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Affiliation(s)
- B C Kieseier
- Neurologische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Bauer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
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Rommer PS, Dörner T, Freivogel K, Haas J, Kieseier BC, Kümpfel T, Paul F, Proft F, Schulze-Koops H, Schmidt E, Wiendl H, Ziemann U, Zettl UK. Safety and Clinical Outcomes of Rituximab Treatment in Patients with Multiple Sclerosis and Neuromyelitis Optica: Experience from a National Online Registry (GRAID). J Neuroimmune Pharmacol 2015; 11:1-8. [PMID: 26589235 DOI: 10.1007/s11481-015-9646-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/13/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disease. Over the last decades therapeutic options have broadened tremendously. Nevertheless, various therapeutic agents, e.g., rituximab, are currently used in the treatment of MS off label. Disease or health registries are useful methods to collect information about off-label treatments. The German registry for autoimmune disease (GRAID) is a multicenter, retrospective, non-interventional database of patients with various autoimmune diseases. AIM/METHODS The aim of this observational analysis is to present safety data of rituximab in the treatment of MS and neuromyelitis optica (NMO) in a real life clinical setting based on the available registry data. RESULTS Data were collected nationwide in patients who received rituximab. 56 patients were treated with rituximab for MS or NMO. Average observation period was 9.6 months (SD 7.6, ranging from 6 to 29.7 months). Interval between treatments cycles differed tremendously (ranging from 0 to 21 months, median 10 months). Number of infusions ranged from 1 up to more than 8. The analysis provides experience on almost 50 patient years. Infusion related reactions were most common and reported in four patients; infections were seen in three patients (two of them were hospitalized for urinary tract infection and urosepsis). All patients recovered from infection. Full treatment response was attested in a quarter of the patients; two thirds benefited partially from treatment. DISCUSSION Safety data of almost 50 patient years of treatment with rituximab show that rituximab is tolerated well in MS/NMO patients. Infections and infusion reactions are the most common adverse events. Our data may help the individual physician to balance efficacy of rituximab against the risk. • Data on rituximab in MS and NMO are provided for almost 50 patientyears • Rituximab was tolerated well • No unexpected side effects were seen • Almost 80% of the patients benefited at least partially from treatment.
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Affiliation(s)
- P S Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany. .,Department of Neurology, Medical University of Vienna, Vienna, Austria.
| | - T Dörner
- Department of Medicine/Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - J Haas
- Department of Neurology, Jewish Hospital Berlin, Berlin, Germany
| | - B C Kieseier
- Department of Neurology, Medical Faculty, Heinrich Heine-University, Düsseldorf, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Proft
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - H Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | | | - H Wiendl
- Department of Neurology, University of Muenster, Muenster, Germany
| | - U Ziemann
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany.,Department of Neurology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - U K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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3
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Affiliation(s)
- B C Kieseier
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.
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4
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Kuhle J, Hardmeier M, Disanto G, Gugleta K, Ecsedi M, Lienert C, Amato MP, Baum K, Buttmann M, Bayas A, Brassat D, Brochet B, Confavreux C, Edan G, Färkkilä M, Fredrikson S, Frontoni M, D'Hooghe M, Hutchinson M, De Keyser J, Kieseier BC, Kümpfel T, Rio J, Polman C, Roullet E, Stolz C, Vass K, Wandinger KP, Kappos L. A 10-year follow-up of the European multicenter trial of interferon β-1b in secondary-progressive multiple sclerosis. Mult Scler 2015; 22:533-43. [PMID: 26362898 DOI: 10.1177/1352458515594440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b). METHODS We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied. RESULTS Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R(2): 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited (R(2): 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability. CONCLUSIONS The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.
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Affiliation(s)
- J Kuhle
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel/Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK University Hospital Basel, Switzerland
| | - M Hardmeier
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - G Disanto
- Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK. Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - K Gugleta
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - M Ecsedi
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - C Lienert
- Department of Medicine, Neurology, Kantonsspital Baselland Bruderholz, Switzerland
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Italy
| | - K Baum
- Department of Neurology, Klinik Hennigsdorf, Germany
| | - M Buttmann
- Department of Neurology, University of Würzburg, Germany
| | - A Bayas
- Department of Neurology, Klinikum Augsburg, Germany
| | - D Brassat
- Unité Institut national de la santé et de la recherche médicale (INSERM) 563, Centre hospitalier universitaire Purpan, Toulouse, France
| | - B Brochet
- Department of Neurology, and INSERM-CHU CIC-P 0005, Centre hospitalier universitaire de Bordeaux, France
| | - C Confavreux
- Centre de coordination EDMUS pour la sclérose en plaques, Hôpital Neurologique Pierre-Wertheimer, Lyon, France
| | - G Edan
- Department of Neurology, Centre hospitalier universitaire Pontchaillou, Rennes, France
| | - M Färkkilä
- Department of Neurology, Central Hospital, Helsinki University, Finland
| | - S Fredrikson
- Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - M Frontoni
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
| | - M D'Hooghe
- Department of Neurology, National MS Center, Melsbroek, Belgium/Vrije Universiteit Brussel, Belgium
| | - M Hutchinson
- Saint Vincent's University Hospital, University College Dublin, Ireland
| | - J De Keyser
- Departments of Neurology, University Medical Center Groningen, Netherlands
| | - B C Kieseier
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
| | - J Rio
- MS Center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Polman
- MS Center Amsterdam, Vrije University Medical Center, Netherlands
| | - E Roullet
- Department of Neurology, Hôpital Tenon, Paris, France
| | - C Stolz
- PAREXEL International GmbH, Berlin, Germany
| | - K Vass
- University Clinic of Neurology, Medical University of Vienna, Austria
| | - K P Wandinger
- University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - L Kappos
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
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5
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Kuhle J, Disanto G, Dobson R, Adiutori R, Bianchi L, Topping J, Bestwick JP, Meier UC, Marta M, Costa GD, Runia T, Evdoshenko E, Lazareva N, Thouvenot E, Iaffaldano P, Direnzo V, Khademi M, Piehl F, Comabella M, Sombekke M, Killestein J, Hegen H, Rauch S, D’Alfonso S, Alvarez-Cermeño JC, Kleinová P, Horáková D, Roesler R, Lauda F, Llufriu S, Avsar T, Uygunoglu U, Altintas A, Saip S, Menge T, Rajda C, Bergamaschi R, Moll N, Khalil M, Marignier R, Dujmovic I, Larsson H, Malmestrom C, Scarpini E, Fenoglio C, Wergeland S, Laroni A, Annibali V, Romano S, Martínez AD, Carra A, Salvetti M, Uccelli A, Torkildsen Ø, Myhr KM, Galimberti D, Rejdak K, Lycke J, Frederiksen JL, Drulovic J, Confavreux C, Brassat D, Enzinger C, Fuchs S, Bosca I, Pelletier J, Picard C, Colombo E, Franciotta D, Derfuss T, Lindberg RLP, Yaldizli Ö, Vécsei L, Kieseier BC, Hartung HP, Villoslada P, Siva A, Saiz A, Tumani H, Havrdová E, Villar LM, Leone M, Barizzone N, Deisenhammer F, Teunissen C, Montalban X, Tintoré M, Olsson T, Trojano M, Lehmann S, Castelnovo G, Lapin S, Hintzen R, Kappos L, Furlan R, Martinelli V, Comi G, Ramagopalan SV, Giovannoni G. Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study. Mult Scler 2015; 21:1013-24. [DOI: 10.1177/1352458514568827] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/19/2014] [Indexed: 11/15/2022]
Abstract
Background and objective: We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort. Methods: Thirty-three centres provided serum samples from 1047 CIS cases with at least two years’ follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS. Results: At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71–2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52–2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04–3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98–0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres. Conclusions: We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.
