affiliation(s)
- Anke Salmen
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Milena Heldt
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Barbara Gisevius
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, MaxDelbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
- Institute for Neuroradiology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
- Institute for Neuroradiology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Martina Flaskamp
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Jan Kirschke
- Department of Neuroradiology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Lüssi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Antonios Bayas
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Sven Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Cristoph Heesen
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gisela Antony
- Central Information Office German Competence Network of Multiple Sclerosis, Philipps University Marburg, Marburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, MaxDelbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Uwe Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, Medical Faculty, University Hospital, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
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17
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Wenger KJ, Hoelter MC, Yalachkov Y, Hendrik Schäfer J, Özkan D, Steffen F, Bittner S, Hattingen E, Foerch C, Schaller-Paule MA. Serum neurofilament light chain is more strongly associated with T2 lesion volume than with number of T2 lesions in patients with multiple sclerosis. Eur J Radiol 2023; 166:111019. [PMID: 37549559 DOI: 10.1016/j.ejrad.2023.111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/24/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging provides information on the number and extend of focal lesions in multiple sclerosis (MS) patients. This study explores whether total brain T2 lesion volume or lesion number shows a better correlation with serum and cerebrospinal fluid (CSF) biomarkers of disease activity. MATERIALS AND METHODS In total, 52 patients suffering from clinically isolated syndrome (CIS)/relapsing-remitting multiple sclerosis (RRMS) were assessed including MRI markers (total brain T2 lesion volume semi-automatically outlined on 3D DIR/FLAIR sequences, number of lesions), serum and CSF biomarkers at the time of neuroimaging (neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP)), and clinical parameters. After log-transformation and partial correlations adjusted for the covariates patients' age, BMI, EDSS-score and diagnosis, the Fisher's r-to-Z transformation was used to compare different correlation coefficients. RESULTS The correlation between lesion volume and serum NfL (r = 0.6, p < 0.001) was stronger compared to the association between the number of T2 lesions and serum NfL (r = 0.4, p < 0.01) (z = -2.0, p < 0.05). With regard to CSF NfL, there was a moderate, positive relationship for both number of T2 lesions and lesion volume (r = 0.5 respectively, p < 0.01). We found no significant association between MRI markers and GFAP levels. CONCLUSION Our findings suggest that there is a stronger association between serum NfL and T2 lesion volume, than there is between serum NfL and T2 lesion number. Improving robustness and accuracy of fully-automated lesion volume segmentation tools can expedite implementation into clinical routine and trials.
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Affiliation(s)
- Katharina J Wenger
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Germany.
| | - Maya C Hoelter
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Germany
| | - Yavor Yalachkov
- Goethe University Frankfurt, University Hospital, Department of Neurology, Germany
| | - Jan Hendrik Schäfer
- Goethe University Frankfurt, University Hospital, Department of Neurology, Germany
| | - Dilek Özkan
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Germany
| | - Falk Steffen
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elke Hattingen
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Germany
| | - Christian Foerch
- Goethe University Frankfurt, University Hospital, Department of Neurology, Germany
| | - Martin A Schaller-Paule
- Goethe University Frankfurt, University Hospital, Department of Neurology, Germany; Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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18
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Eliezer Y, Rührmair U, Wisiol N, Bittner S, Cao H. Tunable nonlinear optical mapping in a multiple-scattering cavity. Proc Natl Acad Sci U S A 2023; 120:e2305027120. [PMID: 37490539 PMCID: PMC10401015 DOI: 10.1073/pnas.2305027120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/18/2023] [Indexed: 07/27/2023] Open
Abstract
Nonlinear disordered systems are not only a model system for fundamental studies but also in high demand for practical applications. However, optical nonlinearity based on intrinsic material response is weak in random scattering systems. Here, we propose and experimentally realize a highly nonlinear mapping between the scattering potential and the emerging light of a reconfigurable multiple-scattering cavity. A quantitative analysis of the degree of nonlinearity reveals its dependence on the number of scattering events. The effective order of nonlinear mapping can be tuned over a wide range at low optical lower. The strong nonlinear mapping enhances output intensity fluctuations and long-range correlations. The flexibility, robustness, and energy efficiency of our approach provides a versatile platform for exploring such nonlinear mappings for various applications.
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Affiliation(s)
- Yaniv Eliezer
- Department of Applied Physics, Yale University, New Haven, CT06520
| | - Ulrich Rührmair
- Electrical and Computer Engineering Department, University of Connecticut, Storrs, CT06249
- Institute for Computer Science, Ludwig Maximilian University of Munich, 80538München, Germany
| | - Nils Wisiol
- Security in Telecommunications, Department of Software Engineering and Theoretical Computer Science, Technische Universität Berlin, Berlin, Germany
| | - Stefan Bittner
- Chair in Photonics, CentraleSupélec, Optical Materials, Photonics and Systems Laboratory, Metz57070, France
- Université de Lorraine, Chair in Photonics, CentraleSupélec, Optical Materials, Photonics and Systems Laboratory, Metz57070, France
| | - Hui Cao
- Department of Applied Physics, Yale University, New Haven, CT06520
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19
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Bittner S, Pape K, Klotz L, Zipp F. Implications of immunometabolism for smouldering MS pathology and therapy. Nat Rev Neurol 2023:10.1038/s41582-023-00839-6. [PMID: 37430070 DOI: 10.1038/s41582-023-00839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
Clinical symptom worsening in patients with multiple sclerosis (MS) is driven by inflammation compartmentalized within the CNS, which results in chronic neuronal damage owing to insufficient repair mechanisms. The term 'smouldering inflammation' summarizes the biological aspects underlying this chronic, non-relapsing and immune-mediated mechanism of disease progression. Smouldering inflammation is likely to be shaped and sustained by local factors in the CNS that account for the persistence of this inflammatory response and explain why current treatments for MS do not sufficiently target this process. Local factors that affect the metabolic properties of glial cells and neurons include cytokines, pH value, lactate levels and nutrient availability. This Review summarizes current knowledge of the local inflammatory microenvironment in smouldering inflammation and how it interacts with the metabolism of tissue-resident immune cells, thereby promoting inflammatory niches within the CNS. The discussion highlights environmental and lifestyle factors that are increasingly recognized as capable of altering immune cell metabolism and potentially responsible for smouldering pathology in the CNS. Currently approved MS therapies that target metabolic pathways are also discussed, along with their potential for preventing the processes that contribute to smouldering inflammation and thereby to progressive neurodegenerative damage in MS.
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Affiliation(s)
- Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Katrin Pape
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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20
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Engel S, Klotz L, Wirth T, Fleck AK, Pickert G, Eschborn M, Kreuzburg S, Curella V, Bittner S, Zipp F, Schuppan D, Luessi F. Attenuation of immune activation in patients with multiple sclerosis on a wheat-reduced diet: a pilot crossover trial. Ther Adv Neurol Disord 2023; 16:17562864231170928. [PMID: 37384112 PMCID: PMC10293514 DOI: 10.1177/17562864231170928] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/03/2023] [Indexed: 06/30/2023] Open
Abstract
Background Western lifestyle has been associated with an increase in relapsing-remitting multiple sclerosis (RRMS). In mice, dietary wheat amylase-trypsin inhibitors (ATIs) activate intestinal myeloid cells and augment T cell-mediated systemic inflammation. Objective The aim of this study was to assess whether a wheat- and thus ATI-reduced diet might exert beneficial effects in RRMS patients with modest disease activity. Methods In this 6-month, crossover, open-label, bicentric proof-of-concept trial, 16 RRMS patients with stable disease course were randomized to either 3 months of a standard wheat-containing diet with consecutive switch to a > 90% wheat-reduced diet, or vice versa. Results The primary endpoint was negative, as the frequency of circulating pro-inflammatory T cells did not decrease during the ATI-reduced diet. We did, however, observe decreased frequencies of CD14+ CD16++ monocytes and a concomitant increase in CD14++ CD16- monocytes during the wheat-reduced diet interval. This was accompanied by an improvement in pain-related quality of life in health-related quality of life assessed (SF-36). Conclusion Our results suggest that the wheat- and thus ATI-reduced diet was associated with changes in monocyte subsets and improved pain-related quality of life in RRMS patients. Thus, a wheat (ATI)-reduced diet might be a complementary approach accompanying immunotherapy for some patients. Registration German Clinical Trial Register (No. DRKS00027967).
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Affiliation(s)
- Sinah Engel
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, University of Münster, Münster, Germany
| | - Timo Wirth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, University of Münster, Münster, Germany
| | - Ann-Katrin Fleck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, University of Münster, Münster, Germany
| | - Geethanjali Pickert
- Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Eschborn
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, University of Münster, Münster, Germany
| | - Samia Kreuzburg
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Valentina Curella
- Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix Luessi
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn²), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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21
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Engeroff K, Warm D, Bittner S, Blanquie O. Different activity patterns control various stages of Reelin synthesis in the developing neocortex. Cereb Cortex 2023:7191711. [PMID: 37288494 PMCID: PMC10393496 DOI: 10.1093/cercor/bhad210] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Reelin is a large extracellular matrix protein abundantly expressed in the developing neocortex of mammals. During embryonic and early postnatal stages in mice, Reelin is secreted by a transient neuronal population, the Cajal-Retzius neurons (CRs), and is mostly known to insure the inside-out migration of neurons and the formation of cortical layers. During the first 2 postnatal weeks, CRs disappear from the neocortex and a subpopulation of GABAergic neurons takes over the expression of Reelin, albeit in lesser amounts. Although Reelin expression requires a tight regulation in a time- and cell-type specific manner, the mechanisms regulating the expression and secretion of this protein are poorly understood. In this study, we establish a cell-type specific profile of Reelin expression in the marginal zone of mice neocortex during the first 3 postnatal weeks. We then investigate whether electrical activity plays a role in the regulation of Reelin synthesis and/or secretion by cortical neurons during the early postnatal period. We show that increased electrical activity promotes the transcription of reelin via the brain-derived neurotrophic factor/TrkB pathway, but does not affect its translation or secretion. We further demonstrate that silencing the neuronal network promotes the translation of Reelin without affecting the transcription or secretion. We conclude that different patterns of activity control various stages of Reelin synthesis, whereas its secretion seems to be constitutive.
