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Wang X, Zhu Z, Sun J, Jia L, Cai L, Chen Q, Yang W, Wang Y, Zhang Y, Guo S, Liu W, Yang Z, Zhao P, Wang Z, Lv H. Changes in iron load in specific brain areas lead to neurodegenerative diseases of the central nervous system. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110903. [PMID: 38036035 DOI: 10.1016/j.pnpbp.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
The causes of neurodegenerative diseases remain largely elusive, increasing their personal and societal impacts. To reveal the causal effects of iron load on Parkinson's disease (PD), Alzheimer's disease (AD), amyotrophic lateral sclerosis and multiple sclerosis, we used Mendelian randomisation and brain imaging data from a UK Biobank genome-wide association study of 39,691 brain imaging samples (predominantly of European origin). Using susceptibility-weighted images, which reflect iron load, we analysed genetically significant brain regions. Inverse variance weighting was used as the main estimate, while MR Egger and weighted median were used to detect heterogeneity and pleiotropy. Nine clear associations were obtained. For AD and PD, an increased iron load was causative: the right pallidum for AD and the right caudate, left caudate and right accumbens for PD. However, a reduced iron load was identified in the right and left caudate for multiple sclerosis, the bilateral hippocampus for mixed vascular dementia and the left thalamus and bilateral accumbens for subcortical vascular dementia. Thus, changes in iron load in different brain regions have causal effects on neurodegenerative diseases. Our results are crucial for understanding the pathogenesis and investigating the treatment of these diseases.
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Affiliation(s)
- Xinghao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Zaimin Zhu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, People's Republic of China
| | - Jing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Li Jia
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Linkun Cai
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China; School of Biological Science and Medical Engineering, Beihang University, No.37 XueYuan Road, Beijing 100191, People's Republic of China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Wenbo Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Yiling Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Yufan Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Sihui Guo
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Wenjuan Liu
- Department of Radiology, Aerospace Center Hospital, Beijing, People's Republic of China; Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China.
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing 100050, People's Republic of China.
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Nabizadeh F, Zafari R, Mohamadi M, Maleki T, Fallahi MS, Rafiei N. MRI features and disability in multiple sclerosis: A systematic review and meta-analysis. J Neuroradiol 2024; 51:24-37. [PMID: 38172026 DOI: 10.1016/j.neurad.2023.11.007] [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: 08/20/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to investigate the correlation between disability in patients with Multiple sclerosis (MS) measured by the Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease. METHODS A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled. RESULTS Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16). CONCLUSION In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.
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Affiliation(s)
- Fardin Nabizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Rasa Zafari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobin Mohamadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Maleki
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nazanin Rafiei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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De Lury AD, Bisulca JA, Lee JS, Altaf MD, Coyle PK, Duong TQ. Magnetic resonance imaging detection of deep gray matter iron deposition in multiple sclerosis: A systematic review. J Neurol Sci 2023; 453:120816. [PMID: 37827008 DOI: 10.1016/j.jns.2023.120816] [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: 07/16/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease involving immune-mediated damage. Iron deposition in deep gray matter (DGM) structures like the thalamus and basal ganglia have been suggested to play a role in MS pathogenesis. Magnetic Resonance Imaging (MRI) imaging methods like T2 and T2* imaging, susceptibility-weighted imaging, and quantitative susceptibility mapping can track iron deposition storage in the brain primarily from ferritin and hemosiderin (paramagnetic iron storage proteins) with varying levels of tissue contrast and sensitivity. In this systematic review, we evaluated the role of DGM iron deposition as detected by MRI techniques in relation to MS-related neuroinflammation and its potential as a novel therapeutic target. We searched through PubMed, Embase, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, against predetermined inclusion and exclusion criteria. We included 89 articles (n = 6630 patients), and then grouped them into different categories: i) methodological techniques to measure DGM iron, ii) cross-sectional and group comparison of DGM iron content, iii) longitudinal comparisons of DGM iron, iv) associations between DGM iron and other imaging and neurobiological markers, v) associations with disability, and vi) associations with cognitive impairment. The review revealed that iron deposition in DGM is independent yet concurrent with demyelination, and that these iron deposits contribute to MS-related cognitive impairment and disability. Variability in iron distributions appears to rely on a positive feedback loop between inflammation, and release of iron by oligodendrocytes. DGM iron seems to be a promising prognostic biomarker for MS pathophysiology.
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Affiliation(s)
- Amy D De Lury
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Joseph A Bisulca
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Jimmy S Lee
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Muhammad D Altaf
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA.
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
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Prajjwal P, Marsool MDM, Asharaf S, Inban P, Gadam S, Yadav R, Vora N, Nandwana V, Marsool ADM, Amir O. Comparison of recent updates in genetics, immunology, biomarkers, and neuroimaging of primary-progressive and relapsing-remitting multiple sclerosis and the role of ocrelizumab in the management of their refractory cases. Health Sci Rep 2023; 6:e1422. [PMID: 37448727 PMCID: PMC10337274 DOI: 10.1002/hsr2.1422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Background Primary-progressive multiple sclerosis (PPMS) and relapsing-remitting multiple sclerosis (RRMS) are two frequent multiple sclerosis (MS) subtypes that involve 10%-15% of patients. PPMS progresses slowly and is diagnosed later in life. Both subtypes are influenced by genetic and environmental factors such as smoking, obesity, and vitamin D insufficiency. Although there is no cure, ocrelizumab can reduce symptoms and delay disease development. RRMS is an autoimmune disease that causes inflammation, demyelination, and disability. Early detection, therapy, and lifestyle changes are critical. This study delves into genetics, immunology, biomarkers, neuroimaging, and the usefulness of ocrelizumab in the treatment of refractory patients of PPMS. Method In search of published literature providing up-to-date information on PPMS and RRMS, this review conducted numerous searches in databases such as PubMed, Google Scholar, MEDLINE, and Scopus. We looked into genetics, immunology, biomarkers, current breakthroughs in neuroimaging, and the role of ocrelizumab in refractory cases. Results Our comprehensive analysis found considerable advances in genetics, immunology, biomarkers, neuroimaging, and the efficacy of ocrelizumab in the treatment of refractory patients. Conclusion Early detection, timely intervention, and the adoption of lifestyle modifications play pivotal roles in enhancing treatment outcomes. Notably, ocrelizumab has demonstrated potential in symptom control and mitigating the rate of disease advancement, further underscoring its clinical significance in the management of MS.
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Affiliation(s)
- Priyadarshi Prajjwal
- Department of NeurologyBharati Vidyapeeth University Medical College PunePuneIndia
| | | | | | | | | | - Rukesh Yadav
- Internal Medicine, Maharajgunj Medical CampusTribhuvan UniversityKathmanduNepal
| | - Neel Vora
- Internal Medicine, B.J. Medical CollegeAhmedabadIndia
| | - Varsha Nandwana
- Department of NeurologyVirginia Tech Carilion School of MedicineRoanokeVirginiaUSA
| | | | - Omniat Amir
- Internal Medicine, Al Manhal AcademyKhartoumSudan
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Application of susceptibility weighted imaging (SWI) in diagnostic imaging of brain pathologies – a practical approach. Clin Neurol Neurosurg 2022; 221:107368. [DOI: 10.1016/j.clineuro.2022.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
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Erbay MF, Kamışlı Ö, Karatoprak NB. Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients? Br J Radiol 2020; 93:20200552. [DOI: 10.1259/bjr.20200552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective : T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. Methods: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI–ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. Results: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. Conclusions: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. Advances in knowledge: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.
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Affiliation(s)
- Mehmet Fatih Erbay
- Department of Radiology, Inonu UniversityFaculty of Medicine, Malatya, Turkey
| | - Özden Kamışlı
- Department of Neurology, Inonu University Faculty of Medicine, Malatya, Turkey
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8
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Belova AN, Solovieva VS, Boyko AN. [Anemia and dysregulation of iron metabolism in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:10-17. [PMID: 30160662 DOI: 10.17116/jnevro201811808210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anemia is one of the common diseases comorbid with multiple sclerosis (MS). This article reviews the prevalence and types of anemia in MS patients. It has been shown that anemia is often accompanied by a decrease in serum iron level. The authors present the data on iron metabolism in patients with MS and MRI findings concerning deposits of iron in the gray matter of the brain. The causal relationship between abnormalities in iron metabolism and MS remains unclear; this study allows to approach the understanding of the MS pathogenesis and to increase the efficacy of therapy for this disease.