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Affiliation(s)
- J Kuhle
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK/ Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - G Disanto
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - R Dobson
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - R Adiutori
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - L Bianchi
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - J Topping
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - JP Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and the London School for Medicine and Dentistry, UK
| | - U-C Meier
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - M Marta
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - G Dalla Costa
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - T Runia
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - E Evdoshenko
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - N Lazareva
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - E Thouvenot
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - P Iaffaldano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - V Direnzo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - M Khademi
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - F Piehl
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - M Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - M Sombekke
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - J Killestein
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - H Hegen
- Department of Neurology, Innsbruck Medical University, Austria
| | - S Rauch
- Department of Radiology, Innsbruck Medical University, Austria
| | - S D’Alfonso
- Department of Health Sciences and IRCAD, Eastern Piedmont University, Italy
| | | | - P Kleinová
- Department of Neurology, Charles University in Prague, Czech Republic
| | - D Horáková
- Department of Neurology, Charles University in Prague, Czech Republic
| | - R Roesler
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - F Lauda
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - S Llufriu
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - T Avsar
- Dr Orhan Öcalgiray Molecular Biology-Biotechnology and Genetics Research Centre, Istanbul Technical University, Turkey
| | - U Uygunoglu
- Department of Neurology, Istanbul University, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - T Menge
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - C Rajda
- Department of Neurology, University of Szeged, Hungary
| | | | - N Moll
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - M Khalil
- Department of Neurology, Medical University of Graz, Austria
| | - R Marignier
- Department of Neurology, Université de Lyon, Université Claude Bernard-Lyon 1, France
| | - I Dujmovic
- Clinic of Neurology, Belgrade University School of Medicine, Serbia
| | - H Larsson
- Unit of Functional Imaging, Glostrup Hospital, University of Copenhagen, Denmark
| | - C Malmestrom
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - E Scarpini
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - C Fenoglio
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - S Wergeland
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway
| | - A Laroni
- Department of Neurology, University of Genoa, Italy
| | - V Annibali
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - S Romano
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - AD Martínez
- Department of Neurology of Hospital Británico of Buenos Aires, Argentina
| | - A Carra
- Department of Neurology of Hospital Británico of Buenos Aires, Argentina
| | - M Salvetti
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - A Uccelli
- Department of Neurology, University of Genoa, Italy
| | - Ø Torkildsen
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway
| | - KM Myhr
- Department of Neurology, University of Genoa, Italy
| | - D Galimberti
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - K Rejdak
- Department of Neurology, Medical University of Lublin, Poland
| | - J Lycke
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - JL Frederiksen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - J Drulovic
- Clinic of Neurology, Belgrade University School of Medicine, Serbia
| | - C Confavreux
- Department of Neurology, Université de Lyon, Université Claude Bernard-Lyon 1, France
| | - D Brassat
- Department of Neurology, University of Toulouse, France
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Austria
| | - S Fuchs
- Department of Neurology, Medical University of Graz, Austria
| | - I Bosca
- MS Unit, Neurology Department, La Fe University and Polytechnic Hospital, Instituto de investigación Sanitaria La Fe, Spain
| | - J Pelletier
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - C Picard
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - E Colombo
- C. Mondino National Neurological Institute, Italy
| | - D Franciotta
- C. Mondino National Neurological Institute, Italy
| | - T Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - RLP Lindberg
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Ö Yaldizli
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - L Vécsei
- Department of Neurology, University of Szeged, Hungary
| | - BC Kieseier
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - HP Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - P Villoslada
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - A Saiz
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - H Tumani
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - E Havrdová
- Department of Neurology, Charles University in Prague, Czech Republic
| | - LM Villar
- Department of Neurology and Immunology, Hospital Ramón y Cajal, Spain
| | - M Leone
- MS Centre, SCDU Neurology, Head and Neck Department, AOU Maggiore della Carità, Italy
| | - N Barizzone
- Department of Health Sciences and IRCAD, Eastern Piedmont University, Italy
| | - F Deisenhammer
- Department of Neurology, Innsbruck Medical University, Austria
| | - C Teunissen
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - X Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - M Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - T Olsson
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - S Lehmann
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - G Castelnovo
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - S Lapin
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - R Hintzen
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - L Kappos
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - R Furlan
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - V Martinelli
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - G Comi
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - SV Ramagopalan
- Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, UK
| | - G Giovannoni
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
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6
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Weber A, Zimmermann C, Kieseier BC, Hartung HP, Hofstetter HH. Bacteria and their cell wall components uniformly co-activate interleukin-17-producing thymocytes. Clin Exp Immunol 2015; 178:504-15. [PMID: 24995465 DOI: 10.1111/cei.12414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 12/16/2022] Open
Abstract
Interleukin (IL)-17-producing T cells play a critical role in the immune response against microbial pathogens. Traditionally, experimental studies have focused upon understanding the activity of IL-17-producing T cells which differentiate from naive T cells in the peripheral immune system. However, we have demonstrated previously that IL-17-producing T cells are also present in the thymus of naive wild-type mice and can be co-activated there by microbial stimuli. Other studies have supported the concept that IL-17-producing thymocytes have a specific role in the immediate defence against microbial pathogens, which is independent from the development of an adaptive immune response. Given an important role of the thymus in systemic bacterial infection and sepsis, in this study we investigate the effect of a broad spectrum of bacteria and cell wall components on thymocyte cytokine production. Surprisingly, we find that all types of bacteria investigated (including non-pathogenic species) uniformly activate IL-17-producing thymocytes upon α-CD3 stimulation. In contrast, there is a heterogeneous effect on IL-6 and interferon (IFN)-γ-production with Gram-negative bacteria inducing far higher frequencies of IL-6- and IFN-γ-producing thymocytes than Gram-positive bacteria. We conclude that IL-17-producing thymocytes constitute a 'first line of recognition', but not a 'first line of defence' against bacteria in general. Their activity might lead to immune activation, but not necessarily to a pathological inflammatory disease condition. The difference between these two states might be determined by other immunological effector molecules, such as IL-6 and IFN-γ.