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Affiliation(s)
- Kira Engeroff
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55128 Mainz, Germany
| | - Davide Warm
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55128 Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Oriane Blanquie
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55128 Mainz, Germany
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- European Medicines Agency, 1083HS Amsterdam, The Netherlands
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22
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Schuckmann A, Steffen F, Zipp F, Bittner S, Pape K. Impact of extended interval dosing of ocrelizumab on immunoglobulin levels in multiple sclerosis. Med 2023:S2666-6340(23)00141-1. [PMID: 37236189 DOI: 10.1016/j.medj.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/17/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Long-term B cell depletion with ocrelizumab in multiple sclerosis (MS) is associated with severe side effects such as hypogammaglobulinemia and infections. Our study therefore aimed to assess immunoglobulin levels under treatment with ocrelizumab and implement an extended interval dosing (EID) scheme. METHODS Immunoglobulin levels of 51 patients with ≥24 months of treatment with ocrelizumab were analyzed. After ≥4 treatment cycles, patients chose to either continue on the standard interval dosing (SID) regimen (n = 14) or, in the case of clinically and radiologically stable disease, switch to B cell-adapted EID (n = 12, next dose at CD19+ B cells >1% of peripheral blood lymphocytes). FINDINGS Levels of immunoglobulin M (IgM) declined rapidly under ocrelizumab treatment. Risk factors for IgM and IgA hypogammaglobulinemia were lower levels at baseline and more previous disease-modifying therapies. B cell-adapted EID of ocrelizumab increased the mean time until next infusion from 27.3 to 46.1 weeks. Ig levels declined significantly in the SID group over 12 months but not in the EID group. Previously stable patients remained stable under EID as measured by expanded disability status scale (EDSS), neurofilament light chain, timed 25-foot walk (T25-FW), 9-hole peg test (9-HPT), symbol digit modalities test (SDMT), and multiple sclerosis impact scale (MSIS-29). CONCLUSIONS In our pilot study, B cell-adapted EID of ocrelizumab prevented the decline of Ig levels without affecting disease activity in previously stable patients with MS. Based on these findings, we propose a new algorithm for long-term ocrelizumab treatment. FUNDING This study was supported by the Deutsche Forschungsgemeinschaft (SFB CRC-TR-128, SFB 1080, and SFB CRC-1292) and the Hertie Foundation.
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Affiliation(s)
- Aaron Schuckmann
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Katrin Pape
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
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23
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Schaefer JH, Schaller-Paule MA, Wenger K, Mayer C, Mann U, Bickert A, Steffen F, Bittner S, Yalachkov Y, Foerch C. Relevance of dedicated multiple sclerosis serum biomarkers in predicting contrast enhancement with gadolinium - Results from the REDUCE-GAD trial. Eur J Neurol 2023. [PMID: 37183506 DOI: 10.1111/ene.15865] [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: 01/30/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The presence of contrast enhancement (CE) on magnetic resonance imaging (MRI) is one of the principal criteria for diagnosis and disease activity of multiple sclerosis (MS). Therefore, MS patients are frequently exposed to contrast agents, which may cause deposition in the brain, restricting its use in repeat examinations. Thus, serum biomarkers may be valuable as surrogate parameters to evaluate MS activity. METHODS REDUCE-GAD was a prospective, multicentric biobanking study to determine whether established serum markers (neurofilament light chain [NFL], glial fibrillary acidic protein (GFAP), tau-protein, ubiquitin-carboxyl-terminal-hydrolase, S100B and matrix-metalloproteinase 9 [MMP9]) are predictive of CE-positive MRI lesions. Blood samples were obtained from patients undergoing MRI 5 days before or after collection. RESULTS 102 patients from 4 different centers with confirmed MS or related disorders were included. N=57 (55.9%) showed CE on MRI vs. n=45 (44.1%) without CE. Only higher Nfl values indicated CE (OR 1.05; 95%-CI 1.0-1.09) and were correlated with number (ρ=0.47; p<0.001) and diameter of CE lesions (ρ=0.58; p<0.001). Nfl Z-scores improved diagnostic accuracy (OR 1.52; 95%-CI 1.06-2.18). Receiver operator characteristic analysis revealed a reasonable cut-off value for Nfl at 14.1 pg/ml (sensitivity 49.1%; specificity 82.2%; positive predictive value 77.8%; negative predictive value 56.0%). Nfl ≥ 59.2pg/ml was exclusively observed in patients with CE. CONCLUSIONS Evaluation of several possible serum biomarkers for CE in MS patients provided the most robust results for NFL, particularly as Z-scores. Following further evaluation, biomarkers may help stratifying the application of contrast agents for brain imaging in MS patients.
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Affiliation(s)
- Jan Hendrik Schaefer
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Martin A Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Katharina Wenger
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Christoph Mayer
- Neurologische Gemeinschaftspraxis am Kaiserplatz, Frankfurt am Main, Germany
| | - Ulrike Mann
- Kopfschmerzzentrum Frankfurt, Frankfurt am Main, Germany
| | - Alexander Bickert
- Department of Neurology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Falk Steffen
- Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Department of Neurology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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24
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Zipp F, Bittner S, Schafer DP. Cytokines as emerging regulators of central nervous system synapses. Immunity 2023; 56:914-925. [PMID: 37163992 DOI: 10.1016/j.immuni.2023.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
Cytokines are key messengers by which immune cells communicate, and they drive many physiological processes, including immune and inflammatory responses. Early discoveries demonstrated that cytokines, such as the interleukin family members and TNF-α, regulate synaptic scaling and plasticity. Still, we continue to learn more about how these traditional immune system cytokines affect neuronal structure and function. Different cytokines shape synaptic function on multiple levels ranging from fine-tuning neurotransmission, to regulating synapse number, to impacting global neuronal networks and complex behavior. These recent findings have cultivated an exciting and growing field centered on the importance of immune system cytokines for regulating synapse and neural network structure and function. Here, we highlight the latest findings related to cytokines in the central nervous system and their regulation of synapse structure and function. Moreover, we explore how these mechanisms are becoming increasingly important to consider in diseases-especially those with a large neuroinflammatory component.
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Affiliation(s)
- Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Dorothy P Schafer
- Department of Neurobiology, Brudnick Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA 01605, USA.
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25
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Schroeter CB, Nelke C, Schewe M, Spohler L, Herrmann AM, Müntefering T, Huntemann N, Kuzikov M, Gribbon P, Albrecht S, Bock S, Hundehege P, Neelsen LC, Baukrowitz T, Seebohm G, Wünsch B, Bittner S, Ruck T, Budde T, Meuth SG. Validation of TREK1 ion channel activators as an immunomodulatory and neuroprotective strategy in neuroinflammation. Biol Chem 2023; 404:355-375. [PMID: 36774650 DOI: 10.1515/hsz-2022-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/16/2023] [Indexed: 02/13/2023]
Abstract
Modulation of two-pore domain potassium (K2P) channels has emerged as a novel field of therapeutic strategies as they may regulate immune cell activation and metabolism, inflammatory signals, or barrier integrity. One of these ion channels is the TWIK-related potassium channel 1 (TREK1). In the current study, we report the identification and validation of new TREK1 activators. Firstly, we used a modified potassium ion channel assay to perform high-throughput-screening of new TREK1 activators. Dose-response studies helped to identify compounds with a high separation between effectiveness and toxicity. Inside-out patch-clamp measurements of Xenopus laevis oocytes expressing TREK1 were used for further validation of these activators regarding specificity and activity. These approaches yielded three substances, E1, B3 and A2 that robustly activate TREK1. Functionally, we demonstrated that these compounds reduce levels of adhesion molecules on primary human brain and muscle endothelial cells without affecting cell viability. Finally, we studied compound A2 via voltage-clamp recordings as this activator displayed the strongest effect on adhesion molecules. Interestingly, A2 lacked TREK1 activation in the tested neuronal cell type. Taken together, this study provides data on novel TREK1 activators that might be employed to pharmacologically modulate TREK1 activity.