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Affiliation(s)
- A N Belova
- Privolzskyi Federal Medical Research Center, Nizhny Novgorod, Russia
| | - V S Solovieva
- City Clinical Hospital #3, Regional Center fo Multiple Sclerosis, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia; Center for Demyelination Diseases 'Neuroclinic', Moscow, Russia
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Pakpoor J, Seminatore B, Graves J, Schreiner T, Waldman A, Lotze T, Belman A, Greenberg B, Weinstock-Guttman B, Aaen G, Tillema J, McDonald J, Hart J, Ness J, Harris Y, Rubin J, Candee M, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Mar S, Kahn I, Rose J, Carmichael S, Roalstad S, Waltz M, Casper T, Waubant E. Dietary factors and pediatric multiple sclerosis: A case-control study. Mult Scler 2018; 24:1067-1076. [PMID: 28608728 PMCID: PMC5711616 DOI: 10.1177/1352458517713343] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of diet in multiple sclerosis (MS) is largely uncharacterized, particularly as it pertains to pediatric-onset disease. OBJECTIVE To determine the association between dietary factors and MS in children. METHODS Pediatric MS patients and controls were recruited from 16 US centers (MS or clinically isolated syndrome onset before age 18, <4 years from symptom onset and at least 2 silent lesions on magnetic resonance imaging). The validated Block Kids Food Screener questionnaire was administered 2011-2016. Chi-squared test compared categorical variables, Kruskal-Wallis test compared continuous variables, and multivariable logistic regression analysis was performed. RESULTS In total, 312 cases and 456 controls were included (mean ages 15.1 and 14.4 years). In unadjusted analyses, there was no difference in intake of fats, proteins, carbohydrates, sugars, fruits, or vegetables. Dietary iron was lower in cases ( p = 0.04), and cases were more likely to consume below recommended guidelines of iron (77.2% of cases vs 62.9% of controls, p < 0.001). In multivariable analysis, iron consumption below recommended guidelines was associated with MS (odds ratio = 1.80, p < 0.01). CONCLUSION Pediatric MS cases may be less likely to consume sufficient iron compared to controls, and this warrants broader study to characterize a temporal relationship. No other significant difference in intake of most dietary factors was found.
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Affiliation(s)
- J. Pakpoor
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - B. Seminatore
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - J. Graves
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - T. Schreiner
- University of Colorado School of Medicine, Neurology
| | - A. Waldman
- Children’s Hospital of Philadelphia, Neurology
| | - T. Lotze
- Texas Children’s Hospital, Child Neurology
| | - A. Belman
- Stony Brook University Medical Center, Department of Neurology, Neurology
| | | | | | - G. Aaen
- Loma Linda University, Neurology
| | | | - J. McDonald
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - J. Hart
- University of California, San Francisco, Regional Pediatric MS Center, Neurology
| | - J. Ness
- University of Alabama at Birmingham, Pediatrics
| | - Y. Harris
- University of Alabama at Birmingham, Pediatrics
| | - J. Rubin
- Ann & Robert Lurie Children's Hospital of Chicago, Neurology
| | | | - L. Krupp
- Stony Brook University Medical Center, Department of Neurology, Neurology
| | - M. Gorman
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center
| | - L. Benson
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center
| | | | | | - S. Mar
- Washington University St. Louis, Neurology
| | - I. Kahn
- Children’s National Medical Center, Washington, D.C
| | - J. Rose
- University of Utah, Neurology
| | - S.L. Carmichael
- Department of Pediatrics Division of Neonatal and Developmental Medicine, Stanford University, California, USA
| | | | | | | | - E. Waubant
- Multiple Sclerosis Center, University of California, San Francisco, CA
- University of California, San Francisco, Regional Pediatric MS Center, Neurology
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Vela D. Hepcidin, an emerging and important player in brain iron homeostasis. J Transl Med 2018; 16:25. [PMID: 29415739 PMCID: PMC5803919 DOI: 10.1186/s12967-018-1399-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023] Open
Abstract
Hepcidin is emerging as a new important factor in brain iron homeostasis. Studies suggest that there are two sources of hepcidin in the brain; one is local and the other comes from the circulation. Little is known about the molecular mediators of local hepcidin expression, but inflammation and iron-load have been shown to induce hepcidin expression in the brain. The most important source of hepcidin in the brain are glial cells. Role of hepcidin in brain functions has been observed during neuronal iron-load and brain hemorrhage, where secretion of abundant hepcidin is related with the severity of brain damage. This damage can be reversed by blocking systemic and local hepcidin secretion. Studies have yet to unveil its role in other brain conditions, but the rationale exists, since these conditions are characterized by overexpression of the factors that stimulate brain hepcidin expression, such as inflammation, hypoxia and iron-overload.
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Affiliation(s)
- Driton Vela
- Department of Physiology, Faculty of Medicine, University of Prishtina, Martyr's Boulevard n.n., 10000, Prishtina, Kosova.
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11
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Abdelhak A, Weber MS, Tumani H. Primary Progressive Multiple Sclerosis: Putting Together the Puzzle. Front Neurol 2017; 8:234. [PMID: 28620346 PMCID: PMC5449443 DOI: 10.3389/fneur.2017.00234] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/12/2017] [Indexed: 12/23/2022] Open
Abstract
The focus of multiple sclerosis research has recently turned to the relatively rare and clearly more challenging condition of primary progressive multiple sclerosis (PPMS). Many risk factors such as genetic susceptibility, age, and Epstein–Barr virus (EBV) infection may interdepend on various levels, causing a complex pathophysiological cascade. Variable pathological mechanisms drive disease progression, including inflammation-associated axonal loss, continuous activation of central nervous system resident cells, such as astrocytes and microglia as well as mitochondrial dysfunction and iron accumulation. Histological studies revealed diffuse infiltration of the gray and white matter as well as of the meninges with inflammatory cells such as B-, T-, natural killer, and plasma cells. While numerous anti-inflammatory agents effective in relapsing remitting multiple sclerosis basically failed in treatment of PPMS, the B-cell-depleting monoclonal antibody ocrelizumab recently broke the dogma that PPMS cannot be treated by an anti-inflammatory approach by demonstrating efficacy in a phase 3 PPMS trial. Other treatments aiming at enhancing remyelination (MD1003) as well as EBV-directed treatment strategies may be promising agents on the horizon. In this article, we aim to summarize new advances in the understanding of risk factors, pathophysiology, and treatment of PPMS. Moreover, we introduce a novel concept to understand the nature of the disease and possible treatment strategies in the near future.
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Affiliation(s)
| | - Martin S Weber
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.,Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Ulm, Germany.,Specialty Clinic of Neurology Dietenbronn, Schwendi, Germany
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12
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Han XM, Tian HJ, Han Z, Zhang C, Liu Y, Gu JB, Bakshi R, Cao X. Correlation between white matter damage and gray matter lesions in multiple sclerosis patients. Neural Regen Res 2017; 12:787-794. [PMID: 28616036 PMCID: PMC5461617 DOI: 10.4103/1673-5374.206650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We observed the characteristics of white matter fibers and gray matter in multiple sclerosis patients, to identify changes in diffusion tensor imaging fractional anisotropy values following white matter fiber injury. We analyzed the correlation between fractional anisotropy values and changes in whole-brain gray matter volume. The participants included 20 patients with relapsing-remitting multiple sclerosis and 20 healthy volunteers as controls. All subjects underwent head magnetic resonance imaging and diffusion tensor imaging. Our results revealed that fractional anisotropy values decreased and gray matter volumes were reduced in the genu and splenium of corpus callosum, left anterior thalamic radiation, hippocampus, uncinate fasciculus, right corticospinal tract, bilateral cingulate gyri, and inferior longitudinal fasciculus in multiple sclerosis patients. Gray matter volumes were significantly different between the two groups in the right frontal lobe (superior frontal, middle frontal, precentral, and orbital gyri), right parietal lobe (postcentral and inferior parietal gyri), right temporal lobe (caudate nucleus), right occipital lobe (middle occipital gyrus), right insula, right parahippocampal gyrus, and left cingulate gyrus. The voxel sizes of atrophic gray matter positively correlated with fractional anisotropy values in white matter association fibers in the patient group. These findings suggest that white matter fiber bundles are extensively injured in multiple sclerosis patients. The main areas of gray matter atrophy in multiple sclerosis are the frontal lobe, parietal lobe, caudate nucleus, parahippocampal gyrus, and cingulate gyrus. Gray matter atrophy is strongly associated with white matter injury in multiple sclerosis patients, particularly with injury to association fibers.
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Affiliation(s)
- Xue-Mei Han
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Hong-Ji Tian
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zheng Han
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ce Zhang
- Department of Clinical Medicine (Grade 2013 Student), School of Clinical Medicine, Jilin University, Changchun, Jilin Province, China
| | - Ying Liu
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jie-Bing Gu
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA
| | - Xia Cao
- School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin Province, China
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Abstract
AbstractFrom the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography. Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily. If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.