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Affiliation(s)
- A Weber
- Department of Neurology, Heinrich Heine University, School of Medicine, Düsseldorf, Germany
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7
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Abstract
ABSTRACT:Background:Controversial data was published about the sodium channel-blocking effect of the endogenous pentapeptide QYNAD, which is elevated in patients with multiple sclerosis and Guillain-Barré-syndrome. In some experiments with single cells and nerve preparations QYNAD inhibited sodium currents to the same extent as the known sodium channel blocker lidocaine whereas in other laboratory testing QYNAD failed to show any effect at all.Methods:Micro-electrode arrays with cultured neuronal networks are highly suitable to determine neuroactive activity of applied substances. The impact on electrophysiological parameter changes was compared between QYNAD and the established sodium channel blockers lidocaine and tetrodotoxin (TTX).Results:QYNAD did not alter network activity whereas the sodium channel blockers lidocaine (IC50 14.9 µM) and tetrodotoxin (IC50 1.1 nM) reversibly decreased network activity in similar concentrations as in patch-clamp experiments. This decrease of spontaneous electrophysiological activity was achieved by prolonging the interburst-interval.Conclusion:Although QYNAD might have mild effects on single-cell sodium currents, there is no significant effect on neuronal network function. These results raise concerns about QYNAD exhibiting a relevant impact on functional disability of the central nervous system in patients.
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Affiliation(s)
- F Otto
- Department of Neurology, Heinrich-Heine-University Düisseldorf, Germany
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8
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9
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Dehmel T, Döbert M, Pankratz S, Leussink VI, Hartung HP, Wiendl H, Kieseier BC. Monomethylfumarate reduces in vitro migration of mononuclear cells. Neurol Sci 2014; 35:1121-5. [PMID: 24504620 DOI: 10.1007/s10072-014-1663-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/24/2014] [Indexed: 12/11/2022]
Abstract
Migration of immunocompetent cells into the central nervous system represents a key event in the immunopathogenesis of multiple sclerosis (MS). Fumaric acid esters have recently been approved for patients with MS. Their mode of action is not fully understood so far. We analyzed the effect of monomethylfumarate (MMF), the immediate metabolite of dimethylfumarate, on migration of lymphocytes and macrophages. Peripheral blood mononuclear cells (PBMCs) were isolated from patients with MS and healthy donors. PBMCs were treated with MMF in vitro and their migratory capacity was studied in a Boyden chamber assay. In addition, expression of matrix metalloproteinases (MMPs), chemokine receptors, adhesion molecules, and molecules of the oxidative stress cascade was assessed. MMF decreased the migratory capacity of T lymphocytes, but not of macrophages. Lymphocytes as well as macrophages responded to MMF by the upregulation of oxidative stress molecules; however, no effect was seen on the expression of MMPs, chemokine receptors, and adhesion molecules. There was no difference in comparison with cells from healthy controls. MMF reduces the migratory activity of lymphocytes most likely by changing their activational state. This points to a potential novel mode of action differentiating this drug from other available immunotherapies.
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Affiliation(s)
- T Dehmel
- Department of Neurology, Medical Faculty, Research Group for Clinical and Experimental Neuroimmunology, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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10
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Zimmermann C, Weber A, Mausberg AK, Kieseier BC, Hartung HP, Hofstetter HH. T cell activation status determines the cytokine pattern induced by zymosan and bacterial DNA both in thymocytes and splenocytes. Clin Exp Immunol 2013; 172:245-53. [PMID: 23574321 DOI: 10.1111/cei.12037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/22/2022] Open
Abstract
Proinflammatory cytokines are essential mediators of the immunopathology associated with microbial sepsis. The fungal cell wall component zymosan and bacterial DNA are well-studied experimental tools for investigating these processes, simulating the presence of fungal or bacterial infection. Cells of the immune periphery, but also immune cells in the thymus, are affected essentially by the presence of microbes or their immune stimuli in sepsis. For this reason, we investigated the cytokine pattern present in the spleen (containing mature immune cells) and the thymus (containing immature immune cells) upon exposure to zymosan and Escherichia coli DNA. To study the role of T cell activation status, we investigated ex-vivo cultures with and without αCD3 stimulation for changes in their cytokine secretion pattern as measured by cytokine enzyme-linked immunospot (ELISPOT) and flow cytometry analysis. We found that both substances strongly co-stimulate αCD3-induced interferon (IFN)-γ and interleukin (IL)-6 secretion in the thymus and in the spleen, but stimulate IL-17 production only moderately. Moreover, zymosan increases PLP peptide (PLPp)-specific IFN-γ and IL-6 production in experimental autoimmune encephalomyelitis (EAE) induced in Swiss Jim Lambert (SJL)/J mice, confirming that T cell activation status is crucial for the cytokines secreted by an immune cell population encountering a microbial pathogen or immunostimulating parts of it.
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Affiliation(s)
- C Zimmermann
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
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11
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Klotz L, Gold R, Hemmer B, Korn T, Zipp F, Hohlfeld R, Kieseier BC, Wiendl H. [Diagnosis of multiple sclerosis 2010 revision of the McDonald criteria]. Nervenarzt 2012; 82:1302-9. [PMID: 21681517 DOI: 10.1007/s00115-011-3283-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Ulrich NH, Dehmel T, Wittsack HJ, Kieseier BC, Seitz RJ. Peripheral blood levels of matrix metalloproteinase-9 predict lesion volume in acute stroke. Neurol Sci 2012; 34:379-82. [PMID: 22395947 DOI: 10.1007/s10072-012-0999-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
Matrix metalloproteinases (MMPs) have been implicated to play an important role in the destruction of the extracellular matrix in diseases of the central nervous system. This study investigated whether the expression of one of these proteases, MMP-9 in blood, is related to the size of human brain infarcts assessed with magnetic resonance imaging. Consecutively, twenty-one acute stroke patients were included prospectively into our study. In blood samples drawn within 24 h after onset, MMP-9 RNA-expression and proteolytic-activity were analyzed by quantitative polymerase chain reaction and gelatin zymography, respectively. The ischemic lesion volumes in time to peak perfusion maps and diffusion weighted imaging were measured morphometrically. RNA-expression levels of MMP-9 in peripheral blood mononuclear cells (PBMCs) correlated with the brain infarct lesion (TTP-delay 4 s, r = -0.61, p = 0.007; TTP-delay 6 s: r = -0.58, p = 0.012; DWI r = -0.47; p = 0.047). Our preliminary results demonstrate that MMP-9 RNA is upregulated in PBMCs in proportion to ischemia. These findings suggest that MMP-9 might contribute to the manifestation of ischemic brain damage. Since MMP-9 is upregulated in acute ischemia inhibition of MMP-9 may represent a complementary treatment target in acute stroke therapy.
