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Canto-Gomes J, Boleixa D, Teixeira C, Martins da Silva A, González-Suárez I, Cerqueira J, Correia-Neves M, Nobrega C. Distinct disease-modifying therapies are associated with different blood immune cell profiles in people with relapsing-remitting multiple sclerosis. Int Immunopharmacol 2024; 131:111826. [PMID: 38461632 DOI: 10.1016/j.intimp.2024.111826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
Disease modifying therapies (DMTs) used for treating people with relapsing-remitting multiple sclerosis (pwRRMS) target the immune system by different mechanisms of action. However, there is a lack of a comprehensive assessment of their effects on the immune system in comparison to treatment-naïve pwRRMS. Herein, we evaluated the numbers of circulating B cells, CD4+ and CD8+ T cells, regulatory T cells (Tregs), natural killer (NK) cells and NKT cells, and their subsets, in pwRRMS who were treatment-naïve or treated with different DMTs. Compared to treatment-naïve pwRRMS, common and divergent effects on immune system cells were observed on pwRRMS treated with different DMTs, with no consistent pattern across all therapies in any of the cell populations analysed. PwRRMS treated with fingolimod, dimethyl fumarate (DMF), or alemtuzumab have reduced numbers of CD4+ and CD8+ T cells, as well as Treg subsets, with fingolimod causing the most pronounced decrease in T cell subsets. In contrast, teriflunomide and interferon (IFN) β have minimal impact on T cells, and natalizumab marginally increases the number of memory T cells in the blood. The effect of DMTs on the B cell, NKT and NK cell subsets is highly variable with alemtuzumab inducing a strong increase in the number of the most immature NK cells and its subsets. This study comprehensively evaluates the magnitude of the effect of different DMTs on blood immune cells providing a better understanding of therapy outcome. Furthermore, the lack of a discernible pattern in the effects of DMTs on blood immune cells suggests that multiple immune cells can independently modulate the disease.
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Affiliation(s)
- João Canto-Gomes
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Daniela Boleixa
- Porto University Hospital Center, Porto, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB) - ICBAS, University of Porto, Porto, Portugal
| | - Catarina Teixeira
- Porto University Hospital Center, Porto, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB) - ICBAS, University of Porto, Porto, Portugal
| | - Ana Martins da Silva
- Porto University Hospital Center, Porto, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB) - ICBAS, University of Porto, Porto, Portugal
| | - Inés González-Suárez
- Álvaro Cunqueiro Hospital, Vigo, Spain; University Hospital Complex of Vigo, Vigo, Spain
| | - João Cerqueira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Hospital of Braga, Braga, Portugal; Clinical Academic Centre, Hospital of Braga, Braga, Portugal
| | - Margarida Correia-Neves
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Division of Infectious Diseases and Center for Molecular Medicine, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Claudia Nobrega
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.
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Zrzavy T, Rieder K, Wuketich V, Thalhammer R, Haslacher H, Altmann P, Kornek B, Krajnc N, Monschein T, Schmied C, Zebenholzer K, Zulehner G, Berger T, Rommer P, Leutmezer F, Bsteh G. Immunophenotyping in routine clinical practice for predicting treatment response and adverse events in patients with MS. Front Neurol 2024; 15:1388941. [PMID: 38689880 PMCID: PMC11058637 DOI: 10.3389/fneur.2024.1388941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Background Recent studies proposed cellular immunoprofiling as a surrogate for predicting treatment response and/or stratifying the occurrence of adverse events (AEs) in persons with multiple sclerosis (pwMS). However, applicability in real-world circumstances is not sufficiently addressed. Objective We aimed to explore whether standard routine clinical leukocyte phenotyping before treatment initiation could help stratify patients according to treatment response or AEs in a real-world MS cohort. Methods In this retrospective study, 150 pwMS were included, who had been newly initiated on a disease-modifying drug (DMD) and had been assessed for standard immunophenotyping before DMD initiation (baseline) and at least once during the following year. Multivariate models were used to assess an association of immune subsets and the association between immune cell profiles regarding treatment response and AEs. Results We found that the composition of T cell subsets was associated with relapse activity, as an increased proportion of CD8+ lymphocytes at baseline indicated a higher likelihood of subsequent relapse (about 9% per 1% increase in CD8+ proportion of all CD3+ cells). This was particularly driven by patients receiving anti-CD20 therapy, where also EDSS worsening was associated with a higher number of CD8+ cells at baseline (3% increase per 10 cells). In the overall cohort, an increase in the proportion of NK cells was associated with a higher risk of EDSS worsening (5% per 1% increase). Occurrence of AEs was associated with a higher percentage of T cells and a lower number of percentual NKT cells at baseline. Conclusion Immune cell profiles are associated with treatment response and the occurrence of AEs in pwMS. Hence, immunophenotyping may serve as a valuable biomarker to enable individually tailored treatment strategies in pwMS.
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Affiliation(s)
- Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Kerstin Rieder
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Viktoria Wuketich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Tobias Monschein
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christiane Schmied
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Sánchez-Sanz A, Muñoz-Viana R, Sabín-Muñoz J, Moreno-Torres I, Brea-Álvarez B, Rodríguez-De la Fuente O, García-Merino A, Sánchez-López AJ. Response to Fingolimod in Multiple Sclerosis Patients Is Associated with a Differential Transcriptomic Regulation. Int J Mol Sci 2024; 25:1372. [PMID: 38338652 PMCID: PMC10855583 DOI: 10.3390/ijms25031372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Fingolimod is an immunomodulatory sphingosine-1-phosphate (S1P) analogue approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). The identification of biomarkers of clinical responses to fingolimod is a major necessity in MS to identify optimal responders and avoid the risk of disease progression in non-responders. With this aim, we used RNA sequencing to study the transcriptomic changes induced by fingolimod in peripheral blood mononuclear cells of MS-treated patients and their association with clinical response. Samples were obtained from 10 RRMS patients (five responders and five non-responders) at baseline and at 12 months of fingolimod therapy. Fingolimod exerted a vast impact at the transcriptional level, identifying 7155 differentially expressed genes (DEGs) compared to baseline that affected the regulation of numerous signaling pathways. These DEGs were predominantly immune related, including genes associated with S1P metabolism, cytokines, lymphocyte trafficking, master transcription factors of lymphocyte functions and the NF-kB pathway. Responder and non-responder patients exhibited a differential transcriptomic regulation during treatment, with responders presenting a higher number of DEGs (6405) compared to non-responders (2653). The S1P, NF-kB and TCR signaling pathways were differentially modulated in responder and non-responder patients. These transcriptomic differences offer the potential of being exploited as biomarkers of a clinical response to fingolimod.
