1
|
John NA, Solanky BS, De Angelis F, Parker RA, Weir CJ, Stutters J, Carrasco FP, Schneider T, Doshi A, Calvi A, Williams T, Plantone D, Monteverdi A, MacManus D, Marshall I, Barkhof F, Gandini Wheeler-Kingshott CAM, Chataway J. Longitudinal Metabolite Changes in Progressive Multiple Sclerosis: A Study of 3 Potential Neuroprotective Treatments. J Magn Reson Imaging 2024; 59:2192-2201. [PMID: 37787109 DOI: 10.1002/jmri.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND 1H-magnetic resonance spectroscopy (1H-MRS) may provide a direct index for the testing of medicines for neuroprotection and drug mechanisms in multiple sclerosis (MS) through measures of total N-acetyl-aspartate (tNAA), total creatine (tCr), myo-inositol (mIns), total-choline (tCho), and glutamate + glutamine (Glx). Neurometabolites may be associated with clinical disability with evidence that baseline neuroaxonal integrity is associated with upper limb function and processing speed in secondary progressive MS (SPMS). PURPOSE To assess the effect on neurometabolites from three candidate drugs after 96-weeks as seen by 1H-MRS and their association with clinical disability in SPMS. STUDY-TYPE Longitudinal. POPULATION 108 participants with SPMS randomized to receive neuroprotective drugs amiloride [mean age 55.4 (SD 7.4), 61% female], fluoxetine [55.6 (6.6), 71%], riluzole [54.6 (6.3), 68%], or placebo [54.8 (7.9), 67%]. FIELD STRENGTH/SEQUENCE 3-Tesla. Chemical-shift-imaging 2D-point-resolved-spectroscopy (PRESS), 3DT1. ASSESSMENT Brain metabolites in normal appearing white matter (NAWM) and gray matter (GM), brain volume, lesion load, nine-hole peg test (9HPT), and paced auditory serial addition test were measured at baseline and at 96-weeks. STATISTICAL TESTS Paired t-test was used to analyze metabolite changes in the placebo arm over 96-weeks. Metabolite differences between treatment arms and placebo; and associations between baseline metabolites and upper limb function/information processing speed at 96-weeks assessed using multiple linear regression models. P-value<0.05 was considered statistically significant. RESULTS In the placebo arm, tCho increased in GM (mean difference = -0.32 IU) but decreased in NAWM (mean difference = 0.13 IU). Compared to placebo, in the fluoxetine arm, mIns/tCr was lower (β = -0.21); in the riluzole arm, GM Glx (β = -0.25) and Glx/tCr (β = -0.29) were reduced. Baseline tNAA(β = 0.22) and tNAA/tCr (β = 0.23) in NAWM were associated with 9HPT scores at 96-weeks. DATA CONCLUSION 1H-MRS demonstrated altered membrane turnover over 96-weeks in the placebo group. It also distinguished changes in neuro-metabolites related to gliosis and glutaminergic transmission, due to fluoxetine and riluzole, respectively. Data show tNAA is a potential marker for upper limb function. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 4.
Collapse
Affiliation(s)
- Nevin A John
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Neurology, Monash Health, Melbourne, Australia
| | - Bhavana S Solanky
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jonathan Stutters
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ferran Prados Carrasco
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing (CMIC), University College London, London, UK
- e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Torben Schneider
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Anisha Doshi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Alberto Calvi
- Laboratory of Advanced Imaging in Neuroimmunological Diseases (imaginEM), Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | - Thomas Williams
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Anita Monteverdi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - David MacManus
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing (CMIC), University College London, London, UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| |
Collapse
|
2
|
Butzkueven H, Ponsonby AL, Stein MS, Lucas RM, Mason D, Broadley S, Kilpatrick T, Lechner-Scott J, Barnett M, Carroll W, Mitchell P, Hardy TA, Macdonell R, McCombe P, Lee A, Kalincik T, van der Walt A, Lynch C, Abernethy D, Willoughby E, Barkhof F, MacManus D, Clarke M, Andrew J, Morahan J, Zhu C, Dear K, Taylor BV. Vitamin D did not reduce multiple sclerosis disease activity after a clinically isolated syndrome. Brain 2024; 147:1206-1215. [PMID: 38085047 PMCID: PMC10994527 DOI: 10.1093/brain/awad409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024] Open
Abstract
Low serum levels of 25-hydroxyvitamin D [25(OH)D] and low sunlight exposure are known risk factors for the development of multiple sclerosis. Add-on vitamin D supplementation trials in established multiple sclerosis have been inconclusive. The effects of vitamin D supplementation to prevent multiple sclerosis is unknown. We aimed to test the hypothesis that oral vitamin D3 supplementation in high-risk clinically isolated syndrome (abnormal MRI, at least three T2 brain and/or spinal cord lesions), delays time to conversion to definite multiple sclerosis, that the therapeutic effect is dose-dependent, and that all doses are safe and well tolerated. We conducted a double-blind trial in Australia and New Zealand. Eligible participants were randomized 1:1:1:1 to placebo, 1000, 5000 or 10 000 international units (IU) of oral vitamin D3 daily within each study centre (n = 23) and followed for up to 48 weeks. Between 2013 and 2021, we enrolled 204 participants. Brain MRI scans were performed at baseline, 24 and 48 weeks. The main study outcome was conversion to clinically definite multiple sclerosis based on the 2010 McDonald criteria defined as either a clinical relapse or new brain MRI T2 lesion development. We included 199 cases in the intention-to-treat analysis based on assigned dose. Of these, 116 converted to multiple sclerosis by 48 weeks (58%). Compared to placebo, the hazard ratios (95% confidence interval) for conversion were 1000 IU 0.87 (0.50, 1.50); 5000 IU 1.37 (0.82, 2.29); and 10 000 IU 1.28 (0.76, 2.14). In an adjusted model including age, sex, latitude, study centre and baseline symptom number, clinically isolated syndrome onset site, presence of infratentorial lesions and use of steroids, the hazard ratios (versus placebo) were 1000 IU 0.80 (0.45, 1.44); 5000 IU 1.36 (0.78, 2.38); and 10 000 IU 1.07 (0.62, 1.85). Vitamin D3 supplementation was safe and well tolerated. We did not demonstrate reduction in multiple sclerosis disease activity by vitamin D3 supplementation after a high-risk clinically isolated syndrome.
Collapse
Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Mark S Stein
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 0200, Australia
| | - Deborah Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand
| | - Simon Broadley
- Department of Neurology, School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Michael Barnett
- Brain and Mind Research Institute University of Sydney, Sydney, NSW 2050, Australia
| | - William Carroll
- Department of Neurology, Sir Charles Gairdner Hospital and Centre for Neuromuscular and Neurological Disorders and Perron Institute, University of Western Australia, WA 6009, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, Sydney, NSW 2139, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Melbourne, VIC 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010Australia
| | - Pamela McCombe
- University of Queensland, Centre for Clinical Research, Brisbane, QLD 4029, Australia
| | - Andrew Lee
- Department of Neurology, Flinders University College of Medicine and Public Health, Adelaide, SA 5042, Australia
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Chris Lynch
- Midland Neurology, Hamilton, Waikato 3240, New Zealand
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington 6021, New Zealand
| | - Ernest Willoughby
- Department of Neurology, Auckland Hospital, Auckland 1023, New Zealand
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HV, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, WC1N 3BG, UK
| | - David MacManus
- University College London Queen Square Institute of Neurology, Queen Square MS Centre, London WC1N 3BG, UK
| | - Michael Clarke
- Metabolomics Australia (WA), School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Julie Andrew
- Neurosciences Trials Australia, North Melbourne, VIC 3051, Australia
| | - Julia Morahan
- Multiple Sclerosis Australia, North Sydney, NSW 2059, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Keith Dear
- Department of Statistics, School of Public Health, University of Adelaide, SA 5005, Australia
| | - Bruce V Taylor
- MS Research Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| |
Collapse
|
3
|
Calvi A, Mendelsohn Z, Hamed W, Chard D, Tur C, Stutters J, MacManus D, Kanber B, Wheeler-Kingshott CAMG, Barkhof F, Prados F. Treatment reduces the incidence of newly appearing multiple sclerosis lesions evolving into chronic active, slowly expanding lesions: A retrospective analysis. Eur J Neurol 2024; 31:e16092. [PMID: 37823722 DOI: 10.1111/ene.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Newly appearing lesions in multiple sclerosis (MS) may evolve into chronically active, slowly expanding lesions (SELs), leading to sustained disability progression. The aim of this study was to evaluate the incidence of newly appearing lesions developing into SELs, and their correlation to clinical evolution and treatment. METHODS A retrospective analysis of a fingolimod trial in primary progressive MS (PPMS; INFORMS, NCT00731692) was undertaken. Data were available from 324 patients with magnetic resonance imaging scans up to 3 years after screening. New lesions at year 1 were identified with convolutional neural networks, and SELs obtained through a deformation-based method. Clinical disability was assessed annually by Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test, Timed 25-Foot Walk, and Paced Auditory Serial Addition Test. Linear, logistic, and mixed-effect models were used to assess the relationship between the Jacobian expansion in new lesions and SELs, disability scores, and treatment status. RESULTS One hundred seventy patients had ≥1 new lesions at year 1 and had a higher lesion count at screening compared to patients with no new lesions (median = 27 vs. 22, p = 0.007). Among the new lesions (median = 2 per patient), 37% evolved into definite or possible SELs. Higher SEL volume and count were associated with EDSS worsening and confirmed disability progression. Treated patients had lower volume and count of definite SELs (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.01, p = 0.015; β = -0.36, 95% CI = -0.67 to -0.06, p = 0.019, respectively). CONCLUSIONS Incident chronic active lesions are common in PPMS, and fingolimod treatment can reduce their number.