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Affiliation(s)
- Nils H Ulrich
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
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13
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Schwab N, Ulzheimer JC, Fox RJ, Schneider-Hohendorf T, Kieseier BC, Monoranu CM, Staugaitis SM, Welch W, Jilek S, Du Pasquier RA, Brück W, Toyka KV, Ransohoff RM, Wiendl H. Fatal PML associated with efalizumab therapy: insights into integrin αLβ2 in JC virus control. Neurology 2012; 78:458-67; discussion 465. [PMID: 22302546 DOI: 10.1212/wnl.0b013e3182478d4b] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Progressive multifocal leukoencephalopathy (PML) has become much more common with monoclonal antibody treatment for multiple sclerosis and other immune-mediated disorders. METHODS We report 2 patients with severe psoriasis and fatal PML treated for ≥3 years with efalizumab, a neutralizing antibody to αLβ2-leukointegrin (LFA-1). In one patient, we conducted serial studies of peripheral blood and CSF including analyses of leukocyte phenotypes, migration ex vivo, and CDR3 spectratypes with controls coming from HIV-infected patients with PML. Extensive pathologic and histologic analysis was done on autopsy CNS tissue of both patients. RESULTS Both patients developed progressive cognitive and motor deficits, and JC virus was identified in CSF. Despite treatment including plasma exchange (PE) and signs of immune reconstitution, both died of PML 2 and 6 months after disease onset. Neuropathologic examination confirmed PML. Efalizumab treatment was associated with reduced transendothelial migration by peripheral T cells in vitro. As expression levels of LFA-1 on peripheral T cells gradually rose after PE, in vitro migration increased. Peripheral and CSF T-cell spectratyping showed CD8+ T-cell clonal expansion but blunted activation, which was restored after PE. CONCLUSIONS From these data we propose that inhibition of peripheral and intrathecal T-cell activation and suppression of CNS effector-phase migration both characterize efalizumab-associated PML. LFA-1 may be a crucial factor in homeostatic JC virus control.
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Affiliation(s)
- N Schwab
- Department of Neurology–Department of Inflammatory Diseases of the Nervous System and Neurooncology,University of Mu¨nster, Germany
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14
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Warnke C, Adams O, Gold R, Hartung HP, Hohlfeld R, Wiendl H, Kieseier BC. [Progressive multifocal leukoencephalopathy under natalizumab. Initial possibilities for risk stratification?]. Nervenarzt 2011; 82:475-80. [PMID: 21240604 DOI: 10.1007/s00115-010-3091-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Natalizumab (Tysabri®) is the first monoclonal antibody approved for the treatment of relapsing forms of multiple sclerosis (MS) but while treatment is highly efficient, it carries the risk of progressive multifocal leukoencephalopathy (PML). Based on reports of confirmed cases of PML, the risk of PML might increase beyond 24 months of treatment. Thus, attempts to stratify patients treated with natalizumab into those carrying higher or lower risk for developing PML are currently being undertaken. Among these strategies JC virus serology might potentially be the first tool available. As a large variety of methods have been published resulting in controversial results for JC virus seroprevalence, standardized testing will be mandatory when applying this method in clinical practice. In addition, risk management strategies for the seropositive majority of patients need to be redefined and optimized further.
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Affiliation(s)
- C Warnke
- Neurologische Klinik, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf
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15
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Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P, Suchet L, Hyde R, Balla I, Frohman EM, Kieseier BC. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2011; 18:69-77. [PMID: 20561039 DOI: 10.1111/j.1468-1331.2010.03110.x] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS. METHODS this was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs. RESULTS two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment. CONCLUSION identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs.
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Affiliation(s)
- V Devonshire
- University of British Columbia Hospital MS Clinic, Canada
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16
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Sabir H, Babor F, Kieseier BC, Mayatepek E, Assmann B. Unilateral facial flushing and sweating after physical exercise: Harlequin syndrome. Klin Padiatr 2011; 223:90-1. [PMID: 21271501 DOI: 10.1055/s-0030-1269925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H Sabir
- General Pediatrics, Heinrich Heine University, Duesseldorf, Germany.
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17
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Lalive PH, Häusler MG, Maurey H, Mikaeloff Y, Tardieu M, Wiendl H, Schroeter M, Hartung HP, Kieseier BC, Menge T. Highly reactive anti-myelin oligodendrocyte glycoprotein antibodies differentiate demyelinating diseases from viral encephalitis in children. Mult Scler 2010; 17:297-302. [DOI: 10.1177/1352458510389220] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Myelin oligodendrocyte glycoprotein (MOG) may be implicated in the immunopathogenesis of multiple sclerosis (MS) inducing demyelination in the animal model of MS. In adults reported anti-MOG antibody frequencies have been variable across a number of studies and can also be detected in controls. Objective: To measure antibodies against MOG in paediatric patients with demyelinating disorders of the central nervous system and in controls. Methods: Serum antibodies against MOG and myelin basic protein were measured by ELISA, flow cytometry (FACS) and in the liquid phase in 11 children with acute disseminated encephalomyelitis (ADEM), 22 children with MS, seven children with acute viral encephalitis and 13 healthy controls. The serostatus of Epstein–Barr virus (EBV) infections were assessed. Results: Anti-MOG antibodies, measured either by ELISA or FACS were exclusively detected in children with demyelination. In ADEM these antibodies were highly reactive. Anti-MBP reactivity was detectable equally in all groups. The presence of either autoantibodies did not associate with EBV serostatus, age, gender or disease course. Conclusions: This study independently corroborates recently published results of seroprevalence and specificity of the assay. Due to their low sensitivity anti-MOG antibodies will not serve as disease-specific biomarkers, but could help to support the diagnosis of ADEM in difficult cases.