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Bergsland N, Tavazzi E, Laganà MM, Baglio F, Cecconi P, Viotti S, Zivadinov R, Baselli G, Rovaris M. White Matter Tract Injury is Associated with Deep Gray Matter Iron Deposition in Multiple Sclerosis. J Neuroimaging 2016; 27:107-113. [DOI: 10.1111/jon.12364] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/21/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Niels Bergsland
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences; State University of New York at Buffalo; Buffalo NY
- Department of Electronics, Information and Bioengineering; Politecnico di Milano; Milan Italy
| | - Eleonora Tavazzi
- Unit of Motor Neurorehabilitation, Multiple Sclerosis Center, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | | | - Francesca Baglio
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Pietro Cecconi
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Stefano Viotti
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences; State University of New York at Buffalo; Buffalo NY
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences; University at Buffalo, State University of New York; Buffalo NY
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering; Politecnico di Milano; Milan Italy
| | - Marco Rovaris
- Unit of Motor Neurorehabilitation, Multiple Sclerosis Center, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
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15
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Gracien RM, Reitz SC, Hof SM, Fleischer V, Zimmermann H, Droby A, Steinmetz H, Zipp F, Deichmann R, Klein JC. Assessment of cortical damage in early multiple sclerosis with quantitative T2 relaxometry. NMR IN BIOMEDICINE 2016; 29:444-450. [PMID: 26820580 DOI: 10.1002/nbm.3486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 12/16/2015] [Indexed: 06/05/2023]
Abstract
T2 relaxation time is a quantitative MRI in vivo surrogate of cerebral tissue damage in multiple sclerosis (MS) patients. Cortical T2 prolongation is a known feature in later disease stages, but has not been demonstrated in the cortical normal appearing gray matter (NAGM) in early MS. This study centers on the quantitative evaluation of the tissue parameter T2 in cortical NAGM in a collective of early MS and clinically isolated syndrome (CIS) patients, hypothesizing that T2 prolongation is already present at early disease stages and variable over space, in line with global and focal inflammatory processes in MS. Additionally, magnetization transfer ratio (MTR) mapping was performed for further characterization of the expected cortical T2 alteration. Quantitative T2 and MTR maps were acquired from 12 patients with CIS and early MS, and 12 matched healthy controls. The lesion-free part of the cortical volume was identified, and the mean T2 and MTR values and their standard deviations within the cortical volume were determined. For evaluation of spatial specificity, cortical lobar subregions were tested separately for differences of mean T2 and T2 standard deviation. We detected significantly prolonged T2 in cortical NAGM in patients. T2 prolongation was found across the whole cerebral cortex and in all individual lobar subregions. Significantly higher standard deviations across the respective region of interest were found for the whole cerebral cortex and all subregions, suggesting the occurrence of spatially inhomogeneous cortical damage in all regions studied. A trend was observed for MTR reduction and increased MTR variability across the whole cortex in the MS group, suggesting demyelination. In conclusion, our results suggest that cortical damage in early MS is evidenced by spatially inhomogeneous T2 prolongation which goes beyond demyelination. Iron deposition, which is known to decrease T2, seems less prominent.
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Affiliation(s)
- René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Sarah C Reitz
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Stephanie-Michelle Hof
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Hilga Zimmermann
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Amgad Droby
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | | | - Frauke Zipp
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Johannes C Klein
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
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16
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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17
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Appraising the Role of Iron in Brain Aging and Cognition: Promises and Limitations of MRI Methods. Neuropsychol Rev 2015; 25:272-87. [PMID: 26248580 DOI: 10.1007/s11065-015-9292-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
Age-related increase in frailty is accompanied by a fundamental shift in cellular iron homeostasis. By promoting oxidative stress, the intracellular accumulation of non-heme iron outside of binding complexes contributes to chronic inflammation and interferes with normal brain metabolism. In the absence of direct non-invasive biomarkers of brain oxidative stress, iron accumulation estimated in vivo may serve as its proxy indicator. Hence, developing reliable in vivo measurements of brain iron content via magnetic resonance imaging (MRI) is of significant interest in human neuroscience. To date, by estimating brain iron content through various MRI methods, significant age differences and age-related increases in iron content of the basal ganglia have been revealed across multiple samples. Less consistent are the findings that pertain to the relationship between elevated brain iron content and systemic indices of vascular and metabolic dysfunction. Only a handful of cross-sectional investigations have linked high iron content in various brain regions and poor performance on assorted cognitive tests. The even fewer longitudinal studies indicate that iron accumulation may precede shrinkage of the basal ganglia and thus predict poor maintenance of cognitive functions. This rapidly developing field will benefit from introduction of higher-field MRI scanners, improvement in iron-sensitive and -specific acquisition sequences and post-processing analytic and computational methods, as well as accumulation of data from long-term longitudinal investigations. This review describes the potential advantages and promises of MRI-based assessment of brain iron, summarizes recent findings and highlights the limitations of the current methodology.
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18
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Iron and multiple sclerosis. Neurobiol Aging 2014; 35 Suppl 2:S51-8. [DOI: 10.1016/j.neurobiolaging.2014.03.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022]
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19
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Weygandt M, Hummel HM, Schregel K, Ritter K, Allefeld C, Dommes E, Huppke P, Haynes JD, Wuerfel J, Gärtner J. MRI-based diagnostic biomarkers for early onset pediatric multiple sclerosis. NEUROIMAGE-CLINICAL 2014; 7:400-8. [PMID: 25685704 PMCID: PMC4310929 DOI: 10.1016/j.nicl.2014.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/17/2014] [Accepted: 06/30/2014] [Indexed: 11/11/2022]
Abstract
Currently, it is unclear whether pediatric multiple sclerosis (PMS) is a pathoetiologically homogeneous disease phenotype due to clinical and epidemiological differences between early and late onset PMS (EOPMS and LOPMS). Consequently, the question was raised whether diagnostic guidelines need to be complemented by specific EOPMS markers. To search for such markers, we analyzed cerebral MRI images acquired with standard protocols using computer-based classification techniques. Specifically, we applied classification algorithms to gray (GM) and white matter (WM) tissue probability parameters of small brain regions derived from T2-weighted MRI images of EOPMS patients (onset <12 years), LOPMS patients (onset ≥12 years), and healthy controls (HC). This was done for PMS subgroups matched for disease duration and participant age independently. As expected, maximal diagnostic information for distinguishing PMS patients and HC was found in a periventricular WM area containing lesions (87.1% accuracy, p < 2.2 × 10−5). MRI-based biomarkers specific for EOPMS were identified in prefrontal cortex. Specifically, a coordinate in middle frontal gyrus contained maximal diagnostic information (77.3%, p = 1.8 × 10−4). Taken together, we were able to identify biomarkers reflecting pathognomonic processes specific for MS patients with very early onset. Especially GM involvement in the separation between PMS subgroups suggests that conventional MRI contains a richer set of diagnostically informative features than previously assumed. EOPMS can be diagnosed accurately with computer-based classification and T2w-MRI. Separation of EOPMS and HC confirmed the pivotal role of WM lesions for diagnosis. Separation of EOPMS and LOPMS showed that GM variations are also informative. Thus, conventional MRI contains a richer set of biomarkers than assumed so far.
