1
|
Rump A, Ratas K, Lepasepp TK, Suurväli J, Smolander OP, Gross-Paju K, Toomsoo T, Kanellopoulos J, Rüütel Boudinot S. Sex-dependent expression levels of VAV1 and P2X7 in PBMC of multiple sclerosis patients. Scand J Immunol 2023; 98:e13283. [PMID: 38441379 DOI: 10.1111/sji.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/21/2023] [Accepted: 05/01/2023] [Indexed: 03/07/2024]
Abstract
Multiple sclerosis (MS) is an inflammatory autoimmune disorder of the central nervous system and the leading cause of progressive neurological disability in young adults. It decreases the patient's lifespan by about 10 years and affects women more than men. No medication entirely restricts or reverses neurological degradation. However, early diagnosis and treatment increase the possibility of a better outcome. To identify new MS biomarkers, we tested the expression of six potential markers (P2X4, P2X7, CXCR4, RGS1, RGS16 and VAV1) using qPCR in peripheral blood mononuclear cells (PBMC) of MS patients treated with interferon β (IFNβ), with glatiramer acetate (GA) or untreated. We showed that P2X7 and VAV1 are significantly induced in MS patients. In contrast, the expression of P2X4, CXCR4, RGS1 and RGS16 was not significantly modified by MS in PBMC. P2X7 and VAV1 are essentially induced in female patients, suggesting these markers are connected to sex-specific mechanisms. Strikingly, VAV1 expression is higher in healthy women than healthy men and IFNβ treatment of MS reduced VAV1 expression in female MS patients while it up-regulated VAV1 in male MS patients. Our data point to the differential, sex-dependent value of MS markers and treatment effects. Although rgs16 expression in PBMC was not a valid MS marker in patients, the strong upregulation of P2X4 and P2X7 induced in the spinal cord of WT mice by EAE was abrogated in rgs16KO mice suggesting that rgs16 is required for P2X4 and P2X7 induction by neurological diseases.
Collapse
Affiliation(s)
- Airi Rump
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Kristel Ratas
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
- Synlab, Tallinn, Estonia
| | - Tuuli Katarina Lepasepp
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Jaanus Suurväli
- Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Olli-Pekka Smolander
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Katrin Gross-Paju
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
- West-Tallinn Central Hospital, Tallinn, Estonia
| | - Toomas Toomsoo
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
- Confido Medical Center, Tallinn, Estonia
| | - Jean Kanellopoulos
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Saclay, France
| | - Sirje Rüütel Boudinot
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| |
Collapse
|
2
|
Rajendran R, Rajendran V, Gupta L, Shirvanchi K, Schunin D, Karnati S, Giraldo-Velásquez M, Berghoff M. Interferon Beta-1a versus Combined Interferon Beta-1a and Oligodendrocyte-Specific FGFR1 Deletion in Experimental Autoimmune Encephalomyelitis. Int J Mol Sci 2022; 23:ijms232012183. [PMID: 36293040 PMCID: PMC9603153 DOI: 10.3390/ijms232012183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Recombinant beta interferons-1 (IFNβ-1) are used as first line therapies in patients with relapsing multiple sclerosis (MS), a chronic inflammatory and neurodegenerative disease of the CNS. IFNβ-1a/b has moderate effects on the prevention of relapses and slowing of disease progression. Fibroblast growth factors (FGFs) and FGF receptors (FGFRs) are known to play a key role in the pathology of MS and its model EAE. To investigate the effects of short-term treatment with s.c. IFNβ-1a versus the combined application of s.c. IFNβ-1a and oligodendrocyte-specific deletion of FGFR1 (Fgfr1ind−/− mice) in MOG35-55-induced EAE. IFNβ-1a (30 mg/kg) was applied s.c. from days 0–7 p.i. of EAE in controls and Fgfr1ind−/− mice. FGFR signaling proteins associated with inflammation/degeneration in MS/EAE were analyzed by western blot in the spinal cord. Further, FGFR1 in Oli-neu oligodendrocytes were inhibited by PD166866 and treated with IFNβ-1a (400 ng/mL). Application of IFNβ-1a over 8 days resulted in less symptoms only at the peak of disease (days 9–11) compared to controls. Application of IFNβ-1a in Fgfr1ind−/− mice resulted in less symptoms primarily in the chronic phase of EAE. Fgfr1ind−/− mice treated with IFNβ-1a showed increased expression of pERK and BDNF. In Oli-neu oligodendrocytes, treatment with PD166866 and IFNβ-1a also showed an increased expression of pERK and BDNF/TrkB. These data suggest that the beneficial effects in the chronic phase of EAE and on signaling molecules associated with ERK and BDNF expression are caused by the modulation of FGFR1 and not by interferon beta-1a. FGFR may be a potential target for therapy in MS.
