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Butzkueven H, Ponsonby AL, Stein MS, Lucas RM, Mason D, Broadley S, Kilpatrick T, Lechner-Scott J, Barnett M, Carroll W, Mitchell P, Hardy TA, Macdonell R, McCombe P, Lee A, Kalincik T, van der Walt A, Lynch C, Abernethy D, Willoughby E, Barkhof F, MacManus D, Clarke M, Andrew J, Morahan J, Zhu C, Dear K, Taylor BV. Vitamin D did not reduce multiple sclerosis disease activity after a clinically isolated syndrome. Brain 2024; 147:1206-1215. [PMID: 38085047 PMCID: PMC10994527 DOI: 10.1093/brain/awad409] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024] Open
Abstract
Low serum levels of 25-hydroxyvitamin D [25(OH)D] and low sunlight exposure are known risk factors for the development of multiple sclerosis. Add-on vitamin D supplementation trials in established multiple sclerosis have been inconclusive. The effects of vitamin D supplementation to prevent multiple sclerosis is unknown. We aimed to test the hypothesis that oral vitamin D3 supplementation in high-risk clinically isolated syndrome (abnormal MRI, at least three T2 brain and/or spinal cord lesions), delays time to conversion to definite multiple sclerosis, that the therapeutic effect is dose-dependent, and that all doses are safe and well tolerated. We conducted a double-blind trial in Australia and New Zealand. Eligible participants were randomized 1:1:1:1 to placebo, 1000, 5000 or 10 000 international units (IU) of oral vitamin D3 daily within each study centre (n = 23) and followed for up to 48 weeks. Between 2013 and 2021, we enrolled 204 participants. Brain MRI scans were performed at baseline, 24 and 48 weeks. The main study outcome was conversion to clinically definite multiple sclerosis based on the 2010 McDonald criteria defined as either a clinical relapse or new brain MRI T2 lesion development. We included 199 cases in the intention-to-treat analysis based on assigned dose. Of these, 116 converted to multiple sclerosis by 48 weeks (58%). Compared to placebo, the hazard ratios (95% confidence interval) for conversion were 1000 IU 0.87 (0.50, 1.50); 5000 IU 1.37 (0.82, 2.29); and 10 000 IU 1.28 (0.76, 2.14). In an adjusted model including age, sex, latitude, study centre and baseline symptom number, clinically isolated syndrome onset site, presence of infratentorial lesions and use of steroids, the hazard ratios (versus placebo) were 1000 IU 0.80 (0.45, 1.44); 5000 IU 1.36 (0.78, 2.38); and 10 000 IU 1.07 (0.62, 1.85). Vitamin D3 supplementation was safe and well tolerated. We did not demonstrate reduction in multiple sclerosis disease activity by vitamin D3 supplementation after a high-risk clinically isolated syndrome.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Mark S Stein
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 0200, Australia
| | - Deborah Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand
| | - Simon Broadley
- Department of Neurology, School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Michael Barnett
- Brain and Mind Research Institute University of Sydney, Sydney, NSW 2050, Australia
| | - William Carroll
- Department of Neurology, Sir Charles Gairdner Hospital and Centre for Neuromuscular and Neurological Disorders and Perron Institute, University of Western Australia, WA 6009, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, Sydney, NSW 2139, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Melbourne, VIC 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010Australia
| | - Pamela McCombe
- University of Queensland, Centre for Clinical Research, Brisbane, QLD 4029, Australia
| | - Andrew Lee
- Department of Neurology, Flinders University College of Medicine and Public Health, Adelaide, SA 5042, Australia
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Chris Lynch
- Midland Neurology, Hamilton, Waikato 3240, New Zealand
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington 6021, New Zealand
| | - Ernest Willoughby
- Department of Neurology, Auckland Hospital, Auckland 1023, New Zealand
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HV, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, WC1N 3BG, UK
| | - David MacManus
- University College London Queen Square Institute of Neurology, Queen Square MS Centre, London WC1N 3BG, UK
| | - Michael Clarke
- Metabolomics Australia (WA), School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Julie Andrew
- Neurosciences Trials Australia, North Melbourne, VIC 3051, Australia
| | - Julia Morahan
- Multiple Sclerosis Australia, North Sydney, NSW 2059, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Keith Dear
- Department of Statistics, School of Public Health, University of Adelaide, SA 5005, Australia
| | - Bruce V Taylor
- MS Research Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
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Foong YC, Merlo D, Gresle M, Zhu C, Buzzard K, Lechner-Scott J, Barnett M, Taylor B, Kalincik T, Kilpatrick T, Darby D, Dobay P, van Beek J, Hyde R, Butzkueven H, van der Walt A. The Patient-Determined Disease Steps scale is not interchangeable with the Expanded Disease Status Scale in mild to moderate multiple sclerosis. Eur J Neurol 2024; 31:e16046. [PMID: 37584176 DOI: 10.1111/ene.16046] [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: 05/08/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND PURPOSE The validity, reliability, and longitudinal performance of the Patient-Determined Disease Steps (PDDS) scale is unknown in people with multiple sclerosis (MS) with mild to moderate disability. We aimed to examine the psychometric properties and longitudinal performance of the PDDS. METHODS We included relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score of less than 4. Validity and test-retest reliability was examined. Longitudinal data were analysed with mixed-effect modelling and Cohen's kappa for concordance in confirmed disability progression (CDP). RESULTS We recruited a total of 1093 participants, of whom 904 had complete baseline data. The baseline correlation between PDDS and EDSS was weak (ρ = 0.45, p < 0.001). PDDS had stronger correlations with patient-reported outcomes (PROs). Conversely, EDSS had stronger correlations with age, disease duration, Kurtzke's functional systems and processing speed test. PDDS test-retest reliability was good to excellent (concordance correlation coefficient = 0.73-0.89). Longitudinally, PDDS was associated with EDSS, age and depression. A higher EDSS score was associated with greater PDSS progression. The magnitude of these associations was small. There was no concordance in CDP as assessed by PDDS and EDSS. CONCLUSION The PDDS has greater correlation with other PROs but less correlation with other MS-related outcome measures compared to the EDSS. There was little correlation between PDDS and EDSS longitudinally. Our findings suggest that the PDDS scale is not interchangeable with the EDSS.
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Affiliation(s)
- Yi Chao Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Katherine Buzzard
- Eastern Health, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| | - Jeannette Lechner-Scott
- The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter New England Health, Newcastle, New South Wales, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, New South Wales, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tomas Kalincik
- Department of Medicine, CORe, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Darby
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | | | | | | | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Xavier A, Maltby VE, Ewing E, Campagna MP, Burnard SM, Tegner JN, Slee M, Butzkueven H, Kockum I, Kular L, Jokubaitis VG, Kilpatrick T, Alfredsson L, Jagodic M, Ponsonby AL, Taylor BV, Scott RJ, Lea RA, Lechner-Scott J. DNA Methylation Signatures of Multiple Sclerosis Occur Independently of Known Genetic Risk and Are Primarily Attributed to B Cells and Monocytes. Int J Mol Sci 2023; 24:12576. [PMID: 37628757 PMCID: PMC10454485 DOI: 10.3390/ijms241612576] [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: 05/22/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Epigenetic mechanisms can regulate how DNA is expressed independently of sequence and are known to be associated with various diseases. Among those epigenetic mechanisms, DNA methylation (DNAm) is influenced by genotype and the environment, making it an important molecular interface for studying disease etiology and progression. In this study, we examined the whole blood DNA methylation profiles of a large group of people with (pw) multiple sclerosis (MS) compared to those of controls. We reveal that methylation differences in pwMS occur independently of known genetic risk loci and show that they more strongly differentiate disease (AUC = 0.85, 95% CI 0.82-0.89, p = 1.22 × 10-29) than known genetic risk loci (AUC = 0.72, 95% CI: 0.66-0.76, p = 9.07 × 10-17). We also show that methylation differences in MS occur predominantly in B cells and monocytes and indicate the involvement of cell-specific biological pathways. Overall, this study comprehensively characterizes the immune cell-specific epigenetic architecture of MS.
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Affiliation(s)
- Alexandre Xavier
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
| | - Vicki E. Maltby
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Ewoud Ewing
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Maria Pia Campagna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
| | - Sean M. Burnard
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
| | - Jesper N. Tegner
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia;
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Unit of Computational Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, L8:05, 17176 Stockholm, Sweden
- Science for Life Laboratory, Tomtebodavagen 23A, 17165 Solna, Sweden
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
- MSBase Foundation, Melbourne, VIC 3004, Australia
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Lara Kular
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | | | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC 3052, Australia; (T.K.); (A.-L.P.)
| | - Lars Alfredsson
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Maja Jagodic
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC 3052, Australia; (T.K.); (A.-L.P.)
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 2601, Australia
| | - Bruce V. Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Rodney J. Scott
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
- Department of Molecular Genetics, Pathology North, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Rodney A. Lea
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Centre for Genomics and Personalised Health, School of Biomedical Science, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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4
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Xavier A, Campagna MP, Maltby VE, Kilpatrick T, Taylor BV, Butzkueven H, Ponsonby AL, Scott RJ, Jokubaitis VG, Lea RA, Lechner-Scott J. Interferon beta treatment is a potent and targeted epigenetic modifier in multiple sclerosis. Front Immunol 2023; 14:1162796. [PMID: 37325639 PMCID: PMC10266220 DOI: 10.3389/fimmu.2023.1162796] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Multiple Sclerosis (MS) has a complex pathophysiology that involves genetic and environmental factors. DNA methylation (DNAm) is one epigenetic mechanism that can reversibly modulate gene expression. Cell specific DNAm changes have been associated with MS, and some MS therapies such as dimethyl fumarate can influence DNAm. Interferon Beta (IFNβ), was one of the first disease modifying therapies in multiple sclerosis (MS). However, how IFNβ reduces disease burden in MS is not fully understood and little is known about the precise effect of IFNβ treatment on methylation. Methods The objective of this study was to determine the changes in DNAm associated with INFβ use, using methylation arrays and statistical deconvolutions on two separate datasets (total ntreated = 64, nuntreated = 285). Results We show that IFNβ treatment in people with MS modifies the methylation profile of interferon response genes in a strong, targeted, and reproducible manner. Using these identified methylation differences, we constructed a methylation treatment score (MTS) that is an accurate discriminator between untreated and treated patients (Area under the curve = 0.83). This MTS is time-sensitive and in consistent with previously identified IFNβ treatment therapeutic lag. This suggests that methylation changes are required for treatment efficacy. Overrepresentation analysis found that IFNβ treatment recruits the endogenous anti-viral molecular machinery. Finally, statistical deconvolution revealed that dendritic cells and regulatory CD4+ T cells were most affected by IFNβ induced methylation changes. Discussion In conclusion, our study shows that IFNβ treatment is a potent and targeted epigenetic modifier in multiple sclerosis.