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Affiliation(s)
- Alicia Sánchez-Sanz
- Neuroimmunology Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Madrid, Spain;
| | - Rafael Muñoz-Viana
- Bioinformatics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Madrid, Spain;
| | - Julia Sabín-Muñoz
- Department of Neurology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (J.S.-M.); (O.R.-D.l.F.)
| | - Irene Moreno-Torres
- Demyelinating Diseases Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Beatriz Brea-Álvarez
- Radiodiagnostic Division, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Ofir Rodríguez-De la Fuente
- Department of Neurology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (J.S.-M.); (O.R.-D.l.F.)
| | - Antonio García-Merino
- Neuroimmunology Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Madrid, Spain;
- Department of Neurology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (J.S.-M.); (O.R.-D.l.F.)
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM), 08028 Barcelona, Spain
| | - Antonio J. Sánchez-López
- Neuroimmunology Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Madrid, Spain;
- Red Española de Esclerosis Múltiple (REEM), 08028 Barcelona, Spain
- Biobank, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Madrid, Spain
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Malone K, Shearer JA, Waeber C, Moore AC. The impact of fingolimod on Treg function in brain ischaemia. Eur J Immunol 2023; 53:e2350370. [PMID: 37366289 DOI: 10.1002/eji.202350370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Fingolimod has generally shown neuroprotective effects in stroke models. Here, we tested the hypothesis that fingolimod modulates T-cell cytokine production towards a regulatory phenotype. Second, we investigated how fingolimod altered the Treg suppressive function and the sensitivity of effector T cells to regulation. Mice that had underwent the permanent electrocoagulation of the left middle cerebral artery received saline or fingolimod (0.5 mg/kg) daily for 10-days post-ischaemia. Fingolimod improved neurobehavioural recovery compared to saline control and increased Treg frequency in the periphery and brain. Tregs from fingolimod-treated animals had a higher expression of CCR8. Fingolimod increased the frequencies of CD4+ IL-10+ , CD4+ IFN-γ+ and CD4+ IL-10+ IFN-γ+ cells in spleen and blood, and CD4+ IL-17+ cells in the spleen, with only minor effects on CD8+ T-cell cytokine production. Treg from post-ischaemic mice had reduced suppressive function compared to Treg from non-ischaemic mice. Fingolimod treatment rescued this function against saline-treated but not fingolimod-treated CD4+ effector T cells. In conclusion, fingolimod seems to improve the suppressive function of Treg post-stroke while also increasing the resistance of CD4+ effector cells to this suppression. Fingolimod's capacity to increase both effector and regulatory functions may explain the lack of consistent improvement in functional recovery in experimental brain ischaemia.
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Affiliation(s)
- Kyle Malone
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Jennifer A Shearer
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Christian Waeber
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Anne C Moore
- School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
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5
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Rodero-Romero A, Sainz de la Maza S, Fernández-Velasco JI, Monreal E, Walo-Delgado PE, Chico-García JL, Villarrubia N, Rodríguez-Jorge F, Rodríguez-Ramos R, Masjuan J, Costa-Frossard L, Villar LM. Blood CD8+ Naïve T-Cells Identify MS Patients with High Probability of Optimal Cellular Response to SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:1399. [PMID: 37766078 PMCID: PMC10535818 DOI: 10.3390/vaccines11091399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
This single-center study included 68 multiple sclerosis (MS) patients who received the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination from one of several approved vaccine preparations in Spain. Blood samples were collected one to three months after the second dose of the vaccine had been administered. Cellular immune responses to the vaccine were assessed using QuantiFERON analysis, and peripheral blood mononuclear cell subsets were assayed using flow cytometry. Response associated with higher percentages of total lymphocytes, naïve CD4+ T-cells (p = 0.028), CD8+ T-cells (p = 0.013), and, mostly, naïve CD8+ T-cells (p = 0.0003). These results were confirmed by analyzing absolute numbers (p = 0.019; p = 0.002, and p = 0.0003, respectively). Naïve CD8 T-cell numbers higher than 17 cells/μL were closely associated with an optimal cellular response to SARS-CoV-2 vaccination (odds ratio: 24.0, confidence interval: 4.8-460.3; p = 0.0001). This finding clearly shows that independent of the treatment received, higher numbers of naïve CD8+ T-cells yield a strong cellular response to SARS-CoV-2 vaccines in MS patients. If this finding is validated with other viruses/vaccines, it could provide a good tool for identifying MS patients undergoing treatment who will develop strong cellular responses to anti-virus vaccines.
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Affiliation(s)
- Alexander Rodero-Romero
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - José Ignacio Fernández-Velasco
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - Paulette Esperanza Walo-Delgado
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
| | - Juan Luis Chico-García
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - Noelia Villarrubia
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
| | - Fernando Rodríguez-Jorge
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - Rafael Rodríguez-Ramos
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - Lucienne Costa-Frossard
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Universidad de Alcalá, 28034 Madrid, Spain (E.M.); (J.L.C.-G.); (F.R.-J.); (J.M.); (L.C.-F.)
| | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Universidad de Alcalá, 28034 Madrid, Spain; (A.R.-R.); (J.I.F.-V.); (P.E.W.-D.); (N.V.); (R.R.-R.)