Collapse
Affiliation(s)
- Ranjithkumar Rajendran
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
| | - Vinothkumar Rajendran
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
| | - Liza Gupta
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
| | - Kian Shirvanchi
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
| | - Darja Schunin
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
| | - Srikanth Karnati
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstrasse 6, 97080 Würzburg, Germany
| | | | - Martin Berghoff
- Experimental Neurology, Department of Neurology, University of Giessen, Klinikstrasse 33, 35385 Giessen, Germany
- Correspondence: ; Tel.: +49-641-98544306; Fax: +49-641-98545329
| |
Collapse
|
3
|
Veroni C, Aloisi F. The CD8 T Cell-Epstein-Barr Virus-B Cell Trialogue: A Central Issue in Multiple Sclerosis Pathogenesis. Front Immunol 2021; 12:665718. [PMID: 34305896 PMCID: PMC8292956 DOI: 10.3389/fimmu.2021.665718] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
The cause and the pathogenic mechanisms leading to multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system (CNS), are still under scrutiny. During the last decade, awareness has increased that multiple genetic and environmental factors act in concert to modulate MS risk. Likewise, the landscape of cells of the adaptive immune system that are believed to play a role in MS immunopathogenesis has expanded by including not only CD4 T helper cells but also cytotoxic CD8 T cells and B cells. Once the key cellular players are identified, the main challenge is to define precisely how they act and interact to induce neuroinflammation and the neurodegenerative cascade in MS. CD8 T cells have been implicated in MS pathogenesis since the 80's when it was shown that CD8 T cells predominate in MS brain lesions. Interest in the role of CD8 T cells in MS was revived in 2000 and the years thereafter by studies showing that CNS-recruited CD8 T cells are clonally expanded and have a memory effector phenotype indicating in situ antigen-driven reactivation. The association of certain MHC class I alleles with MS genetic risk implicates CD8 T cells in disease pathogenesis. Moreover, experimental studies have highlighted the detrimental effects of CD8 T cell activation on neural cells. While the antigens responsible for T cell recruitment and activation in the CNS remain elusive, the high efficacy of B-cell depleting drugs in MS and a growing number of studies implicate B cells and Epstein-Barr virus (EBV), a B-lymphotropic herpesvirus that is strongly associated with MS, in the activation of pathogenic T cells. This article reviews the results of human studies that have contributed to elucidate the role of CD8 T cells in MS immunopathogenesis, and discusses them in light of current understanding of autoreactivity, B-cell and EBV involvement in MS, and mechanism of action of different MS treatments. Based on the available evidences, an immunopathological model of MS is proposed that entails a persistent EBV infection of CNS-infiltrating B cells as the target of a dysregulated cytotoxic CD8 T cell response causing CNS tissue damage.
