Multiple sclerosis

Unraveling brain aging through the lens of oral microbiota

The oral cavity is a complex physiological community encompassing a wide range of microorganisms. Dysbiosis of oral microbiota can lead to various oral infectious diseases, such as periodontitis and tooth decay, and even affect systemic health, including brain aging and neurodegenerative diseases. Recent studies have highlighted how oral microbes might be involved in brain aging and neurodegeneration, indicating potential avenues for intervention strategies. In this review, we summarize clinical evidence demonstrating a link between oral microbes/oral infectious diseases and brain aging/neurodegenerative diseases, and dissect potential mechanisms by which oral microbes contribute to brain aging and neurodegeneration. We also highlight advances in therapeutic development grounded in the realm of oral microbes, with the goal of advancing brain health and promoting healthy aging.

Radiomics-based analysis of choroid plexus abnormalities in neuromyelitis optica spectrum disorders and multiple sclerosis and their clinical implications

BACKGROUND

The choroid plexus (CP) is closely linked to inflammation in multiple sclerosis (MS). While the CP volume is enlarged in MS compared with healthy controls (HC), no such changes are observed in neuromyelitis optica spectrum disorder (NMOSD), a disease with similar clinical and imaging features to MS. It remains unclear whether the CP plays a similar role in NMOSD as in MS.

PURPOSE

To investigate the abnormal CP radiomics in NMOSD and MS and explore their clinical implications.

METHODS

This retrospective study included 111 MS, 69 Aquaporin-4 (AQP4)-IgG positive NMOSD, and 82 HC, with age and sex matching. Radiomics features of the CP were extracted from T1-weighted images after automated segmentation, including shape, first order statistics (intensity), and texture features (N=1051). Analysis of covariance was used to assess group differences in these features, and 11 classic machine learning algorithms were employed to construct disease classification models. Moreover, partial correlation analysis was performed to further explore the relationships between differential radiomics features and clinical measures, such as Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT).

RESULTS

Compared with HC, MS exhibited significant differences in 453 features, including shape, intensity, and texture, while NMOSD displayed differences in 102 intensity and texture features, with no differences in shape. NMOSD and MS differed in 178 features, primarily texture (P < 0.05, Bonferroni correction). In the classification models based on CP radiomics features, the best AUC for MS vs HC was 0.935 (95% CI: 0.830 - 0.997) with the Partial Least Squares Regression Generalized Linear Model (plsRglm), while for NMOSD vs HC, it was 0.822 (95% CI: 0.629 - 0.962) with the Light Gradient Boosting Machine (LightGBM). Meanwhile, the best AUC for NMOSD vs MS was 0.832 (95% CI: 0.667 - 0.960) with the Quadratic Discriminant Analysis (QDA). Furthermore, of the 453 abnormal radiomics features of MS patients, 120 were significantly correlated with EDSS and 234 with SDMT scores (P < 0.05, FDR correction), while no radiomics features in NMOSD were significantly correlated with clinical scores (P > 0.05, FDR correction).

CONCLUSION

Radiomics can detect varying degrees of CP abnormalities in NMOSD and MS, suggesting CP involvement in the pathophysiology of NMOSD, albeit to a lesser extent than in MS. It may help understand the potential pathophysiological differences between the two diseases and their impact on clinical monitoring.

Ginsenoside Rb3 represses CPZ-induced demyelination and neuroinflammation by inhibiting TRAF6 K63 ubiquitination

Multiple sclerosis is a chronic inflammatory and neurodegenerative disorder of the central nervous system. Despite ongoing research, effective treatments remain limited, especially during progressive phase. Saponins extracted from the stem and leaf of Panax notoginseng (PNSL) demonstrate a superior anti-inflammatory effect by inhibiting NO production in LPS-induced BV2 cells. Ginsenoside Rb3, the primary active and most abundant component in PNSL, has been demonstrated to mitigate inflammation-induced damage. However, whether Rb3 mitigates demyelination by inhibiting neuroinflammation had not been previously reported. In this study, biochemical and histological assays revealed that ginsenoside Rb3 effectively mitigated Cuprizone-induced demyelination and attenuated aberrant microglial activation and reactive astrogliosis within the demyelinated areas. Mechanistic investigations demonstrated that Rb3 suppresses glial cell activation and consequently mitigates inflammatory responses by inhibiting the secretion of TNF-α, IL-6, and IL-1β. TNF receptor-associated factor 6 (TRAF6) is activated by K63-linked polyubiquitination, which leads to downstream activation of the inhibitor of nuclear factor-κB kinase (IKK) complex and mitogen-activated protein kinases (MAPKs). Furthermore, Rb3 was found to inhibit the activation of nuclear factor-κB (NF-κB) and MAPKs, as evidenced by the dephosphorylation of NF-κB p65 and the MAPKs p38 and JNK. Further investigation revealed that Rb3 binds to TRAF6 at residues 69 and 88, thereby inhibiting its K63-linked polyubiquitination. Conversely, the TRAF6 mutation at E69Q or R88N abolished the inhibition effects of Rb3 on K63-linked ubiquitination of TRAF6 and subsequent downstream signaling activation. Meta-analysis showed that Rb3 exerts its anti-inflammatory effects primarily by inhibiting the NF-κB pathway. Collectively, it is concluded that Rb3 alleviates demyelination and inhibits inflammation through bound to TRAF6 to prevent its K63-linked ubiquitination and subsequent activation of NF-κB. In this study, we have for the first time elucidated that dual mechanism by which Rb3 inhibits both NF-κB and MAPK pathways to exert its anti-inflammatory effects. This study demonstrates that Rb3 shows promising preclinical therapeutic potential. Additionally, TRAF6 represents a potential therapeutic target for MS treatment.

Multiple sclerosis-like manifestations in systemic autoimmune and inflammatory disorders: Αn update

INTRODUCTION

Multiple sclerosis (MS) is the most recognized CNS autoimmune demyelinating disease, characterized by neuroinflammation, myelin loss, and axonal damage. Due to clinical overlap with several disorders such as systemic autoimmune diseases (SADs), which can closely resemble MS, the diagnostic process can be challenging. SADs with CNS involvement can present with neurological symptoms such as transverse myelitis, optic neuritis, and white matter lesions. This diagnostic uncertainty contributes to a significant rate of misdiagnosis which can lead to improper treatment, worsening symptoms and increasing disability.

AREAS COVERED

In this review we discuss the physiology of myelin in the CNS, the pathophysiology of MS and other immune-mediated demyelinating diseases that can mimic MS. We also discuss similar presentations between MS and MS-like clinical entities, and their appropriate treatment regimes.

EXPERT OPINION

SADs and other clinical entities are key MS mimickers, significantly complicating diagnosis at a first neurological episode. Careful clinical evaluation, imaging, and exclusion of alternative diagnoses are crucial to avoid misdiagnosis. Understanding the subtle distinctions between MS and SADs and looking out for, and further investigating atypical presentations, is vital for ensuring accurate diagnosis and proper treatment, thereby improving patient outcomes and reducing unnecessary disability.

Circulating myeloid-derived suppressor cell load and disease severity are associated to an enhanced oligodendroglial production in a murine model of multiple sclerosis

Multiple sclerosis (MS) is a highly heterogeneous immune-mediated demyelinating disease. Myelin restoration is essential to prevent disability progression in MS patients. However, remyelinating therapies are failing in clinical trials, in part, due to the lack of biomarkers that classify the differing endogenous regenerative capacities of enrolled patients. In the experimental autoimmune encephalomyelitis (EAE) MS model, circulating monocytic myeloid-derived suppressor cells (M-MDSCs) are associated to milder disease courses, better recovery and less degree of tissue damage. Here, we show that disease severity affects the gradient of oligodendrocyte precursor cells (OPCs) present in mixed active-inactive lesions of MS patients, along with a positive correlation between M-MDSC density and OPC abundance. EAE disease severity negatively influences the density of total and newly generated OPCs found associated to the demyelinated lesions. In addition, disease severity also impacts the abundance of newly generated oligodendrocytes throughout the EAE disease course. Interestingly, circulating M-MDSCs at EAE onset and peak of the disease are directly associated to a higher density of newly generated oligodendrocytes in the demyelinated lesions. Our results set the basis for further studies on M-MDSCs as a promising new biomarker that identify a CNS prone to new oligodendrocyte generation in response to an inflammatory insult.

Multiple Sclerosis: A Story of the Interaction Between Gut Microbiome and Components of the Immune System

Multiple sclerosis (MS) is defined as an inflammatory disorder that chronically affects the central nervous system of young people mostly and is distributed globally. It is associated with degeneration and demyelination of the myelin sheath around the nerves, resulting in multiple neurological disability symptoms ranging from mild to severe cases that end with paralysis sometimes. MS is one of the rising diseases globally that is unfortunately associated with reduced quality of life and adding national economic burdens. The definite MS mechanism is not clearly defined; however, all the previous researches confirm the role of the immune system as the master contributor in the pathogenesis. Innate and adaptive immune cells are activated peripherally then attracted toward the central nervous system (CNS) due to the breakdown of the blood-brain barrier. Recently, the gut-brain axis was shown to depend on gut metabolites that are produced by different microorganisms in the colon. The difference in microbiota composition between individuals is responsible for diversity in secreted metabolites that affect immune responses locally in the gut or systemically when reach blood circulation to the brain. It may enhance or suppress immune responses in the central nervous system (CNS) (repeated short forms); consequently, it may exacerbate or ameliorate MS symptoms. Recent data showed that some metabolites can be used as adjuvant therapy in MS and other inflammatory diseases. This review sheds light on the nature of MS and the possible interaction between gut microbiota and immune system regulation through the gut-brain axis, hence contributing to MS pathogenesis.