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Affiliation(s)
- Alexandre Xavier
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Maria Pia Campagna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Vicki E. Maltby
- Hunter Medical Research Institute, Immune Health research program, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bruce V. Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Neuro-Immunology Registry, MSBase Foundation, Melbourne, VIC, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rodney J. Scott
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- New South Wales (NSW) Health Pathology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rodney A. Lea
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Centre of Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, Immune Health research program, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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5
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Campagna MP, Xavier A, Stankovich J, Maltby VE, Slee M, Yeh WZ, Kilpatrick T, Scott RJ, Butzkueven H, Lechner-Scott J, Lea RA, Jokubaitis VG. Parity is associated with long-term differences in DNA methylation at genes related to neural plasticity in multiple sclerosis. Clin Epigenetics 2023; 15:20. [PMID: 36765422 PMCID: PMC9921068 DOI: 10.1186/s13148-023-01438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Pregnancy in women with multiple sclerosis (wwMS) is associated with a reduction of long-term disability progression. The mechanism that drives this effect is unknown, but converging evidence suggests a role for epigenetic mechanisms altering immune and/or central nervous system function. In this study, we aimed to identify whole blood and immune cell-specific DNA methylation patterns associated with parity in relapse-onset MS. RESULTS We investigated the association between whole blood and immune cell-type-specific genome-wide methylation patterns and parity in 192 women with relapse-onset MS, matched for age and disease severity. The median time from last pregnancy to blood collection was 16.7 years (range = 1.5-44.4 years). We identified 2965 differentially methylated positions in whole blood, 68.5% of which were hypermethylated in parous women; together with two differentially methylated regions on Chromosomes 17 and 19 which mapped to TMC8 and ZNF577, respectively. Our findings validated 22 DMPs and 366 differentially methylated genes from existing literature on epigenetic changes associated with parity in wwMS. Differentially methylated genes in whole blood were enriched in neuronal structure and growth-related pathways. Immune cell-type-specific analysis using cell-type proportion estimates from statistical deconvolution of whole blood revealed further differential methylation in T cells specifically (four in CD4+ and eight in CD8+ T cells). We further identified reduced methylation age acceleration in parous women, demonstrating slower biological aging compared to nulligravida women. CONCLUSION Differential methylation at genes related to neural plasticity offers a potential molecular mechanism driving the long-term effect of pregnancy on MS outcomes. Our results point to a potential 'CNS signature' of methylation in peripheral immune cells, as previously described in relation to MS progression, induced by parity. As the first epigenome-wide association study of parity in wwMS reported, validation studies are needed to confirm our findings.
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Affiliation(s)
- Maria Pia Campagna
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.
| | - Alexandre Xavier
- grid.266842.c0000 0000 8831 109XSchool of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia ,grid.266842.c0000 0000 8831 109XHunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia
| | - Jim Stankovich
- grid.1002.30000 0004 1936 7857Department of Neuroscience, Monash University, Melbourne, VIC Australia
| | - Vicki E. Maltby
- grid.266842.c0000 0000 8831 109XHunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia ,grid.414724.00000 0004 0577 6676Neurology Department, John Hunter Hospital, Hunter New England, Newcastle, NSW Australia
| | - Mark Slee
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Wei Z. Yeh
- grid.1002.30000 0004 1936 7857Department of Neuroscience, Monash University, Melbourne, VIC Australia ,grid.267362.40000 0004 0432 5259Neurology Department, Alfred Health, Melbourne, VIC Australia
| | - Trevor Kilpatrick
- grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia ,grid.416153.40000 0004 0624 1200Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Rodney J. Scott
- grid.266842.c0000 0000 8831 109XSchool of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia ,grid.266842.c0000 0000 8831 109XHunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia
| | - Helmut Butzkueven
- grid.1002.30000 0004 1936 7857Department of Neuroscience, Monash University, Melbourne, VIC Australia ,grid.267362.40000 0004 0432 5259Neurology Department, Alfred Health, Melbourne, VIC Australia
| | - Jeannette Lechner-Scott
- grid.266842.c0000 0000 8831 109XHunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia ,grid.414724.00000 0004 0577 6676Neurology Department, John Hunter Hospital, Hunter New England, Newcastle, NSW Australia
| | - Rodney A. Lea
- grid.266842.c0000 0000 8831 109XHunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia ,grid.1024.70000000089150953Queensland University of Technology, Brisbane, QLD Australia
| | - Vilija G. Jokubaitis
- grid.1002.30000 0004 1936 7857Department of Neuroscience, Monash University, Melbourne, VIC Australia ,grid.267362.40000 0004 0432 5259Neurology Department, Alfred Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia ,grid.416153.40000 0004 0624 1200Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC Australia
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6
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Huq AJ, Thompson B, Bennett MF, Bournazos A, Bommireddipalli S, Gorelik A, Schultz J, Sexton A, Purvis R, West K, Cotter M, Valente G, Hughes A, Riaz M, Walsh M, Farrand S, Loi SM, Kilpatrick T, Brodtmann A, Darby D, Eratne D, Walterfang M, Delatycki MB, Storey E, Fahey M, Cooper S, Lacaze P, Masters CL, Velakoulis D, Bahlo M, James PA, Winship I. Clinical impact of whole-genome sequencing in patients with early-onset dementia. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328146. [PMID: 35906014 DOI: 10.1136/jnnp-2021-328146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the clinical setting, identification of the genetic cause in patients with early-onset dementia (EOD) is challenging due to multiple types of genetic tests required to arrive at a diagnosis. Whole-genome sequencing (WGS) has the potential to serve as a single diagnostic platform, due to its superior ability to detect common, rare and structural genetic variation. METHODS WGS analysis was performed in 50 patients with EOD. Point mutations, small insertions/deletions, as well as structural variants (SVs) and short tandem repeats (STRs), were analysed. An Alzheimer's disease (AD)-related polygenic risk score (PRS) was calculated in patients with AD. RESULTS Clinical genetic diagnosis was achieved in 7 of 50 (14%) of the patients, with a further 8 patients (16%) found to have established risk factors which may have contributed to their EOD. Two pathogenic variants were identified through SV analysis. No expanded STRs were found in this study cohort, but a blinded analysis with a positive control identified a C9orf72 expansion accurately. Approximately 37% (7 of 19) of patients with AD had a PRS equivalent to >90th percentile risk. DISCUSSION WGS acts as a single genetic test to identify different types of clinically relevant genetic variations in patients with EOD. WGS, if used as a first-line clinical diagnostic test, has the potential to increase the diagnostic yield and reduce time to diagnosis for EOD.
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Affiliation(s)
- Aamira J Huq
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Department of Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Bryony Thompson
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark F Bennett
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Adam Bournazos
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Shobhana Bommireddipalli
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Gorelik
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Joshua Schultz
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Adrienne Sexton
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Rebecca Purvis
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Kirsty West
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Megan Cotter
- Department of Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
| | - Giulia Valente
- Department of Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew Hughes
- Department of Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
| | - Moeen Riaz
- Public Health and Preventative Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Maie Walsh
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Samantha M Loi
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Trevor Kilpatrick
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Amy Brodtmann
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Florey Neurosciences Institutes, University of Melbourne, Carlton South, Victoria, Australia
| | - David Darby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Mental Health Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Elsdon Storey
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Neuroscience, Alfred Health, Melbourne, Victoria, Australia
| | - Michael Fahey
- Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Sandra Cooper
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Lacaze
- Public Health and Preventative Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Colin L Masters
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Paul A James
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Ingrid Winship
- Department of Genomic Medicine, Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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7
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Chapman C, Lucas RM, Ponsonby AL, Taylor B, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick T, Lucas R, McMichael T, Pender M, Ponsonby AL, Taylor B, Valery PC, van der Mei I, Williams D. Predictors of progression from a first demyelinating event to clinically definite multiple sclerosis. Brain Commun 2022; 4:fcac181. [PMID: 35891671 PMCID: PMC9308470 DOI: 10.1093/braincomms/fcac181] [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: 01/10/2022] [Revised: 04/07/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding the predictors of progression from a first to a second demyelinating event (and formerly, a diagnosis of clinically definite multiple sclerosis) is important clinically. Previous studies have focused on predictors within a single domain, e.g. radiological, lacking prospective data across multiple domains. We tested a comprehensive set of personal, environmental, neurological, MRI and genetic characteristics, considered together, as predictors of progression from a first demyelinating event to clinically definite multiple sclerosis. Participants were aged 18–59 years and had a first demyelinating event during the study recruitment period (1 November 2003–31 December 2006) for the Ausimmune Study (n = 216) and had follow-up data to 2–3 years post-initial interview. Detailed baseline data were available on a broad range of demographic and environmental factors, MRI, and genetic and viral studies. Follow-up data included confirmation of clinically definite multiple sclerosis (or not) and changes in environmental exposures during the follow-up period. We used multivariable logistic regression and Cox proportional hazards regression modelling to test predictors of, and time to, conversion to clinically definite multiple sclerosis. On review, one participant had an undiagnosed event prior to study recruitment and was excluded (n = 215). Data on progression to clinically definite multiple sclerosis were available for 91.2% (n = 196); 77% were diagnosed as clinically definite multiple sclerosis at follow-up. Mean (standard deviation) duration of follow-up was 2.7 (0.7) years. The set of predictors retained in the best predictive model for progression from a first demyelinating event to clinically definite multiple sclerosis were as follows: younger age at first demyelinating event [adjusted odds ratio (aOR) = 0.92, 95% confidence interval (CI) = 0.87–0.97, per additional year of age); being a smoker at baseline (versus not) (aOR = 2.55, 95% CI 0.85–7.69); lower sun exposure at age 6–18 years (aOR = 0.86, 95% CI 0.74–1.00, per 100 kJ/m2 increment in ultraviolet radiation dose), presence (versus absence) of infratentorial lesions on baseline magnetic resonance imaging (aOR = 7.41, 95% CI 2.08–26.41); and single nucleotide polymorphisms in human leukocyte antigen (HLA)-B (rs2523393, aOR = 0.25, 95% CI 0.09–0.68, for any G versus A:A), TNFRSF1A (rs1800693, aOR = 5.82, 95% CI 2.10–16.12, for any C versus T:T), and a vitamin D-binding protein gene (rs7041, aOR = 3.76, 95% CI 1.41–9.99, for any A versus C:C). The final model explained 36% of the variance. Predictors of more rapid progression to clinically definite multiple sclerosis (Cox proportional hazards regression) were similar. Genetic and magnetic resonance imaging characteristics as well as demographic and environmental factors predicted progression, and more rapid progression, from a first demyelinating event to a second event and clinically definite multiple sclerosis.
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Affiliation(s)
- Caron Chapman
- Barwon Health , PO Box 281, Geelong, VIC 3220 , Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University , Cnr Mills and Eggleston Roads, Canberra 2601 , Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health , 30 Royal Pde, Parkville, VIC 3052 , Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania , 17 Liverpool St, Hobart , Australia
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8
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Panisset MG, Kilpatrick T, Cofré Lizama LE, Galea MP. Implementing education: Personal communication with a healthcare professional is a critical step to address vaccine hesitancy for people with multiple sclerosis. Mult Scler Relat Disord 2022; 63:103933. [PMID: 35671672 PMCID: PMC9158244 DOI: 10.1016/j.msard.2022.103933] [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: 02/01/2022] [Revised: 03/30/2022] [Accepted: 05/28/2022] [Indexed: 11/04/2022]
Abstract
Background People with Multiple Sclerosis (PwMS) were first able to access COVID-19 vaccines in Australia from March 2021, when vaccine hesitancy in the general population was high (14–43%). High uptake of vaccination is important globally and critical to protect this vulnerable population. We conducted an on-line survey to examine factors influencing COVID-19 vaccination willingness among PwMS in Australia. Methods 149 PwMS living in Australia completed the on-line survey (April-September 2021) examining demographic, environmental and clinical factors with respect to vaccine willingness, including attitudes towards COVID-19 illness and vaccines. Additional items explored the influence of different information sources on vaccination decisions. Continuous and ordinal data were compared using the Mann-Whitney U test. All tests were two-tailed, with alpha set at 0.5. Results A majority of the respondents were female (87.2%) with relapsing-remitting MS (77.5%) treated by a neurologist (94.0%). A majority were on high efficacy disease-modifying therapies (DMTs) (64.9%), while 19.9% were on no DMTs. About one third of respondents (32.9%) had had two doses, 20.8% had received their first dose, and 22.1% were unvaccinated, while 24.2% of responses were missing. When asked about vaccine intentions, 60.6% of the unvaccinated indicated they were likely to extremely likely to get vaccinated, while 15.2% were very unlikely or extremely unlikely to do so and 24.2% were undecided. Unvaccinated people were significantly more concerned about vaccine side effects (mean 5.3 versus 3.1/10; p < .001). Only 53.3% of people on DMTs were vaccinated, compared to 75% of those who were not. People on ocrelizumab therapy (n = 35) had a lower vaccination rate (39%) than those on other medications (n = 86, 59%). Vaccine willingness in the unvaccinated was most highly correlated with knowledge regarding the vaccine (rs2=.709), agreement with the statement that COVID-19 vaccination is “too new for me to be confident about getting vaccinated” (rs2= -.709), anticipation of regret due to side effects of vaccination (rs2= -.642), and lack of knowledge regarding interactions between COVID-19 vaccines and DMTs (rs2= -.570). Almost two thirds had read MS-specific information about COVID-19 vaccinations and found it easy to understand (67.6%) and applicable to their situation (53.6%). However, less than half (47.8%) reported the information helped them make a personal vaccination decision. Over two-thirds (64.9%) had discussed vaccinations with their healthcare professional and 31.1% had not. Those who had not, were significantly more uninformed about the interactions of the vaccine with MS medications (mean 3.9 versus 2.9/10; p = .044) and significantly lower intention of vaccine uptake than those who had (mean 5.8 versus 7.9/10; p = .009). Conclusion Our study highlights that vaccination efforts should be delivered by healthcare professionals, focus on educating those who are managed with DMTs, and include individual recommendations related to specific DMTs, how the vaccines work, expectations regarding potential side-effects, potential exacerbation of MS symptoms, likelihood of recovery from any exacerbation, and the relative risks of side effects versus COVID-19 infection. Specific recommendations are provided.
