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Khalil M, Teunissen CE, Lehmann S, Otto M, Piehl F, Ziemssen T, Bittner S, Sormani MP, Gattringer T, Abu-Rumeileh S, Thebault S, Abdelhak A, Green A, Benkert P, Kappos L, Comabella M, Tumani H, Freedman MS, Petzold A, Blennow K, Zetterberg H, Leppert D, Kuhle J. Neurofilaments as biomarkers in neurological disorders - towards clinical application. Nat Rev Neurol 2024; 20:269-287. [PMID: 38609644 DOI: 10.1038/s41582-024-00955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
Neurofilament proteins have been validated as specific body fluid biomarkers of neuro-axonal injury. The advent of highly sensitive analytical platforms that enable reliable quantification of neurofilaments in blood samples and simplify longitudinal follow-up has paved the way for the development of neurofilaments as a biomarker in clinical practice. Potential applications include assessment of disease activity, monitoring of treatment responses, and determining prognosis in many acute and chronic neurological disorders as well as their use as an outcome measure in trials of novel therapies. Progress has now moved the measurement of neurofilaments to the doorstep of routine clinical practice for the evaluation of individuals. In this Review, we first outline current knowledge on the structure and function of neurofilaments. We then discuss analytical and statistical approaches and challenges in determining neurofilament levels in different clinical contexts and assess the implications of neurofilament light chain (NfL) levels in normal ageing and the confounding factors that need to be considered when interpreting NfL measures. In addition, we summarize the current value and potential clinical applications of neurofilaments as a biomarker of neuro-axonal damage in a range of neurological disorders, including multiple sclerosis, Alzheimer disease, frontotemporal dementia, amyotrophic lateral sclerosis, stroke and cerebrovascular disease, traumatic brain injury, and Parkinson disease. We also consider the steps needed to complete the translation of neurofilaments from the laboratory to the management of neurological diseases in clinical practice.
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Affiliation(s)
- Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Charlotte E Teunissen
- Neurochemistry Laboratory Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Sylvain Lehmann
- LBPC-PPC, Université de Montpellier, INM INSERM, IRMB CHU de Montpellier, Montpellier, France
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Simon Thebault
- Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Ari Green
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuel Comabella
- Neurology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hayrettin Tumani
- Department of Neurology, CSF Laboratory, Ulm University Hospital, Ulm, Germany
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Axel Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, P. R. China
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.
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Cross AH, Gelfand JM, Thebault S, Bennett JL, von Büdingen HC, Cameron B, Carruthers R, Edwards K, Fallis R, Gerstein R, Giacomini PS, Greenberg B, Hafler DA, Ionete C, Kaunzner UW, Kodama L, Lock C, Longbrake EE, Musch B, Pardo G, Piehl F, Weber MS, Yuen S, Ziemssen T, Bose G, Freedman MS, Anania VG, Ramesh A, Winger RC, Jia X, Herman A, Harp C, Bar-Or A. Emerging Cerebrospinal Fluid Biomarkers of Disease Activity and Progression in Multiple Sclerosis. JAMA Neurol 2024:2816158. [PMID: 38466277 DOI: 10.1001/jamaneurol.2024.0017] [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: 03/12/2024]
Abstract
Importance Biomarkers distinguishing nonrelapsing progressive disease biology from relapsing biology in multiple sclerosis (MS) are lacking. Cerebrospinal fluid (CSF) is an accessible fluid that most closely reflects central nervous system biology. Objective To identify CSF biological measures associated with progressive MS pathobiology. Design, Setting, and Participants This cohort study assessed data from 2 prospective MS cohorts: a test cohort provided serial CSF, clinical, and imaging assessments in a multicenter study of patients with relapsing MS (RMS) or primary progressive MS (PPMS) who were initiating anti-CD20 treatment (recruitment: 2016-2018; analysis: 2020-2023). A single-site confirmation cohort was used to assess CSF at baseline and long-term (>10 year) clinical follow-up (analysis: 2022-2023). Exposures Test-cohort participants initiated standard-of-care ocrelizumab treatment. Confirmation-cohort participants were untreated or received standard-of-care disease-modifying MS therapies. Main Outcomes and Measures Twenty-five CSF markers, including neurofilament light chain, neurofilament heavy chain, and glial fibrillary acid protein (GFAP); 24-week confirmed disability progression (CDP24); and brain magnetic resonance imaging measures reflecting focal injury, tissue loss, and progressive biology (slowly expanding lesions [SELs]). Results The test cohort (n = 131) included 100 patients with RMS (mean [SD] age, 36.6 [10.4] years; 68 [68%] female and 32 [32%] male; Expanded Disability Status Scale [EDSS] score, 0-5.5), and 31 patients with PPMS (mean [SD] age, 44.9 [7.4] years; 15 [48%] female and 16 [52%] male; EDSS score, 3.0-6.5). The confirmation cohort (n = 68) included 41 patients with RMS and 27 with PPMS enrolled at diagnosis (age, 40 years [range, 20-61 years]; 47 [69%] female and 21 [31%] male). In the test cohort, GFAP was correlated with SEL count (r = 0.33), greater proportion of T2 lesion volume from SELs (r = 0.24), and lower T1-weighted intensity within SELs (r = -0.33) but not with acute inflammatory measures. Neurofilament heavy chain was correlated with SEL count (r = 0.25) and lower T1-weighted intensity within SELs (r = -0.28). Immune markers correlated with measures of acute inflammation and, unlike GFAP, were impacted by anti-CD20. In the confirmation cohort, higher baseline CSF GFAP levels were associated with long-term CDP24 (hazard ratio, 2.1; 95% CI, 1.3-3.4; P = .002). Conclusions and Relevance In this study, activated glial markers (in particular GFAP) and neurofilament heavy chain were associated specifically with nonrelapsing progressive disease outcomes (independent of acute inflammatory activity). Elevated CSF GFAP was associated with long-term MS disease progression.
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Affiliation(s)
- Anne H Cross
- Washington University School of Medicine, St Louis, Missouri
| | | | - Simon Thebault
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | | | | | | - Robert Fallis
- The Ohio State University Wexner Medical Center, Columbus
| | | | | | | | | | | | | | - Lay Kodama
- Genentech, South San Francisco, California
| | | | | | | | | | | | - Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Göttingen, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, Dresden, Germany
| | - Gauruv Bose
- Department of Medicine in Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mark S Freedman
- Department of Medicine in Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Ann Herman
- Genentech, South San Francisco, California
| | | | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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3
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Wilson D, Chan D, Chang L, Mathis R, Verberk I, Montalban X, Comabella M, Fissolo N, Bielekova B, Masvekar R, Chitnis T, Ziemssen T, Akgün K, Blennow K, Zetterberg H, Brück W, Giovannoni G, Gnanapavan S, Bittner S, Zipp F, Comi G, Furlan R, Lehmann S, Thebault S, Freedman M, Bar-Or A, Kramer M, Otto M, Halbgebauer S, Hrusovsky K, Plavina T, Khalil M, Piehl F, Wiendl H, Kappos L, Maceski A, Willemse E, Leppert D, Teunissen C, Kuhle J. Development and multi-center validation of a fully automated digital immunoassay for neurofilament light chain: toward a clinical blood test for neuronal injury. Clin Chem Lab Med 2024; 62:322-331. [PMID: 37702323 DOI: 10.1515/cclm-2023-0518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Neurofilament light chain (NfL) has emerged as a promising biomarker for detecting and monitoring axonal injury. Until recently, NfL could only be reliably measured in cerebrospinal fluid, but digital single molecule array (Simoa) technology has enabled its precise measurement in blood samples where it is typically 50-100 times less abundant. We report development and multi-center validation of a novel fully automated digital immunoassay for NfL in serum for informing axonal injury status. METHODS A 45-min immunoassay for serum NfL was developed for use on an automated digital analyzer based on Simoa technology. The analytical performance (sensitivity, precision, reproducibility, linearity, sample type) was characterized and then cross validated across 17 laboratories in 10 countries. Analytical performance for clinical NfL measurement was examined in individual patients with relapsing remitting multiple sclerosis (RRMS) after 3 months of disease modifying treatment (DMT) with fingolimod. RESULTS The assay exhibited a lower limit of detection (LLoD) of 0.05 ng/L, a lower limit of quantification (LLoQ) of 0.8 ng/L, and between-laboratory imprecision <10 % across 17 validation sites. All tested samples had measurable NfL concentrations well above the LLoQ. In matched pre-post treatment samples, decreases in NfL were observed in 26/29 RRMS patients three months after DMT start, with significant decreases detected in a majority of patients. CONCLUSIONS The sensitivity characteristics and reproducible performance across laboratories combined with full automation make this assay suitable for clinical use for NfL assessment, monitoring in individual patients, and cross-comparisons of results across multiple sites.