Modes of Mitochondrial Reactive Oxygen Species Production in Inflammation

Background: Inflammation is one of the most important pathways in innate immunity and its relationship with redox biology is becoming increasingly clear in the last decades. However, the specific redox modes and pathways by which inflammation is produced are not yet well defined. Significance: In this review, we provide a general explanation of the reactive oxygen species (ROS) production and quenching modes occurring in mammalian mitochondria, as well as a summary of the most recent advances in mitochondrial redox biology and bioenergetics regarding sodium (Na+) homeostasis. In addition, we provide a collection of examples in which several inflammatory pathways have been associated with specific modes of either mitochondrial ROS production or quenching. Innovation: The role of Na+ in mitochondrial biology is being developed. Since its discovery as a second messenger, the research of its role in the immune system has emerged. Now, the role of Na+ in mitochondrial bioenergetics has recently been identified, which owns unprecedented applications. The potential implication of Na+ in inflammatory mechanisms grows as its role does not only cover ROS production and respiration but also the control through the management of mitochondrial membrane potential. Future directions: Na+ is becoming relevant for mitochondrial biology. Thus, processes regarding mitochondrial bioenergetics, redox state, or metabolism may probably need to include the study of Na+ in their road map. Some of these pathways are involved in inflammation and more are possibly to come. This review is expected to serve as a bridge between both fields. Antioxid. Redox Signal. 42, 868-884.

Neuroinflammation: An Oligodendrocentric View

Chronic neuroinflammation, driven by central nervous system (CNS)-resident astrocytes and microglia, as well as infiltration of the peripheral immune system, is an important pathologic mechanism across a range of neurologic diseases. For decades, research focused almost exclusively on how neuroinflammation impacted neuronal function; however, there is accumulating evidence that injury to the oligodendrocyte lineage is an important component for both pathologic and clinical outcomes. While oligodendrocytes are able to undergo an endogenous repair process known as remyelination, this process becomes inefficient and usually fails in the presence of sustained inflammation. The present review focuses on our current knowledge regarding activation of the innate and adaptive immune systems in the chronic demyelinating disease, multiple sclerosis, and provides evidence that sustained neuroinflammation in other neurologic conditions, such as perinatal white matter injury, traumatic brain injury, and viral infections, converges on oligodendrocyte injury. Lastly, the therapeutic potential of targeting the impact of inflammation on the oligodendrocyte lineage in these diseases is discussed.

High Fat Low Carbohydrate Diet Is Linked to CNS Autoimmunity Protection

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system (CNS) believed to be driven by autoimmune mechanisms. Genetic and environmental factors are implicated in MS development, and among the latter, diets and nutrients are emerging as potential critical contributors. However, a comprehensive understanding of their impacts and the underlying mechanisms involved is lacking. Harnessing state-of-the-art nutritional geometry analytical methods, it is first revealed that globally, increased carbohydrate supply is associated with increased MS disease burden, while fat supply has an opposite effect. Furthermore, in a MS mouse model, experimental autoimmune encephalomyelitis (EAE), it is found that an isocaloric diet high in carbohydrate aggravated EAE, while a diet enriched in fat (HF) is fully protective. This is reflected by reduced neuroinflammation and skewing toward anti-inflammatory phenotypes. The protective effects from the HF diet are multifaceted. Metabolically, HF increased lipid storage in immune cells, correlating with their increased anti-inflammatory IL-10 production. Transcriptionally and epigenetically, HF feeding preprogrammed naïve T cells toward a less activated but more tolerogenic phenotype. It is showcased that manipulating diets is a potentially efficient and cost-effective approach to prevent and/or ameliorate EAE. This exhibits translational potentials for prevention/intervention of MS and possibly other autoimmune diseases.

Shades of decision making in multiple sclerosis: A systematic review on economic, medical and under risk conditions choices

BACKGROUND

Multiple Sclerosis (MS), a chronic and demyelinating disorder of the central nervous system, is often associated with challenges in decision-making (DM). This systematic review aims to evaluate the performance of patients with different subtypes of MS in DM tasks, focusing on connections with cognitive impairments, emotional changes, and brain structural alterations.

METHODS

We conducted a systematic search, following PRISMA guidelines, for all peer-reviewed articles. We searched the following databases: Scopus, PubMed, and Web of Science. This review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024503190.

RESULTS

Our electronic searches identified 443 papers. After reading the full text of the selected publications and applying predefined inclusion criteria, we included 18 studies based on their pertinence and relevance to the topic.

CONCLUSION

This review highlights the multifaceted nature of DM deficits in individuals with MS. These difficulties result from cognitive impairments such as working memory, brain structural changes, and emotional processing challenges including depression. Our findings present a comprehensive synthesis of the complexities surrounding DM in MS, emphasizing the need for future research to better understand these relationships and their implications for enhancing patient quality of life and autonomy in DM processes.

Lymphopenia associated with sphingosine 1-phosphate receptor modulators (S1PRMs) in multiple sclerosis: analysis of European pharmacovigilance data

BACKGROUND

The treatment landscape for Multiple Sclerosis (MS) has increased significantly over the past few decades, thanks to the introduction of disease-modifying therapies (DMTs). Fingolimod, siponimod, ozanimod, and ponesimod belong to the newer generation of oral DMTs categorized as sphingosine 1-phosphate receptor modulators (S1PRMs). Because of their mechanism of action, they may increase the risk of lymphopenia, which could influence the therapeutic management of people with MS. The aim of this study was to describe and compare the reporting frequency of lymphopenia related to four S1PRMs.

METHODS

Individual case safety reports (ICSRs) were retrieved from the European spontaneous reporting system database (EudraVigilance) from January 1st, 2022, to December 31st, 2023. The reporting odds ratios (RORs) were computed to compare the reporting probability of lymphopenia between a S1PRM versus each other.

RESULTS

We retrieved 4017 ICSRs, of which 521 (13%) reported lymphopenia associated with fingolimod (53.3%), siponimod (38.4%), ozanimod (5.4%), and ponesimod (2.1%). The most common reporting source was the healthcare professional (94.2%), and more than half of the ICSRs (62.6%) reported serious lymphopenia. Fingolimod was associated with a lower reporting frequency of lymphopenia compared to siponimod. Both siponimod and fingolimod were associated with a higher reporting frequency of lymphopenia compared to ozanimod; siponimod also had a higher reporting probability in comparison with ponesimod.

CONCLUSIONS

The most relevant clinical implication of the disproportionality analysis is to increase the awareness of the risk of lymphopenia related to these drugs, thus supporting proactive monitoring and optimizing treatment strategies for people with MS.

CLINICAL TRIAL NUMBER

Not applicable.

MSLesSeg: baseline and benchmarking of a new Multiple Sclerosis Lesion Segmentation dataset

This paper presents MSLesSeg, a new, publicly accessible MRI dataset designed to advance research in Multiple Sclerosis (MS) lesion segmentation. The dataset comprises 115 scans of 75 patients including T1, T2 and FLAIR sequences, along with supplementary clinical data collected across different sources. Expert-validated annotations provide high-quality lesion segmentation labels, establishing a reliable human-labeled dataset for benchmarking. Part of the dataset was shared with expert scientists with the aim to compare the last automatic AI-based image segmentation solutions with an expert-biased handmade segmentation. In addition, an AI-based lesion segmentation of MSLesSeg was developed and technically validated against the last state-of-the-art methods. The dataset, the detailed analysis of researcher contributions, and the baseline results presented here mark a significant milestone for advancing automated MS lesion segmentation research.

Prevalence of epsilon toxin-producing Clostridium perfringens isolates among patients with multiple sclerosis and neuromyelitis optica spectrum disorder in Iran

BACKGROUND

Clostridium perfringens epsilon toxin (ETX) is a potent neurotoxin that crosses the blood-brain barrier (BBB), and has been suggested to be involved in demyelinating CNS disorders. Here, we investigated the prevalence of C. perfringens and anti-ETX immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in stool and sera of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) compared to healthy controls.

METHODS

Between September 2019 and June 2020, 43 stool and 43 sera specimens were collected from MS (n = 33) and NMOSD (n = 10) patients, and 49 samples from healthy subjects. Stool samples were cultured for the presence of C. perfringens and PCR was used to detect etx-encoding gene. The level of serum IgG and IgM against ETX was examined using competitive ELISA. The predictive value of sex, age, ETX IgG and IgM levels, and C. perfringens was assessed using multivariable prediction models, with all models trained on the full set of variables. Independent contributions were evaluated separately using logistic regression (LR) analysis.

RESULTS

Totally, 11 C. perfringens were isolated from MS (n = 4), NMOSD (n = 2), and healthy (n = 5) subjects. The etx gene was detected in 1/4 (25%) isolates from MS and 2/2 (100%) from NMOSD patients, while none of the isolates from healthy subjects carried the gene. The analysis of serum IgG and IgM level against ETX showed no significant difference between patients and healthy subjects. Among the prediction models used, LR and Naïve Bayes (NB), trained on all predictor variables, exhibited the highest statistical accuracy for MS diagnosis, with AUC = 0.71 and AUC = 0.93, respectively. Among individual parameters, sex (AUC = 0.63) and IgG level (AUC = 0.57) were the most reliable predictors. The nomogram prediction demonstrated that the probability of patients' risk of developing MS and NMOSD can be predicted using these predictors.

CONCLUSIONS

Our findings indicate a potential association between ETX-producing C. perfringens strains and MS/NMOSD diseases, as its presence was detected in a subset of patient samples. However, no significant differences in anti-ETX antibody levels were observed between control and patients. Our prediction models highlighted key demographic and serological factors that may contribute to MS diagnosis. These results highlight the need for further research to meticulously decipher the biological interplay of C. perfringens and its ETX toxin with the development of MS and NMOSD.