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Affiliation(s)
- Christina B Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Marcus Schewe
- Institute of Physiology, Christian-Albrechts University Kiel, Hermann-Rodewald-Straße 5, 24118 Kiel, Germany
| | - Lucas Spohler
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Alexander M Herrmann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Thomas Müntefering
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Maria Kuzikov
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Schnackenburgallee 114, D-22525 Hamburg, Germany
- Fraunhofer Cluster of Excellence for Immune mediated diseases (CIMD), Theodor-Stern-Kai 7, D-60596 Frankfurt, Germany
| | - Philip Gribbon
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Schnackenburgallee 114, D-22525 Hamburg, Germany
- Fraunhofer Cluster of Excellence for Immune mediated diseases (CIMD), Theodor-Stern-Kai 7, D-60596 Frankfurt, Germany
| | - Sarah Albrecht
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Stefanie Bock
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Petra Hundehege
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Lea Christine Neelsen
- Institute of Physiology, Christian-Albrechts University Kiel, Hermann-Rodewald-Straße 5, 24118 Kiel, Germany
| | - Thomas Baukrowitz
- Institute of Physiology, Christian-Albrechts University Kiel, Hermann-Rodewald-Straße 5, 24118 Kiel, Germany
| | - Guiscard Seebohm
- IfGH-Cellular Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Bernhard Wünsch
- Institute for Pharmaceutical and Medicinal Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstraße 48, D-48149 Münster, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Thomas Budde
- Institute of Physiology I, University of Münster, Robert-Koch-Straße 27A, D-48149 Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
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Yalachkov Y, Anschütz V, Maiworm M, Jakob J, Schaller-Paule MA, Schäfer JH, Reiländer A, Friedauer L, Behrens M, Steffen F, Bittner S, Foerch C. Serum and cerebrospinal fluid BDNF concentrations are associated with neurological and cognitive improvement in multiple sclerosis: A pilot study. Mult Scler Relat Disord 2023; 71:104567. [PMID: 36805176 DOI: 10.1016/j.msard.2023.104567] [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: 01/05/2023] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Biomarkers of disease activity have been intensively studied in multiple sclerosis (MS) but knowledge on predictors of disability improvement is limited. The aim of this pilot study was to explore whether increased brain-derived neurotrophic factor concentrations in serum and CSF (sBDNF/cBDNF) precede neurological and cognitive improvement in MS. METHODS In this pilot, monocentric prospective cohort study we collected serum/CSF samples at baseline together with EDSS (n = 36) and cognitive testing (n = 34) in patients with relapsing-remitting/primary progressive MS or clinically isolated syndrome. BDNF was assessed in serum and CSF with a single molecule array (SIMOA) HD-1 analyser (Quanterix). Twelve months later EDSS and cognitive testing were repeated. BDNF concentrations of patients with vs. without disability or cognitive improvement (disability improvement: decrease in EDSS ≥ 0.5; cognitive improvement: average z-score increase in neuropsychological performance ≥ 0.5) were compared using univariate ANOVAs adjusting for covariates. RESULTS Compared to subjects without, patients with disability improvement had higher sBDNF at baseline (q = 0.04). Subjects with cognitive improvement had higher cBDNF at baseline than those without cognitive improvement (q = 0.004). Secondary analysis demonstrated significant correlations between sBDNF and EDSS change (q = 0.036), cBDNF and average z-score change (q = 0.04) and cBDNF and number of cognitive tests with improvement (q = 0.04), while controlling for covariates. CONCLUSIONS Our findings suggest a possible role for BDNF in neurological and cognitive improvement in MS. These findings have to be confirmed in a larger sample but they already highlight the potential of BDNF as a biomarker for disability improvement and neuroplasticity in MS.
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Affiliation(s)
- Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Victoria Anschütz
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michelle Maiworm
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jasmin Jakob
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Neurology, University Medical Center Mainz, Mainz, Germany
| | - Martin A Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Annemarie Reiländer
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lucie Friedauer
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Falk Steffen
- Department of Neurology, University Medical Center Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center Mainz, Mainz, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
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Kim K, Bittner S, Jin Y, Zeng Y, Wang Q, Cao H. Spatiotemporal lasing dynamics in a Limaçon-shaped microcavity. Opt Lett 2023; 48:574-577. [PMID: 36723534 DOI: 10.1364/ol.479901] [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] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
Limaçon-shaped microdisk lasers are promising on-chip light sources with low lasing threshold and unidirectional output. We conduct an experimental study on the lasing dynamics of Limaçon-shaped semiconductor microcavities. The edge emission exhibits intensity fluctuations over a wide range of spatial and temporal scales. They result from multiple dynamic processes with different origins and occur on different spatiotemporal scales. The dominant process is an alternate oscillation between two output beams with a period as short as a few nanoseconds.
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Gairing SJ, Danneberg S, Kaps L, Nagel M, Schleicher EM, Quack C, Engel S, Bittner S, Galle PR, Schattenberg JM, Wörns MA, Luessi F, Marquardt JU, Labenz C. Elevated serum levels of glial fibrillary acidic protein are associated with covert hepatic encephalopathy in patients with cirrhosis. JHEP Rep 2023; 5:100671. [PMID: 36866390 PMCID: PMC9972561 DOI: 10.1016/j.jhepr.2023.100671] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Background & Aims Blood biomarkers facilitating the diagnosis of covert hepatic encephalopathy (CHE) in patients with cirrhosis are lacking. Astrocyte swelling is a major component of hepatic encephalopathy. Thus, we hypothesised that glial fibrillary acidic protein (GFAP), the major intermediate filament of astrocytes, might facilitate early diagnosis and management. This study aimed to investigate the utility of serum GFAP (sGFAP) levels as a biomarker of CHE. Methods In this bicentric study, 135 patients with cirrhosis, 21 patients with ongoing harmful alcohol use and cirrhosis, and 15 healthy controls were recruited. CHE was diagnosed using psychometric hepatic encephalopathy score. sGFAP levels were measured using a highly sensitive single-molecule array (SiMoA) immunoassay. Results In total, 50 (37%) people presented with CHE at study inclusion. Participants with CHE displayed significantly higher sGFAP levels than those without CHE (median sGFAP, 163 pg/ml [IQR 136; 268] vs. 106 pg/ml [IQR 75; 153]; p <0.001) or healthy controls (p <0.001). sGFAP correlated with results in psychometric hepatic encephalopathy score (Spearman's ρ = -0.326, p <0.001), model for end-stage liver disease score (Spearman's ρ = 0.253, p = 0.003), ammonia (Spearman's ρ = 0.453, p = 0.002), and IL-6 serum levels (Spearman's ρ = 0.323, p = 0.006). Additionally, sGFAP levels were independently associated with the presence of CHE in multivariable logistic regression analysis (odds ratio 1.009; 95% CI 1.004-1.015; p <0.001). sGFAP levels did not differ between patients with alcohol-related cirrhosis vs. patients with non-alcohol-related cirrhosis or between patients with ongoing alcohol use vs. patients with discontinued alcohol use.Conclusions: sGFAP levels are associated with CHE in patients with cirrhosis. These results suggest that astrocyte injury may already occur in patients with cirrhosis and subclinical cognitive deficits and that sGFAP could be explored as a novel biomarker. Impact and implications Blood biomarkers facilitating the diagnosis of covert hepatic encephalopathy (CHE) in patients with cirrhosis are lacking. In this study, we were able to demonstrate that sGFAP levels are associated with CHE in patients with cirrhosis. These results suggest that astrocyte injury may already occur in patients with cirrhosis and subclinical cognitive deficits and that sGFAP could be explored as a novel biomarker.
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Key Words
- Biomarkers
- CHE
- CHE, covert hepatic encephalopathy
- Cognitive deficit
- Complications of cirrhosis
- GFAP
- GFAP, glial fibrillary acidic protein
- HE
- HE, hepatic encephalopathy
- HE2, grade 2 hepatic encephalopathy
- MELD, model for end-stage liver disease
- MHE, minimal hepatic encephalopathy
- OHE, overt hepatic encephalopathy
- OR, odds ratio
- PHES, psychometric hepatic encephalopathy score
- Psychometric hepatic encephalopathy score
- ROC, receiver operating characteristic
- SiMoA, single-molecule array
- WBC, white blood cell
- sGFAP, serum glial fibrillary acidic protein
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Affiliation(s)
- Simon Johannes Gairing
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sven Danneberg
- Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Leonard Kaps
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Nagel
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
| | - Eva Maria Schleicher
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Charlotte Quack
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sinah Engel
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter Robert Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jörn Markus Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
| | - Felix Luessi
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Uwe Marquardt
- Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Corresponding author. Address: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany. Tel.: +49-6131-17-2380; Fax: +49-6131-17-477282..
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Engel S, Halcour J, Ellwardt E, Uphaus T, Steffen F, Zipp F, Bittner S, Luessi F. Elevated neurofilament light chain CSF/serum ratio indicates impaired CSF outflow in idiopathic intracranial hypertension. Fluids Barriers CNS 2023; 20:3. [PMID: 36631830 PMCID: PMC9832777 DOI: 10.1186/s12987-022-00403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Impaired cerebrospinal fluid (CSF) homeostasis is central to the pathogenesis of idiopathic intracranial hypertension (IIH), although the precise mechanisms involved are still not completely understood. The aim of the current study was to assess the CSF/serum ratio of neurofilament light chain levels (QNfL) as a potential indicator of functional CSF outflow obstruction in IIH patients. METHODS NfL levels were measured by single molecule array in CSF and serum samples of 87 IIH patients and in three control groups, consisting of 52 multiple sclerosis (MS) patients with an acute relapse, 21 patients with an axonal polyneuropathy (PNP), and 41 neurologically healthy controls (HC). QNfL was calculated as the ratio of CSF and serum NfL levels. Similarly, we also assessed the CSF/serum ratio of glial fibrillary acidic protein (QGFAP) levels to validate the QNfL data. Routine CSF parameters including the CSF/serum albumin ratio (QAlb) were determined in all groups. Lumbar puncture opening pressure of IIH patients was measured by manometry. RESULTS CSF-NfL levels (r = 0.29, p = 0.008) and QNfL (0.40, p = 0.0009), but not serum NfL (S-NfL) levels, were associated with lumbar puncture opening pressure in IIH patients. CSF-NfL levels were increased in IIH patients, MS patients, and PNP patients, whereas sNfL levels were normal in IIH, but elevated in MS and PNP. Remarkably, QNfL (p < 0.0001) as well as QGFAP (p < 0.01) were only increased in IIH patients. QNfL was positively correlated with CSF-NfL levels (r = 0.51, p = 0.0012) and negatively correlated with S-NfL levels (r = - 0.51, p = 0.0012) in HC, while it was only positively associated with CSF-NfL levels in IIH patients (r = 0.71, p < 0.0001). An increase in blood-CSF barrier permeability assessed by QAlb did not lead to a decrease in QNfL in any cohort. CONCLUSIONS The observed elevation of QNfL in IIH patients, which was associated with lumbar puncture opening pressure, indicates a reduced NfL transition from the CSF to serum compartment. This supports the hypothesis of a pressure-dependent CSF outflow obstruction to be critically involved in IIH pathogenesis.