Collapse
Affiliation(s)
- Alberto Calvi
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Fundació Clinic per a la Recerca Biomèdica, Barcelona, Spain
| | - Zoe Mendelsohn
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Weaam Hamed
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Mansoura University Hospital, Mansoura, Egypt
| | - Declan Chard
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Carmen Tur
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jon Stutters
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - David MacManus
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - Baris Kanber
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Frederik Barkhof
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam, the Netherlands
| | - Ferran Prados
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
4
|
Williams T, John N, Calvi A, Bianchi A, De Angelis F, Doshi A, Wright S, Shatila M, Yiannakas MC, Chowdhury F, Stutters J, Ricciardi A, Prados F, MacManus D, Braisher M, Blackstone J, Ciccarelli O, Gandini Wheeler-Kingshott CAM, Barkhof F, Chataway J. Cardiovascular risk factors in secondary progressive multiple sclerosis: A cross-sectional analysis from the MS-STAT2 randomized controlled trial. Eur J Neurol 2023; 30:2769-2780. [PMID: 37318885 DOI: 10.1111/ene.15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE There is increasing evidence that cardiovascular risk (CVR) contributes to disability progression in multiple sclerosis (MS). CVR is particularly prevalent in secondary progressive MS (SPMS) and can be quantified through validated composite CVR scores. The aim was to examine the cross-sectional relationships between excess modifiable CVR, whole and regional brain atrophy on magnetic resonance imaging, and disability in patients with SPMS. METHODS Participants had SPMS, and data were collected at enrolment into the MS-STAT2 trial. Composite CVR scores were calculated using the QRISK3 software. Prematurely achieved CVR due to modifiable risk factors was expressed as QRISK3 premature CVR, derived through reference to the normative QRISK3 dataset and expressed in years. Associations were determined with multiple linear regressions. RESULTS For the 218 participants, mean age was 54 years and median Expanded Disability Status Scale was 6.0. Each additional year of prematurely achieved CVR was associated with a 2.7 mL (beta coefficient; 95% confidence interval 0.8-4.7; p = 0.006) smaller normalized whole brain volume. The strongest relationship was seen for the cortical grey matter (beta coefficient 1.6 mL per year; 95% confidence interval 0.5-2.7; p = 0.003), and associations were also found with poorer verbal working memory performance. Body mass index demonstrated the strongest relationships with normalized brain volumes, whilst serum lipid ratios demonstrated strong relationships with verbal and visuospatial working memory performance. CONCLUSIONS Prematurely achieved CVR is associated with lower normalized brain volumes in SPMS. Future longitudinal analyses of this clinical trial dataset will be important to determine whether CVR predicts future disease worsening.
Collapse
Affiliation(s)
- Thomas Williams
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Nevin John
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Alberto Calvi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Alessia Bianchi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Anisha Doshi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Sarah Wright
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Madiha Shatila
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Fatima Chowdhury
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Jon Stutters
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Antonio Ricciardi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Universitat Oberta de Catalunya, Barcelona, Spain
| | - David MacManus
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marie Braisher
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Department of Radiology & Nuclear Medicine, VU University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| |
Collapse
|
5
|
Brown JWL, Prados F, Altmann DR, Kanber B, Stutters J, Cunniffe NG, Jones JL, Georgieva ZG, Needham EJ, Daruwalla C, Wheeler-Kingshott CG, Connick P, Chandran S, Franklin R, MacManus D, Samson R, Coles A, Chard D. Remyelination varies between and within lesions in multiple sclerosis following bexarotene. Ann Clin Transl Neurol 2022; 9:1626-1642. [PMID: 36116011 PMCID: PMC9539389 DOI: 10.1002/acn3.51662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In multiple sclerosis chronic demyelination is associated with axonal loss, and ultimately contributes to irreversible progressive disability. Enhancing remyelination may slow, or even reverse, disability. We recently trialled bexarotene versus placebo in 49 people with multiple sclerosis. While the primary MRI outcome was negative, there was converging neurophysiological and MRI evidence of efficacy. Multiple factors influence lesion remyelination. In this study we undertook a systematic exploratory analysis to determine whether treatment response - measured by change in magnetisation transfer ratio - is influenced by location (tissue type and proximity to CSF) or the degree of abnormality (using baseline magnetisation transfer ratio and T1 values). METHODS We examined treatment effects at the whole lesion level, the lesion component level (core, rim and perilesional tissues) and at the individual lesion voxel level. RESULTS At the whole lesion level, significant treatment effects were seen in GM but not WM lesions. Voxel-level analyses detected significant treatment effects in WM lesion voxels with the lowest baseline MTR, and uncovered gradients of treatment effect in both WM and CGM lesional voxels, suggesting that treatment effects were lower near CSF spaces. Finally, larger treatment effects were seen in the outer and surrounding components of GM lesions compared to inner cores. INTERPRETATION Remyelination varies markedly within and between lesions. The greater remyelinating effect in GM lesions is congruent with neuropathological observations. For future remyelination trials, whole GM lesion measures require less complex post-processing compared to WM lesions (which require voxel level analyses) and markedly reduce sample sizes.
Collapse
Affiliation(s)
- J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK.,Clinical Outcomes Research Unit (CORe), University of Melbourne, Melbourne, Australia
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK.,e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
| | - Daniel R Altmann
- Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK.,Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK.,National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Jonathan Stutters
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Nick G Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Zoya G Georgieva
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Edward J Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Cyrus Daruwalla
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claudia Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK.,Brain Connectivity Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robin Franklin
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - David MacManus
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Rebecca Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, London, UK.,National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| |
Collapse
|
6
|
Calvi A, Carrasco FP, Tur C, Chard DT, Stutters J, De Angelis F, John N, Williams T, Doshi A, Samson RS, MacManus D, Gandini Wheeler-Kingshott CA, Ciccarelli O, Chataway J, Barkhof F. Association of Slowly Expanding Lesions on MRI With Disability in People With Secondary Progressive Multiple Sclerosis. Neurology 2022; 98:e1783-e1793. [PMID: 35277438 DOI: 10.1212/wnl.0000000000200144] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To explore the relationship between slowly expanding lesions (SELs) on MRI and disability in secondary progressive multiple sclerosis (SPMS). METHODS We retrospectively studied 345 patients with SPMS enrolled in the MS-SMART trial. They underwent brain MRI at baseline and at 24 and 96 weeks. Definite SELs were defined as concentrically expanding T2 lesions, as assessed by nonlinear deformation of volumetric T1-weighted images. Associations of SEL volumes with other MRI metrics and disability were assessed through Pearson correlations and regression analyses. RESULTS Averaged across patients, 29% of T2 lesions were classified as being definite SELs. A greater volume of definite SELs correlated with a higher total baseline T2 lesion volume (r = 0.55, p < 0.001) and percentage brain volume reduction (r = -0.26, p < 0.001), a higher number of new persisting T1 black holes (r = 0.19, p < 0.001), and, in a subset of 106 patients, with a greater reduction in magnetization transfer ratio (adjusted difference 0.52, p < 0.001). In regression analyses, a higher definite SEL volume was associated with increasing disability, as assessed by the Expanded Disability Status Scale (β = 0.23, p = 0.020), z scores of the Multiple Sclerosis Functional Composite (β = -0.47, p = 0.048), Timed 25-Foot Walk Test (β = -2.10, p = 0.001), and Paced Auditory Serial Addition Task (β = -0.27, p = 0.006), and increased risk of disability progression (odds ratio 1.92, p = 0.025). DISCUSSION Definite SELs represent almost one-third of T2 lesions in SPMS. They are associated with neurodegenerative MRI markers and related to clinical worsening, suggesting that they may contribute to disease progression and be a new target for therapeutic interventions.
Collapse
Affiliation(s)
- Alberto Calvi
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Ferran Prados Carrasco
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Carmen Tur
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Declan T Chard
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Jonathan Stutters
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Floriana De Angelis
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Nevin John
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Thomas Williams
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Anisha Doshi
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Rebecca S Samson
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - David MacManus
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Claudia A Gandini Wheeler-Kingshott
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Olga Ciccarelli
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Jeremy Chataway
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Frederik Barkhof
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | | |
Collapse
|
7
|
Brown JWL, Cunniffe NG, Prados F, Kanber B, Jones JL, Needham E, Georgieva Z, Rog D, Pearson OR, Overell J, MacManus D, Samson RS, Stutters J, Ffrench-Constant C, Gandini Wheeler-Kingshott CAM, Moran C, Flynn PD, Michell AW, Franklin RJM, Chandran S, Altmann DR, Chard DT, Connick P, Coles AJ. Safety and efficacy of bexarotene in patients with relapsing-remitting multiple sclerosis (CCMR One): a randomised, double-blind, placebo-controlled, parallel-group, phase 2a study. Lancet Neurol 2021; 20:709-720. [PMID: 34418398 DOI: 10.1016/s1474-4422(21)00179-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progressive disability in multiple sclerosis occurs because CNS axons degenerate as a late consequence of demyelination. In animals, retinoic acid receptor RXR-gamma agonists promote remyelination. We aimed to assess the safety and efficacy of a non-selective retinoid X receptor agonist in promoting remyelination in people with multiple sclerosis. METHODS This randomised, double-blind, placebo-controlled, parallel-group, phase 2a trial (CCMR One) recruited patients with relapsing-remitting multiple sclerosis from two centres in the UK. Eligible participants were aged 18-50 years and had been receiving dimethyl fumarate for at least 6 months. Via a web-based system run by an independent statistician, participants were randomly assigned (1:1), by probability-weighted minimisation using four binary factors, to receive 300 mg/m2 of body surface area per day of oral bexarotene or oral placebo for 6 months. Participants, investigators, and outcome assessors were masked to treatment allocation. MRI scans were done at baseline and at 6 months. The primary safety outcome was the number of adverse events and withdrawals attributable to bexarotene. The primary efficacy outcome was the patient-level change in mean lesional magnetisation transfer ratio between baseline and month 6 for lesions that had a baseline magnetisation transfer ratio less than the within-patient median. We analysed the primary safety outcome in the safety population, which comprised participants who received at least one dose of their allocated treatment. We analysed the primary efficacy outcome in the intention-to-treat population, which comprised all patients who completed the study. This study is registered in the ISRCTN Registry, 14265371, and has been completed. FINDINGS Between Jan 17, 2017, and May 17, 2019, 52 participants were randomly assigned to receive either bexarotene (n=26) or placebo (n=26). Participants who received bexarotene had a higher mean number of adverse events (6·12 [SD 3·09]; 159 events in total) than did participants who received placebo (1·63 [SD 1·50]; 39 events in total). All bexarotene-treated participants had at least one adverse event, which included central hypothyroidism (n=26 vs none on placebo), hypertriglyceridaemia (n=24 vs none on placebo), rash (n=13 vs one on placebo), and neutropenia (n=10 vs none on placebo). Five (19%) participants on bexarotene and two (8%) on placebo discontinued the study drug due to adverse events. One episode of cholecystitis in a placebo-treated participant was the only serious adverse event. The change in mean lesional magnetisation transfer ratio was not different between the bexarotene group (0·25 percentage units [pu; SD 0·98]) and the placebo group (0·09 pu [0·84]; adjusted bexarotene-placebo difference 0·16 pu, 95% CI -0·39 to 0·71; p=0·55). INTERPRETATION We do not recommend the use of bexarotene to treat patients with multiple sclerosis because of its poor tolerability and negative primary efficacy outcome. However, statistically significant effects were seen in some exploratory MRI and electrophysiological analyses, suggesting that other retinoid X receptor agonists might have small biological effects that could be investigated in further studies. FUNDING Multiple Sclerosis Society of the United Kingdom.