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Affiliation(s)
- PH Lalive
- Department of Neurosciences, Division of Neurology, University Hospital of Geneva, Geneva, Switzerland
- Department of Genetics and Laboratory Medicine, Laboratory Medicine Service, University Hospital of Geneva, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - MG Häusler
- Department of Pediatrics, Neuropediatric Section, University Hospital, RWTH Aachen, Germany
| | - H Maurey
- Assistance Publique Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin-Bicêtre Cedex, France
| | - Y Mikaeloff
- Assistance Publique Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin-Bicêtre Cedex, France
| | - M Tardieu
- Assistance Publique Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin-Bicêtre Cedex, France
| | - H Wiendl
- Department of Neurology – Inflammatory Disorders of the Nervous System and Neurooncology, University of Münster, Germany
| | - M Schroeter
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - HP Hartung
- Department of Neurology, Heinrich-Heine-University Medical School, University Hospital Düsseldorf, Düsseldorf, Germany
| | - BC Kieseier
- Department of Neurology, Heinrich-Heine-University Medical School, University Hospital Düsseldorf, Düsseldorf, Germany
| | - T Menge
- Department of Neurology, Heinrich-Heine-University Medical School, University Hospital Düsseldorf, Düsseldorf, Germany
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18
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Warnke C, Leussink VI, Kieseier BC, Hartung HP. [Interferon β for multiple sclerosis. How much is good enough?]. Nervenarzt 2010; 81:1476-1482. [PMID: 21104222 DOI: 10.1007/s00115-010-3017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Interferon β-1b (IFNB-1b, Betaferon®) was the first therapy for multiple sclerosis (MS) showing efficacy in a randomized controlled clinical trial. Early studies suggested a dose-dependency of the clinical efficacy of IFNB-1b. However, until recently no reliable clinical data were available to assess the potential of higher dosing to increase therapeutic efficacy. In addition, no clinical trials have been conducted to directly compare the efficacy of IFNB-1b with that of glatiramer acetate, an alternative first line treatment option for relapsing-remitting MS. Just recently, the prospective, randomized, multicenter study BEYOND was published which addressed both issues. In this review the BEYOND trial is reviewed and placed in the context of advantages and disadvantages of currently available first line therapies for MS.
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Affiliation(s)
- C Warnke
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf
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19
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20
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Lehmann HC, Hoffmann FR, Meyer Zu Hörste G, Hartung HP, Kieseier BC. Central nervous system involvement in patients with monoclonal gammopathy and polyneuropathy. Eur J Neurol 2010; 17:1075-81. [PMID: 20236302 DOI: 10.1111/j.1468-1331.2010.02977.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate clinical presentation of patients with the clinical triad of monoclonal gammopathy, polyneuropathy and signs of CNS involvement. METHODS Nineteen patients with monoclonal protein (M-protein, 9 IgM, 10 IgG) were studied. Clinical examination, MRI, cerebrospinal fluid analysis and immune reactivity against myelin-associated glycoprotein and gangliosides in serum were obtained. By immunohistochemistry, different binding patterns of M-proteins to human CNS tissue were investigated. RESULTS Nine out of 19 patients (four IgM, five IgG) showed one or more clinical signs of CNS involvement. Clinical features associated with signs of CNS pathology were disease duration and greater concentration of IgM paraprotein. The IgM M-protein of two patients strongly stained the cortex/cerebellar neurons in human brain sections. CONCLUSION Our results complement previous reports that some patients with monoclonal gammopathy and polyneuropathy can develop solitary or disseminated signs of CNS involvement. It indicates that pathological effects of M-proteins are not necessarily restricted to the peripheral nervous system. The specificity and affinity of circulating M-protein to antigens in the CNS might be critical for the development of different clinical phenotypes.
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Affiliation(s)
- H C Lehmann
- Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany.
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21
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Husseini L, Leussink VI, Kieseier BC, Hartung HP. [4-Aminopyridine (Fampridine). A new attempt for the symptomatic treatment of multiple sclerosis]. Nervenarzt 2010; 81:203-211. [PMID: 20112006 DOI: 10.1007/s00115-009-2902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Mobility limitation is a frequent clinical symptom of multiple sclerosis (MS) that poses a therapeutic challenge. For years results of animal experiments and clinical experience have indicated that the potassium channel blocker 4-aminopyridine improves axonal excitatory circuits and thus muscular strength in demyelinating diseases. A recently conducted randomized, placebo-controlled, multicenter phase 3 clinical trial in MS patients was able to show that an oral sustained-release formulation of 4-aminopyridine (Fampridine-SR) represents a suitable agent for treatment of walking disability in MS patients.This overview presents the study data and discusses the value of 4-aminopyridine for the symptomatic treatment of MS as a neurofunctional modifier of this disabling disease.
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Affiliation(s)
- L Husseini
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany
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22
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23
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Menge T, Schloot NC, Schott M, Hemmer B, Wiendl H, Roden M, Hartung HP, Kieseier BC. Interferon beta treatment does not induce organ-specific autoantibodies in multiple sclerosis. Neurology 2009; 73:900-2. [PMID: 19752459 DOI: 10.1212/wnl.0b013e3181b78460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T Menge
- Department of Neurology, Heinrich-Heine University, Moorenstr. 5, D-40225 Düsseldorf, Germany.
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24
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Lehmann HC, Jangouk P, Kierysch E, Meyer zu Hörste G, Hartung HP, Kieseier BC. Autonomic dysfunction in Guillain-Barré syndrome: circulating IgG alter noradrenaline synthesis in sympathetic neurons. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stangel M, Hartung HP, Gold R, Kieseier BC. [The significance of intravenous immunoglobulin in treatment of immune-mediated polyneuropathies]. Nervenarzt 2009; 80:678-687. [PMID: 19139838 DOI: 10.1007/s00115-008-2631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Long-term treatment of immune-mediated polyneuropathies remains difficult. For acute polyneuritis, or Guillain-Barré syndrome, the established standard therapy utilizes high doses of polyvalent intravenous immunoglobulins (IVIG). A recently published randomized placebo-controlled study of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) showed IVIG to be clinically effective also for this disorder in both short and long term. This survey presents data of this so-called ICE study ("Intravenous immune globulin for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy"). It also discusses the value of IVIG in the treatment of immune-mediated polyneuropathies.
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Affiliation(s)
- M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Bernal F, Elias B, Hartung HP, Kieseier BC. Regulation of matrix metalloproteinases and their inhibitors by interferon-beta: a longitudinal study in multiple sclerosis patients. Mult Scler 2009; 15:721-7. [PMID: 19383643 DOI: 10.1177/1352458509102920] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) represent a large family of proteolytic enzymes, with some members being implicated in the immunopathogenesis of multiple sclerosis (MS). Interferon (IFN)-beta is one of the current mainstays in MS therapy and known to downregulate the expression of MMP-9. However, only sparse information is available on the effects of IFN-beta on the other 20 members of the MMP family. METHODS This is a longitudinal analysis on the RNA expression pattern of all known MMPs and their endogenous inhibitors before and after 1 and 6 months of IFN-beta therapy. RNA expression levels were assessed in peripheral venous blood cells from 14 MS patients and 8 matched controls by real time-PCR. RESULTS RNA expression levels before treatment differed in part in MS patients compared to healthy controls (MMP-9, MMP-14, MMP-19, TIMP-1, TIMP-2). Some of the MMPs responded to therapy specifically (MMP-8, MMP-9, MMP-19), whereas others remained unchanged over time. CONCLUSIONS These data suggest that MMPs may differ in their expression levels in MS patients and that this group of enzymes is differentially regulated during the treatment with IFN-beta in MS for at least 6 months.
