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Sarasso E, Emedoli D, Gardoni A, Zenere L, Canu E, Basaia S, Doretti A, Ticozzi N, Iannaccone S, Amadio S, Del Carro U, Filippi M, Agosta F. Cervical motion alterations and brain functional connectivity in cervical dystonia. Parkinsonism Relat Disord 2024; 120:106015. [PMID: 38325256 DOI: 10.1016/j.parkreldis.2024.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Evaluating the neural correlates of sensorimotor control deficits in cervical dystonia (CD) is fundamental to plan the best treatment. This study aims to assess kinematic and resting-state functional connectivity (RS-FC) characteristics in CD patients relative to healthy controls. METHODS Seventeen CD patients and 14 age-/sex-matched healthy controls were recruited. Electromagnetic sensors were used to evaluate dystonic pattern, mean/maximal cervical movement amplitude and joint position error with eyes open and closed, and movement quality during target reaching with the head. RS-fMRI was acquired to compare the FC of brain sensorimotor regions between patients and controls. In patients, correlations between motion analysis and FC data were assessed. RESULTS CD patients relative to controls showed reduced mean and maximal cervical range of motion (RoM) in rotation both towards and against dystonia pattern and reduced total RoM in rotation both with eyes open and closed. They had less severe dystonia pattern with eyes open vs eyes closed. CD patients showed an altered movement quality and sensorimotor control during target reaching and a higher joint position error. Compared to controls, CD patients showed reduced FC between supplementary motor area (SMA), occipital and cerebellar areas, which correlated with lower cervical RoM in rotation both with eyes open and closed and with worse movement quality during target reaching. CONCLUSIONS FC alterations between SMA and occipital and cerebellar areas may represent the neural basis of cervical sensorimotor control deficits in CD patients. Electromagnetic sensors and RS-fMRI might be promising tools to monitor CD and assess the efficacy of rehabilitative interventions.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Daniele Emedoli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Zenere
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Amadio
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Touvier T, Veneri FA, Claessens A, Ferri C, Mastrangelo R, Sorgiati N, Bianchi F, Valenzano S, Del Carro U, Rivellini C, Duong P, Shy ME, Kelly JW, Svaren J, Wiseman RL, D'Antonio M. Activation of XBP1s attenuates disease severity in models of proteotoxic Charcot-Marie-Tooth type 1B. bioRxiv 2024:2024.01.31.577760. [PMID: 38352425 PMCID: PMC10862880 DOI: 10.1101/2024.01.31.577760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Mutations in myelin protein zero (MPZ) are generally associated with Charcot-Marie-Tooth type 1B (CMT1B) disease, one of the most common forms of demyelinating neuropathy. Pathogenesis of some MPZ mutants, such as S63del and R98C, involves the misfolding and retention of MPZ in the endoplasmic reticulum (ER) of myelinating Schwann cells. To cope with proteotoxic ER-stress, Schwann cells mount an unfolded protein response (UPR) characterized by activation of the PERK, ATF6 and IRE1α/XBP1 pathways. Previous results showed that targeting the PERK UPR pathway mitigates neuropathy in mouse models of CMT1B; however, the contributions of other UPR pathways in disease pathogenesis remains poorly understood. Here, we probe the importance of the IRE1α/XBP1 signalling during normal myelination and in CMT1B. In response to ER stress, IRE1α is activated to stimulate the non-canonical splicing of Xbp1 mRNA to generate spliced Xbp1 (Xbp1s). This results in the increased expression of the adaptive transcription factor XBP1s, which regulates the expression of genes involved in diverse pathways including ER proteostasis. We generated mouse models where Xbp1 is deleted specifically in Schwann cells, preventing XBP1s activation in these cells. We observed that Xbp1 is dispensable for normal developmental myelination, myelin maintenance and remyelination after injury. However, Xbp1 deletion dramatically worsens the hypomyelination and the electrophysiological and locomotor parameters observed in young and adult CMT1B neuropathic animals. RNAseq analysis suggested that XBP1s exerts its adaptive function in CMT1B mouse models in large part via the induction of ER proteostasis genes. Accordingly, the exacerbation of the neuropathy in Xbp1 deficient mice was accompanied by upregulation of ER-stress pathways and of IRE1-mediated RIDD signaling in Schwann cells, suggesting that the activation of XBP1s via IRE1 plays a critical role in limiting mutant protein toxicity and that this toxicity cannot be compensated by other stress responses. Schwann cell specific overexpression of XBP1s partially re-established Schwann cell proteostasis and attenuated CMT1B severity in both the S63del and R98C mouse models. In addition, the selective, pharmacologic activation of IRE1α/XBP1 signaling ameliorated myelination in S63del dorsal root ganglia explants. Collectively, these data show that XBP1 has an essential adaptive role in different models of proteotoxic CMT1B neuropathy and suggest that activation of the IRE1α/XBP1 pathway may represent a therapeutic avenue in CMT1B and possibly for other neuropathies characterized by UPR activation.
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Affiliation(s)
- Thierry Touvier
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Francesca A Veneri
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Anke Claessens
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Cinzia Ferri
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Rosa Mastrangelo
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Noémie Sorgiati
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Francesca Bianchi
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Serena Valenzano
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157 Milan, Italy
- University of Camerino, Center for Neuroscience, 62032 Camerino, Italy
| | - Ubaldo Del Carro
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Cristina Rivellini
- Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Phu Duong
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242 USA
| | - Jeffery W Kelly
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA 92037, USA
- The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - John Svaren
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - R Luke Wiseman
- Department of Molecular and Cellular Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Maurizio D'Antonio
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Bhat GP, Maurizio A, Motta A, Podini P, Diprima S, Malpighi C, Brambilla I, Martins L, Badaloni A, Boselli D, Bianchi F, Pellegatta M, Genua M, Ostuni R, Del Carro U, Taveggia C, de Pretis S, Quattrini A, Bonanomi D. Structured wound angiogenesis instructs mesenchymal barrier compartments in the regenerating nerve. Neuron 2024; 112:209-229.e11. [PMID: 37972594 DOI: 10.1016/j.neuron.2023.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
Organ injury stimulates the formation of new capillaries to restore blood supply raising questions about the potential contribution of neoangiogenic vessel architecture to the healing process. Using single-cell mapping, we resolved the properties of endothelial cells that organize a polarized scaffold at the repair site of lesioned peripheral nerves. Transient reactivation of an embryonic guidance program is required to orient neovessels across the wound. Manipulation of this structured angiogenic response through genetic and pharmacological targeting of Plexin-D1/VEGF pathways within an early window of repair has long-term impact on configuration of the nerve stroma. Neovessels direct nerve-resident mesenchymal cells to mold a provisionary fibrotic scar by assembling an orderly system of stable barrier compartments that channel regenerating nerve fibers and shield them from the persistently leaky vasculature. Thus, guided and balanced repair angiogenesis enables the construction of a "bridge" microenvironment conducive for axon regrowth and homeostasis of the regenerated tissue.
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Affiliation(s)
- Ganesh Parameshwar Bhat
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Aurora Maurizio
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessia Motta
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Paola Podini
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Santo Diprima
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Malpighi
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Ilaria Brambilla
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Luis Martins
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Aurora Badaloni
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Daniela Boselli
- FRACTAL-Flow cytometry Resource Advanced Cytometry Technical Applications Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Bianchi
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Marta Pellegatta
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Marco Genua
- San Raffaele Telethon Institute for Gene therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Renato Ostuni
- San Raffaele Telethon Institute for Gene therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Carla Taveggia
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Stefano de Pretis
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Angelo Quattrini
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Dario Bonanomi
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
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Schito P, Russo T, Domi T, Mandelli A, Pozzi L, Del Carro U, Carrera P, Agosta F, Quattrini A, Furlan R, Filippi M, Riva N. Clinical Features and Biomarkers to Differentiate Primary and Amyotrophic Lateral Sclerosis in Patients With an Upper Motor Neuron Syndrome. Neurology 2023; 101:352-356. [PMID: 36927885 PMCID: PMC10449441 DOI: 10.1212/wnl.0000000000207223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Differentiation between primary (PLS) and amyotrophic lateral sclerosis (ALS) entails relevant consequences for prognosis and management but is mostly unreliable at early stages. The objectives of the study are (1) to determine the features at onset that could help to differentiate between PLS and ALS, (2) to evaluate the diagnostic performance of an integrated serum biomarker panel, and (3) to identify the prognostic factors for patients presenting with upper motor neuron (UMN) syndrome. METHODS We selected and retrospectively analyzed the clinical data of patients presenting with UMN syndrome. At the first evaluation, when available, serum biomarkers were measured using ultrasensitive single molecule array. RESULTS The study population included 55 patients with PLS and 50 patients with ALS. Patients with PLS presented a longer time to first neurologic evaluation (PLS: 35.0 months, interquartile range [IQR] 17.0-38.0 months; ALS: 12.5 months, IQR 7.0-21.3 months; p < 0.01) and lower levels of neurofilament light chain (NfL) (PLS: 81.8 pg/mL, IQR 38.4-111.1 pg/mL; ALS: 155.9 pg/mL, IQR 85.1-366.4 pg/mL; p = 0.01). Two patients with PLS and 3 patients with ALS carried the C9orf72 expansion. NfL resulted an independent predictor of final diagnosis (odds ratio 1.01, 95% CI 1.00-1.02; p = 0.04) and an independent prognostic factor (hazard ratio 1.01, 95% CI 1.00-1.01; p < 0.01). DISCUSSION NfL might help to differentiate patients with PLS from patients with ALS and to predict prognosis in patients with UMN syndrome.
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Affiliation(s)
- Paride Schito
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tommaso Russo
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Teuta Domi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Mandelli
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Pozzi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ubaldo Del Carro
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Carrera
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Agosta
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angelo Quattrini
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Furlan
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Filippi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nilo Riva
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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5
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Cutillo G, Bonacchi R, Cecchetti G, Bellini A, Vabanesi M, Zambon A, Natali Sora MG, Baldoli C, Del Carro U, Minicucci F, Fanelli GF, Filippi M. Interstitial 6q deletion in a patient presenting with drug-resistant epilepsy and Prader-Willi like phenotype: An electroclinical description with literature review. Seizure 2023; 109:45-49. [PMID: 37210930 DOI: 10.1016/j.seizure.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023] Open
Abstract
PURPOSE Interstitial 6q deletions are associated with rare genetic syndromes characterized by different signs, including developmental delay, dysmorphisms, and Prader-Willi (PWS)-like features. Drug-resistant epilepsy, a relatively rare finding in this condition, is often a challenge in terms of therapeutic approach. Our aim is to present a new case of interstitial 6q deletion and to conduct a systematic review of the literature with an emphasis on the neurophysiological and clinical traits of afflicted individuals. METHODS We report a patient with an interstitial 6q deletion. Standard electroencephalograms (EEG), video-EEG with polygraphy and MRI features are discussed. We also conducted a literature review of previously described cases. RESULTS We describe a relatively small interstitial 6q deletion (2 Mb circa), detected by CGH-Array, not encompassing the previously described 6q22 critical region for epilepsy occurrence. The patient, a 12-year-old girl, presented with multiple absence-like episodes and startle-induced epileptic spasms since the age of 11, with partial polytherapy control. Treatment with lamotrigine induced the resolution of startle-induced phenomena. From the literature review, we identified 28 patients with overlapping deletions, often larger than our patient's mutation. Seventeen patients presented with PWS-like features. Epilepsy was reported in 4 patients, and 8 patients presented abnormal EEG findings. In our patient, the deletion included genes MCHR2, SIM1, ASCC3, and GRIK2, but, interestingly, it did not encompass the 6q22 critical region for epilepsy occurrence. The involvement of GRIK2 in the deletion may play a role. CONCLUSION Literature data are limited, and specific EEG or epileptological phenotypes cannot yet be identified. Epilepsy, although uncommon in the syndrome, deserves a specific diagnostic workup. We speculate on the existence of an additional locus in the 6q16.1-q21 region, different from the already hypothesized q22, promoting the development of epilepsy in affected patients.
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Affiliation(s)
- Gianni Cutillo
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaello Bonacchi
- Vita-Salute San Raffaele University, Milan, Italy; Neuroradiology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giordano Cecchetti
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Bellini
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Vabanesi
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zambon
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Grazia Natali Sora
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ubaldo Del Carro
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Minicucci
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanna F Fanelli
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Filippi
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy; Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.