Collapse
Affiliation(s)
- J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Clinical Outcomes Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Nick G Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK; e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Edward Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Zoya Georgieva
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Owen R Pearson
- Department of Neurology, Swansea Bay University Health Board, Swansea, UK
| | - James Overell
- Product Development Neuroscience, F Hoffmann-La Roche, Basel, Switzerland; Institute of Neurological Sciences, University of Glasgow, Glasgow, UK
| | - David MacManus
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca S Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan Stutters
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Brain Connectivity Centre, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Carla Moran
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Paul D Flynn
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Andrew W Michell
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Robin J M Franklin
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniel R Altmann
- Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Declan T Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| |
Collapse
|
8
|
Hartung HP, Derfuss T, Cree BA, Sormani MP, Selmaj K, Stutters J, Prados F, MacManus D, Schneble HM, Lambert E, Porchet H, Glanzman R, Warne D, Curtin F, Kornmann G, Buffet B, Kremer D, Küry P, Leppert D, Rückle T, Barkhof F. Efficacy and safety of temelimab in multiple sclerosis: Results of a randomized phase 2b and extension study. Mult Scler 2021; 28:429-440. [PMID: 34240656 DOI: 10.1177/13524585211024997] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The envelope protein of human endogenous retrovirus W (HERV-W-Env) is expressed by macrophages and microglia, mediating axonal damage in chronic active MS lesions. OBJECTIVE AND METHODS This phase 2, double-blind, 48-week trial in relapsing-remitting MS with 48-week extension phase assessed the efficacy and safety of temelimab; a monoclonal antibody neutralizing HERV-W-Env. The primary endpoint was the reduction of cumulative gadolinium-enhancing T1-lesions in brain magnetic resonance imaging (MRI) scans at week 24. Additional endpoints included numbers of T2 and T1-hypointense lesions, magnetization transfer ratio, and brain atrophy. In total, 270 participants were randomized to receive monthly intravenous temelimab (6, 12, or 18 mg/kg) or placebo for 24 weeks; at week 24 placebo-treated participants were re-randomized to treatment groups. RESULTS The primary endpoint was not met. At week 48, participants treated with 18 mg/kg temelimab had fewer new T1-hypointense lesions (p = 0.014) and showed consistent, however statistically non-significant, reductions in brain atrophy and magnetization transfer ratio decrease, as compared with the placebo/comparator group. These latter two trends were sustained over 96 weeks. No safety issues emerged. CONCLUSION Temelimab failed to show an effect on features of acute inflammation but demonstrated preliminary radiological signs of possible anti-neurodegenerative effects. Current data support the development of temelimab for progressive MS. TRIAL REGISTRATION CHANGE-MS: ClinicalTrials.gov: NCT02782858, EudraCT: 2015-004059-29; ANGEL-MS: ClinicalTrials.gov: NCT03239860, EudraCT: 2016-004935-18.
Collapse
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Universitätsklinikum Düsseldorf (UKD) and Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany/Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany/Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tobias Derfuss
- Department of Neurology, Universitätsspital Basel, Basel, Switzerland
| | - Bruce Ac Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy/Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, Genova, Italy
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Department of Neurology, Medical Academy of Łódź, Łódź, Poland
| | - Jonathan Stutters
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ferran Prados
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Universitat Oberta de Catalunya, Barcelona, Spain
| | - David MacManus
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Hans-Martin Schneble
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Estelle Lambert
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Hervé Porchet
- GeNeuro SA, Geneva, Switzerland/Department of Pharmacology, University of Pretoria, Pretoria, South Africa
| | | | | | - Francois Curtin
- GeNeuro SA, Geneva, Switzerland; Clinical Pharmacology and Toxicology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - David Kremer
- Department of Neurology, Universitätsklinikum Düsseldorf (UKD) and Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany/Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Patrick Küry
- Department of Neurology, Universitätsklinikum Düsseldorf (UKD) and Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany/Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - David Leppert
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/GeNeuro SA, Geneva, Switzerland
| | | | - Frederik Barkhof
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK/Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Solanky BS, John NA, DeAngelis F, Stutters J, Prados F, Schneider T, Parker RA, Weir CJ, Monteverdi A, Plantone D, Doshi A, MacManus D, Marshall I, Barkhof F, Gandini Wheeler-Kingshott CAM, Chataway J. NAA is a Marker of Disability in Secondary-Progressive MS: A Proton MR Spectroscopic Imaging Study. AJNR Am J Neuroradiol 2020; 41:2209-2218. [PMID: 33154071 DOI: 10.3174/ajnr.a6809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The secondary progressive phase of multiple sclerosis is characterised by disability progression due to processes that lead to neurodegeneration. Surrogate markers such as those derived from MRI are beneficial in understanding the pathophysiology that drives disease progression and its relationship to clinical disability. We undertook a 1H-MRS imaging study in a large secondary progressive MS (SPMS) cohort, to examine whether metabolic markers of brain injury are associated with measures of disability, both physical and cognitive. MATERIALS AND METHODS A cross-sectional analysis of individuals with secondary-progressive MS was performed in 119 participants. They underwent 1H-MR spectroscopy to obtain estimated concentrations and ratios to total Cr for total NAA, mIns, Glx, and total Cho in normal-appearing WM and GM. Clinical outcome measures chosen were the following: Paced Auditory Serial Addition Test, Symbol Digit Modalities Test, Nine-Hole Peg Test, Timed 25-foot Walk Test, and the Expanded Disability Status Scale. The relationship between these neurometabolites and clinical disability measures was initially examined using Spearman rank correlations. Significant associations were then further analyzed in multiple regression models adjusting for age, sex, disease duration, T2 lesion load, normalized brain volume, and occurrence of relapses in 2 years preceding study entry. RESULTS Significant associations, which were then confirmed by multiple linear regression, were found in normal-appearing WM for total NAA (tNAA)/total Cr (tCr) and the Nine-Hole Peg Test (ρ = 0.23; 95% CI, 0.06-0.40); tNAA and tNAA/tCr and the Paced Auditory Serial Addition Test (ρ = 0.21; 95% CI, 0.03-0.38) (ρ = 0.19; 95% CI, 0.01-0.36); mIns/tCr and the Paced Auditory Serial Addition Test, (ρ = -0.23; 95% CI, -0.39 to -0.05); and in GM for tCho and the Paced Auditory Serial Addition Test (ρ = -0.24; 95% CI, -0.40 to -0.06). No other GM or normal-appearing WM relationships were found with any metabolite, with associations found during initial correlation testing losing significance after multiple linear regression analysis. CONCLUSIONS This study suggests that metabolic markers of neuroaxonal integrity and astrogliosis in normal-appearing WM and membrane turnover in GM may act as markers of disability in secondary-progressive MS.
Collapse
Affiliation(s)
- B S Solanky
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - N A John
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - F DeAngelis
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - J Stutters
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - F Prados
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Centre for Medical Image Computing (F.P., F.B.), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Universitat Oberta de Catalunya (F.P.), Barcelona, Spain
| | | | - R A Parker
- Edinburgh Clinical Trials Unit (R.A.P., C.J.W.), Usher Institute
| | - C J Weir
- Edinburgh Clinical Trials Unit (R.A.P., C.J.W.), Usher Institute
| | - A Monteverdi
- Department of Brain and Behavioural Sciences (A.M., C.A.M.G.W.-K.), University of Pavia, Pavia, Italy
| | - D Plantone
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - A Doshi
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - D MacManus
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - I Marshall
- Centre for Clinical Brain Sciences (I.M.), University of Edinburgh, Edinburgh, UK
| | - F Barkhof
- Centre for Medical Image Computing (F.P., F.B.), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- National Institute for Health Research (F.B.), University College London Hospitals Biomedical Research Centre, London, UK
- Department of Radiology and Nuclear Medicine (F.B., J.C.), MS Center Amsterdam, Amsterdam, the Netherlands
| | - C A M Gandini Wheeler-Kingshott
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Brain MRI 3T Research Center (C.A.M.G.W.-K.), Scientific Institute for Research, Hospitalization and Healthcare Mondino National Neurological Institute Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences (A.M., C.A.M.G.W.-K.), University of Pavia, Pavia, Italy
| | - J Chataway
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Department of Radiology and Nuclear Medicine (F.B., J.C.), MS Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Kwan J, Sparrow K, Facer-Irwin E, Thandi G, Fear N, MacManus D. Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis. Aggress Violent Behav 2020; 53:101419. [PMID: 32714067 PMCID: PMC7375166 DOI: 10.1016/j.avb.2020.101419] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 01/28/2020] [Accepted: 04/03/2020] [Indexed: 05/25/2023]
Abstract
Intimate partner violence (IPV) is a global health issue that impacts both civilian and military populations. Factors associated with military service may result in increased risk of IPV perpetration among Veterans and Active Duty military personnel. Six bibliographic databases were searched to identify studies that estimated the prevalence of IPV perpetration among military populations by sociodemographic and military characteristics. Where possible, random effect meta-analyses were conducted to determine pooled prevalence estimates. 42 studies were eligible for inclusion in this systematic review. 28 of these studies met the requirements for inclusion in subsequent meta-analyses. Among studies that measured past-year physical IPV perpetration, the pooled prevalence was higher among men compared to women (26% and 20% respectively). Among Veterans, there were consistently higher prevalences compared to Active Duty samples. Similarly, higher prevalences were found among studies in general military settings compared to clinical settings. Further research that considers the impact of the act(s) of IPV perpetration on the victims is needed. This, along with the use of a consistent measurement tools across studies will help to develop a stronger evidence base to inform prevention and management programs for all types of IPV perpetration among military personnel.
Collapse
Affiliation(s)
- J. Kwan
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - K. Sparrow
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - E. Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - G. Thandi
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - N.T. Fear
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - D. MacManus
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| |
Collapse
|
11
|
Connick P, De Angelis F, Parker RA, Plantone D, Doshi A, John N, Stutters J, MacManus D, Prados Carrasco F, Barkhof F, Ourselin S, Braisher M, Ross M, Cranswick G, Pavitt SH, Giovannoni G, Gandini Wheeler-Kingshott CA, Hawkins C, Sharrack B, Bastow R, Weir CJ, Stallard N, Chandran S, Chataway J. Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART): a multiarm phase IIb randomised, double-blind, placebo-controlled clinical trial comparing the efficacy of three neuroprotective drugs in secondary progressive multiple sclerosis. BMJ Open 2018; 8:e021944. [PMID: 30166303 PMCID: PMC6119433 DOI: 10.1136/bmjopen-2018-021944] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The major unmet need in multiple sclerosis (MS) is for neuroprotective therapies that can slow (or ideally stop) the rate of disease progression. The UK MS Society Clinical Trials Network (CTN) was initiated in 2007 with the purpose of developing a national, efficient, multiarm trial of repurposed drugs. Key underpinning work was commissioned by the CTN to inform the design, outcome selection and drug choice including animal models and a systematic review. This identified seven leading oral agents for repurposing as neuroprotective therapies in secondary progressive MS (SPMS). The purpose of the Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART) will be to evaluate the neuroprotective efficacy of three of these drugs, selected with distinct mechanistic actions and previous evidence of likely efficacy, against a common placebo arm. The interventions chosen were: amiloride (acid-sensing ion channel antagonist); fluoxetine (selective serotonin reuptake inhibitor) and riluzole (glutamate antagonist). METHODS AND ANALYSIS Patients with progressing SPMS will be randomised 1:1:1:1 to amiloride, fluoxetine, riluzole or matched placebo and followed for 96 weeks. The primary outcome will be the percentage brain volume change (PBVC) between baseline and 96 weeks, derived from structural MR brain imaging data using the Structural Image Evaluation, using Normalisation, of Atrophy method. With a sample size of 90 per arm, this will give 90% power to detect a 40% reduction in PBVC in any active arm compared with placebo and 80% power to detect a 35% reduction (analysing by analysis of covariance and with adjustment for multiple comparisons of three 1.67% two-sided tests), giving a 5% overall two-sided significance level. MS-SMART is not powered to detect differences between the three active treatment arms. Allowing for a 20% dropout rate, 110 patients per arm will be randomised. The study will take place at Neuroscience centres in England and Scotland. ETHICS AND DISSEMINATION MS-SMART was approved by the Scotland A Research Ethics Committee on 13 January 2013 (REC reference: 13/SS/0007). Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBERS NCT01910259; 2012-005394-31; ISRCTN28440672.