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Affiliation(s)
- Sinah Engel
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Johannes Halcour
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Erik Ellwardt
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Timo Uphaus
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Falk Steffen
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Frauke Zipp
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Stefan Bittner
- grid.410607.4Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Yalachkov Y, Schäfer JH, Jakob J, Friedauer L, Steffen F, Bittner S, Foerch C, Schaller-Paule MA. Effect of Estimated Blood Volume and Body Mass Index on GFAP and NfL Levels in the Serum and CSF of Patients With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200045. [PMID: 36316116 PMCID: PMC9673750 DOI: 10.1212/nxi.0000000000200045] [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: 04/14/2022] [Accepted: 08/30/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVES To increase the validity of biomarker measures in multiple sclerosis (MS), factors affecting their concentration need to be identified. Here, we test whether the volume of distribution approximated by the patients' estimated blood volume (BV) and body mass index (BMI) affect the serum concentrations of glial fibrillary acidic protein (GFAP). As a control, we also determine the relationship between BV/BMI and GFAP concentrations in CSF. To confirm earlier findings, we test the same hypotheses for neurofilament light chain (NfL). METHODS NfL and GFAP concentrations were measured in serum and CSF (sNFL/sGFAP and cNFL/cGFAP) in 157 patients (n = 106 with MS phenotype and n = 51 with other neurologic/somatoform diseases). Using multivariate linear regressions, BV was tested in the MS cohort as a predictor for each of the biomarkers while controlling for age, sex, MS phenotype, Expanded Disability Status Scale score, gadolinium-enhancing lesions, and acute relapse. In addition, overweight/obese patients (BMI ≥25 kg/m2) were compared with patients with BMI <25 kg/m2 using the general linear model. The analyses were repeated including the neurologic/somatoform controls. RESULTS In the MS cohort, BV predicted sGFAP (ß = -0.301, p = 0.014). Overweight/obese patients with MS had lower sGFAP concentrations compared with patients with MS and BMI <25 kg/m2 (F = 4.732, p = 0.032). Repeating the analysis after adding patients with other neurologic/somatoform diseases did not change these findings (ß = -0.276, p = 0.009; F = 7.631, p = 0.006). Although sNfL was inversely correlated with BV (r = -0.275, p = 0.006) and body weight (r = -0.258, p = 0.010), those results did not remain significant after adjusting for covariates. BV and BMI were not associated with cGFAP or cNfL concentrations. DISCUSSION These findings support the notion that the volume of distribution of sGFAP approximated by BV and BMI is a relevant variable and should therefore be controlled for when measuring sGFAP in MS, while this might not be necessary when measuring cGFAP concentrations.
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Affiliation(s)
- Yavor Yalachkov
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany.
| | - Jan Hendrik Schäfer
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Jasmin Jakob
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Lucie Friedauer
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Falk Steffen
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Stefan Bittner
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Christian Foerch
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
| | - Martin Alexander Schaller-Paule
- From the Department of Neurology (Y.Y., J.H.S., L.F., C.F., M.A.S.-P.), University Hospital Frankfurt; and Department of Neurology (J.J., F.S., S.B.), Universitätsmedizin Mainz, Germany
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31
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Lutfullin I, Eveslage M, Bittner S, Antony G, Flaskamp M, Luessi F, Salmen A, Gisevius B, Klotz L, Korsukewitz C, Berthele A, Groppa S, Then Bergh F, Wildemann B, Bayas A, Tumani H, Meuth SG, Trebst C, Zettl UK, Paul F, Heesen C, Kuempfel T, Gold R, Hemmer B, Zipp F, Wiendl H, Lünemann JD. Association of obesity with disease outcome in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:57-61. [PMID: 36319190 PMCID: PMC9763191 DOI: 10.1136/jnnp-2022-329685] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obesity reportedly increases the risk for developing multiple sclerosis (MS), but little is known about its association with disability accumulation. METHODS This nationwide longitudinal cohort study included 1066 individuals with newly diagnosed MS from the German National MS cohort. Expanded Disability Status Scale (EDSS) scores, relapse rates, MRI findings and choice of immunotherapy were compared at baseline and at years 2, 4 and 6 between obese (body mass index, BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) patients and correlated with individual BMI values. RESULTS Presence of obesity at disease onset was associated with higher disability at baseline and at 2, 4 and 6 years of follow-up (p<0.001). Median time to reach EDSS 3 was 0.99 years for patients with BMI ≥30 kg/m2 and 1.46 years for non-obese patients. Risk to reach EDSS 3 over 6 years was significantly increased in patients with BMI ≥30 kg/m2 compared with patients with BMI <30 kg/m2 after adjustment for sex, age, smoking (HR 1.87; 95% CI 1.3 to 2.6; log-rank test p<0.001) and independent of disease-modifying therapies. Obesity was not significantly associated with higher relapse rates, increased number of contrast-enhancing MRI lesions or higher MRI T2 lesion burden over 6 years of follow-up. CONCLUSIONS Obesity in newly diagnosed patients with MS is associated with higher disease severity and poorer outcome. Obesity management could improve clinical outcome of MS.
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Affiliation(s)
- Isabel Lutfullin
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, JGU, Mainz, Germany
| | - Gisela Antony
- Competence Network Parkinson's Disease, Central Information Office, Philipps-University Marburg, Marburg, Germany
| | - Martina Flaskamp
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, München, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, JGU, Mainz, Germany
| | - Anke Salmen
- Department of Neurology, St Josef-Hospital, Ruhr-Universitat Bochum, Bochum, Germany.,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Barbara Gisevius
- Department of Neurology, St Josef-Hospital, Ruhr-Universitat Bochum, Bochum, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina Korsukewitz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, München, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, JGU, Mainz, Germany
| | - Florian Then Bergh
- Clinic and Polyclinic for Neurology, University Hospital Leipzig, University Leipzig, UL, Leipzig, Germany
| | - Brigitte Wildemann
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Antonios Bayas
- Department of Neurology, Faculty of Medicine, University of Augsburg, 86156, Augsburg, Germany
| | | | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Uwe K Zettl
- Division of Neuroimmunology, Department of Neurology, University Medicine Rostock Center of Neurology, Rostock, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, CHA, Berlin, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Tania Kuempfel
- Institute for Clinical Neuroimmunology, University Hospital und Centre for Biomedicine, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Ralf Gold
- Department of Neurology, St Josef-Hospital, Ruhr-Universitat Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, München, Germany.,Department of Neurology, Technische Universitat Munchen and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, JGU, Mainz, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster and University of Münster, Faculty of Medicine, Munster, Germany
| | - Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster and University of Münster, Faculty of Medicine, Munster, Germany
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Pape K, Rolfes L, Steffen F, Muthuraman M, Korsen M, Meuth SG, Zipp F, Bittner S. Comparative effectiveness of natalizumab versus ocrelizumab in multiple sclerosis: a real-world propensity score-matched study. Ther Adv Neurol Disord 2022; 15:17562864221142924. [PMID: 36568489 PMCID: PMC9772974 DOI: 10.1177/17562864221142924] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background For treatment of relapsing-remitting multiple sclerosis (RRMS), a broad range of disease-modifying therapies (DMT) is available. However, few comparative effectiveness studies between different drugs have been performed. Objectives This study aimed to compare the efficacy and treatment continuation of natalizumab and ocrelizumab in a real-world cohort of patients with relapsing-remitting multiple sclerosis (RRMS) from two German university hospitals. Methods We performed a retrospective analysis of RRMS patients who initiated treatment with natalizumab or ocrelizumab between January 2016 and April 2019 at the German university hospitals of Mainz and Düsseldorf. Bayesian propensity score matching was conducted to correct for differences in baseline characteristics. Our primary outcome was no evidence of disease activity [NEDA-3: no relapses, no confirmed disability progression, and no magnetic resonance imaging (MRI) activity] and its subcomponents. Secondary outcomes included measurement of neurofilament light chain (NfL) in serum, analysis of premature discontinuation, and evidence of rebound activity in patients switching from natalizumab to ocrelizumab. Results We identified 63 patients starting treatment with natalizumab and 76 patients starting with ocrelizumab. Binary logistic regression showed that treatment with natalizumab or a higher number of relapses in the previous year were independently associated with a higher risk for relapses. Patients receiving natalizumab had a higher probability of premature discontinuation of therapy (p = 0.002). After propensity score matching of the two treatment arms, 55 patients remained per group. NEDA-3 after 30 months of follow-up was reached by 53.1% in the ocrelizumab group and 36.1% in the natalizumab group (p = 0.177). Ocrelizumab was superior to natalizumab concerning the occurrence of relapses in log-rank test (p = 0.019). NfL levels in serum were low under both treatments. Patients who switched from natalizumab to ocrelizumab showed no increased rebound activity. Discussion This study provides class IV evidence that treatment of RRMS patients with ocrelizumab and natalizumab show comparable effectiveness in combined endpoints, while ocrelizumab might be more effective in preventing the occurrence of relapses.