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6
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Veneri FA, Prada V, Mastrangelo R, Ferri C, Nobbio L, Passalacqua M, Milanesi M, Bianchi F, Del Carro U, Vallat JM, Duong P, Svaren J, Schenone A, Grandis M, D’Antonio M. A novel mouse model of CMT1B identifies hyperglycosylation as a new pathogenetic mechanism. Hum Mol Genet 2022; 31:4255-4274. [PMID: 35908287 PMCID: PMC9759335 DOI: 10.1093/hmg/ddac170] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/21/2023] Open
Abstract
Mutations in the Myelin Protein Zero gene (MPZ), encoding P0, the major structural glycoprotein of peripheral nerve myelin, are the cause of Charcot-Marie-Tooth (CMT) type 1B neuropathy, and most P0 mutations appear to act through gain-of-function mechanisms. Here, we investigated how misglycosylation, a pathomechanism encompassing several genetic disorders, may affect P0 function. Using in vitro assays, we showed that gain of glycosylation is more damaging for P0 trafficking and functionality as compared with a loss of glycosylation. Hence, we generated, via CRISPR/Cas9, a mouse model carrying the MPZD61N mutation, predicted to generate a new N-glycosylation site in P0. In humans, MPZD61N causes a severe early-onset form of CMT1B, suggesting that hyperglycosylation may interfere with myelin formation, leading to pathology. We show here that MPZD61N/+ mice develop a tremor as early as P15 which worsens with age and correlates with a significant motor impairment, reduced muscular strength and substantial alterations in neurophysiology. The pathological analysis confirmed a dysmyelinating phenotype characterized by diffuse hypomyelination and focal hypermyelination. We find that the mutant P0D61N does not cause significant endoplasmic reticulum stress, a common pathomechanism in CMT1B, but is properly trafficked to myelin where it causes myelin uncompaction. Finally, we show that myelinating dorsal root ganglia cultures from MPZD61N mice replicate some of the abnormalities seen in vivo, suggesting that they may represent a valuable tool to investigate therapeutic approaches. Collectively, our data indicate that the MPZD61N/+ mouse represents an authentic model of severe CMT1B affirming gain-of-glycosylation in P0 as a novel pathomechanism of disease.
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Affiliation(s)
- Francesca A Veneri
- Biology of Myelin Unit, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, 16132 Genova, Italy
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, 16132 Genova, Italy
| | - Rosa Mastrangelo
- Biology of Myelin Unit, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Cinzia Ferri
- Biology of Myelin Unit, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Lucilla Nobbio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, 16132 Genova, Italy
| | - Mario Passalacqua
- Department of Experimental Medicine, University of Genova, 16132 Genova, Italy
| | - Maria Milanesi
- Experimental Oncology and Immunology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Francesca Bianchi
- Movement Disorders Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Ubaldo Del Carro
- Movement Disorders Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for ‘Rare Peripheral Neuropathies’, University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, 87000 Limoges, France
| | - Phu Duong
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - John Svaren
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, 16132 Genova, Italy,Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Marina Grandis
- To whom correspondence should be addressed at: Department of Neurology, IRCCS Ospedale Policlinico San Martino, Largo Daneo 3, 16132 Genova, Italy. Tel: +39 010 3537562; (M.G.); San Raffaele Scientific Institute, DIBIT, via Olgettina 58, 20132 Milan, Italy. Tel: +39 02 26435307; (M.D.)
| | - Maurizio D’Antonio
- To whom correspondence should be addressed at: Department of Neurology, IRCCS Ospedale Policlinico San Martino, Largo Daneo 3, 16132 Genova, Italy. Tel: +39 010 3537562; (M.G.); San Raffaele Scientific Institute, DIBIT, via Olgettina 58, 20132 Milan, Italy. Tel: +39 02 26435307; (M.D.)
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7
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Filosto M, Cotti Piccinelli S, Gazzina S, Foresti C, Frigeni B, Servalli MC, Sessa M, Cosentino G, Marchioni E, Ravaglia S, Briani C, Castellani F, Zara G, Bianchi F, Del Carro U, Fazio R, Filippi M, Magni E, Natalini G, Palmerini F, Perotti AM, Bellomo A, Osio M, Nascimbene C, Carpo M, Rasera A, Squintani G, Doneddu PE, Bertasi V, Cotelli MS, Bertolasi L, Fabrizi GM, Ferrari S, Ranieri F, Caprioli F, Grappa E, Manganotti P, Bellavita G, Furlanis G, De Maria G, Leggio U, Poli L, Rasulo F, Latronico N, Nobile-Orazio E, Beghi E, Padovani A, Uncini A. Guillain-Barré Syndrome and COVID-19: a one-year observational multicenter study. Eur J Neurol 2022; 29:3358-3367. [PMID: 35837806 PMCID: PMC9349567 DOI: 10.1111/ene.15497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/04/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023]
Abstract
Background and purpose Many single cases and small series of Guillain–Barré syndrome (GBS) associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection were reported during the coronavirus disease 19 (COVID‐19) outbreak worldwide. However, the debate regarding the possible role of infection in causing GBS is still ongoing. This multicenter study aimed to evaluate epidemiological and clinical findings of GBS diagnosed during the COVID‐19 pandemic in northeastern Italy in order to further investigate the possible association between GBS and COVID‐19. Methods Guillain–Barré syndrome cases diagnosed in 14 referral hospitals from northern Italy between March 2020 and March 2021 were collected and divided into COVID‐19‐positive and COVID‐19‐negative. As a control population, GBS patients diagnosed in the same hospitals from January 2019 to February 2020 were considered. Results The estimated incidence of GBS in 2020 was 1.41 cases per 100,000 persons/year (95% confidence interval 1.18–1.68) versus 0.89 cases per 100,000 persons/year (95% confidence interval 0.71–1.11) in 2019. The cumulative incidence of GBS increased by 59% in the period March 2020–March 2021 and, most importantly, COVID‐19‐positive GBS patients represented about 50% of the total GBS cases with most of them occurring during the two first pandemic waves in spring and autumn 2020. COVID‐19‐negative GBS cases from March 2020 to March 2021 declined by 22% compared to February 2019–February 2020. Conclusions Other than showing an increase of GBS in northern Italy in the “COVID‐19 era” compared to the previous year, this study emphasizes how GBS cases related to COVID‐19 represent a significant part of the total, thus suggesting a relation between COVID‐19 and GBS.
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Affiliation(s)
- Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Stefano Gazzina
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Camillo Foresti
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Barbara Frigeni
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | | | - Maria Sessa
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Giuseppe Cosentino
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Enrico Marchioni
- IRCCS Mondino Foundation, Neurooncology and Neuroinflammation Unit, Pavia, Italy
| | - Sabrina Ravaglia
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Chiara Briani
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | - Gabriella Zara
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Francesca Bianchi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Raffaella Fazio
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Eugenio Magni
- Unit of Neurology, Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Natalini
- Unit of Intensive Care and Anesthesiology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Andrea Bellomo
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Maurizio Osio
- Unit of Neurology, ASST Fatebenefratelli Sacco, Milano
| | | | | | | | | | - Pietro Emiliano Doneddu
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
| | | | | | - Laura Bertolasi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Elena Grappa
- Intensive Care Unit, ASST Cremona, Cremona, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giulia Bellavita
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | | | - Ugo Leggio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Eduardo Nobile-Orazio
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
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8
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Falzone YM, Domi T, Mandelli A, Pozzi L, Schito P, Russo T, Barbieri A, Fazio R, Volontè MA, Magnani G, Del Carro U, Carrera P, Malaspina A, Agosta F, Quattrini A, Furlan R, Filippi M, Riva N. Integrated evaluation of a panel of neurochemical biomarkers to optimize diagnosis and prognosis in amyotrophic lateral sclerosis. Eur J Neurol 2022; 29:1930-1939. [PMID: 35263489 PMCID: PMC9314044 DOI: 10.1111/ene.15321] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to determine the diagnostic and prognostic value of a panel of serum biomarkers and to correlate their concentrations with several clinical parameters in a large cohort of patients with amyotrophic lateral sclerosis (ALS). METHODS One hundred forty-three consecutive patients with ALS and a control cohort consisting of 70 patients with other neurodegenerative disorders (DEG), 70 patients with ALS mimic disorders (ALSmd), and 45 healthy controls (HC) were included. Serum neurofilament light chain (NfL), ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1), glial fibrillary acidic protein (GFAP), and total tau protein levels were measured using ultrasensitive single molecule array. RESULTS NfL correlated with disease progression rate (p < 0.001) and with the measures of upper motor neuron burden (p < 0.001). NfL was higher in the ALS patients with classic and pyramidal phenotype. GFAP was raised in ALS with cognitive-behavioral impairment compared with ALS with normal cognition. NfL displayed the best diagnostic performance in discriminating ALS from HC (area under the curve [AUC] = 0.990), DEG (AUC = 0.946), and ALSmd (AUC = 0.850). UCHL1 performed well in distinguishing ALS from HC (AUC = 0.761), whereas it was not helpful in differentiating ALS from DEG and ALSmd. In multivariate analysis, NfL (p < 0.001) and UCHL1 (p = 0.038) were independent prognostic factors. Survival analysis combining NfL and UCHL1 effectively stratified patients with lower NfL levels (p < 0.001). CONCLUSIONS NfL is a useful biomarker for the diagnosis of ALS and the strongest predictor of survival. UCHL1 is an independent prognostic factor helpful in stratifying survival in patients with low NfL levels, likely to have slowly progressive disease. GFAP reflects extramotor involvement, namely cognitive impairment or frontotemporal dementia.
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Affiliation(s)
- Yuri Matteo Falzone
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Teuta Domi
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
| | - Alessandra Mandelli
- Clinical Neuroimmunology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
| | - Laura Pozzi
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
| | - Paride Schito
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Tommaso Russo
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Alessandra Barbieri
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Raffaella Fazio
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Maria Antonietta Volontè
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Giuseppe Magnani
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Ubaldo Del Carro
- Neurophysiology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Paola Carrera
- Unit of Genomics for Human Disease DiagnosisLaboratory of Clinical Molecular BiologyDivision of Genetics and Cell BiologySan Raffaele Hospital, Scientific Institute for Research and Health CareMilanItaly
| | - Andrea Malaspina
- Centre for Neuroscience and TraumaBlizard InstituteQueen Mary University of LondonLondonUK
| | - Federica Agosta
- Neuroimaging Research UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Angelo Quattrini
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
| | - Roberto Furlan
- Clinical Neuroimmunology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
| | - Massimo Filippi
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
- Neurophysiology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
- Neuroimaging Research UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
- Neurorehabilitation UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
| | - Nilo Riva
- Experimental Neuropathology UnitDivision of NeuroscienceInstitute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- Neurology UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
- Neurorehabilitation UnitSan Raffaele Scientific Institute, Scientific Institute for Research and Health CareMilanItaly
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9
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Bai Y, Treins C, Volpi VG, Scapin C, Ferri C, Mastrangelo R, Touvier T, Florio F, Bianchi F, Del Carro U, Baas FF, Wang D, Miniou P, Guedat P, Shy ME, D'Antonio M. Treatment with IFB-088 Improves Neuropathy in CMT1A and CMT1B Mice. Mol Neurobiol 2022; 59:4159-4178. [PMID: 35501630 PMCID: PMC9167212 DOI: 10.1007/s12035-022-02838-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/09/2022] [Indexed: 11/24/2022]
Abstract
Charcot-Marie-Tooth disease type 1A (CMT1A), caused by duplication of the peripheral myelin protein 22 (PMP22) gene, and CMT1B, caused by mutations in myelin protein zero (MPZ) gene, are the two most common forms of demyelinating CMT (CMT1), and no treatments are available for either. Prior studies of the MpzSer63del mouse model of CMT1B have demonstrated that protein misfolding, endoplasmic reticulum (ER) retention and activation of the unfolded protein response (UPR) contributed to the neuropathy. Heterozygous patients with an arginine to cysteine mutation in MPZ (MPZR98C) develop a severe infantile form of CMT1B which is modelled by MpzR98C/ + mice that also show ER stress and an activated UPR. C3-PMP22 mice are considered to effectively model CMT1A. Altered proteostasis, ER stress and activation of the UPR have been demonstrated in mice carrying Pmp22 mutations. To determine whether enabling the ER stress/UPR and readjusting protein homeostasis would effectively treat these models of CMT1B and CMT1A, we administered Sephin1/IFB-088/icerguestat, a UPR modulator which showed efficacy in the MpzS63del model of CMT1B, to heterozygous MpzR98C and C3-PMP22 mice. Mice were analysed by behavioural, neurophysiological, morphological and biochemical measures. Both MpzR98C/ + and C3-PMP22 mice improved in motor function and neurophysiology. Myelination, as demonstrated by g-ratios and myelin thickness, improved in CMT1B and CMT1A mice and markers of UPR activation returned towards wild-type values. Taken together, our results demonstrate the capability of IFB-088 to treat a second mouse model of CMT1B and a mouse model of CMT1A, the most common form of CMT. Given the recent benefits of IFB-088 treatment in amyotrophic lateral sclerosis and multiple sclerosis animal models, these data demonstrate its potential in managing UPR and ER stress for multiple mutations in CMT1 as well as in other neurodegenerative diseases.