Collapse
Affiliation(s)
- Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Floriana De Angelis
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Domenico Plantone
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Anisha Doshi
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Nevin John
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Jonathan Stutters
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - David MacManus
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Ferran Prados Carrasco
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Department of Medical Physics and Biomedical Engineering, Translational Imaging Group (TIG), Centre for Medical Image Computing (CMIC), UCL, London, UK
| | - Frederik Barkhof
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sebastien Ourselin
- Department of Medical Physics and Biomedical Engineering, Translational Imaging Group (TIG), Centre for Medical Image Computing (CMIC), UCL, London, UK
| | - Marie Braisher
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Moira Ross
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gina Cranswick
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit (part of the NIHR Leeds CRF), University of Leeds, Leeds, UK
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudia Angela Gandini Wheeler-Kingshott
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Clive Hawkins
- Keele Medical School and Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | - Basil Sharrack
- Department of Neuroscience, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nigel Stallard
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jeremy Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| |
Collapse
|
12
|
Gold J, Marta M, Meier UC, Christensen T, Miller D, Altmann D, Holden D, Bianchi L, Adiutori R, MacManus D, Yousry T, Schmierer K, Turner B, Giovannoni G. A phase II baseline versus treatment study to determine the efficacy of raltegravir (Isentress) in preventing progression of relapsing remitting multiple sclerosis as determined by gadolinium-enhanced MRI: The INSPIRE study. Mult Scler Relat Disord 2018; 24:123-128. [PMID: 29990894 DOI: 10.1016/j.msard.2018.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/24/2018] [Accepted: 06/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although the aetiology of multiple sclerosis (MS) remains elusive, it is clear that Epstein Barr virus (EBV) and possibly other viruses play a role in the pathogenesis of MS. Laboratory evidence suggests that human endogenous retroviruses (HERVs) could also have a role, but no interventional therapy has determined what will happen if HERVs are suppressed. Recent epidemiological evidence indicates patients with HIV infection have a significantly lower risk of developing MS and that HIV antiretroviral therapies may be coincidentally inhibiting HERVs, or other retroelements, that could be implicated in MS. OBJECTIVES To systematically investigate the effects of an HIV integrase strand inhibitor, raltegravir, on the number of gadolinium (Gd)-enhanced MRI lesions in people with active relapsing MS. METHODS This is a Phase 2a clinical trial where twenty participants were enrolled in a 3 month baseline phase followed by 3 months of treatment with raltegravir 400 mg twice a day. Patients had monthly Gd-enhanced MRI, saliva collection to test for EBV shedding, blood sampling for safety monitoring, virology (including HERVs), measurement of immunological and inflammatory markers; and physical, neurological and quality-of-life assessments. RESULTS All patients completed the six months trial period.The primary outcome measure of MS disease activity was the number of Gd-enhancing lesions observed, and raltegravir had no significant effect on the rate of development of Gd-enhancing lesions during the treatment phase compared with the baseline phase. Additionally, there was no change in secondary outcomes of either disability or quality-of-life measures that could reasonably be attributed to the intervention. There was a significant positive between HERV-W/MSRV (multiple sclerosis related virus) Gag Flix (Fluorescence index) B cells and the number of Gd-enhanced lesions at any visit (p = 0.029), which was independent of any potential influence of the trial drug administration. Regarding EBV shedding, there was no significant correlation between the amount of EBV shedding and the number of lesions. No change was detected in inflammatory markers (IL-8, IL-1β, IL-6, IL-10, TNF, IL-12p70 and HCRP), which were all within normal limits both before and after the intervention. Serum CD163 expression was also unchanged by raltegravir. CONCLUSIONS Raltegravir did not have any impact on MS disease activity. This could be due to the choice of antiretroviral agent used in this study, the need for a combination of agents, as used in treating HIV infection, the short treatment period or dosing regimen, or the lack of a role of HERV expression in MS once the disease is established. Borderline significance for the association between EBV shedding and the total number of lesions, probably driven by new lesion development, may indicate EBV shedding as a marker of inflammatory disease activity. In conclusion, interesting correlations between HERV-W markers, EBV shedding and new MRI lesions, independent from treatment effects, were found.
Collapse
Affiliation(s)
- Julian Gold
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom; The Albion Centre, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Monica Marta
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - Ute C Meier
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | | | - David Miller
- Institute of Neurology, University College London, United Kingdom
| | - Daniel Altmann
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Holden
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - Lucia Bianchi
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - Rocco Adiutori
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - David MacManus
- Institute of Neurology, University College London, United Kingdom
| | - Tarek Yousry
- Institute of Neurology, University College London, United Kingdom
| | - Klaus Schmierer
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - Benjamin Turner
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| | - Gavin Giovannoni
- Neuroscience and Trauma, Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, United Kingdom
| |
Collapse
|
13
|
Gilchrist MD, MacManus D, Murphy JG, Pierrat B. A new formulation of slight compressibility for arterial tissue and its Finite Element implementation. Comput Methods Biomech Biomed Engin 2016; 20:403-414. [DOI: 10.1080/10255842.2016.1236371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. D. Gilchrist
- Department of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - D. MacManus
- Department of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - J. G. Murphy
- Department of Mechanical Engineering, Dublin City University, Dublin, Ireland
- School of Mathematics, Statistics, and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - B. Pierrat
- Department of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| |
Collapse
|
14
|
Ball S, Vickery J, Hobart J, Wright D, Green C, Shearer J, Nunn A, Cano MG, MacManus D, Miller D, Mallik S, Zajicek J. The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial: a randomised double-blind placebo-controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Assess 2015; 19:vii-viii, xxv-xxxi, 1-187. [PMID: 25676540 DOI: 10.3310/hta19120] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial aimed to determine whether or not oral Δ(9)-tetrahydrocannabinol (Δ(9)-THC) slowed the course of progressive multiple sclerosis (MS); evaluate safety of cannabinoid administration; and, improve methods for testing treatments in progressive MS. OBJECTIVES There were three objectives in the CUPID study: (1) to evaluate whether or not Δ(9)-THC could slow the course of progressive MS; (2) to assess the long-term safety of Δ(9)-THC; and (3) to explore newer ways of conducting clinical trials in progressive MS. DESIGN The CUPID trial was a randomised, double-blind, placebo-controlled, parallel-group, multicentre trial. Patients were randomised in a 2 : 1 ratio to Δ(9)-THC or placebo. Randomisation was balanced according to Expanded Disability Status Scale (EDSS) score, study site and disease type. Analyses were by intention to treat, following a pre-specified statistical analysis plan. A cranial magnetic resonance imaging (MRI) substudy, Rasch measurement theory (RMT) analyses and an economic evaluation were undertaken. SETTING Twenty-seven UK sites. PARTICIPANTS Adults aged 18-65 years with primary or secondary progressive MS, 1-year evidence of disease progression and baseline EDSS 4.0-6.5. INTERVENTIONS Oral Δ(9)-THC (maximum 28 mg/day) or matching placebo. ASSESSMENT VISITS Three and 6 months, and then 6-monthly up to 36 or 42 months. MAIN OUTCOME MEASURES Primary outcomes were time to EDSS progression, and change in Multiple Sclerosis Impact Scale-29 version 2 (MSIS-29v2) 20-point physical subscale (MSIS-29phys) score. Various secondary patient- and clinician-reported outcomes and MRI outcomes were assessed. RMT analyses examined performance of MS-specific rating scales as measurement instruments and tested for a symptomatic or disease-modifying treatment effect. Economic evaluation estimated mean incremental costs and quality-adjusted life-years (QALYs). RESULTS Effectiveness - recruitment targets were achieved. Of the 498 randomised patients (332 to active and 166 to placebo), 493 (329 active and 164 placebo) were analysed. PRIMARY OUTCOMES no significant treatment effect; hazard ratio EDSS score progression (active : placebo) 0.92 [95% confidence interval (CI) 0.68 to 1.23]; and estimated between-group difference in MSIS-29phys score (active-placebo) -0.9 points (95% CI -2.0 to 0.2 points). Secondary clinical and MRI outcomes: no significant treatment effects. Safety - at least one serious adverse event: 35% and 28% of active and placebo patients, respectively. RMT analyses - scale evaluation: MSIS-29 version 2, MS Walking Scale-12 version 2 and MS Spasticity Scale-88 were robust measurement instruments. There was no clear symptomatic or disease-modifying treatment effect. Economic evaluation - estimated mean incremental cost to NHS over usual care, over 3 years £27,443.20 per patient. No between-group difference in QALYs. CONCLUSIONS The CUPID trial failed to demonstrate a significant treatment effect in primary or secondary outcomes. There were no major safety concerns, but unwanted side effects seemed to affect compliance. Participants were more disabled than in previous studies and deteriorated less than expected, possibly reducing our ability to detect treatment effects. RMT analyses supported performance of MS-specific rating scales as measures, enabled group- and individual person-level examination of treatment effects, but did not influence study inferences. The intervention had significant additional costs with no improvement in health outcomes; therefore, it was dominated by usual care and not cost-effective. Future work should focus on determining further factors to predict clinical deterioration, to inform the development of new studies, and modifying treatments in order to minimise side effects and improve study compliance. The absence of disease-modifying treatments in progressive MS warrants further studies of the cannabinoid pathway in potential neuroprotection. TRIAL REGISTRATION Current Controlled Trials ISRCTN62942668. FUNDING The National Institute for Health Research Health Technology Assessment programme, the Medical Research Council Efficacy and Mechanism Evaluation programme, Multiple Sclerosis Society and Multiple Sclerosis Trust. The report will be published in full in Health Technology Assessment; Vol. 19, No. 12. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Susan Ball
- Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jeremy Hobart
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Dave Wright
- Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | - James Shearer
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | - Andrew Nunn
- Medical Research Council Clinical Trials Unit, London, UK
| | - Mayam Gomez Cano
- Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - David MacManus
- University College London's Institute of Neurology, London, UK
| | - David Miller
- University College London's Institute of Neurology, London, UK
| | - Shahrukh Mallik
- University College London's Institute of Neurology, London, UK
| | - John Zajicek
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| |
Collapse
|
15
|
MacManus D, Rona R, Dickson H, Somaini G, Fear N, Wessely S. Aggressive and Violent Behavior Among Military Personnel Deployed to Iraq and Afghanistan: Prevalence and Link With Deployment and Combat Exposure. Epidemiol Rev 2015; 37:196-212. [DOI: 10.1093/epirev/mxu006] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
|
16
|
Prados F, Cardoso MJ, MacManus D, Wheeler-Kingshott CAM, Ourselin S. A modality-agnostic patch-based technique for lesion filling in multiple sclerosis. Med Image Comput Comput Assist Interv 2015; 17:781-8. [PMID: 25485451 DOI: 10.1007/978-3-319-10470-6_97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple Sclerosis lesions influence the process of image analysis, leading to tissue segmentation problems and biased morphometric estimates. With the aim of reducing this bias, existing techniques fill segmented lesions as normal appearing white matter. However, due to lesion segmentation errors or the presence of neighbouring structures, such as the ventricles and deep grey matter structures, filling all lesions as white matter like intensities is prone to introduce errors and artefacts. In this paper, we present a novel lesion filling strategy based on in-painting techniques for image completion. This technique makes use of a patch-based Non-Local Means algorithm that fills the lesions with the most plausible texture, rather than normal appearing white matter. We demonstrate that this strategy introduces less bias and fewer artefacts and spurious edges than previous techniques. The advantages of the proposed methodology are that it preserves both anatomical structure and signal-to-noise characteristics even when the lesions are neighbouring grey matter and cerebrospinal fluid, and avoids excess blurring or rasterisation due to the choice of segmentation plane, and lesion shape, size and/or position.
