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van Langelaar J, Wierenga-Wolf AF, Samijn JPA, Luijks CJM, Siepman TA, van Doorn PA, Bell A, van Zelm MC, Smolders J, van Luijn MM. The association of Epstein-Barr virus infection with CXCR3 + B-cell development in multiple sclerosis: impact of immunotherapies. Eur J Immunol 2020; 51:626-633. [PMID: 33152118 PMCID: PMC7984177 DOI: 10.1002/eji.202048739] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/17/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
Epstein–Barr virus (EBV) infection of B cells is associated with increased multiple sclerosis (MS) susceptibility. Recently, we found that CXCR3‐expressing B cells preferentially infiltrate the CNS of MS patients. In chronic virus‐infected mice, these types of B cells are sustained and show increased antiviral responsiveness. How EBV persistence in B cells influences their development remains unclear. First, we analyzed ex vivo B‐cell subsets from MS patients who received autologous bone marrow transplantation (n = 9), which is often accompanied by EBV reactivation. The frequencies of nonclass‐switched and class‐switched memory B cells were reduced at 3–7 months, while only class‐switched B cells returned back to baseline at 24–36 months posttransplantation. At these time points, EBV DNA load positively correlated to the frequency of CXCR3+, and not CXCR4+ or CXCR5+, class‐switched B cells. Second, for CXCR3+ memory B cells trapped within the blood of MS patients treated with natalizumab (anti‐VLA‐4 antibody n = 15), latent EBV infection corresponded to enhanced in vitro formation of anti‐EBNA1 IgG‐secreting plasma cells under GC‐like conditions. These findings imply that EBV persistence in B cells potentiates brain‐homing and antibody‐producing CXCR3+ subsets in MS.
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Affiliation(s)
- Jamie van Langelaar
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johnny P A Samijn
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline J M Luijks
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Theodora A Siepman
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Andrew Bell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Menno C van Zelm
- Department of Immunology and Pathology, Monash University and Alfred Health, Melbourne, Australia
| | - Joost Smolders
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Neuroimmunology Research group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Marvin M van Luijn
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Koetzier SC, van Langelaar J, Blok KM, van den Bosch TPP, Wierenga-Wolf AF, Melief MJ, Pol K, Siepman TA, Verjans GMGM, Smolders J, Lubberts E, de Vries HE, van Luijn MM. Brain-homing CD4 + T cells display glucocorticoid-resistant features in MS. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e894. [PMID: 33037101 PMCID: PMC7577536 DOI: 10.1212/nxi.0000000000000894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
Objective To study whether glucocorticoid (GC) resistance delineates disease-relevant T helper (Th) subsets that home to the CNS of patients with early MS. Methods The expression of key determinants of GC sensitivity, multidrug resistance protein 1 (MDR1/ABCB1) and glucocorticoid receptor (GR/NR3C1), was investigated in proinflammatory Th subsets and compared between natalizumab-treated patients with MS and healthy individuals. Blood, CSF, and brain compartments from patients with MS were assessed for the recruitment of GC-resistant Th subsets using fluorescence-activated cell sorting (FACS), quantitative polymerase chain reaction (qPCR), immunohistochemistry, and immunofluorescence. Results An MS-associated Th subset termed Th17.1 showed a distinct GC-resistant phenotype as reflected by high MDR1 and low GR expression. This expression ratio was further elevated in Th17.1 cells that accumulated in the blood of patients with MS treated with natalizumab, a drug that prevents their entry into the CNS. Proinflammatory markers C-C chemokine receptor 6, IL-23R, IFN-γ, and GM-CSF were increased in MDR1-expressing Th17.1 cells. This subset predominated the CSF of patients with early MS, which was not seen in the paired blood or in the CSF from patients with other inflammatory and noninflammatory neurologic disorders. The potential of MDR1-expressing Th17.1 cells to infiltrate brain tissue was confirmed by their presence in MS white matter lesions. Conclusion This study reveals that GC resistance coincides with preferential CNS recruitment of pathogenic Th17.1 cells, which may hamper the long-term efficacy of GCs in early MS.