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Affiliation(s)
- Martin Weygandt
- Bernstein Center for Computational Neuroscience Berlin, Charité - Universitätsmedizin, Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - Hannah-Maria Hummel
- Department of Pediatrics and Pediatric Neurology, and German Center for Multiple Sclerosis in Childhood and Adolescence, University Medicine Göttingen, Germany
| | | | - Kerstin Ritter
- Bernstein Center for Computational Neuroscience Berlin, Charité - Universitätsmedizin, Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - Carsten Allefeld
- Bernstein Center for Computational Neuroscience Berlin, Charité - Universitätsmedizin, Berlin, Germany
| | - Esther Dommes
- Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Peter Huppke
- Department of Pediatrics and Pediatric Neurology, and German Center for Multiple Sclerosis in Childhood and Adolescence, University Medicine Göttingen, Germany
| | - John Dylan Haynes
- Bernstein Center for Computational Neuroscience Berlin, Charité - Universitätsmedizin, Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany ; Institute of Neuroradiology, University Medicine Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Pediatric Neurology, and German Center for Multiple Sclerosis in Childhood and Adolescence, University Medicine Göttingen, Germany
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20
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Ropele S, Kilsdonk ID, Wattjes MP, Langkammer C, de Graaf WL, Frederiksen JL, Larsson HB, Yiannakas M, Wheeler-Kingshott CA, Enzinger C, Khalil M, Rocca MA, Sprenger T, Amann M, Kappos L, Filippi M, Rovira A, Ciccarelli O, Barkhof F, Fazekas F. Determinants of iron accumulation in deep grey matter of multiple sclerosis patients. Mult Scler 2014; 20:1692-8. [PMID: 24787429 DOI: 10.1177/1352458514531085] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iron accumulation in deep grey matter (GM) structures is a consistent finding in multiple sclerosis (MS) patients. This study focused on the identification of independent determinants of iron accumulation using R2* mapping. SUBJECTS AND METHODS Ninety-seven MS patients and 81 healthy controls were included in this multicentre study. R2* mapping was performed on 3T MRI systems. R2*in deep GM was corrected for age and was related to disease duration, disability, T2 lesion load and brain volume. RESULTS Compared to controls, R2* was increased in all deep GM regions of MS patients except the globus pallidus and the substantia nigra. R2* increase was most pronounced in the progressive stage of the disease and independently predicted by disease duration and disability. Reduced cortical volume was not associated with iron accumulation in the deep GM with the exception of the substantia nigra and the red nucleus. In lesions, R2* was inversely correlated with disease duration and higher total lesion load. CONCLUSION Iron accumulation in deep GM of MS patients is most strongly and independently associated with duration and severity of the disease. Additional associations between cortical GM atrophy and deep GM iron accumulation appear to exist in a region specific manner.
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Affiliation(s)
- Stefan Ropele
- Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | | | | | | | | | | | | | | | | | | | | | - Maria A Rocca
- Institute of Experimental Neurology, Vita-Salute San Raffaele University, Italy
| | | | | | | | - Massimo Filippi
- Institute of Experimental Neurology, Vita-Salute San Raffaele University, Italy
| | | | - Olga Ciccarelli
- UCL Institute of Neurology, UK/NIHR UCL-UCLH Biomedical Research Centre, UK
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21
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Abstract
Histochemical and MRI studies have demonstrated that MS (multiple sclerosis) patients have abnormal deposition of iron in both gray and white matter structures. Data is emerging indicating that this iron could partake in pathogenesis by various mechanisms, e.g., promoting the production of reactive oxygen species and enhancing the production of proinflammatory cytokines. Iron chelation therapy could be a viable strategy to block iron-related pathological events or it can confer cellular protection by stabilizing hypoxia inducible factor 1α, a transcription factor that normally responds to hypoxic conditions. Iron chelation has been shown to protect against disease progression and/or limit iron accumulation in some neurological disorders or their experimental models. Data from studies that administered a chelator to animals with experimental autoimmune encephalomyelitis, a model of MS, support the rationale for examining this treatment approach in MS. Preliminary clinical studies have been performed in MS patients using deferoxamine. Although some side effects were observed, the large majority of patients were able to tolerate the arduous administration regimen, i.e., 6-8 h of subcutaneous infusion, and all side effects resolved upon discontinuation of treatment. Importantly, these preliminary studies did not identify a disqualifying event for this experimental approach. More recently developed chelators, deferasirox and deferiprone, are more desirable for possible use in MS given their oral administration, and importantly, deferiprone can cross the blood-brain barrier. However, experiences from other conditions indicate that the potential for adverse events during chelation therapy necessitates close patient monitoring and a carefully considered administration regimen.
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22
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Filippi M, Charil A, Rovaris M, Absinta M, Rocca MA. Insights from magnetic resonance imaging. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:115-149. [PMID: 24507516 DOI: 10.1016/b978-0-444-52001-2.00006-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent years have witnessed impressive advancements in the use of magnetic resonance imaging (MRI) for the assessment of patients with multiple sclerosis (MS). Complementary to the clinical evaluation, conventional MRI (cMRI) provides crucial pieces of information for the diagnosis of MS, the understanding of its natural history, and monitoring the efficacy of experimental treatments. Measures derived from cMRI present clear advantages over the clinical assessment, including their more objective nature and an increased sensitivity to MS-related changes. However, the correlation between these measures and the clinical manifestations of the disease remains weak, and this can be explained, at least partially, by the limited ability of cMRI to characterize and quantify the heterogeneous features of MS pathology. Quantitative MR-based techniques have the potential to overcome the limitations of cMRI. Magnetization transfer MRI, diffusion-weighted and diffusion tensor MRI with fiber tractography, proton magnetic resonance spectroscopy, T1 and T2 relaxation time measurement, and functional MRI are contributing to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. All conventional and nonconventional MR techniques will benefit from the use of high-field MR systems (3.0T or more).
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Arnaud Charil
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Rovaris
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Absinta
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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23
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LeVine SM, Bilgen M, Lynch SG. Iron accumulation in multiple sclerosis: an early pathogenic event. Expert Rev Neurother 2013; 13:247-50. [PMID: 23448214 DOI: 10.1586/ern.13.14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Iron has been shown to accumulate in deep gray matter structures in many forms of multiple sclerosis (MS), but detecting its presence early in the disease course (e.g., clinically isolated syndrome [CIS]) has been less clear. Here, we review a recent study where MRI scanning at 7 T together with susceptibility mapping was performed to assess iron deposition in CIS and control subjects. Susceptibility indicative of iron deposition was found to be increased in the globus pallidus, caudate, putamen and pulvinar of CIS patients compared with controls. The findings suggest that iron deposition is a pathological change that occurs early in the development of MS. Identifying the mechanisms of iron accumulation and determining whether iron promotes pathogenesis in MS are important areas of future research.
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Affiliation(s)
- Steven M LeVine
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
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24
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Abstract
Although the definition of benign multiple sclerosis (BMS) remains controversial, it is generally applied to a subgroup of MS patients showing little disease progression, with minimal disability decades after disease onset, and is based mainly on changes in motor function. Recent studies, however, reveal that deterioration of cognitive function, fatigue, pain, and depression also occur in BMS patients, causing negative impact on work and social activities, despite complete preservation of motor function. Using conventional MRI techniques, lesion load observed in BMS is similar to levels in other disease subtypes; however, newer quantitative MRI techniques show less tissue damage, as well as greater repair and compensatory efficiency following MS injury. Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of nonmotor symptoms and imaging studies. Clearly, the definition of BMS currently applied in clinical practice requires reassessment.
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25
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Bagnato F, Hametner S, Welch EB. Visualizing iron in multiple sclerosis. Magn Reson Imaging 2013; 31:376-84. [PMID: 23347601 PMCID: PMC4776767 DOI: 10.1016/j.mri.2012.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 10/30/2012] [Accepted: 11/10/2012] [Indexed: 01/19/2023]
Abstract
Magnetic resonance imaging (MRI) protocols that are designed to be sensitive to iron typically take advantage of (1) iron effects on the relaxation of water protons and/or (2) iron-induced local magnetic field susceptibility changes. Increasing evidence sustains the notion that imaging iron in brain of patients with multiple sclerosis (MS) may add some specificity toward the identification of the disease pathology. The present review summarizes currently reported in vivo and post mortem MRI evidence of (1) iron detection in white matter and gray matter of MS brains, (2) pathological and physiological correlates of iron as disclosed by imaging and (3) relations between iron accumulation and disease progression as measured by clinical metrics.
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Affiliation(s)
- Francesca Bagnato
- Radiology Department, Vanderbilt University, Institute of Imaging Science, Nashville, TN 37232, USA. :
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26
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DTI Measurements in Multiple Sclerosis: Evaluation of Brain Damage and Clinical Implications. Mult Scler Int 2013; 2013:671730. [PMID: 23606965 PMCID: PMC3628664 DOI: 10.1155/2013/671730] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) is an effective means of quantifying parameters of demyelination and axonal loss. The application of DTI in Multiple Sclerosis (MS) has yielded noteworthy results. DTI abnormalities, which are already detectable in patients with clinically isolated syndrome (CIS), become more pronounced as disease duration and neurological impairment increase. The assessment of the microstructural alterations of white and grey matter in MS may shed light on mechanisms responsible for irreversible disability accumulation. In this paper, we examine the DTI analysis methods, the results obtained in the various tissues of the central nervous system, and correlations with clinical features and other MRI parameters. The adoption of DTI metrics to assess the outcome of prognostic measures may represent an extremely important step forward in the MS research field.