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Affiliation(s)
- Katrin Pape
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leoni Rolfes
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Korsen
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Steffen F, Uphaus T, Ripfel N, Fleischer V, Schraad M, Gonzalez-Escamilla G, Engel S, Groppa S, Zipp F, Bittner S. Serum Neurofilament Identifies Patients With Multiple Sclerosis With Severe Focal Axonal Damage in a 6-Year Longitudinal Cohort. Neurol Neuroimmunol Neuroinflamm 2022; 10:10/1/e200055. [PMID: 36411080 PMCID: PMC9679887 DOI: 10.1212/nxi.0000000000200055] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunomodulatory therapies reduce the relapse rate but only marginally control disability progression in patients with MS. Although serum neurofilament light chain (sNfL) levels correlate best with acute signs of inflammation (e.g., relapses and gadolinium-enhancing [Gd+] lesions), their role in predicting progressive biology and irreversible axonal damage is less clear. We aimed to determine the ability of sNfL to dissect distinct measures of disease severity and predict future (no) evidence of disease activity (EDA/no evidence of disease activity [NEDA]). METHODS One hundred fifty-three of 221 patients with relapsing-remitting MS initially enrolled in the Neurofilament and longterm outcome in MS cohort at the MS outpatient clinic of the University Medical Center Mainz (Germany) met the inclusion criteria for this prospective observational cohort study with a median follow-up of 6 years (interquartile range 4-7 years). Progressive disease forms were excluded. Inclusion criteria consisted of Expanded Disability Status Scale (EDSS) assessment within 3 months and MRI within 12 months around blood sampling at baseline (y0) and follow-up (y6). EDSS progression at y6 had to be confirmed 12 weeks later. sNfL was measured by single-molecule array, and the following additional variables were recorded: therapy, medical history, and detailed MRI parameters (T2 hyperintense lesions, Gd+ lesions, and new persistent T1 hypointense lesions). RESULTS Patients experiencing EDSS progression or new persistent T1 lesions at y6 showed increased sNfL levels at y0 compared with stable patients or patients with inflammatory activity only. As a potential readily accessible marker of neurodegeneration, we incorporated the absence of persistent T1 lesions to the NEDA-3 concept (NEDA-3T1: n = 54, 35.3%; EDAT1: n = 99, 64.7%) and then evaluated a risk score with factors that distinguish patients with and without NEDA-3T1 status. Adding sNfL to this risk score significantly improved NEDA-3T1 prediction (0.697 95% CI 0.616-0.770 vs 0.819 95% CI 0.747-0.878, p < 0.001). Patients with sNfL values ≤8.6 pg/mL showed a 76% risk reduction for EDAT1 at y6 (hazard ratio 0.244, 95% CI 0.142-0.419, p < 0.001). DISCUSSION sNfL levels associate with severe focal axonal damage as reflected by development of persistent T1 lesions. Baseline sNfL values predicted NEDA-3T1 status at 6-year follow-up.
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Affiliation(s)
- Falk Steffen
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nina Ripfel
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muriel Schraad
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sinah Engel
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- From the Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Pfeuffer S, Rolfes L, Wirth T, Steffen F, Pawlitzki M, Schulte-Mecklenbeck A, Gross CC, Brand M, Bittner S, Ruck T, Klotz L, Wiendl H, Meuth SG. Immunoadsorption versus double-dose methylprednisolone in refractory multiple sclerosis relapses. J Neuroinflammation 2022; 19:220. [PMID: 36071461 PMCID: PMC9450381 DOI: 10.1186/s12974-022-02583-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Intravenous methylprednisolone is the standard treatment for a multiple sclerosis relapse; however, this fails to improve symptoms in up to one quarter of patients. Immunoadsorption is an accepted treatment for refractory relapses, but prospective comparator-controlled studies are missing. Methods In this observational study, patients with steroid-refractory acute multiple sclerosis relapses receiving either six courses of tryptophan-immunoadsorption or double-dose methylprednisolone therapy were analysed. Outcomes were evaluated at discharge and three months later. Immune profiling of blood lymphocytes and proteomic analysis were performed by multi-parameter flow cytometry and Olink analysis, respectively (NCT04450030). Results 42 patients were enrolled (methylprednisolone: 26 patients; immunoadsorption: 16 patients). For determination of the primary outcome, treatment response was stratified according to relative function system score changes (“full/best” vs. “average” vs. “worse/none”). Upon discharge, the adjusted odds ratio for any treatment response (“full/best” + ”average” vs. “worse/none”) was 10.697 favouring immunoadsorption (p = 0.005 compared to methylprednisolone). At follow-up, the adjusted odds ratio for the best treatment response (“full/best” vs. “average” + ”worse/none”) was 103.236 favouring IA patients (p = 0.001 compared to methylprednisolone). Similar results were observed regarding evoked potentials and quality of life outcomes, as well as serum neurofilament light-chain levels. Flow cytometry revealed a profound reduction of B cell subsets following immunoadsorption, which was closely correlated to clinical outcomes, whereas methylprednisolone had a minimal effect on B cell populations. Immunoadsorption treatment skewed the blood cytokine network, reduced levels of B cell-related cytokines and reduced immunoglobulin levels as well as levels of certain coagulation factors. Interpretation Immunoadsorption demonstrated favourable outcomes compared to double-dose methylprednisolone. Outcome differences were significant at discharge and follow-up. Further analyses identified modulation of B cell function as a potential mechanism of action for immunoadsorption, as reduction of B cell subsets correlated with clinical improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02583-y.
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Affiliation(s)
- Steffen Pfeuffer
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Leoni Rolfes
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Timo Wirth
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Falk Steffen
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Marc Pawlitzki
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Catharina C Gross
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Marcus Brand
- Medical Department D - Nephrology, University Hospital Muenster, Muenster, Germany
| | - Stefan Bittner
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Luisa Klotz
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Sven G Meuth
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. .,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany.
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Brummer T, Muthuraman M, Steffen F, Uphaus T, Minch L, Person M, Zipp F, Groppa S, Bittner S, Fleischer V. Improved prediction of early cognitive impairment in multiple sclerosis combining blood and imaging biomarkers. Brain Commun 2022; 4:fcac153. [PMID: 35813883 PMCID: PMC9263885 DOI: 10.1093/braincomms/fcac153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 06/17/2022] [Indexed: 12/30/2022] Open
Abstract
Disability in multiple sclerosis is generally classified by sensory and motor symptoms, yet cognitive impairment has been identified as a frequent manifestation already in the early disease stages. Imaging- and more recently blood-based biomarkers have become increasingly important for understanding cognitive decline associated with multiple sclerosis. Thus, we sought to determine the prognostic utility of serum neurofilament light chain levels alone and in combination with MRI markers by examining their ability to predict cognitive impairment in early multiple sclerosis. A comprehensive and detailed assessment of 152 early multiple sclerosis patients (Expanded Disability Status Scale: 1.3 ± 1.2, mean age: 33.0 ± 10.0 years) was performed, which included serum neurofilament light chain measurement, MRI markers (i.e. T2-hyperintense lesion volume and grey matter volume) acquisition and completion of a set of cognitive tests (Symbol Digits Modalities Test, Paced Auditory Serial Addition Test, Verbal Learning and Memory Test) and mood questionnaires (Hospital Anxiety and Depression scale, Fatigue Scale for Motor and Cognitive Functions). Support vector regression, a branch of unsupervised machine learning, was applied to test serum neurofilament light chain and combination models of biomarkers for the prediction of neuropsychological test performance. The support vector regression results were validated in a replication cohort of 101 early multiple sclerosis patients (Expanded Disability Status Scale: 1.1 ± 1.2, mean age: 34.4 ± 10.6 years). Higher serum neurofilament light chain levels were associated with worse Symbol Digits Modalities Test scores after adjusting for age, sex Expanded Disability Status Scale, disease duration and disease-modifying therapy (B = −0.561; SE = 0.192; P = 0.004; 95% CI = −0.940 to −0.182). Besides this association, serum neurofilament light chain levels were not linked to any other cognitive or mood measures (all P-values > 0.05). The tripartite combination of serum neurofilament light chain levels, lesion volume and grey matter volume showed a cross-validated accuracy of 88.7% (90.8% in the replication cohort) in predicting Symbol Digits Modalities Test performance in the support vector regression approach, and outperformed each single biomarker (accuracy range: 68.6–75.6% and 68.9–77.8% in the replication cohort), as well as the dual biomarker combinations (accuracy range: 71.8–82.3% and 72.6–85.6% in the replication cohort). Taken together, early neuro-axonal loss reflects worse information processing speed, the key deficit underlying cognitive dysfunction in multiple sclerosis. Our findings demonstrate that combining blood and imaging measures improves the accuracy of predicting cognitive impairment, highlighting the clinical utility of cross-modal biomarkers in multiple sclerosis.
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Affiliation(s)
- Tobias Brummer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Lena Minch
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Maren Person
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz , Langenbeckstr, 1, Mainz 55131 , Germany
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Yalachkov Y, Anschütz V, Jakob J, Schaller-Paule MA, Schäfer JH, Reiländer A, Friedauer L, Behrens M, Steffen F, Bittner S, Foerch C. Brain-derived neurotrophic factor and neurofilament light chain in cerebrospinal fluid are inversely correlated with cognition in Multiple Sclerosis at the time of diagnosis. Mult Scler Relat Disord 2022; 63:103822. [DOI: 10.1016/j.msard.2022.103822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 12/21/2022]
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Brummer T, Zipp F, Bittner S. T cell-neuron interaction in inflammatory and progressive multiple sclerosis biology. Curr Opin Neurobiol 2022; 75:102588. [PMID: 35732103 DOI: 10.1016/j.conb.2022.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune condition of the central nervous system (CNS) characterized by acute inflammatory relapses, chronic neuro-axonal degeneration, and subsequent disability progression. T cells - in interaction with B cells and CNS-resident glial cells - are key initiators and drivers of neurodegeneration in MS. However, it is not entirely clear how encephalitogenic T cells orchestrate the local immune response within the brain and how they overtake disease stage-specific roles in MS pathogenesis. This review highlights recent advances in understanding direct and indirect T cell-neuron interactions in inflammatory and progressive MS. Finally, we discuss new diagnostic tools such as neurofilament light chain (NfL), which is on the cusp of becoming a key factor in clinical and therapeutic decision-making.