Collapse
Affiliation(s)
| | - Francesca Aloisi
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
4
|
Shajarian M, Alsahebfosoul F, Etemadifar M. The Effect of IFN-β Treatment on Plasma Levels of BDNF and IL-6 in Relapsing-Remitting Multiple Sclerosis Patients. Neuroimmunomodulation 2021; 28:150-157. [PMID: 34182566 DOI: 10.1159/000515595] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In recent investigations addressing neurodegenerative diseases, especially multiple sclerosis (MS), the roles of brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) have been examined. METHODS Forty-five relapsing-remitting MS (RRMS) patients, including 32 IFN-β-treated and 13 newly identified untreated cases as well as 45 sex- and age-matched healthy controls, were recruited in the study. Plasma levels of BDNF and IL-6 were assessed using the ELISA method. Data were analyzed by SPSS (ver.21). RESULTS There were significant differences between the case and healthy control groups in terms of the plasma levels of BDNF (p value = 0.044) and IL-6 (p value <0.001). Besides, the treatment with IFN-β had no significant impact on the level of BDNF or IL-6 in RRMS patients as compared to healthy controls (p value = 0.716 and 0.623 for BDNF and IL-6, respectively). Furthermore, the increase in the plasma levels of BDNF and IL-6 indicated a direct correlation in the case group (r = 0.508, p value = 0.008). In detail, following the classification of the case group into 2 subgroups of IFN-β-treated and untreated patients, a direct positive correlation was observed between the plasma levels of BDNF and IL-6 in IFN-β-treated patients (r = 0.495, p value = 0.026). CONCLUSION The IFN-β treatment seems not to be effective for upregulating BDNF and IL-6 in RRMS patients.
Collapse
Affiliation(s)
- Mansour Shajarian
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Alsahebfosoul
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Pulido-Valdeolivas I, Zubizarreta I, Martinez-Lapiscina EH, Villoslada P. Precision medicine for multiple sclerosis: an update of the available biomarkers and their use in therapeutic decision making. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1393315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Irene Pulido-Valdeolivas
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
|
7
|
Bhise V, Dhib-Jalbut S. Further understanding of the immunopathology of multiple sclerosis: impact on future treatments. Expert Rev Clin Immunol 2016; 12:1069-89. [PMID: 27191526 DOI: 10.1080/1744666x.2016.1191351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The understanding of the immunopathogenesis of multiple sclerosis (MS) has expanded with more research into T-cell subtypes, cytokine contributors, B-cell participation, mitochondrial dysfunction, and more. Treatment options have rapidly expanded with three relatively recent oral therapy alternatives entering the arena. AREAS COVERED In the following review, we discuss current mechanisms of immune dysregulation in MS, how they relate to current treatments, and the impact these findings will have on the future of therapy. Expert commentary: The efficacy of these medications and understanding their mechanisms of actions validates the immunopathogenic mechanisms thought to underlie MS. Further research has exposed new targets, while new promising therapies have shed light on new aspects into the pathophysiology of MS.
Collapse
Affiliation(s)
- Vikram Bhise
- a Rutgers Biomedical and Health Sciences - Departments of Pediatrics , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Suhayl Dhib-Jalbut
- b Rutgers Biomedical and Health Sciences - Departments of Neurology , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| |
Collapse
|
8
|
Sinha S, Boyden AW, Itani FR, Crawford MP, Karandikar NJ. CD8(+) T-Cells as Immune Regulators of Multiple Sclerosis. Front Immunol 2015; 6:619. [PMID: 26697014 PMCID: PMC4674574 DOI: 10.3389/fimmu.2015.00619] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/26/2015] [Indexed: 11/13/2022] Open
Abstract
The vast majority of studies regarding the immune basis of MS (and its animal model, EAE) have largely focused on CD4(+) T-cells as mediators and regulators of disease. Interestingly, CD8(+) T-cells represent the predominant T-cell population in human MS lesions and are oligoclonally expanded at the site of pathology. However, their role in the autoimmune pathologic process has been both understudied and controversial. Several animal models and MS patient studies support a pathogenic role for CNS-specific CD8(+) T-cells, whereas we and others have demonstrated a regulatory role for these cells in disease. In this review, we describe studies that have investigated the role of CD8(+) T-cells in MS and EAE, presenting evidence for both pathogenic and regulatory functions. In our studies, we have shown that cytotoxic/suppressor CD8(+) T-cells are CNS antigen-specific, MHC class I-restricted, IFNγ- and perforin-dependent, and are able to inhibit disease. The clinical relevance for CD8(+) T-cell suppressive function is best described by a lack of their function during MS relapse, and importantly, restoration of their suppressive function during quiescence. Furthermore, CD8(+) T-cells with immunosuppressive functions can be therapeutically induced in MS patients by glatiramer acetate (GA) treatment. Unlike CNS-specific CD8(+) T-cells, these immunosuppressive GA-induced CD8(+) T-cells appear to be HLA-E restricted. These studies have provided greater fundamental insight into the role of autoreactive as well as therapeutically induced CD8(+) T-cells in disease amelioration. The clinical implications for these findings are immense and we propose that this natural process can be harnessed toward the development of an effective immunotherapeutic strategy.