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Affiliation(s)
- Yunhong Bai
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | | | - Vera G Volpi
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Cristina Scapin
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Cinzia Ferri
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Rosa Mastrangelo
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Thierry Touvier
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Francesca Florio
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Francesca Bianchi
- Division of Neuroscience, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy
| | - Frank F Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - David Wang
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | | | | | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Maurizio D'Antonio
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute DIBIT, 20132, Milan, Italy.
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10
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Mascia D, Kahlberg A, Tinaglia S, Pena A, Morgad DE Freitas D, Del Carro U, Bosco L, Monaco F, DE Luca M, Chiesa R, Melissano G. Intraoperative electroneurography-guided intercostal nerve cryoablation for pain control after thoracoabdominal aneurysm open surgical repair. INT ANGIOL 2022; 41:128-135. [PMID: 35112827 DOI: 10.23736/s0392-9590.22.04817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative pain after thoracoabdominal (TAAA) or thoracic (TAA) aortic aneurysm open surgical repair may be debilitating and induce limitations in mobilization resulting in a longer length of stay, higher rate of pulmonary adverse events, readmissions and a higher risk of mortality. Commonly employed analgesic strategies do not completely solve this issue and have their own drawbacks. Cryoablation of intercostal nerves has been proposed as an appealing alternative to address the post-operative pain. METHODS Between 2020 and 2021, data of all consecutive patients undergoing TAA or TAAA aortic aneurysms open repair with electroneurography-guided cryoablation of intercostal nerves were collected. Post-operative pain was recorded using patient-reported 0-10 numeric rating scale (NRS). Need for adjunctive opioid drugs and postoperative complications were also recorded. Narcotic usage was calculated as Morphine Milligram Equivalents (MMEs) per day. RESULTS A total of 15 patients (8 males, mean age 61.1-year-old) underwent open surgical repair for TAAA (13 cases) or TAA (2 cases) and received intercostal nerve cryoablation. There were no intraoperative deaths and cases of spinal cord ischemia. Overall, 70 intercostal nerves underwent electroneurography-guided cryoablation, with a a mean of 4.6 nerves per patient. On the first day after extubation, mean NRS was 4.6 and the MMEs calculated was 6.7, decreasing over the days. There was one case of pneumonia and atelectasis requiring bronchoscopy. There were no reported bowel complications. The mean postoperative length of stay was 16 days and in the intensive care unit stay was 6.5 days. CONCLUSIONS Electroneurography-guided cryoablation of intercostal nerves is a safe and reproducible technique which can be used in addition to systemic pain management for TAA and TAAA open repair.
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Affiliation(s)
- Daniele Mascia
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy -
| | - Andrea Kahlberg
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah Tinaglia
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Americo Pena
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Dhaniel Morgad DE Freitas
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Luca Bosco
- Neurology Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Fabrizio Monaco
- Anesthesiology Department, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milano, Italy
| | - Monica DE Luca
- Anesthesiology Department, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milano, Italy
| | - Roberto Chiesa
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Germano Melissano
- Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
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11
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Fumagalli F, Calbi V, Natali Sora MG, Sessa M, Baldoli C, Rancoita PMV, Ciotti F, Sarzana M, Fraschini M, Zambon AA, Acquati S, Redaelli D, Attanasio V, Miglietta S, De Mattia F, Barzaghi F, Ferrua F, Migliavacca M, Tucci F, Gallo V, Del Carro U, Canale S, Spiga I, Lorioli L, Recupero S, Fratini ES, Morena F, Silvani P, Calvi MR, Facchini M, Locatelli S, Corti A, Zancan S, Antonioli G, Farinelli G, Gabaldo M, Garcia-Segovia J, Schwab LC, Downey GF, Filippi M, Cicalese MP, Martino S, Di Serio C, Ciceri F, Bernardo ME, Naldini L, Biffi A, Aiuti A. Lentiviral haematopoietic stem-cell gene therapy for early-onset metachromatic leukodystrophy: long-term results from a non-randomised, open-label, phase 1/2 trial and expanded access. Lancet 2022; 399:372-383. [PMID: 35065785 PMCID: PMC8795071 DOI: 10.1016/s0140-6736(21)02017-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Effective treatment for metachromatic leukodystrophy (MLD) remains a substantial unmet medical need. In this study we investigated the safety and efficacy of atidarsagene autotemcel (arsa-cel) in patients with MLD. METHODS This study is an integrated analysis of results from a prospective, non-randomised, phase 1/2 clinical study and expanded-access frameworks. 29 paediatric patients with pre-symptomatic or early-symptomatic early-onset MLD with biochemical and molecular confirmation of diagnosis were treated with arsa-cel, a gene therapy containing an autologous haematopoietic stem and progenitor cell (HSPC) population transduced ex vivo with a lentiviral vector encoding human arylsulfatase A (ARSA) cDNA, and compared with an untreated natural history (NHx) cohort of 31 patients with early-onset MLD, matched by age and disease subtype. Patients were treated and followed up at Ospedale San Raffaele, Milan, Italy. The coprimary efficacy endpoints were an improvement of more than 10% in total gross motor function measure score at 2 years after treatment in treated patients compared with controls, and change from baseline of total peripheral blood mononuclear cell (PBMC) ARSA activity at 2 years after treatment compared with values before treatment. This phase 1/2 study is registered with ClinicalTrials.gov, NCT01560182. FINDINGS At the time of analyses, 26 patients treated with arsa-cel were alive with median follow-up of 3·16 years (range 0·64-7·51). Two patients died due to disease progression and one due to a sudden event deemed unlikely to be related to treatment. After busulfan conditioning, all arsa-cel treated patients showed sustained multilineage engraftment of genetically modified HSPCs. ARSA activity in PBMCs was significantly increased above baseline 2 years after treatment by a mean 18·7-fold (95% CI 8·3-42·2; p<0·0001) in patients with the late-infantile variant and 5·7-fold (2·6-12·4; p<0·0001) in patients with the early-juvenile variant. Mean differences in total scores for gross motor function measure between treated patients and age-matched and disease subtype-matched NHx patients 2 years after treatment were significant for both patients with late-infantile MLD (66% [95% CI 48·9-82·3]) and early-juvenile MLD (42% [12·3-71·8]). Most treated patients progressively acquired motor skills within the predicted range of healthy children or had stabilised motor performance (maintaining the ability to walk). Further, most displayed normal cognitive development and prevention or delay of central and peripheral demyelination and brain atrophy throughout follow-up; treatment benefits were particularly apparent in patients treated before symptom onset. The infusion was well tolerated and there was no evidence of abnormal clonal proliferation or replication-competent lentivirus. All patients had at least one grade 3 or higher adverse event; most were related to conditioning or to background disease. The only adverse event related to arsa-cel was the transient development of anti-ARSA antibodies in four patients, which did not affect clinical outcomes. INTERPRETATION Treatment with arsa-cel resulted in sustained, clinically relevant benefits in children with early-onset MLD by preserving cognitive function and motor development in most patients, and slowing demyelination and brain atrophy. FUNDING Orchard Therapeutics, Fondazione Telethon, and GlaxoSmithKline.
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Affiliation(s)
- Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maria V Rancoita
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Ciotti
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Fraschini
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Andrea Zambon
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Acquati
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Redaelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vanessa Attanasio
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Miglietta
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabiola De Mattia
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vera Gallo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Specialistic Neurological Rehabilitation, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Ivana Spiga
- Clinical Molecular Biology Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Sophia Fratini
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Morena
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Locatelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ambra Corti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Zancan
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gigliola Antonioli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Gabaldo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Neurorehabilitation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabata Martino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University and Padua University Hospital, Padua, Italy; Gene Therapy Program, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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12
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Fumagalli F, Zambon AA, Rancoita PMV, Baldoli C, Canale S, Spiga I, Medaglini S, Penati R, Facchini M, Ciotti F, Sarzana M, Lorioli L, Cesani M, Natali Sora MG, Del Carro U, Cugnata F, Antonioli G, Recupero S, Calbi V, Di Serio C, Aiuti A, Biffi A, Sessa M. Metachromatic leukodystrophy: A single-center longitudinal study of 45 patients. J Inherit Metab Dis 2021; 44:1151-1164. [PMID: 33855715 DOI: 10.1002/jimd.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
In this study, we characterize the natural course of metachromatic leukodystrophy (MLD), explore intra/inter group differences, and identify biomarkers to monitor disease progression. This is a longitudinal observational study. Genotype and characteristics at disease onset were recorded. Time-to-event analyses were performed to assess time to major disease-related milestones in different subgroups. Longitudinal trajectories of nerve conduction velocities (NCV), brain MRI score, and brainstem auditory evoked responses (BAERs) were described. We recruited 22 late-infantile, 14 early-juvenile, 5 late-juvenile, and 4 adult MLD patients. Thirty-four were prospectively evaluated (median FU time 43 months). In late-infantile patients, the attainment of independent walking was associated with a later age at dysphagia. In early-juvenile, the presence of isolated cognitive impairment at onset was not a favorable prognostic factor. Late-infantile and early-juvenile subjects showed similar rapid loss of ambulation and onset of seizures, but late-infantile displayed earlier loss of trunk control, dysphagia, and death. We found significant differences in all major disease-related milestones (except death) between early-juvenile and late-juvenile patients. Late-juvenile and adult patients both presented with a predominant cognitive impairment, mild/no peripheral neuropathy, lower brain MRI score at plateau compared to LI/EJ, and later cerebellar involvement. NCV and BAER were consistently severely abnormal in late-infantile but not in older subjects, in whom both NCV and BAER were variably affected, with no deterioration over time in some cases. This study clarifies intra/inter group differences between MLD subtypes and provides additional indications regarding reliable clinical and instrumental tools to monitor disease progression and to serve as areference to evaluate the efficacy of future therapeutic interventions inthe different MLD variants.
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Affiliation(s)
- Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto A Zambon
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Specialistic Neurological Rehabilitation, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Ivana Spiga
- Clinical Molecular Biology Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Medaglini
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rachele Penati
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ciotti
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Cesani
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- AGC Biologics S.p.a, Bresso (MI), Italy
| | | | - Ubaldo Del Carro
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Gigliola Antonioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women and Child Health, University of Padova, Padova, Italy
| | - Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Filosto M, Cotti Piccinelli S, Gazzina S, Foresti C, Frigeni B, Servalli MC, Sessa M, Cosentino G, Marchioni E, Ravaglia S, Briani C, Castellani F, Zara G, Bianchi F, Del Carro U, Fazio R, Filippi M, Magni E, Natalini G, Palmerini F, Perotti AM, Bellomo A, Osio M, Scopelliti G, Carpo M, Rasera A, Squintani G, Doneddu PE, Bertasi V, Cotelli MS, Bertolasi L, Fabrizi GM, Ferrari S, Ranieri F, Caprioli F, Grappa E, Broglio L, De Maria G, Leggio U, Poli L, Rasulo F, Latronico N, Nobile-Orazio E, Padovani A, Uncini A. Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions. J Neurol Neurosurg Psychiatry 2021; 92:751-756. [PMID: 33158914 PMCID: PMC7650204 DOI: 10.1136/jnnp-2020-324837] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. METHODS GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered. RESULTS Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002). CONCLUSIONS This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.