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Affiliation(s)
| | | | | | | | - Inge Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam, University Medical Centers, Amsterdam, The Netherlands
| | - Xavier Montalban
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Manuel Comabella
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Nicolas Fissolo
- Laboratori de Neuroinmunologia Clinica Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Bibi Bielekova
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ruturaj Masvekar
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, Dresden University of Technology, Dresden, Germany
| | - Katja Akgün
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, Dresden University of Technology, Dresden, Germany
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Wolfgang Brück
- Institute for Neuropathology at the University Medical Center, Göttingen, Germany
| | - Gavin Giovannoni
- Department of Neurology, Barts Health NHS Trust, The Royal London Hospital, E1 1FR, London, UK
| | - Sharmilee Gnanapavan
- Department of Neurology, Barts Health NHS Trust, The Royal London Hospital, E1 1FR, London, UK
| | - Stefan Bittner
- University Medical Center Mainz, Department of Neurology, Mainz, Germany
| | - Frauke Zipp
- University Medical Center Mainz, Department of Neurology, Mainz, Germany
| | - Giancarlo Comi
- Institute of Experimental Neurology, Division of Neuroscience, University Vita e Salute San Raffaele and IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, University Vita e Salute San Raffaele and IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Simon Thebault
- University of Ottawa, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Freedman
- University of Ottawa, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Markus Otto
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Steffen Halbgebauer
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
| | | | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Aleksandra Maceski
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eline Willemse
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam, University Medical Centers, Amsterdam, The Netherlands
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Thebault S, Bar-Or A, Banwell B. NfL is ready for translation into paediatrics. Lancet Neurol 2023; 22:774-776. [PMID: 37524099 DOI: 10.1016/s1474-4422(23)00284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Simon Thebault
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Banwell
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19010, USA.
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5
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Thebault S, Gandelman S, Lane C, Kim EJ, Pileggi C, Zuroff L, Yamashita LD, Schindler MK, Chiu C, Wilson MR, Berger JR, Markowitz C, Bar-Or A, Fuller R, Brandstadter R, Pruitt AA, Jacobs DA. Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200154. [PMID: 37562975 PMCID: PMC10414775 DOI: 10.1212/nxi.0000000000200154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The objective of this study was to report on the development of neuroinvasive West Nile virus (WNV) infection in the context of anti-CD20 monotherapy for multiple sclerosis (MS). METHODS This is a case series study. RESULTS In 2021-2022, we observed 4 cases of neuroinvasive WNV infection in our patient population of 2009 patients with MS on ocrelizumab, compared with a total of 46 cases of neuroinvasive WNV infection reported in Pennsylvania and 40 in New Jersey. Odds were 258 times that of the general population (95% confidence interval 97-691), χ2 p < 0.0001). All were women aged 41-61 years with variable disease duration, level of disability, and duration of anti-CD20 therapy. All presented in summer/early fall with fever, headache, and encephalopathy consistent with meningoencephalitis. Three patients had acute cerebellitis. Two had anterior nerve root involvement progressing to quadriparesis, and 1 developed refractory nonconvulsive status epilepticus. All required intubation and experienced significant morbidity. All had CSF pleocytosis. Two patients were WNV IgM positive in both the serum and CSF, 1 patient had positive serum IgM and CSF metagenomic next-generation sequencing (mNGS), while 1 had positive CSF mNGS with negative serum and CSF antibodies. DISCUSSION Neuroinvasive WNV infection can develop with anti-CD20 monotherapy in the absence of additional immunosuppression. WNV serologies may be negative in the setting of anti-CD20 treatment; in the appropriate clinical context, one should consider direct detection methods such as PCR or mNGS-based testing.
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Affiliation(s)
- Simon Thebault
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco.
| | - Stephanie Gandelman
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Camryn Lane
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Erin J Kim
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Caitlin Pileggi
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Leah Zuroff
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Luana D Yamashita
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Matthew K Schindler
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Charles Chiu
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Michael R Wilson
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Joseph R Berger
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Clyde Markowitz
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Amit Bar-Or
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Ryan Fuller
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Rachel Brandstadter
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Amy A Pruitt
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
| | - Dina A Jacobs
- From the Division of Multiple Sclerosis (S.T., S.G., C.L., E.J.K., C.P., L.Z., L.D.Y., M.K.S., J.R.B., C.M., A.B.-O., R.F., R.B., A.A.P., D.A.J.), Hospital of the University of Pennsylvania and Perelman School of Medicine; Division of Infectious Diseases (C.C.), Department of Medicine; and Weill Institute for Neurosciences (M.R.W.), Department of Neurology, University of California, San Francisco
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Sohaei D, Thebault S, Avery LM, Batruch I, Lam B, Xu W, Saadeh RS, Scarisbrick IA, Diamandis EP, Prassas I, Freedman MS. Cerebrospinal fluid camk2a levels at baseline predict long-term progression in multiple sclerosis. Clin Proteomics 2023; 20:33. [PMID: 37644477 PMCID: PMC10466840 DOI: 10.1186/s12014-023-09418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) remains a highly unpredictable disease. Many hope that fluid biomarkers may contribute to better stratification of disease, aiding the personalisation of treatment decisions, ultimately improving patient outcomes. OBJECTIVE The objective of this study was to evaluate the predictive value of CSF brain-specific proteins from early in the disease course of MS on long term clinical outcomes. METHODS In this study, 34 MS patients had their CSF collected and stored within 5 years of disease onset and were then followed clinically for at least 15 years. CSF concentrations of 64 brain-specific proteins were analyzed in the 34 patient CSF, as well as 19 age and sex-matched controls, using a targeted liquid-chromatography tandem mass spectrometry approach. RESULTS We identified six CSF brain-specific proteins that significantly differentiated MS from controls (p < 0.05) and nine proteins that could predict disease course over the next decade. CAMK2A emerged as a biomarker candidate that could discriminate between MS and controls and could predict long-term disease progression. CONCLUSION Targeted approaches to identify and quantify biomarkers associated with MS in the CSF may inform on long term MS outcomes. CAMK2A may be one of several candidates, warranting further exploration.
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Affiliation(s)
- Dorsa Sohaei
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Simon Thebault
- Department of Medicine, The Ottawa Hospital, 01 Smyth Road, Box 601, Ottawa, ON, K1H 8L6, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lisa M Avery
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Biostatistics, The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ihor Batruch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Brian Lam
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States of America
| | - Wei Xu
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Biostatistics, The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Rubah S Saadeh
- Department of Physical Medicine and Rehabilitation, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Isobel A Scarisbrick
- Department of Physical Medicine and Rehabilitation, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Clinical Biochemistry, University Health Network, Toronto, Canada
| | - Ioannis Prassas
- Mount Sinai Hospital, Joseph & Wolf Lebovic Ctr, 60 Murray St [Box 32]; Flr 6 - Rm L6-201, Toronto, ON, M5T 3L9, Canada.
- Laboratory Medicine Program, University Health Network, Toronto, Canada.
| | - Mark S Freedman
- Department of Medicine, The Ottawa Hospital, 01 Smyth Road, Box 601, Ottawa, ON, K1H 8L6, Canada.
- The Ottawa Hospital Research Institute, Ottawa, Canada.
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Ulndreaj A, Sohaei D, Thebault S, Pons-Belda OD, Fernandez-Uriarte A, Campbell C, Cheo D, Stengelin M, Sigal G, Freedman MS, Scarisbrick IA, Prassas I, Diamandis EP. Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay. Diagnosis (Berl) 2023; 10:275-280. [PMID: 36788117 PMCID: PMC10424569 DOI: 10.1515/dx-2022-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Neurofilament light (NfL) chain is a marker of neuroaxonal damage in various neurological diseases. Here we quantitated NfL levels in the cerebrospinal fluid (CSF) and serum from patients with multiple sclerosis (MS) and controls, using the R-PLEX NfL assay, which employs advanced Meso Scale Discovery® (MSD) electrochemiluminescence (ECL)-based detection technology. METHODS NfL was quantitated in samples from 116 individuals from two sites (Ottawa Hospital Research Institute and Mayo Clinic), consisting of patients with MS (n=71) and age- and sex-matched inflammatory neurological controls (n=13) and non-inflammatory controls (n=32). Correlation of NfL levels between CSF and serum was assessed in paired samples in a subset of MS patients and controls (n=61). Additionally, we assessed the correlation between NfL levels obtained with MSD's R-PLEX® and Quanterix's single molecule array (Simoa®) assays in CSF and serum (n=32). RESULTS Using the R-PLEX, NfL was quantitated in 99% of the samples tested, and showed a broad range in the CSF (82-500,000 ng/L) and serum (8.84-2,014 ng/L). Nf-L levels in both biofluids correlated strongly (r=0.81, p<0.0001). Lastly, Nf-L measured by MSD's R-PLEX and Quanterix's Simoa assays were highly correlated for both biofluids (CSF: r=0.94, p<0.0001; serum: r=0.95, p<0.0001). CONCLUSIONS We show that MSD's R-PLEX NfL assay can reliably quantitate levels of NfL in the CSF and serum from patients with MS and controls, where levels correlate strongly with Simoa.