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Affiliation(s)
- F Bernal
- Department of Neurology, Research Group for Clinical and Experimental Neuroimmunology, Heinrich-Heine-University, Düsseldorf, Germany
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Kopadze T, Döbert M, Leussink VI, Dehmel T, Kieseier BC. Cladribine impedesin vitromigration of mononuclear cells: a possible implication for treating multiple sclerosis. Eur J Neurol 2009; 16:409-12. [DOI: 10.1111/j.1468-1331.2008.02433.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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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Menge T, Büdingen HC, Dalakas MC, Kieseier BC, Hartung HP. [Targeting B cells in multiple sclerosis. Current concepts and strategies]. Nervenarzt 2009; 80:190-8. [PMID: 19189075 DOI: 10.1007/s00115-008-2664-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating autoimmune disease of the CNS and a leading cause of lasting neurological disability in younger adults. In the last decade our knowledge of its immunopathogenesis expanded vastly. It is now widely appreciated that B cells are key players in the autoreactive immune network. They exert far more functions than merely being the precursors of antibody-producing plasma cells. B cells act as efficient antigen-presenting cells and may stimulate an autoreactive immune response through secretion of proinflammatory cytokines. It is thus only logical to test therapeutic strategies targeting B cells in MS. Rituximab is a depleting chimeric monoclonal antibody directed against CD20 and expressed on developing, naïve, and memory B cells but not stem or plasma cells. Several smaller studies have been conducted that led to a placebo controlled, double blind phase II study on efficacy which was reported recently. The results are very promising, meeting not only the primary endpoint of reduction of the surrogate MRI marker of contrast-enhancing lesions but also showing a reduction in clinical relapse rate of patients treated with rituximab. This review discusses the role of autoreactive B cells in the context of MS, analyzes the B-cell-depleting treatment studies reported, and provides information on planned and future B-cell-directed therapeutic strategies in MS.
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Affiliation(s)
- T Menge
- Neurologische Klinik, Heinrich-Heine-Universität, Moorenstrasse 5, 40225, Düsseldorf, Deutschland
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29
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Abstract
Recent advances in understanding of the immunopathogenesis of multiple sclerosis (MS) have led to the development of new treatment options. To date several immunomodulatory agents have been licensed for the treatment of relapsing-remitting MS. However, some debate remains on the optimal time point for initiating therapy. While there is general consensus on the benefit of an early treatment start, the issues of how to define "early MS" and how to identify patients with a "benign" disease course have not yet been finally addressed. Further open questions include the situations of treatment failure and therapeutic escalation. Here we summarize available data from studies on early treatment with immunomodulatory drugs for a first demyelinating event, also referred to as clinically isolated syndrome. Furthermore, options for the escalation of immunomodulatory therapy will be discussed, e.g. with the recently licensed monoclonal antibody natalizumab.
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MESH Headings
- Adjuvants, Immunologic/adverse effects
- Adjuvants, Immunologic/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Brain/pathology
- Humans
- Immunologic Factors/therapeutic use
- Interferon beta-1b
- Interferon-beta/adverse effects
- Interferon-beta/therapeutic use
- Magnetic Resonance Imaging
- Mitoxantrone/therapeutic use
- Multiple Sclerosis, Relapsing-Remitting/diagnosis
- Multiple Sclerosis, Relapsing-Remitting/prevention & control
- Natalizumab
- Randomized Controlled Trials as Topic
- Rituximab
- Secondary Prevention
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Affiliation(s)
- R A Linker
- Abteilung Neurologie, St.-Josef-Hospital, Ruhr-Universität, Bochum, Deutschland
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30
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Kopadze T, Dehmel T, Mylius HA, Hartung HP, Wiendl H, Kieseier BC. Treosulfan impedes the migration of immunocompetent cells. J Neurol 2007; 254:1457-8. [DOI: 10.1007/s00415-007-0552-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/14/2007] [Accepted: 02/26/2007] [Indexed: 11/28/2022]
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31
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Kleinschnitz C, Meuth SG, Kieseier BC, Wiendl H. [Update on pathophysiologic and immunotherapeutic approaches for the treatment of multiple sclerosis]. Nervenarzt 2007; 78:883-911. [PMID: 17551708 DOI: 10.1007/s00115-007-2261-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is a chronic disabling disease with significant implications for patients and society. The individual disease course is difficult to predict due to the heterogeneity of clinical presentation and of radiologic and pathologic findings. Although its etiology still remains unknown, the last decade has brought considerable understanding of the underlying pathophysiology of MS. In addition to its acceptance as a prototypic inflammatory autoimmune disorder, recent data reveal the importance of primary and secondary neurodegenerative mechanisms such as oligodendrocyte death, axonal loss, and ion channel dysfunction. The deepened understanding of its immunopathogenesis and the limited effectiveness of currently approved disease-modifying therapies have led to a tremendous number of trials investigating potential new drugs. Emerging treatments take into account the different immunopathological mechanisms and strategies, to protect against axonal damage and promote remyelination. This review provides a compilation of novel immunotherapeutic strategies and recently uncovered aspects of known immunotherapeutic agents. The pathogenetic rationale of these novel drugs for the treatment of MS and accompanying preclinical and clinical data are highlighted.
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Affiliation(s)
- C Kleinschnitz
- Neurologische Klinik und Poliklinik, Universitätsklinikum, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany
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32
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Wiendl H, Kieseier BC, Gold R, Hohlfeld R, Bendszus M, Hartung HP. [Revision of McDonald's new diagnostic criteria for multiple sclerosis]. Nervenarzt 2007; 77:1235, 1237-45. [PMID: 16912904 DOI: 10.1007/s00115-006-2127-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2001, an international panel suggested new diagnostic criteria for multiple sclerosis (MS). These criteria integrate clinical, imaging (MRI), and paraclinical results in order to facilitate diagnosis. Since then, these so-called McDonald criteria have been broadly accepted and widely propagated. In the meantime a number of publications have dealt with the sensitivity and specificity for MS diagnosis and with implementing these new criteria in clinical practice. Based on these empirical values and newer data on MS, an international expert group recently proposed a revision of the criteria. Substantial changes affect (1) MRI criteria for the dissemination of lesions over time, (2) the role of spinal cord lesions in the MRI and (3) diagnosis of primary progressive MS. In this article we present recent experiences with the McDonald and revised criteria.