Collapse
|
17
|
Chataway J, Schuerer N, Alsanousi A, Chan D, MacManus D, Hunter K, Anderson V, Bangham CRM, Clegg S, Nielsen C, Fox NC, Wilkie D, Nicholas JM, Calder VL, Greenwood J, Frost C, Nicholas R. Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2 trial. Lancet 2014; 383:2213-21. [PMID: 24655729 DOI: 10.1016/s0140-6736(13)62242-4] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Secondary progressive multiple sclerosis, for which no satisfactory treatment presently exists, accounts for most of the disability in patients with multiple sclerosis. Simvastatin, which is widely used for treatment of vascular disease, with its excellent safety profile, has immunomodulatory and neuroprotective properties that could make it an appealing candidate drug for patients with secondary progressive multiple sclerosis. METHODS We undertook a double-blind, controlled trial between Jan 28, 2008, and Nov 4, 2011, at three neuroscience centres in the UK. Patients aged 18-65 years with secondary progressive multiple sclerosis were randomly assigned (1:1), by a centralised web-based service with a block size of eight, to receive either 80 mg of simvastatin or placebo. Patients, treating physicians, and outcome assessors were masked to treatment allocation. The primary outcome was the annualised rate of whole-brain atrophy measured from serial volumetric MRI. Analyses were by intention to treat and per protocol. This trial is registered with ClinicalTrials.gov, number NCT00647348. FINDINGS 140 participants were randomly assigned to receive either simvastatin (n=70) or placebo (n=70). The mean annualised atrophy rate was significantly lower in patients in the simvastatin group (0·288% per year [SD 0·521]) than in those in the placebo group (0·584% per year [0·498]). The adjusted difference in atrophy rate between groups was -0·254% per year (95% CI -0·422 to -0·087; p=0·003); a 43% reduction in annualised rate. Simvastatin was well tolerated, with no differences between the placebo and simvastatin groups in proportions of participants who had serious adverse events (14 [20%] vs nine [13%]). INTERPRETATION High-dose simvastatin reduced the annualised rate of whole-brain atrophy compared with placebo, and was well tolerated and safe. These results support the advancement of this treatment to phase 3 testing. FUNDING The Moulton Foundation [charity number 1109891], Berkeley Foundation [268369], the Multiple Sclerosis Trials Collaboration [1113598], the Rosetrees Trust [298582] and a personal contribution from A Pidgley, UK National Institute of Health Research (NIHR) University College London Hospitals/UCL Biomedical Research Centres funding scheme.
Collapse
Affiliation(s)
- Jeremy Chataway
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK; UCL Institute of Neurology, University College London, London, UK; Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK.
| | - Nadine Schuerer
- UCL Institiute of Ophthalmology, University College London, London, UK
| | | | - Dennis Chan
- Brighton and Sussex Medical School, Brighton, UK
| | - David MacManus
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK; UCL Institute of Neurology, University College London, London, UK
| | - Kelvin Hunter
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK; UCL Institute of Neurology, University College London, London, UK
| | - Val Anderson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK; UCL Institute of Neurology, University College London, London, UK
| | | | - Shona Clegg
- UCL Institute of Neurology, University College London, London, UK
| | - Casper Nielsen
- UCL Institute of Neurology, University College London, London, UK
| | - Nick C Fox
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK; UCL Institute of Neurology, University College London, London, UK
| | | | - Jennifer M Nicholas
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia L Calder
- UCL Institiute of Ophthalmology, University College London, London, UK
| | - John Greenwood
- UCL Institiute of Ophthalmology, University College London, London, UK
| | - Chris Frost
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Nicholas
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| |
Collapse
|
18
|
Mallik S, Ball S, Dalton C, MacManus D, Tozer D, Miller D, Zajicek J. CANNABINOID USE IN PROGRESSIVE INFLAMMATORY BRAIN DISEASE (CUPID) MRI SUB–STUDY. J Neurol Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306573.182] [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: 11/03/2022]
|
19
|
MacManus D, Dean K, Jones M, Rona R, Hull L, Greenberg N, Fahy T, Wessely S, Fear N. OP92 The Impact of Military Deployment, Combat Experiences and Post-Deployment Mental Health Problems on Violent Behaviour among UK Military Personnel. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
20
|
Miller DH, Weber T, Grove R, Wardell C, Horrigan J, Graff O, Atkinson G, Dua P, Yousry T, MacManus D, Montalban X. Firategrast for relapsing remitting multiple sclerosis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2012; 11:131-9. [DOI: 10.1016/s1474-4422(11)70299-x] [Citation(s) in RCA: 42] [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] [Indexed: 01/21/2023]
|
21
|
Woodhead C, Rona RJ, Iversen A, MacManus D, Hotopf M, Dean K, McManus S, Meltzer H, Brugha T, Jenkins R, Wessely S, Fear NT. Mental health and health service use among post-national service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England. Psychol Med 2011; 41:363-372. [PMID: 20406527 DOI: 10.1017/s0033291710000759] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is concern surrounding the psychological health and uptake of treatment services among veterans of the UK Armed Forces. METHOD Data from a cross-sectional, nationally representative sample were used to compare health outcomes and treatment seeking among 257 post-national service veterans aged 16-64 years and 504 age and sex frequency-matched non-veterans living in the community in England. Early leavers (<4 years service) were compared with longer serving veterans. RESULTS Male veterans reported more childhood adversity and were more likely to have experienced a major trauma in adulthood than non-veterans. There was no association between any measure of mental health and veteran status in males, except reporting more violent behaviours [adjusted odds ratio (aOR) 1.44, 95% confidence interval (CI) 1.01-2.06]. In females, a significant association was found between veteran status and ever having suicidal thoughts (aOR 2.82, 95% CI 1.13-7.03). No differences in treatment-seeking behaviour were identified between veterans and non-veterans with any mental disorder. Early service leavers were more likely to be heavy drinkers (aOR 4.16, 95% CI 1.08-16.00), to have had suicidal thoughts (aOR 2.37, 95% CI 1.21-4.66) and to have self-harmed (aOR 12.36, 95% CI 1.61-94.68) than longer serving veterans. CONCLUSIONS The findings of this study do not suggest that being a veteran is associated with adversity in terms of mental health, social disadvantage or reluctance to seek treatment compared with the general population. Some evidence implies that early service leavers may experience more mental health problems than longer-serving veterans.
Collapse
Affiliation(s)
- C Woodhead
- Academic Centre for Defence Mental Health, King's College London, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Cohn RD, Bornhauser C, MacManus D, Sadakane M, Read W. A study of lavender and tea tree oils on postmenopausal FSH levels and hot flash severity. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1516] [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: 11/20/2022] Open
Abstract
1516 Background: Products containing lavender and tea tree oil have been linked to prepubertal male gynecomastia.(N Engl J Med 356:479–485) This implies that these products may be phytoestrogens, or plant products with estrogenic effects. Exogenous estrogens increase the risk of developing breast cancer and could counteract benefit from adjuvant hormonal manipulations in women with a history of breast cancer. We designed a study to determine the effects of lavender and tea tree oil on healthy postmenopausal women's FSH as a means to determine the estrogenic effect of both products. Hot flashes are a side effect of decreased endogenous estrogen, and in this study we used hot flash severity as an additional assay of estrogenic effect. Methods: Lavender lotion and tea tree oil products were generously donated by The Body Shop. Nine healthy postmenopausal women suffering from hot flashes were asked to apply lavender lotion and tea tree oil according to product directions for a week each, with a washout period in between. Participants were menopausal with baseline FSH > 26 IU/mL. Serum FSH was obtained at baseline, after each lotion and after the washout period. Participants also recorded daily hot flash number and severity. Average daily hot flash severity was calculated for each patient during each period, with lotion use periods compared to Paired, 2-tailed T-tests were used to compare average hot flash severity for each participant as well as FSH values as compared to the baseline obtained before it. Results: Compliance was excellent. No significant differences were seen between time periods with either product for either measure. In no case did FSH dip to premenopausal levels. No indication of improvement in hot flash frequency or severity was seen. Conclusions: In our population, the lavender and tea tree oil products showed no estrogenic effects. This is similar to clinical trials of phytoestrogens, which as used by humans are not potent enough to affect FSH or hot flash severity. Both lotions can probably be used without increasing the risk of recurrent or de novo breast cancer. We intend one more study period in which participants will use a large daily amount of lavender lotion, again tracking hot flash severity and FSH. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. D. Cohn
- University of California, San Diego, La Jolla, CA
| | | | - D. MacManus
- University of California, San Diego, La Jolla, CA
| | - M. Sadakane
- University of California, San Diego, La Jolla, CA
| | - W. Read
- University of California, San Diego, La Jolla, CA
| |
Collapse
|
23
|
Stüve O, Cravens PD, Frohman EM, Phillips JT, Remington GM, von Geldern G, Cepok S, Singh MP, Tervaert JWC, De Baets M, MacManus D, Miller DH, Radü EW, Cameron EM, Monson NL, Zhang S, Kim R, Hemmer B, Racke MK. Immunologic, clinical, and radiologic status 14 months after cessation of natalizumab therapy. Neurology 2008; 72:396-401. [PMID: 18987352 DOI: 10.1212/01.wnl.0000327341.89587.76] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [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] Open
Abstract
OBJECTIVE Natalizumab is a humanized recombinant monoclonal antibody against very late activation antigen-4 approved for the treatment of patients with multiple sclerosis (MS). A phase II study failed to demonstrate a difference between natalizumab treatment groups and the placebo group with regard to gadolinium enhancing lesions on MRI 3 months after discontinuation of therapy. The objective of this study was to assess clinical MS disease activity, surrogate disease markers on MRI, immunologic parameters in peripheral blood and CSF, as well as safety in patients with MS after discontinuation of natalizumab therapy. METHODS This study is a longitudinal and serial cross-sectional assessment, in which 23 patients who were treated with natalizumab in the context of two phase III clinical trials were originally enrolled. A subgroup of patients was followed over 14 months. The annual relapse rate, neurologic disease progression assessed by the Expanded Disability Status Scale, disease surrogate markers on MRI, cellular and humoral immune markers in peripheral blood and CSF, and adverse events of the drug were monitored. RESULTS With regard to clinical disease activity, neuroimaging, and immune responses, the majority of patients in our cohort were stable. Decreased lymphocyte cell numbers and altered cell ratios returned to normal 14 months after cessation of natalizumab. No infectious complications were observed. CONCLUSION This is the first long-term follow-up of patients who discontinued natalizumab. We did not observe a clinical, radiographic, or immunologic rebound phenomenon after discontinuation of natalizumab therapy.