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Affiliation(s)
- Steven C Koetzier
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Jamie van Langelaar
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Katelijn M Blok
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Thierry P P van den Bosch
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Annet F Wierenga-Wolf
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marie-José Melief
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Kim Pol
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Theodora A Siepman
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Georges M G M Verjans
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Joost Smolders
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Erik Lubberts
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Helga E de Vries
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marvin M van Luijn
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands.
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van Langelaar J, Rijvers L, Janssen M, Wierenga-Wolf AF, Melief MJ, Siepman TA, de Vries HE, Unger PPA, van Ham SM, Hintzen RQ, van Luijn MM. Induction of brain-infiltrating T-bet-expressing B cells in multiple sclerosis. Ann Neurol 2019; 86:264-278. [PMID: 31136008 PMCID: PMC6771938 DOI: 10.1002/ana.25508] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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: 01/24/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 12/24/2022]
Abstract
Objective Results from anti‐CD20 therapies demonstrate that B‐ and T‐cell interaction is a major driver of multiple sclerosis (MS). The local presence of B‐cell follicle‐like structures and oligoclonal bands in MS patients indicates that certain B cells infiltrate the central nervous system (CNS) to mediate pathology. Which peripheral triggers underlie the development of CNS‐infiltrating B cells is not fully understood. Methods Ex vivo flow cytometry was used to assess chemokine receptor profiles of B cells in blood, cerebrospinal fluid, meningeal, and brain tissues of MS patients (n = 10). Similar analyses were performed for distinct memory subsets in the blood of untreated and natalizumab‐treated MS patients (n = 38). To assess T‐bet(CXCR3)+ B‐cell differentiation, we cultured B cells from MS patients (n = 21) and healthy individuals (n = 34) under T helper 1‐ and TLR9‐inducing conditions. Their CNS transmigration capacity was confirmed using brain endothelial monolayers. Results CXC chemokine receptor 3 (CXCR3)‐expressing B cells were enriched in different CNS compartments of MS patients. Treatment with the clinically effective drug natalizumab prevented the recruitment of CXCR3high IgG1+ subsets, corresponding to their increased ability to cross CNS barriers in vitro. Blocking of interferon‐γ (IFNγ) reduced the transmigration potential and antigen‐presenting function of these cells. IFNγ‐induced B cells from MS patients showed increased T‐bet expression and plasmablast development. Additional TLR9 triggering further upregulated T‐bet and CXCR3, and was essential for IgG1 switching. Interpretation This study demonstrates that T‐bethigh IgG1+ B cells are triggered by IFNγ and TLR9 signals, likely contributing to enhanced CXCR3‐mediated recruitment and local reactivity in the CNS of MS patients. ANN NEUROL 2019;86:264–278
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Affiliation(s)
- Jamie van Langelaar
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Liza Rijvers
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Malou Janssen
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Marie-José Melief
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Theodora A Siepman
- Department of Neurology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Helga E de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Peter-Paul A Unger
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Rogier Q Hintzen
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Marvin M van Luijn
- Department of Immunology, MS Center ErasMS, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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4
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van Langelaar J, van der Vuurst de Vries RM, Janssen M, Wierenga-Wolf AF, Spilt IM, Siepman TA, Dankers W, Verjans GMGM, de Vries HE, Lubberts E, Hintzen RQ, van Luijn MM. T helper 17.1 cells associate with multiple sclerosis disease activity: perspectives for early intervention. Brain 2018; 141:1334-1349. [DOI: 10.1093/brain/awy069] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jamie van Langelaar
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Roos M van der Vuurst de Vries
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Malou Janssen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Isis M Spilt
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Theodora A Siepman
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wendy Dankers
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Research Center for Emerging Infections and Zoonosis, University of Veterinary Medicine, Hannover, Germany
| | - Helga E de Vries
- Department of Molecular Cell Biology and Immunology; Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rogier Q Hintzen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marvin M van Luijn
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MS Center ErasMS at Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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