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Abbadessa G, Miele G, Cavalla P, Valentino P, Marfia GA, Vercellino M, De Martino A, Simeon V, Lavorgna L, Bonavita S. Previous disease-modifying treatments influence T lymphocyte kinetics in people with multiple sclerosis switching to ocrelizumab. J Neuroimmunol 2023; 378:578072. [PMID: 36996621 DOI: 10.1016/j.jneuroim.2023.578072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Recently, concern has been raised about the influence of the previous disease-modifying treatments (DMTs) on the clinical efficacy of ocrelizumab (OCR). We aimed to evaluate whether the previous DMT affects the lymphocyte subset kinetics in people with Multiple Sclerosis (MS) switching to OCR. METHODS This is a multicenter, retrospective, real-world study on consecutive MS patients who started or switched to OCR. We grouped them by prior DMT in: (i) naïve-to-treatment (NTT), (ii) switching from fingolimod (SF) and (iii) switching from natalizumab (SN). Differences in absolute lymphocyte count and lymphocyte subset count changes, considering the period from baseline to 6 months, over all the three groups were assessed with an inverse-probability-weighted regression adjustment model. RESULTS Mean T CD4+ cell count reduction from baseline to the six-month follow-up was more pronounced in the SN group compared to the NTT (p = 0,026). Further, patients in the SF group experienced a less pronounced CD4 T cell number decrease than both NTT and SN groups (p = 0,04 and p < 0,001, respectively). Patients in the SF group experienced an increase in CD8 T cell absolute number, whereas those in the NTT and SN groups experienced a significant decrease (p = 0,015 and p < 0,001, respectively). Patients experiencing early inflammatory activity showed a lower CD8+ cell count at baseline than stable patients (p = 0,02). CONCLUSIONS Previous DMTs influence the lymphocyte kinetics in people with MS switching to OCR. Reassessment of these findings over a larger population may help optimize the switch.
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Malhotra S, Hurtado-Navarro L, Pappolla A, Villar LMM, Río J, Montalban X, Pelegrin P, Comabella M. Increased NLRP3 Inflammasome Activation and Pyroptosis in Patients With Multiple Sclerosis With Fingolimod Treatment Failure. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200100. [PMID: 36973075 PMCID: PMC10042441 DOI: 10.1212/nxi.0000000000200100] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Inflammasomes are involved in the pathogenesis of different neuroimmune and neurodegenerative diseases, including multiple sclerosis (MS). In a previous study by our group, the nucleotide-binding oligomerization domain, leucine-rich repeat receptor and pyrin-domain-containing 3 (NLRP3) inflammasome was reported to be associated with the response to interferon-beta in MS. Based on recent data showing the potential for the oral therapy fingolimod to inhibit NLRP3 inflammasome activation, here we investigated whether fingolimod could also be implicated in the response to this therapy in patients with MS. METHODS NLRP3 gene expression levels were measured by real-time PCR in peripheral blood mononuclear cells at baseline and after 3, 6, and 12 months in a cohort of patients with MS treated with fingolimod (N = 23), dimethyl fumarate (N = 21), and teriflunomide (N = 21) and classified into responders and nonresponders to the treatment according to clinical and radiologic criteria. In a subgroup of fingolimod responders and nonresponders, the percentage of monocytes with an oligomer of ASC was determined by flow cytometry, and the levels of interleukin (IL)-1β, IL-18, IL-6, tumor necrosis factor (TNF)α, and galectin-3 were quantified by ELISA. RESULTS NLPR3 expression levels were significantly increased in fingolimod nonresponders after 3 (p = 0.03) and 6 months (p = 0.008) of treatment compared with the baseline but remained similar in responders at all time points. These changes were not observed in nonresponders to the other oral therapies tested. The formation of an oligomer of ASC in monocytes after lipopolysaccharide and adenosine 5'-triphosphate stimulation was significantly decreased in responders (p = 0.006) but increased in nonresponders (p = 0.0003) after 6 months of fingolimod treatment compared with the baseline. Proinflammatory cytokine release from stimulated peripheral blood mononuclear cells was comparable between responders and nonresponders, but galectin-3 levels on cell supernatants, as a marker of cell damage, were significantly increased in fingolimod nonresponders (p = 0.02). DISCUSSION The differential effect of fingolimod on the formation of an inflammasome-triggered ASC oligomer in monocytes between responders and nonresponders could be used as a response biomarker after 6 months of fingolimod treatment and suggests that fingolimod may exert their beneficial effects by reducing inflammasome signaling in a subset of patients with MS.
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Affiliation(s)
- Sunny Malhotra
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Laura Hurtado-Navarro
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Agustin Pappolla
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Luisa M M Villar
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Jordi Río
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Xavier Montalban
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pablo Pelegrin
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Manuel Comabella
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain.