Collapse
Affiliation(s)
- O Stüve
- Neurology Section, VA North Texas Health Care System, Medical Service, Dallas, TX 75216, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Cordery RJ, MacManus D, Godbolt A, Rossor MN, Waldman AD. Short TE Quantitative Proton Magnetic Resonance Spectroscopy in Variant Creutzfeldt-Jakob Disease. Eur Radiol 2006; 16:1692-8. [PMID: 16408201 DOI: 10.1007/s00330-005-0090-4] [Citation(s) in RCA: 18] [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: 07/18/2005] [Revised: 10/05/2005] [Accepted: 11/08/2005] [Indexed: 11/27/2022]
Abstract
Variant Creutzfeldt-Jakob disease (vCJD) is a fatal neurodegenerative disorder. Clinical diagnosis is difficult in the early stages as the disease often presents with non-specific psychiatric and neurological symptoms. To investigate the diagnostic potential of quantitative short TE in vivo MRS, and the nature and anatomical distribution of biochemical abnormalities in vCJD, localised single-voxel spectra (TE/TR 30 ms/2,000 ms) were acquired from three brain regions: thalami, caudate nuclei and frontal white matter. Metabolite concentrations and ratios from three patients with definite or probable vCJD were compared with eight normal age-matched controls. Abnormal signal on T2-weighted MRI was apparent in the pulvinar region in all vCJD patients; this region also showed greatly increased myo-inositol [MI] (mean 2.5-fold, P=0.01) and decreased N-acetyl-aspartate (NAA; mean 2-fold, P=0.01). Two patients also showed increased [MI] (z=17, 11; one with decreased NAA, z=-12) in normal-appearing caudate nuclei. The magnitude of metabolite abnormalities in the thalami in moderately advanced vCJD suggests a potential role in earlier diagnosis. Short TE protocols allow the measurement of MI, which adds discriminant power to the MRS examination.
Collapse
Affiliation(s)
- R J Cordery
- Dementia Research Group, Institute of Neurology, University College London, London, UK
| | | | | | | | | |
Collapse
|
25
|
Page RA, Davie CA, MacManus D, Miszkiel KA, Walshe JM, Miller DH, Lees AJ, Schapira AHV. Clinical correlation of brain MRI and MRS abnormalities in patients with Wilson disease. Neurology 2005; 63:638-43. [PMID: 15326235 DOI: 10.1212/01.wnl.0000134793.50831.c1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The progression of Wilson disease (WD), a disorder of copper metabolism, can be arrested by chelation therapy. However, neurologic deficits may persist despite adequate treatment. MRI is used to assess patients with WD, but previous attempts to correlate clinical progression with the investigation findings have often been unsuccessful. OBJECTIVE To identify MR visible markers that could help stratify disease severity and to clarify the mechanism of persistent neurologic deficit after treatment. METHODS MRI and proton MR spectroscopy (1H-MRS) were performed in 17 patients with WD. MRI was assessed semiquantitatively and used to locate volumes of interest (voxels) in the striatum for 1H-MRS. RESULTS MRI showed abnormalities predominantly confined to those patients with neurologic features of WD. The 1H spectra demonstrated a reduction of N-acetylaspartate and N-acetylaspartylglutamate (2.05 mM; p < 0.01) in those patients with neurologic features but not in patients without clinical neurologic involvement (0.42 mM; p > 0.1) in comparison with age-matched normal control subjects. Choline was also reduced in both patient groups (0.08 mM; p < 0.01) compared with age-matched controls. CONCLUSIONS There may be a biochemical correlate of tissue-specific dysfunction in patients with Wilson disease who develop neurologic features. These changes appear to be present despite prior clinical improvement and may imply a need for additional treatment.
Collapse
Affiliation(s)
- R A Page
- University Department of Clinical Neurosciences, Royal Free and University College Medical School, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Tijssen MAJ, Brown P, MacManus D, McLean MA, Davie C. Magnetic resonance spectroscopy of cerebral cortex is normal in hereditary hyperekplexia due to mutations in the GLRA1 gene. Mov Disord 2003; 18:1538-41. [PMID: 14673895 DOI: 10.1002/mds.10613] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Excessive startling and stiffness in hereditary hyperekplexia has been attributed to lack of inhibition at either the cortical or brainstem level. Six patients with hereditary hyperekplexia (HH) and a confirmed mutation in the gene encoding the alpha(1) subunit of the glycine receptor (GLRA1) underwent single voxel (1)H magnetic resonance spectroscopy (MRS) of the brainstem and an area of frontal cortex and white matter using a method that allows absolute quantification of metabolites. The results of MRS were within normal limits, although there was a tendency for the neuronal marker N-acetyl aspartate to be reduced in the brainstem of patients compared with that in controls. Thus, we found no evidence to support a deficit in the cerebral cortex in patients with hereditary hyperekplexia due to mutations in the GLRA1 gene.
Collapse
Affiliation(s)
- Marina A J Tijssen
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
27
|
Molyneux PD, Barker GJ, Barkhof F, Beckmann K, Dahlke F, Filippi M, Ghazi M, Hahn D, MacManus D, Polman C, Pozzilli C, Kappos L, Thompson AJ, Wagner K, Yousry T, Miller DH. Clinical-MRI correlations in a European trial of interferon beta-1b in secondary progressive MS. Neurology 2001; 57:2191-7. [PMID: 11756596 DOI: 10.1212/wnl.57.12.2191] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [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: 11/15/2022] Open
Abstract
BACKGROUND The recently completed placebo-controlled multicenter randomized trial of interferon beta-1b (Betaferon) in 718 patients with secondary progressive MS shows significant delay of disease progression and reduction of relapse rate. This study provides an opportunity to assess the level of relationship between clinical and MRI outcomes in this cohort of patients with secondary progressive MS. METHODS Brain T2-weighted lesion volume was measured annually in all available patients, with visual analysis to identify any new or enlarging (active) T2 lesions at each annual time point. A subgroup of 125 patients had monthly gadolinium-enhanced, T1-weighted imaging at months 0 to 6 and 18 to 24. Relapses were documented and expanded disability status scale (EDSS) was measured every 3 months. RESULTS For the annual MRI outcomes, a significant but modest correlation was identified between the change in T2 lesion volume from baseline to the final scan and the corresponding change from baseline in EDSS (r = 0.17, p < 0.0001). There were significant correlations between the cumulative number of active T2 lesions and 1) change in EDSS (r = 0.18, p < 0.0001) and 2) relapse rate (r = 0.24, p < 0.0001). In the subgroup of 125 patients undergoing monthly imaging, MRI lesion activity was correlated with relapse rate over months 0 to 24 (r = 0.24, p = 0.006) but not with change in EDSS. CONCLUSIONS These results confirm that the clinical-MRI relationships previously identified in relapsing-remitting MS still are apparent in the secondary progressive phase of the disease and support the use of MRI as a relevant outcome measure. In view of the relatively modest nature of the correlations, it seems unwise to rely on such MRI measures alone as primary efficacy variables in secondary progressive MS trials.
Collapse
Affiliation(s)
- P D Molyneux
- NMR Research Unit, Institute of Neurology, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Paolillo A, Coles AJ, Molyneux PD, Gawne-Cain M, MacManus D, Barker GJ, Compston DA, Miller DH. Quantitative MRI in patients with secondary progressive MS treated with monoclonal antibody Campath 1H. Neurology 1999; 53:751-7. [PMID: 10489036 DOI: 10.1212/wnl.53.4.751] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.1] [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: 11/15/2022] Open
Abstract
BACKGROUND To assess the long-term effect of the lymphocyte-depleting humanized monoclonal antibody Campath 1H on MR markers of disease activity and progression in secondary progressive MS patients. METHODS Twenty-five patients participated in a crossover treatment trial with monthly run-in MR scans for 3 months, followed (after a single pulse of Campath 1H) by monthly MR scans from months 1 to 6 and again from months 12 to 18. MR analysis was performed to provide measurements of the number and volume of gadolinium (Gd)-enhancing lesions as well as the hypointense lesion volume on a T1-weighted sequence. In addition, serial measurements of T2 brain lesion volume, brain volume, and spinal cord cross-sectional area were made over the duration of the study. The relationship between clinical and MR measures of disease evolution was also assessed. RESULTS Treatment was associated with a reduction in the number and volume of Gd-enhancing lesions (p < 0.01). Despite this, a decrease in brain volume was seen in 13 patients during the 18 months post-treatment. The mean pretreatment Gd-enhancing lesion volume was predictive of subsequent reduction in brain volume (r = 0.77, p = 0.002). Reduction in brain volume also correlated with the change in T1 hypointense lesion volume after treatment (r = 0.53, p < 0.01). A reduction in spinal cord area was also seen throughout the study duration, and this correlated with an increase in disability (r = 0.65, p = 0.01). CONCLUSION Campath 1H treatment was associated with a sustained and marked reduction in the volume of Gd enhancement, indicating suppression of active inflammation. Nevertheless, many patients developed increasing brain and spinal cord atrophy, T1 hypointensity, and disability. This study highlights the potential role for novel MR techniques in monitoring the effect of treatment on the pathologic process in MS.