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Affiliation(s)
- Antigona Ulndreaj
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Dorsa Sohaei
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Simon Thebault
- Department of Medicine, Univeristy of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Oscar D. Pons-Belda
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | - David Cheo
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | | | - George Sigal
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | - Mark S. Freedman
- Department of Medicine, Univeristy of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Isobel A. Scarisbrick
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Eleftherios P. Diamandis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
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Meier S, Willemse EA, Schaedelin S, Oechtering J, Lorscheider J, Melie-Garcia L, Cagol A, Barakovic M, Galbusera R, Subramaniam S, Barro C, Abdelhak A, Thebault S, Achtnichts L, Lalive P, Müller S, Pot C, Salmen A, Disanto G, Zecca C, D’Souza M, Orleth A, Khalil M, Buchmann A, Du Pasquier R, Yaldizli Ö, Derfuss T, Berger K, Hermesdorf M, Wiendl H, Piehl F, Battaglini M, Fischer U, Kappos L, Gobbi C, Granziera C, Bridel C, Leppert D, Maleska Maceski A, Benkert P, Kuhle J. Serum Glial Fibrillary Acidic Protein Compared With Neurofilament Light Chain as a Biomarker for Disease Progression in Multiple Sclerosis. JAMA Neurol 2023; 80:287-297. [PMID: 36745446 PMCID: PMC10011932 DOI: 10.1001/jamaneurol.2022.5250] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 08/31/2022] [Accepted: 11/23/2022] [Indexed: 02/07/2023]
Abstract
Importance There is a lack of validated biomarkers for disability progression independent of relapse activity (PIRA) in multiple sclerosis (MS). Objective To determine how serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) correlate with features of disease progression vs acute focal inflammation in MS and how they can prognosticate disease progression. Design, Setting, and Participants Data were acquired in the longitudinal Swiss MS cohort (SMSC; a consortium of tertiary referral hospitals) from January 1, 2012, to October 20, 2022. The SMSC is a prospective, multicenter study performed in 8 centers in Switzerland. For this nested study, participants had to meet the following inclusion criteria: cohort 1, patients with MS and either stable or worsening disability and similar baseline Expanded Disability Status Scale scores with no relapses during the entire follow-up; and cohort 2, all SMSC study patients who had initiated and continued B-cell-depleting treatment (ie, ocrelizumab or rituximab). Exposures Patients received standard immunotherapies or were untreated. Main Outcomes and Measures In cohort 1, sGFAP and sNfL levels were measured longitudinally using Simoa assays. Healthy control samples served as the reference. In cohort 2, sGFAP and sNfL levels were determined cross-sectionally. Results This study included a total of 355 patients (103 [29.0%] in cohort 1: median [IQR] age, 42.1 [33.2-47.6] years; 73 female patients [70.9%]; and 252 [71.0%] in cohort 2: median [IQR] age, 44.3 [33.3-54.7] years; 156 female patients [61.9%]) and 259 healthy controls with a median [IQR] age of 44.3 [36.3-52.3] years and 177 female individuals (68.3%). sGFAP levels in controls increased as a function of age (1.5% per year; P < .001), were inversely correlated with BMI (-1.1% per BMI unit; P = .01), and were 14.9% higher in women than in men (P = .004). In cohort 1, patients with worsening progressive MS showed 50.9% higher sGFAP levels compared with those with stable MS after additional sNfL adjustment, whereas the 25% increase of sNfL disappeared after additional sGFAP adjustment. Higher sGFAP at baseline was associated with accelerated gray matter brain volume loss (per doubling: 0.24% per year; P < .001) but not white matter loss. sGFAP levels remained unchanged during disease exacerbations vs remission phases. In cohort 2, median (IQR) sGFAP z scores were higher in patients developing future confirmed disability worsening compared with those with stable disability (1.94 [0.36-2.23] vs 0.71 [-0.13 to 1.73]; P = .002); this was not significant for sNfL. However, the combined elevation of z scores of both biomarkers resulted in a 4- to 5-fold increased risk of confirmed disability worsening (hazard ratio [HR], 4.09; 95% CI, 2.04-8.18; P < .001) and PIRA (HR, 4.71; 95% CI, 2.05-9.77; P < .001). Conclusions and Relevance Results of this cohort study suggest that sGFAP is a prognostic biomarker for future PIRA and revealed its complementary potential next to sNfL. sGFAP may serve as a useful biomarker for disease progression in MS in individual patient management and drug development.
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Affiliation(s)
- Stephanie Meier
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Eline A.J. Willemse
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johanna Oechtering
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Johannes Lorscheider
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Lester Melie-Garcia
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Suvitha Subramaniam
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Barro
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco
| | - Simon Thebault
- Department of Medicine and the Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Patrice Lalive
- Unit of Neuroimmunology, Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Caroline Pot
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anke Salmen
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marcus D’Souza
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Annette Orleth
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Özgür Yaldizli
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tobias Derfuss
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Center for Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Marco Battaglini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Urs Fischer
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Cristina Granziera
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Claire Bridel
- Unit of Neuroimmunology, Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - David Leppert
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Aleksandra Maleska Maceski
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
| | - Pascal Benkert
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Switzerland
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Thebault S, Bergman H, Atkins HL, Freedman MS, Brooks J. CLIPPERS Responsive to Cladribine as a Durable Steroid-Sparing Agent. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/1/e200060. [DOI: 10.1212/nxi.0000000000200060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Abstract
ObjectiveWe report a case of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) who achieved durable and steroid-free remission after IV cladribine.MethodsA 25 year-old man presented with progressively worsening headaches, polydipsia, dysarthria, diplopia and vertigo, and obtundation requiring respiratory support. CSF revealed lymphocytosis, and MRI revealed a perivascular pattern of punctate enhancement involving the pons. An extensive workup for inflammatory, autoimmune, infective, and malignant explanations was unrevealing. He responded dramatically to steroids, compatible with CLIPPERS as a diagnosis of exclusion. Attempts to wean prednisone over the ensuing year resulted in 2 clinical relapses and persistent punctate enhancement. Given significant steroid side effects, steroid-sparing agents were considered.ResultsIV cladribine IV (0.0875 mg/kg adjusted body weight daily × 4 days at 0, 4, 8, and 16 months) was selected, given its favorable side effect profile including lower risks of malignancy and infertility and the potential for long-lasting effects. The only side effect was short-term fatigue at the time of infusion. At 20 months after cladribine initiation, he was able to wean-off prednisone altogether. Now at 33 months, he remains in clinical and MRI remission.DiscussionCladribine is a rational candidate steroid-sparing treatment for presumed neurologic autoimmune conditions such as CLIPPERS.Classification of EvidenceThis study provides Class IV evidence that cladribine is a steroid-sparing treatment consideration in CLIPPERS.
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Reilly A, Deguise MO, Beauvais A, Yaworski R, Thebault S, Tessier DR, Tabard-Cossa V, Hensel N, Schneider BL, Kothary R. Central and peripheral delivered AAV9-SMN are both efficient but target different pathomechanisms in a mouse model of spinal muscular atrophy. Gene Ther 2022; 29:544-554. [DOI: 10.1038/s41434-022-00338-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
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Thebault S, Kim W, Hadwen J, Walker GB, Drake B, Fantaneanu TA. Progressive Myelopathy With Acute Worsening After Steroids and Lumbar Puncture. Neurohospitalist 2022; 12:318-322. [PMID: 35419159 PMCID: PMC8995581 DOI: 10.1177/19418744211073389] [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: 11/16/2022] Open
Abstract
We present the case of a 73-year-old woman with a 3-month history of non-traumatic thoracic myelopathy. Initial MRI showed a T6-conus T2 signal hyperintensity. Based on this presentation, and given a personal and family history of autoimmune disease, our patient was first managed as an inflammatory transverse myelitis. Subsequent worsening after lumbar puncture and steroids prompted re-evaluation, ultimately identifying the cause as a thoracic spinal dural AV fistula. Both investigation of possible transverse myelitis with lumbar puncture and empiric treatment with steroids may not only result in diagnostic delays but also precipitate venous infarction and irreversible harm. While the MRI often provides the initial diagnosis, clinical suspicion for this under-diagnosed cause of myelopathy should be raised in older patients with a more progressive thoracic myelopathy with worsening after lumbar puncture and/or steroids. Definitive and time-sensitive treatment by interventional neuroradiology or neurosurgery results in stabilization or improvement of disability in most cases.