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Affiliation(s)
- M G Panisset
- Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia.
| | - T Kilpatrick
- Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia; MS Unit, Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, VIC 3050, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Level 5, 30 Royal Parade, Parkville, VIC 3010, Australia
| | - L E Cofré Lizama
- Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - M P Galea
- Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia; Department of Rehabilitation, Royal Melbourne Hospital, Royal Park Campus, 34-45 Poplar Rd, Parkville, VIC 3052, Australia; Australia Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Royal Park Campus, 34-45 Poplar Rd, Parkville, VIC 3052, Australia
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9
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Li V, Roos I, Monif M, Malpas C, Roberts S, Marriott M, Buzzard K, Nguyen AL, Seery N, Taylor L, Kalincik T, Kilpatrick T. Impact of telehealth on health care in a multiple sclerosis outpatient clinic during the COVID-19 pandemic. Mult Scler Relat Disord 2022; 63:103913. [PMID: 35661564 PMCID: PMC9137249 DOI: 10.1016/j.msard.2022.103913] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Vivien Li
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
| | - Izanne Roos
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mastura Monif
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia
| | - Charles Malpas
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stefanie Roberts
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mark Marriott
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia
| | - Katherine Buzzard
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Ai-Lan Nguyen
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Nabil Seery
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Lisa Taylor
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia
| | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Trevor Kilpatrick
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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10
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Vaux A, Robinson K, Saglam B, Cheuk N, Kilpatrick T, Evans A, Monif M. Autoimmune Encephalitis in Long-Standing Schizophrenia: A Case Report. Front Neurol 2022; 12:810926. [PMID: 35222231 PMCID: PMC8873086 DOI: 10.3389/fneur.2021.810926] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/27/2021] [Indexed: 01/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate (NMDA) receptor antibody (anti-NMDAR Ab)-mediated encephalitis is an autoimmune disorder involving the production of antibodies against NMDARs in the central nervous system that leads to neurological or psychiatric dysfunction. Initially described as a paraneoplastic syndrome in young women with teratomas, increased testing has found it to be a heterogeneous condition that affects both the sexes with varying clinical manifestations, severity, and aetiology. This case report describes a 67-year-old man with a 40-year history of relapsing, severe, treatment-refractory schizophrenia. Due to the worsening of his condition during a prolonged inpatient admission for presumed relapse of psychosis, a revisit of the original diagnosis was considered with extensive investigations performed including an autoimmune panel. This revealed anti-NMDAR Abs in both the serum and cerebrospinal fluid on two occasions. Following treatment with intravenous immunoglobulin and methylprednisolone, he demonstrated rapid symptom improvement. This is a rare case of a long-standing psychiatric presentation with a preexisting diagnosis of schizophrenia subsequently found to have anti-NMDAR Ab-mediated encephalitis. Whether the case is one of initial NMDAR encephalitis vs. overlap syndrome is unknown. Most importantly, this case highlights the need for vigilance and balanced consideration for treatment in cases of long-standing psychiatric presentation where the case remains treatment refractory to antipsychotics or when atypical features including seizures and autonomic dysfunction or focal neurology are observed.
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Affiliation(s)
- Amy Vaux
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- *Correspondence: Amy Vaux
| | - Karen Robinson
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Burcu Saglam
- Department of Psychiatry, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nathan Cheuk
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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11
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Merlo D, Kalincik T, Zhu C, Gresle M, Lechner-Scott J, Kilpatrick T, Barnett M, Taylor B, Buzzard K, Darby D, Butzkueven H, van der Walt A. Subjective versus objective performance in people with multiple sclerosis using the MSReactor computerised cognitive tests. Mult Scler Relat Disord 2022; 58:103393. [PMID: 35216774 DOI: 10.1016/j.msard.2021.103393] [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: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Perceived cognitive impairment in MS is associated with adverse changes in employment capacity, sexual function, and aspects of daily living. Studies have shown relationships between perceived cognitive impairment and objective neuropsychological functioning and mood. Subjective cognitive performance in people with MS has not previously been compared to their objective performance on a computerised cognitive battery. METHODS All participants completed at least 6-monthly serial testing on the MSReactor computerised cognitive testing platform consisting of 3 reaction time tasks. These measure psychomotor processing speed (simple reaction time), attention (choice reaction time) and working memory (One back task). In addition, we collected subjective cognitive performance and patient reported outcomes of depression, anxiety and quality of life. The strength and direction of the relationships between subjective and objective performance on the cognitive tasks were examined using Kendalls rank coefficient at year 1 and year 2. We calculated partial correlation estimates where subjective performance was also associated with patient reported outcomes. RESULTS Subjective overall performance correlated weakly with the working memory task (Tau -0.10; (95% confidence interval (CI) -0.19, -0.01). Subjective performance also correlated weakly with depression but not anxiety or quality of life. Subjective reaction speed correlated weakly with psychomotor processing speed (Tau -0.10; CI -0.19, -0.01); and subjective accuracy correlated weakly with the attention (Tau 0.12; CI 0.03, 0.21) and working memory (Tau 0.15; CI 0.05, 0.24) tasks, respectively. CONCLUSION Participants' perceived performance on the MSReactor tests correlated only weakly with objective changes. Depression was associated with subjective cognitive performance reports. These results suggest that a person with MS' perception of their cognitive performance is only weakly associated with cognitive changes detected using MSReactor.
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Affiliation(s)
- Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
| | - Tomas Kalincik
- CORe, Department of Medicine at RMH, University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Bruce Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia
| | | | - David Darby
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
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12
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Merlo D, Stankovich J, Bai C, Kalincik T, Zhu C, Gresle M, Lechner-Scott J, Kilpatrick T, Barnett M, Taylor B, Darby D, Butzkueven H, Van der Walt A. Association Between Cognitive Trajectories and Disability Progression in Patients With Relapsing-Remitting Multiple Sclerosis. Neurology 2021; 97:e2020-e2031. [PMID: 34556562 DOI: 10.1212/wnl.0000000000012850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Longitudinal cognitive trajectories in multiple sclerosis are heterogeneous and difficult to measure. We aimed to identify discrete longitudinal reaction time trajectories in relapsing-remitting multiple sclerosis using a computerized cognitive battery and to assess the association between trajectories of reaction time and disability progression. METHODS All participants serially completed computerized reaction time tasks measuring psychomotor speed, visual attention, and working memory. Participants completed at least 3 testing sessions over a minimum of 180 days. Longitudinal reaction times were modeled with latent class mixed models to identify groups of individuals sharing similar latent characteristics. Optimal models were validated for consistency and baseline associations with class membership tested using multinomial logistic regression. Interclass differences in the probability of reaction time worsening and the probability of 6-month confirmed disability progression were assessed with survival analysis. RESULTS A total of 460 people with relapsing-remitting multiple sclerosis were included in the analysis. For each task of the MSReactor battery, the optimal model comprised 3 latent classes. All MSReactor tasks could identify a group with high probability of reaction time slowing. The visual attention and working memory tasks could identify a group of participants who were 3.7 and 2.6 times more likely to experience a 6-month confirmed disability progression, respectively. Participants could be classified into predicted cognitive trajectories after just 5 tests with 64% to 89% accuracy. DISCUSSION Latent class modeling of longitudinal cognitive data collected by a computerized battery identified patients with worsening reaction times and increased risk of disability progression. Slower baseline reaction time, age, and disability increased assignment into this trajectory. Monitoring of cognition in clinical practice with computerized tests may enable detection of cognitive change trajectories and people with relapsing-remitting multiple sclerosis at risk of disability progression.
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Affiliation(s)
- Daniel Merlo
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Jim Stankovich
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Claire Bai
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Tomas Kalincik
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Chao Zhu
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Melissa Gresle
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Jeannette Lechner-Scott
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Trevor Kilpatrick
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Michael Barnett
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Bruce Taylor
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - David Darby
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Helmut Butzkueven
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia
| | - Anneke Van der Walt
- From the Department of Neuroscience (D.M., J.S., C.Z., M.G., H.B., A.V.d.W.), Central Clinical School, Monash University; CORe (C.B., T. Kalincik), Department of Medicine at RMH, University of Melbourne; Department of Neurology (T. Kalincik, T. Kilpatrick), Royal Melbourne Hospital, Parkville; Department of Neurology (J.L.-S.), John Hunter Hospital; School of Medicine and Public Health (J.L.-S.), University of Newcastle; Florey Institute of Neuroscience and Mental Health (T. Kilpatrick, D.D.), Melbourne; Brain and Mind Centre (M.B.), University of Sydney; Department of Neurology (B.T.), Royal Hobart Hospital; Department of Neurology (D.D.), Box Hill Hospital; and Department of Neurology (H.B., A.V.d.W.), MSNI Service, Alfred Health, Melbourne, Australia.
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Kiropoulos L, Kilpatrick T, Kalincik T, Churilov L, McDonald E, Wijeratne T, Threader J, Rozenblat V, O’Brien-Simpson N, Van Der Walt A, Taylor L. Correction to: Comparison of the effectiveness of a tailored cognitive behavioural therapy with a supportive listening intervention for depression in those newly diagnosed with multiple sclerosis (the ACTION-MS trial): protocol of an assessor-blinded, active comparator, randomised controlled trial. Trials 2020; 21:284. [PMID: 32197627 PMCID: PMC7082993 DOI: 10.1186/s13063-020-04261-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Williams E, Isles NS, Seemann T, Kilpatrick T, Grigg A, Leroi M, Howden BP, Kwong JC. Case Report: Confirmation by Metagenomic Sequencing of Visceral Leishmaniasis in an Immunosuppressed Returned Traveler. Am J Trop Med Hyg 2020; 103:1930-1933. [PMID: 32959759 DOI: 10.4269/ajtmh.19-0841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There has been increased interest in using metagenomic next-generation sequencing as an unbiased approach for diagnosing infectious diseases. We describe a 61-year-old man on fingolimod therapy for multiple sclerosis with an extensive travel history who presented with 7 months of fevers, night sweats, and weight loss. Peripheral blood tests showed pancytopenia and abnormal acute phase reactants. A bone marrow aspirate showed the presence of numerous intracellular and extracellular amastigotes consistent with visceral leishmaniasis (VL). Metagenomic sequencing of the bone marrow aspirate confirmed Leishmania infantum, a species widely reported in the Mediterranean region. This correlated with acquisition of VL infection during the patient's most recent epidemiological exposure in southern Italy 12 months prior. This case demonstrates the potential application of metagenomic sequencing for identification and speciation of Leishmania in cases of VL; however, further assessment is required using other more readily obtained clinical samples such as blood.