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Affiliation(s)
- H Wiendl
- Neurologische Klinik und Poliklinik, Julius-Maximilians-Universität, Würzburg
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33
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Kleinschnitz C, Meuth SG, Kieseier BC, Wiendl H. Immunotherapeutic approaches in MS: update on pathophysiology and emerging agents or strategies 2006. Endocr Metab Immune Disord Drug Targets 2007; 7:35-63. [PMID: 17346203 DOI: 10.2174/187153007780059414] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [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: 11/22/2022]
Abstract
Multiple sclerosis (MS) is a chronic disabling disease with significant implications for patients and society. The individual disease course is difficult to predict due to the heterogeneity of clinical presentation as well as radiological and pathological findings. Although its etiology still remains unknown, the last decade has generated considerable success in understanding the underlying pathophysiology of MS. In addition to its view as a prototypic inflammatory autoimmune disorder, recent data support the importance of primary and secondary neurodegenerative mechanisms such as oligodendrocyte death, axonal loss and ion channel dysfunction. The deepened understanding of the immunopathogenesis as well as the limited effectiveness of the currently approved disease modifying therapies have led to a tremendous number of trials investigating potentially new drug targets. Emerging treatments take into account the different immunopathological mechanisms as well as strategies to protect against axonal damage or to promote remyelination. This review provides a compilation of novel immunotherapeutic strategies or new aspects of known immunotherapeutic agents which have evolved recently. The pathogenetic rationale of these novel drug targets for the treatment of MS as well as accompanying preclinical and clinical data are highlighted.
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Affiliation(s)
- C Kleinschnitz
- Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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34
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Hu W, Janke A, Ortler S, Hartung HP, Leder C, Kieseier BC, Wiendl H. Expression of CD28-related costimulatory molecule and its ligand in inflammatory neuropathies. Neurology 2007; 68:277-82. [PMID: 17242332 DOI: 10.1212/01.wnl.0000250240.99311.9d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Activation of effector T lymphocytes, mediated in part by costimulatory molecules, is an important mechanism in the pathogenesis of immune-mediated diseases of the peripheral nervous system (PNS). OBJECTIVE To analyze the expression and distribution pattern of the inducible costimulator (ICOS), a recently identified costimulatory molecule implicated in T-cell activation, and its unique ligand (ICOS-L), in inflammatory disorders of the PNS. METHODS We studied RNA and protein expression in sural nerve biopsy specimens from patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and vasculitic neuropathy (VN) vs patients with hereditary neuropathies (HNs) serving as a noninflammatory control using reverse-transcriptase PCR and immunohistochemistry. In addition, in vitro analysis was performed by flow cytometry. RESULTS ICOS and ICOS-L mRNA was found to be significantly upregulated in samples from patients with GBS, CIDP, and VN compared to HNs. Immunohistochemistry identified T lymphocytes as the cellular source of ICOS, whereas macrophages expressed the corresponding ligand ICOS-L. Further analysis revealed that the distribution of ICOS-expressing T cells did not differ between acute and chronic inflamed PNS diseases. Correspondingly, the expression pattern of ICOS-L was similar in the inflamed tissues but differed significantly when compared to HNs. CONCLUSIONS Inducible costimulator, expressed by T lymphocytes, and inducible costimulator ligand, expressed by macrophages within the peripheral nerve, might not only be relevant in inducing an acute immune response but might also be critically involved in perpetuating inflammation in chronically immune-mediated disorders of the peripheral nervous system.
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Affiliation(s)
- W Hu
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
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35
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Lehmann HC, Hartung HP, Hetzel GR, Kieseier BC. [Plasma exchange as a therapeutic option in neurological disorders]. Nervenarzt 2007; 78:166, 168-70, 172-6. [PMID: 17268791 DOI: 10.1007/s00115-006-2229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Plasma exchange is a therapeutic procedure commonly used in various neurological disorders. Here we review its current role as a treatment option in diseases of the central and peripheral nervous system.
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Affiliation(s)
- H C Lehmann
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf
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36
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Lehmann HC, Hoffmann F, Meyer zu Hörste G, Fußhöller A, Hetzel R, Schroeter M, Hartung HP, Kieseier BC. Therapeutic plasma exchange in multifocal motor neuropathy. Akt Neurol 2007. [DOI: 10.1055/s-2007-987616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Meyer zu Hörste G, Hartung HP, Wiendl H, Kieseier BC. Schwann cells as conditional antigen presenting cells in inflammatory neuropathies. Akt Neurol 2007. [DOI: 10.1055/s-2007-988051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Methner A, Albrecht P, Fröhlich R, Hartung HP, Kieseier BC. Optical coherence tomography measures axonal loss in multiple sclerosis independently of optic neuritis. Akt Neurol 2007. [DOI: 10.1055/s-2007-987765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Köhne A, Lehmann HC, Kiehl O, Meyer zu Hörste G, Hartung HP, Kieseier BC. Metalloproteinases as mediators of tissue regeneration in the peripheral nerve: an important role for metalloproteinase-2. Akt Neurol 2007. [DOI: 10.1055/s-2007-988050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Köller H, Neuen-Jacob E, Saleh A, Kieseier BC, Jander S, Hartung HP. A patient with a benign course of neuromyelitis optica (Devic's syndrome) over 12 years: MRI follow up and histological findings. J Neurol 2006; 253:819-20. [PMID: 16511648 DOI: 10.1007/s00415-006-0116-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 12/02/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
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41
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Stüve O, Nessler S, Hartung HP, Hemmer B, Wiendl H, Kieseier BC. [Acute disseminated encephalomyelitis. Pathogenesis, diagnosis, treatment, and prognosis]. Nervenarzt 2005; 76:701-7. [PMID: 15580467 DOI: 10.1007/s00115-004-1842-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the CNS that predominantly affects children. Typically, its clinical symptoms follow an infection or vaccination. In this regard, numerous viral and bacterial pathogens as well as several vaccinations have been associated with ADEM. Studies from animal models suggest that primary and secondary autoimmune responses may contribute to CNS inflammation and demyelination in ADEM. The diagnosis of ADEM is strongly suggested by a close temporal relationship between a viral infection or immunization and the onset of neurologic symptoms, and it is supported by extensive, multifocal, subcortical white-matter disease on brain magnetic resonance imaging. While mild lymphocytic pleocytosis and elevated proteins are detectable in the CSF in ADEM, oligoclonal bands are not always present. Treatment of this disorder consists of anti-inflammatory and immunosuppressive therapies, and the prognosis is generally considered favorable.
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Affiliation(s)
- O Stüve
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf.
