1
|
Pfeuffer S, Rolfes L, Wirth T, Steffen F, Pawlitzki M, Schulte-Mecklenbeck A, Gross CC, Brand M, Bittner S, Ruck T, Klotz L, Wiendl H, Meuth SG. Immunoadsorption versus double-dose methylprednisolone in refractory multiple sclerosis relapses. J Neuroinflammation 2022; 19:220. [PMID: 36071461 PMCID: PMC9450381 DOI: 10.1186/s12974-022-02583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Intravenous methylprednisolone is the standard treatment for a multiple sclerosis relapse; however, this fails to improve symptoms in up to one quarter of patients. Immunoadsorption is an accepted treatment for refractory relapses, but prospective comparator-controlled studies are missing. Methods In this observational study, patients with steroid-refractory acute multiple sclerosis relapses receiving either six courses of tryptophan-immunoadsorption or double-dose methylprednisolone therapy were analysed. Outcomes were evaluated at discharge and three months later. Immune profiling of blood lymphocytes and proteomic analysis were performed by multi-parameter flow cytometry and Olink analysis, respectively (NCT04450030). Results 42 patients were enrolled (methylprednisolone: 26 patients; immunoadsorption: 16 patients). For determination of the primary outcome, treatment response was stratified according to relative function system score changes (“full/best” vs. “average” vs. “worse/none”). Upon discharge, the adjusted odds ratio for any treatment response (“full/best” + ”average” vs. “worse/none”) was 10.697 favouring immunoadsorption (p = 0.005 compared to methylprednisolone). At follow-up, the adjusted odds ratio for the best treatment response (“full/best” vs. “average” + ”worse/none”) was 103.236 favouring IA patients (p = 0.001 compared to methylprednisolone). Similar results were observed regarding evoked potentials and quality of life outcomes, as well as serum neurofilament light-chain levels. Flow cytometry revealed a profound reduction of B cell subsets following immunoadsorption, which was closely correlated to clinical outcomes, whereas methylprednisolone had a minimal effect on B cell populations. Immunoadsorption treatment skewed the blood cytokine network, reduced levels of B cell-related cytokines and reduced immunoglobulin levels as well as levels of certain coagulation factors. Interpretation Immunoadsorption demonstrated favourable outcomes compared to double-dose methylprednisolone. Outcome differences were significant at discharge and follow-up. Further analyses identified modulation of B cell function as a potential mechanism of action for immunoadsorption, as reduction of B cell subsets correlated with clinical improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02583-y.
Collapse
Affiliation(s)
- Steffen Pfeuffer
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Leoni Rolfes
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Timo Wirth
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Falk Steffen
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Marc Pawlitzki
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Catharina C Gross
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Marcus Brand
- Medical Department D - Nephrology, University Hospital Muenster, Muenster, Germany
| | - Stefan Bittner
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Luisa Klotz
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Sven G Meuth
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. .,Department of Neurology, University Hospital Duesseldorf, Duesseldorf, Germany.
| |
Collapse
|
2
|
Sterlin D, Larsen M, Fadlallah J, Parizot C, Vignes M, Autaa G, Dorgham K, Juste C, Lepage P, Aboab J, Vicart S, Maillart E, Gout O, Lubetzki C, Deschamps R, Papeix C, Gorochov G. Perturbed Microbiota/Immune Homeostasis in Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e997. [PMID: 33975914 PMCID: PMC8114833 DOI: 10.1212/nxi.0000000000000997] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/09/2021] [Indexed: 12/21/2022]
Abstract
Objective Based on animal models and human studies, there is now strong suspicion that host/microbiota mutualism in the context of gut microbial dysbiosis could influence immunity and multiple sclerosis (MS) evolution. Our goal was to seek evidence of deregulated microbiota-induced systemic immune responses in patients with MS. Methods We investigated gut and systemic commensal-specific antibody responses in healthy controls (n = 32), patients with relapsing-remitting MS (n = 30), and individuals with clinically isolated syndromes (CISs) (n = 15). Gut microbiota composition and diversity were compared between controls and patients by analysis of 16S ribosomal ribonucleic acid (rRNA) sequencing. Autologous microbiota and cultivable bacterial strains were used in bacterial flow cytometry assays to quantify autologous serum IgG and secretory IgA responses to microbiota. IgG-bound bacteria were sorted by flow cytometry and identified using 16S rRNA sequencing. Results We show that commensal-specific gut IgA responses are drastically reduced in patients with severe MS, disease severity being correlated with the IgA-coated fecal microbiota fraction (r = −0.647, p < 0.0001). At the same time, IgA-unbound bacteria elicit qualitatively broad and quantitatively increased serum IgG responses in patients with MS and CIS compared with controls (4.1% and 2.5% vs 1.9%, respectively, p < 0.001). Conclusions Gut and systemic microbiota/immune homeostasis are perturbed in MS. Our results argue that defective IgA responses in MS are linked to a breakdown of systemic tolerance to gut microbiota leading to an enhanced triggering of systemic IgG immunity against gut commensals occurring early in MS.