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Affiliation(s)
- Tobias Brummer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Piepgras J, Rohrbeck A, Just I, Bittner S, Ahnert-Hilger G, Höltje M. Enhancement of Phosphorylation and Transport Activity of the Neuronal Glutamate Transporter Excitatory Amino Acid Transporter 3 by C3bot and a 26mer C3bot Peptide. Front Cell Neurosci 2022; 16:860823. [PMID: 35783090 PMCID: PMC9240211 DOI: 10.3389/fncel.2022.860823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
In primary murine hippocampal neurons we investigated the regulation of EAAT3-mediated glutamate transport by the Clostridium botulinum C3 transferase C3bot and a 26mer peptide derived from full length protein. Incubation with either enzyme-competent C3bot or enzyme-deficient C3bot156–181 peptide resulted in the upregulation of glutamate uptake by up to 22% compared to untreated cells. A similar enhancement of glutamate transport was also achieved by the classical phorbol-ester-mediated activation of protein kinase C subtypes. Yet comparable, effects elicited by C3 preparations seemed not to rely on PKCα, γ, ε, or ζ activation. Blocking of tyrosine phosphorylation by tyrosine kinase inhibitors prevented the observed effect mediated by C3bot and C3bot 26mer. By using biochemical and molecular biological assays we could rule out that the observed C3bot and C3bot 26mer-mediated effects solely resulted from enhanced transporter expression or translocation to the neuronal surface but was rather mediated by transporter phosphorylation at tyrosine residues that was found to be significantly enhanced following incubation with either full length protein or the 26mer C3 peptide.
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Affiliation(s)
- Johannes Piepgras
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Astrid Rohrbeck
- Institute of Toxicology, Hannover Medical School, Hanover, Germany
| | - Ingo Just
- Institute of Toxicology, Hannover Medical School, Hanover, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gudrun Ahnert-Hilger
- Department of Neurobiology, Max Planck Institute for Biophysical Chemistry, University of Göttingen, Göttingen, Germany
| | - Markus Höltje
- Institut für Integrative Neuroanatomie, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Markus Höltje,
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Hanuscheck N, Thalman C, Domingues M, Schmaul S, Muthuraman M, Hetsch F, Ecker M, Endle H, Oshaghi M, Martino G, Kuhlmann T, Bozek K, van Beers T, Bittner S, von Engelhardt J, Vogt J, Vogelaar CF, Zipp F. Interleukin-4 receptor signaling modulates neuronal network activity. J Exp Med 2022; 219:213227. [PMID: 35587822 PMCID: PMC9123307 DOI: 10.1084/jem.20211887] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/13/2021] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Evidence is emerging that immune responses not only play a part in the central nervous system (CNS) in diseases but may also be relevant for healthy conditions. We discovered a major role for the interleukin-4 (IL-4)/IL-4 receptor alpha (IL-4Rα) signaling pathway in synaptic processes, as indicated by transcriptome analysis in IL-4Rα–deficient mice and human neurons with/without IL-4 treatment. Moreover, IL-4Rα is expressed presynaptically, and locally available IL-4 regulates synaptic transmission. We found reduced synaptic vesicle pools, altered postsynaptic currents, and a higher excitatory drive in cortical networks of IL-4Rα–deficient neurons. Acute effects of IL-4 treatment on postsynaptic currents in wild-type neurons were mediated via PKCγ signaling release and led to increased inhibitory activity supporting the findings in IL-4Rα–deficient neurons. In fact, the deficiency of IL-4Rα resulted in increased network activity in vivo, accompanied by altered exploration and anxiety-related learning behavior; general learning and memory was unchanged. In conclusion, neuronal IL-4Rα and its presynaptic prevalence appear relevant for maintaining homeostasis of CNS synaptic function.
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Affiliation(s)
- Nicholas Hanuscheck
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Carine Thalman
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Micaela Domingues
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Samantha Schmaul
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Florian Hetsch
- Institute for Pathophysiology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manuela Ecker
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heiko Endle
- Department of Molecular and Translational Neuroscience, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases and Center of Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mohammadsaleh Oshaghi
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita Salute San Raffaele University, Milan, Italy
| | - Tanja Kuhlmann
- Institute for Neuropathology, University Hospital Münster, Münster, Germany
| | - Katarzyna Bozek
- Center for Molecular Medicine, Faculty of Medicine and University Hospital Cologne; University of Cologne, Cologne, Germany
| | - Tim van Beers
- Molecular Cell Biology, Institute I of Anatomy, University of Cologne, Cologne, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jakob von Engelhardt
- Institute for Pathophysiology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Johannes Vogt
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Molecular and Translational Neuroscience, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases and Center of Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christina Francisca Vogelaar
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Ellwardt E, Muthuraman M, Gonzalez-Escamilla G, Chirumamilla VC, Luessi F, Bittner S, Zipp F, Groppa S, Fleischer V. Network alterations underlying anxiety symptoms in early multiple sclerosis. J Neuroinflammation 2022; 19:119. [PMID: 35610651 PMCID: PMC9131528 DOI: 10.1186/s12974-022-02476-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety, often seen as comorbidity in multiple sclerosis (MS), is a frequent neuropsychiatric symptom and essentially affects the overall disease burden. Here, we aimed to decipher anxiety-related networks functionally connected to atrophied areas in patients suffering from MS. METHODS Using 3-T MRI, anxiety-related atrophy maps were generated by correlating longitudinal cortical thinning with the severity of anxiety symptoms in MS patients. To determine brain regions functionally connected to these maps, we applied a technique termed "atrophy network mapping". Thereby, the anxiety-related atrophy maps were projected onto a large normative connectome (n = 1000) performing seed-based functional connectivity. Finally, an instructed threat paradigm was conducted with regard to neural excitability and effective connectivity, using transcranial magnetic stimulation combined with high-density electroencephalography. RESULTS Thinning of the left dorsal prefrontal cortex was the only region that was associated with higher anxiety levels. Atrophy network mapping identified functional involvement of bilateral prefrontal cortex as well as amygdala and hippocampus. Structural equation modeling confirmed that the volumes of these brain regions were significant determinants that influence anxiety symptoms in MS. We additionally identified reduced information flow between the prefrontal cortex and the amygdala at rest, and pathologically increased excitability in the prefrontal cortex in MS patients as compared to controls. CONCLUSION Anxiety-related prefrontal cortical atrophy in MS leads to a specific network alteration involving structures that resemble known neurobiological anxiety circuits. These findings elucidate the emergence of anxiety as part of the disease pathology and might ultimately enable targeted treatment approaches modulating brain networks in MS.
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Affiliation(s)
- Erik Ellwardt
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN) Neuroimaging Center, Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Venkata Chaitanya Chirumamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Ciolac D, Gonzalez-Escamilla G, Winter Y, Melzer N, Luessi F, Radetz A, Fleischer V, Groppa SA, Kirsch M, Bittner S, Zipp F, Muthuraman M, Meuth SG, Grothe M, Groppa S. Altered grey matter integrity and network vulnerability relate to epilepsy occurrence in patients with multiple sclerosis. Eur J Neurol 2022; 29:2309-2320. [PMID: 35582936 DOI: 10.1111/ene.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/13/2021] [Revised: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the relevance of compartmentalized grey matter (GM) pathology and network reorganization in MS patients with concomitant epilepsy. METHODS From 3T MRI scans of 30 MS patients with epilepsy (MSE; age 41±15 years, 21 females, disease duration 8±6 years, median Expanded Disability Status Scale (EDSS) 3), 60 MS patients without epilepsy (MS; age 41±12 years, 35 females, disease duration 6±4 years, EDSS 2), and 60 healthy subjects (HS; age 40±13 years, 27 females) regional volumes of GM lesions and of cortical, subcortical, and hippocampal structures were quantified. Network topology and vulnerability were modeled within the graph theoretical framework. The receiver operating characteristic (ROC) analysis was applied to assess the accuracy of GM pathology measures to discriminate between MSE and MS patients. RESULTS Higher lesion volumes within the hippocampus, mesiotemporal cortex, and amygdala were detected in MSE compared to MS (all p<0.05). MSE displayed lower cortical volumes mainly in temporal and parietal areas compared to MS and HS (all p<0.05). Lower volumes of hippocampal tail and presubiculum were identified in both MSE and MS patients compared to HS (all p<0.05). Network topology in MSE was characterized by higher transitivity and assortativity, and higher vulnerability compared to MS and HS (all p<0.05). Hippocampal lesion volume yielded the highest accuracy (area under the ROC curve 0.80 [0.67-0.91]) in discriminating between MSE and MS patients. CONCLUSIONS High lesion load, altered integrity of mesiotemporal GM structures, and network reorganization are associated with a greater propensity of epilepsy occurrence in MS.