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27
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Minagar A, Barnett MH, Benedict RHB, Pelletier D, Pirko I, Sahraian MA, Frohman E, Zivadinov R. The thalamus and multiple sclerosis: modern views on pathologic, imaging, and clinical aspects. Neurology 2013; 80:210-9. [PMID: 23296131 DOI: 10.1212/wnl.0b013e31827b910b] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The paired thalamic nuclei are gray matter (GM) structures on both sides of the third ventricle that play major roles in cortical activation, relaying sensory information to the higher cortical centers that influence cognition. Multiple sclerosis (MS) is an immune-mediated disease of the human CNS that affects both the white matter (WM) and GM. A number of clinical observations as well as recent neuropathologic and neuroimaging studies have clearly demonstrated extensive involvement of the thalamus, basal ganglia, and neocortex in patients with MS. Modern MRI techniques permit visualization of GM lesions and measurement of atrophy. These contemporary methods have fundamentally altered our understanding of the pathophysiologic nature of MS. Evidence confirms the contention that GM injury can be detected in the earliest phases of MS, and that iron deposition and atrophy of deep gray nuclei are closely related to the magnitude of inflammation. Extensive involvement of GM, and particularly of the thalamus, is associated with a wide range of clinical manifestations including cognitive decline, motor deficits, fatigue, painful syndromes, and ocular motility disturbances in patients with MS. In this review, we characterize the neuropathologic, neuroimaging, and clinical features of thalamic involvement in MS. Further, we underscore the contention that neuropathologic and neuroimaging correlative investigations of thalamic derangements in MS may elucidate not heretofore considered pathobiological underpinnings germane to understanding the ontogeny, magnitude, and progression of the disease process.
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Affiliation(s)
- Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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28
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Muhlert N, Sethi V, Schneider T, Daga P, Cipolotti L, Haroon HA, Parker GJ, Ourselin S, Wheeler-Kingshott CA, Miller DH, Ron MA, Chard DT. Diffusion MRI-based cortical complexity alterations associated with executive function in multiple sclerosis. J Magn Reson Imaging 2012; 38:54-63. [DOI: 10.1002/jmri.23970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/02/2012] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nils Muhlert
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Varun Sethi
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Torben Schneider
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Pankaj Daga
- UCL Centre for Medical Image Computing; London; UK
| | - Lisa Cipolotti
- Neuropsychology department; National Hospital for Neurology and Neurosurgery; London; UK
| | - Hamied A. Haroon
- Biomedical Imaging Institute; University of Manchester; Manchester; UK
| | - Geoff J.M. Parker
- Biomedical Imaging Institute; University of Manchester; Manchester; UK
| | | | | | - David H. Miller
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Maria A. Ron
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Declan T. Chard
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
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29
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Vigeveno RM, Wiebenga OT, Wattjes MP, Geurts JJG, Barkhof F. Shifting imaging targets in multiple sclerosis: from inflammation to neurodegeneration. J Magn Reson Imaging 2012; 36:1-19. [PMID: 22696123 DOI: 10.1002/jmri.23578] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Classically multiple sclerosis (MS) has been regarded as an auto-immune disease of the white matter in the central nervous system leading to severe disability over the course of several decades. Current therapeutic strategies in MS are mostly based on either immune suppression or immune modulation. Although effective in decreasing relapse frequency and severity as well as delaying disease progression, MS pathology ensues nonetheless. In the last decade it became evident that gray matter pathology plays an important role in disease progression and helps explaining certain aspects of MS-related disability such as cognitive decline. Conventional MRI outcome measures commonly used in clinical trials are sufficient to demonstrate an anti-inflammatory drug-effect but lack pathological specificity and are poor to moderate predictors of disability. In this article, we review new insights in gray matter pathology and functional reorganization in MS and how these novel fields in MS research may validate and establish new MRI outcome measures, aid in the development of new therapeutic strategies for neuroprotection and neurorepair, and may lead to development of novel predictive measures of disability and disease progression in MS.
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Affiliation(s)
- René M Vigeveno
- VU University Medical Center, Department of Radiology, Amsterdam, the Netherlands
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30
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Hagemeier J, Yeh EA, Brown MH, Bergsland N, Dwyer MG, Carl E, Weinstock-Guttman B, Zivadinov R. Iron content of the pulvinar nucleus of the thalamus is increased in adolescent multiple sclerosis. Mult Scler 2012; 19:567-76. [PMID: 22968543 DOI: 10.1177/1352458512459289] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to assess abnormal phase values, indicative of increased iron content, using susceptibility-weighted imaging (SWI)-filtered phase of the subcortical deep gray matter (SDGM) in adolescent multiple sclerosis (MS) and other neurological disorders (OND) patients, and in healthy controls (HC). METHODS Twenty adolescent MS and eight adolescent OND patients and 21 age- and sex-matched HC were scanned on a 3T GE scanner. Mean phase of abnormal phase tissue (MP-APT), MP-APT volume, normal phase tissue volume (NPTV) and normalized volume measurements were obtained for total SDGM, as well as specific structures separately. RESULTS Significantly increased MP-APT (28.2%, p<.001) and MP-APT volume (82.7%, p<.001), and decreased NPTV (-23.3%, p<.001) and normalized volume (-15.5%, p<.001) in the pulvinar nucleus of the thalamus was found in MS patients compared to HC. MP-APT in MS patients was also increased in total SDGM (p=.012) and thalamus (p=.044). Compared to OND patients, MS patients had increased MP-APT volume in the pulvinar nucleus of the thalamus (p=.044) and caudate (p=.045). Increased MP-APT of the SDGM structures were associated with increased T2 and T1 lesion burden and brain atrophy in MS patients. CONCLUSION Adolescent MS patients showed increased iron content in the SDGM compared to OND patients and HC.
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Affiliation(s)
- Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, University at Buffalo, USA
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Hagemeier J, Weinstock-Guttman B, Bergsland N, Heininen-Brown M, Carl E, Kennedy C, Magnano C, Hojnacki D, Dwyer MG, Zivadinov R. Iron deposition on SWI-filtered phase in the subcortical deep gray matter of patients with clinically isolated syndrome may precede structure-specific atrophy. AJNR Am J Neuroradiol 2012; 33:1596-601. [PMID: 22460343 DOI: 10.3174/ajnr.a3030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Increasing evidence suggests that iron deposition is present in the later stages of MS. In this study we examined abnormal phase values, indicative of increased iron content on SWI-filtered phase images of the SDGM in CIS patients and HC. We also examined the association of abnormal phase with conventional MR imaging outcomes at first clinical onset. MATERIALS AND METHODS Forty-two patients with CIS (31 female, 11 male) and 65 age and sex-matched HC (41 female, 24 male) were scanned on a 3T scanner. Mean age was 40.1 (SD = 10.4) years in patients with CIS, and 42.8 (SD = 14) years in HC, while mean disease duration was 1.2 years (SD = 1.3) in patients with CIS. MP-APT, NPTV, and normalized volume measurements were derived for all SDGM structures. Parametric and nonparametric group-wise comparisons were performed, and associations were determined with other MR imaging metrics. RESULTS Patients with CIS had significantly increased MP-APT (P = .029) and MP-APT volume (P = .045) in the pulvinar nucleus of the thalamus compared with HC. Furthermore, the putamen (P = .004), caudate (P = .035), and total SDGM (P = .048) displayed significant increases in MP-APT volume, while MP-APT was also significantly increased in the putamen (P = .029). No global or regional volumetric MR imaging differences were found between the study groups. Significant correlations were observed between increased MP-APT volumes of total SDGM, caudate, thalamus, hippocampus, and substantia nigra with white matter atrophy and increased T2 lesion volume (P < .05). CONCLUSION Patients with CIS showed significantly increased content and volume of iron, as determined by abnormal SWI-phase measurement, in the various SDGM structures, suggesting that iron deposition may precede structure-specific atrophy.
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Affiliation(s)
- J Hagemeier
- Buffalo Neuroimaging Analysis Center, State University of New York at Buffalo, Buffalo, NY 14203, USA
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van Rensburg SJ, Kotze MJ, van Toorn R. The conundrum of iron in multiple sclerosis--time for an individualised approach. Metab Brain Dis 2012; 27:239-53. [PMID: 22422107 PMCID: PMC3402663 DOI: 10.1007/s11011-012-9290-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/23/2012] [Indexed: 11/21/2022]
Abstract
Although the involvement of immune mechanisms in multiple sclerosis (MS) is undisputed, some argue that there is insufficient evidence to support the hypothesis that MS is an autoimmune disease, and that the difference between immune- and autoimmune disease mechanisms has yet to be clearly delineated. Uncertainties surrounding MS disease pathogenesis and the modest efficacy of currently used disease modifying treatments (DMTs) in the prevention of disability, warrant the need to explore other possibilities. It is evident from the literature that people diagnosed with MS differ widely in symptoms and clinical outcome--some patients have a benign disease course over many years without requiring any DMTs. Attempting to include all patients into a single entity is an oversimplification and may obscure important observations with therapeutic consequences. In this review we advocate an individualised approach named Pathology Supported Genetic Testing (PSGT), in which genetic tests are combined with biochemical measurements in order to identify subgroups of patients requiring different treatments. Iron dysregulation in MS is used as an example of how this approach may benefit patients. The theory that iron deposition in the brain contributes to MS pathogenesis has caused uncertainty among patients as to whether they should avoid iron. However, the fact that a subgroup of people diagnosed with MS show clinical improvement when they are on iron supplementation emphasises the importance of individualised therapy, based on genetic and biochemical determinations.