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Affiliation(s)
- Eloise Williams
- Department of Infectious Diseases, Austin Health, Heidelberg, Australia.,Department of Microbiology, Austin Health, Heidelberg, Australia
| | - Nicole S Isles
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | - Marcel Leroi
- Department of Microbiology, Austin Health, Heidelberg, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Jason C Kwong
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
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15
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Cofré Lizama LE, Bastani A, van der Walt A, Kilpatrick T, Khan F, Galea MP. Increased ankle muscle coactivation in the early stages of multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320905870. [PMID: 32110431 PMCID: PMC7016311 DOI: 10.1177/2055217320905870] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/30/2019] [Accepted: 01/21/2020] [Indexed: 01/20/2023] Open
Abstract
Background Neural damage at early stages of multiple sclerosis (MS) can subtly affect gait muscle activation patterns. Detecting these changes using current clinical tools, however, is not possible. We propose using muscle coactivation measures to detect these subtle gait changes. This may also help in identifying people with MS (PwMS) that may benefit from strategies aimed at preventing further mobility impairments. Objective We aimed to determine if coactivation of ankle muscles during gait is greater in PwMS with Expanded Disability Status Scale (EDSS) score <3.5. A secondary aim is to determine whether coactivation increases are speed dependent. Methods For this study 30 PwMS and 15 healthy controls (HC) walked on a treadmill at 1.0 m/s, 1.2 m/s and 1.4 m/s. Electromyography was recorded from the tibialis anterior (TA), soleus (SO) and lateral gastrocnemius (LG). The coactivation index was calculated between SO/TA and LG/TA. Ankle kinematics data were also collected. Results Compared with HC, PwMS exhibited significantly greater SO/TA and LG/TA coactivation, which was greater during early stance and swing phases (p < .01). Speed did not affect coactivation except during early stance. Ankle kinematic changes were also observed. Conclusion PwMS exhibited greater ankle muscles coactivation than controls regardless of the speed of walking. These changes in muscle activation may serve as a biomarker of neurodegeneration occurring at early stages of the disease.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Andisheh Bastani
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neurosciences, Alfred Health, Central Clinical School, Monash University, Melbourne, Australia
| | - Trevor Kilpatrick
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Fary Khan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, Australia.,Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, Australia.,Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
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16
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Kiropoulos L, Kilpatrick T, Kalincik T, Churilov L, McDonald E, Wijeratne T, Threader J, Rozenblat V, O’Brien-Simpson N, Van Der Walt A, Taylor L. Comparison of the effectiveness of a tailored cognitive behavioural therapy with a supportive listening intervention for depression in those newly diagnosed with multiple sclerosis (the ACTION-MS trial): protocol of an assessor-blinded, active comparator, randomised controlled trial. Trials 2020; 21:100. [PMID: 31959224 PMCID: PMC6971867 DOI: 10.1186/s13063-019-4018-8] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an unpredictable, chronic neurological disease accompanied with high rates of depression and anxiety, particularly in the early stages of diagnosis. There is evidence to suggest that cognitive behavioural therapy (CBT) is effective for the treatment of depression amongst individuals with MS; however, there is a paucity of tailored CBT interventions designed to be offered in the newly diagnosed period. This trial is the first to assess the effectiveness and cost-effectiveness of a tailored CBT intervention compared to a supportive listening (SL) intervention amongst individuals with MS who are depressed. METHODS ACTION-MS is a two-arm parallel group, assessor-blinded, active comparator, randomised controlled trial which will test whether a tailored CBT-based intervention compared to an SL intervention can reduce depression and related factors such as anxiety, fatigue, pain and sleep problems in those newly diagnosed with MS. Sixty participants who are within 5 years of having received a diagnosis of MS and scored within the mild to moderate range of depression on the Beck Depression Inventory (BDI-II) will be recruited from MS clinics located across three hospital sites in Melbourne, Australia. The primary outcome is depression severity using the BDI-II at post-assessment. Intervention satisfaction and acceptability will be assessed. A cost-effectiveness analysis will also be conducted. Data will be analysed on an intention-to-treat basis. DISCUSSION There is a scarcity of psychological interventions for depression targeting the newly diagnosed period. However, interventions during this time point have the potential to have a major impact on the mental and physical wellbeing of those newly diagnosed with MS. The current trial will provide data on the effectiveness of a tailored CBT intervention for the treatment of depression in those newly diagnosed with MS. Findings will also provide effect size estimates that can be used to power a later-stage multi-centre trial of treatment efficacy, and will provide information on the mechanisms underlying any treatment effects and cost-effectiveness data for delivering this intervention in outpatient MS clinics. TRIAL REGISTRATION ISRCTN trials registry, ISRCTN63987586. Current controlled trials. Retrospectively registered on 20 October 2017.
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Affiliation(s)
- Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia.
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Tomas Kalincik
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Elizabeth McDonald
- Rehabilitation and Neuroimmunology, Department of Neuroscience, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, Sunshine, Victoria, Australia
| | - Jennifer Threader
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Vanja Rozenblat
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | | | - Anneke Van Der Walt
- Department of Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa Taylor
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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17
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Carter A, Richards LJ, Apthorp D, Azghadi MR, Badcock DR, Balleine B, Bekkers JM, Berk M, Bourne JA, Bradley AP, Breakspear M, Brichta A, Carter O, Castles A, Chakli K, Cohen-Woods S, Conn SJ, Cornish J, Cornish K, de Zubicaray G, Egan GF, Enticott PG, Fitzgibbon BM, Forlini C, Fornito A, Griffiths L, Gullifer J, Hall W, Halliday G, Hannan AJ, Harrer S, Harvey A, Hatherly C, Hickie IB, Kennett J, Kiernan M, Kilpatrick T, Kiral-Kornek I, Korgaonkar MS, Lawrence AJ, Leventer R, Levy N, Licinio J, Lovell N, Mackellar G, Malcolm L, Mason A, Mattingley JB, Medland SE, Michie PT, Nithianantharajah J, Parker J, Payne JM, Poole-Warren L, Sah P, Sarnyai Z, Schofield PR, Shimoni O, Shum DH, Silk T, Slee M, Smith AE, Soulis T, Sriram S, Stuart GJ, Tapson J, Thompson MB, van Schaik A, Vincent NA, Vissel B, Waters A. A Neuroethics Framework for the Australian Brain Initiative. Neuron 2020; 105:201. [DOI: 10.1016/j.neuron.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Lechner-Scott J, Maltby V, Lyndon A, Monif M, Kilpatrick T, Butzkueven H, Taylor B, McCombe P, Hodgkinson S, Fabis-Pedrini M, Kermode A, Barnett M, Kalincik T. 134 Cladribine: a multicentre long-term efficacy biomarker australian study (CLOBAS). J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionCladribine tablets (marketed as Mavenclad®) is a new oral therapy, which has recently been listed on the pharmaceuticals benefit scheme (PBS) in Australia for treatment of relapsing MS. The current dosing schedule is for 2 courses given a year apart, which has been shown to be effective for treatment of MS up to 4 years in 75% of patients (based on annualised relapse rate). However, re-initiation of therapy after year 4 has not been studied.MethodsThis will be a multicentre, 6-year, phase IV, low interventional trial. Subjects considered for treatment with cladribine will receive an initial treatment course in year 1 and a continuing treatment course in year 2. After year 3, patients will have the option for re-dosing, if clinically indicated or to switch to another disease modifying therapy. Throughout the duration of the study we will assess blood based biomarkers including lymphocyte subsets, serum neurofilament light chain, DNA methylation and RNA analysis as well as MRI findings (brain volume/lesion load) and cognitive performance.ResultsThis study has been approved by the Hunter New England Local Health District Human Research Ethics Committee. The study is due to commence on March 14th.ConclusionsThis will be the first long-term efficacy trial of cladribine which offers re-initiation of therapy after the initial two courses. We expect this study will be an indication if any of the assessed biomarkers can be used to predict treatment efficacy or the need for re-initiation of Cladribine in MS patients.
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19
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Gajamange S, Stankovich J, Egan G, Kilpatrick T, Butzkueven H, Fielding J, van der Walt A, Kolbe S. Early imaging predictors of longer term multiple sclerosis risk and severity in acute optic neuritis. Mult Scler J Exp Transl Clin 2019; 5:2055217319863122. [PMID: 31384479 PMCID: PMC6651676 DOI: 10.1177/2055217319863122] [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: 03/25/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background Biomarkers are urgently required for predicting the likely progression of multiple sclerosis (MS) at the earliest stages of the disease to aid in personalised therapy. Objective We aimed to examine early brain volumetric and microstructural changes and retinal nerve fibre layer thinning as predictors of longer term MS severity in patients with clinically isolated syndromes (CIS). Methods Lesion metrics, brain and regional atrophy, diffusion fractional anisotropy and retinal nerve fibre layer thickness were prospectively assessed in 36 patients with CIS over the first 12 months after presentation and compared with clinical outcomes at longer term follow-up [median (IQR) = 8.5 (7.8–8.9) years]. Results In total, 25 (69%) patients converted to MS and had greater baseline lesion volume (p = 0.008) and number (p = 0.03)than CIS patients. Over the initial 12 months, new lesions (p = 0.0001), retinal nerve fibre layer thinning (p = 0.04) and ventricular enlargement (p = 0.03) were greater in MS than CIS patients. In MS patients, final Expanded Disability Status Scale score correlated with retinal nerve fibre layer thinning over the first 12 months (ρ = −0.67, p = 0.001). Conclusions Additional to lesion metrics, early measurements of fractional anisotropy and retinal nerve fibre layer thinning are informative about longer term clinical outcomes in CIS.