Collapse
Affiliation(s)
- Sushmita Sinha
- Department of Pathology, University of Iowa , Iowa City, IA , USA
| | | | - Farah R Itani
- Department of Pathology, University of Iowa , Iowa City, IA , USA
| | | | | |
Collapse
|
9
|
Segal BM. Stage-specific immune dysregulation in multiple sclerosis. J Interferon Cytokine Res 2015; 34:633-40. [PMID: 25084180 DOI: 10.1089/jir.2014.0025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A large body of data indicates that multiple sclerosis (MS) is an autoimmune disease which is initiated by CD4(+) T-helper 1 (Th1) and Th17 cells that are reactive against proteins in the myelin sheath. MS typically begins with a relapsing-remitting course, punctuated by clinical exacerbations associated with the development of focal inflammatory lesions in central nervous system white matter, followed by a secondary progressive (SP) phase, characterized by a gradual accumulation of neurological disability associated with widespread microglial activation and axonal loss. The molecular and cellular basis for this transition is unclear, and the role of inflammation during the SP stage is a subject of active debate. As of now, no immunological biomarkers have been identified in MS that are predictive of the clinical course or therapeutic responsiveness to disease-modifying agents, or that correlate with new lesion development, cumulative lesion load, or degree of disability. The discovery of such biomarkers would greatly facilitate clinical management and provide power for smaller and shorter clinical trials. In this article, we discuss the literature on immunological biomarkers in MS with a focus on stage-specific differences and similarities.
Collapse
Affiliation(s)
- Benjamin M Segal
- Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, Department of Neurology, University of Michigan , Ann Arbor, Michigan
| |
Collapse
|
10
|
Graber JJ, Dhib-Jalbut S. Biomarkers of Interferon Beta Therapy in Multiple Sclerosis. J Interferon Cytokine Res 2014; 34:600-4. [DOI: 10.1089/jir.2013.0144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Jerome J. Graber
- Department of Neurology, Montefiore-Einstein Medical Center, Bronx, New York
| | - Suhayl Dhib-Jalbut
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
11
|
Kasper LH, Reder AT. Immunomodulatory activity of interferon-beta. Ann Clin Transl Neurol 2014; 1:622-31. [PMID: 25356432 PMCID: PMC4184564 DOI: 10.1002/acn3.84] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is a complex disorder of the central nervous system that appears to be driven by a shift in immune functioning toward excess inflammation that results in demyelination and axonal loss. Beta interferons were the first class of disease-modifying therapies to be approved for patients with MS after treatment with this type I interferon improved the course of MS on both clinical and radiological measures in clinical trials. The mechanism of action of interferon-beta appears to be driven by influencing the immune system at many levels, including antigen-presenting cells, T cells, and B cells. One effect of these interactions is to shift cytokine networks in favor of an anti-inflammatory effect. The pleiotropic mechanism of action may be a critical factor in determining the efficacy of interferon-beta in MS. This review will focus on select immunological mechanisms that are influenced by this type I cytokine.