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8
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Houston TW, Howlett-Prieto Q, Regenauer C, Testai FD, Yao F, Feng X, Reder AT. Increased Percentage of CD8 +CD28 - Regulatory T Cells With Fingolimod Therapy in Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/2/e200075. [PMID: 36535763 PMCID: PMC9764330 DOI: 10.1212/nxi.0000000000200075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Fingolimod, an oral therapy for MS, decreases expression of membrane S1P1 receptors on CD4+ memory cells, causing their retention and deactivation in lymph nodes. We determined fingolimod effects on the number and proportion of potentially CNS-damaging CD8+CD28+ cytolytic T lymphocyte cells (CTLs) and on MS-depleted and dysfunctional CD8+CD28- anti-inflammatory suppressor/regulatory T cells (Treg) and on CD8+ T-cell expression of the CD69 activation/lymph node retention protein in MS. METHODS CD8, CD28, CD4, and CD69 expression on peripheral blood mononuclear cells was measured with flow cytometry. In vitro concanavalin A (ConA) activation of T cells, including CD8+CD28- cells, was used to mimic inflammation. RESULTS Fifty-nine patients with MS, 35 therapy-naive (16 clinically stable; 19 exacerbating) and 24 fingolimod-treated (19 clinically stable; 5 exacerbating), and 26 matched healthy controls (HCs) were compared. In therapy-naive patients, the CD8+ Treg percent of total lymphocytes was only 1/4 of HC levels. In fingolimod-treated patients, however, CD8+ Treg percentages rose to 2.5-fold higher than in HC and 10-fold higher than in therapy-naive MS. With fingolimod therapy, in contrast, CD8+ CTL levels were less than half of levels in HCs and therapy-naive patients. In HCs and all MS, activation with ConA strongly induced CD69 expression on CD4+ cells and induced 3-fold higher CD69 levels on CD8+ CTL than on CD8+ Treg. Fingolimod and analogs in vitro did not modify lymphocyte CD69 expression. Lower levels of CD69 on CD8+ Treg than on CTL may allow easier Treg egress from lymph nodes and enhance control of peripheral inflammation. In vitro activation reduced the already low CD8+ Treg population in therapy-naive MS, but only slightly altered Treg levels in fingolimod-treated MS. DISCUSSION Fingolimod therapy markedly increases the percentage of CD8+ Treg in MS, reversing the low CD8+ Treg:CTL ratio seen in untreated MS. The increase in immune regulatory cells has potential therapeutic benefit in MS. Activation in vitro depletes CD8+CD28+CTL in patients with MS; the loss is more pronounced in older patients with MS. This suggests that inflammation can disrupt the tenuous immune regulation in MS, especially in older patients.
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Affiliation(s)
- Timothy W Houston
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL
| | - Quentin Howlett-Prieto
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL
| | - Colin Regenauer
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL
| | - Fernando D Testai
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL
| | - Faith Yao
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL
| | - Xuan Feng
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL.
| | - Anthony T Reder
- From the Department of Neurology A-205 (T.W.H., Q.H.-P., C.R., X.F., A.T.R.), MC-2030 University of Chicago Medicine, IL; and Department of Neurology (F.D.T.), University of Illinois Chicago, IL.
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9
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Mao-Draayer Y, Cohen JA, Bar-Or A, Han MH, Singer B, Williams IM, Meng X, Elam C, Weiss JL, Cox GM, Ziehn M, Cree BAC. Immune cell subset profiling in multiple sclerosis after fingolimod initiation and continued treatment: The FLUENT study. Mult Scler J Exp Transl Clin 2022; 8:20552173221115023. [PMID: 35936922 PMCID: PMC9346260 DOI: 10.1177/20552173221115023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Fingolimod is a sphingosine 1-phosphate receptor modulator approved for
relapsing MS. Long-term effects on the immunological profile are not fully
understood. Objective Investigate fingolimod's temporal effects on immune cell subsets, and safety
outcomes. Methods In FLUENT, a 12-month, prospective, non-randomized, open-label, phase IV
study, adult participants received fingolimod 0.5 mg/day. Changes in immune
cell subsets, anti-John Cunningham virus (JCV) antibody index, and serum
neurofilament levels were assessed. Results 165 fingolimod-naive and 217 participants treated for 2–12 years in routine
clinical practice were enrolled. Levels of all monitored peripheral
lymphocyte subsets were reduced from month 3 in fingolimod-naive
participants. Greatest reductions occurred in naive and central memory
CD4+ and CD8+ T cells, and in naive and memory B cells. Most lymphocyte
subset levels remained stable in the continuous fingolimod group. Components
of the innate immune system remained within reference ranges. No increase in
JCV seropositivity was observed. No single cellular subset correlated with
anti-JCV antibody index at any time point. Neurofilament levels remained
within healthy adult reference limits throughout. No opportunistic
infections were reported; no new or unexpected safety signals were
observed. Conclusion FLUENT provides insights into the utility of immunological profiling to
evaluate therapy response and potential infection risk.
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Affiliation(s)
- Yang Mao-Draayer
- Autoimmunity Center of Excellence, Multiple Sclerosis Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, and the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - May H Han
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Barry Singer
- Missouri Baptist Medical Center, St Louis, MO, USA
| | | | | | | | | | | | - Marina Ziehn
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Bruce AC Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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10
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Liston A, Dooley J, Yshii L. Brain-resident regulatory T cells and their role in health and disease. Immunol Lett 2022; 248:26-30. [PMID: 35697195 DOI: 10.1016/j.imlet.2022.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 01/01/2023]
Abstract
Regulatory T cells (Tregs) control inflammation and maintain immune homeostasis. The well-characterised circulatory population of CD4+Foxp3+ Tregs is effective at preventing autoimmunity and constraining the immune response, through direct and indirect restraint of conventional T cell activation. Recent advances in Treg cell biology have identified tissue-resident Tregs, with tissue-specific functions that contribute to the maintenance of tissue homeostasis and repair. A population of brain-resident Tregs, characterised as CD69+, has recently been identified in the healthy brain of mice and humans, with rapid population expansion observed under a number of neuroinflammatory conditions. During neuroinflammation, brain-resident Tregs have been proposed to control astrogliosis through the production of amphiregulin, polarize microglia into neuroprotective states, and restrain inflammatory responses by releasing IL-10. While protective effects for Tregs have been demonstrated in a number of neuroinflammatory pathologies, a clear demarcation between the role of circulatory and brain-resident Tregs has been difficult to achieve. Here we review the state-of-the-art for brain-resident Treg population, and describe their potential utilization as a therapeutic target across different neuroinflammatory conditions.
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Affiliation(s)
- Adrian Liston
- Immunology Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT United Kingdom.
| | - James Dooley
- Immunology Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT United Kingdom
| | - Lidia Yshii
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Leuven 3000, Belgium; KU Leuven, Department of Neurosciences, Leuven 3000, Belgium.