Collapse
Affiliation(s)
- A Paolillo
- Institute of Neurology, National Hospital, Queens Square, London
| | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Stevenson VL, Moseley IF, Phatouros CC, MacManus D, Thompson AJ, Miller DH. Improved imaging of the spinal cord in multiple sclerosis using three-dimensional fast spin echo. Neuroradiology 1998; 40:416-9. [PMID: 9730338 DOI: 10.1007/s002340050614] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report assessment of a new three-dimensional fast spin echo (3D FSE) sequence in ten patients with clinically definite multiple sclerosis, comparing it with standard 2D FSE, and in ten normal controls. We saw 29 focal lesions on the 2D images and 53 on the 3D FSE images (P = 0.05); none were seen in controls. Lesion length was significantly smaller on the 3D FSE than on to the 2D FSE images (3D: 1.36; 2D 2.0; P = 0.03). This may relate in part to separation into several lesions on the 3D images of confluent abnormal signal seen on 2D and in part to detection of small lesions missed by the thicker 2D FSE slices (3 mm compared to 1.5 mm). The 3D FSE sequence looks promising in improving spinal cord imaging.
Collapse
Affiliation(s)
- V L Stevenson
- NMR Research Unit, Institute of Neurology, London, UK
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
The authors define the dose-limiting toxicities and the recommended phase II doses of paclitaxel combined with etoposide, without and with filgrastim support. Patients with advanced solid tumors were eligible if they had a performance status of 0 to 2 and normal renal, hepatic, and bone marrow function. Patients with cardiac arrhythmias or congestive heart failure requiring medical therapy were excluded. Prior radiation was allowed only if it involved less than 30% of the marrow-containing skeleton. The dose of etoposide was fixed at 100 mg/m2/d for 3 days beginning on day 1. Paclitaxel was administered over 3 hours on day 4. The dose of paclitaxel was escalated until the maximum tolerated dose (MTD), without and with filgrastim 5 microg/kg (or 300 microg total dose) subcutaneously beginning on day 5, was reached. Treatment cycles were repeated every 21 days. Of 39 patients entered, 37 were evaluable for toxicity and 30 for response. The principal toxicity was neutropenia. Without filgrastim, the MTD of paclitaxel was 150 mg/m2. With filgrastim, the dose of paclitaxel was escalated to 250 mg/m2 in combination with etoposide 100 mg/m2. One episode of pulmonary toxicity was observed. Five patients responded: two with previously treated non-small-cell lung cancer (NSCLC), two with refractory small-cell lung cancer (SCLC), and one with refractory germ-cell tumor (GCT). We conclude that paclitaxel and etoposide can be given in combination at clinically relevant doses with filgrastim support. In this phase I trial, a dose of paclitaxel of 200 mg/m2 on day 4 and etoposide at 100 mg/m2/d on days 1-3, with filgrastim 5 microg/kg beginning on day 5, was found to be well tolerated, and can be recommended for future studies. Without filgrastim, a paclitaxel dose of 150 mg/m2 with the same dose of etoposide can also be recommended.
Collapse
Affiliation(s)
- R C Lilenbaum
- University of Maryland Cancer Center, Baltimore, USA
| | | | | | | |
Collapse
|
32
|
Gass A, Barker GJ, Riordan-Eva P, MacManus D, Sanders M, Tofts PS, McDonald WI, Moseley IF, Miller DH. MRI of the optic nerve in benign intracranial hypertension. Neuroradiology 1996; 38:769-73. [PMID: 8957802 DOI: 10.1007/s002340050344] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [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: 02/03/2023]
Abstract
We investigated the MRI appearance of the optic nerve and its cerebrospinal-fluid-containing sheath in 17 patients with benign intracranial hypertension (BIH) and 15 normal controls. Using phased-array local coils, 3-mm coronal T2-weighted fat-suppressed fast spin-echo images were obtained with an in-plane resolution of < 0.39 mm. The optic nerve and its sheath were clearly differentiated. An enlarged, elongated subarachnoid space around the optic nerve was demonstrated in patients with BIH. High-resolution MRI of the optic nerve offers additional information which may be of value for diagnosis and in planning and monitoring treatment.
Collapse
Affiliation(s)
- A Gass
- NMR Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Gass A, Moseley IF, Barker GJ, Jones S, MacManus D, McDonald WI, Miller DH. Lesion discrimination in optic neuritis using high-resolution fat-suppressed fast spin-echo MRI. Neuroradiology 1996; 38:317-21. [PMID: 8738086 DOI: 10.1007/bf00596577] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [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: 02/01/2023]
Abstract
Fast spin-echo (FSE) is a new sequence with acquisition times currently down to one-sixteenth of those obtained with conventional spin-echo sequences, which allows high-resolution (512 x 512 matrix) images to be acquired in an acceptable time. We compared the higher resolution of FSE with the medium resolution of a short inversion-time inversion-recovery (STIR) sequence in depicting the optic nerves of healthy controls and patients with optic neuritis. Optic nerve MRI examinations were performed in 18 patients with optic neuritis and 10 normal controls. Two sequences were obtained coronally: fat-suppressed FSE (FSE TR 3250 ms/TEef 68 ms, echo-train length 16, 4 excitations, 24 cm rectangular field of view, 3 mm interleaved contiguous slices, in-plane resolution 0.5 x 0.5 mm) and STIR (TR 2000 ms/TE 50 ms/TI 175 ms, in-plane resolution 0.8 x 0.8 mm, slice thickness 5 mm). FSE demonstrated much more anatomical detail than STIR, e.g. distinction of optic nerve and sheath. Lesions were seen in 20 of 21 symptomatic nerves using FSE and in 18 of 21 using STIR. Nerve swelling or partial cross-sectional lesions of the optic nerve were each seen only on FSE in 3 cases. Fat-suppressed FSE imaging of the optic nerve improves anatomical definition and increases lesion detection in optic neuritis.
Collapse
Affiliation(s)
- A Gass
- NMR Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | | | | | | |
Collapse
|
34
|
Lai M, Hodgson T, Gawne-Cain M, Webb S, MacManus D, McDonald WI, Thompson AJ, Miller DH. A preliminary study into the sensitivity of disease activity detection by serial weekly magnetic resonance imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 1996; 60:339-41. [PMID: 8609517 PMCID: PMC1073863 DOI: 10.1136/jnnp.60.3.339] [Citation(s) in RCA: 50] [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: 01/31/2023]
Abstract
Long TR and gadolinium enhanced spin echo brain MRI was performed weekly for three months in three patients with relapsing-remitting or secondary progressive multiple sclerosis. During the study, 38 new enhancing lesions were seen; 11 showed enhancement for less than four weeks, and two enhanced on only one scan. All 16 new lesions seen on long TR scans showed initial enhancement. When only every fourth (monthly) scan was analysed, a total of 33 new enhancing lesions were seen. Subject to confirmation in a larger cohort, the results suggest: (a) that blood brain barrier leakage is an invariable event in new lesion development in relapsing-remitting and secondary progressive multiple sclerosis; (b) the small increase in sensitivity of weekly scanning does not justify its use in preference to monthly scanning when monitoring treatments.
Collapse
Affiliation(s)
- M Lai
- Institute of Neurology, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Tofts PS, Sisodiya S, Barker GJ, Webb S, MacManus D, Fish F, Shorvon S. MR magnetization transfer measurements in temporal lobe epilepsy: a preliminary study. AJNR Am J Neuroradiol 1995; 16:1862-3. [PMID: 8693987 PMCID: PMC8338225] [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: 02/01/2023]
Abstract
MR magnetization transfer ratio was measured in both hippocampi of three patients with temporal lobe epilepsy, and in two control subjects. The magnetization transfer ratio in each section was significantly lower on the affected side than on the contralateral side and in control subjects. Magnetization transfer ratio measurements are relatively fast and precise, this preliminary study shows that they may provide useful presurgical information.
Collapse
Affiliation(s)
- P S Tofts
- NMR Research Unit, Institute of Neurology, Queen Square, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
36
|
Gass A, Barker GJ, MacManus D, Sanders M, Riordan-Eva P, Tofts PS, Thorpe J, McDonald WI, Moseley IF, Miller DH. High resolution magnetic resonance imaging of the anterior visual pathway in patients with optic neuropathies using fast spin echo and phased array local coils. J Neurol Neurosurg Psychiatry 1995; 58:562-9. [PMID: 7745403 PMCID: PMC1073486 DOI: 10.1136/jnnp.58.5.562] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [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: 01/26/2023]
Abstract
High resolution MRI of the anterior visual pathways was evaluated using frequency selective fat suppressed fast spin echo (FSE) sequences in conjunction with phased array local coils in patients with optic neuropathies. Fifteen normal controls and 57 patients were examined. Coronal T2 weighted fat suppressed FSE images were obtained in 11 minutes with an in plane resolution of 0.39 x 0.39 mm. The optic nerve and its sheath containing CSF were clearly differentiated. Central retinal vessels were often visible. In demyelinating optic neuritis and in anterior ischaemic optic neuropathy high signal within the nerve was readily delineated. Meningiomas and gliomas involving the optic nerve were precisely visualised both in the orbit and intracranially. Extrinsic compression of the optic nerves was readily visualised in carotid artery ectasia and dysthyroid eye disease. Enlarged subarachnoid spaces around the optic nerves were demonstrated in benign intracranial hypertension. High resolution MRI of the anterior visual pathway represents an advance in the diagnosis and management of patients presenting with optic neuropathy.
Collapse
Affiliation(s)
- A Gass
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Gass A, Barker GJ, Kidd D, Thorpe JW, MacManus D, Brennan A, Tofts PS, Thompson AJ, McDonald WI, Miller DH. Correlation of magnetization transfer ratio with clinical disability in multiple sclerosis. Ann Neurol 1994; 36:62-7. [PMID: 8024264 DOI: 10.1002/ana.410360113] [Citation(s) in RCA: 203] [Impact Index Per Article: 6.8] [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: 01/28/2023]
Abstract
We performed spin echo magnetic resonance imaging with and without application of an off-resonance saturation pulse in 43 patients with multiple sclerosis (MS), 10 age-matched controls, and 4 elderly asymptomatic patients with the radiological diagnosis of small-vessel disease. Magnetization transfer (MT) ratio images were obtained from these. All MS subgroups (primary progressive, secondary progressive, benign, early relapsing-remitting) showed significantly lower average lesion MT ratios than small-vessel disease patients. Secondary progressive MS patients showed significantly lower lesion MT ratios than those with benign disease, and there was an inverse correlation of disability with average lesion MT ratio. The degree of reduction of MT ratios is an indicator of the extent of tissue destruction. Thus, reduced MT ratios in MS may provide an indication of the degree of demyelination and axonal loss, both of which are likely to cause functional deficits in MS. We conclude that MT measurement is (1) a robust quantitative method that may increase the pathological specificity of magnetic resonance imaging, (2) has the potential to differentiate demyelination in MS from less destructive pathological changes, and (3) may be useful in monitoring modifications in tissue structure brought about by treatment.