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Affiliation(s)
- Sanuji Gajamange
- Department of Medicine and Radiology, University of Melbourne, Australia
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Scott Kolbe
- Department of Neuroscience, Central Clinical School, Monash University, Australia
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20
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Jia X, Madireddy L, Caillier S, Santaniello A, Esposito F, Comi G, Stuve O, Zhou Y, Taylor B, Kilpatrick T, Martinelli-Boneschi F, Cree BAC, Oksenberg JR, Hauser SL, Baranzini SE. Genome sequencing uncovers phenocopies in primary progressive multiple sclerosis. Ann Neurol 2018; 84:51-63. [PMID: 29908077 PMCID: PMC6119489 DOI: 10.1002/ana.25263] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/29/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 01/06/2023]
Abstract
Objective Primary progressive multiple sclerosis (PPMS) causes accumulation of neurological disability from disease onset without clinical attacks typical of relapsing multiple sclerosis (RMS). However, whether genetic variation influences the disease course remains unclear. We aimed to determine whether mutations causative of neurological disorders that share features with multiple sclerosis (MS) contribute to risk for developing PPMS. Methods We examined whole‐genome sequencing (WGS) data from 38 PPMS and 81 healthy subjects of European ancestry. We selected pathogenic variants exclusively found in PPMS patients that cause monogenic neurological disorders and performed two rounds of replication genotyping in 746 PPMS, 3,049 RMS, and 1,000 healthy subjects. To refine our findings, we examined the burden of rare, potentially pathogenic mutations in 41 genes that cause hereditary spastic paraplegias (HSPs) in PPMS (n = 314), secondary progressive multiple sclerosis (SPMS; n = 587), RMS (n = 2,248), and healthy subjects (n = 987) genotyped using the MS replication chip. Results WGS and replication studies identified three pathogenic variants in PPMS patients that cause neurological disorders sharing features with MS: KIF5A p.Ala361Val in spastic paraplegia 10; MLC1 p.Pro92Ser in megalencephalic leukodystrophy with subcortical cysts, and REEP1 c.606 + 43G>T in Spastic Paraplegia 31. Moreover, we detected a significant enrichment of HSP‐related mutations in PPMS patients compared to controls (risk ratio [RR] = 1.95; 95% confidence interval [CI], 1.27–2.98; p = 0.002), as well as in SPMS patients compared to controls (RR = 1.57; 95% CI, 1.18–2.10; p = 0.002). Importantly, this enrichment was not detected in RMS. Interpretation This study provides evidence to support the hypothesis that rare Mendelian genetic variants contribute to the risk for developing progressive forms of MS. Ann Neurol 2018;83:51–63
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Affiliation(s)
- Xiaoming Jia
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Lohith Madireddy
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Stacy Caillier
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Adam Santaniello
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Department of Neurology and Neuro-rehabilitation, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Department of Neurology and Neuro-rehabilitation, San Raffaele Scientific Institute, Milan, Italy
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical, Dallas, TX
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Trevor Kilpatrick
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Filippo Martinelli-Boneschi
- Laboratory of Genomics of Neurological Diseases and Department of Neurology, Policlinico San Donato Hospital and Scientific Institute, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Jorge R Oksenberg
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | - Sergio E Baranzini
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.,Department of Neurology, University of California San Francisco, San Francisco, CA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA.,Graduate Program in Bioinformatics, University of California San Francisco, San Francisco, CA
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Abstract
We present a case of monocytopaenia and mycobacteria-related infection (MonoMac) syndrome in a 30-year-old man of Indian origin. The clinical diagnosis of GATA2 haploinsufficiency was suspected after an unusual neurological presentation on a background of myelodysplastic syndrome and childhood pulmonary tuberculosis. The patient had a longitudinally extensive spinal cord lesion and a lesion in the medulla. No obvious infective cause for the spinal cord MRI abnormality was found, and the lesions were presumed to be inflammatory in nature. The family history consisted of autosomal dominant clinical features suggestive of GATA2 haploinsufficiency. Genetic testing in peripheral leucocytes revealed a pathogenic mutation in GATA2 This is the first-ever published case of possible MonoMac syndrome with a neurological presentation. The case highlights the rarity and complexity of the diagnosis and the clinical sequelae that ensued with the patient dying of gram-negative septicaemia while receiving intravenous steroid therapy for the spinal cord lesion.
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Affiliation(s)
- Mastura Monif
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Physiology, University of Melbourne Faculty of Medicine, Melbourne, Victoria, Australia
| | - Aamira Huq
- Department of Clinical Genetics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lynette Chee
- Department of Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Trevor Kilpatrick
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuroscience Institute, University of Melbourne, Melbourne, Victoria, Australia
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Gajamange S, Raffelt D, Dhollander T, Lui E, van der Walt A, Kilpatrick T, Fielding J, Connelly A, Kolbe S. Fibre-specific white matter changes in multiple sclerosis patients with optic neuritis. Neuroimage Clin 2017. [PMID: 29527473 PMCID: PMC5842545 DOI: 10.1016/j.nicl.2017.09.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Long term irreversible disability in multiple sclerosis (MS) is thought to be primarily driven by axonal degeneration. Axonal degeneration leads to degenerative atrophy, therefore early markers of axonal degeneration are required to predict clinical disability and treatment efficacy. Given that additional pathologies such as inflammation, demyelination and oedema are also present in MS, it is essential to develop axonal markers that are not confounded by these processes. The present study investigated a novel method for measuring axonal degeneration in MS based on high angular resolution diffusion magnetic resonance imaging. Unlike standard methods, this novel method involved advanced acquisition and modelling for improved axonal sensitivity and specificity. Recent work has developed analytical methods, two novel axonal markers, fibre density and cross-section, that can be estimated for each fibre direction in each voxel (termed a “fixel”). This technique, termed fixel-based analysis, thus simultaneously estimates axonal density and white matter atrophy from specific white matter tracts. Diffusion-weighted imaging datasets were acquired for 17 patients with a history of acute unilateral optic neuritis (35.3 ± 10.2 years, 11 females) and 14 healthy controls (32.7 ± 4.8 years, 8 females) on a 3 T scanner. Fibre density values were compared to standard diffusion tensor imaging parameters (fractional anisotropy and mean diffusivity) in lesions and normal appearing white matter. Group comparisons were performed for each fixel to assess putative differences in fibre density and fibre cross-section. Fibre density was observed to have a comparable sensitivity to fractional anisotropy for detecting white matter pathology in MS, but was not affected by crossing axonal fibres. Whole brain fixel-based analysis revealed significant reductions in fibre density and fibre cross-section in the inferior fronto-occipital fasciculus (including the optic radiations) of patients compared to controls. We interpret this result to indicate that this fixel-based approach is able to detect early loss of fibre density and cross-section in the optic radiations in MS patients with a history of optic neuritis. Fibre-specific markers of axonal degeneration should be investigated further for use in early stage therapeutic trials, or to monitor axonal injury in early stage MS. Fibre density is reduced in lesions and normal-appearing white matter in MS Fibre density detects white matter pathology in regions of crossing fibres Loss of fibre density and cross-section selectively evident in visual pathways of optic neuritis patients.
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Affiliation(s)
- Sanuji Gajamange
- Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - David Raffelt
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Thijs Dhollander
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Elaine Lui
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia
| | | | - Trevor Kilpatrick
- Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - Joanne Fielding
- School of Psychological Sciences, Monash University, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; The Florey Department of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Scott Kolbe
- Department of Anatomy and Neuroscience, University of Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
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Dwyer C, Jokubaitis V, Baker J, Haartsen J, Rath L, Coleman J, Fryer K, Macintyre J, Cartwright A, Skibina O, Macdonell R, Butler E, Shuey N, Butzkueven H, Kilpatrick T, Walt AVD. JC virus conversion rates in natalizumab treated patients: the melbourne longitudinal cohort study. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kiropoulos LA, Kilpatrick T, Holmes A, Threader J. A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis. BMC Psychiatry 2016; 16:435. [PMID: 27927175 PMCID: PMC5142334 DOI: 10.1186/s12888-016-1152-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis. METHODS The current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention. RESULTS Large between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66-1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17-1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as 'very useful', and most (73.4%) reported that the intervention had addressed their problems 'completely'. CONCLUSIONS These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371).
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Affiliation(s)
- Litza A. Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, 3010 Australia
- Psychology Department, Royal Melbourne Hospital, Parkville, Victoria Australia
| | - Trevor Kilpatrick
- Melbourne Brain Centre and MS unit, Royal Melbourne Hospital, Parkville, Victoria Australia
- Centre for Neuroscience and the Melbourne Neuroscience Institute, University of Melbourne, Parkville, Victoria Australia
- Florey Neuroscience Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Parkville, Victoria Australia
| | - Jennifer Threader
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, 3010 Australia
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Jonas A, Thiem S, Kuhlmann T, Wagener R, Aszodi A, Nowell C, Hagemeier K, Laverick L, Perreau V, Jokubaitis V, Emery B, Kilpatrick T, Butzkueven H, Gresle M. Axonally derived matrilin-2 induces proinflammatory responses that exacerbate autoimmune neuroinflammation. J Clin Invest 2014; 124:5042-56. [PMID: 25329699 DOI: 10.1172/jci71385] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/11/2014] [Indexed: 01/14/2023] Open
Abstract
In patients with multiple sclerosis (MS) and mice with experimental autoimmune encephalomyelitis (EAE), inflammatory axonal injury is a major determinant of disability; however, the drivers of this injury are incompletely understood. Here, we used the EAE model and determined that the extracellular matrix protein matrilin-2 (MATN2) is an endogenous neuronal molecule that is regulated in association with inflammatory axonal injury. Compared with WT mice, mice harboring a deletion of Matn2 exhibited reduced disease severity and axon damage following induction of EAE. Evaluation of neuron-macrophage cocultures revealed that exogenous MATN2 specifically signals through TLR4 and directly induces expression of proinflammatory genes in macrophages, promoting axonal damage. Moreover, the MATN2-induced proinflammatory response was attenuated greatly in macrophages from Myd88 KO mice. Examination of brain sections from patients with MS revealed that MATN2 is expressed in lesions but not in normal-appearing white matter. Together, our results indicate that MATN2 is a deleterious endogenous neuroaxonal injury response signal that activates innate immune cells and could contribute to early axonal damage in CNS inflammatory diseases like MS.
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Law S, Roberts C, Kilpatrick T, Yu L, Ribaudo T, Shaner EA, Podolskiy V, Wasserman D. All-semiconductor negative-index plasmonic absorbers. Phys Rev Lett 2014; 112:017401. [PMID: 24483930 DOI: 10.1103/physrevlett.112.017401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 06/03/2023]
Abstract
We demonstrate epitaxially grown all-semiconductor thin-film midinfrared plasmonic absorbers and show that absorption in these structures is linked to the excitation of highly confined negative-index surface plasmon polaritons. Strong (>98%) absorption is experimentally observed, and the spectral position and intensity of the absorption resonances are studied by reflection and transmission spectroscopy. Numerical models as well as an analytical description of the excited guided modes in our structures are presented, showing agreement with experiment. The structures investigated demonstrate a wavelength-flexible, all-semiconductor, plasmonic architecture with potential for both sensing applications and enhanced interaction of midinfrared radiation with integrated semiconductor optoelectronic elements.
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Affiliation(s)
- S Law
- University of Illinois Urbana Champaign, Department of Electrical and Computer Engineering, Micro and Nanotechnology Lab, Urbana, Illinois 61801, USA
| | - C Roberts
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA
| | - T Kilpatrick
- University of Illinois Urbana Champaign, Department of Electrical and Computer Engineering, Micro and Nanotechnology Lab, Urbana, Illinois 61801, USA
| | - L Yu
- University of Illinois Urbana Champaign, Department of Electrical and Computer Engineering, Micro and Nanotechnology Lab, Urbana, Illinois 61801, USA
| | - T Ribaudo
- Sandia National Labs, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - E A Shaner
- Sandia National Labs, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - V Podolskiy
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA
| | - D Wasserman
- University of Illinois Urbana Champaign, Department of Electrical and Computer Engineering, Micro and Nanotechnology Lab, Urbana, Illinois 61801, USA
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Curley M, Josey L, Lucas R, Dear K, Taylor BV, Coulthard A, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick T, Lucas R, McMichael T, Pender MP, Ponsonby AL, Taylor B, Valery P, van der Mei I, Williams D. Adherence to MRI protocol consensus guidelines in multiple sclerosis: an Australian multi-centre study. J Med Imaging Radiat Oncol 2013; 56:594-8. [PMID: 23210577 DOI: 10.1111/1754-9485.12000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates. METHODS The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS. RESULTS The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2). CONCLUSION Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.