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Affiliation(s)
- Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Stefano Gazzina
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Camillo Foresti
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Barbara Frigeni
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | | | - Maria Sessa
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Giuseppe Cosentino
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Enrico Marchioni
- IRCCS Mondino Foundation, Neurooncology and Neuroinflammation Unit, Pavia, Italy
| | - Sabrina Ravaglia
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Chiara Briani
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | - Gabriella Zara
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Francesca Bianchi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute SanRaffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute SanRaffaele University, Milano, Italy
| | - Raffaella Fazio
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute SanRaffaele University, Milano, Italy
| | - Massimo Filippi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute SanRaffaele University, Milano, Italy
| | - Eugenio Magni
- Unit of Neurology, Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Natalini
- Unit of Intensive Care and Anesthesiology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Andrea Bellomo
- ''Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Maurizio Osio
- Unit of Neurology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giuseppe Scopelliti
- ''Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | | | | | | | - Pietro Emiliano Doneddu
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine,Milan University, Milano, Italy
| | | | | | - Laura Bertolasi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Elena Grappa
- Intensive Care Unit, ASST Cremona, Cremona, Italy
| | - Laura Broglio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | | | - Ugo Leggio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili;Department of Medical and Surgical Specialties, Radiological Sciences and Public Health,University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili;Department of Medical and Surgical Specialties, Radiological Sciences and Public Health,University of Brescia, Brescia, Italy
| | - Eduardo Nobile-Orazio
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine,Milan University, Milano, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
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Uncini A, Foresti C, Frigeni B, Storti B, Servalli MC, Gazzina S, Cosentino G, Bianchi F, Del Carro U, Alfonsi E, Piccinelli SC, De Maria G, Padovani A, Filosto M, Ippoliti L. Electrophysiological features of acute inflammatory demyelinating polyneuropathy associated with SARS-CoV-2 infection. Neurophysiol Clin 2021; 51:183-191. [PMID: 33685769 PMCID: PMC7891083 DOI: 10.1016/j.neucli.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. Methods Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. Results S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P = 0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P = 0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P = 0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P = 0.002) and F waves were more often absent (45.6% vs. 31.8%, P = 0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P = 0.000);11 S-AIDP patients showed this pattern in 2 nerves. Conclusion Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.
| | - Camillo Foresti
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Barbara Frigeni
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Benedetta Storti
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | | | | | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia and IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Bianchi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy
| | | | - Stefano Cotti Piccinelli
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Alessandro Padovani
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Massimiliano Filosto
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Luigi Ippoliti
- Statistics Unit, Department of Economics, University "G. d'Annunzio", Pescara, Italy
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15
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Brugliera L, Filippi M, Del Carro U, Butera C, Bianchi F, Castellazzi P, Cimino P, Capodaglio P, Monti G, Mortini P, Pradotto LG, Priano L, Spina A, Iannaccone S. Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series. Arch Phys Med Rehabil 2020; 102:359-362. [PMID: 33245939 PMCID: PMC7685952 DOI: 10.1016/j.apmr.2020.10.131] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prone positioning improves oxygenation in adult respiratory distress syndrome. This procedure has been widely used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, this procedure can also be responsible for nerve damage and plexopathy. METHODS We retrospectively reviewed a series of 7 infectious patients with coronavirus disease 2019 who underwent prone positioning ventilation at the San Raffaele Hospital of Milan, Italy, during the SARS-CoV-2 pandemic. RESULTS Clinical and neurophysiological data of 7 patients with nerve compression injuries have been reported. CONCLUSIONS Health care workers should take into consideration the risk factors for prone positioning-related plexopathy and nerve damage, especially in patients with coronavirus disease 2019, to prevent this type of complication.
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Affiliation(s)
- Luigia Brugliera
- Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan.
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan
| | - Ubaldo Del Carro
- Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan
| | - Calogera Butera
- Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan
| | - Francesca Bianchi
- Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan
| | - Paola Castellazzi
- Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
| | - Paolo Cimino
- Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
| | - Paolo Capodaglio
- Rehabilitation Unit, I.R.C.C.S. Istituto Auxologico Italiano, Piancavallo
| | - Giacomo Monti
- Department of Anaesthesia and Intensive Care, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
| | - Luca G Pradotto
- Neurology Unit, I.R.C.C.S. Istituto Auxologico Italiano, Piancavallo, Italy; Department of Neuroscience, University of Torino, Turin, Italy
| | - Lorenzo Priano
- Neurology Unit, I.R.C.C.S. Istituto Auxologico Italiano, Piancavallo, Italy; Department of Neuroscience, University of Torino, Turin, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan
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16
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Falzone YM, Domi T, Agosta F, Pozzi L, Schito P, Fazio R, Del Carro U, Barbieri A, Comola M, Leocani L, Comi G, Carrera P, Filippi M, Quattrini A, Riva N. Serum phosphorylated neurofilament heavy-chain levels reflect phenotypic heterogeneity and are an independent predictor of survival in motor neuron disease. J Neurol 2020; 267:2272-2280. [PMID: 32306171 PMCID: PMC7166001 DOI: 10.1007/s00415-020-09838-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 01/23/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
To investigate the prognostic role and the major determinants of serum phosphorylated neurofilament heavy -chain (pNfH) concentration across a large cohort of motor neuron disease (MND) phenotypes. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum pNfH concentration in 219 MND patients consecutively enrolled in our tertiary MND clinic. A multifactorial analysis was carried out to investigate the major clinical determinants of serum pNfH. Kaplan–Meier survival curves and Cox regression analysis were performed to explore the prognostic value of serum pNfH. Serum pNfH levels were not homogenous among MND phenotypes; higher concentrations in pyramidal, bulbar, and classic phenotypes were observed. C9orf72-MND exhibited higher pNfH concentrations compared to non-C9orf72 MND. Multiple linear regression analysis revealed mean MEP/cMAP and disease progression rate as the two major predictors of serum pNfH levels (R2 = 0.188; p ≤ 0.001). Kaplan–Meier curves showed a significant difference of survival among MND subgroups when divided into quartiles based on pNfH concentrations, log-rank X2 = 53.0, p ≤ 0.0001. Our study evidenced that higher serum pNfH concentration is a negative independent prognostic factor for survival. In Cox multivariate model, pNfH concentration showed the highest hazard ratio compared to the other factors influencing survival included in the analysis. pNfH differs among the MND phenotypes and is an independent prognostic factor for survival. This study provides supporting evidence of the role of pNfH as useful prognostic biomarker for MND patients. Neurofilament measurements should be considered in the future prognostic models and in clinical trials for biomarker-based stratification, and to evaluate treatment response.
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Affiliation(s)
- Yuri Matteo Falzone
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Paride Schito
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Fazio
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Barbieri
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Comola
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Paola Carrera
- Division of Genetics and Cell Biology, Unit of Genomics for Human Disease Diagnosis, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy.
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.
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17
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Scapin C, Ferri C, Pettinato E, Zambroni D, Bianchi F, Del Carro U, Belin S, Caruso D, Mitro N, Pellegatta M, Taveggia C, Schwab MH, Nave KA, Feltri ML, Wrabetz L, D'Antonio M. Enhanced axonal neuregulin-1 type-III signaling ameliorates neurophysiology and hypomyelination in a Charcot-Marie-Tooth type 1B mouse model. Hum Mol Genet 2020; 28:992-1006. [PMID: 30481294 DOI: 10.1093/hmg/ddy411] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/30/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022] Open
Abstract
Charcot-Marie-Tooth (CMT) neuropathies are a group of genetic disorders that affect the peripheral nervous system with heterogeneous pathogenesis and no available treatment. Axonal neuregulin 1 type III (Nrg1TIII) drives peripheral nerve myelination by activating downstream signaling pathways such as PI3K/Akt and MAPK/Erk that converge on master transcriptional regulators of myelin genes, such as Krox20. We reasoned that modulating Nrg1TIII activity may constitute a general therapeutic strategy to treat CMTs that are characterized by reduced levels of myelination. Here we show that genetic overexpression of Nrg1TIII ameliorates neurophysiological and morphological parameters in a mouse model of demyelinating CMT1B, without exacerbating the toxic gain-of-function that underlies the neuropathy. Intriguingly, the mechanism appears not to be related to Krox20 or myelin gene upregulation, but rather to a beneficial rebalancing in the stoichiometry of myelin lipids and proteins. Finally, we provide proof of principle that stimulating Nrg1TIII signaling, by pharmacological suppression of the Nrg1TIII inhibitor tumor necrosis factor-alpha-converting enzyme (TACE/ADAM17), also ameliorates the neuropathy. Thus, modulation of Nrg1TIII by TACE/ADAM17 inhibition may represent a general treatment for hypomyelinating neuropathies.
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Affiliation(s)
| | | | | | | | - Francesca Bianchi
- INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | | | - Donatella Caruso
- DiSFeB-Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Nico Mitro
- DiSFeB-Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marta Pellegatta
- INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Carla Taveggia
- INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Markus H Schwab
- Max Planck Institute for Experimental Medicine, 37075 Göttingen, Germany.,Cellular Neurophysiology, Hannover Medical School, Hannover, Germany
| | - Klaus-Armin Nave
- Max Planck Institute for Experimental Medicine, 37075 Göttingen, Germany
| | - M Laura Feltri
- DIBIT, Divisions of Genetics and Cell Biology.,Hunter James Kelly Research Institute.,Department of Neurology.,Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Lawrence Wrabetz
- DIBIT, Divisions of Genetics and Cell Biology.,Hunter James Kelly Research Institute.,Department of Neurology.,Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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18
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Sarasso E, Agosta F, Piramide N, Bianchi F, Butera C, Gatti R, Amadio S, Del Carro U, Filippi M. Sensory trick phenomenon in cervical dystonia: a functional MRI study. J Neurol 2020; 267:1103-1115. [DOI: 10.1007/s00415-019-09683-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
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19
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Volpi VG, Ferri C, Fregno I, Del Carro U, Bianchi F, Scapin C, Pettinato E, Solda T, Feltri ML, Molinari M, Wrabetz L, D’Antonio M. Schwann cells ER-associated degradation contributes to myelin maintenance in adult nerves and limits demyelination in CMT1B mice. PLoS Genet 2019; 15:e1008069. [PMID: 30995221 PMCID: PMC6488099 DOI: 10.1371/journal.pgen.1008069] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/29/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
In the peripheral nervous system (PNS) myelinating Schwann cells synthesize large amounts of myelin protein zero (P0) glycoprotein, an abundant component of peripheral nerve myelin. In humans, mutations in P0 cause the demyelinating Charcot-Marie-Tooth 1B (CMT1B) neuropathy, one of the most diffused genetic disorders of the PNS. We previously showed that several mutations, such as the deletion of serine 63 (P0-S63del), result in misfolding and accumulation of P0 in the endoplasmic reticulum (ER), with activation of the unfolded protein response (UPR). In addition, we observed that S63del mouse nerves display the upregulation of many ER-associated degradation (ERAD) genes, suggesting a possible involvement of this pathway in the clearance of the mutant P0. In ERAD in fact, misfolded proteins are dislocated from the ER and targeted for proteasomal degradation. Taking advantage of inducible cells that express the ER retained P0, here we show that the P0-S63del glycoprotein is degraded via ERAD. Moreover, we provide strong evidence that the Schwann cell-specific ablation of the ERAD factor Derlin-2 in S63del nerves exacerbates both the myelin defects and the UPR in vivo, unveiling a protective role for ERAD in CMT1B neuropathy. We also found that lack of Derlin-2 affects adult myelin maintenance in normal nerves, without compromising their development, pinpointing ERAD as a previously unrecognized player in preserving Schwann cells homeostasis in adulthood. Finally, we provide evidence that treatment of S63del peripheral nerve cultures with N-Acetyl-D-Glucosamine (GlcNAc), known to enhance protein quality control pathways in C.elegans, ameliorates S63del nerve myelination ex vivo. Overall, our study suggests that potentiating adaptive ER quality control pathways might represent an appealing strategy to treat both conformational and age-related PNS disorders. Charcot-Marie-Tooth neuropathies are a large family of peripheral nerve disorders, showing extensive clinical and genetic heterogeneity. Although strong advances have been made in the identification of genes and mutations involved, effective therapies are still lacking. Intracellular retention of abnormal proteins has been recently suggested as one of the pathogenetic events that might underlie several conformational neuropathies. To limit the toxic effects of accumulated mutant proteins, cells have developed efficient protein quality control systems aimed at optimizing both protein folding and degradation. Here we show that ER-associated degradation limits Schwann cells stress and myelin defects caused by the accumulation of a mutant myelin protein into the ER. In addition, we also describe for the first time the importance of Schwann cells ERAD in preserving myelin integrity in adult nerves, showing that genetic ERAD impairment leads to a late onset, motor-predominant, peripheral neuropathy in vivo. Effort in the design of strategies that potentiate ERAD and ER quality controls is therefore highly desirable.