Personalized therapy in multiple sclerosis: an Italian Delphi consensus

OBJECTIVE

The increasing availability of disease-modifying therapies (DMTs) may provide more personalized treatment options for multiple sclerosis (MS) based on various factors, including patients' characteristics, prognostic indicators, comorbidities, and safety. In Italy, recent efforts focused on promoting interdisciplinary, patient-centered care and equitable access to optimized therapies, as reported in the 2023 Barometer of Multiple Sclerosis and Related Diseases from the Italian Multiple Sclerosis Association. A key challenge is ensuring equitable access to homogeneous and personalized therapeutic strategies.

MATERIALS AND METHODS

Using a Delphi methodology, a panel of Italian neurologists with expertise in MS evaluated consensus on specific aspects of MS treatments, including personalized therapy, patient involvement in decision-making, treatment flexibility, self-management of therapies, perception of treatment efficacy and safety and therapeutic sequence management.

RESULTS

Of 166 votes, 116 statements reached consensus (68% positive, 2% negative), representing 70% of the total, whereas 50 (30%) highlighted areas of non-consensus. The findings emphasize the central role of neurologists, the importance of personalized therapy, the inclusion of patients in therapeutic choices to enhance adherence and quality of life, and managing both quality of life and caregiver burden. Most high-efficacy disease-modifying therapies (HE DMTs), like cladribine and anti-CD20 therapies, recognized for their efficacy and convenience of administration, received positive consensus, emphasizing their perceived value in individualized treatment approaches.

CONCLUSIONS

This research highlights best practices and provides a roadmap for improving patient outcomes through tailored, well-communicated therapeutic strategies.

Broxyquinoline targets NLRP3 to inhibit inflammasome activation and alleviate NLRP3-associated inflammatory diseases

The NLR family pyrin domain-containing 3 (NLRP3) inflammasome is responsible for various pathogenic and non-pathogenic damage signals and plays a critical role in host defense against pathogens and physiological damage. However, inflammasome activation and its subsequent effects also lead to a variety of inflammatory diseases. In this study, we identified broxyquinoline, an FDA-approved antimicrobial drug, as a effective NLRP3 inflammasome inhibitor. Broxyquinoline suppressed NLRP3 inflammasome-dependent interleukin-1β (IL-1β) release, but did not affect NLRC4 or AIM2 inflammasome activation. Mechanistically, broxyquinoline directly targets Arg165 of NLRP3 protein, thus preventing NEK7-NLRP3 interaction, NLRP3 oligomerization, and ASC speck formation, without affecting the NF-κB pathway. Consequently, broxyquinoline significantly attenuated the progression of monosodium urate (MSU)-induced peritonitis and myelin oligodendrocyte glycoprotein (MOG35-55)-induced experimental autoimmune encephalomyelitis (EAE) in murine models. In conclusion, we demonstrated that broxyquinoline directly targets the NLRP3 protein to suppress the activation of NLRP3 inflammasome and provide a promising therapeutic agent for NLRP3 inflammasome-associated diseases.

Multiple Sclerosis-Specific Reference Curves for Brain Volumes to Explain Disease Severity

BACKGROUND AND OBJECTIVES

Brain atrophy is relevant for understanding disease progression and treatment response in people with multiple sclerosis (pwMS). Automatic brain volume-reporting tools often rely on healthy control (HC) reference curves to interpret brain volumes, whereas brain volume loss is different in pwMS. This observational study aimed to develop an MS-specific reference model for brain volumes and evaluate its performance compared with HC-based curves, as a proof-of-concept.

METHODS

Participants, pwMS and HCs, from the Amsterdam MS cohort were included based on the availability of T1-weighted MR scans. Normalized brain volumes (NBVs) were obtained using commercially available software. The software program also provides NBV percentiles, based on age-specific and sex-specific HC curves, grouped into NBV quartiles, describing deviation from expected NBVs. Disease severity was determined with the MS severity score (MSSS), Symbol Digit Modalities Test (SDMT), and 9-Hole Peg Test (9HPT). An MS-specific model was developed by regressing NBVs against age, sex, disease duration, and MS phenotype. The resulting MS model was also used to classify pwMS into quartiles describing deviation from expected NBV, given the modeled patient characteristics, with leave-one-out predictions. Quartile classification from HC-based and MS-based reference curves was compared with MSSS using analysis of variance (ANOVA).

RESULTS

Regressions for NBVs from 713 pwMS and 259 HCs (mean age: 49.1 ± 9.7 and 48.3 ± 10.1, %female: 70.4% and 67.2%, respectively) were significant for age, sex, disease duration, and phenotype, which were included in the MS-specific model. MS-specific model quartile designations significantly improved associations with MSSS values (p = 2.2*10-9, η2 = 0.06) compared with HC-based quartiles. MSSS values worsened with lower NBV quartiles in the MS-specific model (difference between quartiles 1-4 = -0.84, p = 6.1*10-3, 95% CI [-1.5 to -0.18])), which was not observed for HC-based quartiles (p = 0.98). Quartile group differences were observed for 9HPT (MS: p = 3.5*10-3, η2 = 0.02, HC: p = 6.6*10-3, η2 = 0.02) and SDMT (MS: p = 3.1*10-4, η2 = 0.05, HC: p = 5.4*10-4, η2 = 0.04) values, but MS-specific quartiles again improved quartile associations (p = 0.036, η2 = 0.01 and p = 0.02, η2 = 0.01, respectively).

DISCUSSION

NBV values derived from an MS-specific reference model offer improved relevance for assessing disease severity compared with curves derived from age-specific and sex-specific HC reference models. Improving the model toward application in individual people could enhance clinical implementation.

The path to prevention of multiple sclerosis: Considerations for Epstein-Barr virus vaccine-based prevention studies

Recent advancements in our understanding of the association between Epstein-Barr virus (EBV) and multiple sclerosis (MS), along with progress in EBV vaccine development, warrant serious considerations of future EBV vaccine-based MS-prevention studies. The clinical, financial, logistical, and technological considerations for designing and conducting retrospective and/or prospective prevention studies with the primary objective of evaluating the effectiveness of EBV vaccines in preventing MS and other EBV-associated sequelae are presented here. As implementation of these studies may require hundreds of thousands of participants, millions of dollars, and decades to observe if meaningful reductions in MS incidence occur, alternative approaches using pragmatic phase IV, post-licensure study designs focused on either the prevention of MS or infectious mononucleosis (IM), a common clinical manifestation of EBV infection that has been associated with increased risk of MS, are also explored. Current knowledge gaps in technology, funding, and research that must be addressed for a study protocol to be successfully designed and implemented are also discussed.

The topography of infratentorial lesions in depression and anxiety in multiple sclerosis

BACKGROUND

Depression and anxiety are highly prevalent in multiple sclerosis and significantly impact patient outcomes. However, their link to specific areas of demyelination remains unclear.

OBJECTIVES

This study examines the association between infratentorial lesions and depression or anxiety, focusing on three regions of interest: raphe nuclei, locus coeruleus, and cerebellar lobule VIIA.

METHODS

Patients were recruited from the cognitive neuroimmunology clinic at the Royal Melbourne Hospital. Participants were categorised as belonging to the groups 'depression'/'no depression' and 'anxiety'/'no anxiety' based on SPECTRA Indices of Psychopathology. MRI scans were examined for lesion presence in regions of interest. Association analyses were performed using multivariable logistic regression, adjusting for demographics, clinical parameters, and therapy.

RESULTS

Of 73 patients, 21 (29%) had clinically relevant depressive symptoms, and 18 (25%) had anxiety. Depression was significantly associated with lesions in the raphe nuclei (47.6% vs. 17.3%, OR 10.5, 95%CI 1.9-57.5, p=0.007) and locus coeruleus (38.1% vs. 15.4%, OR 20.5, 95%CI 2.3-184, p=0.007). Anxiety showed a potential association with locus coeruleus lesions (38.9% vs. 16.4%, OR 8.62, 95%CI 0.9-79.2, p=0.057).

CONCLUSIONS

Depression in multiple sclerosis is associated with lesions within serotoninergic and noradrenergic brainstem nuclei. No definitive anatomical substrate for anxiety was identified. These findings suggest that inflammatory structural changes may underlie mood disorders in multiple sclerosis, potentially serving as early imaging markers of susceptibility to depression.

Kynurenines and Mitochondrial Disturbances in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease characterised by inflammation, demyelination, and neurodegeneration within the central nervous system. The pathogenesis of MS involves an immune-mediated attack on myelin and neurons, accompanied by blood-brain barrier dysfunction and chronic CNS inflammation. Central to MS pathology is dysregulation of the kynurenine pathway, which metabolises tryptophan into neuroactive compounds. Kynurenine pathway (KP) activation, driven by inflammatory cytokines, leads to the production of both neuroprotective (e.g., kynurenic acid, KYNA) and neurotoxic (e.g., quinolinic acid, QUIN) metabolites. Imbalance between these metabolites, particularly increased QUIN production, exacerbates glutamate excitotoxicity, oxidative stress, and mitochondrial dysfunction, contributing to neuronal and oligodendrocyte damage. Mitochondrial dysfunction plays a critical role in the pathophysiology of MS, exacerbating neurodegeneration through impaired energy metabolism and oxidative stress. This review integrates the current understanding of KP dysregulation in multiple sclerosis across disease stages. In RRMS, heightened KP activity correlates with inflammation and neuroprotection attempts through increased KYNA production. In contrast, SPMS and PPMS are associated with a shift towards a more neurotoxic KP profile, marked by elevated QUIN levels and reduced KYNA, exacerbating neurodegeneration and disability progression. Understanding these mechanisms offers insights into potential biomarkers and therapeutic targets for MS, emphasising the need for strategies to rebalance KP metabolism and mitigate neurotoxicity in progressive disease stages.