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Abstract
PURPOSE OF REVIEW Increasingly, therapeutic strategy in multiple sclerosis (MS) is informed by imaging and laboratory biomarkers, in addition to traditional clinical factors. Here, we review aspects of monitoring the efficacy and risks of disease-modifying therapy (DMT) with both conventional and emerging MRI and laboratory measures. RECENT FINDINGS The adoption of consensus-driven, stable MRI acquisition protocols and artificial intelligence-based, quantitative image analysis is heralding an era of precision monitoring of DMT efficacy. New MRI measures of compartmentalized inflammation, neuro-degeneration and repair complement traditional metrics but require validation before use in individual patients. Laboratory markers of brain cellular injury, such as neurofilament light, are robust outcomes in DMT efficacy trials; their use in clinical practice is being refined. DMT-specific laboratory monitoring for safety is critical and may include lymphocytes, immunoglobulins, autoimmunity surveillance, John Cunningham virus serology and COVID-19 vaccination seroresponse. SUMMARY A biomarker-enhanced monitoring strategy has immediate clinical application, with growing evidence of long-term reductions in disability accrual when both clinically symptomatic and asymptomatic inflammatory activity is fully suppressed; and amelioration of the risks associated with therapy. Emerging MRI and blood-based measures will also become important tools for monitoring agents that target the innate immune system and promote neuro-repair.
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12
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Sphingosine 1-phosphate receptor-targeted therapeutics in rheumatic diseases. Nat Rev Rheumatol 2022; 18:335-351. [PMID: 35508810 DOI: 10.1038/s41584-022-00784-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
Sphingosine 1-phosphate (S1P), which acts via G protein-coupled S1P receptors (S1PRs), is a bioactive lipid essential for vascular integrity and lymphocyte trafficking. The S1P-S1PR signalling axis is a key component of the inflammatory response in autoimmune rheumatic diseases. Several drugs that target S1PRs have been approved for the treatment of multiple sclerosis and inflammatory bowel disease and are under clinical testing for patients with systemic lupus erythematosus (SLE). Preclinical studies support the hypothesis that targeting the S1P-S1PR axis would be beneficial to patients with SLE, rheumatoid arthritis (RA) and systemic sclerosis (SSc) by reducing pathological inflammation. Whereas most preclinical research and development efforts are focused on reducing lymphocyte trafficking, protective effects of circulating S1P on endothelial S1PRs, which maintain the vascular barrier and enable blood circulation while dampening leukocyte extravasation, have been largely overlooked. In this Review, we take a holistic view of S1P-S1PR signalling in lymphocyte and vascular pathobiology. We focus on the potential of S1PR modulators for the treatment of SLE, RA and SSc and summarize the rationale, pathobiology and evidence from preclinical models and clinical studies. Improved understanding of S1P pathobiology in autoimmune rheumatic diseases and S1PR therapeutic modulation is anticipated to lead to efficacious and safer management of these diseases.
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Kunkl M, Amormino C, Tedeschi V, Fiorillo MT, Tuosto L. Astrocytes and Inflammatory T Helper Cells: A Dangerous Liaison in Multiple Sclerosis. Front Immunol 2022; 13:824411. [PMID: 35211120 PMCID: PMC8860818 DOI: 10.3389/fimmu.2022.824411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Multiple Sclerosis (MS) is a neurodegenerative autoimmune disorder of the central nervous system (CNS) characterized by the recruitment of self-reactive T lymphocytes, mainly inflammatory T helper (Th) cell subsets. Once recruited within the CNS, inflammatory Th cells produce several inflammatory cytokines and chemokines that activate resident glial cells, thus contributing to the breakdown of blood-brain barrier (BBB), demyelination and axonal loss. Astrocytes are recognized as key players of MS immunopathology, which respond to Th cell-defining cytokines by acquiring a reactive phenotype that amplify neuroinflammation into the CNS and contribute to MS progression. In this review, we summarize current knowledge of the astrocytic changes and behaviour in both MS and experimental autoimmune encephalomyelitis (EAE), and the contribution of pathogenic Th1, Th17 and Th1-like Th17 cell subsets, and CD8+ T cells to the morphological and functional modifications occurring in astrocytes and their pathological outcomes.
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Affiliation(s)
- Martina Kunkl
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Carola Amormino
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Valentina Tedeschi
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Maria Teresa Fiorillo
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Loretta Tuosto
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
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14
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Li R, Tropea TF, Baratta LR, Zuroff L, Diaz-Ortiz ME, Zhang B, Shinoda K, Rezk A, Alcalay RN, Chen-Plotkin A, Bar-Or A. Abnormal B-Cell and Tfh-Cell Profiles in Patients With Parkinson Disease: A Cross-sectional Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1125. [PMID: 34955458 PMCID: PMC8711073 DOI: 10.1212/nxi.0000000000001125] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/09/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives There has been growing interest in potential roles of the immune system in the pathogenesis of Parkinson disease (PD). The aim of the current study was to comprehensively characterize phenotypic and functional profiles of circulating immune cells in patients with PD vs controls. Methods Peripheral blood was collected from patients with PD and age- and sex-matched neurologically normal controls (NCs) in 2 independent cohorts (discovery and validation). Comprehensive multicolor flow cytometry was performed on whole blood leukocytes and peripheral blood mononuclear cells to characterize different immune subsets and their ex vivo responses. Results The discovery cohort included 17 NCs and 12 participants with PD, and the validation cohort included 18 NCs and 18 participants with PD. Among major immune cell types, B cells appeared to be preferentially affected in PD. Proliferating B cell counts were decreased in patients with PD compared with controls. Proportions of B-cell subsets with regulatory capacity such as transitional B cells were preferentially reduced in the patients with PD, whereas proportions of proinflammatory cytokine-producing B cells increased, resulting in a proinflammatory shift of their B-cell functional cytokine responses. Unsupervised principal component analysis revealed increased expression of TNFα and GM-CSF by both B cells and T cells of patients with PD. In addition, levels of follicular T cells, an important B-cell helper T-cell population, decreased in the patients with PD, correlating with their B-cell abnormality. Discussion Our findings define a novel signature of peripheral immune cells and implicate aberrant Tfh:B-cell interactions in patients with PD.