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Affiliation(s)
- Simon Thebault
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - WooJin Kim
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jeremiah Hadwen
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Gregory B. Walker
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Brian Drake
- Division of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Tadeu A. Fantaneanu
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Thebault S, Reaume M, Marrie RA, Marriott JJ, Furlan R, Laroni A, Booth RA, Uccelli A, Freedman MS. High or increasing serum NfL is predictive of impending multiple sclerosis relapses. Mult Scler Relat Disord 2022; 59:103535. [PMID: 35078125 DOI: 10.1016/j.msard.2022.103535] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/12/2021] [Accepted: 01/16/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND One-off serum levels of neurofilament light chain (sNfL) is an established predictor of emerging disease activity in multiple sclerosis (MS). However, the importance of longitudinal increases in sNfL is yet to be enumerated, an important consideration as this test is translated for serial monitoring. Glial Fibrillary Acidic Protein (sGFAP) is another biomarker of predictive interest. Our objective was to assess the association between longitudinal changes sNfL and prediction of future relapses, as well as a possible role for sGFAP. METHODS Participants with active MS were prospectively monitored for one year as part of a clinical trial testing mesenchymal stem cells. Visits every three months or less included clinical assessments, MRI scans and serum draws. sNfL and sGFAP concentrations were quantified with Single Molecule Array immunoassay. We used Kaplan-Meier estimates and Anderson-Gill Cox regression models with and without adjustment for age, sex, disease subtype, disease duration and expanded disability status score (EDSS) to estimate the rate of relapse predicted by baseline and longitudinal changes in biomarker. RESULTS 58 Canadian and Italian participants with MS were enrolled in this study. Higher baseline sNfL was future relapse (Log-rank p = 0.0068), MRI lesions (p=0.0096), composite-relapse associated worsening (p=0.01) and progression independent of relapse activity (p=0.0096). Conversely, baseline sGFAP was only weakly associated with MRI lesions (0.044). Cross-sectional analyses of baseline sNfL revealed that a two-fold difference in baseline sNfL, e.g. from 10 to 20 pg/mL, was associated with a 2.3-fold increased risk of relapse during follow-up (95% confidence interval 1.65-3.17). Longitudinally, a two-fold increase in sNfL level from the first measurement was associated with an additional 1.46 times increased risk of relapse (1.07-2.00). The impact of longitudinal increases in sNfL on the risk of relapse were most pronounced for patients with lower baseline values of sNfL (<10 pg/mL: HR = 1.54, 1.06-2.24). These associations remained significant after adjustment for potential confounders. CONCLUSION We enumerate the risk of relapse associated with dynamic changes in sNfL. Both baseline and longitudinal change in sNfL may help identify patients who would benefit from early treatment optimisation. TRIAL REGISTRATIONS Canada:NCT02239393, Italy:NCT01854957&EudraCT, 2011-001295-19 CLASSIFICATION OF EVIDENCE: This study provides class 1 evidence that high baseline and longitudinal increases in sNfL are predictive of impending relapses in patients with active MS.
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Affiliation(s)
- Simon Thebault
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Michael Reaume
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine (Neurology), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James J Marriott
- Department of Internal Medicine (Neurology), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Ronald A Booth
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Eastern Ontario Regional Laboratory Association (EORLA)
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mark S Freedman
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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13
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Thebault S, Gibbs E, Bourque P, McKim D, Rakhra K, Breiner A, Frykman H, Warman-Chardon J. MuSK not MNGIE: Atypical MuSK-antibody myasthenia presenting as a genetic disorder. Neuromuscul Disord 2021; 31:1279-1281. [PMID: 34690051 DOI: 10.1016/j.nmd.2021.08.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022]
Abstract
Myasthenia gravis is a treatable autoimmune disease caused by autoantibodies directed against membrane proteins at the neuromuscular junction. While acetylcholine receptor antibodies are most common, a minority of patients have antibodies directed against muscle-specific kinase (MuSK-antibody). Differentiating features often include subacute onset and rapid progression of bulbar, respiratory and neck extensor muscles, with sparing of distal appendicular muscles, most commonly in middle-aged females. Here we present an atypical presentation of MuSK-antibody myasthenic syndrome in a young male consisting of a gradual-onset, insidiously-progressive, non-fatigable and non-fluctuating ocular, bulbar and oesophageal weakness, with a normal frontalis single fibre EMG. This case clinically resembled a mitochondrial myopathy (Mitochondrial Neurogastrointestinal Encephalopathy-MNGIE) with a poor prognosis. Because of the atypical presentation, MuSK antibodies were identified very late in the disease course, at which point the patient responded very well to immunotherapy. We report an unusual presentation of an uncommon but treatable condition, illustrating significant phenotypic heterogeneity possible in MuSK-antibody myasthenic syndrome.
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Affiliation(s)
- Simon Thebault
- Department of Medicine, The Ottawa Hospital, Centre for Neuromuscular Disease and University of Ottawa, Canada.
| | - Ebrima Gibbs
- The University of British Columbia Neuroimmunology lab, Canada
| | - Pierre Bourque
- Department of Medicine, The Ottawa Hospital, Centre for Neuromuscular Disease and University of Ottawa, Canada
| | - Doug McKim
- Department of Medicine, The Ottawa Hospital, Centre for Neuromuscular Disease and University of Ottawa, Canada
| | - Kawan Rakhra
- Department of Diagnostic Imaging, The Ottawa Hospital and University of Ottawa, Canada
| | - Ari Breiner
- Department of Medicine, The Ottawa Hospital, Centre for Neuromuscular Disease and University of Ottawa, Canada
| | - Hans Frykman
- The University of British Columbia Neuroimmunology lab, Canada
| | - Jodi Warman-Chardon
- Department of Medicine, The Ottawa Hospital, Centre for Neuromuscular Disease and University of Ottawa, Canada; Department of Genetics, Children's Hospital of Eastern Ontario Research Institute.
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14
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Thebault S, Booth RA, Rush CA, MacLean H, Freedman MS. Serum Neurofilament Light Chain Measurement in MS: Hurdles to Clinical Translation. Front Neurosci 2021; 15:654942. [PMID: 33841093 PMCID: PMC8027110 DOI: 10.3389/fnins.2021.654942] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Measurement of serum neurofilament light chain concentration (sNfL) promises to become a convenient, cost effective and meaningful adjunct for multiple sclerosis (MS) prognostication as well as monitoring disease activity in response to treatment. Despite the remarkable progress and an ever-increasing literature supporting the potential role of sNfL in MS over the last 5 years, a number of hurdles remain before this test can be integrated into routine clinical practice. In this review we highlight these hurdles, broadly classified by concerns relating to clinical validity and analytical validity. After setting out an aspirational roadmap as to how many of these issues can be overcome, we conclude by sharing our vision of the current and future role of sNfL assays in MS clinical practice.
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Affiliation(s)
- Simon Thebault
- Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
| | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, The Eastern Ontario Regional Laboratory Association, The Ottawa Hospital, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
| | - Carolina A Rush
- Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
| | - Heather MacLean
- Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
| | - Mark S Freedman
- Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
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15
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Abstract
A simple blood-derived biomarker is desirable in the routine management
of multiple sclerosis (MS) patients and serum neurofilament light
chain (sNfL) is the most promising candidate. Although its utility was
first shown in cerebrospinal fluid (CSF), technological advancements
have enabled reliable detection in serum and less frequently plasma,
obviating the need for repeated lumbar punctures. In this review,
after defining the knowledge gap in MS management that many hope sNfL
could fill, we summarize salient studies demonstrating associations of
sNfL levels with outcomes of interest. We group these outcomes into
inflammatory activity, progression, treatment response, and
prediction/prognosis. Where possible we focus on data from real-world
perspective observational cohorts. While acknowledging the limitations
of sNfL and highlighting key areas for ongoing work, we conclude with
our opinion of the role for sNfL as an objective, convenient, and
cost-effective adjunct to clinical assessment. Paving the way for
other promising biomarkers both blood-derived and otherwise, sNfL is
an incremental step toward precision medicine for MS patients.