Discrepancy Between Vaccination Willingness and Actual SARS-CoV-2 Vaccination Status in People with Multiple Sclerosis: A Longitudinal Study

Background/Objectives: Infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) poses a significant health risk, especially for individuals with chronic medical conditions. Multiple sclerosis (MS) is the most prevalent chronic, immune-mediated neurological disorder, and vaccinations are essential to its management. This study aimed to compare the reported willingness to be vaccinated against SARS-CoV-2 with the actual vaccination status among people with MS (pwMS) and identify factors explaining the discrepancy. Methods: In a longitudinal, two-center study, we analyzed 149 patients aged 18 or older with a diagnosis of clinically isolated syndrome or MS. The participants completed three surveys: a baseline survey (from June 2019 to June 2020), a pre-vaccine follow-up (from May to July 2020), and a post-vaccine follow-up (from October 2021 to January 2022). The data included sociodemographic, clinical, and psychological information. Results: Among the 149 participants, 122 (81.9%) received a SARS-CoV-2 vaccination, while 27 (18.1%) did not. The pwMS who were unwilling to become vaccinated and remained unvaccinated were less likely to live with a partner, had higher smoking rates, took more medications, had a higher number of previously discontinued disease-modifying therapies, and found pandemic policies inappropriate. No significant associations were found between vaccination willingness/status and factors like age, sex, depression, or anxiety. Conclusions: This study highlights the gap between vaccination willingness and actual status in pwMS, revealing factors associated with vaccine hesitancy. The findings of this study offer insights into addressing vaccine uptake.

Cognitive interviewing study to assess the content validity of a Spanish version of the Multiple Sclerosis Health Literacy Questionnaire

OBJECTIVES

To develop a Spanish version of the Multiple Sclerosis Health Literacy Questionnaire (MSHLQ) and assess its content validity from the perspective of people with multiple sclerosis (MS).

STUDY DESIGN

Cognitive interviewing study.

METHODS

We used a step-by-step process to translate the MSHLQ into Spanish and employed purposive sampling to achieve a representative sample of the target population. We invited people aged 18 and older with MS who are users of a public healthcare service to participate. We carried out two rounds of interviews, both conducted by the same skilled interviewer. Two coders independently assessed the interview transcriptions using the Question Appraisal System.

RESULTS

Thirteen interviews were analysed in the first round, reaching saturation. The sample comprised people with MS, with a balanced gender distribution and varied educational backgrounds, and with MS diagnosis durations ranging from 1 to 24 years. Problematic issues found in the pre-final MSHLQ-SPA included 15 out of 22 items. We identified 45 clarity issues and 23 assumption-related problems, plus two overlapping responses. After amendments, only five issues were found in the second round.

CONCLUSIONS

Over two-thirds of items in the pre-final MSHLQ-SPA version had problematic issues, mostly clarity-related. This study contributes to the body of evidence regarding MSHLQ content validity, an essential instrument property for ensuring its accurate interpretation and use across different countries or contexts. Tailored health literacy measurement instruments for people with MS have the potential to improve health outcomes and reduce health inequalities.

Beyond EDSS: multidomain impairments are detectable and associated with walking disorders in low-disabled people with multiple sclerosis

INTRODUCTION

Multiple sclerosis is characterized by a spectrum of motor, sensory, and cognitive impairments often overlooked in low-disabled people with multiple sclerosis (PwMS). The assessment of subtle functional deficits in this population is crucial to track the evolution of impairments and treatments effects. This study aims to explore the prevalence of multidomain impairments and their association with walking disorders in minimally disabled PwMS.

METHODS

In this cross-sectional study, 80 PwMS with EDSS scores < 2.5 underwent a comprehensive assessment that included both EDSS Functional Scores (EDSS FS) and clinical scales measuring lower limb strength (Squat Jump test), tactile sensitivity (Monofilament Test), balance (instrumented test), fatigue (Fatigue Severity Scale) and cognitive function (Symbol Digit Modalities Test). Walking performances in PwMS were objectively measured with the Six-Minute Walking Test (6MWT) and subjectively by the MS Walking Scale-12 (MSWS-12).

RESULTS

Abnormalities in EDSS FS were common, with over 50% (95% CI 43-65%) of PwMS exhibiting impaired Pyramidal FS and more than 20% (95% CI 13-32%) showing deficit in sensory FS. Compared with normative values, 30% of PwMS demonstrated reduced lower limb strength (95% CI 21-41%), impaired tactile sensation (95% CI 20-40%), and increased fatigue (95% CI 9-26%). Multivariate analyses indicated that while EDSS FS moderately predicted subjective (MSWS-12) and objective (6MWT) walking impairments, strength (β = 8.62, p < 0.001) and fatigue (β = 0.10, p < 0.001) emerged as stronger predictors.

CONCLUSION

Low-disabled PwMS exhibit multidomain impairments and incorporating sensitive clinical assessments may facilitate early identification of subtle deficits, thereby enabling targeted interventions to improve mobility.

TRIAL REGISTRATION

NCT06219291 (09/11/2023).

Loss of ADAP1/CentA1 Protects Against Autoimmune Demyelination

ArfGAP with dual PH domain-containing protein 1 (ADAP1), also known as Centaurin alpha-1 (CentA1), is an actin-binding protein highly expressed in the central nervous system (CNS) that was previously shown to regulate dendritic spine density and plasticity. In the context of disease, ADAP1/CentA1 has been linked to Alzheimer's disease (AD) pathogenesis, cancer progression, and human immunodeficiency virus (HIV) reactivation. Here, we document that ADAP1/CentA1 is also mechanistically involved in CNS autoimmunity. We show that ADAP1/CentA1 deficient mice exhibit partial resistance to developing experimental autoimmune encephalomyelitis (EAE), an in vivo disease model recapitulating several features of multiple sclerosis (MS) pathogenesis. MS is a chronic autoimmune disorder of the CNS characterized by focal immune cell infiltration, demyelination, and axonal injury. Its etiology is still elusive, but genetic and environmental factors contribute to disease risk. By combining detailed immunophenotyping and single-cell RNA sequencing (scRNA-seq), we demonstrate that ADAP1/CentA1 is necessary for mounting a sufficient autoimmune response for EAE initiation and progression. In particular, the current study highlights that ADAP1/CentA1 expression in the immune system mainly targets the functioning of regulatory T cells (Tregs), monocytes, and natural killer (NK) cells. In summary, our study defines a novel function for ADAP/CentA1 outside of the CNS and helps elucidate the early molecular events taking place in the peripheral immune system in response to encephalitogenic challenges.

Protein Arginine Methyltransferases from Regulatory Function to Clinical Implication in Central Nervous System

Arginine methylation, catalyzed by protein arginine methyltransferases (PRMTs), is a regulatory key mechanism involved in various cellular processes such as gene expression, RNA processing, DNA damage repair. Increasing evidence highlights the crucial role of PRMTs in human diseases, including cancer, cardiovascular and metabolic diseases. Here, this review focuses on the latest findings regarding PRMTs in the central nervous system (CNS), emphasizing their regulatory roles in neural stem cells, neurons, and glial cells. Additionally, we examine the connection between PRMTs dysregulation and neurological diseases affecting the CNS, including brain tumors, neurodegenerative diseases, and neurodevelopmental disorders. Therefore, this review aims to deepen our understanding of PRMTs-mediated arginine methylation in CNS and open avenues for developing novel therapeutic strategies for neurological diseases.

Cyclooxygenase-1 and cyclooxygenase-2 densities measured using positron emission tomography are not altered in the brains of individuals with stable multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system that involves immune-mediated demyelination and axonal degeneration. Clinical imaging techniques play a critical role in diagnosing and assessing the prognosis of MS. Magnetic resonance imaging has been most frequently used to visualize demyelination and detect acute and chronic active lesions, which are key indicators of clinical course of illness. Previous research has also highlighted the effectiveness of translocator protein 18-kDa (TSPO) positron emission tomography (PET) imaging for identifying chronic active lesions and progressive pathology. Building on this work, the present study used PET imaging to explore the role of cyclooxygenase-1 and -2 (COX-1 and COX-2)-key enzymes involved in neuroinflammation-in individuals with MS. Five participants with MS were recruited, and lesions were identified using 7 Tesla MRI. No significant differences in COX radioligand binding were observed in the co-registered PET images between lesioned areas and normal-appearing brain tissues, nor between individuals with MS and healthy volunteers. The negative findings underscore the complexity of MS pathology and raise several important considerations for planning future studies using COX PET for imaging in MS.

Sphingosine 1-phosphate receptor 1 modulators exert neuroprotective effects in central nervous system disorders

The sphingosine 1-phosphate (S1P) signaling pathway has important and diverse functions. S1P receptors (S1PRs) are involved in the regulation of lymphocyte trafficking, cardio-cerebral function, vascular permeability, and bronchiolar tone, and have been recognized as therapeutic targets for a variety of diseases. A number of drugs related to the S1P signaling pathway have been approved for clinical use in the treatment of multiple sclerosis, and many similar drugs are also currently being tested in clinical trials at various stages. It appears that S1PR modulators may not only be useful for the treatment of multiple sclerosis, but may also have therapeutic effects on other types of central nervous system (CNS) disorders. The present review focuses on the therapeutic potential of S1PR1 modulators for treating disorders of the CNS.