Collapse
Affiliation(s)
- Delphine Sterlin
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Martin Larsen
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Jehane Fadlallah
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Christophe Parizot
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Marina Vignes
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Gaëlle Autaa
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Catherine Juste
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Patricia Lepage
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Jennifer Aboab
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Savine Vicart
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Elisabeth Maillart
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Gout
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Catherine Lubetzki
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Romain Deschamps
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Caroline Papeix
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Guy Gorochov
- From the Sorbonne Université (D.S., M.L., J.F., C.P., M.V., G.A., K.D., G.G.), Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP Hôpital Pitié-Salpêtrière, France; Université Paris-Saclay (C.J., P.L.), INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Hôpital Ophtalmologique Adolphe de Rothschild (J.A., O.G., R.D.), Département de Neurologie, Paris, France; and Sorbonne Université (S.V., E.M., C.L., C.P.), Département de Neurologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France.
| |
Collapse
|
4
|
Puentes F, van der Star BJ, Boomkamp SD, Kipp M, Boon L, Bosca I, Raffel J, Gnanapavan S, van der Valk P, Stephenson J, Barnett SC, Baker D, Amor S. Neurofilament light as an immune target for pathogenic antibodies. Immunology 2017; 152:580-588. [PMID: 28718500 DOI: 10.1111/imm.12797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 01/15/2023] Open
Abstract
Antibodies to neuronal antigens are associated with many neurological diseases including paraneoplastic neurological disorders, epilepsy, amyotrophic lateral sclerosis and multiple sclerosis. Immunization with neuronal antigens such as neurofilament light (NF-L), a neuronal intermediate filament in axons, has been shown to induce neurological disease and spasticity in mice. Also, although antibodies to NF-L are widely used as surrogate biomarkers of axonal injury in amyotrophic lateral sclerosis and multiple sclerosis, it remains to be elucidated if antibodies to NF-L contribute to neurodegeneration and neurological disease. To address this, we examined the pathogenic role of antibodies directed to NF-L in vitro using spinal cord co-cultures and in vivo in experimental autoimmune encephalomyelitis (EAE) and optic neuritis animal models of multiple sclerosis. Here we show that peripheral injections of antibodies to NF-L augmented clinical signs of neurological disease in acute EAE, increased retinal ganglion cell loss in experimental optic neuritis and induced neurological signs following intracerebral injection into control mice. The pathogenicity of antibodies to NF-L was also observed in spinal cord co-cultures where axonal loss was induced. Taken together, our results reveal that as well as acting as reliable biomarkers of neuronal damage, antibodies to NF-L exacerbate neurological disease, suggesting that antibodies to NF-L generated during disease may also be pathogenic and play a role in the progression of neurodegeneration.
Collapse
Affiliation(s)
- Fabiola Puentes
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Stephanie D Boomkamp
- Regenerative Medicine Institute, School of Medicine, National University of Ireland, Galway, Ireland
| | - Markus Kipp
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Louis Boon
- Bioceros Holdings BV, Utrecht, The Netherlands
| | - Isabel Bosca
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,MS Unit, Neurology Department, La Fe University Hospital, Valencia, Spain
| | - Joel Raffel
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sharmilee Gnanapavan
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul van der Valk
- Pathology Department, Vrije University Medical Centre, Amsterdam, The Netherlands
| | - Jodie Stephenson
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Susan C Barnett
- Institute of Infection, Immunity & Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Baker
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Amor
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Pathology Department, Vrije University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|