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Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, National Health Laboratory Service and University of Stellenbosch, Tygerberg Hospital, PO Box 19113, 7505 Tygerberg, South Africa.
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Hagemeier J, Heininen-Brown M, Poloni GU, Bergsland N, Magnano CR, Durfee J, Kennedy C, Carl E, Weinstock-Guttman B, Dwyer MG, Zivadinov R. Iron deposition in multiple sclerosis lesions measured by susceptibility-weighted imaging filtered phase: a case control study. J Magn Reson Imaging 2012; 36:73-83. [PMID: 22407571 DOI: 10.1002/jmri.23603] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 01/09/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate phase lesions identified on susceptibility-weighted imaging (SWI)-filtered phase images in patients with multiple sclerosis (MS), clinically isolated syndrome (CIS) and healthy controls (HC). To relate phase lesion characteristics to other clinical and MRI outcomes. MATERIALS AND METHODS 95 relapsing-remitting (RR), 40 secondary-progressive (SP) MS patients, as well as 19 CIS patients and 49 age- and sex-matched HC, were scanned on a 3T scanner. Phase-, T1-, and T2-lesion characteristics were determined. Overlap of T1- and T2-weighted imaging (WI) lesions with phase lesions (T1P and T2P), as well as brain atrophy outcomes, was assessed. RESULTS MS patients showed significantly greater numbers and larger volume of phase lesions, compared with HC (P < 0.001). 23.6% of T2 lesions overlapped with phase lesions, whereas the same figure for T1 lesions was 37.3%. Conversely, 33.4% and 69.7% of phase lesions were not visible on T2- or T1-WI, respectively. Phase, T1P and T2P lesions were not related to clinical outcomes, but phase lesions were related to ventricular enlargement. CONCLUSION Phase lesions were present in both MS and CIS patients, and showed partial overlap with lesions observed using conventional MRI. The role of phase lesions in clinical progression remains unclear and should be further explored.
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Affiliation(s)
- Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, New York, USA
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Filippi M, Rocca MA. New magnetic resonance imaging biomarkers for the diagnosis of multiple sclerosis. ACTA ACUST UNITED AC 2012; 6:109-20. [PMID: 23480654 DOI: 10.1517/17530059.2012.657624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is sensitive in revealing focal white matter (WM) lesions in patients suspected of having multiple sclerosis (MS). As a consequence, MRI has become an established tool in addition to clinical evaluation in the diagnostic work-up of these patients. AREAS COVERED This review discusses the role of MRI biomarkers in patients at presentation with clinically isolated syndromes (CIS) suggestive of MS. Conventional MRI has been formally included in the diagnostic work-up of these patients, and imaging criteria have been proposed and are updated on a regular basis. Since in patients with established MS, pathologic and MRI studies have demonstrated that the disease affects the normal-appearing WM and gray matter of the brain and spinal cord in a distributed fashion, significant efforts have been devoted to the development of quantitative MR measures, sensitive to damage to these central nervous system compartments, to better characterize lesion burden at disease onset, to differentiate MS from other neurological conditions and to identify objective markers of an unfavorable clinical evolution in the subsequent years. EXPERT OPINION In addition to clinical measures, conventional MR sequences are the 'reference standard' for diagnosis and monitoring disease progression in patients who present with CIS suggestive of MS. The potential and utility of novel advanced MRI techniques in these patients still need to be fully evaluated.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute , Vita-Salute San Raffaele University, Milan , Italy
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Abnormal subcortical deep-gray matter susceptibility-weighted imaging filtered phase measurements in patients with multiple sclerosis. Neuroimage 2012; 59:331-9. [DOI: 10.1016/j.neuroimage.2011.07.045] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/16/2011] [Accepted: 07/15/2011] [Indexed: 01/26/2023] Open
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Williams R, Buchheit CL, Berman NEJ, LeVine SM. Pathogenic implications of iron accumulation in multiple sclerosis. J Neurochem 2011; 120:7-25. [PMID: 22004421 DOI: 10.1111/j.1471-4159.2011.07536.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Iron, an essential element used for a multitude of biochemical reactions, abnormally accumulates in the CNS of patients with multiple sclerosis (MS). The mechanisms of abnormal iron deposition in MS are not fully understood, nor do we know whether these deposits have adverse consequences, that is, contribute to pathogenesis. With some exceptions, excess levels of iron are represented concomitantly in multiple deep gray matter structures often with bilateral representation, whereas in white matter, pathological iron deposits are usually located at sites of inflammation that are associated with veins. These distinct spatial patterns suggest disparate mechanisms of iron accumulation between these regions. Iron has been postulated to promote disease activity in MS by various means: (i) iron can amplify the activated state of microglia resulting in the increased production of proinflammatory mediators; (ii) excess intracellular iron deposits could promote mitochondria dysfunction; and (iii) improperly managed iron could catalyze the production of damaging reactive oxygen species (ROS). The pathological consequences of abnormal iron deposits may be dependent on the affected brain region and/or accumulation process. Here, we review putative mechanisms of enhanced iron uptake in MS and address the likely roles of iron in the pathogenesis of this disease.
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Affiliation(s)
- Rachel Williams
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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Ropele S, de Graaf W, Khalil M, Wattjes MP, Langkammer C, Rocca MA, Rovira A, Palace J, Barkhof F, Filippi M, Fazekas F. MRI assessment of iron deposition in multiple sclerosis. J Magn Reson Imaging 2011; 34:13-21. [PMID: 21698703 DOI: 10.1002/jmri.22590] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Iron deposition in the human brain tissue occurs in the process of normal aging and in many neurodegenerative diseases. Elevated iron levels in certain brain regions are also an increasingly recognized finding in multiple sclerosis (MS). The exact mechanism(s) for this phenomenon and its implication in terms of pathophysiology and clinical significance are still largely unknown and debated. Reliable methods to exactly quantify brain iron are a first step to clarify these issues. Therefore, the aim of this review is to present currently available magnetic resonance imaging (MRI) techniques for the assessment of brain iron. These include relaxation time mapping, phase imaging, susceptibility-weighted imaging, susceptibility mapping, magnetic field correlation imaging, and direct saturation imaging. After discussing their advantages and disadvantages, existing MRI clinical correlations with brain iron concentration in MS are summarized and future research directions are shown.
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Affiliation(s)
- Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria.
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Pawate S, Wang L, Song Y, Sriram S. Analysis of T2 Intensity by Magnetic Resonance Imaging of Deep Gray Matter Nuclei in Multiple Sclerosis Patients: Effect of Immunomodulatory Therapies. J Neuroimaging 2011; 22:137-44. [DOI: 10.1111/j.1552-6569.2011.00622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Weygandt M, Hackmack K, Pfüller C, Bellmann-Strobl J, Paul F, Zipp F, Haynes JD. MRI pattern recognition in multiple sclerosis normal-appearing brain areas. PLoS One 2011; 6:e21138. [PMID: 21695053 PMCID: PMC3117878 DOI: 10.1371/journal.pone.0021138] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/20/2011] [Indexed: 12/26/2022] Open
Abstract
Objective Here, we use pattern-classification to investigate diagnostic information for multiple sclerosis (MS; relapsingremitting type) in lesioned areas, areas of normalappearing grey matter (NAGM), and normal-appearing white matter (NAWM) as measured by standard MR techniques. Methods A lesion mapping was carried out by an experienced neurologist for Turbo Inversion Recovery Magnitude (TIRM) images of individual subjects. Combining this mapping with templates from a neuroanatomic atlas, the TIRM images were segmented into three areas of homogenous tissue types (Lesions, NAGM, and NAWM) after spatial standardization. For each area, a linear Support Vector Machine algorithm was used in multiple local classification analyses to determine the diagnostic accuracy in separating MS patients from healthy controls based on voxel tissue intensity patterns extracted from small spherical subregions of these larger areas. To control for covariates, we also excluded group-specific biases in deformation fields as a potential source of information. Results Among regions containing lesions a posterior parietal WM area was maximally informative about the clinical status (96% accuracy, p<10−13). Cerebellar regions were maximally informative among NAGM areas (84% accuracy, p<10−7). A posterior brain region was maximally informative among NAWM areas (91% accuracy, p<10−10). Interpretation We identified regions indicating MS in lesioned, but also NAGM, and NAWM areas. This complements the current perception that standard MR techniques mainly capture macroscopic tissue variations due to focal lesion processes. Compared to current diagnostic guidelines for MS that define areas of diagnostic information with moderate spatial specificity, we identified hotspots of MS associated tissue alterations with high specificity defined on a millimeter scale.