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Affiliation(s)
- Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Neurology, Philipps-University, Marburg, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Angela Radetz
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Michael Kirsch
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine of Greifswald, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Masanneck L, Rolfes L, Regner-Nelke L, Willison A, Räuber S, Steffen F, Bittner S, Zipp F, Albrecht P, Ruck T, Hartung HP, Meuth SG, Pawlitzki M. Detecting ongoing disease activity in mildly affected multiple sclerosis patients under first-line therapies. Mult Scler Relat Disord 2022; 63:103927. [DOI: 10.1016/j.msard.2022.103927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 12/12/2022]
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Bitar L, Uphaus T, Thalman C, Muthuraman M, Gyr L, Ji H, Domingues M, Endle H, Groppa S, Steffen F, Koirala N, Fan W, Ibanez L, Heitsch L, Cruchaga C, Lee JM, Kloss F, Bittner S, Nitsch R, Zipp F, Vogt J. Inhibition of the enzyme autotaxin reduces cortical excitability and ameliorates the outcome in stroke. Sci Transl Med 2022; 14:eabk0135. [PMID: 35442704 DOI: 10.1126/scitranslmed.abk0135] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/16/2022]
Abstract
Stroke penumbra injury caused by excess glutamate is an important factor in determining stroke outcome; however, several therapeutic approaches aiming to rescue the penumbra have failed, likely due to unspecific targeting and persistent excitotoxicity, which continued far beyond the primary stroke event. Synaptic lipid signaling can modulate glutamatergic transmission via presynaptic lysophosphatidic acid (LPA) 2 receptors modulated by the LPA-synthesizing molecule autotaxin (ATX) present in astrocytic perisynaptic processes. Here, we detected long-lasting increases in brain ATX concentrations after experimental stroke. In humans, cerebrospinal fluid ATX concentration was increased up to 14 days after stroke. Using astrocyte-specific deletion and pharmacological inhibition of ATX at different time points after experimental stroke, we showed that inhibition of LPA-related cortical excitability improved stroke outcome. In transgenic mice and in individuals expressing a single-nucleotide polymorphism that increased LPA-related glutamatergic transmission, we found dysregulated synaptic LPA signaling and subsequent negative stroke outcome. Moreover, ATX inhibition in the animal model ameliorated stroke outcome, suggesting that this approach might have translational potential for improving the outcome after stroke.
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Affiliation(s)
- Lynn Bitar
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Carine Thalman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Luzia Gyr
- Transfer Group Anti-Infectives, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, 07745 Jena, Germany
| | - Haichao Ji
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Department of Molecular and Translational Neuroscience, Cologne Excellence Cluster for Stress Responses in Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
| | - Micaela Domingues
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Heiko Endle
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Department of Molecular and Translational Neuroscience, Cologne Excellence Cluster for Stress Responses in Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Nabin Koirala
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Wei Fan
- Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Laura Ibanez
- Department of Psychiatry, Department of Neurology, NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura Heitsch
- Department of Emergency Medicine, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Department of Neurology, NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jin-Moo Lee
- Department of Neurology, Radiology, and Biomedical Engineering, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Florian Kloss
- Transfer Group Anti-Infectives, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, 07745 Jena, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Robert Nitsch
- Institute of Translational Neuroscience, Westfälische Wilhelms-Universität Münster, 48149 Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Johannes Vogt
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Department of Molecular and Translational Neuroscience, Cologne Excellence Cluster for Stress Responses in Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
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Engel S, Molina Galindo LS, Bittner S, Zipp F, Luessi F. A Case of Progressive Multifocal Leukoencephalopathy in a Fumaric Acid-Treated Psoriasis Patient With Severe Lymphopenia Among Other Risk Factors. J Cent Nerv Syst Dis 2022; 13:11795735211037798. [PMID: 34992484 PMCID: PMC8725211 DOI: 10.1177/11795735211037798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a potentially fatal condition caused by a brain infection with JC polyomavirus (JCV), which occurs almost exclusively in immunocompromised patients. Modern immunosuppressive and immunomodulatory treatments for cancers and autoimmune diseases have been accompanied by increasing numbers of PML cases. We report a psoriasis patient treated with fumaric acid esters (FAEs) with concomitant hypopharyngeal carcinoma and chronic alcohol abuse who developed PML. Grade 4 lymphopenia at the time point of PML diagnosis suggested an immunocompromised state. This case underscores the importance of immune cell monitoring in patients treated with FAEs, even more so in the presence of additional risk factors for an immune dysfunction.
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Affiliation(s)
- Sinah Engel
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Lara S Molina Galindo
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Ruck T, Barman S, Schulte-Mecklenbeck A, Pfeuffer S, Steffen F, Nelke C, Schroeter CB, Willison A, Heming M, Müntefering T, Melzer N, Krämer J, Lindner M, Riepenhausen M, Gross CC, Klotz L, Bittner S, Muraro PA, Schneider-Hohendorf T, Schwab N, Meyer zu Hörste G, Goebels N, Meuth SG, Wiendl H. OUP accepted manuscript. Brain 2022; 145:1711-1725. [PMID: 35661859 PMCID: PMC9166548 DOI: 10.1093/brain/awac064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
Alemtuzumab is a monoclonal antibody that causes rapid depletion of CD52-expressing immune cells. It has proven to be highly efficacious in active relapsing–remitting multiple sclerosis; however, the high risk of secondary autoimmune disorders has greatly complicated its use. Thus, deeper insight into the pathophysiology of secondary autoimmunity and potential biomarkers is urgently needed. The most critical time points in the decision-making process for alemtuzumab therapy are before or at Month 12, where the ability to identify secondary autoimmunity risk would be instrumental. Therefore, we investigated components of blood and CSF of up to 106 multiple sclerosis patients before and after alemtuzumab treatment focusing on those critical time points. Consistent with previous reports, deep flow cytometric immune-cell profiling (n = 30) demonstrated major effects on adaptive rather than innate immunity, which favoured regulatory immune cell subsets within the repopulation. The longitudinally studied CSF compartment (n = 18) mainly mirrored the immunological effects observed in the periphery. Alemtuzumab-induced changes including increased numbers of naïve CD4+ T cells and B cells as well as a clonal renewal of CD4+ T- and B-cell repertoires were partly reminiscent of haematopoietic stem cell transplantation; in contrast, thymopoiesis was reduced and clonal renewal of T-cell repertoires after alemtuzumab was incomplete. Stratification for secondary autoimmunity did not show clear immununological cellular or proteomic traits or signatures associated with secondary autoimmunity. However, a restricted T-cell repertoire with hyperexpanded T-cell clones at baseline, which persisted and demonstrated further expansion at Month 12 by homeostatic proliferation, identified patients developing secondary autoimmune disorders (n = 7 without secondary autoimmunity versus n = 5 with secondary autoimmunity). Those processes were followed by an expansion of memory B-cell clones irrespective of persistence, which we detected shortly after the diagnosis of secondary autoimmune disease. In conclusion, our data demonstrate that (i) peripheral immunological alterations following alemtuzumab are mirrored by longitudinal changes in the CSF; (ii) incomplete T-cell repertoire renewal and reduced thymopoiesis contribute to a proautoimmune state after alemtuzumab; (iii) proteomics and surface immunological phenotyping do not identify patients at risk for secondary autoimmune disorders; (iv) homeostatic proliferation with disparate dynamics of clonal T- and B-cell expansions are associated with secondary autoimmunity; and (v) hyperexpanded T-cell clones at baseline and Month 12 may be used as a biomarker for the risk of alemtuzumab-induced autoimmunity.
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Affiliation(s)
- Tobias Ruck
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Correspondence to: PD Dr. med. Tobias Ruck Department of Neurology with Institute of Translational Neurology University Hospital Muenster Albert-Schweitzer-Campus 1 D-48149 Muenster, Germany E-mail:
| | - Sumanta Barman
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Steffen Pfeuffer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Christopher Nelke
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Christina B. Schroeter
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Alice Willison
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Michael Heming
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Thomas Müntefering
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Julia Krämer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Maren Lindner
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Marianne Riepenhausen
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Catharina C. Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Paolo A. Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Tilman Schneider-Hohendorf
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
| | - Norbert Goebels
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, 48149 Muenster, Germany
- Correspondence may also be addressed to: Univ.-Prof. Prof. h.c. Dr. med. Heinz Wiendl E-mail:
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Benakis C, Simats A, Tritschler S, Heindl S, Besson-Girard S, Llovera G, Pinkham K, Kolz A, Ricci A, Theis FJ, Bittner S, Gökce Ö, Peters A, Liesz A. T cells modulate the microglial response to brain ischemia. eLife 2022; 11:82031. [PMID: 36512388 PMCID: PMC9747154 DOI: 10.7554/elife.82031] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 07/20/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Neuroinflammation after stroke is characterized by the activation of resident microglia and the invasion of circulating leukocytes into the brain. Although lymphocytes infiltrate the brain in small number, they have been consistently demonstrated to be the most potent leukocyte subpopulation contributing to secondary inflammatory brain injury. However, the exact mechanism of how this minimal number of lymphocytes can profoundly affect stroke outcome is still largely elusive. Here, using a mouse model for ischemic stroke, we demonstrated that early activation of microglia in response to stroke is differentially regulated by distinct T cell subpopulations - with TH1 cells inducing a type I INF signaling in microglia and regulatory T cells (TREG) cells promoting microglial genes associated with chemotaxis. Acute treatment with engineered T cells overexpressing IL-10 administered into the cisterna magna after stroke induces a switch of microglial gene expression to a profile associated with pro-regenerative functions. Whereas microglia polarization by T cell subsets did not affect the acute development of the infarct volume, these findings substantiate the role of T cells in stroke by polarizing the microglial phenotype. Targeting T cell-microglia interactions can have direct translational relevance for further development of immune-targeted therapies for stroke and other neuroinflammatory conditions.