Collapse
Affiliation(s)
- Lloyd H Kasper
- Departments of Microbiology/Immunology and Medicine, Geisel School of Medicine, Dartmouth College Hanover, New Hampshire
| | - Anthony T Reder
- Department of Neurology, University of Chicago Chicago, Illinois
| |
Collapse
|
12
|
Park SY, Kim HB, Kim JH, Lee JM, Kim SR, Shin HS, Yi TH. Immunostimulatory effect of fermented red ginseng in the mouse model. Prev Nutr Food Sci 2014; 19:10-8. [PMID: 24772404 PMCID: PMC3999803 DOI: 10.3746/pnf.2014.19.1.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022] Open
Abstract
In this study, Woongjin fermented red ginseng extract (WFRG) was evaluated for its potential ability to act as an adjuvant for the immune response of mice. For the in vitro study, macrophages were treated with serial concentrations (1 μg/mL, 10 μg/mL, and 100 μg/mL) of WFRG. For in vivo studies, mice were administered different concentrations (10 mg/kg/day, 100 mg/kg/day, and 200 mg/kg/day) of WFRG orally for 21 days. In vitro, the production of nitric oxide and TNF-α by RAW 264.7 cells increased in a dose-dependent manner. In vivo, WFRG enhanced the proliferation of splenocytes induced by two mitogens (i.e., concanavalin A and lipopolysaccharide [LPS]) and increased LPS-induced production of TNF-α and IL-6, but not IL-1β. In conclusion, WFRG has the potential to modulate immune function and should be further investigated as an immunostimulatory agent.
Collapse
Affiliation(s)
- Sang-Yong Park
- Department of Oriental Medicinal Materials & Processing, Kyung Hee University, Gyeonggi 446-701, Korea
| | - Ho-Bin Kim
- Woongjin Food Co., Ltd., Seoul 100-705, Korea
| | | | - Joo-Mi Lee
- Woongjin Food Co., Ltd., Seoul 100-705, Korea
| | | | - Heon-Sub Shin
- Department of Oriental Medicinal Materials & Processing, Kyung Hee University, Gyeonggi 446-701, Korea
| | - Tae-Hoo Yi
- Department of Oriental Medicinal Materials & Processing, Kyung Hee University, Gyeonggi 446-701, Korea
| |
Collapse
|
13
|
Dhib-Jalbut S, Markowitz C, Patel P, Boateng F, Rametta M. The Combined Effect of Nursing Support and Adverse Event Mitigation on Adherence to Interferon Beta-1b Therapy in Early Multiple Sclerosis: The START Study. Int J MS Care 2014; 14:198-208. [PMID: 24453752 DOI: 10.7224/1537-2073-14.4.198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is limited clinical evidence on the impact of nurse support and adverse event (AE) mitigation techniques on adherence to interferon beta-1b (IFNβ-1b) therapy in multiple sclerosis (MS) in a real-world setting. The aim of the Success of Titration, analgesics, and BETA nurse support on Acceptance Rates in MS Treatment (START) trial was to assess the combined effect of titration, analgesics, and BETA (Betaseron Education, Training, Assistance) nurse support on adherence to IFNβ-1b therapy in patients with early-onset MS and to evaluate safety. Participants were instructed to titrate IFNβ-1b and use analgesics to minimize flu-like symptoms. All received BETA nurse follow-up at frequent intervals: live training, two telephone calls during the first month of therapy, and monthly calls thereafter. Participants were considered adherent if they took at least 75% of the total prescribed doses over 12 months (≥75% compliance). Safety was monitored via reported AEs and laboratory test results. Participants who took at least one IFNβ-1b dose over 12 months were analyzed (N = 104); 73.8% of participants completed the study. The mean age of participants was 37.2 years; 72.1% were women and 78.8% were white. Ninety participants had relapsing-remitting MS and 14 had clinically isolated syndrome. The mean compliance rate, reported for 96 participants with complete dose interruption records, was 84.4%. At 12 months, 78.1% of participants were considered adherent. The serious adverse event rate was 9.6%; most events were unrelated to therapy. Thus in the START study, in which participants received nursing support combined with dose titration and use of analgesics, the majority of participants were adherent to therapy.