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Affiliation(s)
- Vera G. Volpi
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cinzia Ferri
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Fregno
- Instuitute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Bellinzona, Switzerland
- Department of Biology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Ubaldo Del Carro
- Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Bianchi
- Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Scapin
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Pettinato
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tatiana Solda
- Instuitute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Bellinzona, Switzerland
| | - M. Laura Feltri
- Hunter James Kelly Research Institute, University at Buffalo, Buffalo, New York, United States of America
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Maurizio Molinari
- Instuitute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Bellinzona, Switzerland
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lawrence Wrabetz
- Hunter James Kelly Research Institute, University at Buffalo, Buffalo, New York, United States of America
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Maurizio D’Antonio
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
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Butera C, Tronci S, Bianchi F, Guerriero R, Amadio S, Tettamanti A, Comola M, Esposito F, Radaelli M, Leocani L, Comi G, Del Carro U. Focal spasticity in multiple sclerosis: Treatment-goal attainment evaluation after botulinum toxin type A therapy and physical rehabilitation. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.037] [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: 11/24/2022]
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Velardo D, Riva N, Del Carro U, Bianchi F, Comi G, Fazio R. Rituximab in refractory chronic inflammatory demyelinating polyradiculoneuropathy: report of four cases. J Neurol 2017; 264:1011-1014. [PMID: 28337614 DOI: 10.1007/s00415-017-8462-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Daniele Velardo
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy.
| | - Nilo Riva
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience, Department of Neurophysiology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy
| | - Francesca Bianchi
- Division of Neuroscience, Department of Neurophysiology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy
| | - Giancarlo Comi
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Via Olgettina 48, Milan, 20132, Italy
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Picelli A, Buzzi MG, Cisari C, Gandolfi M, Porru D, Bonadiman S, Brugnera A, Carone R, Cerbo R, Del Carro U, Gimigliano R, Invernizzi M, Miotti D, Nappi R, Negrini S, Schweiger V, Tassorelli C, Tamburin S. Headache, low back pain, other nociceptive and mixed pain conditions in neurorehabilitation. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation. Eur J Phys Rehabil Med 2016; 52:867-880. [PMID: 27830925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pain is a disabling symptom and is often the foremost symptom of conditions for which patients undergo neurorehabilitation. We systematically searched the PubMed and Embase electronic databases for current evidence on the frequency, evolution, predictors, assessment, and pharmacological and non-pharmacological treatment of pain in patients with headache, craniofacial pain, low back pain, failed back surgery syndrome, osteoarticular pain, myofascial pain syndrome, fibromyalgia, and chronic pelvic pain. Despite the heterogeneity of published data, consensus was reached on pain assessment and management of patients with these conditions and on the utility of a multidisciplinary approach to pain therapy that combines the benefits of pharmacological therapy, physiotherapy, neurorehabilitation, and psychotherapy. We of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) suggest a need to conduct randomized controlled trials on the efficacy of pain treatments and their risk-benefit profile for the conditions we have reviewed.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy -
| | | | - Carlo Cisari
- Health Sciences Department, University of Piemonte Orientale, Novara, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Daniele Porru
- Urology Section, Policlinico San Matteo Foundation IRCCS, Pavia, Italy
| | - Silvia Bonadiman
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Annalisa Brugnera
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Carone
- Neurourology Department, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Rosanna Cerbo
- Pain Therapy Hub Center of Regione Lazio, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Ubaldo Del Carro
- Section of Clinical Neurophysiology and Neurorehabilitation, San Raffaele Hospital, Milan, Italy
| | - Raffaele Gimigliano
- Department of Physical and Mental Health, Second University of Naples, Naples, Italy
| | - Marco Invernizzi
- Health Sciences Department, University of Piemonte Orientale, Novara, Italy
| | - Danilo Miotti
- Palliative Care and Pain Therapy Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute of Pavia, Pavia, Italy
| | - Rossella Nappi
- University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- IRCCS Don Gnocchi ONLUS, Italian Scientific Spine Institute, Milan, Italy
| | | | - Cristina Tassorelli
- C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Tamburin
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Sessa M, Lorioli L, Fumagalli F, Acquati S, Redaelli D, Baldoli C, Canale S, Lopez ID, Morena F, Calabria A, Fiori R, Silvani P, Rancoita PMV, Gabaldo M, Benedicenti F, Antonioli G, Assanelli A, Cicalese MP, Del Carro U, Sora MGN, Martino S, Quattrini A, Montini E, Di Serio C, Ciceri F, Roncarolo MG, Aiuti A, Naldini L, Biffi A. Lentiviral haemopoietic stem-cell gene therapy in early-onset metachromatic leukodystrophy: an ad-hoc analysis of a non-randomised, open-label, phase 1/2 trial. Lancet 2016; 388:476-87. [PMID: 27289174 DOI: 10.1016/s0140-6736(16)30374-9] [Citation(s) in RCA: 327] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metachromatic leukodystrophy (a deficiency of arylsulfatase A [ARSA]) is a fatal demyelinating lysosomal disease with no approved treatment. We aimed to assess the long-term outcomes in a cohort of patients with early-onset metachromatic leukodystrophy who underwent haemopoietic stem-cell gene therapy (HSC-GT). METHODS This is an ad-hoc analysis of data from an ongoing, non-randomised, open-label, single-arm phase 1/2 trial, in which we enrolled patients with a molecular and biochemical diagnosis of metachromatic leukodystrophy (presymptomatic late-infantile or early-juvenile disease or early-symptomatic early-juvenile disease) at the Paediatric Clinical Research Unit, Ospedale San Raffaele, in Milan. Trial participants received HSC-GT, which consisted of the infusion of autologous HSCs transduced with a lentiviral vector encoding ARSA cDNA, after exposure-targeted busulfan conditioning. The primary endpoints of the trial are safety (toxicity, absence of engraftment failure or delayed haematological reconstitution, and safety of lentiviral vector-tranduced cell infusion) and efficacy (improvement in Gross Motor Function Measure [GMFM] score relative to untreated historical controls, and ARSA activity, 24 months post-treatment) of HSC-GT. For this ad-hoc analysis, we assessed safety and efficacy outcomes in all patients who had received treatment and been followed up for at least 18 months post-treatment on June 1, 2015. This trial is registered with ClinicalTrials.gov, number NCT01560182. FINDINGS Between April, 2010, and February, 2013, we had enrolled nine children with a diagnosis of early-onset disease (six had late-infantile disease, two had early-juvenile disease, and one had early-onset disease that could not be definitively classified). At the time of analysis all children had survived, with a median follow-up of 36 months (range 18-54). The most commonly reported adverse events were cytopenia (reported in all patients) and mucositis of different grades of severity (in five of nine patients [grade 3 in four of five patients]). No serious adverse events related to the medicinal product were reported. Stable, sustained engraftment of gene-corrected HSCs was observed (a median of 60·4% [range 14·0-95·6] lentiviral vector-positive colony-forming cells across follow-up) and the engraftment level was stable during follow-up; engraftment determinants included the duration of absolute neutropenia and the vector copy number of the medicinal product. A progressive reconstitution of ARSA activity in circulating haemopoietic cells and in the cerebrospinal fluid was documented in all patients in association with a reduction of the storage material in peripheral nerve samples in six of seven patients. Eight patients, seven of whom received treatment when presymptomatic, had prevention of disease onset or halted disease progression as per clinical and instrumental assessment, compared with historical untreated control patients with early-onset disease. GMFM scores for six patients up to the last follow-up showed that gross motor performance was similar to that of normally developing children. The extent of benefit appeared to be influenced by the interval between HSC-GT and the expected time of disease onset. Treatment resulted in protection from CNS demyelination in eight patients and, in at least three patients, amelioration of peripheral nervous system abnormalities, with signs of remyelination at both sites. INTERPRETATION Our ad-hoc findings provide preliminary evidence of safety and therapeutic benefit of HSC-GT in patients with early-onset metachromatic leukodystrophy who received treatment in the presymptomatic or very early-symptomatic stage. The results of this trial will be reported when all 20 patients have achieved 3 years of follow-up. FUNDING Italian Telethon Foundation and GlaxoSmithKline.
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Affiliation(s)
- Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Acquati
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Redaelli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ignazio D Lopez
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Morena
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Andrea Calabria
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Fiori
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michela Gabaldo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Benedicenti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gigliola Antonioli
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Sabata Martino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Angelo Quattrini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugenio Montini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Fabio Ciceri
- Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy.
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Musner N, Sidoli M, Zambroni D, Del Carro U, Ungaro D, D'Antonio M, Feltri ML, Wrabetz L. Perk Ablation Ameliorates Myelination in S63del-Charcot-Marie-Tooth 1B Neuropathy. ASN Neuro 2016; 8:8/2/1759091416642351. [PMID: 27095827 PMCID: PMC4844932 DOI: 10.1177/1759091416642351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/20/2015] [Accepted: 02/18/2016] [Indexed: 12/31/2022] Open
Abstract
In peripheral nerves, P0 glycoprotein accounts for more than 20% of myelin protein content. P0 is synthesized by Schwann cells, processed in the endoplasmic reticulum (ER) and enters the secretory pathway. However, the mutant P0 with S63 deleted (P0S63del) accumulates in the ER lumen and induces a demyelinating neuropathy in Charcot–Marie–Tooth disease type 1B (CMT1B)–S63del mice. Accumulation of P0S63del in the ER triggers a persistent unfolded protein response. Protein kinase RNA-like endoplasmic reticulum kinase (PERK) is an ER stress sensor that phosphorylates eukaryotic initiation factor 2 alpha (eIF2alpha) in order to attenuate protein synthesis. We have shown that increasing phosphophorylated-eIF2alpha (P-eIF2alpha) is a potent therapeutic strategy, improving myelination and motor function in S63del mice. Here, we explore the converse experiment: Perk haploinsufficiency reduces P-eIF2alpha in S63del nerves as expected, but surprisingly, ameliorates, rather than worsens S63del neuropathy. Motor performance and myelin abnormalities improved in S63del//Perk+/− compared with S63del mice. These data suggest that mechanisms other than protein translation might be involved in CMT1B/S63del neuropathy. In addition, Perk deficiency in other cells may contribute to demyelination in a non–Schwann-cell autonomous manner.
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Affiliation(s)
- Nicolò Musner
- Hunter James Kelly Research Institute, University at Buffalo, NY, USA
| | - Mariapaola Sidoli
- Hunter James Kelly Research Institute, University at Buffalo, NY, USA Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Desireè Zambroni
- Division of Neuroscience, San Raffaele Scientific Institute, DIBIT, Milan, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience, San Raffaele Scientific Institute, DIBIT, Milan, Italy
| | - Daniela Ungaro
- Division of Neuroscience, San Raffaele Scientific Institute, DIBIT, Milan, Italy
| | - Maurizio D'Antonio
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, DIBIT, Milan, Italy
| | - Maria L Feltri
- Hunter James Kelly Research Institute, University at Buffalo, NY, USA Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Lawrence Wrabetz
- Hunter James Kelly Research Institute, University at Buffalo, NY, USA Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
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Melissano G, Bertoglio L, Mascia D, Rinaldi E, Del Carro U, Nardelli P, Chiesa R. Spinal cord ischemia is multifactorial: what is the best protocol? J Cardiovasc Surg (Torino) 2016; 57:191-201. [PMID: 26731537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite the improved understanding of spinal cord anatomy and spinal cord ischemia pathophysiology, the rate of debilitating postoperative paraparesis or paraplegia is still not negligible after procedures for thoracic or thoracoabdominal aortic disease. Single studies have demonstrated the role of different treatment modalities to prevent or treat spinal cord ischemia. A multimodal approach, however, is advocated by most authors. Even after the employment of endovascular techniques become routine, the rate of spinal cord ischemia after treatment of thoracoabdominal aortic pathology remained unchanged over time. Spinal cord ischemia is often treatable by different means that concur to improve indirect spinal perfusion through collateral circulation; it should, therefore, be managed promptly and aggressively due to its potential reversibility. Ongoing technical improvements of non-invasive diagnostic tools may allow a better preoperative assessment of the spinal vascular network and a better planning of both open and endovascular thoracic or thoracoabdominal repair.
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Affiliation(s)
- Germano Melissano
- Scientific Institute H. San Raffaele, Chair of Vascular Surgery, "Vita Salute" San Raffaele University, Milan, Italy -
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Ricca A, Rufo N, Ungari S, Morena F, Martino S, Kulik W, Alberizzi V, Bolino A, Bianchi F, Del Carro U, Biffi A, Gritti A. Combined gene/cell therapies provide long-term and pervasive rescue of multiple pathological symptoms in a murine model of globoid cell leukodystrophy. Hum Mol Genet 2015; 24:3372-89. [PMID: 25749991 PMCID: PMC4498152 DOI: 10.1093/hmg/ddv086] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 02/02/2015] [Accepted: 03/04/2015] [Indexed: 01/11/2023] Open
Abstract
Globoid cell leukodystrophy (GLD) is a lysosomal storage disease caused by deficient activity of β-galactocerebrosidase (GALC). The infantile forms manifest with rapid and progressive central and peripheral demyelination, which represent a major hurdle for any treatment approach. We demonstrate here that neonatal lentiviral vector-mediated intracerebral gene therapy (IC GT) or transplantation of GALC-overexpressing neural stem cells (NSC) synergize with bone marrow transplant (BMT) providing dramatic extension of lifespan and global clinical–pathological rescue in a relevant GLD murine model. We show that timely and long-lasting delivery of functional GALC in affected tissues ensured by the exclusive complementary mode of action of the treatments underlies the outstanding benefit. In particular, the contribution of neural stem cell transplantation and IC GT during the early asymptomatic stage of the disease is instrumental to enhance long-term advantage upon BMT. We clarify the input of central nervous system, peripheral nervous system and periphery to the disease, and the relative contribution of treatments to the final therapeutic outcome, with important implications for treatment strategies to be tried in human patients. This study gives proof-of-concept of efficacy, tolerability and clinical relevance of the combined gene/cell therapies proposed here, which may constitute a feasible and effective therapeutic opportunity for children affected by GLD.