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Affiliation(s)
- Martin Weygandt
- Bernstein Center for Computational Neuroscience Berlin, Charité - University Medicine, Berlin, Germany.
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40
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Iron and neurodegeneration in multiple sclerosis. Mult Scler Int 2011; 2011:606807. [PMID: 22096640 PMCID: PMC3196218 DOI: 10.1155/2011/606807] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 12/26/2010] [Accepted: 01/02/2011] [Indexed: 02/07/2023] Open
Abstract
Increased iron deposition might be implicated in multiple sclerosis (MS). Recent development of MRI enabled to determine brain iron levels in a quantitative manner, which has put more interest on studying the role of iron in MS. Evidence for abnormal iron homeostasis in MS comes also from analyses of iron and iron-related proteins in CSF and blood and postmortem MS brain sections. However, it is not yet clear if iron accumulation is implicated in MS pathology or merely reflects an epiphenomenon. Further interest has been generated by the idea of chronic cerebrospinal venous insufficiency that might be associated with brain iron accumulation due to a reduction in venous outflow, but its existence and etiologic role in MS are currently controversially debated. In future studies, combined approaches applying quantitative MRI together with CSF and serum analyses of iron and iron-related proteins in a clinical followup setting might help to elucidate the implication of iron accumulation in MS.
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Ceccarelli A, Rocca MA, Perego E, Moiola L, Ghezzi A, Martinelli V, Comi G, Filippi M. Deep grey matter T2 hypo-intensity in patients with paediatric multiple sclerosis. Mult Scler 2011; 17:702-7. [PMID: 21228024 DOI: 10.1177/1352458510395645] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE T2 hypo-intensity on magnetic resonance imaging scans is thought to reflect pathological iron deposition in the presence of disease. In this pilot study, we evaluated the utility of the quantification of T2 hypo-intensities in paediatric patients by estimating deep grey matter (DGM) T2 hypo-intensities in paediatric patients with multiple sclerosis (MS) or clinically isolated syndromes (CIS), and their changes over 1 year. METHODS A dual-echo sequence was obtained from 45 paediatric patients (10 with CIS, 35 with relapsing-remitting MS, 8 with an onset of the disease before the age of 10 and 37 during adolescence) and 14 age-matched healthy controls (HC). Eleven patients were reassessed both clinically and with MRI after 1 year. Normalized T2 intensity in the basal ganglia and thalamus was quantified. RESULTS At baseline, DGM T2 intensity was similar between paediatric patients and HC in all the structures analysed, except for the head of the left caudate nucleus (p=0.001). DGM T2 intensity of the head of the left caudate nucleus was similar between paediatric CIS and RRMS patients, but it was reduced in adolescent-onset paediatric patients versus HC (p=0.002). In all patients, DGM T2 intensity of the head of the left caudate nucleus was correlated with T2 lesion volume (r= -0.39, p=0.007). DGM T2 intensity in all the structures analysed with longitudinal assessment remained stable over the follow-up in the cohort of patients. CONCLUSIONS The quantification of DGM T2 intensity in paediatric patients may provide surrogate markers of neurodegeneration. In paediatric MS, DGM is likely to be affected by iron-related changes, which are likely to be, at least partially, secondary to WM damage.
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Affiliation(s)
- Antonia Ceccarelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
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Kell DB. Towards a unifying, systems biology understanding of large-scale cellular death and destruction caused by poorly liganded iron: Parkinson's, Huntington's, Alzheimer's, prions, bactericides, chemical toxicology and others as examples. Arch Toxicol 2010; 84:825-89. [PMID: 20967426 PMCID: PMC2988997 DOI: 10.1007/s00204-010-0577-x] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/14/2010] [Indexed: 12/11/2022]
Abstract
Exposure to a variety of toxins and/or infectious agents leads to disease, degeneration and death, often characterised by circumstances in which cells or tissues do not merely die and cease to function but may be more or less entirely obliterated. It is then legitimate to ask the question as to whether, despite the many kinds of agent involved, there may be at least some unifying mechanisms of such cell death and destruction. I summarise the evidence that in a great many cases, one underlying mechanism, providing major stresses of this type, entails continuing and autocatalytic production (based on positive feedback mechanisms) of hydroxyl radicals via Fenton chemistry involving poorly liganded iron, leading to cell death via apoptosis (probably including via pathways induced by changes in the NF-κB system). While every pathway is in some sense connected to every other one, I highlight the literature evidence suggesting that the degenerative effects of many diseases and toxicological insults converge on iron dysregulation. This highlights specifically the role of iron metabolism, and the detailed speciation of iron, in chemical and other toxicology, and has significant implications for the use of iron chelating substances (probably in partnership with appropriate anti-oxidants) as nutritional or therapeutic agents in inhibiting both the progression of these mainly degenerative diseases and the sequelae of both chronic and acute toxin exposure. The complexity of biochemical networks, especially those involving autocatalytic behaviour and positive feedbacks, means that multiple interventions (e.g. of iron chelators plus antioxidants) are likely to prove most effective. A variety of systems biology approaches, that I summarise, can predict both the mechanisms involved in these cell death pathways and the optimal sites of action for nutritional or pharmacological interventions.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and the Manchester Interdisciplinary Biocentre, The University of Manchester, Manchester M1 7DN, UK.
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Abstract
Recent years have witnessed impressive advances in the use of magnetic resonance imaging (MRI) for the assessment of patients with multiple sclerosis (MS). Complementary to the clinical evaluation, conventional MRI provides crucial pieces of information for the diagnosis of MS. However, the correlation between the burden of lesions observed on conventional MRI scans and the clinical manifestations of the disease remains weak. The discrepancy between clinical and conventional MRI findings in MS is explained, at least partially, by the limited ability of conventional MRI to characterize and quantify the heterogeneous features of MS pathology. Other quantitative MR-based techniques, however, have the potential to overcome such a limitation of conventional MRI. Indeed, magnetization transfer MRI, diffusion tensor MRI, proton MR spectroscopy, and functional MRI are contributing to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. Such techniques are likely to benefit from the use of high-field MR systems and thus allow in the near future providing additional insight into all these aspects of the disease. This review summarizes how MRI is dramatically changing our understanding of the factors associated with the accumulation of irreversible disability in MS and highlights the reasons why they should be used more extensively in studies of disease evolution and clinical trials.
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Affiliation(s)
- M Filippi
- Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Hospital San Raffaele, Milan, Italy.
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Abstract
PURPOSE OF REVIEW This review summarizes novel MRI approaches for the investigation of lesion burden and understanding of the pathophysiology of multiple sclerosis (MS). RECENT FINDINGS Recent technical advances are improving our ability to detect and define the nature of focal lesions and 'diffuse' tissue damage in MS as well as the functional consequences of such structural abnormalities. New contrast agents allow to monitor the pluriformity of MS inflammation. Double inversion recovery sequences enable us to detect and monitor the evolution of MS lesions in the cortex. High and ultra-high field scanners are improving imaging of MS-related abnormalities at an unprecedented resolution. Furthermore, this new generation of scanners has the potential to ameliorate structural and functional MR studies of the disease. All of this has contributed, and is likely to continue to contribute, to the definition of the factors associated with the development of irreversible disability in MS. Finally, new analysis methods have allowed to track regional disease-related changes and are resulting in an increased correlation between MRI and clinical deficits. SUMMARY Novel MR approaches highlighted previously unrecognized or neglected aspects of MS pathophysiology, which are likely to improve our understanding of the heterogeneous clinical manifestations of this condition.