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Affiliation(s)
- Simon Thebault
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gauruv Bose
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ronald Booth
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada/The University of Ottawa, Ottawa, ON, Canada
| | - Mark S Freedman
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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16
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Bose G, Thebault S, Rush CA, Atkins HL, Freedman MS. Autologous hematopoietic stem cell transplantation for multiple sclerosis: A current perspective. Mult Scler 2020; 27:167-173. [PMID: 32364422 DOI: 10.1177/1352458520917936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The most effective treatment at halting inflammation in patients with highly active multiple sclerosis (MS) is immune ablation followed by autologous hematopoietic stem cell transplantation (AHSCT). Better patient selection and supportive management, as well as advances in conditioning regimens have resulted in improved safety with AHSCT. However, which comorbidities or prior therapies increase the risks associated with AHSCT still need to be determined. In addition, there is still debate as to which AHSCT conditioning regimen offers the best balance of long-term efficacy and safety. New studies comparing AHSCT with highly effective disease-modifying therapies will help to inform on the ideal placement of AHSCT in the treatment algorithm. Currently, many centers are experienced and use AHSCT to treat select patients with MS, contributing to ongoing registries and clinical trials which will help answer these questions.
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Affiliation(s)
- Gauruv Bose
- Department of Medicine, Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Simon Thebault
- Department of Medicine, Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Carolina A Rush
- Department of Medicine, Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Harold L Atkins
- Department of Medicine, Division of Hematology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mark S Freedman
- Department of Medicine, Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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17
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Thebault S, Lee H, Bose G, Tessier D, Abdoli M, Bowman M, Berard J, Walker L, Rush CA, MacLean H, Booth RA, Narayanan S, Arnold DL, Tabard-Cossa V, Atkins HL, Bar-Or A, Freedman MS. Neurotoxicity after hematopoietic stem cell transplant in multiple sclerosis. Ann Clin Transl Neurol 2020; 7:767-775. [PMID: 32304358 PMCID: PMC7261754 DOI: 10.1002/acn3.51045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/03/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Accelerated brain volume loss has been noted following immunoablative autologous hematopoietic stem cell transplantation (IAHSCT) for multiple sclerosis. As with other MS treatments, this is often interpreted as 'pseudoatrophy', related to reduced inflammation. Treatment-related neurotoxicity may be contributory. We sought objective evidence of post-IAHSCT toxicity by quantifying levels of Neurofilament Light Chain (sNfL) and Glial Fibrillary Acidic Protein (sGFAP) before and after treatment as markers of neuroaxonal and glial cell damage. METHODS Sera were collected from 22 MS patients pre- and post-IAHSCT at 3, 6, 9, and 12 months along with 28 noninflammatory controls. sNfL and sGFAP quantification was performed using the SiMoA single-molecule assay. RESULTS Pre-IAHSCT levels of sNfL and sGFAP were elevated in MS patients compared with controls (geometric mean sNfL 21.8 vs. 6.4 pg/mL, sGFAP 107.4 vs. 50.7 pg/mL, P = 0.0001 for both). Three months after IAHSCT, levels of sNfL and sGFAP increased from baseline by 32.1% and 74.8%, respectively (P = 0.0029 and 0.0004). sNfL increases correlated with total busulfan dose (P = 0.034), EDSS score worsening at 6 months (P = 0.041), and MRI grey matter volume loss at 6 months (P = 0.0023). Subsequent NfL levels reduced to less than baseline (12-month geometric mean 11.3 pg/mL P = 0.0001) but were still higher than controls (P = 0.0001). sGFAP levels reduced more slowly but at 12 months were approaching baseline levels (130.7 pg/mL). INTERPRETATION There is direct evidence of transient CNS toxicity immediately after IAHSCT which may be chemotherapy mediated and contributes to transient increases in MRI atrophy.
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Affiliation(s)
- Simon Thebault
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Hyunwoo Lee
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Gauruv Bose
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Tessier
- Department of Physics, The University of Ottawa, Ottawa, ON, Canada
| | - Mohammad Abdoli
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marjorie Bowman
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jason Berard
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lisa Walker
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Carolina A Rush
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Heather MacLean
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ronald A Booth
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sridar Narayanan
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Douglas L Arnold
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | - Harold L Atkins
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, Perelman School of Medicine, and the Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark S Freedman
- The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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18
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Thebault S, R Tessier D, Lee H, Bowman M, Bar-Or A, Arnold DL, L Atkins H, Tabard-Cossa V, Freedman MS. High serum neurofilament light chain normalizes after hematopoietic stem cell transplantation for MS. Neurol Neuroimmunol Neuroinflamm 2019; 6:e598. [PMID: 31516913 PMCID: PMC6715458 DOI: 10.1212/nxi.0000000000000598] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/29/2019] [Indexed: 12/02/2022]
Abstract
Objective To evaluate neurofilament light chain (NfL) levels in serum and CSF of patients with aggressive MS pre- and post-treatment with immunoablation followed by autologous hematopoietic stem cell transplantation (IAHSCT) and examine associations with clinical and MRI outcomes. Methods Paired serum and CSF in addition to MRI and clinical measures were collected on 23 patients with MS at baseline and 1 and 3 years post-IAHSCT. An additional 33 sera and CSF pairs were taken from noninflammatory neurologic controls. NfL levels were quantitated using the Simoa platform (Quanterix). Results Baseline MS NfL levels were significantly elevated relative to controls in serum (p = 0.001) and CSF (p = 0.001). Following IAHSCT, high pretreatment NfL levels significantly reduced in serum (p = 0.0023) and CSF (p = 0.0068) and were not significantly different from controls. Serum and CSF NfL levels highly correlated (r = 0.81, p < 0.0001). Baseline NfL levels were associated with worse pretreatment disease measures (Expanded Disability Status Scale [EDSS], relapses, MRI lesions, and MR spectroscopy (MRS) N-acetylaspartate/creatine). Elevated baseline NfL levels were associated with persistently worse indices of disease burden post-IAHSCT (sustained EDSS progression, cognition, quality of life, T1 and T2 lesion volumes, MRS, and brain atrophy). Conclusion These data substantiate that serum and CSF NfL levels reflect disease severity and treatment response in patients with MS and may therefore be a useful biomarker. Baseline serum levels associated with markers of pretreatment disease severity and post-treatment outcomes. Classification of evidence This study provides Class II evidence that for patients with aggressive MS, serum NfL levels are associated with disease severity.
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Affiliation(s)
- Simon Thebault
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Daniel R Tessier
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Hyunwoo Lee
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Marjorie Bowman
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Amit Bar-Or
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Douglas L Arnold
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Harold L Atkins
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Vincent Tabard-Cossa
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Mark S Freedman
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
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19
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Thebault S, Hanes I, Woulfe J, Bourque PR. Paraneoplastic recurrent tumefactive demyelination in a 62-year-old man with metastatic seminoma. Neurol Neuroimmunol Neuroinflamm 2018; 6:e527. [PMID: 30588483 PMCID: PMC6299676 DOI: 10.1212/nxi.0000000000000527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/17/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Simon Thebault
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - Ilana Hanes
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - John Woulfe
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - Pierre R Bourque
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
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20
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Fitzpatrick T, Moores M, Thebault S, Rabinovitch H. One-and-a-half syndrome secondary to transorbital penetrating injury. Neurology 2018; 90:91-92. [PMID: 29311367 DOI: 10.1212/wnl.0000000000004807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Thebault S, Waters P, Snape MD, Cottrell D, Darin N, Hallböök T, Huutoniemi A, Partinen M, Pollard AJ, Vincent A. Neuronal Antibodies in Children with or without Narcolepsy following H1N1-AS03 Vaccination. PLoS One 2015; 10:e0129555. [PMID: 26090827 PMCID: PMC4474558 DOI: 10.1371/journal.pone.0129555] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/11/2015] [Indexed: 01/03/2023] Open
Abstract
Type 1 narcolepsy is caused by deficiency of hypothalamic orexin/hypocretin. An autoimmune basis is suspected, but no specific antibodies, either causative or as biomarkers, have been identified. However, the AS03 adjuvanted split virion H1N1 (H1N1-AS03) vaccine, created to protect against the 2009 Pandemic, has been implicated as a trigger of narcolepsy particularly in children. Sera and CSFs from 13 H1N1-AS03-vaccinated patients (12 children, 1 young adult) with type 1 narcolepsy were tested for autoantibodies to known neuronal antigens including the N-methyl-D-aspartate receptor (NMDAR) and contactin-associated protein 2 (CASPR2), both associated with encephalopathies that include disordered sleep, to rodent brain tissue including the lateral hypothalamus, and to live hippocampal neurons in culture. When sufficient sample was available, CSF levels of melanin-concentrating hormone (MCH) were measured. Sera from 44 H1N1-ASO3-vaccinated children without narcolepsy were also examined. None of these patients' CSFs or sera was positive for NMDAR or CASPR2 antibodies or binding to neurons; 4/13 sera bound to orexin-neurons in rat brain tissue, but also to other neurons. MCH levels were a marginally raised (n = 8; p = 0.054) in orexin-deficient narcolepsy patients compared with orexin-normal children (n = 6). In the 44 H1N1-AS03-vaccinated healthy children, there was no rise in total IgG levels or in CASPR2 or NMDAR antibodies three weeks following vaccination. In conclusion, there were no narcolepsy-specific autoantibodies identified in type 1 narcolepsy sera or CSFs, and no evidence for a general increase in immune reactivity following H1N1-AS03 vaccination in the healthy children. Antibodies to other neuronal specific membrane targets, with their potential for directing use of immunotherapies, are still an important goal for future research.