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Affiliation(s)
- Michael Curley
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia
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Beecham AH, Patsopoulos NA, Xifara DK, Davis MF, Kemppinen A, Cotsapas C, Shah TS, Spencer C, Booth D, Goris A, Oturai A, Saarela J, Fontaine B, Hemmer B, Martin C, Zipp F, D'Alfonso S, Martinelli-Boneschi F, Taylor B, Harbo HF, Kockum I, Hillert J, Olsson T, Ban M, Oksenberg JR, Hintzen R, Barcellos LF, Agliardi C, Alfredsson L, Alizadeh M, Anderson C, Andrews R, Søndergaard HB, Baker A, Band G, Baranzini SE, Barizzone N, Barrett J, Bellenguez C, Bergamaschi L, Bernardinelli L, Berthele A, Biberacher V, Binder TMC, Blackburn H, Bomfim IL, Brambilla P, Broadley S, Brochet B, Brundin L, Buck D, Butzkueven H, Caillier SJ, Camu W, Carpentier W, Cavalla P, Celius EG, Coman I, Comi G, Corrado L, Cosemans L, Cournu-Rebeix I, Cree BAC, Cusi D, Damotte V, Defer G, Delgado SR, Deloukas P, di Sapio A, Dilthey AT, Donnelly P, Dubois B, Duddy M, Edkins S, Elovaara I, Esposito F, Evangelou N, Fiddes B, Field J, Franke A, Freeman C, Frohlich IY, Galimberti D, Gieger C, Gourraud PA, Graetz C, Graham A, Grummel V, Guaschino C, Hadjixenofontos A, Hakonarson H, Halfpenny C, Hall G, Hall P, Hamsten A, Harley J, Harrower T, Hawkins C, Hellenthal G, Hillier C, Hobart J, Hoshi M, Hunt SE, Jagodic M, Jelčić I, Jochim A, Kendall B, Kermode A, Kilpatrick T, Koivisto K, Konidari I, Korn T, Kronsbein H, Langford C, Larsson M, Lathrop M, Lebrun-Frenay C, Lechner-Scott J, Lee MH, Leone MA, Leppä V, Liberatore G, Lie BA, Lill CM, Lindén M, Link J, Luessi F, Lycke J, Macciardi F, Männistö S, Manrique CP, Martin R, Martinelli V, Mason D, Mazibrada G, McCabe C, Mero IL, Mescheriakova J, Moutsianas L, Myhr KM, Nagels G, Nicholas R, Nilsson P, Piehl F, Pirinen M, Price SE, Quach H, Reunanen M, Robberecht W, Robertson NP, Rodegher M, Rog D, Salvetti M, Schnetz-Boutaud NC, Sellebjerg F, Selter RC, Schaefer C, Shaunak S, Shen L, Shields S, Siffrin V, Slee M, Sorensen PS, Sorosina M, Sospedra M, Spurkland A, Strange A, Sundqvist E, Thijs V, Thorpe J, Ticca A, Tienari P, van Duijn C, Visser EM, Vucic S, Westerlind H, Wiley JS, Wilkins A, Wilson JF, Winkelmann J, Zajicek J, Zindler E, Haines JL, Pericak-Vance MA, Ivinson AJ, Stewart G, Hafler D, Hauser SL, Compston A, McVean G, De Jager P, Sawcer SJ, McCauley JL. Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis. Nat Genet 2013; 45:1353-60. [PMID: 24076602 PMCID: PMC3832895 DOI: 10.1038/ng.2770] [Citation(s) in RCA: 980] [Impact Index Per Article: 89.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/03/2013] [Indexed: 12/13/2022]
Abstract
Using the ImmunoChip custom genotyping array, we analyzed 14,498 subjects with multiple sclerosis and 24,091 healthy controls for 161,311 autosomal variants and identified 135 potentially associated regions (P < 1.0 × 10(-4)). In a replication phase, we combined these data with previous genome-wide association study (GWAS) data from an independent 14,802 subjects with multiple sclerosis and 26,703 healthy controls. In these 80,094 individuals of European ancestry, we identified 48 new susceptibility variants (P < 5.0 × 10(-8)), 3 of which we found after conditioning on previously identified variants. Thus, there are now 110 established multiple sclerosis risk variants at 103 discrete loci outside of the major histocompatibility complex. With high-resolution Bayesian fine mapping, we identified five regions where one variant accounted for more than 50% of the posterior probability of association. This study enhances the catalog of multiple sclerosis risk variants and illustrates the value of fine mapping in the resolution of GWAS signals.
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Hughes SE, Spelman T, Gray OM, Boz C, Trojano M, Lugaresi A, Izquierdo G, Duquette P, Girard M, Grand’Maison F, Grammond P, Oreja-Guevara C, Hupperts R, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Edite Rio M, van Pesch V, Amato MP, Iuliano G, Slee M, Verheul F, Cristiano E, Fernández-Bolaños R, Poehlau D, Saladino ML, Deri N, Cabrera-Gomez J, Vella N, Herbert J, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, McDonnell G, Hawkins S, Kee F, Butzkueven H, Paolicelli D, Lucchese G, Iaffaldano P, Zwanikken C, De Luca G, Di Tommaso V, Travaglini D, Pietrolongo E, di Ioia M, Farina D, Mancinelli L, Marriott M, Kilpatrick T, King J, van der Walt A, Skibina O, Haartsen J, Chamorro B, Petersen T, Cartechini E, Pucci E, William D, Dark L, Fiol M, Correale J, Ysrraelit C, Den Braber-Moerland L, Jaacks G, Laffue A, Fernanda Páez M, Muñoz D, Oleschko Arruda W, Paine M, Vella M, Vetere S. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 2013; 20:739-46. [DOI: 10.1177/1352458513507816] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. Objective: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse. Methods: An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses. Results: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model. Conclusion: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.
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Affiliation(s)
- Stella E Hughes
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, UK
| | - Tim Spelman
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
| | | | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | - Alessandra Lugaresi
- MS Center, Department of Neuroscience and Imaging, University ‘G. d’Annunzio’, Chieti, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dieter Poehlau
- Multiple Sclerosis Centre Kamillus-Klinik, Asbach, Germany
| | | | - Norma Deri
- Hospital Fernandez, Buenos Aires, Argentina
| | | | | | | | - Eli Skromne
- Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico
| | - Aldo Savino
- Consultorio Privado, Buenos Aires, Argentina
| | | | | | - Steve Vucic
- Westmead Hospital, New South Wales, Australia
| | | | - Gavin McDonnell
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
| | - Stanley Hawkins
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queen’s University Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, UK
| | - Helmut Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Medicine, Melbourne Brain Centre, The University of Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Australia
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Chandler D, Lopaticki S, Huang D, Hunter M, Angelicheva D, Kilpatrick T, King RH, Kalaydjieva L, Morahan G. The stretcher spontaneous neurodegenerative mutation models Charcot-Marie-Tooth disease type 4D. F1000Res 2013; 2:46. [PMID: 24715951 PMCID: PMC3976107 DOI: 10.12688/f1000research.2-46.v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 11/20/2022] Open
Abstract
Mice affected by a spontaneous mutation which arose within our colony exhibited a neuromuscular phenotype involving tremor and characteristic stretching of the rear limbs. The mutant, named
stretcher, was used to breed a backcross cohort for genetic mapping studies. The gene responsible for the mutant phenotype was mapped to a small region on mouse chromosome 15, with a LOD score above 20. Candidate genes within the region included the
Ndrg1 gene. Examination of this gene in the mutant mouse strain revealed that exons 10 to 14 had been deleted. Mutations in the human orthologue are known to result in Charcot-Marie-Tooth disease type 4D (CMT4D) a severe early-onset disorder involving Schwann cell dysfunction and extensive demyelination. The
stretcher mutant mouse is more severely affected than mice in which the
Ndrg1 gene had been knocked out by homologous recombination. Our results demonstrate that the
Ndrg1str mutation provides a new model for CMT4D, and demonstrate that exons 10 to 14 of
Ndrg1 encode amino acids crucial to the appropriate function of Ndrg1 in the central nervous system.
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Affiliation(s)
- David Chandler
- Western Australian Institute for Medical Research and Centre for Diabetes Research, University of Western Australia, Perth, 6000, Australia ; Australian Genome Research Facility, Perth, 6000, Australia
| | - Sash Lopaticki
- The Walter and Eliza Hall Institute of Medical Research, Victoria, 3065, Australia
| | - Dexing Huang
- St Vincent's Institute of Medical Research, Victoria, 3010, Australia
| | - Michael Hunter
- Western Australian Institute for Medical Research and Centre for Diabetes Research, University of Western Australia, Perth, 6000, Australia ; Centre for Medical Research, University of Western Australia, Perth, 6000, Australia
| | - Dora Angelicheva
- Western Australian Institute for Medical Research and Centre for Diabetes Research, University of Western Australia, Perth, 6000, Australia ; Centre for Medical Research, University of Western Australia, Perth, 6000, Australia
| | | | - Rosalind Hm King
- Department of Clinical Neurosciences, Institute of Neurology University College London, London, NW3 2PF, UK
| | - Luba Kalaydjieva
- Western Australian Institute for Medical Research and Centre for Diabetes Research, University of Western Australia, Perth, 6000, Australia ; Centre for Medical Research, University of Western Australia, Perth, 6000, Australia
| | - Grant Morahan
- Western Australian Institute for Medical Research and Centre for Diabetes Research, University of Western Australia, Perth, 6000, Australia ; Centre for Medical Research, University of Western Australia, Perth, 6000, Australia ; The Walter and Eliza Hall Institute of Medical Research, Victoria, 3065, Australia
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Gresle MM, Alexandrou E, Wu Q, Egan G, Jokubaitis V, Ayers M, Jonas A, Doherty W, Friedhuber A, Shaw G, Sendtner M, Emery B, Kilpatrick T, Butzkueven H. Leukemia inhibitory factor protects axons in experimental autoimmune encephalomyelitis via an oligodendrocyte-independent mechanism. PLoS One 2012; 7:e47379. [PMID: 23077604 PMCID: PMC3471848 DOI: 10.1371/journal.pone.0047379] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 09/12/2012] [Indexed: 01/13/2023] Open
Abstract
Leukemia inhibitory factor (LIF) and Ciliary Neurotrophic factor (CNTF) are members of the interleukin-6 family of cytokines, defined by use of the gp130 molecule as an obligate receptor. In the murine experimental autoimmune encephalomyelitis (EAE) model, antagonism of LIF and genetic deletion of CNTF worsen disease. The potential mechanism of action of these cytokines in EAE is complex, as gp130 is expressed by all neural cells, and could involve immuno-modulation, reduction of oligodendrocyte injury, neuronal protection, or a combination of these actions. In this study we aim to investigate whether the beneficial effects of CNTF/LIF signalling in EAE are associated with axonal protection; and whether this requires signalling through oligodendrocytes. We induced MOG35–55 EAE in CNTF, LIF and double knockout mice. On a CNTF null background, LIF knockout was associated with increased EAE severity (EAE grade 2.1±0.14 vs 2.6±0.19; P<0.05). These mice also showed increased axonal damage relative to LIF heterozygous mice, as indicated by decreased optic nerve parallel diffusivity on MRI (1540±207 µm2−/s vs 1310±175 µm2−/s; P<0.05), and optic nerve (−12.5%) and spinal cord (−16%) axon densities; and increased serum neurofilament-H levels (2.5 fold increase). No differences in inflammatory cell numbers or peripheral auto-immune T-cell priming were evident. Oligodendrocyte-targeted gp130 knockout mice showed that disruption of CNTF/LIF signalling in these cells has no effect on acute EAE severity. These studies demonstrate that endogenous CNTF and LIF act centrally to protect axons from acute inflammatory destruction via an oligodendrocyte-independent mechanism.