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Affiliation(s)
- Rui Li
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Thomas Francis Tropea
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Laura Rosa Baratta
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Leah Zuroff
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Maria E Diaz-Ortiz
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Bo Zhang
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Koji Shinoda
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Ayman Rezk
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Roy N Alcalay
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Alice Chen-Plotkin
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY
| | - Amit Bar-Or
- From the The Center for Neuroinflammation and Neurotherapeutics and the Department of Neurology (R.L., L.Z., K.S., A.R., A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology (T.F.T., L.R.B., M.E.D.-O., A.C-P.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Bioengineering (M.E.D.-O.), School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia; Department of Cardiology (B.Z.), the Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Neurology (R.N.A.), Columbia University, New York, NY.
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15
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Cohan SL, Benedict RHB, Cree BAC, DeLuca J, Hua LH, Chun J. The Two Sides of Siponimod: Evidence for Brain and Immune Mechanisms in Multiple Sclerosis. CNS Drugs 2022; 36:703-719. [PMID: 35725892 PMCID: PMC9259525 DOI: 10.1007/s40263-022-00927-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 12/13/2022]
Abstract
Siponimod is a selective sphingosine 1-phosphate receptor subtype 1 (S1P1) and 5 (S1P5) modulator approved in the United States and the European Union as an oral treatment for adults with relapsing forms of multiple sclerosis (RMS), including active secondary progressive multiple sclerosis (SPMS). Preclinical and clinical studies provide support for a dual mechanism of action of siponimod, targeting peripherally mediated inflammation and exerting direct central effects. As an S1P1 receptor modulator, siponimod reduces lymphocyte egress from lymph nodes, thus inhibiting their migration from the periphery to the central nervous system. As a result of its peripheral immunomodulatory effects, siponimod reduces both magnetic resonance imaging (MRI) lesion (gadolinium-enhancing and new/enlarging T2 hyperintense) and relapse activity compared with placebo. Independent of these effects, siponimod can penetrate the blood-brain barrier and, by binding to S1P1 and S1P5 receptors on a variety of brain cells, including astrocytes, oligodendrocytes, neurons, and microglia, exert effects to modulate neural inflammation and neurodegeneration. Clinical data in patients with SPMS have shown that, compared with placebo, siponimod treatment is associated with reductions in levels of neurofilament light chain (a marker of neuroaxonal damage) and thalamic and cortical gray matter atrophy, with smaller reductions in MRI magnetization transfer ratio and reduced confirmed disability progression. This review examines the preclinical and clinical data supporting the dual mechanism of action of siponimod in RMS.
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Affiliation(s)
- Stanley L Cohan
- Providence Multiple Sclerosis Center, Providence Brain Institute, 9135 SW Barnes Rd Suite 461, Portland, OR, 97225, USA.
| | | | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jerold Chun
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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16
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Fingolimod as a first- or second-line treatment in a mini-series of young Hellenic patients with adolescent-onset multiple sclerosis: focus on immunological data. Neurol Sci 2021; 43:2641-2649. [PMID: 34596776 DOI: 10.1007/s10072-021-05623-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric onset multiple sclerosis(POMS) is characterized by a highly active profile, often warranting treatment with high efficacy disease-modulating therapies (DMTs). Fingolimod, an oral sphingosine-1-phosphate receptor modulator, is the first Food and Drug Administration (FDA)- and European Medicines Agency (EMA)-approved DMT for the treatment of POMS. OBJECT Our aim is to present real-world data of seven fingolimod-treated POMS-patients, recruited in a single MS center in Greece. METHODS Clinical and imaging/laboratory data from 7 Hellenic patients fulfilling the International Pediatric Multiple Sclerosis Study Group (IPMSSG) criteria for POMS diagnosis, who have received fingolimod treatment, were selected. Human leukocyte antigen (HLA) genotyping was performed with standard low-resolution sequence-specific oligonucleotide techniques. RESULTS Three patients were treatment-naïve adolescents who received fingolimod as first-line treatment. Two experienced ongoing clinical and radiological disease activity and have been switched to natalizumab. The remaining cases were post-adolescent adults with POMS, where the vast majority experienced total/near-total disease remission. Fingolimod was generally well-tolerated. Two patients with high disease activity carried the HLA-DRB1*03 allele, while five patients were carriers of at least one of the HLA-DRB1*04, HLA-DRB1*13, and HLA-DRB1*14 alleles, which when not combined with HLA-DRB1*03 showed a trend towards a more favorable clinical course. Fingolimod responders showed a trend towards increased CD(16-56)+NK cell counts in immunophenotyping assays. CONCLUSIONS Our preliminary results support that response of POMS patients to fingolimod may be partially dependent on age and previous DMT, with younger and treatment-naïve patients presenting worse outcomes. The role of immunogenetics and immunophenotyping in personalized treatment warrants investigation in larger and more diverse populations.
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17
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Colombo E, Farina C. Lessons from S1P receptor targeting in multiple sclerosis. Pharmacol Ther 2021; 230:107971. [PMID: 34450231 DOI: 10.1016/j.pharmthera.2021.107971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
Sphingosine 1-phosphate (S1P) is a potent bioactive sphingolipid binding to specific G protein-coupled receptors expressed in several organs. The relevance of S1P-S1P receptor axis in the pathophysiology of immune and nervous systems has encouraged the development of S1P receptor modulators for the treatment of neurological, autoimmune and/or inflammatory disorders. Currently, four S1P receptor modulators are approved drugs for multiple sclerosis (MS), an inflammatory disorder of the central nervous system. As main pharmacologic effect, these treatments induce lymphopenia due to the loss of responsiveness to S1P gradients guiding lymphocyte egress from lymphoid organs into the bloodstream. Recent data point to immunological effects of the S1P modulators beyond the inhibition of lymphocyte trafficking. Further, these drugs may cross the blood-brain barrier and directly target CNS resident cells expressing S1P receptors. Here we review the role of S1P signalling in neuroimmunology at the light of the evidences generated from the study of the mechanism of action of S1P receptor modulators in MS and integrate this information with findings derived from neuroinflammatory animal models and in vitro observations. These insights can direct the application of therapeutic approaches targeting S1P receptors in other disease areas.
