Multiple sclerosis and the incidence of venous thromboembolism: a systematic review and meta-analysis

Characterisation of Platelet Releasate Proteome in Relapsing-Remitting Multiple Sclerosis Reveals Dysregulation of Inflammatory Signalling and Extracellular Vesicle Dynamics

PURPOSE

Multiple Sclerosis is an inflammatory neurodegenerative disease characterised by blood-brain barrier dysfunction and leukocyte infiltration into the CNS. Platelets are best known for their contributions to haemostasis, however, upon activation, platelets release an abundance of soluble and vesicular-associated proteins, termed the platelet releasate (PR). This milieu contains numerous inflammatory and vasoactive proteins, that can attract leukocytes and alter endothelial permeability.

EXPERIMENTAL DESIGN

We aimed to characterise the PR of Relapsing-Remitting multiple sclerosis (RRMS) patients, previously characterized regarding thrombin generation dynamics compared to healthy controls. We carried out LFQ proteomic profiling of the PR from 15 RRMS and 19 aged-matched healthy controls.

RESULTS

We identified 9 proteins increased and 16 proteins decreased in the PR of RRMS patients. Platelet/endothelial cell-adhesion molecule-1 (PECAM-1) was uniquely found in healthy control PR and circulating levels of PECAM-1 were significantly lower in RRMS patient samples. GO analysis revealed a strong link between altered proteins and extracellular vesicles (EVs). Small EV levels were significantly reduced in RRMS PR compared to healthy PR and showed a negative correlation with PECAM-1 levels in RRMS plasma.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings suggest that platelet reactivity may be linked to disease activity, even in periods of disease remission.

Neurocardiology Update: The Brain-Heart Connection in Multiple Sclerosis-A Narrative Review

Background and Aims

While multiple sclerosis (MS) is primarily considered a neurological disorder, mounting evidence suggests a strong association with cardiovascular diseases (CVDs), impacting both disease progression and patient outcomes. This paper aims to raise awareness of this disease association while promoting a clinical-oriented, multidisciplinary approach that can provide long-term benefits for these patients.

Methods

A comprehensive literature review was conducted to gather up-to-date evidence concerning the incidence and type of CVDs associated with MS, the mechanisms underlying this disease association, as well as the impact on MS progression. Based on this evidence, a neurocardiological approach to MS in clinical practice was proposed.

Results

Past and present research agree on the high rates of arterial hypertension, metabolic syndrome, stroke, and myocardial infarction in people with MS. However, other prevalent comorbidities, such as venous thromboembolism and autonomic dysfunction may be easily overlooked in clinical practice. A complex interplay between genetic predisposition, traditional risk factors, autonomic dysfunction, inflammation, and treatment-related factors likely plays a role in promoting CVDs in MS. The impact of cardiovascular dysfunction on MS progression ranges from subclinical impairments, such as impaired axonal repairing, to overt physical disability and cognitive dysfunction. This paper proposes a neurocardiological approach to the daily clinical practice of MS patients, comprising general lifestyle measures, comorbidity screening at MS diagnosis, extensive work-ups for progressive/active forms, and selected autonomic dysfunction screening.

Conclusion

MS is a lifelong disorder that can be associated with a multitude of comorbidities, particularly cardiovascular ones. Along with increased mortality, cardiovascular pathology can adversely affect clinical and radiological-derived MS outcomes. Thus, surveillance and preventative measures are required for this population.

Targeting Vascular Impairment, Neuroinflammation, and Oxidative Stress Dynamics with Whole-Body Cryotherapy in Multiple Sclerosis Treatment

Multiple sclerosis (MS), traditionally perceived as a neurodegenerative disease, exhibits significant vascular alternations, including blood-brain barrier (BBB) disruption, which may predispose patients to increased cardiovascular risks. This vascular dysfunction is intricately linked with the infiltration of immune cells into the central nervous system (CNS), which plays a significant role in perpetuating neuroinflammation. Additionally, oxidative stress serves not only as a byproduct of inflammatory processes but also as an active contributor to neural damage. The synthesis of these multifaceted aspects highlights the importance of understanding their cumulative impact on MS progression. This review reveals that the triad of vascular damage, chronic inflammation, and oxidative imbalance may be considered interdependent processes that exacerbate each other, underscoring the need for holistic and multi-targeted therapeutic approaches in MS management. There is a necessity for reevaluating MS treatment strategies to encompass these overlapping pathologies, offering insights for future research and potential therapeutic interventions. Whole-body cryotherapy (WBCT) emerges as one of the potential avenues for holistic MS management approaches which may alleviate the triad of MS progression factors in multiple ways.

Safety and effectiveness of rehabilitation training for stroke complicated with muscular call vein thrombosis: An observational study

This study aimed to explore the safety and effectiveness of rehabilitation treatment for stroke patients with muscular call vein thrombosis (MCVT) in the lower limbs. A total of 173 patients were recruited with stroke complicated by MCVT, including 130 who received rehabilitation training and 43 who did not receive rehabilitation training. The t test and chi-square test were used to analyze the basic data of the 2 groups. There were no significant differences in the Fugl-Meyer Assessment scores between 2 groups at the beginning of recruitment (P = .149). There was a significant difference in the Fugl-Meyer Assessment scores of the lower limbs in patients with MCVT after 3 weeks of rehabilitation treatment (P < .001), and there was a significant difference in the rate of MCVT recanalization and extension between the 2 groups (χ2 = 11.646, P = 0001). Combined with anticoagulation therapy, rehabilitation training did not increase the thrombosis progression of MCVT and was effective in the recovery of lower limb motor function in stroke patients.