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Affiliation(s)
- Simon Thebault
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Patrick Waters
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Matthew D. Snape
- Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- The NIHR Oxford Biomedical Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Dominic Cottrell
- Imperial College of Medicine, University of London, London, United Kingdom
| | - Niklas Darin
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Huutoniemi
- Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Helsinki, Finland
| | - Markku Partinen
- Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Andrew J. Pollard
- Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- The NIHR Oxford Biomedical Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Angela Vincent
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
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22
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Bulai Livideanu C, Thebault S, Boutault F, Chauveau D, Paul C. Le laser CO2 améliore l’ouverture buccale des patients atteints de sclérodermie systémique. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Nicot F, Alric L, Barange K, Métivier S, Dramard JM, Combis JM, Castan B, Meurisse JJ, Payen JL, Garipuy D, Desmorat H, Peron JM, Thebault S, Morin T, Renou C, Barel P, Guerin B, Imbert Y, Sire S, Sauné K, Chatelut E, Izopet J. Influence of HCV genotype 1 subtypes on the virus response to PEG interferon alpha-2a plus ribavirin therapy. J Med Virol 2011; 83:437-44. [PMID: 21264864 DOI: 10.1002/jmv.21976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
New factors that influence the viral response in HCV non-genotype 2/3 patients must be identified in order to optimize anti-HCV treatment. This multicenter prospective study evaluates the influence of HCV variability and pharmacological parameters on the virological response of these patients to pegylated interferon α2a (peg-IFN-α2a: 180 µg/week) and ribavirin (RBV; 800-1,200 mg/day) for 48 weeks. HCV subtypes were identified by sequencing the NS5B region. Serum RBV and peg-IFN-α2a concentrations were measured at weeks 4 and 12. The 115 patients (67 men; median age = 49, range 31-76) included 64 who had never been treated and 27 co-infected with HIV. The mean baseline HCV RNA was 6.30 ± 0.06 log IU/ml and the HCV genotypes were: G1 (n = 93) with 1a (n = 37) and 1b (n = 50), G4 (n = 20) and G5 (n = 2). Most patients (79/108; 73%) had an early virological response. Independent predictors of an early virological response were interferon naive patients (OR= 2.98, 95% CI: 1.15-7.72) and RBV of >2,200 ng/ml at week 12 (OR = 3.41, 95% CI: 1.31-8.90). Forty of 104 patients (38%) had a sustained virological response. The only independent predictors of a sustained virological response were subtype 1b (OR = 6.82, 95% CI: 1.7-26.8), and HCV RNA <15 IU/ml at week 12 (OR = 25, 95% CI: 6.4-97.6). Thus a serum RBV concentration of >2,200 ng/ml was associated with an early virological response and patients infected with HCV subtype 1b had a better chance of a sustained virological response than did those infected with subtype 1a.
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Affiliation(s)
- F Nicot
- CHU Toulouse, IFB Purpan, Laboratoire de Virologie, Toulouse, France
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24
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Stevens D, Thebault S, Dickson JK. Re: Dickson JK, Morris G, Heron M. The importance of hand anatomy in the Accident and Emergency department: assessment of hand anatomy knowledge in doctors in training. J Hand Surg Eur. 2009, 34: 682. J Hand Surg Eur Vol 2010; 35:334; author reply 334-5. [PMID: 20444797 DOI: 10.1177/1753193410365794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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25
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Haennig A, Bonnet D, Thebault S, Alric L. Infliximab-induced acute hepatitis during Crohn's disease therapy: absence of cross-toxicity with adalimumab. ACTA ACUST UNITED AC 2010; 34:e7-8. [PMID: 20189334 DOI: 10.1016/j.gcb.2010.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 12/23/2009] [Accepted: 01/07/2010] [Indexed: 12/21/2022]
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26
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Martin-Blondel G, Camara B, Selves J, Robic MA, Thebault S, Bonnet D, Alric L. Étiologies et évolution des hépatites granulomateuses : étude rétrospective de 21 cas consécutifs. Rev Med Interne 2010; 31:97-106. [DOI: 10.1016/j.revmed.2009.10.430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 09/19/2009] [Accepted: 10/12/2009] [Indexed: 11/24/2022]
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27
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Martin-Blondel G, Camara B, Robic MA, Thebault S, Selves J, Alric L. Étiologie et profil évolutif des hépatites granulomateuses révélées par des anomalies du bilan biologique hépatique : étude monocentrique de 21 cas consécutifs. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Abstract
A major clinical problem with PC (prostate cancer) is the cell's ability to survive and proliferate upon androgen withdrawal. Indeed, deregulated cell differentiation and proliferation, together with the suppression of apoptosis, provides the condition for abnormal tissue growth. Here, we examine the differential role of TRP (transient receptor potential) channels in the control of Ca2+ homoeostasis and growth of PC cells.
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Affiliation(s)
- N Prevarskaya
- Inserm, U-800, Equipe labellisée par la Ligue Nationale contre le cancer, Villeneuve d'Ascq F-59655, France.
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29
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Alric L, Thebault S, Peron JM, Balard P, Metivier S, Pipy B, Izopet J, Vinel JP. Pilot study of interferon-alpha-ribavirin-interleukin-2 for treatment of nonresponder patients with severe liver disease infected by hepatitis C virus genotype 1. J Viral Hepat 2006; 13:139-44. [PMID: 16436132 DOI: 10.1111/j.1365-2893.2005.00694.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The aim of this randomized prospective study was to assess the efficacy and safety of a triple therapy with interferon-alpha (IFN-alpha)-ribavirin-interleukin-2 (IL-2) for the treatment of patients with genotype 1 infection and high viral load nonresponsive to primary IFN-ribavirin therapy. Twenty hepatitis C virus (HCV) genotype 1 patients with high viral load and Metavir fibrosis score >or=2 without HIV co-infection who were previously nonviral responders to standard treatment with IFN plus ribavirin were intensively re-treated with IFN-alpha2a (3 millions (M) IU every 2 days) combined with ribavirin (1000-1200 mg/day) for a 24-week period. Patients were randomized to receive four cycles of subcutaneous injection of IL-2 (3 MIU/day, 5 days a week every 3 weeks) during either the first 12 weeks (group 1, n = 10) or the last 12 weeks (group 2, n = 10) of combination therapy. At the end of triple therapy, six patients (30%) achieved a biochemical response and 4 (20%) a viral response followed by a relapse after triple therapy withdrawal. After 12 weeks of therapy, no difference in viral load was observed between the groups. The decrease in viral load in group 2 was not raised after the addition of IL-2 to IFN plus ribavirin combination therapy. No serious adverse effects were observed. In conclusion, in patients with poor predictive factors of response, the addition of IL-2 to IFN ribavirin combination therapy does not exert a favourable impact on HCV treatment.
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Affiliation(s)
- L Alric
- Service de Médecine Interne-Fédération Digestive, Hôpital Purpan, Toulouse, France.