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Affiliation(s)
- Emanuela Colombo
- Institute of Experimental Neurology (INSpe), Division of Neuroscience, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Cinthia Farina
- Institute of Experimental Neurology (INSpe), Division of Neuroscience, IRCCS San Raffaele Hospital, 20132 Milan, Italy.
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18
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Karaaslan Z, Kurtuncu M, Akcay Hİ, Gunduz T, Altunrende B, Turkoglu R, Eraksoy M, Ulusoy C, Yilmaz V, Tüzün E. CXCL13 Levels Indicate Treatment Responsiveness to Fingolimod in MS Patients. Eur Neurol 2021; 85:69-71. [PMID: 34340233 DOI: 10.1159/000517770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Zerrin Karaaslan
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey,
| | - Murat Kurtuncu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil İbrahim Akcay
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gunduz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Burcu Altunrende
- Department of Neurology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Recai Turkoglu
- Department of Neurology, Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Ulusoy
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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19
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Veroni C, Aloisi F. The CD8 T Cell-Epstein-Barr Virus-B Cell Trialogue: A Central Issue in Multiple Sclerosis Pathogenesis. Front Immunol 2021; 12:665718. [PMID: 34305896 PMCID: PMC8292956 DOI: 10.3389/fimmu.2021.665718] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
The cause and the pathogenic mechanisms leading to multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system (CNS), are still under scrutiny. During the last decade, awareness has increased that multiple genetic and environmental factors act in concert to modulate MS risk. Likewise, the landscape of cells of the adaptive immune system that are believed to play a role in MS immunopathogenesis has expanded by including not only CD4 T helper cells but also cytotoxic CD8 T cells and B cells. Once the key cellular players are identified, the main challenge is to define precisely how they act and interact to induce neuroinflammation and the neurodegenerative cascade in MS. CD8 T cells have been implicated in MS pathogenesis since the 80's when it was shown that CD8 T cells predominate in MS brain lesions. Interest in the role of CD8 T cells in MS was revived in 2000 and the years thereafter by studies showing that CNS-recruited CD8 T cells are clonally expanded and have a memory effector phenotype indicating in situ antigen-driven reactivation. The association of certain MHC class I alleles with MS genetic risk implicates CD8 T cells in disease pathogenesis. Moreover, experimental studies have highlighted the detrimental effects of CD8 T cell activation on neural cells. While the antigens responsible for T cell recruitment and activation in the CNS remain elusive, the high efficacy of B-cell depleting drugs in MS and a growing number of studies implicate B cells and Epstein-Barr virus (EBV), a B-lymphotropic herpesvirus that is strongly associated with MS, in the activation of pathogenic T cells. This article reviews the results of human studies that have contributed to elucidate the role of CD8 T cells in MS immunopathogenesis, and discusses them in light of current understanding of autoreactivity, B-cell and EBV involvement in MS, and mechanism of action of different MS treatments. Based on the available evidences, an immunopathological model of MS is proposed that entails a persistent EBV infection of CNS-infiltrating B cells as the target of a dysregulated cytotoxic CD8 T cell response causing CNS tissue damage.
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Affiliation(s)
| | - Francesca Aloisi
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
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20
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Schwichtenberg SC, Wisgalla A, Schroeder-Castagno M, Alvarez-González C, Schlickeiser S, Siebert N, Bellmann-Strobl J, Wernecke KD, Paul F, Dörr J, Infante-Duarte C. Fingolimod Therapy in Multiple Sclerosis Leads to the Enrichment of a Subpopulation of Aged NK Cells. Neurotherapeutics 2021; 18:1783-1797. [PMID: 34244929 PMCID: PMC8608997 DOI: 10.1007/s13311-021-01078-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Fingolimod is an approved oral treatment for relapsing-remitting multiple sclerosis (RRMS) that modulates agonistically the sphingosin-1-phosphate receptor (S1PR), inhibiting thereby the egress of lymphocytes from the lymph nodes. In this interventional prospective clinical phase IV trial, we longitudinally investigated the impact of fingolimod on frequencies of NK cell subpopulations by flow cytometry in 17 RRMS patients at baseline and 1, 3, 6, and 12 months after treatment initiation. Clinical outcome was assessed by the Expanded Disability Status Scale (EDSS) and annualized relapse rates (ARR). Over the study period, median EDSS remained stable from month 3 to month 12, and ARR decreased compared to ARR in the 24 months prior treatment. Treatment was paralleled by an increased frequency of circulating NK cells, due primarily to an increase in CD56dimCD94low mature NK cells, while the CD56bright fraction and CD127+ innate lymphoid cells (ILCs) decreased over time. An unsupervised clustering algorithm further revealed that a particular fraction of NK cells defined by the expression of CD56dimCD16++KIR+/-NKG2A-CD94-CCR7+/-CX3CR1+/-NKG2C-NKG2D+NKp46-DNAM1++CD127+ increased during treatment. This specific phenotype might reflect a status of aged, fully differentiated, and less functional NK cells. Our study confirms that fingolimod treatment affects both NK cells and ILC. In addition, our study suggests that treatment leads to the enrichment of a specific NK cell subset characterized by an aged phenotype. This might limit the anti-microbial and anti-tumour NK cell activity in fingolimod-treated patients.