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Affiliation(s)
- Alessandra Ricca
- San Raffaele Scientific Institute, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Telethon Institute for Gene Therapy (TIGET), Via Olgettina 58, Milano 20132, Italy
| | - Nicole Rufo
- San Raffaele Scientific Institute, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Telethon Institute for Gene Therapy (TIGET), Via Olgettina 58, Milano 20132, Italy
| | - Silvia Ungari
- San Raffaele Scientific Institute, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Telethon Institute for Gene Therapy (TIGET), Via Olgettina 58, Milano 20132, Italy
| | - Francesco Morena
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, via del Giochetto, Perugia, Italy
| | - Sabata Martino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, via del Giochetto, Perugia, Italy
| | - Wilem Kulik
- Laboratory of Genetic Metabolic Diseases, Academic Medical Center AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands and
| | - Valeria Alberizzi
- Division of Neuroscience, San Raffaele Scientific Institute, INSPE, Via Olgettina 58, Milano, Italy
| | - Alessandra Bolino
- Division of Neuroscience, San Raffaele Scientific Institute, INSPE, Via Olgettina 58, Milano, Italy
| | - Francesca Bianchi
- Division of Neuroscience, San Raffaele Scientific Institute, INSPE, Via Olgettina 58, Milano, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience, San Raffaele Scientific Institute, INSPE, Via Olgettina 58, Milano, Italy
| | - Alessandra Biffi
- San Raffaele Scientific Institute, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Telethon Institute for Gene Therapy (TIGET), Via Olgettina 58, Milano 20132, Italy
| | - Angela Gritti
- San Raffaele Scientific Institute, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Telethon Institute for Gene Therapy (TIGET), Via Olgettina 58, Milano 20132, Italy,
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27
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de Ceglia R, Chaabane L, Biffi E, Bergamaschi A, Ferrigno G, Amadio S, Del Carro U, Mazzocchi N, Comi G, Bianchi V, Taverna S, Forti L, D'Adamo P, Martino G, Menegon A, Muzio L. Down-sizing of neuronal network activity and density of presynaptic terminals by pathological acidosis are efficiently prevented by Diminazene Aceturate. Brain Behav Immun 2015; 45:263-76. [PMID: 25499583 DOI: 10.1016/j.bbi.2014.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 07/29/2014] [Revised: 12/02/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022] Open
Abstract
Local acidosis is associated with neuro-inflammation and can have significant effects in several neurological disorders, including multiple sclerosis, brain ischemia, spinal cord injury and epilepsy. Despite local acidosis has been implicated in numerous pathological functions, very little is known about the modulatory effects of pathological acidosis on the activity of neuronal networks and on synaptic structural properties. Using non-invasive MRI spectroscopy we revealed protracted extracellular acidosis in the CNS of Experimental Autoimmune Encephalomyelitis (EAE) affected mice. By multi-unit recording in cortical neurons, we established that acidosis affects network activity, down-sizing firing and bursting behaviors as well as amplitudes. Furthermore, a protracted acidosis reduced the number of presynaptic terminals, while it did not affect the postsynaptic compartment. Application of the diarylamidine Diminazene Aceturate (DA) during acidosis significantly reverted both the loss of neuronal firing and bursting and the reduction of presynaptic terminals. Finally, in vivo DA delivery ameliorated the clinical disease course of EAE mice, reducing demyelination and axonal damage. DA is known to block acid-sensing ion channels (ASICs), which are proton-gated, voltage-insensitive, Na(+) permeable channels principally expressed by peripheral and central nervous system neurons. Our data suggest that ASICs activation during acidosis modulates network electrical activity and exacerbates neuro-degeneration in EAE mice. Therefore pharmacological modulation of ASICs in neuroinflammatory diseases could represent a new promising strategy for future therapies aimed at neuro-protection.
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Affiliation(s)
- Roberta de Ceglia
- Neuroimmunolgy Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Linda Chaabane
- Neuroimmunolgy Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy; Department of Neurology, Institute of Experimental Neurology (INSPE), Vita Salute San Raffaele University, Milan, Italy
| | - Emilia Biffi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Andrea Bergamaschi
- Neuroimmunolgy Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Giancarlo Ferrigno
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Stefano Amadio
- Neurophysiology Unit, Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Ubaldo Del Carro
- Neurophysiology Unit, Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Nausicaa Mazzocchi
- Advanced Light and Electron Microscopy Bio-Imaging Centre, Experimental Imaging Centre, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology (INSPE), Vita Salute San Raffaele University, Milan, Italy
| | - Veronica Bianchi
- Dulbecco Telethon Institute at San Raffaele Scientific Institute, Division of Neuroscience, 20132 Milan, Italy
| | - Stefano Taverna
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lia Forti
- Center for Neuroscience and Dept. of Theoretical and Applied Sciences, Biomedical Division, University of Insubria, 21052 Busto Arsizio, Italy
| | - Patrizia D'Adamo
- Dulbecco Telethon Institute at San Raffaele Scientific Institute, Division of Neuroscience, 20132 Milan, Italy
| | - Gianvito Martino
- Neuroimmunolgy Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy.
| | - Andrea Menegon
- Advanced Light and Electron Microscopy Bio-Imaging Centre, Experimental Imaging Centre, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luca Muzio
- Neuroimmunolgy Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy.
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Vaccari I, Carbone A, Previtali SC, Mironova YA, Alberizzi V, Noseda R, Rivellini C, Bianchi F, Del Carro U, D'Antonio M, Lenk GM, Wrabetz L, Giger RJ, Meisler MH, Bolino A. Loss of Fig4 in both Schwann cells and motor neurons contributes to CMT4J neuropathy. Hum Mol Genet 2014; 24:383-96. [PMID: 25187576 PMCID: PMC4275070 DOI: 10.1093/hmg/ddu451] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Indexed: 02/06/2023] Open
Abstract
Mutations of FIG4 are responsible for Yunis-Varón syndrome, familial epilepsy with polymicrogyria, and Charcot-Marie-Tooth type 4J neuropathy (CMT4J). Although loss of the FIG4 phospholipid phosphatase consistently causes decreased PtdIns(3,5)P2 levels, cell-specific sensitivity to partial loss of FIG4 function may differentiate FIG4-associated disorders. CMT4J is an autosomal recessive neuropathy characterized by severe demyelination and axonal loss in human, with both motor and sensory involvement. However, it is unclear whether FIG4 has cell autonomous roles in both motor neurons and Schwann cells, and how loss of FIG4/PtdIns(3,5)P2-mediated functions contribute to the pathogenesis of CMT4J. Here, we report that mice with conditional inactivation of Fig4 in motor neurons display neuronal and axonal degeneration. In contrast, conditional inactivation of Fig4 in Schwann cells causes demyelination and defects in autophagy-mediated degradation. Moreover, Fig4-regulated endolysosomal trafficking in Schwann cells is essential for myelin biogenesis during development and for proper regeneration/remyelination after injury. Our data suggest that impaired endolysosomal trafficking in both motor neurons and Schwann cells contributes to CMT4J neuropathy.
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Affiliation(s)
- Ilaria Vaccari
- Division of Neuroscience, INSPE-Institute of Experimental Neurology
| | | | - Stefano Carlo Previtali
- Division of Neuroscience, INSPE-Institute of Experimental Neurology Department of Neurology and
| | | | | | - Roberta Noseda
- Division of Neuroscience, INSPE-Institute of Experimental Neurology
| | | | - Francesca Bianchi
- Division of Neuroscience, INSPE-Institute of Experimental Neurology Department of Neurology and
| | - Ubaldo Del Carro
- Division of Neuroscience, INSPE-Institute of Experimental Neurology Department of Neurology and
| | - Maurizio D'Antonio
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Guy M Lenk
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA and
| | - Lawrence Wrabetz
- Hunter James Kelly Research Institute, State University of New York, Buffalo, NY 14203, USA
| | | | - Miriam H Meisler
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA and
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Bianchi F, Cursi M, Ferrari M, Salonia A, Amadio S, Comi G, Danuser H, Del Carro U, Mattei A. Quantitative EMG of external urethral sphincter in neurologically healthy men with prostate pathology. Muscle Nerve 2014; 50:571-6. [DOI: 10.1002/mus.24189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/17/2014] [Accepted: 01/22/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Francesca Bianchi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Marco Cursi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Matteo Ferrari
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
| | - Andrea Salonia
- Department of Urology; University Vita-Salute, San Raffaele Hospital; Milan Italy
| | - Stefano Amadio
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Giancarlo Comi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Hansjörg Danuser
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
| | - Ubaldo Del Carro
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Agostino Mattei
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
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Amadio S, Houdayer E, Bianchi F, Tesfaghebriel Tekle H, Urban IP, Butera C, Guerriero R, Cursi M, Leocani L, Comi G, Del Carro U. Sensory tricks and brain excitability in cervical dystonia: A transcranial magnetic stimulation study. Mov Disord 2014; 29:1185-8. [DOI: 10.1002/mds.25888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/28/2014] [Accepted: 03/10/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stefano Amadio
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Elise Houdayer
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Francesca Bianchi
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Habtom Tesfaghebriel Tekle
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Ivan Pietro Urban
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Calogera Butera
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Roberta Guerriero
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Marco Cursi
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Letizia Leocani
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Giancarlo Comi
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
| | - Ubaldo Del Carro
- Department of Neurology, Neurophysiology and Neurorehabilitation-INSPE; Institute of Experimental Neurology, Scientific Institute Ospedale San Raffaele; Via Olgettina 60 Milan Italy
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31
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Bianchi F, Ferrari M, La Croce G, Cursi M, Salonia A, Germann C, Comi G, Del Carro U, Danuser H, Mattei A. PD11-03 NEW APPROACH AND SET OF REFERENCE VALUES FOR QUANTITATIVE ELECTROMYOGRAPHIC ANALYSIS OF THE EXTERNAL URETHRAL SPHINCTER IN MEN. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Di Maggio G, Santangelo R, Guerrieri S, Bianco M, Ferrari L, Medaglini S, Rodegher M, Colombo B, Moiola L, Chieffo R, Del Carro U, Martinelli V, Comi G, Leocani L. Optical coherence tomography and visual evoked potentials: which is more sensitive in multiple sclerosis? Mult Scler 2014; 20:1342-7. [PMID: 24591532 DOI: 10.1177/1352458514524293] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the sensitivity of optic coherence tomography (OCT) and visual evoked potentials (VEPs) to visual pathway abnormalities in multiple sclerosis (MS). METHODS A total of 40 MS subjects, 28 with optic neuritis (ON) at least 3 months before (bilateral in 5), underwent assessment of visual acuity, Expanded Disability Status Scale (EDSS), OCT and VEPs, the latter quantified with a 0-4 conventional score. RESULTS OCT and VEPs were abnormal in 36% and 56% respectively in all eyes (p=0.11), 68% and 86% in eyes with previous ON (p=0.12), and in 19% versus 40% in eyes without ON history (p=0.007). Combining VEP and OCT increased sensitivity to 89% in ON and 44% in non-ON eyes. Considering all eyes, global retinal nerve fibre layer (RNFL) thickness and VEP score were significantly correlated between them (ρ=-0.63, p<0.001) and with EDSS (RNFL: ρ=0.40, p<0.001; VEP score: ρ=0.47, p<0.001). Disease duration correlated with VEP score (ρ=0.25, p=0.025) and RNFL thickness (ρ=-0.71, p<0.001). CONCLUSIONS In eyes without ON, VEPs were more frequently abnormal than OCT, while the two techniques showed similar sensitivity in eyes previously affected by ON. The correlation of VEPs and OCT measures with disability prompts further exploration of the two techniques as potential markers of disease burden.
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Affiliation(s)
- Giovanni Di Maggio
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Roberto Santangelo
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Simone Guerrieri
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Mariangela Bianco
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Laura Ferrari
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Stefania Medaglini
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Mariaemma Rodegher
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Bruno Colombo
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Lucia Moiola
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Raffaella Chieffo
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Ubaldo Del Carro
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Vittorio Martinelli
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Giancarlo Comi
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
| | - Letizia Leocani
- San Raffaele Scientific Institute, Department of Neurology and Institute of Experimental Neurology-INSPE, Milan, Italy
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Cerri F, Salvatore L, Memon D, Boneschi FM, Madaghiele M, Brambilla P, Del Carro U, Taveggia C, Riva N, Trimarco A, Lopez ID, Comi G, Pluchino S, Martino G, Sannino A, Quattrini A. Peripheral nerve morphogenesis induced by scaffold micropatterning. Biomaterials 2014; 35:4035-4045. [PMID: 24559639 DOI: 10.1016/j.biomaterials.2014.01.069] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 12/06/2013] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
Several bioengineering approaches have been proposed for peripheral nervous system repair, with limited results and still open questions about the underlying molecular mechanisms. We assessed the biological processes that occur after the implantation of collagen scaffold with a peculiar porous micro-structure of the wall in a rat sciatic nerve transection model compared to commercial collagen conduits and nerve crush injury using functional, histological and genome wide analyses. We demonstrated that within 60 days, our conduit had been completely substituted by a normal nerve. Gene expression analysis documented a precise sequential regulation of known genes involved in angiogenesis, Schwann cells/axons interactions and myelination, together with a selective modulation of key biological pathways for nerve morphogenesis induced by porous matrices. These data suggest that the scaffold's micro-structure profoundly influences cell behaviors and creates an instructive micro-environment to enhance nerve morphogenesis that can be exploited to improve recovery and understand the molecular differences between repair and regeneration.