Collapse
Affiliation(s)
- Suhayl Dhib-Jalbut
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA (SDJ); University of Pennsylvania, Philadelphia, PA, USA (CM); and Bayer HealthCare, Wayne, NJ, USA (PP, FB, MR)
| | - Clyde Markowitz
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA (SDJ); University of Pennsylvania, Philadelphia, PA, USA (CM); and Bayer HealthCare, Wayne, NJ, USA (PP, FB, MR)
| | - Payal Patel
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA (SDJ); University of Pennsylvania, Philadelphia, PA, USA (CM); and Bayer HealthCare, Wayne, NJ, USA (PP, FB, MR)
| | - Francis Boateng
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA (SDJ); University of Pennsylvania, Philadelphia, PA, USA (CM); and Bayer HealthCare, Wayne, NJ, USA (PP, FB, MR)
| | - Mark Rametta
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA (SDJ); University of Pennsylvania, Philadelphia, PA, USA (CM); and Bayer HealthCare, Wayne, NJ, USA (PP, FB, MR)
| | | |
Collapse
|
14
|
Chemokines and chemokine receptors in multiple sclerosis. Mediators Inflamm 2014; 2014:659206. [PMID: 24639600 PMCID: PMC3930130 DOI: 10.1155/2014/659206] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/18/2013] [Indexed: 02/08/2023] Open
Abstract
Multiple sclerosis is an autoimmune disease with classical traits of demyelination, axonal damage, and neurodegeneration. The migration of autoimmune T cells and macrophages from blood to central nervous system as well as the destruction of blood brain barrier are thought to be the major processes in the development of this disease. Chemokines, which are small peptide mediators, can attract pathogenic cells to the sites of inflammation. Each helper T cell subset expresses different chemokine receptors so as to exert their different functions in the pathogenesis of MS. Recently published results have shown that the levels of some chemokines and chemokine receptors are increased in blood and cerebrospinal fluid of MS patients. This review describes the advanced researches on the role of chemokines and chemokine receptors in the development of MS and discusses the potential therapy of this disease targeting the chemokine network.
Collapse
|
15
|
Steinman L. Inflammatory cytokines at the summits of pathological signal cascades in brain diseases. Sci Signal 2013; 6:pe3. [PMID: 23322904 DOI: 10.1126/scisignal.2003898] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
When considering the hierarchical organization of pathological signaling cascades in immunological disorders of the brain, certain cytokines might be considered pinnacles of pathophysiological importance, with their presence determining the appearance or the course of a particular disease. Interleukin-1 (IL-1), IL-6, IL-17, and tumor necrosis factor are critical for the pathogenesis of inflammation in specific brain disorders. Targeting these cytokines or their receptors can alter the course of several neurological diseases, but the effects may be beneficial or harmful.
Collapse
Affiliation(s)
- Lawrence Steinman
- Departments of Pediatrics and Neurology and Neurological Sciences, Stanford University, Beckman Center for Molecular Medicine, Stanford, CA 94305-5316, USA.
| |
Collapse
|
16
|
Steinman L, Axtell RC, Barbieri D, Bhat R, Brownell SE, de Jong BA, Dunn SE, Grant JL, Han MH, Ho PP, Kuipers HF, Kurnellas MP, Ousman SS, Rothbard JB. Piet Mondrian’s trees and the evolution in understanding multiple sclerosis, Charcot Prize Lecture 2011. Mult Scler 2013; 19:5-14. [DOI: 10.1177/1352458512470730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Four questions were posed about multiple sclerosis (MS) at the 2011 Charcot Lecture, Oct. 22, 2011. 1. The Male/Female Disparity: Why are women developing MS so much more frequently than men? 2. Neuronal and Glial Protection: Are there guardian molecules that protect the nervous system in MS? 3. Predictive Medicine: With all the approved drugs, how can we rationally decide which one to use? 4. The Precise Scalpel vs. the Big Hammer for Therapy: Is antigen-specific therapy for demyelinating disease possible? To emphasize how our views on the pathogenesis and treatment of MS are evolving, and given the location of the talk in Amsterdam, Piet Mondrian’s progressive interpretations of trees serve as a heuristic.
Collapse
Affiliation(s)
- Lawrence Steinman
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Robert C Axtell
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Donald Barbieri
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Roopa Bhat
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Sara E Brownell
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Brigit A de Jong
- Department of Neurology (HP935), Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - Jacqueline L Grant
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - May H Han
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Peggy P Ho
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | - Hedwich F Kuipers
- Department of Neurology and Neurological Sciences, Stanford University, USA
| | | | - Shalina S Ousman
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada
| | | |
Collapse
|