Laser-Induced Cortical Lesions in Mice as a Model for Progressive Multiple Sclerosis Pathology

Background: The current animal models of multiple sclerosis (MS) predominantly emphasize white matter inflammation, reflecting early-stage disease. However, progressive MS (PMS) is characterized by cortical pathology, including subpial demyelination, chronic meningeal inflammation, and microglial activation, which are underrepresented in the existing models. While alternative mouse models replicate the relapsing-remitting phenotype and gray matter pathology, pathology is frequently dispersed throughout the brain, complicating the analysis of the specific lesion sites. Methods: To address this gap, we developed a novel model that integrates laser-induced focal demyelination with cytokine-driven meningeal inflammation to replicate the key aspects of PMS cortical pathology. Results: Using two-photon laser irradiation, we induced controlled subpial cortical lesions in CX3CR1-GFP mice, leading to microglial activation, astrocytosis, and focal demyelination. The addition of IFNγ-expressing adenovirus to promote meningeal inflammation which resulted in prolonged glial responses, increased immune cell infiltration, and exacerbated demyelination, mimicking the PMS-associated pathology. Conclusions: This model provides a powerful tool to investigate the mechanisms underlying the cortical lesion development and immune-mediated neurodegeneration in PMS. By capturing the critical aspects of cortical pathology, it enables the evaluation of therapeutic strategies targeting neuroinflammation and demyelination, ultimately aiding in the development of new treatments of progression in PMS patients.

Virus-specific antibody responses in multiple sclerosis patients treated with Ocrevus

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. B cell-depleting therapy is highly efficient in treating patients with relapsing-remitting MS (RRMS), although the mechanisms behind reducing disease progression with this type of therapy is unknown. Virus infections are associated with the onset of MS and antibodies to these have previously been suggested to supplement MS diagnostics. Based on this, we aimed to investigate the effect of Ocrevus (OCR) (B cell depletion therapy) on selected virus antibody levels. Blood samples were collected from RRMS patients before (n = 13) and during OCR treatment (n = 29) and from healthy controls (HCs) (n = 15). Serum antibodies to virus antigens from Epstein-Barr virus (EBV), severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), Rubella virus, Measles virus, John Cunningham polyomavirus, Mumps virus, Merkel cell polyomavirus, Varicella zoster virus, Influenza A virus, Human herpes virus 6, and Cytomegalovirus were analyzed by enzyme-linked immunosorbent assay. EBV nuclear antigen 1 (EBNA1) IgG levels were elevated in RRMS patients compared to HCs independent of OCR treatment. However, no significant difference in virus antibody levels was observed following OCR treatment. Only SARS-CoV-2 spike protein IgG levels were significantly reduced following OCR treatment. The effect of OCR treatment on antibody levels may correlate with the time of infection. Only EBV EBNA1 IgG levels were significantly elevated RRMS patients at baseline compared to HCs, supporting that EBV infection is involved in the development of MS and confirming the diagnostic value of EBNA1 IgG.

Treatment effects of cladribine tablets on data-driven patterns of regional grey matter atrophy in multiple sclerosis

BACKGROUND

Treatment with cladribine tablets (CladT) in relapsing-remitting multiple sclerosis (RRMS) reduced global grey matter (GM) atrophy, but the effects on regional GM are unknown.

OBJECTIVES

This study aimed to investigate the effect of CladT compared with placebo on magnetic resonance imaging (MRI)-derived patterns of GM atrophy.

METHODS

We used MRI and clinical data from the CLARITY study, including 393 people with RRMS (CladT (3.5 mg/kg), n = 200 or placebo, n = 193) at baseline, 24, 48 and 96 weeks after treatment initiation. SynthSeg-derived volume changes and GM atrophy patterns derived from source-based morphometry were analysed for group differences over time and associations with disability using mixed-effect models.

RESULTS

Deep GM (β = -0.03, p < 0.01), thalamus (β = -0.04, p < 0.01) and the brainstem-thalamus pattern (β = -0.03, p < 0.05) showed higher reduction in the placebo compared with treated group. These regions showed no effect during a predefined pseudo-atrophy period, where global volume loss was worse in the treatment group. Between W24 and W96, Expanded Disability Status Scale (EDSS) scores were associated with lower deep GM volume (β = -0.16, p = 0.001), thalamic volume (β = -0.16, p < 0.001), and the brainstem-thalamus pattern (β = -0.12, p < 0.05).

CONCLUSION

CladT are associated with clinically relevant and slower neurodegeneration in RRMS. Strongest effects were seen in deep GM, thalamus, and brainstem, underlining the importance of regional MRI measures for assessing treatment effects.

Explainable time-to-progression predictions in multiple sclerosis

BACKGROUND

Prognostic machine learning research in multiple sclerosis has been mainly focusing on black-box models predicting whether a patients' disability will progress in a fixed number of years. However, as this is a binary yes/no question, it cannot take individual disease severity into account. Therefore, in this work we propose to model the time to disease progression instead. Additionally, we use explainable machine learning techniques to make the model outputs more interpretable.

METHODS

A preprocessed subset of 29,201 patients of the international data registry MSBase was used. Disability was assessed in terms of the Expanded Disability Status Scale (EDSS). We predict the time to significant and confirmed disability progression using random survival forests, a machine learning model for survival analysis. Performance is evaluated on a time-dependent area under the receiver operating characteristic and the precision-recall curves. Importantly, predictions are then explained using SHAP and Bellatrex, two explainability toolboxes, and lead to both global (population-wide) as well as local (patient visit-specific) insights.

RESULTS

On the task of predicting progression in 2 years, the random survival forest achieves state-of-the-art performance, comparable to previous work employing a random forest. However, here the random survival forest has the added advantage of being able to predict progression over a longer time horizon, with AUROC >60% for the first 10 years after baseline. Explainability techniques further validated the model by extracting clinically valid insights from the predictions made by the model. For example, a clear decline in the per-visit probability of progression is observed in more recent years since 2012, likely reflecting globally increasing use of more effective MS therapies.

CONCLUSION

The binary classification models found in the literature can be extended to a time-to-event setting without loss of performance, thus allowing a more comprehensive prediction of patient prognosis. Furthermore, explainability techniques proved to be key to reach a better understanding of the model and increase validation of its behaviour.

Pregnancy-induced metabolic reprogramming and regenerative responses to pro-aging stresses

Pregnancy is associated with physiological adaptations that affect virtually all organs, enabling the mother to support the growing fetus and placenta while withstanding the demands of pregnancy. As a result, mammalian pregnancy is a unique state that exerts paradoxical effects on maternal health. On one hand, the metabolic stress induced by pregnancy can accelerate aging and functional decline in organs. On the other hand, pregnancy activates metabolic programming and tissue regenerative responses that can reverse age-related impairments. In this sense, the oocyte-to-blastocyst transition is not the only physiological reprogramming event in the mammalian body, as pregnancy-induced regeneration could constitute a second physiological reprogramming event. Here, we review findings on how pregnancy dualistically leads to aging and rejuvenation in the maternal body.

Cannabinoid Receptor 2 (CB2R) as potential target for the pharmacological treatment of neurodegenerative diseases

The endocannabinoid system (ECS) is a ubiquitous physiological system that plays a crucial role in maintaining CNS homeostasis and regulating its functions. It includes cannabinoid receptors (CBRs), endogenous cannabinoids (eCBs), and the enzymes responsible for their synthesis and degradation. In recent years, growing evidence has highlighted the therapeutic potential of the ECS and CBRs, in a wide range of severe diseases and pathological conditions, including Alzheimer's and Parkinson's diseases, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Huntington's Disease, HIV-1 associated neurocognitive disorders, neuropathic pain and migraine. Targeting the cannabinoid type 2 receptor (CB2R) has gained attention due to its ability to (i) mitigate neuroinflammatory responses, (ii) regulate mitochondrial function and (iii) provide trophic support, all without eliciting the psychotropic actions associated with CB1R activation. This review aims to explore the potential of CB2R modulation as a strategy for the prevention and treatment of neurologic disorders, exploring both preclinical and clinical findings.

Immune response to influenza vaccine in patients with relapsing multiple sclerosis treated with ofatumumab: Results from an open-label, multicenter, phase 4 study

BACKGROUND

There is currently a need for data regarding whether treatment with ofatumumab (OMB) impacts humoral immune response to vaccines, including the influenza vaccine, in patients with relapsing multiple sclerosis (RMS).

METHODS

Patients with RMS aged 18-55 years were grouped into three cohorts: cohort 1 (C1) received the influenza vaccine ≥2 weeks before starting OMB; cohort 2 (C2) received the vaccine ≥4 weeks after starting OMB; and cohort 3 (C3) was currently being treated with interferon/glatiramer acetate and received the influenza vaccine ≥4 weeks after enrollment. Patients with recent major infections were excluded. All groups underwent a hemagglutination inhibition (HI) titer before vaccination and 4 weeks after vaccination. The primary endpoint was achieving seroprotection to influenza at week 4 (post-vaccination antibody titer ≥40). Secondary endpoints included achieving seroconversion (post-vaccination HI titers ≥4-fold increase or ≥40 in those with pre-vaccination titers ≥10 or <10, respectively), change in HI titer, and adverse events (AEs).

RESULTS

Sixty-three patients (mean [standard deviation] age, 41.1 [8.5] years; 76.2 % female; 85.7 % White) were included (C1, n = 22; C2, n = 22; C3, n = 19). At week 4, seroprotection rates for influenza A Cambodia (C1, 86.7 %, 13/15; C2, 80.0 %, 4/5; C3, 66.7 %, 6/9) and influenza A Victoria (C1, 86.7 %, 13/15; C2, 100 %, 5/5; C3, 77.8 %, 7/9) were generally high. Seroprotection rates for influenza A Wisconsin (C1, 53.3 %, 8/15; C2, 40.0 %, 8/20; C3, 61.1 %, 11/18), influenza B Phuket (C1, 63.6 %, 14/22; C2, 68.2 %, 15/22; C3, 68.4 %, 13/19), and influenza B Washington (C1, 66.7 %, 10/15; C2, 20.0 %, 1/5; C3, 55.6 %, 5/9) were lower across all cohorts. Seroconversion rates at week 4 were variable across vaccine influenza strains. However, trends for lower rates of seroconversion in cohort 2 vs. cohorts 1 and 3 were broadly consistent across strains. Over the entire study, 16/22 (72.7 %) patients from cohort 1, 6/22 (27.3 %) patients from cohort 2, and 2/19 (10.5 %) patients from cohort 3 experienced one or more AEs. The higher frequency of AEs in cohort 1 is likely related to OMB initiation (i.e., systemic and injection-related reactions). One patient from cohort 2 experienced a serious AE (MS pseudo-relapse). No AEs resulting in discontinuation were reported.