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Affiliation(s)
- Federica Cerri
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Luca Salvatore
- Department of Innovation Engineering, University of Lecce, Via per Monteroni, 73100 Lecce, Italy
| | - Danish Memon
- Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Robinson Way CB2 0PY, UK
| | | | - Marta Madaghiele
- Department of Innovation Engineering, University of Lecce, Via per Monteroni, 73100 Lecce, Italy
| | - Paola Brambilla
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Ubaldo Del Carro
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Carla Taveggia
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Nilo Riva
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Amelia Trimarco
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Ignazio D Lopez
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Giancarlo Comi
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Stefano Pluchino
- Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Robinson Way CB2 0PY, UK
| | - Gianvito Martino
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Sannino
- Department of Innovation Engineering, University of Lecce, Via per Monteroni, 73100 Lecce, Italy
| | - Angelo Quattrini
- Division of Neuroscience and INSPE, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
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Porrello E, Rivellini C, Dina G, Triolo D, Del Carro U, Ungaro D, Panattoni M, Feltri ML, Wrabetz L, Pardi R, Quattrini A, Previtali SC. Jab1 regulates Schwann cell proliferation and axonal sorting through p27. J Biophys Biochem Cytol 2013. [PMCID: PMC3871443 DOI: 10.1083/jcb.2036oia155] [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] Open
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Porrello E, Rivellini C, Dina G, Triolo D, Del Carro U, Ungaro D, Panattoni M, Feltri ML, Wrabetz L, Pardi R, Quattrini A, Previtali SC. Jab1 regulates Schwann cell proliferation and axonal sorting through p27. ACTA ACUST UNITED AC 2013; 211:29-43. [PMID: 24344238 PMCID: PMC3892969 DOI: 10.1084/jem.20130720] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Indexed: 12/22/2022]
Abstract
Jab1 constitutes a regulatory molecule that integrates laminin211 signals in Schwann cells to govern cell cycle, cell number, and differentiation. Axonal sorting is a crucial event in nerve formation and requires proper Schwann cell proliferation, differentiation, and contact with axons. Any defect in axonal sorting results in dysmyelinating peripheral neuropathies. Evidence from mouse models shows that axonal sorting is regulated by laminin211– and, possibly, neuregulin 1 (Nrg1)–derived signals. However, how these signals are integrated in Schwann cells is largely unknown. We now report that the nuclear Jun activation domain–binding protein 1 (Jab1) may transduce laminin211 signals to regulate Schwann cell number and differentiation during axonal sorting. Mice with inactivation of Jab1 in Schwann cells develop a dysmyelinating neuropathy with axonal sorting defects. Loss of Jab1 increases p27 levels in Schwann cells, which causes defective cell cycle progression and aberrant differentiation. Genetic down-regulation of p27 levels in Jab1-null mice restores Schwann cell number, differentiation, and axonal sorting and rescues the dysmyelinating neuropathy. Thus, Jab1 constitutes a regulatory molecule that integrates laminin211 signals in Schwann cells to govern cell cycle, cell number, and differentiation. Finally, Jab1 may constitute a key molecule in the pathogenesis of dysmyelinating neuropathies.
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Affiliation(s)
- Emanuela Porrello
- Institute of Experimental Neurology (INSPE), Division of Neuroscience; 2 Department of Neurology; and 3 Division of Immunology, Transplantation, and Infectious Disease; San Raffaele Scientific Institute, 20132 Milan, Italy
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Biffi A, Montini E, Lorioli L, Cesani M, Fumagalli F, Plati T, Baldoli C, Martino S, Calabria A, Canale S, Benedicenti F, Vallanti G, Biasco L, Leo S, Kabbara N, Zanetti G, Rizzo WB, Mehta NAL, Cicalese MP, Casiraghi M, Boelens JJ, Del Carro U, Dow DJ, Schmidt M, Assanelli A, Neduva V, Di Serio C, Stupka E, Gardner J, von Kalle C, Bordignon C, Ciceri F, Rovelli A, Roncarolo MG, Aiuti A, Sessa M, Naldini L. Lentiviral hematopoietic stem cell gene therapy benefits metachromatic leukodystrophy. Science 2013; 341:1233158. [PMID: 23845948 DOI: 10.1126/science.1233158] [Citation(s) in RCA: 857] [Impact Index Per Article: 77.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Metachromatic leukodystrophy (MLD) is an inherited lysosomal storage disease caused by arylsulfatase A (ARSA) deficiency. Patients with MLD exhibit progressive motor and cognitive impairment and die within a few years of symptom onset. We used a lentiviral vector to transfer a functional ARSA gene into hematopoietic stem cells (HSCs) from three presymptomatic patients who showed genetic, biochemical, and neurophysiological evidence of late infantile MLD. After reinfusion of the gene-corrected HSCs, the patients showed extensive and stable ARSA gene replacement, which led to high enzyme expression throughout hematopoietic lineages and in cerebrospinal fluid. Analyses of vector integrations revealed no evidence of aberrant clonal behavior. The disease did not manifest or progress in the three patients 7 to 21 months beyond the predicted age of symptom onset. These findings indicate that extensive genetic engineering of human hematopoiesis can be achieved with lentiviral vectors and that this approach may offer therapeutic benefit for MLD patients.
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Affiliation(s)
- Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, 20132 Milan, Italy.
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D’Antonio M, Musner N, Scapin C, Ungaro D, Del Carro U, Ron D, Feltri ML, Wrabetz L. Resetting translational homeostasis restores myelination in Charcot-Marie-Tooth disease type 1B mice. J Biophys Biochem Cytol 2013. [DOI: 10.1083/jcb2012oia3] [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: 11/22/2022] Open
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D'Antonio M, Musner N, Scapin C, Ungaro D, Del Carro U, Ron D, Feltri ML, Wrabetz L. Resetting translational homeostasis restores myelination in Charcot-Marie-Tooth disease type 1B mice. ACTA ACUST UNITED AC 2013; 210:821-38. [PMID: 23547100 PMCID: PMC3620355 DOI: 10.1084/jem.20122005] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [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] [Indexed: 12/28/2022]
Abstract
Reduction of the CHOP target Gadd34 restores motor function in P0S63del mice with demyelinating neuropathy. P0 glycoprotein is an abundant product of terminal differentiation in myelinating Schwann cells. The mutant P0S63del causes Charcot-Marie-Tooth 1B neuropathy in humans, and a very similar demyelinating neuropathy in transgenic mice. P0S63del is retained in the endoplasmic reticulum of Schwann cells, where it promotes unfolded protein stress and elicits an unfolded protein response (UPR) associated with translational attenuation. Ablation of Chop, a UPR mediator, from S63del mice completely rescues their motor deficit and reduces active demyelination by half. Here, we show that Gadd34 is a detrimental effector of CHOP that reactivates translation too aggressively in myelinating Schwann cells. Genetic or pharmacological limitation of Gadd34 function moderates translational reactivation, improves myelination in S63del nerves, and reduces accumulation of P0S63del in the ER. Resetting translational homeostasis may provide a therapeutic strategy in tissues impaired by misfolded proteins that are synthesized during terminal differentiation.
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Affiliation(s)
- Maurizio D'Antonio
- Division of Genetics and Cell Biology and 2 Division of Neuroscience, San Raffaele Scientific Institute, DIBIT, 20132 Milan, Italy
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Rivellini C, Dina G, Porrello E, Cerri F, Scarlato M, Domi T, Ungaro D, Carro UD, Bolino A, Quattrini A, Comi G, Previtali SC. Urokinase plasminogen receptor and the fibrinolytic complex play a role in nerve repair after nerve crush in mice, and in human neuropathies. PLoS One 2012; 7:e32059. [PMID: 22363796 PMCID: PMC3283718 DOI: 10.1371/journal.pone.0032059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/21/2012] [Indexed: 11/18/2022] Open
Abstract
Remodeling of extracellular matrix (ECM) is a critical step in peripheral nerve regeneration. In fact, in human neuropathies, endoneurial ECM enriched in fibrin and vitronectin associates with poor regeneration and worse clinical prognosis. Accordingly in animal models, modification of the fibrinolytic complex activity has profound effects on nerve regeneration: high fibrinolytic activity and low levels of fibrin correlate with better nerve regeneration. The urokinase plasminogen receptor (uPAR) is a major component of the fibrinolytic complex, and binding to urokinase plasminogen activator (uPA) promotes fibrinolysis and cell movement. uPAR is expressed in peripheral nerves, however, little is known on its potential function on nerve development and regeneration. Thus, we investigated uPAR null mice and observed that uPAR is dispensable for nerve development, whereas, loss of uPAR affects nerve regeneration. uPAR null mice showed reduced nerve repair after sciatic nerve crush. This was a consequence of reduced fibrinolytic activity and increased deposition of endoneurial fibrin and vitronectin. Exogenous fibrinolysis in uPAR null mice rescued nerve repair after sciatic nerve crush. Finally, we measured the fibrinolytic activity in sural nerve biopsies from patients with peripheral neuropathies. We showed that neuropathies with defective regeneration had reduced fibrinolytic activity. On the contrary, neuropathies with signs of active regeneration displayed higher fibrinolytic activity. Overall, our results suggest that enforced fibrinolysis may facilitate regeneration and outcome of peripheral neuropathies.
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Affiliation(s)
- Cristina Rivellini
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Dina
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Porrello
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cerri
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Marina Scarlato
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Ungaro
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Bolino
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Dulbecco Telethon Institute, Rome, Italy
| | - Angelo Quattrini
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
- “Vita e Salute” San Raffaele University, Milan, Italy
| | - Stefano C. Previtali
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
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Colom B, Poitelon Y, Huang W, Woodfin A, Averill S, Del Carro U, Zambroni D, Brain SD, Perretti M, Ahluwalia A, Priestley JV, Chavakis T, Imhof BA, Feltri ML, Nourshargh S. Schwann cell-specific JAM-C-deficient mice reveal novel expression and functions for JAM-C in peripheral nerves. FASEB J 2011; 26:1064-76. [PMID: 22090315 PMCID: PMC3370675 DOI: 10.1096/fj.11-196220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Junctional adhesion molecule-C (JAM-C) is an adhesion molecule expressed at junctions between adjacent endothelial and epithelial cells and implicated in multiple inflammatory and vascular responses. In addition, we recently reported on the expression of JAM-C in Schwann cells (SCs) and its importance for the integrity and function of peripheral nerves. To investigate the role of JAM-C in neuronal functions further, mice with a specific deletion of JAM-C in SCs (JAM-C SC KO) were generated. Compared to wild-type (WT) controls, JAM-C SC KO mice showed electrophysiological defects, muscular weakness, and hypersensitivity to mechanical stimuli. In addressing the underlying cause of these defects, nerves from JAM-C SC KO mice were found to have morphological defects in the paranodal region, exhibiting increased nodal length as compared to WTs. The study also reports on previously undetected expressions of JAM-C, namely on perineural cells, and in line with nociception defects of the JAM-C SC KO animals, on finely myelinated sensory nerve fibers. Collectively, the generation and characterization of JAM-C SC KO mice has provided unequivocal evidence for the involvement of SC JAM-C in the fine organization of peripheral nerves and in modulating multiple neuronal responses.
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Affiliation(s)
- Bartomeu Colom
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M6BQ, UK
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Bejarano B, Bianco M, Gonzalez-Moron D, Sepulcre J, Goñi J, Arcocha J, Soto O, Del Carro U, Comi G, Leocani L, Villoslada P. Computational classifiers for predicting the short-term course of Multiple sclerosis. BMC Neurol 2011; 11:67. [PMID: 21649880 PMCID: PMC3118106 DOI: 10.1186/1471-2377-11-67] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 06/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the diagnostic accuracy (sensitivity and specificity) of clinical, imaging and motor evoked potentials (MEP) for predicting the short-term prognosis of multiple sclerosis (MS). METHODS We obtained clinical data, MRI and MEP from a prospective cohort of 51 patients and 20 matched controls followed for two years. Clinical end-points recorded were: 1) expanded disability status scale (EDSS), 2) disability progression, and 3) new relapses. We constructed computational classifiers (Bayesian, random decision-trees, simple logistic-linear regression-and neural networks) and calculated their accuracy by means of a 10-fold cross-validation method. We also validated our findings with a second cohort of 96 MS patients from a second center. RESULTS We found that disability at baseline, grey matter volume and MEP were the variables that better correlated with clinical end-points, although their diagnostic accuracy was low. However, classifiers combining the most informative variables, namely baseline disability (EDSS), MRI lesion load and central motor conduction time (CMCT), were much more accurate in predicting future disability. Using the most informative variables (especially EDSS and CMCT) we developed a neural network (NNet) that attained a good performance for predicting the EDSS change. The predictive ability of the neural network was validated in an independent cohort obtaining similar accuracy (80%) for predicting the change in the EDSS two years later. CONCLUSIONS The usefulness of clinical variables for predicting the course of MS on an individual basis is limited, despite being associated with the disease course. By training a NNet with the most informative variables we achieved a good accuracy for predicting short-term disability.