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42
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Schreiner B, Kieseier BC, Hartung HP, Hohlfeld R, Wiendl H. Blockade von Adhäsionsmolekülen mit Natalizumab in der Therapie der Multiplen Sklerose. Nervenarzt 2005; 76:999-1005. [PMID: 15812675 DOI: 10.1007/s00115-005-1900-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Natalizumab is a humanized, monoclonal antibody, that inhibits adhesion molecules (alpha(4)-integrins) on the surface of immune cells. These adhesion molecules are important for binding of lymphocytes to endothelial cells of blood vessels and infiltration of inflammatory cells into tissues. Natalizumab is currently being tested in large clinical trials for the treatment of multiple sclerosis (MS) and other autoimmune diseases (inflammatory bowel diseases, rheumatoid arthritis). After demonstrating the safety and potential effectiveness of natalizumab in MS therapy during shorter treatment periods (</=6 months) in clinical phase I and II studies, two ongoing large, double-blinded, placebo-controlled phase III trials (named AFFIRM and SENTINEL) are evaluating its efficacy for patients with relapsing-remitting MS in respect to primary clinical endpoints (relapse rate, disease progression). Based a 1-year interim analysis of these studies, natalizumab was recently authorized by the U.S. Food and Drug Administration for treatment in reducing the frequency of clinical surges in multiple sclerosis, and an application was also made for its use in Europe. After more than 2 years of combined natalizumab (Tysabri) and interferon beta-1a (Avonex) therapy in the so-called Sentinel Study, there was one unexpected death and one appearance of progressive multifocal leukoencephalopathy. As a result, in February 2005 the manufacturers (Biogen/Elan) stopped all running studies of natalizumab and removed the drug from the market. New studies are underway to gain more understanding and especially to determine the risk to patients treated in the Sentinel Study. This article summarizes and updates the results of previous and ongoing natalizumab trials in the context of MS.
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Affiliation(s)
- B Schreiner
- Neurologische Klinik und Poliklinik der Julius-Maximilians-Universität Würzburg
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43
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Menge T, von Büdingen HC, Zamvil SS, Hartung HP, Kieseier BC, Stüve O. Statine zur Behandlung von Erkrankungen des zentralen Nervensystems. Nervenarzt 2005; 76:426-37. [PMID: 15448914 DOI: 10.1007/s00115-004-1806-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
3-Hydroxy-3-methyglutaryl coenzyme A (HMG-CoA) reductase inhibitors, "statins," are widely used oral cholesterol-lowering drugs. Statins competitively inhibit HMG-CoA reductase, the enzyme that catalyzes conversion of HMG-CoA to L-mevalonate, a key intermediate in cholesterol synthesis. Certain metabolites of L-mevalonate are also involved in posttranslational modifications of specific proteins with cell proliferation and differentiation properties. Thus, statins have important biologic effects beyond their cholesterol-reducing properties. Here we discuss recent experimental and clinical data that may support a potential role for statins in the treatment of three central nervous system (CNS) neurological diseases: Multiple sclerosis (MS), Alzheimer's disease (AD), and ischemic stroke. Despite their considerable pathogenic differences, in animal models of these disorders statins have shown beneficial effects. In both stroke and AD cohort studies suggest a beneficial treatment effect in humans; in MS, results from small open-label studies look encouraging. Multicenter, randomized, placebo-controlled clinical trials are in the planning or recruiting stage to evaluate the therapeutic effects of statins in all three disorders.
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Affiliation(s)
- T Menge
- Department of Neurology, University of California, San Francisco, USA
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44
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Wiendl H, Lehmann HC, Hohlfeld R, Hartung HP, Kieseier BC. [Multiple sclerosis: potential therapeutic options and update of ongoing studies]. Nervenarzt 2004; 75:536-52. [PMID: 15257377 DOI: 10.1007/s00115-003-1665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The therapeutic options for the treatment of multiple sclerosis (MS) have experienced enormous progress over recent years. Despite these encouraging developments, available therapies are only partially effective, and the ultimate goal of curing MS is still far from being attained. The improved understanding of the cellular and molecular mechanisms of MS (immune) pathogenesis together with recent shifts in paradigms led to a variety of new therapeutic targets and approaches. In addition to modulation of the inflammatory process, therapeutic approaches focussing on active neuroprotection, remyelinization, and regeneration have become increasingly important. Based on current concepts of the MS pathogenesis, this article summarizes new therapeutic approaches. Substances and strategies currently tested in clinical trials are reviewed.
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Affiliation(s)
- H Wiendl
- Abteilung für Allgemeine Neurologie und Hertie-Institut für Klinische Hirnforschung, Neurologische Klinik der Eberhard-Karls-Universität Tübingen.
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45
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Abstract
Jean-Martin Charcot (1825-1893), well known as the founder of modern neurology, was the most celebrated neurologist in the nineteenth century. His international success stemmed not only from mastery descriptions of various neurological disorders but also from his many contacts with scientists all over the world. The aim of this article is to review Charcot's ambivalent relationship to German neuropsychiatry of the time and to examine the German reception of his personality and work. Wilhelm Erb, Ludwig Hirt, Ernst von Leyden, Max Nonne, Adolph Strümpell, and other German physicians cultivated -to varying degrees - professional contacts with Charcot and, based on the fascination of his personality and significance of his work, were long and intensively influenced by the Salpêtrière school. The extent of their admiration became apparent in 1882 by the award of an honorary doctorate to Charcot by the University of Würzburg. Along with increasingly severe criticism of Charcot's research on hysteria and hypnosis, most German neuropsychiatrists became estranged, without neglecting his importance to the development of neurology in Germany.
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Affiliation(s)
- H C Lehmann
- Neurologische Universitätsklinik Düsseldorf.
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46
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Ramacher M, Hu W, Hartung HP, Kieseier BC. Schwann'sche Zellen exprimieren Toll-ähnliche Rezeptoren. Akt Neurol 2004. [DOI: 10.1055/s-2004-833437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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47
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Mitsdörffer M, Schreiner B, Kieseier BC, Neuhaus O, Dichgans J, Hartung HP, Weller M, Wiendl H. Monocyte-derived HLA-G, a strong inhibitor of autologous CD4 T-cell activation, is upregulated by interferon-β in vitro and in vivo: rationale for the therapy of multiple sclerosis? Akt Neurol 2004. [DOI: 10.1055/s-2004-833324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Elias B, Köller H, Hartung HP, Kieseier BC. Interferon-β-1b als therapeutische Option bei chronisch inflammatorischer demyelinisierender Polyneuropathie. Akt Neurol 2004. [DOI: 10.1055/s-2004-833434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Otto F, Kieseier BC, Görtz P, Siebler M. The pentapeptide QYNAD does not inhibit neuronal network activity. Akt Neurol 2004. [DOI: 10.1055/s-2004-833319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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50
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Kieseier BC, Gold R, Hartung HP. Mitoxantron zur Therapie der Multiplen Sklerose. Der Nervenarzt 2003; 74:906-10. [PMID: 14551698 DOI: 10.1007/s00115-003-1566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The recent publication of the MIMS study (Mitoxantrone in multiple sclerosis), approval by local health authorities, and the recommendation by the MS Therapy Consensus Group (MSTCG) support the use of mitoxantrone in patients with active multiple sclerosis. This review provides an outline of relevant preclinical and clinical studies, discusses relevant side effects of the compound, and compares its use with other therapeutic approaches to this crippling disorder.
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Affiliation(s)
- B C Kieseier
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf
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