Collapse
Affiliation(s)
- A Gass
- Institute of Neurology, National Hospital, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ormerod IE, Harding AE, Miller DH, Johnson G, MacManus D, du Boulay EP, Kendall BE, Moseley IF, McDonald WI. Magnetic resonance imaging in degenerative ataxic disorders. J Neurol Neurosurg Psychiatry 1994; 57:51-7. [PMID: 8301305 PMCID: PMC485039 DOI: 10.1136/jnnp.57.1.51] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
MRI of the brain was performed in 53 patients with a variety of degenerative ataxias and related disorders and 96 control subjects. Atrophy of intracranial structures was not seen in patients with the pure type of hereditary spastic paraplegia, or in early cases of Friedreich's ataxia. In advanced Friedreich's ataxia there was atrophy of the vermis and medulla. The MRI features of early onset cerebellar ataxia with retained reflexes were variable, and suggest heterogeneity. In autosomal dominant cerebellar ataxias, most patients had cerebellar and brainstem atrophy, probably reflecting the pathological process of olivopontocerebellar atrophy; there was no clearly defined group with both clinical and imaging features of isolated cerebellar involvement. The MRI abnormalities in idiopathic late onset cerebellar ataxia were predominantly those of cerebellar and brainstem atrophy or pure cerebellar atrophy. The clinical and imaging features of brainstem abnormalities were discordant in several patients. Pure cerebellar atrophy was associated with slower progression of disability. Cerebral atrophy was common in the late onset ataxias. Cerebral white matter lesions, although usually few in number, were observed in significantly more patients than controls, particularly those aged over 50 years.
Collapse
|
39
|
Thompson AJ, Miller D, Youl B, MacManus D, Moore S, Kingsley D, Kendall B, Feinstein A, McDonald WI. Serial gadolinium-enhanced MRI in relapsing/remitting multiple sclerosis of varying disease duration. Neurology 1992; 42:60-3. [PMID: 1734325 DOI: 10.1212/wnl.42.1.60] [Citation(s) in RCA: 154] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the planning of MRI protocols to monitor disease activity in multiple sclerosis (MS), the clinical subtype needs to be considered. In this serial gadolinium-enhanced MRI study, we demonstrated differences between patients with early relapsing/remitting MS and benign MS in both the production of new lesions and the occurrence of enhancement.
Collapse
Affiliation(s)
- A J Thompson
- NMR Research Group, Institute of Neurology, Queen Square, London, England
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Newcombe J, Hawkins CP, Henderson CL, Patel HA, Woodroofe MN, Hayes GM, Cuzner ML, MacManus D, du Boulay EP, McDonald WI. Histopathology of multiple sclerosis lesions detected by magnetic resonance imaging in unfixed postmortem central nervous system tissue. Brain 1991; 114 ( Pt 2):1013-23. [PMID: 2043938 DOI: 10.1093/brain/114.2.1013] [Citation(s) in RCA: 106] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postmortem unfixed whole brains from 17 multiple sclerosis and 6 control cases were examined by magnetic resonance imaging (MRI) using a T2-weighted spin echo sequence and histology to determine the relationship between areas of abnormal MRI signal and underlying pathological change. In group 1, small MRI lesions and correspondingly small plaques, most of which were chronic, were detected histologically in 5 brains. In 4 brains there were more extensive areas of both abnormal signal and histological plaques which were more often active (group 2). However, in a further 5 brains extensive MRI abnormalities were observed when only small periventricular plaques were present histologically (group 3). Lesions in the hindbrain and cerebral grey matter were infrequently observed by MRI. The extensive MRI abnormalities seen in areas in which only small histological plaques were found may be the result of vascular permeability changes in the normal-appearing white matter surrounding plaques.
Collapse
Affiliation(s)
- J Newcombe
- Multiple Sclerosis Society Laboratory, Institute of Neurology, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Miller DH, Johnson G, Tofts PS, MacManus D, McDonald WI. Precise relaxation time measurements of normal-appearing white matter in inflammatory central nervous system disease. Magn Reson Med 1989; 11:331-6. [PMID: 2779420 DOI: 10.1002/mrm.1910110307] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.5] [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: 01/02/2023]
Abstract
Precise relaxation time (RT) measurements have been made, with a standard deviation of 3% for T1 and T2 in white matter in normal volunteers. This sets an upper limit to the instrumental random errors (imprecision). Achieving this precision requires careful adjustment and use of the imager. The wide variation in RTs seen by other workers may be in part due to larger instrumental errors. We have measured RTs (both T1 and T2) in normal-appearing white matter in 16 normal controls and patients with multiple sclerosis (MS, 18), systemic lupus erythematosis (SLE, 16) and cerebral sarcoidosis (8). Both RTs were significantly higher in MS than in other patient groups and controls (P less than .05), possibly caused by microscopic lesions. T2 was elevated in SLE patients relative to controls and sarcoidosis patients (P less than .05), possibly because of microhemorrhages. Lesion RTs were abnormal but more variable and no significant differences between diseases were found.
Collapse
Affiliation(s)
- D H Miller
- Multiple Sclerosis NMR Research Group, Institute of Neurology, London, United Kingdom
| | | | | | | | | |
Collapse
|
42
|
MacManus D, Bartlett P. Magnetic resonance imaging (MRI) of the orbit. Radiogr Today 1988; 54:40-1. [PMID: 3269230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
43
|
Johnson G, Miller DH, MacManus D, Tofts PS, Barnes D, du Boulay EP, McDonald WI. STIR sequences in NMR imaging of the optic nerve. Neuroradiology 1987; 29:238-45. [PMID: 3614619 DOI: 10.1007/bf00451760] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Orbital fat surrounding the optic nerve causes considerable difficulties in NMR imaging due to its high image intensity and the chemical shift artefact. We have investigated the ability of inversion recovery sequences with short inversion times (STIR sequences) to suppress fat signals in imaging the optic nerve. We have also compared the contrast attainable with STIR sequences with that obtainable from other sequences. Measurements were made on 4 normal controls and 5 patients with multiple sclerosis (MS) to obtain typical values of relaxation times and proton densities for orbital fat, cerebral white matter and MS lesions. The fat T1 measurements were used to predict an appropriate inversion time for the STIR sequence and estimate how much residual fat signal might be expected as a result of natural variations in fat T1. STIR sequences can be used to suppress the signal from orbital fat with little residual signal. Measurements from white matter and MS lesions were used to predict the contrast between normal and pathological tissues that is attainable with STIR sequences. STIR contrast compares favourably with that obtainable from other sequences.
Collapse
|
44
|
Johnson G, Ormerod IE, Barnes D, Tofts PS, MacManus D. Accuracy and precision in the measurement of relaxation times from nuclear magnetic resonance images. Br J Radiol 1987; 60:143-53. [PMID: 3815010 DOI: 10.1259/0007-1285-60-710-143] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The accuracy (proximity to the true value) and precision (reproducibility) of relaxation times derived from nuclear magnetic resonance images were investigated. Two methods of deriving relaxation times were considered. A patient scanning protocol in which the minimum number of scans necessary for the calculation (three) were performed. Calculated T1 and T2 images were then formed. An animal (cat) protocol in which many more scans were performed. The data were read from the display and fitted by computer to the theoretical curves. The accuracy of the measurements was determined by an empirical method. A series of bottles with different concentrations of MnCl2 and CuSO4 in water were prepared and their relaxation times determined using the imager as a simple pulsed spectrometer. These values were compared with those derived from images. Over the normal range of tissue values (T1 less than 700 ms, T2 less than 200 ms) the animal protocol gave values of T1 up to 1% shorter than the true values. The T2 values were up to 5% shorter. Patient protocol values were up to 7% shorter for T1 and up to 20% shorter for T2. There was some difference between results for MnCl2 and for CuSO4 (particularly for patient T2s), suggesting that the results depend to a small extent on the T1/T2 ratio. The precision of the values was investigated by considering the standard deviations (SDs) of brain tissue measurements over populations of cats (animal protocols) and normal control subjects and multiple sclerosis patients (patient protocols). These were compared with the SDs of measurements of calibration bottles scanned with the patients. Standard deviations of 3% for T1 and 6% for T2 were found over 19 cats using the animal protocols; SDs of 7% for T1 and 14% for T2 were found over 15 normal control subjects using the patient protocols. Standard deviations of bottle measurements were similar to these figures. There are also variations between different subjects and different regions of the brain. There was no significant change between readings on the same patient in follow-up studies. Other sources of variation in the measurements made with the patient protocols were investigated by scanning phantoms. Noise in T1 and T2 images is about 2%. Spatial non-uniformity within slices is about 1% for T1 and 10% for T2. Non-uniformity between slices in multislice sets is 4% for T1 and 14% for T2. There is no long-term variation in measured values over 9 months; short-term variation is approximately 1%.
Collapse
|
45
|
MacManus D, Bartlett P. The role of nuclear magnetic resonance imaging in the diagnosis of Arnold-Chiari malformation. Radiography (Lond) 1986; 52:275-80. [PMID: 3628745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The diagnosis and demonstration of an Arnold-Chiari malformation (ACM), in particular the Type I ACM, presents a challenge to the clinician and diagnostic imaging specialist. Various imaging techniques have been used to demonstrate this condition in the past; as with other pathologies, the value of nuclear magnetic resonance imaging (NMRI) will naturally be compared with current techniques in the diagnosis of this abnormality. In this paper the authors give a brief history of the condition, an indication of current imaging techniques, and suggest an important role for NMRI in the demonstration of Arnold-Chiari malformations.
Collapse
|
46
|
James DT, MacManus D. The effects of post-acquisition-trial sodium amylobarbitone on subsequent extinction behaviour. Q J Exp Psychol B 1986; 38:327-40. [PMID: 3763956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
47
|
Miller DH, Johnson G, McDonald WI, MacManus D, duBoulay EP, Kendall BE, Moseley IF. Detection of optic nerve lesions in optic neuritis with magnetic resonance imaging. Lancet 1986; 1:1490-1. [PMID: 2873291 DOI: 10.1016/s0140-6736(86)91517-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
48
|
MacManus D, Bartlett P. Image contrast in nuclear magnetic resonance imaging. Radiography (Lond) 1986; 52:103-8. [PMID: 3749487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
49
|
|
50
|
MacManus D. Advertisements in the Post-bag. West J Med 1952. [DOI: 10.1136/bmj.2.4787.779-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|