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Pluchino S, Gritti A, Blezer E, Amadio S, Brambilla E, Borsellino G, Cossetti C, Del Carro U, Comi G, 't Hart B, Vescovi A, Martino G. Human neural stem cells ameliorate autoimmune encephalomyelitis in non-human primates. Ann Neurol 2009; 66:343-54. [PMID: 19798728 DOI: 10.1002/ana.21745] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Transplanted neural stem/precursor cells (NPCs) display peculiar therapeutic plasticity in vivo. Although the replacement of cells was first expected as the prime therapeutic mechanism of stem cells in regenerative medicine, it is now clear that transplanted NPCs simultaneously instruct several therapeutic mechanisms, among which replacement of cells might not necessarily prevail. A comprehensive understanding of the mechanism(s) by which NPCs exert their therapeutic plasticity is lacking. This study was designed as a preclinical approach to test the feasibility of human NPC transplantation in an outbreed nonhuman primate experimental autoimmune encephalomyelitis (EAE) model approximating the clinical and complex neuropathological situation of human multiple sclerosis (MS) more closely than EAE in the standard laboratory rodent. METHODS We examined the safety and efficacy of the intravenous (IV) and intrathecal (IT) administration of human NPCs in common marmosets affected by human myelin oligodendrocyte glycoprotein 1-125-induced EAE. Treatment commenced upon the occurrence of detectable brain lesions on a 4.7T spectrometer. RESULTS EAE marmosets injected IV or IT with NPCs accumulated lower disability and displayed increased survival, as compared with sham-treated controls. Transplanted NPCs persisted within the host central nervous system (CNS), but were also found in draining lymph nodes, for up to 3 months after transplantation and exhibited remarkable immune regulatory capacity in vitro. INTERPRETATION Herein, we provide the first evidence that human CNS stem cells ameliorate EAE in nonhuman primates without overt side effects. Immune regulation (rather than neural differentiation) is suggested as the major putative mechanism by which NPCs ameliorate EAE in vivo. Our findings represent a critical step toward the clinical use of human NPCs in MS.
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Affiliation(s)
- Stefano Pluchino
- Neuroimmunology Unit, San Raffaele Scientific Institute, Milan, Italy.
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Salonia A, Rocchini L, Sacca' A, Pellucchi F, Ferrari M, Carro UD, Ribotto P, Gallina A, Zanni G, Deho' F, Rigatti P, Montorsi F. ORIGINAL RESEARCH—EJACULATORY DISORDERS: Acceptance of and Discontinuation Rate from Paroxetine Treatment in Patients with Lifelong Premature Ejaculation. J Sex Med 2009; 6:2868-77. [DOI: 10.1111/j.1743-6109.2009.01404.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salonia A, Saccà A, Briganti A, Del Carro U, Dehò F, Zanni G, Rocchini L, Raber M, Guazzoni G, Rigatti P, Montorsi F. ORIGINAL RESEARCH—EJACULATORY DISORDERS: Quantitative Sensory Testing of Peripheral Thresholds in Patients with Lifelong Premature Ejaculation: A Case-Controlled Study. J Sex Med 2009; 6:1755-1762. [DOI: 10.1111/j.1743-6109.2009.01276.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riva N, Riva N, Morana P, Cerri F, Gerevini S, Amadio S, Formaglio F, Comi G, Comola M, Del Carro U. Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin. BMJ Case Rep 2009; 2009:bcr08.2008.0669. [PMID: 21686691 DOI: 10.1136/bcr.08.2008.0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a patient who developed acute myelopathy after intranasal insufflation of amphetamines and heroin. The functional prognosis was very poor; after 4 months, she remained paraplegic. MRI imaging showed selective T2 hyperintensity and intense enhancement confined to the spinal anterior horns and lumbar nerve roots and plexus. This unique MRI pattern, together with neurophysiological data, suggests that the pathological process at the first primary affected spinal anterior horns (SAH), conditioning motoneuron cell death, and then nerve roots and lumbar plexus as a consequence of wallerian degeneration.
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Affiliation(s)
- Nilo Riva
- San Raffaele Scientific Institute, Department of Neuroradiology, Via Olgettina 60, Milan, 20132, Italy
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Pennuto M, Tinelli E, Malaguti M, Del Carro U, D'Antonio M, Ron D, Quattrini A, Feltri ML, Wrabetz L. Ablation of the UPR-mediator CHOP restores motor function and reduces demyelination in Charcot-Marie-Tooth 1B mice. Neuron 2008; 57:393-405. [PMID: 18255032 DOI: 10.1016/j.neuron.2007.12.021] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 10/30/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
Abstract
Deletion of serine 63 from P0 glycoprotein (P0S63del) causes Charcot-Marie-Tooth 1B neuropathy in humans, and P0S63del produces a similar demyelinating neuropathy in transgenic mice. P0S63del is retained in the endoplasmic reticulum and fails to be incorporated into myelin. Here we report that P0S63del is misfolded and Schwann cells mount a consequential canonical unfolded protein response (UPR), including expression of the transcription factor CHOP, previously associated with apoptosis in ER-stressed cells. UPR activation and CHOP expression respond dynamically to P0S63del levels and are reversible but are associated with only limited apoptosis of Schwann cells. Nonetheless, Chop ablation in S63del mice completely rescues their motor deficit and reduces active demyelination 2-fold. This indicates that signaling through the CHOP arm of the UPR provokes demyelination in inherited neuropathy. S63del mice also provide an opportunity to explore how cells can dysfunction yet survive in prolonged ER stress-important for neurodegeneration related to misfolded proteins.
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Affiliation(s)
- Maria Pennuto
- DIBIT, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
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Butera C, Guerriero R, Vimercati O, Amadio S, Comi G, Carro UD. WO12 Neurophysiological study of botulinum toxin long-term effects in hemifacial spasm. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60090-5] [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: 11/28/2022]
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Panseri S, Cunha C, Lowery J, Del Carro U, Taraballi F, Amadio S, Vescovi A, Gelain F. Electrospun micro- and nanofiber tubes for functional nervous regeneration in sciatic nerve transections. BMC Biotechnol 2008; 8:39. [PMID: 18405347 PMCID: PMC2358889 DOI: 10.1186/1472-6750-8-39] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [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: 08/02/2007] [Accepted: 04/11/2008] [Indexed: 12/22/2022] Open
Abstract
Background Although many nerve prostheses have been proposed in recent years, in the case of consistent loss of nervous tissue peripheral nerve injury is still a traumatic pathology that may impair patient's movements by interrupting his motor-sensory pathways. In the last few decades tissue engineering has opened the door to new approaches;: however most of them make use of rigid channel guides that may cause cell loss due to the lack of physiological local stresses exerted over the nervous tissue during patient's movement. Electrospinning technique makes it possible to spin microfiber and nanofiber flexible tubular scaffolds composed of a number of natural and synthetic components, showing high porosity and remarkable surface/volume ratio. Results In this study we used electrospun tubes made of biodegradable polymers (a blend of PLGA/PCL) to regenerate a 10-mm nerve gap in a rat sciatic nerve in vivo. Experimental groups comprise lesioned animals (control group) and lesioned animals subjected to guide conduits implantated at the severed nerve stumps, where the tubular scaffolds are filled with saline solution. Four months after surgery, sciatic nerves failed to reconnect the two stumps of transected nerves in the control animal group. In most of the treated animals the electrospun tubes induced nervous regeneration and functional reconnection of the two severed sciatic nerve tracts. Myelination and collagen IV deposition have been detected in concurrence with regenerated fibers. No significant inflammatory response has been found. Neural tracers revealed the re-establishment of functional neuronal connections and evoked potential results showed the reinnervation of the target muscles in the majority of the treated animals. Conclusion Corroborating previous works, this study indicates that electrospun tubes, with no additional biological coating or drug loading treatment, are promising scaffolds for functional nervous regeneration. They can be knitted in meshes and various frames depending on the cytoarchitecture of the tissue to be regenerated. The versatility of this technique gives room for further scaffold improvements, like tuning the mechanical properties of the tubular structure or providing biomimetic functionalization. Moreover, these guidance conduits can be loaded with various fillers like collagen, fibrin, or self-assembling peptide gels or loaded with neurotrophic factors and seeded with cells. Electrospun scaffolds can also be synthesized in different micro-architectures to regenerate lesions in other tissues like skin and bone.
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Affiliation(s)
- Silvia Panseri
- Bioscience and Biotechnology Department, University of Milan-Bicocca, Piazza della Scienza 2, Milan, Italy.
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Del Carro U, Fiorina P, Amadio S, De Toni Franceschini L, Petrelli A, Menini S, Martinelli Boneschi F, Ferrari S, Pugliese G, Maffi P, Comi G, Secchi A. Evaluation of polyneuropathy markers in type 1 diabetic kidney transplant patients and effects of islet transplantation: neurophysiological and skin biopsy longitudinal analysis. Diabetes Care 2007; 30:3063-9. [PMID: 17804685 DOI: 10.2337/dc07-0206] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether islet transplantation may stabilize polyneuropathy in uremic type 1 diabetic patients (end-stage renal disease [ESRD] and type 1 diabetes), who received a successful islet-after-kidney transplantation (KI-s). RESEARCH DESIGN AND METHODS Eighteen KI-s patients underwent electroneurographic tests of sural, peroneal, ulnar, and median nerves: the nerve conduction velocity (NCV) index and amplitudes of both sensory action potentials (SAPs) and compound motor action potentials (CMAPs) were analyzed longitudinally at 2, 4, and 6 years after islet transplantation. Skin content of advanced glycation end products (AGEs) and expression of their specific receptors (RAGE) were also studied at the 4-year follow-up. Nine patients with ESRD and type 1 diabetes who received kidney transplantation alone (KD) served as control subjects. RESULTS The NCV score improved in the KI-s group up to the 4-year time point (P = 0.01 versus baseline) and stabilized 2 years later, whereas the same parameter did not change significantly in the KD group throughout the follow-up period or when a cross-sectional analysis between groups was performed. Either SAP or CMAP amplitudes recovered in the KI-s group, whereas they continued worsening in KD control subjects. AGE and RAGE levels in perineurium and vasa nervorum of skin biopsies were lower in the KI-s than in the KD group (P < 0.01 for RAGE). CONCLUSIONS Islet transplantation seems to prevent long-term worsening of polyneuropathy in patients with ESRD and type 1 diabetes who receive islets after kidney transplantation. No statistical differences between the two groups were evident on cross-sectional analysis. A reduction in AGE/RAGE expression in the peripheral nervous system was shown in patients receiving islet transplantation.
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Affiliation(s)
- Ubaldo Del Carro
- Department of Neurology and Clinical Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
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Triolo D, Dina G, Lorenzetti I, Malaguti M, Morana P, Del Carro U, Comi G, Messing A, Quattrini A, Previtali SC. Loss of glial fibrillary acidic protein (GFAP) impairs Schwann cell proliferation and delays nerve regeneration after damage. J Cell Sci 2006; 119:3981-93. [PMID: 16988027 DOI: 10.1242/jcs.03168] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Axonal loss causes disabling and permanent deficits in many peripheral neuropathies, and may result from inefficient nerve regeneration due to a defective relationship between Schwann cells, axons and the extracellular matrix. These interactions are mediated by surface receptors and transduced by cytoskeletal molecules. We investigated whether peripheral nerve regeneration is perturbed in mice that lack glial fibrillary acidic protein (GFAP), a Schwann-cell-specific cytoskeleton constituent upregulated after damage. Peripheral nerves develop and function normally in GFAP-null mice. However, axonal regeneration after damage was delayed. Mutant Schwann cells maintained the ability to dedifferentiate but showed defective proliferation, a key event for successful nerve regeneration. We also showed that GFAP and the other Schwann-cell-intermediate filament vimentin physically interact in two distinct signaling pathways involved in proliferation and nerve regeneration. GFAP binds integrin αvβ8, which initiates mitotic signals soon after damage by interacting with fibrin. Consistently, ERK phosphorylation was reduced in crushed GFAP-null nerves. Vimentin instead binds integrin α5β1, which regulates proliferation and differentiation later in regeneration, and may compensate for the absence of GFAP in mutant mice. GFAP might contribute to form macro-complexes to initiate mitogenic and differentiating signaling for efficient nerve regeneration.
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Affiliation(s)
- Daniela Triolo
- Neuropathology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
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