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30
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Thebault S, Zholos A, Enfissi A, Slomianny C, Dewailly E, Roudbaraki M, Parys J, Prevarskaya N. Receptor-operated Ca2+ entry mediated by TRPC3/TRPC6 proteins in rat prostate smooth muscle (PS1) cell line. J Cell Physiol 2005; 204:320-8. [PMID: 15672411 DOI: 10.1002/jcp.20301] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [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: 11/06/2022]
Abstract
Prostate smooth muscle cells predominantly express alpha1-adrenoceptors (alpha1-AR). alpha1-AR antagonists induce prostate smooth muscle relaxation and therefore they are useful therapeutic compounds for the treatment of benign prostatic hyperplasia symptoms. However, the Ca(2+) entry pathways associated with the activation of alpha1-AR in the prostate have yet to be elucidated. In many cell types, mammalian homologues of transient receptor potential (TRP) genes, first identified in Drosophila, encode TRPC (canonical TRP) proteins. They function as receptor-operated channels (ROCs) which are involved in various physiological processes such as contraction, proliferation, apoptosis, and differentiation. To date, the expression and function of TRPC channels have not been studied in prostate smooth muscle. In fura-2 loaded PS1 (a prostate smooth muscle cell line) which express endogenous alpha1A-ARs, alpha-agonists epinephrine (EPI), and phenylephrine (PHE) induced Ca(2+) influx which depended on the extracellular Ca(2+) and PLC activation but was independent of PKC activation. Thus, we have tested two membrane-permeable analogues of diacylglycerol (DAG), oleoyl-acyl-sn-glycerol (OAG) and 1,2-dioctanoyl-sn-glycerol (DOG). They initiated Ca(2+) influx whose properties were similar to those induced by the alpha-agonists. Sensitivity to 2-aminoethyl diphenylborate (2-APB), SKF-96365 and flufenamate implies that Ca(2+)-permeable channels mediated both alpha-agonist- and OAG-evoked Ca(2+) influx. Following the sarcoplasmic reticulum (SR) Ca(2+) store depletion by thapsigargin (Tg), a SERCA inhibitor, OAG and PHE were both still able to activate Ca(2+) influx. However, OAG failed to enhance Ca(2+) influx when added in the presence of an alpha-agonist. RT-PCR and Western blotting performed on PS1 cells revealed the presence of mRNAs and the corresponding TRPC3 and TRPC6 proteins. Experiments using an antisense strategy showed that both alpha-agonist- and OAG-induced Ca(2+) influx required TRPC3 and TRPC6, whereas the Tg-activated ("capacitative") Ca(2+) entry involved only TRPC3 encoded protein. It may be thus concluded that PS1 cells express TRPC3 and TRPC6 proteins which function as receptor- and store-operated Ca(2+) entry pathways.
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Affiliation(s)
- S Thebault
- Laboratoire de Physiologie Cellulaire, INSERM EMI 0228, France
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31
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Lemonnier L, Lazarenko R, Shuba Y, Thebault S, Roudbaraki M, Lepage G, Prevarskaya N, Skryma R. Alterations in the regulatory volume decrease (RVD) and swelling-activated Cl- current associated with neuroendocrine differentiation of prostate cancer epithelial cells. Endocr Relat Cancer 2005; 12:335-49. [PMID: 15947107 DOI: 10.1677/erc.1.00898] [Citation(s) in RCA: 25] [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: 11/27/2022]
Abstract
Neuroendocrine (NE) differentiation of prostate epithelial/basal cells is a hallmark of advanced, androgen-independent prostate cancer, for which there is no successful therapy. Here we report for the first time on alterations in regulatory volume decrease (RVD) and its key determinant, swelling-activated Cl- current (I(Cl,swell)), associated with NE differentiation of androgen-dependent LNCaP prostate cancer epithelial cells. NE-differentiating regimens, namely, chronic cAMP elevation or androgen deprivation, resulted in generally augmented I(Cl,swell) and enhanced RVD. This occurred as a result of both the increased endogenous expression of ClC-3, which is a volume-sensitive Cl- channel involved, as we show, in I(Cl,swell) in LNCaP (lymph-node carcinoma of the prostate) cells and the weaker negative I(Cl,swell) control from Ca2+ entering via store-dependent pathways. The changes in the RVD of NE-differentiated cells generally mimicked those reported for Bcl-2-conferred apoptotic resistance. Our results suggest that strengthening the mechanism that helps to maintain volume constancy may contribute to better survival rates of apoptosis-resistant NE cells.
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Affiliation(s)
- L Lemonnier
- Laboratoire de Physiologie Cellulaire, INSERM EMI 0228, USTL Bât. SN3, 59655 Villeneuve d'Ascq, France
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Bidaux G, Roudbaraki M, Merle C, Crépin A, Delcourt P, Slomianny C, Thebault S, Bonnal JL, Benahmed M, Cabon F, Mauroy B, Prevarskaya N. Evidence for specific TRPM8 expression in human prostate secretory epithelial cells: functional androgen receptor requirement. Endocr Relat Cancer 2005; 12:367-82. [PMID: 15947109 DOI: 10.1677/erc.1.00969] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
TRPM8 (melastatine-related transient receptor potential member 8), a member of the transient receptor potential (TRP) superfamily of cation channels, has been shown to be a calcium-channel protein. TRPM8 mRNA has also been shown to be overexpressed in prostate cancer and is considered to play an important role in prostate physiology. This study was designed to determine the androgen-regulation mechanisms for TRPM8 mRNA expression and to identify the phenotype of TRPM8-expressing cells in the human prostate. Our findings show that trpm8 gene expression requires a functional androgen receptor. Furthermore, this article argues strongly in favour of the fact that the trpm8 gene is a primary androgen-responsive gene. Single-cell reverse transcriptase PCR and immunohistochemical experiments also showed that the trpm8 gene was mainly expressed in the apical secretory epithelial cells of the human prostate and trpm8 down-regulation occurred during the loss of the apical differentiated phenotype of the primary cultured human prostate epithelial cells. The androgen-regulated trpm8 expression mechanisms are important in understanding the progression of prostate cancer to androgen-independence. These findings may contribute to design a strategy to predict prostate cancer status from the TRPM8 mRNA level. Furthermore, as the TRPM8 channel is localized in human prostate cells, it will be interesting to understand its physiological function in the normal prostate and its potential role in prostate cancer development.
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Affiliation(s)
- G Bidaux
- Laboratoire de Physiologie Cellulaire, INSERM EMI 0228, Bâtiment SN3, Université des Sciences et Technologies de Lille, 59655 Villeneuve d'Ascq Cedex, France
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Sydorenko V, Shuba Y, Thebault S, Roudbaraki M, Lepage G, Prevarskaya N, Skryma R. Receptor-coupled, DAG-gated Ca2+-permeable cationic channels in LNCaP human prostate cancer epithelial cells. J Physiol 2003; 548:823-36. [PMID: 12724346 PMCID: PMC2342876 DOI: 10.1113/jphysiol.2002.036772] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although the prostate gland is a rich source of alpha1-adreno- (alpha1-AR) and m1-cholino receptors (m1-AChR), the membrane processes associated with their activation in glandular epithelial cells is poorly understood. We used the whole-cell patch-clamp technique to show that the agonists of the respective receptors, phenylephrine (PHE) and carbachol (CCh), activate cationic membrane currents in lymph node carcinoma of the prostate (LNCaP) human prostate cancer epithelial cells, which are not dependent on the filling status of intracellular IP3-sensitive Ca2+ stores, but directly gated by diacylglycerol (DAG), as evidenced by the ability of its membrane permeable analogue, OAG, to mimic the effects of the agonists. The underlying cationic channels are characterized by the weak field-strength Eisenman IV permeability sequence for monovalent cations (PK(25) > PCs(4.6) > PLi(1.4) > PNa(1.0)), and the following permeability sequence for divalent cations: PCa(1.0) > PMg(0.74) > PBa(0.6) > PSr(0.36) > PMn(0.3). They are 4.3 times more permeable to Ca2+ than Na+ and more sensitive to the inhibitor 2-APB than SK&F 96365. RT-PCR analysis shows that DAG-gated members of the transient receptor potential (TRP) channel family, including TRPC1 and TRPC3, are present in LNCaP cells. We conclude that, in prostate cancer epithelial cells, alpha1-ARs and m1-AChRs are functionally coupled to Ca2+-permeable DAG-gated cationic channels, for which TRPC1 and TRPC3 are the most likely candidates.
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Affiliation(s)
- V Sydorenko
- Laboratoire de Physiologie Cellulaire, INSERM EMI 0228, Bâtiment SN3, USTL, 59655 Villeneuve d'Ascq, France
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34
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Alric L, Bourinet A, Toulemonde P, Thebault S, Peron J, Vinel J, Duffaut M. Syndrome de Budd-Chiari ou thrombose portale en dehors de la cirrhose :aspects étiologiques à propos de 12 cas. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Portefaix JM, Thebault S, Bourgain-Guglielmetti F, Del Rio M, Granier C, Mani JC, Navarro-Teulon I, Nicolas M, Soussi T, Pau B. Critical residues of epitopes recognized by several anti-p53 monoclonal antibodies correspond to key residues of p53 involved in interactions with the mdm2 protein. J Immunol Methods 2000; 244:17-28. [PMID: 11033015 DOI: 10.1016/s0022-1759(00)00246-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this work was to study the reactivity of antibodies directed against the N-terminus of p53 protein. First, we analysed the cross-reactivity of anti-p53 antibodies from human, mouse and rabbit sera with peptides derived from human, mouse and Xenopus p53. Next, we characterized more precisely a series of monoclonal antibodies directed against the N-terminal part of p53 and produced by immunizing mice with either full length human or Xenopus p53. For each of these mAbs we localized the epitope recognized on human p53 by the Spot method of multiple peptide synthesis, defined critical residues on p53 involved in the interaction by alanine scanning replacement experiments and determined kinetic parameters using real-time interaction analysis. These antibodies could be divided into two groups according to their epitopic and kinetic characteristics and their cross-reactivity with murine p53. Our results indicate that critical residues involved in the interaction of some of these mAbs with p53 correspond to key residues on p53 involved in its interaction with the mdm2 protein. These antibodies could, therefore, represent powerful tools for the study of p53 regulation.