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Affiliation(s)
- Corinne Benakis
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Alba Simats
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Sophie Tritschler
- Institute of Diabetes and Regeneration Research, Institute of Computational Biology, Helmholtz Zentrum MünchenNeuherbergGermany
| | - Steffanie Heindl
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Simon Besson-Girard
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Gemma Llovera
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Kelsey Pinkham
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Anna Kolz
- Institute of Clinical Neuroimmunology, University Hospital, LMU MunichMunichGermany
| | - Alessio Ricci
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany
| | - Fabian J Theis
- Institute of Diabetes and Regeneration Research, Institute of Computational Biology, Helmholtz Zentrum MünchenNeuherbergGermany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), RhineMain Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Özgün Gökce
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany,Munich Cluster for Systems Neurology (SyNergy)MunichGermany
| | - Anneli Peters
- Institute of Clinical Neuroimmunology, University Hospital, LMU MunichMunichGermany,Biomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, University Hospital, LMU MunichMunichGermany,Munich Cluster for Systems Neurology (SyNergy)MunichGermany
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Fleischer V, Ciolac D, Gonzalez-Escamilla G, Grothe M, Strauss S, Molina Galindo LS, Radetz A, Salmen A, Lukas C, Klotz L, Meuth SG, Bayas A, Paul F, Hartung HP, Heesen C, Stangel M, Wildemann B, Bergh FT, Tackenberg B, Kümpfel T, Zettl UK, Knop M, Tumani H, Wiendl H, Gold R, Bittner S, Zipp F, Groppa S, Muthuraman M. Subcortical volumes as early predictors of fatigue in multiple sclerosis. Ann Neurol 2021; 91:192-202. [PMID: 34967456 DOI: 10.1002/ana.26290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fatigue is a frequent and severe symptom in multiple sclerosis (MS), but its pathophysiological origin remains incompletely understood. We aimed to examine the predictive value of subcortical gray matter volumes for fatigue severity at disease onset and after four years by applying structural equation modeling (SEM). METHODS This multi-center cohort study included 601 treatment-naive MS patients after the first demyelinating event. All patients underwent a standardized 3T MRI protocol. A subgroup of 230 patients with available clinical follow-up data after four years was also analyzed. Associations of subcortical volumes (included into SEM) with MS-related fatigue were studied regarding their predictive value. In addition, subcortical regions that have a central role in the brain network (hubs) were determined through structural covariance network (SCN) analysis. RESULTS Predictive causal modeling identified volumes of the caudate (s [standardized path coefficient]=0.763, p=0.003 [left]; s=0.755, p=0.006 [right]), putamen (s=0.614, p=0.002 [left]; s=0.606, p=0.003 [right]) and pallidum (s=0.606, p=0.012 [left]; s=0.606, p=0.012 [right]) as prognostic factors for fatigue severity in the cross-sectional cohort. Moreover, the volume of the pons was additionally predictive for fatigue severity in the longitudinal cohort (s=0.605, p=0.013). In the SCN analysis, network hubs in patients with fatigue worsening were detected in the putamen (p=0.008 [left]; p=0.007 [right]) and pons (p=0.0001). INTERPRETATION We unveiled predictive associations of specific subcortical gray matter volumes with fatigue in an early and initially untreated MS cohort. The colocalization of these subcortical structures with network hubs suggests an early role of these brain regions in terms of fatigue evolution. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sebastian Strauss
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Lara S Molina Galindo
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Angela Radetz
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Carsten Lukas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany.,Department of Neurology, University of Duesseldorf, Duesseldorf, Germany
| | - Antonios Bayas
- Department of Neurology, University Hospital Augsburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hans-Peter Hartung
- Department of Neurology, University of Duesseldorf, Duesseldorf, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Björn Tackenberg
- Department of Neurology, Philipps-University Marburg, Germany.,F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Germany
| | | | | | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
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48
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Grothe C, Steffen F, Bittner S. Humoral immune response and lymphocyte levels after complete vaccination against COVID-19 in a cohort of multiple sclerosis patients treated with cladribine tablets. J Cent Nerv Syst Dis 2021; 13:11795735211060118. [PMID: 34880703 PMCID: PMC8647228 DOI: 10.1177/11795735211060118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with multiple sclerosis (MS) receiving immunomodulatory drugs were excluded from clinical trials on COVID-19 vaccines. Therefore, data regarding the efficacy of COVID-19 vaccines to induce humoral immunity in MS patients treated with B- and T-cell depleting agents is urgently warranted. Cladribine tablets are a high-efficacy disease-modifying treatment that exerts its therapeutic effect via sustained but transient lymphocyte depletion. AIM We report humoral responses in a German cohort of MS patients treated with cladribine tablets. METHODS This retrospective analysis included patients ≥18 years who were treated with cladribine tablets for relapsing MS in the first or second year and were fully vaccinated against COVID-19. Two weeks after the second vaccination at the earliest, blood samples were obtained for the assessment of anti-SARS-CoV-2 IgG antibodies, lymphocyte counts, B-cells, CD4+ T-cells, and CD8+ T-cells. Anti-SARS-CoV-2 IgG antibodies were quantified with the LIAISON® SARS-CoV-2 TrimericS IgG assay. Positivity was defined at a cutoff value of 33.8 BAU/mL. RESULTS In total, 38 patients (73.7% female, aged 23-66 years) were included in the analysis. Ten patients (26.3%) were treatment-naïve before initiating treatment with cladribine tablets. Most patients (84.2%) received mRNA vaccines. The time between the last dose of cladribine tablets and vaccination ranged between 2 and 96 weeks. Six patients (15.8%) were vaccinated within 4 weeks of their last cladribine dose. All patients achieved positive anti-SARS-CoV-2 IgG antibody levels. Humoral immune response was independent of age, time of vaccination in relation to the last cladribine dose, lymphocyte counts as well as B- and T-cell counts. CONCLUSIONS Treatment with cladribine tablets did not impair humoral response to COVID-19 vaccination. Time since last cladribine dose, age, prior therapy, lymphocyte count as well as B- and T-cell counts had no effect on seropositivity of anti-SARS-CoV-2 IgG antibodies.
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Affiliation(s)
| | - Falk Steffen
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany
| | - Stefan Bittner
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany
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49
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Liebmann M, Korn L, Janoschka C, Albrecht S, Lauks S, Herrmann AM, Schulte-Mecklenbeck A, Schwab N, Schneider-Hohendorf T, Eveslage M, Wildemann B, Luessi F, Schmidt S, Diebold M, Bittner S, Gross CC, Kovac S, Zipp F, Derfuss T, Kuhlmann T, König S, Meuth SG, Wiendl H, Klotz L. Dimethyl fumarate treatment restrains the antioxidative capacity of T cells to control autoimmunity. Brain 2021; 144:3126-3141. [PMID: 34849598 PMCID: PMC8634070 DOI: 10.1093/brain/awab307] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 03/08/2021] [Revised: 06/11/2021] [Accepted: 07/25/2021] [Indexed: 02/02/2023] Open
Abstract
Dimethyl fumarate, an approved treatment for relapsing-remitting multiple sclerosis, exerts pleiotropic effects on immune cells as well as CNS resident cells. Here, we show that dimethyl fumarate exerts a profound alteration of the metabolic profile of human CD4+ as well as CD8+ T cells and restricts their antioxidative capacities by decreasing intracellular levels of the reactive oxygen species scavenger glutathione. This causes an increase in mitochondrial reactive oxygen species levels accompanied by an enhanced mitochondrial stress response, ultimately leading to impaired mitochondrial function. Enhanced mitochondrial reactive oxygen species levels not only result in enhanced T-cell apoptosis in vitro as well as in dimethyl fumarate-treated patients, but are key for the well-known immunomodulatory effects of dimethyl fumarate both in vitro and in an animal model of multiple sclerosis, i.e. experimental autoimmune encephalomyelitis. Indeed, dimethyl fumarate immune-modulatory effects on T cells were completely abrogated by pharmacological interference of mitochondrial reactive oxygen species production. These data shed new light on dimethyl fumarate as bona fide immune-metabolic drug that targets the intracellular stress response in activated T cells, thereby restricting mitochondrial function and energetic capacity, providing novel insight into the role of oxidative stress in modulating cellular immune responses and T cell-mediated autoimmunity.
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Affiliation(s)
- Marie Liebmann
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Lisanne Korn
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Claudia Janoschka
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Stefanie Albrecht
- Institute of Neuropathology, University Hospital Münster, Münster 48149, Germany
| | - Sarah Lauks
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Alexander M Herrmann
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf 40225, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Tilman Schneider-Hohendorf
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster 48149, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg 69120, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | | | - Martin Diebold
- Laboratory of Clinical Neuroimmunology, Neurologic Clinic and Policlinic, Departments of Biomedicine and Clinical Research, University Hospital Basel, and University of Basel, Basel 4031, Switzerland
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Tobias Derfuss
- Laboratory of Clinical Neuroimmunology, Neurologic Clinic and Policlinic, Departments of Biomedicine and Clinical Research, University Hospital Basel, and University of Basel, Basel 4031, Switzerland
| | - Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Münster 48149, Germany
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Clinical Research Center, University of Münster, Münster 48149, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf 40225, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, Münster 48149, Germany
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50
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Schmaul S, Hanuscheck N, Bittner S. Astrocytic potassium and calcium channels as integrators of the inflammatory and ischemic CNS microenvironment. Biol Chem 2021; 402:1519-1530. [PMID: 34455729 DOI: 10.1515/hsz-2021-0256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022]
Abstract
Astrocytes are key regulators of their surroundings by receiving and integrating stimuli from their local microenvironment, thereby regulating glial and neuronal homeostasis. Cumulating evidence supports a plethora of heterogenic astrocyte subpopulations that differ morphologically and in their expression patterns of receptors, transporters and ion channels, as well as in their functional specialisation. Astrocytic heterogeneity is especially relevant under pathological conditions. In experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis (MS), morphologically distinct astrocytic subtypes were identified and could be linked to transcriptome changes during different disease stages and regions. To allow for continuous awareness of changing stimuli across age and diseases, astrocytes are equipped with a variety of receptors and ion channels allowing the precise perception of environmental cues. Recent studies implicate the diverse repertoire of astrocytic ion channels - including transient receptor potential channels, voltage-gated calcium channels, inwardly rectifying K+ channels, and two-pore domain potassium channels - in sensing the brain state in physiology, inflammation and ischemia. Here, we review current evidence regarding astrocytic potassium and calcium channels and their functional contribution in homeostasis, neuroinflammation and stroke.
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Affiliation(s)
- Samantha Schmaul
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Nicholas Hanuscheck
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
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