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Affiliation(s)
- Melissa M Gresle
- Department of Medicine, The Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
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Fielding J, Kilpatrick T, Millist L, Clough M, White O. Longitudinal assessment of antisaccades in patients with multiple sclerosis. PLoS One 2012; 7:e30475. [PMID: 22319570 PMCID: PMC3271102 DOI: 10.1371/journal.pone.0030475] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/19/2011] [Indexed: 12/05/2022] Open
Abstract
We have previously demonstrated that assessment of antisaccades (AS) provides not only measures of motor function in multiple sclerosis (MS), but measures of cognitive control processes in particular, attention and working memory. This study sought to demonstrate the potential for AS measures to sensitively reflect change in functional status in MS. Twenty-four patients with relapsing-remitting MS and 12 age-matched controls were evaluated longitudinally using an AS saccade task. Compared to control subjects, a number of saccade parameters changed significantly over a two year period for MS patients. These included saccade error rates, latencies, and accuracy measures. Further, for MS patients, correlations were retained between OM measures and scores on the PASAT, which is considered the reference task for the cognitive evaluation of MS patients. Notably, EDSS scores for these patients did not change significantly over this period. These results demonstrate that OM measures may reflect disease evolution in MS, in the absence of clinically evident changes as measured using conventional techniques. With replication, these markers could ultimately be developed into a cost-effective, non-invasive, and well tolerated assessment tool to assist in confirming progression early in the disease process, and in measuring and predicting response to therapy.
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Affiliation(s)
- Joanne Fielding
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- * E-mail:
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Lynette Millist
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Meaghan Clough
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Owen White
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia
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Kolbe S, Bajraszewski C, Chapman C, Nguyen T, Mitchell P, Paine M, Butzkueven H, Johnston L, Kilpatrick T, Egan G. Diffusion tensor imaging of the optic radiations after optic neuritis. Hum Brain Mapp 2011; 33:2047-61. [PMID: 21915943 DOI: 10.1002/hbm.21343] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/27/2011] [Accepted: 04/11/2011] [Indexed: 12/24/2022] Open
Abstract
Trans-synaptic degeneration could exacerbate neurodegeneration in multiple sclerosis (MS). We aimed to assess whether anterograde trans-synaptic degeneration could be identified in the primary visual pathway in vivo. Diffusion tensor imaging (DTI) was used to assess the optic radiations in 15 patients with previous optic nerve inflammation and 9 healthy volunteers. A probabilistic atlas of the optic radiations was created from healthy diffusion tractography data. Lengthwise profiles for DTI parameters (axial [λ(||) ], radial [λ(⟂) ] and mean diffusivity [MD], fractional anisotropy [FA] and the angle of deviation of the principal eigenvector [α]) were analyzed for patients and controls. Patients also underwent multifocal visual evoked potential (mfVEP) assessments to characterize the latency and amplitude of cortical potentials. Correlations were performed between mfVEP latency and amplitude in the left and right visual hemi-fields and DTI parameters in the contra-lateral optic radiations. Patients displayed a significant decrease in λ(||) within the body of both optic radiations, which significantly correlated with loss of mfVEP amplitude. Abnormal λ(⟂) and FA were detected bilaterally throughout the optic radiations in patients but the abnormality was not associated with amplitude reduction or latency prolongation of the mfVEP. An abnormal α value was observed in the left optic radiations of patients, and the α value in the body of the optic radiations also correlated with mfVEP amplitude loss. The assocation between bilateral DTI abnormalities within the optic radiations and loss of afferent electrical activity could indicate anterograde trans-synaptic degeneration occurs following optic neuritis.
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Affiliation(s)
- Scott Kolbe
- Florey Neuroscience Institutes, Melbourne, Australia.
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35
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Lucas RM, Ponsonby AL, Dear K, Valery P, Pender MP, Burrows JM, Burrows SR, Chapman C, Coulthard A, Dwyer DE, Dwyer T, Kilpatrick T, Lay MLJ, McMichael AJ, Taylor BV, van der Mei IAF, Williams D. Current and past Epstein-Barr virus infection in risk of initial CNS demyelination. Neurology 2011; 77:371-9. [DOI: 10.1212/wnl.0b013e318227062a] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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King RHM, Chandler D, Lopaticki S, Huang D, Blake J, Muddle JR, Kilpatrick T, Nourallah M, Miyata T, Okuda T, Carter KW, Hunter M, Angelicheva D, Morahan G, Kalaydjieva L. Ndrg1 in development and maintenance of the myelin sheath. Neurobiol Dis 2011; 42:368-80. [PMID: 21303696 DOI: 10.1016/j.nbd.2011.01.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 01/13/2011] [Accepted: 01/28/2011] [Indexed: 02/04/2023] Open
Abstract
CMT4D disease is a severe autosomal recessive demyelinating neuropathy with extensive axonal loss leading to early disability, caused by mutations in the N-myc downstream regulated gene 1 (NDRG1). NDRG1 is expressed at particularly high levels in the Schwann cell (SC), but its physiological function(s) are unknown. To help with their understanding, we characterise the phenotype of a new mouse model, stretcher (str), with total Ndrg1 deficiency, in comparison with the hypomorphic Ndrg1 knock-out (KO) mouse. While both models display normal initial myelination and a transition to overt pathology between weeks 3 and 5, the markedly more severe str phenotype suggests that even low Ndrg1 expression results in significant phenotype rescue. Neither model replicates fully the features of CMT4D: although axon damage is present, regenerative capacity is unimpaired and the mice do not display the early severe axonal loss typical of the human disease. The widespread large fibre demyelination coincides precisely with the period of rapid growth of the animals and the dramatic (160-500-fold) increase in myelin volume and length in large fibres. This is followed by stabilisation after week 10, while small fibres remain unaffected. Gene expression profiling of str peripheral nerve reveals non-specific secondary changes at weeks 5 and 10 and preliminary data point to normal proteasomal function. Our findings do not support the proposed roles of NDRG1 in growth arrest, terminal differentiation, gene expression regulation and proteasomal degradation. Impaired SC trafficking failing to meet the considerable demands of nerve growth, emerges as the likely pathogenetic mechanism in NDRG1 deficiency.
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Affiliation(s)
- Rosalind H M King
- Department of Clinical Neurosciences, Institute of Neurology, UCL, London NW3 2PF, UK.
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37
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Skibina OG, Perreau VM, Hu Y, Binder M, Judith J, Butzkueven H, Smyth G, Kilpatrick T. 89. Modulation of regulatory and cytotoxic T cell expression signature in first demyelinating events and early multiple sclerosis. J Clin Neurosci 2010. [DOI: 10.1016/j.jocn.2010.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Kilpatrick T. 29. Probing neuron-glial interactions for therapeutic benefit. J Clin Neurosci 2010. [DOI: 10.1016/j.jocn.2010.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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39
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Lyne JC, Kilpatrick T, Duncan A, Knight CJ, Sigwart U, Fox KM. Long-term follow-up of the first patients to undergo transcatheter alcohol septal ablation. Cardiology 2010; 116:168-73. [PMID: 20616549 DOI: 10.1159/000318307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 03/29/2010] [Indexed: 12/21/2022]
Abstract
We describe the 10-year outcome of the first-in-human series of 12 patients with hypertrophic cardiomyopathy treated with alcohol septal ablation. There was no 30-day mortality. Survival free of death, internal cardiac defibrillator discharge for treatment of ventricular fibrillation or tachycardia, severe New York Heart Association (NYHA) class III/IV and/or Canadian Cardiovascular Society class III/IV symptoms and the need for surgical myectomy in this cohort was 91% at 1 year and 73% at 10 years. The reduction in outflow tract gradient was maintained over the 10 years, from a mean preoperative gradient of 70 mm Hg to a median of 3 mm Hg at 126 months of follow-up (p < 0.01). Two patients (16%) underwent a further ablation procedure. Two patients (16%) suffered sudden cardiac death, 91 and 102 months after the procedure. Long-term symptom benefit was experienced by all patients, with a reduction in mean NYHA class from 2.7 +/- 0.6 before the procedure to 1 after the procedure at the last follow-up (p < 0.01). This historic small cohort study demonstrates that septal ablation can provide long-term haemodynamic and symptomatic benefit.
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Affiliation(s)
- J C Lyne
- Department of Cardiology, Royal Brompton Hospital, London, UK.
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40
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Van der Walt A, Butzkueven H, Kolbe S, Marriott M, Alexandrou E, Gresle M, Egan G, Kilpatrick T. Neuroprotection in multiple sclerosis: a therapeutic challenge for the next decade. Pharmacol Ther 2010; 126:82-93. [PMID: 20122960 DOI: 10.1016/j.pharmthera.2010.01.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis (MS) is the commonest cause of progressive neurological disability amongst young, Caucasian adults. MS is considered to be an auto-immune disease that results from an attack against myelin, the layer which surrounds axons. The pathophysiology of MS is complex, with both demyelination and axonal degeneration contributing to what is essentially an inflammatory neurodegenerative disease. Axonal loss is increasingly being accepted as the histopathological correlate of neurological disability. Currently, the underpinnings of neurodegeneration in MS, and how to promote neuroprotection are only partly understood. No established treatments that directly reduce nervous system damage or enhance its repair are currently available. Moreover, the ability of currently available immunomodulatory therapies used to treat MS, such as interferon-beta, to prevent long-term disability is uncertain. Results from short-term randomized-controlled trials suggest a partial benefit with regards to disability outcomes, but this is yet to be established in long-term studies. Novel neuroprotective agents have been identified in preclinical studies but their development is being hampered by the absence of appropriate clinical platforms to test them. In this article, we will discuss some of the principal therapeutic candidates that could provide neuroprotection in MS and emerging methodologies by which to test them.
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Affiliation(s)
- Anneke Van der Walt
- The Royal Melbourne Hospital, Grattan St. Parkville, Melbourne, Australia; Centre for Neuroscience, University of Melbourne, Australia.
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41
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Lucas RM, Ponsonby AL, Dear K, Taylor BV, Dwyer T, McMichael AJ, Valery P, van der Mei I, Williams D, Pender MP, Chapman C, Coulthard A, Kilpatrick T. Associations between silicone skin cast score, cumulative sun exposure, and other factors in the ausimmune study: a multicenter Australian study. Cancer Epidemiol Biomarkers Prev 2009; 18:2887-94. [PMID: 19843682 DOI: 10.1158/1055-9965.epi-09-0191] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Past sun exposure is linked to a wide range of disease outcomes but is difficult to measure accurately. Silicone skin casts measure skin damage, but some studies show that age rather than sun exposure is the most important determinant of cast score. We examined skin damage scores from silicone casts of the back of the hand in a large adult sample (n = 534) with a broad range of past cumulative UV radiation (UVR) doses. Participants were ages 18 to 61 years and resided in one of four locations down the eastern Australian seaboard, spanning 27-43 degrees S. Data were collected by questionnaire and during a nurse-led interview and examination. Silicone casts were graded from 1 to 6, where higher score represents greater damage. Higher skin damage score was associated with lighter skin pigmentation [adjusted odds ratio (AOR), 4.51; 95% confidence interval (95% CI), 2.33-8.75], fairer natural hair color, particularly red hair (AOR, 11.31; 95% CI, 4.08-31.36), and blue/gray eyes (AOR, 1.72; 95% CI, 1.14-2.59). Higher cumulative UVR dose, particularly before age 18 years, was associated with higher skin damage score (AOR, 2.06; 95% CI, 1.15-2.67 per 1,000 KJ/m(2)), as was number of sunburns, even after adjustment for cumulative UVR dose (AOR, 2.86; 95% CI, 1.50-5.43 for >10 sunburns ever compared with no sunburns ever). Silicone casts of the dorsum of the hand provide a measure of cumulative UVR dose and number of sunburns over the lifetime, which persists after adjustment for chronological age. They can be used as an objective measure of cumulative past sun exposure in epidemiologic studies, but other determinants of skin damage, such as skin pigmentation, should be concurrently evaluated.