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Affiliation(s)
- J M Portefaix
- CNRS UMR5094, CRLC Val d'Aurelle/Bât Recherche, Rue de la Croix Verte, 34298 Cedex 5, Montpellier, France.
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Thebault S, Gilbert D, Machour N, Marvin L, Lange C, Tron F, Charlionet R. Two-dimensional electrophoresis and mass spectrometry identification of proteins bound by a murine monoclonal anti-cardiolipin antibody: a powerful technique to characterize the cross-reactivity of a single autoantibody. Electrophoresis 2000; 21:2531-9. [PMID: 10939468 DOI: 10.1002/1522-2683(20000701)21:12<2531::aid-elps2531>3.0.co;2-e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Antigenic cross-reactivity, i.e., the capacity of a single antibody to react with apparently dissimilar structures, is a common characteristic of autoantibodies produced during systemic lupus erythematosus (SLE), an autoimmune disease developed by humans and certain strains of mice. Characterization of the extent of cross-reactivity of SLE-related autoantibodies may help identify the immunogenic stimulus, or stimuli, of autoantibody-secreting B-lymphocytes. Two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) was combined with mass spectrometry (MS) to identify cell proteins recognized by a single monoclonal autoantibody (mAb 4B7), derived from an (NZW x BXSB)F1 mouse and selected based on its capacity to react with cardiolipin, that binds to elements in the cytoplasm and nucleoli of HEp-2 cells as assessed by indirect immunofluorescence assay. Proteins from HL-60 extract were separated by 1-D and 2-D PAGE. Western blotting with mAb 4B7 after SDS-PAGE revealed four bands, two intensely labeled at 35 and 32 kDa, and two weaker ones at 20 and 60 kDa; three spots were detected after 2-D PAGE. After trypsin in-gel digestion of the three protein spots, MS yielded representative matrix assisted laser desorption/ionization-time of flight (MALDI-TOF) Reflector or quadrupole-time of flight (Q-TOF) spectra. The three corresponding proteins were identified as the nucleolar phosphoprotein B23 (nucleophosmin), heterogeneous nuclear ribonucleoprotein A2 (hnRNP A2) and the 60 kDa Ro/SS-A RNP. Thus, these results showed that 2-D PAGE combined with MS constitutes a sensitive and powerful technique to characterize the full extent of cross-reactivity of a single mAb and may constitute a new approach to further characterize the immunogenic cellular components involved in the breakage of B-cell tolerance observed in SLE.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/immunology
- Autoantibodies/immunology
- Autoantigens/immunology
- Blotting, Western/methods
- Cardiolipins/immunology
- Cell Extracts
- Cross Reactions
- Electrophoresis, Gel, Two-Dimensional/methods
- Electrophoresis, Polyacrylamide Gel/methods
- Fluorescent Antibody Technique, Indirect
- Glycoproteins/immunology
- HL-60 Cells
- Heterogeneous-Nuclear Ribonucleoprotein Group A-B
- Heterogeneous-Nuclear Ribonucleoproteins
- Humans
- Mice
- Molecular Sequence Data
- Nuclear Proteins/immunology
- Nucleophosmin
- Phosphoproteins/immunology
- RNA, Small Cytoplasmic
- Ribonucleoproteins/immunology
- Serum Albumin, Bovine/immunology
- Sodium Dodecyl Sulfate
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods
- Tumor Cells, Cultured
- beta 2-Glycoprotein I
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Affiliation(s)
- S Thebault
- INSERM U519, Faculté Mixte de Médecine-Pharmacie, Hôpital Charles Nicolle, Rouen, France
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Gachon F, Thebault S, Peleraux A, Devaux C, Mesnard JM. Molecular interactions involved in the transactivation of the human T-cell leukemia virus type 1 promoter mediated by Tax and CREB-2 (ATF-4). Mol Cell Biol 2000; 20:3470-81. [PMID: 10779337 PMCID: PMC85640 DOI: 10.1128/mcb.20.10.3470-3481.2000] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [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: 11/20/2022] Open
Abstract
The human T-cell leukemia virus type 1 (HTLV-1) Tax protein activates viral transcription through three 21-bp repeats located in the U3 region of the HTLV-1 long terminal repeat and called Tax-responsive elements (TxREs). Each TxRE contains nucleotide sequences corresponding to imperfect cyclic AMP response elements (CRE). In this study, we demonstrate that the bZIP transcriptional factor CREB-2 is able to bind in vitro to the TxREs and that CREB-2 binding to each of the 21-bp motifs is enhanced by Tax. We also demonstrate that Tax can weakly interact with CREB-2 bound to a cellular palindromic CRE motif such as that found in the somatostatin promoter. Mutagenesis of Tax and CREB-2 demonstrates that both N- and C-terminal domains of Tax and the C-terminal region of CREB-2 are required for direct interaction between the two proteins. In addition, the Tax mutant M47, defective for HTLV-1 activation, is unable to form in vitro a ternary complex with CREB-2 and TxRE. In agreement with recent results suggesting that Tax can recruit the coactivator CREB-binding protein (CBP) on the HTLV-1 promoter, we provide evidence that Tax, CREB-2, and CBP are capable of cooperating to stimulate viral transcription. Taken together, our data highlight the major role played by CREB-2 in Tax-mediated transactivation.
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Affiliation(s)
- F Gachon
- Laboratoire Infections Rétrovirales et Signalisation Cellulaire, CNRS EP 2104, Institut de Biologie, 34060 Montpellier, France
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Gachon F, Peleraux A, Thebault S, Dick J, Lemasson I, Devaux C, Mesnard JM. CREB-2, a cellular CRE-dependent transcription repressor, functions in association with Tax as an activator of the human T-cell leukemia virus type 1 promoter. J Virol 1998; 72:8332-7. [PMID: 9733879 PMCID: PMC110203 DOI: 10.1128/jvi.72.10.8332-8337.1998] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Tax protein of the human T-cell leukemia virus type 1 (HTLV-1) has been implicated in human T-cell immortalization. The primary function of Tax is to transcriptionally activate the HTLV-1 promoter, but Tax is also known to stimulate expression of cellular genes. It has been reported to associate with several transcription factors, as well as proteins not involved in transcription. To better characterize potential cellular targets of Tax present in infected cells, a Saccharomyces cerevisiae two-hybrid screening was performed with a cDNA library constructed from the HTLV-1-infected MT2 cell line. From this study, we found 158 positive clones representing seven different cDNAs. We focused our attention on the cDNA encoding the transcription factor CREB-2. CREB-2 is an unconventional member of the ATF/CREB family in that it lacks a protein kinase A (PKA) phosphorylation site and has been reported to negatively regulate transcription from the cyclic AMP response element of the human enkephalin promoter. In this study, we demonstrate that CREB-2 cooperates with Tax to enhance viral transcription and that its basic-leucine zipper C-terminal domain is required for both in vitro and in vivo interactions with Tax. Our results confirm that the activation of the HTLV-1 promoter through Tax and factors of the ATF/CREB family is PKA independent.
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Affiliation(s)
- F Gachon
- Laboratoire Infections Rétrovirales et Signalisation Cellulaire, CRBM-CNRS UPR 1086, Institut de Biologie, 34060 Montpellier, France
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Chopin D, Thebault S, Lagneau P. [False prosthetic aneurysms. Evaluation of etiologic factors]. J Chir (Paris) 1983; 120:603-9. [PMID: 6655008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There is a need for new evaluation of anastomotic aneurysms with increasing use of prosthetic material in aortoiliac reconstructive surgery. 503 lower extremity revascularisations performed between 1972 and 1978 were reviewed. 20 false aneurysms complication of synthetic grafts, operated on from 1972 to 1981 were analysed. A retrospective study on the aorto-iliofemoral prosthesis group (N = 97) was enable to compare patients with and without false aneurysm occurrence with an average follow up of 5 years (3 to 9 years). The management of false aneurysm is discussed. This study suggest that most important etiologic factors are the vascular pattern just below the revascularisation, the anastomotic level, an iterative intervention. Extensive reconstructive procedures on the anastomosis level should be avoided. On the other hand choice of anastomotic procedure (termino-terminal versus latero-lateral anastomosis) and HTA seems to have no deleterious in spite of the findings of other authors.
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