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Giorgio A, Portaccio E, Stromillo ML, Marino S, Zipoli V, Battaglini M, Blandino A, Bartolozzi ML, Siracusa G, Amato MP, De Stefano N. Cortical functional reorganization and its relationship with brain structural damage in patients with benign multiple sclerosis. Mult Scler 2010; 16:1326-34. [DOI: 10.1177/1352458510377333] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patients with multiple sclerosis (MS) who have a favourable clinical status several years after disease onset are classified as ‘benign’. In many cases brain tissue damage does not differ between benign MS and the ‘classical’ MS forms. Objective: To assess whether the favourable clinical course in benign MS could be explained by the presence of an efficient functional cortical reorganization. Method: Twenty-five right-handed patients with benign MS (defined as having Expanded Disability Status Scale ≤ 3 and disease duration >15 years) underwent functional MRI during a simple motor task (right-hand tapping) to assess movement-associated brain activation. This was compared with that of 10 patients with relapsing—remitting MS and 10 normal controls. Benign MS patients also underwent conventional brain MRI and magnetization transfer imaging, which was compared with an identical examination obtained 1 year before. Quantitative structural magnetic resonance measures were baseline and changes over time in T2-lesion volume, magnetization transfer ratio in T2 lesions and normal-appearing brain and total brain volume. Results: Movement-related activation was greater in patients with benign MS than in those with relapsing—remitting MS or normal controls, extensively involving bilateral regions of the sensorimotor network as well as basal ganglia, insula and cerebellum. Greater activation correlated with lower T2-lesion magnetization transfer ratio, and with decreasing brain volume and increasing T2 lesion volume. Conclusions: The results suggest that bilateral brain networks, beyond those normally engaged in motor tasks, are recruited during a simple hand movement in patients with benign MS. This increased activation is probably the expression of an extensive, compensatory and tissue-damage related functional cortical reorganization. This can explain, at least in part, the favourable clinical expression of patients with benign MS.
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Affiliation(s)
- Antonio Giorgio
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | | | - Maria Laura Stromillo
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Silvia Marino
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy, IRCCS Centro Neurolesi, 'Bonino-Pulejo', Messina, Italy
| | | | - Marco Battaglini
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Anita Blandino
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | | | | | | | - Nicola De Stefano
- Neurology and Neurometabolic Unit, Department of Neurological and Behavioural Sciences, University of Siena, Italy,
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Wulff K, Gatti S, Wettstein JG, Foster RG. Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci 2010; 11:589-99. [DOI: 10.1038/nrn2868] [Citation(s) in RCA: 682] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Differential changes in deep and cortical gray matters of patients with multiple sclerosis: a quantitative magnetic resonance imaging study. J Comput Assist Tomogr 2010; 34:431-6. [PMID: 20498549 DOI: 10.1097/rct.0b013e3181cbf73c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the changes in quantitative diffusion tensor (DT) metrics and normalized T2-signal intensity (nT2-SI) values of normal-appearing cortical gray matter (CGM) and deep gray matter (DGM) in patients with multiple sclerosis (MS). METHODS Fifty patients with MS and 25 patients with no MS matched on sex/age were selected as controls. Conventional magnetic resonance imaging and DT imaging were performed. Fractional anisotropy (FA)/mean diffusivity (MD) and nT2-SI values of CGM and DGM were measured. Analyses of variance between the 2 groups were analyzed; Pearson correlations between DT metrics and nT2-SI values and brain parenchymal fraction (BPF) and T2 lesion volumes (LVs) were used. RESULTS Patients with MS showed larger MD/smaller FA values in the CGM region compared with controls (P < 0.05). However, MD/FA values were not statistically significant in the DGM between MS and healthy control group. In DGM of MS patients, a significant decrease of nT2-SI values were observed when compared with controls (P < 0.05), but nT2-SI values in the CGM of MS patients showed no significant decrease. In CGM, only MD values of frontal lobes in MS patients were significantly (negatively) correlated with BPF(right: P = 0.009, left: P = 0.036) or T2 LVs (right: P = 0.002, left: P = 0.047). Normalized T2-SI values in all DGM regions of MS patients were significantly correlated with BPF (r = 0.282-0.504, P < 0.05) except for the left thalamus and bilateral red nucleus. There was no correlation between nT2-SI in all DGM regions and T2 LVs of MS patients. CONCLUSION In CGM, the change in quantitative DT metrics of MS patients and the association with BPF and T2 LVs suggest the existence of microstructural destruction corresponding to inflammation, demyelination, or wallerian degeneration, but the changes in CGM were independent of the concomitant changes in BPF and T2 lesion. In DGM, a decrease of nT2-SI in MS patients and the correlation of nT2-SI values with BPF (brain atrophy) suggest excessive iron deposition related to chronic destruction. Our investigation indicates the possibility of different mechanism of pathological change in CGM and DGM.
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Urbanek C, Weinges-Evers N, Bellmann-Strobl J, Bock M, Dörr J, Hahn E, Neuhaus AH, Opgen-Rhein C, Thi Minh Tam Ta, Herges K, Pfueller CF, Radbruch H, Wernecke KD, Ohlraun S, Zipp F, Dettling M, Paul F. Attention Network Test reveals alerting network dysfunction in multiple sclerosis. Mult Scler 2009; 16:93-9. [DOI: 10.1177/1352458509350308] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention is one of the cognitive domains typically affected in multiple sclerosis. The Attention Network Test was developed to measure the function of the three distinct attentional networks, alerting, orienting, and executive control. The Attention Network Test has been performed in various neuropsychiatric conditions, but not in multiple sclerosis. Our objective was to investigate functions of attentional networks in multiple sclerosis by means of the Attention Network Test. Patients with relapsing—remitting multiple sclerosis (n = 57) and healthy controls (n = 57) matched for age, sex, and education performed the Attention Network Test. Significant differences between patients and controls were detected in the alerting network (p = 0.003), in contrast to the orienting (p = 0.696) and the conflict (p = 0.114) network of visual attention. Mean reaction time in the Attention Network Test was significantly longer in multiple sclerosis patients than in controls (p = 0.032), Multiple sclerosis patients benefited less from alerting cues for conflict resolution compared with healthy controls. The Attention Network Test revealed specific alterations of the attention network in multiple sclerosis patients which were not explained by an overall cognitive slowing.
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Affiliation(s)
- Carsten Urbanek
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Nicholetta Weinges-Evers
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Markus Bock
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Jan Dörr
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Carolin Opgen-Rhein
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Katja Herges
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Caspar F Pfueller
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Helena Radbruch
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Klaus D Wernecke
- Sostana GmbH and Charité University Medicine Berlin, Berlin, Germany
| | - Stephanie Ohlraun
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Frauke Zipp
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Friedemann Paul
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, , NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
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Abstract
Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant anomalies in cerebral venous outflow hemodynamics, permit to propose a parallel with chronic venous disorders (CVDs) in the mechanism of iron deposition. Abnormal cerebral venous reflux is peculiar to MS, and was not found in a miscellaneous of patients affected by other neurodegenerative disorders characterized by iron stores, such as Parkinson's, Alzheimer's, amyotrophic lateral sclerosis. Several recently published studies support the hypothesis that MS progresses along the venous vasculature. The peculiarity of CCSVI-related cerebral venous blood flow disturbances, together with the histology of the perivenous spaces and recent findings from advanced magnetic resonance imaging techniques, support the hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage.
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50
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Ceccarelli A, Rocca MA, Neema M, Martinelli V, Arora A, Tauhid S, Ghezzi A, Comi G, Bakshi R, Filippi M. Deep gray matter T2 hypointensity is present in patients with clinically isolated syndromes suggestive of multiple sclerosis. Mult Scler 2009; 16:39-44. [PMID: 19965516 DOI: 10.1177/1352458509350310] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gray matter (GM) magnetic resonance imaging (MRI) T2 hypointensity, a putative marker of iron deposition, is a frequent finding in patients with clinically definite (CD) multiple sclerosis (MS). The objective of this study was to assess: (a) how early deep GM T2 hypointensity occurs in MS, by studying patients with clinically isolated syndromes (CIS) suggestive of MS, and (b) whether they contribute to predict subsequent evolution to CDMS. Dual-echo scans using two different acquisition protocols were acquired from 47 CIS patients and 13 healthy controls (HC). Normalized T2-intensity of the basal ganglia and thalamus was quantified. Patients were assessed clinically at the time of MRI acquisition and after three years. During the observation period, 18 patients (38%) evolved to CDMS. At the baseline, only the GM T2-intensity of the left caudate nucleus was significantly reduced in CIS patients in comparison with the HC (p = 0.04). At the baseline, the T2 intensity of the left caudate nucleus was significantly lower (p = 0.01) in CIS patients with disease dissemination in space (DIS), but not in those without DIS, compared to the HC. The baseline T2 lesion volume, but not GM T2 hypointensity, was associated with evolution to CDMS (hazard ratio = 1.60, 95% confidence interval (CI) = 1.05-2.42; p = 0.02). In CIS patients, deep GM is not spared, suggesting that iron-related changes and neurodegeneration occurs early. The magnitude of such damage is only minor and not associated with an increased risk of evolution to CDMS.
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Affiliation(s)
- Antonia Ceccarelli
- Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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