CONCLUSION

Some OMB-treated patients with RMS were able to mount an immune response following inactivated influenza vaccination. Patients who were vaccinated before OMB initiation generally had a better immune response than those vaccinated after OMB initiation. No T-cell analyses were performed.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT04667117 (https://clinicaltrials.gov/study/NCT04667117).

Cholesterol Metabolism in CNS Diseases: The Potential of SREBP2 and LXR as Therapeutic Targets

The brain is the organ with the highest cholesterol content in the body. Cholesterol in the brain plays a crucial role in maintaining the integrity of synapses and myelin sheaths to ensure normal brain function. Disruptions in cholesterol metabolism are closely associated with various central nervous system (CNS) diseases, including Alzheimer's disease (AD), Huntington's disease (HD), and multiple sclerosis (MS). In this review, we explore the synthesis, regulation, transport, and functional roles of cholesterol in the CNS. We discuss in detail the associations between cholesterol homeostasis imbalance and CNS diseases including AD, HD, and MS, highlighting the significant role of cholesterol metabolism abnormalities in the development of these diseases. Sterol regulatory element binding protein-2 (SREBP2) and liver X receptor (LXR) are two critical transcription factors that play central roles in cholesterol synthesis and reverse transport, respectively. Their cooperative interaction finely tunes the balance of brain cholesterol metabolism, presenting potential therapeutic value for preventing and treating CNS diseases. We particularly emphasize the alterations in SREBP2 and LXR under pathological conditions and their impacts on disease progression. This review summarizes current therapeutic agents targeting these two pathways, with the hope of broadening the perspectives of CNS drug developers and encouraging further study into SREBP2 and LXR-related therapies for CNS diseases.

Tubulin Polymerization Promoting Proteins: Functional Diversity With Implications in Neurological Disorders

Tubulin Polymerization Promoting Proteins (TPPPs) are highly conserved across species but remain poorly understood. There are three TPPP genes in humans, with only one homologous TPPP gene in invertebrates, such as Drosophila and C. elegans. The human TPPP (TPPP1/p25/p25α) is enriched in the brain and shares sequence similarities with the invertebrate TPPPs. TPPP/p25 associates with microtubules and plays a pivotal role in microtubule dynamics, bundling, and polymerization, thereby stabilizing the microtubular network. This is essential for cytoskeletal organization and proper functioning of neurons and glial cells, including axonal growth, regeneration, migration, trafficking, synapse formation, and myelination of axons. However, studies have also uncovered that besides its cytoplasmic/microtubular localization, TPPP/p25 is present in other subcellular compartments, including the mitochondria and nucleus, underscoring the presence of additional novel functions. At the molecular level, TPPP/p25 is predicted to exist as an intrinsically disordered protein and is implicated in neurological and neurodegenerative disorders, including Parkinson's and related disorders and Multiple Sclerosis. In this article, we provide a comprehensive overview of TPPP/p25, highlighting its evolutionary conservation, cellular and subcellular localization, established and emerging functions in the nervous system, interacting partners, potential clinical relevance to human neurological disorders, and conclude with unresolved questions and future areas of study.

CLU polymorphisms and plasma clusterin levels in patients with multiple sclerosis: association with disability scores, progression rate and fingolimod therapy

OBJECTIVES

Multiple sclerosis (MS) is a chronic, demyelinating disorder of the central nervous system that is widely accepted to result from a complex interplay of genetic and environmental factors. The involvement of clusterin in neurodegenerative and autoimmune diseases has been highlighted, but its role in MS remains unclear. This study aimed to investigate the association of four single nucleotide polymorphisms (SNPs) in the clusterin gene (CLU) with MS susceptibility.

METHODS

The study group consisted of 310 patients with RRMS (pwRRMS) and 310 controls. 25 treatment-naïve pwRRMS, 25 pwRRMS on fingolimod treatment and 25 controls composed a subgroup for further analysis. The genotypes of 4 CLU SNPs were determined using either restriction endonuclease digestion following PCR (rs11136000 & rs3087554) or the real-time PCR method using TaqMan genotyping assays (rs2279590 & rs1532278). Plasma clusterin concentration was determined by ELISA in the subgroup (n = 75).

RESULTS

Our results revealed that CLU rs3087554 C allele (p = .008) and TC  +  CC genotype were significantly associated with RRMS (p = .002). Furthermore, haplotype analysis has also shown that T-C-T-T haplotype was associated with RRMS (p < .001). Moreover, plasma clusterin concentrations were significantly higher in pwRRMS on fingolimod therapy compared to treatment-naïve pwRRMS and the control group. In addition, plasma clusterin concentration was increased in patients with rs11136000 & rs1532278 CC genotypes in the subgroup.

DISCUSSION

These findings suggest that CLU SNPs and plasma clusterin concentrations could serve as significant biomarkers at different stages of MS.

Exploring the Potential Link Between Autoimmune Diseases and Pan-Cancer: A Multidatabase Mendelian Randomization Analysis

Background: The relationship between autoimmune diseases (AIDs) and cancer is unclear and this study aimed to investigate the relationship between AIDs and cancer at the genetic level using Mendelian randomization (MR). Methods: The study employed two-sample MR and meta-analysis to investigate the association between AIDs and 33 types of cancer, following STROBE-MR guidelines. Single nucleotide polymorphisms (SNPs) associated with AIDs were used as instrumental variables, with data from FinnGen, UK Biobank, and other databases. MR analyses included sensitivity checks, heterogeneity assessments, and reverse causality tests, using multiple MR methods (inverse-variance weighted (IVW), weighted median, MR-Egger, etc.). Meta-analysis was performed on validated results to confirm findings, with statistical analyses conducted using R software. Results: The results identified eight significant associations in both discovery and replication stages. Key findings include that myasthenia gravis (MG) significantly increases the risk of oral cavity cancer, multiple sclerosis (MS) is linked to increased risks of chronic lymphocytic leukemia (CLL) and small intestine cancer, and ulcerative colitis (UC) has mixed effects, reducing the risk of uterine cervix and larynx cancers, but increasing risks for pancreatic and bladder cancers. Meta-analysis confirmed eight secondary findings, highlighting pathogenic associations such as type 1 diabetes with esophagus cancer and protective effects like systemic lupus erythematosus (SLE) against acute myelocytic leukemia. Conclusions: This study provides evidence of a causal relationship between multiple AIDs and different cancer risks at the genetic level and provides a reference for the health management of patients with AIDs.

Sex Hormone-Related Pathogenic Genes in Multiple Sclerosis: A Multi-omics Mendelian Randomization Study

Multiple sclerosis (MS) is a chronic autoimmune disease with complex etiologies, including genetic factors. Sex hormones have been implicated in MS pathogenesis, but the underlying genetic mechanisms remain unclear.This study employed a multi-omics Mendelian randomization (MR) approach to evaluate the causal associations between sex hormone-related genes and MS. We utilized summary data from genome-wide association studies (GWAS) and blood-based methylation quantitative trait loci (mQTLs), expression QTL (eQTLs), and proteomic QTL (pQTLs). The analysis employed the summary data-based MR (SMR) method and the HEIDI test for pleiotropy. Colocalization analysis identified shared genetic determinants, validated in UK Biobank and FinnGen R10 cohort. Our study identified a total of 30 mQTLs and 15 eQTLs that confirmed the causal associations between sex hormone-related genes and MS by SMR and colocalization analyses. Notably, the methylation site cg19286687 of the DES gene was positively associated with MS risk. Similarly, DES expression was positively associated with MS risk in eQTL data. Integration of mQTL and eQTL data revealed a positive regulatory association between cg19286687 and DES expression, suggesting that low methylation level of cg19286687 may inhibit DES expression, potentially contributing to MS risk reduction. This multi-omics MR study suggests a potential causal association between sex hormone-related genes and MS. The findings highlight the importance of DES and its methylation the pathogenesis of MS, offering new ideas on disease mechanisms.

Performance of a Modified Version of the Charlson Comorbidity Index in Predicting Multiple Sclerosis Disability Accrual

BACKGROUND

The natural history of multiple sclerosis (MS) is highly heterogeneous and almost unpredictable since several factors may affect the disease course including comorbidities. The aims of this study were to predict the risk of disability worsening and disease progression at the first patient's visit by using a modified version of the Charlson Comorbidity Index (mCCI).

METHODS

the mCCI was obtained by incorporating the grade of pyramidal functional system scores extracted by the Expanded Disability Status Scale (EDSS) into the original CCI version. The risk of reaching EDSS 4, EDSS 6, and secondary MS progression (SPMS) associated to mCCI classes was calculated by carrying out multivariable Cox-regression models and it was reported as hazard ratios (HRs) and 95% confidence intervals (95% CIs). The accuracy of mCCI for the recognition of individuals who reached the study milestones was estimated by building the receiving operator curves and the optimal cut-off values were estimated.

RESULTS

A total of n = 622 individuals were enrolled (72.7% women; median age 30.8 years [24-40]). Compared with patients with a mCCI equal to zero, the HRs for those with a mCCI comprised between 1 and 2 at the first visit were 1.53 (1.1-2.1), 2.17 (1.48-2.96), and 1.57 (1.16-2.1) for the reaching of EDSS 4, EDSS 6, and SPMS, respectively. Moreover, individuals with a mCCI equal or higher than 3 were at even higher risk of reaching EDSS 6 (HR = 2.34 [1.44-3.8]) and SPMS conversion (HR = 2.38 [1.29-4.01]). The mCCI cut-off value of 3 reached a sensitivity and specificity of 88.1% and 77.8%, respectively, for the recognition of EDSS 4, while the mCCI cut-off of 4 reached a sensitivity of 83.1% and a specificity of 80.7% for the recognition of EDSS 6 and a sensitivity and a specificity of 76.8% and 87.5%, respectively, for the recognition of SPMS conversion.