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Affiliation(s)
- Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra 0200, Australian Capital Territory, Australia.
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42
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Kilpatrick T. IN43-WE-02 Multiple sclerosis in pregnancy. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Fielding J, Kilpatrick T, Millist L, White O. Antisaccade performance in patients with multiple sclerosis. Cortex 2009; 45:900-3. [PMID: 19327763 DOI: 10.1016/j.cortex.2009.02.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/16/2009] [Accepted: 02/27/2009] [Indexed: 10/21/2022]
Abstract
Commonly used measures of disability in patients with Multiple sclerosis (MS) inadequately reflect disease severity and progression. Further, cognitive deficits experienced by up to 70% of patients, are poorly represented by these measures. Saccadic eye movements may provide a powerful tool for the analysis of cognitive changes in MS, providing a surrogate measure of performance that extends more conventional measures. The cognitive control of eye movements has not previously been investigated in patients with MS. We studied antisaccade (AS) performance in 25 patients with MS and compared the results with 25 age matched healthy controls, to evaluate the resolution of response conflict between volitional and automatic processes. Experimental measures were also correlated with a battery of neuropsychological tests evaluating attention, working memory and executive processes, the most commonly reported cognitive deficits in MS. Compared to controls, patients with MS generated significantly more prosaccade errors, and AS latencies were prolonged and more variable. Error rates correlated significantly with scores on the commonly used PASAT. MS patients also exhibited poor spatial accuracy, with mean absolute error significantly larger and more variable than control subjects. The sensitivity of this task in dissociating function in MS, as well as clear correlation with a key measure of cognition, suggests that eye movements, may provide a surrogate measure of cognitive function in MS, with the potential to sensitively assess disease severity and progression.
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Affiliation(s)
- Joanne Fielding
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
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Fielding J, Kilpatrick T, Millist L, White O. Control of visually guided saccades in multiple sclerosis: Disruption to higher-order processes. Neuropsychologia 2009; 47:1647-53. [PMID: 19397859 DOI: 10.1016/j.neuropsychologia.2009.01.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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: 09/10/2008] [Revised: 01/12/2009] [Accepted: 01/30/2009] [Indexed: 11/13/2022]
Abstract
Ocular motor abnormalities are a common feature of multiple sclerosis (MS), with more salient deficits reflecting tissue damage within brainstem and cerebellar circuits. However, MS may also result in disruption to higher level or cognitive control processes governing eye movement, including attentional processes that enhance the neural processing of behaviourally relevant information. The attentional control of eye movement was investigated in 25 individuals with MS and a comparable number of neurologically healthy individuals matched for age and IQ. This entailed an evaluation of distractor-related effects on the generation of both unpredictable and predictable visually guided saccades, as well as an evaluation of the effects of presenting endogenous cues prior to target onset. For unpredictable saccades, we revealed an exaggerated distractor effect in MS, with saccade latencies prolonged and endpoints less accurate in the presence of a visual distractor. Predictable saccades tended to be hypometric for MS patients, although we found no significant distractor effects. For endogenously cued saccades, we found no group differences in latency following a valid cue, but an exaggerated increase in latency following invalid cues for MS patients. MS patients also generated a significantly greater proportion of erroneous responses to cue stimuli. These ocular motor characteristics demonstrate considerable sensitivity with respect to evaluating attentional deficits in MS, evident even in the absence of clinical signs of disease.
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Affiliation(s)
- Joanne Fielding
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
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45
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Kolbe S, Chapman C, Nguyen T, Bajraszewski C, Johnston L, Kean M, Mitchell P, Paine M, Butzkueven H, Kilpatrick T, Egan G. Optic nerve diffusion changes and atrophy jointly predict visual dysfunction after optic neuritis. Neuroimage 2009; 45:679-86. [PMID: 19162205 DOI: 10.1016/j.neuroimage.2008.12.047] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 12/11/2008] [Accepted: 12/23/2008] [Indexed: 11/28/2022] Open
Abstract
Recently, there has been strong interest in the development of imaging techniques to quantify axonal and myelin pathology in patients with multiple sclerosis (MS). Optic neuritis, a condition characterised by inflammatory demyelination of the optic nerve, is one of the commonest sites of MS relapse, and exhibits similar pathological alterations to MS lesions elsewhere in the central nervous system (CNS). Unlike other regions of the CNS, however, the function of the optic nerve can be accurately assessed using clinical measures, as well as electrophysiological techniques such as visual evoked potential recordings. Therefore, optic neuritis is useful for investigating the relationship between abnormalities in optic nerve structure, assessed using magnetic resonance imaging (MRI), and visual dysfunction, assessed clinically and electrophysiologically. The aims of the present study were to assess optic nerve structural abnormalities in patients with a history of unilateral optic neuritis using MRI, and then to identify correlations between abnormalities in optic nerve MRI and visual dysfunction. Ten controls and sixteen patients underwent high resolution optic nerve diffusion tensor imaging (DTI), T2- and T1-weighted MRI. In addition, Snellen visual acuity and the latency and amplitude of multifocal visual evoked potentials (mfVEP) were tested in all patients. Diffusion and volumetric MRI indices were correlated to mfVEP functional indices. Significant abnormalities were detected in MRI and mfVEP measures in patients' affected nerves compared to unaffected optic nerves or optic nerves from healthy controls. Reduced mfVEP amplitude in the affected side significantly correlated with both affected optic nerve atrophy (R=0.58, p=0.02) and reduced fractional anisotropy (FA) (R=0.52, p=0.04). However, atrophy and reduced FA did not correlate with each other. To further investigate this disassociation, we used linear regression analysis with optic nerve atrophy and optic nerve FA as independent variables and mfVEP amplitude as the dependent variable. The resulting linear regression model was highly significant (R=0.819, p=0.001). These results show that, 4 years after unilateral optic neuritis, MRI-based measures of optic nerve structural abnormalities (decreased anisotropy and volume) independently predict visual dysfunction.
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Affiliation(s)
- Scott Kolbe
- The Howard Florey Institute, University of Melbourne, Melbourne, Australia.
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Fielding J, Kilpatrick T, Millist L, White O. Multiple sclerosis: Cognition and saccadic eye movements. J Neurol Sci 2008; 277:32-6. [PMID: 18977003 DOI: 10.1016/j.jns.2008.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
Ocular motor abnormalities are frequently reported in Multiple Sclerosis (MS), the most salient of which are well represented by the commonly used clinical measure, the EDSS. However, cognitive function, which is poorly represented by this scale, may also be ascertained from ocular motor measures, suggesting that an analysis of eye movements has the potential to extend and complement this more conventional measure. The generation of single and triple-step memory-guided saccades was investigated in 25 individuals with MS and a comparable number of neurologically healthy individuals matched for age and IQ. Experimental measures were correlated with a battery of neuropsychological tests evaluating attentional, working memory and executive processes, the cognitive domains most commonly compromised in MS. For single memory-guided saccades, MS patients were less accurate and generated more erroneous responses to non-target stimuli. Saccadic latencies were also prolonged. For triple-step memory-guided saccades, MS patients were less accurate and more variable. A number of significant correlations were revealed between measures of each of these characteristics and scores on the range of neuropsychological assessments. These ocular motor measures demonstrate considerable sensitivity with respect to evaluating cognitive function in MS, particularly working memory and inhibitory control processes. This suggests that they could represent the foundation of a user-friendly surrogate marker of disease severity and progression in MS.
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Affiliation(s)
- Joanne Fielding
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
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47
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48
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Affiliation(s)
- F Khan
- Department of Rehabilitation Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville VIC 3052, Australia.
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Abstract
BACKGROUND Multidisciplinary rehabilitation (MD) is an important component of symptomatic and supportive treatment for Multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established. OBJECTIVES To assess the effectiveness of organized MD rehabilitation in adults with MS. To explore rehabilitation approaches that are effective in different settings and the outcomes that are affected. SEARCH STRATEGY The sources used included: Cochrane Central Register of Controlled Trials "CENTRAL", MEDLINE (1966- 2005), CINAHL (1982- 2005), PEDro (1990- 2005), EMBASE (1988- 2005), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register (NRR). SELECTION CRITERIA Randomized and controlled clinical trials that compared MD rehabilitation with routinely available local services or lower levels of intervention; or trials comparing interventions in different settings or at different levels of intensity. DATA COLLECTION AND ANALYSIS Three reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis based on methodological quality was performed. Trials were grouped in terms of setting and type of rehabilitation and duration of patient follow up. MAIN RESULTS Eight trials (7 RCTs; 1 CCT) (747 participants and 73 caregivers) were identified. Seven RCTs scored well and one CCT scored poorly on the methodological quality assessment. There was 'strong evidence' that despite no change in the level of impairment, inpatient MD rehabilitation can produce short-term gains at the levels of activity (disability) and participation for patients with MS. For outpatient and home-based rehabilitation programmes there was 'limited evidence' for short-term improvements in symptoms and disability with high intensity programmes, which translated into improvement in participation and quality of life. For low intensity programmes conducted over a longer period there was strong evidence for longer-term gains in quality of life; and also limited evidence for benefits to carers. Although some studies reported potential for cost-savings, there is no convincing evidence regarding the long-term cost-effectiveness of these programmes. It was not possible to suggest best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials. AUTHORS' CONCLUSIONS MD rehabilitation programmes do not change the level of impairment, but can improve the experience of people with MS in terms of activity and participation. Regular evaluation and assessment of these persons for rehabilitation is recommended. Further research into appropriate outcome measures, optimal intensity, frequency, cost and effectiveness of rehabilitation therapy over a longer time period is needed. Future research in rehabilitation should focus on improving methodological and scientific rigour of clinical trials.
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Affiliation(s)
- F Khan
- University of Melbourne, Department of Rehabilitation Medicine, Poplar Road, Parkville, Melbourne, Victoria, Australia, 3052.
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50
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van der Mei IAF, Ponsonby AL, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ. Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol 2007; 254:581-90. [PMID: 17426912 DOI: 10.1007/s00415-006-0315-8] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 02/02/2006] [Accepted: 05/11/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adequate 25(OH)D levels are required to prevent adverse effects on bone health. Population-based data on factors associated with 25(OH)D levels of people with MS have been lacking. OBJECTIVES To examine the prevalence and determinants of vitamin D insufficiency in a population-based sample of MS cases and controls, and to compare 25(OH)D status between MS cases and controls, taking into account case disability. METHODS We conducted a population based case-control study in Tasmania, Australia (latitude 41-43 degrees S) on 136 prevalent cases with MS confirmed by magnetic resonance imaging and 272 community controls, matched on sex and year of birth. Measurements included serum 25(OH)D, sun exposure, skin type, dietary vitamin D intake and disability including EDSS. RESULTS A high prevalence of vitamin D insufficiency was found in MS cases and controls. Among MS cases, increasing disability was strongly associated with lower levels of 25(OH)D and with reduced sun exposure. Cases with higher disability (EDSS > 3) were more likely to have vitamin D insufficiency than controls (OR = 3.07 (1.37, 6.90) for 25(OH)D </= 40 nmol/l), but cases with low disability were not (OR = 0.87 (0.41, 1.86)). CONCLUSION The strong associations between disability, sun exposure and vitamin D status indicate that reduced exposure to the sun, related to higher disability, may contribute to the high prevalence of vitamin D insufficiency found in this population-based MS case sample. Active detection of vitamin D insufficiency among people with MS and intervention to restore vitamin D status to adequate levels should be considered as part of the clinical management of MS.
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Affiliation(s)
- I A F van der Mei
- Menzies Research Institute, Private Bag 23, Hobart, Tasmania, 7001, Australia.
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