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Affiliation(s)
- Svenja C Schwichtenberg
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Campus Virchow Klinikum, Augustenburger Platz 1 (Südstr. 2/Föhrer Str. 15), 13353, Berlin, Germany
| | - Anne Wisgalla
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Campus Virchow Klinikum, Augustenburger Platz 1 (Südstr. 2/Föhrer Str. 15), 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for "Psychiatrie Und Medizinische Klinik M.S. Psychosomatik,", Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Maria Schroeder-Castagno
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Campus Virchow Klinikum, Augustenburger Platz 1 (Südstr. 2/Föhrer Str. 15), 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
| | - Cesar Alvarez-González
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Campus Virchow Klinikum, Augustenburger Platz 1 (Südstr. 2/Föhrer Str. 15), 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
| | - Stephan Schlickeiser
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Föhrer Str. 15, 13353, Berlin, Germany
| | - Nadja Siebert
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité - Universitätsmedizin Berlin, Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Judith Bellmann-Strobl
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité - Universitätsmedizin Berlin, Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Klaus-Dieter Wernecke
- Charité - Universitätsmedizin Berlin and CRO SOSTANA GmbH, Wildensteiner Straße 27, 10318, Berlin, Germany
| | - Friedemann Paul
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité - Universitätsmedizin Berlin, Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Jan Dörr
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Campus Mitte, Sauerbruchweg 5, 10117, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité - Universitätsmedizin Berlin, Robert-Rössle-Straße 10, 13125, Berlin, Germany
- Current Affiliation: Multiple Sclerosis Center, Oberhavel Kliniken, Marwitzer Straße 91, 16761, Hennigsdorf, Germany
| | - Carmen Infante-Duarte
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Campus Virchow Klinikum, Augustenburger Platz 1 (Südstr. 2/Föhrer Str. 15), 13353, Berlin, Germany.
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité - Universitätsmedizin Berlin, Robert-Rössle-Straße 10, 13125, Berlin, Germany.
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21
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Mockus TE, Munie A, Atkinson JR, Segal BM. Encephalitogenic and Regulatory CD8 T Cells in Multiple Sclerosis and Its Animal Models. THE JOURNAL OF IMMUNOLOGY 2021; 206:3-10. [PMID: 33443060 DOI: 10.4049/jimmunol.2000797] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Multiple sclerosis (MS), a neuroinflammatory disease that affects millions worldwide, is widely thought to be autoimmune in etiology. Historically, research into MS pathogenesis has focused on autoreactive CD4 T cells because of their critical role in the animal model, experimental autoimmune encephalomyelitis, and the association between MS susceptibility and single-nucleotide polymorphisms in the MHC class II region. However, recent studies have revealed prominent clonal expansions of CD8 T cells within the CNS during MS. In this paper, we review the literature on CD8 T cells in MS, with an emphasis on their potential effector and regulatory properties. We discuss the impact of disease modifying therapies, currently prescribed to reduce MS relapse rates, on CD8 T cell frequency and function. A deeper understanding of the role of CD8 T cells in MS may lead to the development of more effective and selective immunomodulatory drugs for particular subsets of patients.
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Affiliation(s)
- Taryn E Mockus
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210
| | - Ashley Munie
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210.,Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI 48109; and
| | - Jeffrey R Atkinson
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210
| | - Benjamin M Segal
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210; .,Neuroscience Research Institute, The Ohio State University, Columbus, OH 43210
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22
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Herpesvirus Antibodies, Vitamin D and Short-Chain Fatty Acids: Their Correlation with Cell Subsets in Multiple Sclerosis Patients and Healthy Controls. Cells 2021; 10:cells10010119. [PMID: 33435197 PMCID: PMC7826528 DOI: 10.3390/cells10010119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Although the etiology of multiple sclerosis (MS) is still unknown, it is commonly accepted that environmental factors could contribute to the disease. The objective of this study was to analyze the humoral response to Epstein-Barr virus, human herpesvirus 6A/B and cytomegalovirus, and the levels of 25-hydroxyvitamin D (25(OH)D) and the three main short-chain fatty acids (SCFA), propionate (PA), butyrate (BA) and acetate (AA), in MS patients and healthy controls (HC) to understand how they could contribute to the pathogenesis of the disease. With this purpose, we analyzed the correlations among them and with different clinical variables and a wide panel of cell subsets. We found statistically significant differences for most of the environmental factors analyzed when we compared MS patients and HC, supporting their possible involvement in the disease. The strongest correlations with the clinical variables and the cell subsets analyzed were found for 25(OH)D and SCFAs levels. A correlation was also found between 25(OH)D and PA/AA ratio, and the interaction between these factors negatively correlated with interleukin 17 (IL-17)-producing CD4+ and CD8+ T cells in untreated MS patients. Therapies that simultaneously increase vitamin D levels and modify the proportion of SCFA could be evaluated in the future.
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23
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CD56bright Natural Killer Cells: A Possible Biomarker of Different Treatments in Multiple Sclerosis. J Clin Med 2020; 9:jcm9051450. [PMID: 32414131 PMCID: PMC7291063 DOI: 10.3390/jcm9051450] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system, which leads, in many cases, to irreversible disability. More than 15 disease-modifying treatments (DMTs) are available for the treatment of MS. Clinical activity or activity at magnetic resonance imaging (MRI) are now used to assess the efficacy of DMTs, but are negative prognostic factors per se. Therefore, a biomarker permitting us to identify patients who respond to treatment before they develop clinical/radiological signs of MS activity would be of high importance. The number of circulating CD56bright natural killer (NK) cells may be such a biomarker. CD56bright NK cells are a regulatory immune population belonging to the innate immune system. The number of CD56bright NK cells increases upon treatment with interferon-beta, alemtuzumab, dimethyl fumarate, after autologous hematopoietic stem cell transplantation, and is higher in those who respond to fingolimod. In some cases, an increased number of CD56bright NK cells is associated with an increase in their regulatory function. In the current review, we will evaluate the known effect on CD56bright NK cells of DMTs for MS, and will discuss their possible role as a biomarker for treatment response in MS.
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