CONCLUSION

mCCI appeared a simple and fast tool for the prediction of MS prognosis since the first patient's visit and its best cut-off values showed higher sensitivity and specificity for the recognition of patients who undergo disability worsening and SPMS conversion.

Internet-based exercise and physical activity promotion for persons with multiple sclerosis: a randomized controlled trial

BACKGROUND

We evaluated the effects of a 12-week internet-based exercise and physical activity promotion program for persons with multiple sclerosis.

METHODS

We performed a multicenter, randomized, waitlist-controlled study. The intervention group (IG) received the 12-week program, followed by 12 weeks with usual care. The control group (CG) received usual care only. The main components of the 12-week program were: (1) a tailored home-based exercise prescription, (2) e-learning resources, (3) telephone and video meetings with an exercise therapist, (4) the provision of a consumer-based PA monitor. Measurements were taken at baseline, postintervention, and after 24 weeks. The primary outcome was device-measured steps/day. Other outcomes were device-measured moderate-to-vigorous physical activity, subjectively measured leisure-time and transportation physical activity and sport/exercise, physical activity-related health competence, walking ability, quality of life, fatigue, depression, and PA-related self-concordance. We compared changes from baseline to postintervention between groups and analyzed changes in the IG during the follow-up.

RESULTS

Analysis of 56 persons with multiple sclerosis (IG: n = 29, CG: n = 27, age: 45.6 ± 10.9) revealed no significant intervention effect on steps/day. However, significant improvements were observed in moderate-to-vigorous physical activity, sport/exercise, control competence, fatigue, and quality of life (physical). During the follow-up, sport/exercise and quality of life decreased significantly. Leisure-time and transportation physical activity increased significantly.

CONCLUSIONS

Our study provides first evidence that the developed program can increase control competence, aspects of physical activity and health in persons with multiple sclerosis. A trial with a larger sample is recommended to confirm our results and examine intervention mechanisms.

TRIAL REGISTRATION

Registry: Clinicaltrials.gov; registration number: NCT04367389; date of registration: 2020-04-21 (retrospectively registered).

Lipid Metabolism and Statin Therapy in Neurodegenerative Diseases: An Endocrine View

Background/aim: A growing body of evidence suggests a link between dyslipidemias and neurodegenerative diseases, highlighting the crucial role of lipid metabolism in the health of the central nervous system. The aim of our work was to provide an update on this topic, with a focus on clinical practice from an endocrinological point of view. Endocrinologists, being experts in the management of dyslipidemias, can play a key role in the prevention and treatment of neurodegenerative conditions, through precocious and effective lipid profile optimization. Methods: The literature was scanned to identify clinical trials and correlation studies on the association between dyslipidemia, statin therapy, and the following neurodegenerative diseases: Alzheimer's disease (AD), Parkisons's disease (PD), Multiple sclerosis (MS), and Amyotrophic lateral sclerosis (ALS). Results: Impaired lipid homeostasis, such as that frequently observed in patients affected by obesity and diabetes, is related to neurodegenerative diseases, such as AD, PD, and other cognitive deficits related to aging. AD and related dementias are now a real priority health problem. In the United States, there are approximately 7 million subjects aged 65 and older living with AD and related dementias, and this number is projected to grow to 12 million in the coming decades. Lipid-lowering therapy with statins is an effective strategy in reducing serum low-density lipoprotein cholesterol to normal range concentrations and, therefore, cardiovascular disease risk; moreover, statins have been reported to have a positive effect on neurodegenerative diseases. Conclusions: Several pieces of research have found inconsistent information following our review. There was no association between statin use and ALS incidence. More positive evidence has emerged regarding statin use and AD/PD. However, further large-scale prospective randomized control trials are required to properly understand this issue.

Selective IgM Hypogammaglobulinemia and Multiple Sclerosis Treated with Natalizumab and Ofatumumab: A Case Report

Background: B-cell-depleting drugs targeting the CD20 antigen have been increasingly implemented as an "exit strategy" from natalizumab for relapsing-remitting multiple sclerosis (RRMS) patients due to the increased risk of progressive multifocal leukoencephalopathy. Data on recently approved anti-CD20 drugs, such as ofatumumab serving as a natalizumab "exit strategy", are lacking. Furthermore, due to their immunosuppressive mechanism of action, prolonged use of these "highly effective" drugs is associated with the development of hypogammaglobulinemia and, consequently, a higher risk of infections. There are no guidelines for monitoring serum immunoglobulin levels in individuals undergoing "highly effective" multiple sclerosis treatment. Methods: We present a case of a 26-year-old male RRMS patient with selective IgM deficiency and multiple sclerosis initially treated with natalizumab and later ofatumumab. Results: The patient achieved "no evident disease activity "status while undergoing treatment with natalizumab and ofatumumab, but these therapies, especially ofatumumab, greatly impacted further drops in IgM levels. However, no significant decrease in IgG levels was observed, and no infectious events occurred. In addition, the patient did not show signs of disease activity while on ofatumumab, which also offered a more convenient mode of administration. Conclusions: Our experience points to the need to further explore benefit-risk ratios of highly effective treatments, even in cases with low immunoglobulin levels. However, closely monitoring immunoglobulin levels and conducting clinical follow-ups to ensure prompt recognition of potential infectious complications constitute approaches that have been thought of for such patients.

Vitamin B6 status is related to disease severity and modulated by endurance exercise in individuals with multiple sclerosis: a secondary analysis of a randomized controlled trial

BACKGROUND

Low circulating concentrations of B vitamins are linked to various chronic and neurodegenerative diseases. Notably, pyridoxal 5'-phosphate (vitamin B6) deficiency is linked to altered inflammatory responses and cellular immune function, both critical in multiple sclerosis (MS). Nevertheless, most MS research has focused on folate (vitamin B9) and vitamin B12, leaving other B vitamins understudied.

OBJECTIVES

This secondary analysis investigated B-vitamin serum concentrations and related metabolites across MS phenotypes (primary progressive MS, relapsing-remitting MS, and secondary progressive MS) and disease severity levels. Additionally, the impact of endurance exercise on B-vitamin concentrations was investigated.

METHODS

In total, 106 individuals with MS participated in a randomized controlled trial, including different endurance exercise conditions. Serum B-vitamin concentrations were analyzed in 99 participants before and after 3 wk of intervention. Before analysis, participants were dichotomized to 1 of the 2 disability groups based on their expanded disability status scale (EDSS) score: EDSS≥4.5 (n = 47, EDSS: 5.86 ± 0.56) and EDSS<4 (n = 52, EDSS: 3.59 ± 0.83).

RESULTS

Higher EDSS scores were associated with lower pyridoxal 5'-phosphate (vitamin B-6) concentrations (rs: -0.32; 95% CI: -0.49, -0.12; P = 0.011), with the EDSS≥4.5 group also showing lower baseline pyridoxal 5'-phosphate (vitamin B6) concentrations (β: -0.18; 95% CI: -0.30, -0.07; P = 0.007) than the EDSS<4 group. Significant time × EDSS group interactions were evident for pyridoxal 5'-phosphate (vitamin B6; β: 0.05; 95% CI: 0.02, 0.08; P = 0.011), pyridoxal (vitamin B6; β: 0.05; 95% CI: 0.02, 0.09; P = 0.005), and riboflavin (vitamin B2; β: 0.06; 95% CI: 0.02, 0.09; P = 0.008), showing increases in these vitamers in the EDSS≥4.5 group postexercise. N1-Methylnicotinamide (vitamin B3; β: -0.11; 95% CI: -0.15, -0.06; P < 0.001) decreased in both groups over time.

CONCLUSIONS

Disease severity is associated with distinct B-vitamin profiles in individuals with MS, although endurance exercise appears to modify specific B-vitamin concentrations. This trial was registered at clinicaltrials.gov as NCT04356248.

User requirements for quantitative radiological reports in multiple sclerosis

OBJECTIVES

Quantitative radiological reports (QReports) can enhance clinical management of multiple sclerosis (MS) by including quantitative data from MRI scans. However, the lack of consensus on the specific information to include, on and clinicians' preferences, hinders the adoption of these imaging analysis tools. This study aims to facilitate the clinical implementation of QReports by determining clinicians' requirements regarding their use in MS management.

MATERIALS AND METHODS

A four-phase Delphi panel approach was employed, involving neurologists and (neuro)radiologists across Europe. Initial interviews with experts helped develop a questionnaire addressing various QReport aspects. This questionnaire underwent refinement based on feedback and was distributed through the MAGNIMS network. A second questionnaire, incorporating additional questions, was circulated following a plenary discussion at the MAGNIMS workshop in Milan in November 2023. Responses from both questionnaire iterations were collected and analyzed, with adjustments made based on participant feedback.

RESULTS

The study achieved a 49.6% response rate, involving 78 respondents. Key preferences and barriers to QReport adoption were identified, highlighting the importance of integration into clinical workflows, cost-effectiveness, educational support for interpretation, and validation standards. Strong consensus emerged on including detailed lesion information and specific brain and spinal cord volume measurements. Concerns regarding report generation time, data protection, and reliability were also raised.

CONCLUSION

While QReports show potential for improving MS management, incorporation of the key metrics and addressing the identified barriers related to cost, validation, integration, and clinician education is crucial for practical implementation. These recommendations for developers to refine QReports could enhance their utility and adoption in clinical practice.

KEY POINTS

Question A lack of consensus on essential features for quantitative magnetic resonance imaging reports limits their integration into multiple sclerosis management. Findings This study identified key preferences, including detailed lesion information, specific brain and spinal cord measurements, and rigorous validation for effective quantitative reports. Clinical relevance This study identified essential features and barriers for implementing quantitative radiological reports in multiple sclerosis management, aiming to enhance clinical workflows, improve disease monitoring, and ultimately provide better, data-driven care for patients through tailored imaging solutions.

Experimental autoimmune encephalomyelitis pathogenesis alters along animal age: impact of S100B expression

Multiple Sclerosis (MS) is the leading inflammatory and non-traumatic cause of disability in young adults, with late-onset MS emerging in middle-aged patients often resulting in poorer treatment responses and worse prognoses. The calcium-binding protein S100B is elevated in MS patients, and its targeting has shown promise in reducing disease severity in experimental autoimmune encephalomyelitis (EAE) models. However, most studies on MS pathology have focused on young animal models, leaving a gap in understanding the effects of age and S100B ablation on disease progression throughout the lifespan. This study aimed to characterize EAE in mice of different ages, examining demyelination, inflammation, and immune responses to determine whether S100B ablation could mitigate MS pathogenesis across the lifespan. EAE was induced in six cohorts of C57BL/6 mice: young adults (3 months), older adults (6 months), and middle-aged (12 months), including corresponding S100B knockout (KO) groups, followed for 23 days. Upon sacrifice, spinal cords were assessed via immunohistochemistry and Real-Time qPCR, while splenocytes were analyzed for immune cell characterization. Results indicated a more severe disease course in 12-month-old mice, marked by increased gliosis, inflammation, and impaired microglial phagocytic activity. Notably, S100B absence reduced gliosis and inflammatory markers across all ages, with 12-month-old S100B KO mice showing increased regulatory T cells. These findings highlight the exacerbating role of age and elevated S100B in MS progression, underscoring the importance of identifying age-specific MS markers and therapeutic targets.

Trauma Burden Affected People with Multiple Sclerosis During SARS-CoV-2 Pandemic

Background/Objectives: Trauma is a psychological injury resulting from a distressing or overwhelming event. The SARS-CoV-2 pandemic has been disruptive and traumatic for many people with multiple sclerosis (pwMS). The relationship between patient characteristics and trauma in pwMS during the pandemic has not yet been thoroughly explored. The aim of this bicentric prospective cohort study was to analyze the prevalence and development of probable post-traumatic stress disorder (PTSD) among pwMS during the SARS-CoV-2 pandemic and to identify patient parameters associated with this condition. Methods: We have assessed pwMS for probable PTSD before and after the approval of the first SARS-CoV-2 vaccines in Germany using an adapted version of the Trauma Screening Questionnaire (TSQ). We compared pwMS with probable PTSD (TSQ sum score ≥ 6) with those without probable PTSD (TSQ sum score < 6) regarding sociodemographic and MS-specific clinical characteristics, polypharmacy status, comorbidities, anxiety/depression levels, personality traits, mental/physical/social burden, and general vaccination willingness. Results: Out of the 149 pwMS included, 8.1% were identified as having probable PTSD. These patients had significantly higher rates of pre-pandemic abnormal anxiety (66.7% vs. 18.5%, p < 0.001) and depression scores (45.5% vs. 12.6%, p = 0.013). The patients with probable PTSD exhibited a distinct personality profile, with significantly higher neuroticism and harm avoidance scores and lower conscientiousness, cooperativeness, and self-directedness scores. They were also significantly more likely to report severe or very severe mental/physical/social burdens during the pandemic compared to those without probable PTSD (p ≤ 0.045). Conclusions: Medical and social services should be provided to support patients who experienced serious stress or trauma. The development of concepts for education and vaccination procedures should be accompanied by comprehensive and clear communication that recognizes individual risk factors and addresses possible concerns with evidence-based and convincing arguments.

Neuroprotective effects of ghrelin in cuprizone-induced rat model of multiple sclerosis

Multiple sclerosis (MS) is an inflammatory central nervous system disease characterized by demyelination and axonal loss and is the main cause of non-traumatic neurological disability in young adults. Although there are several treatment approaches to manage the disease, there is no definitive cure for multiple sclerosis. Inflammation and oxidative stress are known to play important roles in the pathophysiology of MS. Ghrelin, a peptide secreted by the stomach, is reported to have neuroprotective properties through several pathways, including attenuating oxidative stress and inflammation. In the present study cuprizone (CPZ)-induced model of MS was used in Wistar albino rats to study the possible anti-inflammatory, antioxidant and neuroprotective effects of ghrelin. Rats were randomly divided into six groups: Control groups (Control35 and Control-S42), demyelination group, remyelination group, remyelination + ghrelin (20 µg/kg) group and remyelination + ghrelin (40 µg/kg) group. Y maze test was performed on the rats on their last day of the experiment. Oxidative stress and inflammatory parameters were investigated in brain using commercial kits by enzyme-linked immunosorbent assay (ELISA). Luxol fast blue (LFB) and hematoxylen&eosin (H&E) staining were performed in brain tissues. CPZ leads to a significant decrease in glutathione peroxidase (GSH-Px) levels and myelin content and a significant increase in malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-ɑ), interleukin- 6 (IL- 6) levels, the number of lymphatic cells and inflammatory cells. A significant increase in the antioxidant parameter levels and a significant decrease in MDA levels were found in the ghrelin treated groups (p < 0.05). CPZ leads to irregular, fragmented, demyelinating nerve fibers. A more significant remyelination was observed in the ghrelin treated groups compared to the other groups (p < 0.05). In conclusion, ghrelin treatment showed neuroprotective and antioxidant properties and reduced demyelination in the CPZ-induced rat model of multiple sclerosis.

Long-term disability trajectories in multiple sclerosis: a group-based trajectory analysis of the AusLong cohort

BACKGROUND

Previous natural history studies highlighted a consistent heterogeneity of disability trajectories among individuals with primary or secondary progressive multiple sclerosis (MS). However, evidence on disability progression in relapsing onset MS is scarce.The aim of this study was to investigate heterogeneity in disability accumulation over 10 years following a first clinical diagnosis of central nervous system demyelination (FCD) and identify genetic, demographic, environmental and clinical factors associated with these trajectories.

METHODS

We used group-based trajectory models to measure heterogeneity in disability trajectories based on the Expanded Disability Status Scale (EDSS) in a prospectively assessed cohort of 263 participants. To capture sustained neurological impairments and avoid issues related to significant changes in EDSS associated with relapse, we did not consider EDSS points recorded within 3 months of a relapse.

RESULTS

We identified three distinct and clinically meaningful disability trajectories: No/minimal, moderate and severe. Those in the no/minimal disability trajectory showed no appreciable progression of disability (median EDSS∼1 at 10-year review) while those in the moderate and severe disability trajectories experienced disability worsening (median time to reach EDSS 4 was 9 and 7 years, respectively). Compared with the no/minimal disability trajectory, those with older age, a higher number of relapses within the first 5 years post-FCD, and a higher number of comorbidities at baseline were more likely to be in the worse disability trajectory. Surprisingly, baseline MRI and anatomical site of initial symptoms did not influence long-term outcomes.

CONCLUSIONS

Those at higher risk of faster MS disability progression can be identified based on their early clinical characteristics with potential therapeutic implications for early intervention and treatment escalation.

Brain Volume Measures in Adults with MOG-Antibody-Associated Disease: A Longitudinal Multicenter Study

Background/Objectives: Little is known about the impact of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) on brain atrophy. This multicenter longitudinal study compares brain MRI volumes and T2 lesion volume between MOGAD patients, relapsing-remitting MS (RRMS) patients and a healthy control (HC) group with brain MRI scans available from an online repository. Methods: In total, 16 adult MOGAD patients (9 F) were age- and sex-matched with 44 RRMS patients (17 F) recruited in Verona MS Center and 14 HC subjects. The availability of two brain MRI scans performed 18 ± 6 months apart was mandatory for each patient. Annual percentage brain volume change (PBVC/y), baseline global brain, white matter (WM), gray matter (GM) regional brain volumes and T2 lesion volume were compared between groups. Results: PBVC/y was lower in MOGAD than in RRMS patients (p = 0.014) and lower in HC subjects than in MS patients (p = 0.005). Overall, MOGAD showed higher mean global brain (p = 0.012) and WM volume (p = 0.024) but lower median T2 lesion volume at timepoint 1 (p < 0.001); T2 lesion volume increased over time in the RRMS (p < 0.001) but not in the MOGAD cohort (p = 0.262). Conclusions: The structural brain MRI features of MOGAD show higher global brain and WM volumes and lower brain volume loss over time compared to RRMS, suggesting different underlining pathogenetic mechanisms.

Repurposed Drugs to Enhance the Therapeutic Potential of Oligodendrocyte Precursor Cells Derived from Adult Rat Adipose Tissue

Failure in the proliferation, recruitment, mobilization, and/or differentiation of oligodendrocyte precursor cells (OPCs) impedes remyelination in central nervous system (CNS) demyelinating diseases. Our group has recently achieved the generation of functional oligodendroglia through direct lineage conversion by expressing Sox10, Olig2, and Zfp536 genes in adult rat adipose tissue-derived stromal cells. The present study aimed to determine whether various repurposed drugs or molecules could enhance the myelinating capacities of these induced OPCs (iOPCs). We report that kainate, benztropine, miconazole, clobetasol, and baclofen promote in vitro iOPCs migration, differentiation, and ensheathing abilities through mechanisms similar to those observed in rat neural stem cell-derived OPCs. This research supports the potential use of iOPCs as they provide an alternative and reliable cell source for testing the effects of in vitro promyelinating repurposed drugs and for assessing the molecular and cellular mechanisms involved in therapeutic strategies for demyelinating diseases.